Health inspection·November 26, 2024

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observation, and staff and resident interviews, it was determined the facility failed to reasonably accommodate a request and need for more frequent bed linen changes for one resident out of eight residents sampled (Resident 2). Residents Affected - Few Findings incudes: Clinical record review revealed that Resident 2 was admitted to the facility on [DATE], with diagnoses to include morbid obesity (complex chronic disease in which a person has a body mass index of 40 or higher) and lymphedema (chronic condition that causes tissue swelling usually in the arms or legs in which accumulated fluid could break the skin resulting in leakage). A review of a quarterly Minimum Data Set assessment (MDS - a federally mandated standardized assessment conducted at specific intervals to plan resident care) dated August 31, 2024, revealed the resident had a BIMS (brief interview for mental status- tool to screen and identify the cognitive condition of long-term care residents) score of 15 (a score of 13-15 indicates cognitively intact), required the assistance of one staff member for bed mobility, and the assistance of two staff members for transfers. During an interview conducted on November 26, 2024, at 11:45 AM Resident 2 stated that he utilizes a bariatric bed (a specialized bed to accommodate overweight or obese patients). Resident 2 stated the sheets frequently need to be changed every shift due to excessive leakage from his legs due his diagnosis of lymphedema. Resident 2 revealed there are times the staff is unable to change the bed because sheets are unavailable. Observation at this time revealed that Resident 2 was lying on visibly soiled sheets. Interview with Employee 1 (laundry aide) on November 26th, 2024, at 12:50 PM revealed the facility frequently did not have enough sheets for Resident 2's bariatric bed to be changed each shift due to the sheets tearing or finding the sheets cut with scissors by other staff to fit the bariatric bed. Interview with the nursing home administrator and director of nursing on November 26, 2024, at approximately at 3:00 PM failed to provide documented evidence that Resident 2's bed linens were being changed frequently enough to ensure a reasonable accommodation of the resident's individual needs. 28 Pa Code 204.13 Linen (continued on next page) 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: 395397 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 395397 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edenbrook on Second Ave 200 Second Avenue Kingston, PA 18704 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)