Inspection·March 21, 2025

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of select facility policy, facility investigative reports, clinical records, and interview with facility staff it was determined the facility failed to ensure that one received the necessary care and services to prevent physical harm and maintain physical health for one resident out of 14 residents sampled (Resident 1). Findings include: A review of facility policy titled Abuse Policy revealed it is the policy of the facility that acts of physical, verbal, psychosocial, and financial abuse directed against residents is absolutely prohibited. Each resident has the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, involuntary seclusion, mistreatment, neglect, exploitation, and misappropriation of property. The policy indicated residents shall not be subjected to abuse by anyone including but not limited to staff, other residents, consultants, volunteers, family members, friends, or other individuals A review of the clinical record revealed Resident 1 was admitted to the facility on [DATE], with diagnoses which included unspecified dementia (the loss of cognitive functioning - thinking, remembering, and reasoning to such an extent that it interferes with a person's daily life and activities). A Quarterly Minimum Data Set assessment (MDS- a federally mandated standardized assessment process conducted at specific intervals to plan resident care) dated January 23, 2025, revealed the resident was severely cognitively impaired with a BIMs score of 7 (brief interview for mental status, a tool to assess the residents attention, orientation and ability to register and recall new information, a score of 00-07 equates severe cognitive impairment). The assessment further revealed the resident was fully dependent on staff for transfers from the bed to a chair. A review of the resident's current plan of care, initially developed on June 16, 2016, included a care plan for decreased ADL (activities of daily living) self-care performance due to immobility, weakness, and cognitive impairment. An intervention initiated on November 9, 2024, stated that the resident was to be transferred with the assistance of two staff members. A review of facility documentation, including an incident note and a facility investigation report dated March 10, 2025, at 6:05 AM, revealed that at approximately 6:00 AM, Resident 1 sustained a deep skin tear/tendon injury while being moved from bed during morning care. Employee 1, a nurse aide (NA), reported the injury to the nurse on duty, stating that the resident's leg was bleeding. Upon assessment, the nurse observed a large amount of blood pooled next to the bed and on the floor mat, (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 6 Event ID: 395414 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 395414 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Terrace View 260 Terrace Drive Peckville, PA 18452 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)