Health inspection·January 18, 2024

F 0576 Ensure residents have reasonable access to and privacy in their use of communication methods. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interviews, it was determined that the facility failed to ensure residents had access to a telephone that afforded privacy for residents during telephone calls on two out of two resident units. Residents Affected - Some Findings include: Observation of the Countryside nursing station on January 18, 2024, at approximately 10:50 AM revealed no telephones intended for resident use that afforded the residents privacy during telephone calls. Interview with Employee 1 (nurse aide) on January 18, 2024, at approximately 10:52 AM revealed that the residents may use the corded telephone located behind the nursing station. The resident may sit behind the nurses station or staff place the phone on the counter for the resident to reach. Employee 1 confirmed there is no area for the residents to have a private conversation while at the nurses station. Employee 1 explained that the facility previously had cordless phones for the residents use however the phones stopped working and they were never replaced. Observation of the Grandview nursing station on January 18, 2024, at approximately 11:05 AM revealed no telephone for resident use that afforded privacy during resident phone calls. Observation revealed a corded telephone located in the Activities Room across from the Grandview nursing station. Interview with Employee 2 (Activities Director) on January 18, 2024, at 11:10 AM revealed that if the Activities room is empty, staff can close the door and the resident may have a private conversation, but that may not always be the situation when a resident wishes to use the phone. Employee 2 stated employees allow residents to use their personal employee cell phones for private telephone calls if they are in bed or unable to get to the nurses station or activities room. Interview with Employee 3 (licensed practical nurse) on January 18, 2024, at 11:12 AM revealed that the facility previously had cordless phones for resident use, but the connection was poor and calls were unable to be maintained. The facility disconnected the cordless phones for resident use and did not obtain replacements. Resident access to telephones was limited to nurses' stations alone and failed to meet the provisions of the regulatory requirement. The facility failed to provide reasonable access to the use of a telephone without being overheard such as providing cordless telephones or phones with telephone [NAME] in residents' rooms. Interview with the Nursing Home Administrator on January 18, 2024, at approximately 3:05 PM (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 4 Event ID: 395493 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 395493 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Julia Ribaudo Extended Care Center 1404 Golf Park Drive Lake Ariel, PA 18436 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)