Health inspection·September 25, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, a review of clinical records, resident council meeting minutes, and resident and staff interviews, it was determined the facility failed to provide services to maintain a clean and homelike environment for four out of five nursing units (Units Medbridge Hall, A Hall, B Hall, and D Hall), including experiences reported by two out of three residents interviewed (Residents 1 and 2). Findings include:A review of resident council meeting minutes dated August 4, 2025, revealed residents in attendance expressed concerns regarding the housekeeping services. Residents reported that only garbage is emptied, and floors are occasionally mopped. Additional concerns included housekeepers using dirty water to mop floors, particularly in hallways and dining areas; lack of top dusting; dusty surfaces; spider webs; over-bed tables not being cleaned; and bathroom floors uncleaned. Observations on September 25, 2025, at 8:26 AM revealed a black mat with multiple pieces of white debris, a wet paper towel, and black-gray discolorations in front of the ice machine in the Medbridge Nursing Unit dining area.Observations on September 25, 2025, at 8:44 AM revealed a clump of hair measuring 2 inches by 1 inch and multiple pieces of dirt and debris in the Nursing A Hall.Observations on September 25, 2025, at 8:51 AM revealed missing and stained tiles, saturated paper, and hair in the B Hall shower room drain. A resident bathtub in the B Hall shower room was also observed with several pieces of hair and debris inside the tub. The shower room floor had multiple areas with discolorations, a discarded plastic glove, stains, and pieces of debris.Observations on September 25, 2025, at 8:55 AM revealed dirt, debris, and stains on the floor around the A Hall nursing station. The running board adjacent to the Nursing A Hall nursing station was observed with a brown-red substance stain and buildup.A clinical record review revealed Resident 1 was admitted to the facility on [DATE], with diagnoses that included schizophrenia (a chronic mental health condition characterized by a combination of symptoms, such as flat affect, hallucinations, and/or impairments with cognitive functioning, that significantly impact a person's thoughts, emotions, and behaviors).A review of a quarterly Minimum Data Set assessment (MDS-a federally mandated standardized assessment process conducted periodically to plan resident care) dated August 3, 2025, revealed that Resident 1 was moderately cognitively impaired with a BIMS score of 10 (Brief Interview for Mental Status-a tool within the Cognitive Section of the MDS that is used to assess the resident's attention, orientation, and ability to register and recall new information; a score of 8-12 indicates moderate cognitive impairment).During an interview on September 25, 2025, at 8:57 AM, Resident 1 stated that his room is never cleaned. He explained that he saw staff cleaning today because the surveyors were here. An observation of Resident 1's room revealed the resident's floor with a substance splattered near his bed measuring 5 inches by 10 inches, small white pieces of paper, dirt, and debris.Observations on September 25, 2025, at 8:58 AM revealed the Resident B Hall hallway with dirt, debris, and a substance buildup on the edges of the floor near the baseboard. The dirt and (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 3 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 09/25/2025 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)