Inspection·August 7, 2024

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm Based on review of Pennsylvania's Nursing Practice Act, job descriptions, and clinical records, as well as staff interviews, it was determined that the facility failed to correctly transcribe physician's orders for one of five residents reviewed (Resident 2). Residents Affected - Few Findings include: The Pennsylvania Code, Title 49, Professional and Vocational Standards, State Board of Nursing, 21.11 (a)(1)(2)(4) indicated that the registered nurse was to collect complete and ongoing data to determine nursing care needs, analyze the health status of individuals and compare the data with the norm when determining nursing care needs, and carry out nursing care actions that promote, maintain and restore the well-being of individuals. A job description for registered nurses, undated, indicated that the registered nurse was to ensure that the highest degree of quality care was maintained at all times and was to provide direct nursing care as needed. An admission Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 2, dated April 3, 2024, indicated that the resident was cognitively impaired, received a diuretic (water pill), and had diagnoses that included heart failure. A nursing note, dated May 22, 2024, revealed laboratory results were reviewed with the Certified Registered Nurse Practitioner (CRNP - a registered nurse who has advanced education and clinical training in a health care specialty area), and new orders were received for 40 milligrams (mg) of Torsemide (water pill) twice a day for two days and 20 milliequivalents of potassium chloride (supplement) daily for three days and obtain a basic metabolic panel (BMP-blood test that checks the levels of different substances in your blood) on May 24, 2024. A laboratory result, dated May 24, 2024, was reviewed by the physician, and new orders were received to continue the 40 mg of Torsemide twice a day. A nursing note written by Registered Nurse 2, dated May 24, 2024, at 3:05 p.m. revealed that the laboratory results were reviewed with the physician, new orders were received to continue 40 mg of Torsemide twice a day indefinitely, and that the orders were updated. A CRNP note, dated May 29, 2024, at 8:21 a.m., revealed that Resident 2 was fluid overloaded with 4+ pitting edema (severe swelling) of the lower extremities and that she was currently receiving 40 mg of Torsemide twice a day. The plan was to add 50 mg of Spironolactone daily to the already ordered 40 mg of Torsemide twice a day. (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: 395514 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 395514 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Maybrook Hills Rehabilitation and Healthcare Cente 301 Valley View Boulevard Altoona, PA 16602 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)