Health inspection·March 5, 2025

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, clinical record review, hospital record review, and resident and staff interviews, it was determined that the facility failed to provide appropriate respiratory care and follow the physician's orders for two of the two residents reviewed (Resident CL1 and Resident 1). Residents Affected - Few Findings include: A review of Resident CL1's hospital records dated February 2, 2025, revealed that the resident was sent to the hospital on January 26, 2025, for shortness of breath and was admitted with a diagnosis of Acute Respiratory Failure. The same report revealed that the Resident was using a BIPAP (a non-invasive ventilator technique that provides pressurized air to assist with breathing) in the hospital. A review of the hospital record BIPAP order dated February 10, 2025, revealed Auto Bipap Max-18 Min-5 PS-5 for associated diagnosis of Acute Respiratory Failure and Obstructive Sleep Apnea (A potentially serious sleep disorder in which breathing repeatedly stops and starts). A review of the hospital discharge summary order dated February 11, 2025, revealed DME (Durable medical equipment) SUPPTY-RT-CPAP/BiPAP A review of Resdient CL1's clinical records revealed the resident was admitted to the facility on [DATE]. Further review of resident CL1's clinical record revealed there was no physician order for Bipap or that the physician was notified of Resident CL1's Bipap order from the hospital. An interview with the supply staff, Employee E3 conducted on March 5, 2025, at 11:00 a.m., revealed that the facility liaison sent her/him Resident CL1's Bipap order supplies and settings from the hospital so she/he could order it and have it ready for the resident's admission to the facility. Employee E3 reported that the order was made from [name of the DME company] and got a confirmation email that the machine and supplies would be delivered on February 11, 2025. A phone interview with the DME representative conducted on March 5, 2025, at 11:30 a.m., confirmed that Resident CL1's Bipap (with supplies) was delivered to the facility on February 11, 2025. An interview with the Director of Nursing conducted March 5, 2025, at 1:00 p.m., revealed that hospital reports are reviewed by the facility's liaison and communicated to the facility to determine the Resident's device and treatment needs for admission. The DON was unable to provide an explanation as to why Resident CL1 did not have a Bipap order despite it being on the Resdient CL1's hospital orders when discharged from the hospital on February 10, 2025. (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 2 Event ID: 395400 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 395400 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Susquehanna Health and Wellness Center 745 Old Chickies Hill Road Columbia, PA 17512 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)