Health inspection·December 2, 2025

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, policy review, review of facility documentation, and staff interview, it was determined that the facility failed to ensure that a licensed practical nurse (LPN) maintained professional standards of quality care in following the established policies and procedures of the facility set forth in the Pennsylvania Code Title 49 Professional and Vocational standards for one of three sampled residents who were at risk for falls. (Resident 1)Findings include: Review of Pennsylvania Code Title 49, Chapter 21, Subchapter B. Practical Nurses, revealed guidelines which included that an LPN shall follow the written, established policies and procedures of the facility. Review of the facility policy entitled, Falls Management Program, last reviewed January 2025, revealed that when a resident sustained a fall, an examination by a licensed nurse was completed and a Registered Nurse (RN) must assess the resident post fall and document on the accident/incident report.Clinical record review revealed that Resident 1 had diagnoses that included orthostatic hypotension, history of stroke, and glaucoma. On September 13, 2025, LPN 1 noted that Resident 1 was found on the floor after a fall, the RN supervisor was notified but did not assess the resident, and the resident was placed back into his chair by LPN 1. Review of facility documentation indicated that the resident's family and physician were notified of the fall. There was no evidence in the clinical record or facility documentation that Resident 1 was assessed by an RN after the fall. In an interview on November 10, 2025, at 3:02 p.m., the Director of Nursing stated that LPN 1 did not directly notify the RN supervisor of the fall, LPN 1 should not have transferred the resident before an RN assessment, and Resident 1 was not assessed by an RN after the fall. 28 Pa. Code 211.10(c) Resident Care Policies.28 Pa. Code 211.12(d)(1)(5) Nursing Services. Residents Affected - Few 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 3 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 12/02/2025 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)