Health inspection·March 7, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on review of facility policy and clinical records, and staff interview, it was determined that the facility failed to notify the resident's emergency contact/representative regarding a transfer to the emergency room and a change in condition in a timely manner for one of two residents reviewed (Resident R1). Findings include: Review of the facility policy entitled Notification of Changes dated 12/4/24, revealed that The Manor must inform the resident immediately, the attending physician, and the resident's representative or interested family member when there is a significant change in the resident's physical, mental, or psychosocial status. Review of Resident R1's clinical record revealed an admission date of 1/23/25, with diagnoses that included hypertension (high blood-pressure), muscle weakness, and a presence of an aortocoronary bypass graft (a surgical procedure that improves blood flow in the heart by treating narrowed or blocked arteries). Review of Resident R1's clinical record revealed a progress note dated 2/2/25, at 2:15 a.m. indicating the resident was hallucinating, had an unsteady gait, and had increased confusion resulting in transport to the emergency room. The clinical record lacked evidence that the resident's emergency contact/representative was notified of Resident R1's transfer to the emergency room. Further review of the clinical record progress notes dated 2/5/25, at 11:08 p.m. revealed that Resident R1 was wheezing, fatigued, had a non-productive cough, required a breathing treatment, and required administration of an as needed cough medicine. Therapy progress notes dated 2/6/25, at 12:00 a.m. revealed Resident R1 was having coughing fits and was extremely fatigued throughout therapy sessions. A progress note dated 2/6/25, at 6:07 a.m. revealed Resident R1 had a very moist cough during position changes which required a breathing treatment and as needed cough medicine to be administered. A progress note dated 2/6/25, at 7:42 a.m. indicated an in-house chest x-ray was ordered due to Resident R1's symptoms. A progress note dated 2/6/25, at 8:03 p.m. revealed the emergency contact/representative was notified of Resident R1 having increased coughing and that he/she was using accessory muscles when breathing, at this time the emergency contact/representative requested Resident R1 to be transferred to the emergency room and he/she was admitted to the hospital with Respiratory Syncytial Virus (RSV). These progress notes in Resident R1's clinical record revealed the emergency contact/representative was not notified of Resident R1's change in condition until approximately 21 hours Page 1 of 2 395489 395489 03/07/2025 Corry Manor 640 Worth Street Corry, PA 16407

F 0580 after his/her onset of symptoms. Level of Harm - Minimal harm or potential for actual harm During an interview on 3/6/25, at 11:55 a.m. the Nursing Home Administrator confirmed that the clinical record lacked evidence of Resident R1's emergency contact/representative being notified of the above transfer to the emergency room and change in condition in a timely manner and that the facility staff should have notified the resident's emergency contact/representative and documented the notification in the clinical record. Residents Affected - Few 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.12(d)(1)(5) Nursing services 395489 Page 2 of 2