F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or
her rights.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
clinical record review and resident interview, it was determined that the facility failed to provide services to
enhance each resident's quality of life by offering showers as scheduled to four of six sampled residents.
(Residents 1, 2, 3, 4)
Findings include:
Clinical record review revealed that Resident 1 was admitted to the facility on [DATE] with diagnoses that
included hypertension and chronic obstructive pulmonary disease . The Minimum Data Set (MDS)
assessment dated [DATE], indicated that the resident needed staff assistance for bathing. The resident was
to receive a shower twice per week on Monday and Thursday. Review of documentation in the clinical
record revealed that the resident only received two showers since admission to the facility on July 4, 2024.
Clinical record review revealed that Resident 2 had diagnoses that included congestive heart failure and
hypertension. The MDS assessment dated [DATE], indicated the resident needed staff assistance for
bathing. The resident was to receive a shower twice per week on Monday and Thursday. Review of
documentation in the clinical record revealed that the resident was not offered a shower eight of 18
scheduled times in the past 90 days.
Clinical record review revealed that Resident 3 had diagnoses that included diabetes mellitus and chronic
obstructive pulmonary disease. The MDS assessment dated [DATE], indicated that the resident was
oriented and needed staff assistance for bathing. The resident was to receive a shower twice per week on
Wednesday and Saturday. In an interview on September 11, 2024, at 12:05 p.m. the resident stated that
she preferred to take a shower twice a week and was not offered the opportunity to do so. Resident 3
stated that she would not refuse the opportunity to shower. Review of documentation in the clinical record
revealed that the resident was not offered a shower 14 of 17 scheduled times in the past 90 days.
Clinical record review revealed that Resident 4 had diagnoses that included hypertension and depression.
The MDS assessment dated [DATE], indicated that the resident was oriented and was dependent on staff
assistance for bathing. The resident was to receive a shower twice per week on Monday and Thursday. In
an interview on September 11, 2024, at 12:30 p.m. the resident stated that she preferred to take a shower
twice a week and was not offered the opportunity to do so. Resident 4 stated that she would not refuse the
opportunity to shower. Review of documentation in the clinical record revealed that the resident was not
offered a shower eight of 18 scheduled times in the past 90 days.
(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:
395499
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
395499
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/11/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Tremont Health & Rehabilitation Center
44 Donaldson Road
Tremont, PA 17981
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)
F 0550
28 Pa. Code 211.12(d)(5) Nursing services.
Level of Harm - Minimal harm
or potential for actual harm
Previously cited 10/28/23
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395499
If continuation sheet
Page 2 of 4
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
395499
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/11/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Tremont Health & Rehabilitation Center
44 Donaldson Road
Tremont, PA 17981
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)
F 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
clinical record review and staff interview, it was determined that the facility failed to provide care and
services to meet each resident's needs for one of six sampled residents. (Resident 1)
Residents Affected - Few
Findings include:
Clinical record review revealed that Resident 1 was admitted to the facility on [DATE], with diagnoses that
included hypertension and chronic obstructive pulmonary disease. Review of the current care plan revealed
that the resident had hearing loss and wore hearing aides. Review of a progress note dated August 15,
2024, revealed that Resident 1 had an appointment for the physician to clean his ears on September 6,
2024, and that the physician was to clean his ears in the facility. Review of a physician's progress note
dated August 22, 2024, revealed that there was no evidence that the physician addressed or cleaned
Resident 1's ears. On August 28, 2024, the physician ordered for staff to administer ear drops to both the
resident's ears for seven days and then the physician would flush. There was no documented evidence that
the physician cleaned or flushed Resident 1's ears or that the resident went to his scheduled appointment
on September 6, 2024.
In an interview on September 11, 2024, at 2:25 p.m., the Administrator and Director of Nursing confirmed
there was no evidence that the physician cleaned Resident 1's ears and that Resident did not attend the
September 6, 2024 appointment to have his ears cleaned.
28 Pa. Code 211.12(d)(1)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395499
If continuation sheet
Page 3 of 4
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
395499
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/11/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Tremont Health & Rehabilitation Center
44 Donaldson Road
Tremont, PA 17981
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)
F 0921
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and
the public.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation it was determined that the facility failed to provide a safe, sanitary, and comfortable
environment on two of three nursing units (B and C unit) and the main dining room.
Findings include:
Observation on the B nursing unit on September 11, 2024, from 10:30 a.m. through 2:00 p.m. revealed the
following:
The wall paper was peeling and hanging off the wall in multiple areas in the common area across from the
nurses' station. The floor outside the door to the janitor's closet had a large accummulation of black dirt. In
rooms 101, 102, 104, 105, 106, and 107, the floors were sticky and the tiles had a dull black/brown coating
of dirt accummulation.
In room [ROOM NUMBER] the heating unit contained peeling paint and cobwebs near the controls. The
wall to the right of the closet was heavily marred. In the shared bathroom there was a brown/black ring of
dirt on floor around the bottom of the toilet, the right side toilet grab bar was loose, the wall around the soap
dispenser was peeling, and the bathroom door was heavily marred.
In room [ROOM NUMBER] near the doorway, the floor was cracked and missing a piece of tile.
In room [ROOM NUMBER], bed 2's top drawer to the night stand was broken and crooked, the bottom
drawer near the sink did not close and was misaligned, and the closet doors did not close and were
misaligned.
Obersvations on the C nursing unit on September 11, 2024, from 10:30 a.m. through 2:30 p.m. revealed the
following:
In room [ROOM NUMBER] the front cover to the heating unit was broke and sticking out exposing a sharp
edge.
In room [ROOM NUMBER] there was a chair for resident use that the cushion was peeling and flaking off.
In the main dining room there was a missing ceiling tile in the middle of the room.
28 Pa. Code 201.14(a) Responsibility of licensee.
28 Pa. Code 201.18(b)(1) Management.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395499
If continuation sheet
Page 4 of 4