Health inspection·March 22, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on clinical record review and observation, it was determined that the facility failed to ensure that dignity was maintained for two of 18 sampled residents. (Residents 45, 222) Residents Affected - Few Findings include: Clinical record review revealed that Resident 45 had diagnoses that included stroke, hemiplegia to the left side, depression, and muscle weakness. Review of the care plan revealed that the resident preferred activities that identified with his prior lifestyle and staff were to include the resident's preferences in rendering care and services. On March 19, 2024, at 1:33 p.m., Resident 45 was observed in bed. The white board on the wall in his room displayed March 11, 2024, and identified an assigned nurse and nurse aide for that date. During the observation, the resident stated that he preferred the white board to be updated daily with accurate and current information and he does not recall the last time staff updated the board. Observations on March 20, 2024, at 11:52 a.m., and March 21, 2024, at 11:20 a.m., revealed that the resident's white board still displayed March 11, 2024, with the same staff names. Clinical record review revealed that Resident 222 had diagnoses that included obstructive uropathy (a disorder of the urinary tract that occurs due to obstructed urinary flow) and neurogenic bladder (lack of bladder control due to brain, spinal cord or nerve problems). Resident 222 was ordered by the physician to utilize a foley catheter for urination. Observations on March 19, 2024, from 11:04 a.m. through 1:00 p.m., and March 21, 2024, from 10:39 a.m. through 11:15 a.m., revealed Resident 222 sitting in a wheelchair in the common area. The foley catheter bag was not covered and contained urine. Multiple residents and staff were present in the same area during those time periods. During an interview on March 22, 2024, at 10:49 a.m., the Director of Nursing confirmed that Resident 222 had a foley catheter without a dignity bag. 28 Pa. Code 211.12(d)(1)(5) Nursing services. Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 395366 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395366 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine Run Health Center 777 Ferry Road Doylestown, PA 18901 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)