Health inspection·February 6, 2026

F 0691 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review clinical records, as well as observations and staff interviews, it was determined that the facility failed to ensure that residents were provided with proper colostomy care for one of four residents reviewed (Resident 4).Findings include: The facility's policy regarding colostomy care (care for an artificial opening in the bowel), dated January 31, 2025, colostomy care will be provided per physician orders to provide the stoma with good skin care and check the condition of the stoma and surrounding skin. An admission Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 4 dated November 30, 2025,indicated that the resident was cognitively impaired, required assistance from staff for daily care needs, had a diagnosis of sepsis (infection in the bloodstream) and had an ostomy (a surgically created opening in the abdomen- part of the body between the chest and the hips). A nurse's note for Resident 4, dated November 24, 2025, at 6:47 p.m. indicated that the resident was admitted with a colostomy. A review of Resident 4's clinical record revealed that the ostomy appliance had not been changed or cared for from November 24, 2025, until December 4, 2025, when she was sent out to the hospital. She was readmitted on [DATE], and there was no documentation that the ostomy had been changed or cared for until December 19, 2025. There was no physician's order for changing the ostomy appliance or emptying the colostomy for Resident 4. Interview with the Director of Nursing on February 5, 2026, at 3:44 p.m. confirmed that there was no physician order for the ostomy and that there was no documented evidence that colostomy care was being provided to Resident 4. 28 Pa. Code 211.12(d)(5) Nursing Services. 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: 395430 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 395430 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dubois Nursing Home 212 S. Eighth St. Dubois, PA 15801 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)