Health inspection·September 10, 2024

F 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, observation, and staff and resident interview, it was determined that the facility failed to assist residents to obtain routine dental care for four of eight residents reviewed (Residents 1, 2, 6, and 7). Residents Affected - Some Findings include: Clinical record review for Resident 1 revealed documentation by the facility's consultant dental hygienist provider dated September 8, 2023, that recommended prophylactic adult dental cleaning every six months; and that the next scheduled visit would be March 8, 2024. Documentation by the facility's consultant dentist provider dated October 10, 2023, November 9, 2023, February 27, 2024, and March 21, 2024, continued to indicate that the treatment plan for Resident 1 was adult prophylactic cleaning every six months and that the next scheduled visit would be March 8, 2024. Resident 1's medical record contained no evidence that she received a dental cleaning on March 8, 2024. Interview with the Nursing Home Administrator, the Director of Nursing, Employee 1 (medical records), and Employee 2 (social worker), on September 10, 2024, at 3:04 PM confirmed that Resident 1's medical record contained no evidence of dental prophylactic cleaning for 12 months. The interview confirmed that Resident 1's responsible party notified Employee 2 that an appointment for a dental prophylactic cleaning was missed on July 21, 2024. The facility had no evidence that staff acted upon the notification of the missed appointment. Employee 2 confirmed that Resident 1's responsible party notified her of a second missed appointment on August 22, 2024. Documentation by Employee 1 dated August 22, 2024, at 2:06 PM indicated that Resident 1's responsible party expressed frustration regarding Resident 1's oral health. The documentation indicated that the next available appointment with the dental hygienist would be December 17, 2024 (more than 15 months since her last cleaning). The facility failed to obtain routine dental services covered under the State plan for Resident 1. Interview with, and observation of, Resident 2 on September 10, 2024, at 10:20 AM indicated that she had a denture on her top jaw and natural teeth on the bottom jaw. Resident 2 stated that, .one time, long ago, last year, someone looked in (her) mouth, said she needed a new plate, and never came back. Resident 2 stated that she knew that she needed a new denture because she has had to use, glue (denture paste), to keep them secured in her mouth. Resident 2 denied that anyone has ever (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 3 Event ID: 395512 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 395512 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunbury Skilled Nursing and Rehabilitation Center 901 Court Street Sunbury, PA 17801 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)