Health inspection·April 30, 2025

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records, as well as resident and staff interviews, it was determined that the facility failed to maintain clinical records that were complete and accurately documented for one of four residents reviewed (Resident 1). Findings include: A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 1, dated April 10, 2025, revealed that the resident was understood, could understand others, had diagnosis that included hemiplegia (paralysis on one side of the body), chronic obstructive pulmonary disease (COPD - a condition caused by damage to the airways or other parts of the lung), and respiratory failure (a serious condition where the respiratory system is unable to adequately supply the body with oxygen or remove carbon dioxide), received oxygen therapy, suctioning and tracheostomy (a procedure to help air and oxygen reach the lungs by creating an opening into the trachea (windpipe) from outside the neck) care. A care plan for the resident, dated April 4, 2025, revealed that the resident has/at risk for respiratory impairment related to acute and chronic respiratory failure, hypoxia (a condition where the body, or a specific region of it, does not receive enough oxygen at the tissue level), COPD, and tracheostomy. Staff was to evaluate the resident's lung sounds and vital signs as needed and report significant changes to the physician, and obtain the resident's pulse oximetry (a test used to measure the oxygen level (oxygen saturation) of the blood) as clinically indicated and report abnormal findings. Physician's orders for Resident 1, dated April 23, 2025, revealed that Registered Nurse 1 placed orders from the physician for staff to obtain a STAT (order should be prioritized first as it is needed urgently) chest xray, complete blood count (CBC - a laboratory test that provides information about the cells in a person's blood, specifically red blood cells, white blood cells, and platelets), comprehensive metabolic panel (CMP a blood test that assesses various aspects of your body's chemical balance and metabolism, including kidney and liver function, electrolyte levels, blood sugar, and protein levels), and sputum culture (a laboratory test that analyzes a sample of mucus (sputum) from the lungs or airways to identify bacteria, fungi, or other microorganisms that may be causing an infection) related to hypoxia. However, review of Resident 1's clinical record revealed that there was no documented evidence as to why Registered Nurse 1 obtained orders from the physician due to the resident's hypoxia on April 23, 2025. Interview with Licensed Practical Nurse 2 on April 30, 2025, at 12:35 p.m. revealed that Resident 1's pulse oximetry's were running between 78 and 80 percent (a normal pulse oximeter reading for oxygen saturation is typically between 95 and 100 percent), so she suctioned the resident's tracheostomy (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: 395500 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 395500 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twin Lakes Rehabilitation and Healthcare Center 227 Sand Hill Road Greensburg, PA 15601 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)