Inspection·December 4, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, facility provided documents, clinical record review, and staff interviews it was determined that the facility failed to protect residents from neglect for one of three residents (Residents R1). This was identified for past non-compliance for Resident R1.Findings include: Review of the facility policy Abuse, Neglect and Exploitation last reviewed 10/13/25, indicated the facility is to provide protection for the health, welfare, and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, and exploitation and misappropriation of resident property. Review of the admission record indicated Resident R1 was admitted to the facility on [DATE]. Review of Resident R1's Minimum Data Set (MDS - a periodic assessment of care needs) dated 10/11/25, indicated diagnoses of high blood pressure, dementia (a group of symptoms that affect memory, thinking and interfere with daily life), and impulse disorder. Review of Resident R1's progress note dated 10/24/25, at 10:24 a.m. revealed that Resident R1 was complaining of increased hip pain. Hospice was consulted for further orders. New order was obtained for an X-ray. Family updated. Review of Resident R1's progress note dated 10/25/25, at 10:24 a.m. revealed X-ray results received. Acute displaced fracture of left proximal femur noted. Hospice notified and will call physician. At 2:46 p.m. Resident R1 was sent to Acute care hospital for evaluation and treatment.During an interview on 12/3/25, at 11:59 a.m. the Director of Nursing (DON) stated that she was made aware of the fracture and arrived at facility after receiving notification of event to start an investigation. DON stated that witness statements were gathered, and staff interviews were conducted. We didn't know he had a previous fall on 10/23/25, or that the Alleged Perpetrator Licensed Practical Nurse (LPN) Employee E1 threw him back to bed after he fell out of bed. While gathering statements and conducting an investigation, Activity Aide Employee E2 came up to me and described an incident that happened concerning Resident R1. Review of a written statement indicated that Activity Aide Employee E2 stated the following: I was in the room with another resident. I turned around and Resident R1 fell out of bed. I ran to get a nurse. LPN Employee E1 was who I got. I told her that Resident R1 had just fallen. LPN Employee E1 said Again, He's always falling. I don't know where his aide was and sat there. I asked her if she wanted me to help. LPN Employee E1 said I suppose. We went to the room. I took him under his right arm to lift him, and she grabbed the back of his pants and threw him on to the bed. LPN Employee E1 just walked out of the room. I stayed there to see if he was alright. I asked him if he was ok. He just shook his head yes. During a review of Resident R1's clinical record failed to include a fall from bed or any notification or documentation of incident. Review of documentation provided by the facility indicated that LPN Employee E1 was suspended pending investigation and was terminated on 11/4/25. The facility implemented a plan of correction that included the following: - Facility initiated whole house audits on 10/25/25, of all incidents/risk for any indications of abuse.- Facility initiated whole house audits on (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: 395471 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 395471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Armstrong Rehabilitation and Nursing Center 265 South McKean Street Kittanning, PA 16201 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)