Health inspection·February 23, 2026

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical records, and staff interviews, it was determined that the facility failed to ensure that residents were free from significant medication errors for three of five residents (Resident R4, R5, and R9).Findings include: Review of facility policy Medication Administration dated 8/12/25, indicated that medications will be administered in accordance with written orders of licensed physicians, manufacturer's specifications, and professional standards of practice. A medication error occurs when a resident receives a medication at an incorrect time, does not receive a medication which was ordered. A locked Emergency Medication Kit is maintained by Quality Pharmacy and is kept in a designated medication room in the facility. Review of the clinical record indicated Resident R4's was admitted to the facility on [DATE]. Review of Resident R4's Minimum Data Set (MDS - mandated assessment of a resident's abilities and care needs) dated 1/5/26, included diagnoses of anxiety, depression, and diabetes (a condition that causes blood sugar to rise). Review of a physician's order dated 12/3/25, indicated for Resident R4 to receive Insulin Lispro Subcutaneous Solution Pen-Injector 100 unit/milliliter (ml), inject subcutaneously before meals and bedtime for diabetes.as per sliding scale:If less than 70, initiate hypoglycemia protocol,70-140 = 0 units141-180 = 1 units181-220 = 2 units221-260 = 3 units261-300 = 4 units301-340 = 5 units341-600 = 6 unitsGreater than 340, initiate hyperglycemic protocol, call physician. Review of Resident R4's progress note dated 1/13/26, at 1:27 a.m. revealed the resident did not receive Insulin Lispro before bedtime because unable to log into computer- too close to next dose to administer. Review of the clinical record indicated Resident R5's was admitted to the facility on [DATE]. Review of Resident R5's Minimum Data Set (MDS - mandated assessment of a resident's abilities and care needs) dated 1/5/26, included diagnoses of anxiety, depression, and diabetes (a condition that causes blood sugar to rise). Review of a physician's order dated 11/4/25, indicated for Resident R5 to receive Insulin Lispro (1 Unit Dial) Subcutaneous Solution Pen-Injector 100 unit/milliliter (ml), inject subcutaneously before meals and bedtime for diabetes as per sliding scale:If 0-140 = 0 units141-180 = 2 units181-220 = 4 units221-260 = 6 units261-300 = 8 units301-350 = 10 units351-400 = 12 units401-999 = 14 units and call physician Review of Resident R5's progress note dated 1/13/26, at 1:20 a.m. revealed the resident did not receive Insulin Lispro before bedtime because patient sleeping. Review of the clinical record indicated Resident R9's was admitted to the facility on [DATE]. Review of Resident R9's Minimum Data Set (MDS - mandated assessment of a resident's abilities and care needs) dated 12/20/25, included diagnoses of heart failure, high blood pressure, and atrial fibrillation (irregular heartbeat). Review of a physician's order dated 12/14/25, indicated for Resident R9 to receive 6.25 milligram (mg) Carvedilol by mouth two times a day for ventricular tachycardia (irregular heartbeat). Review of Resident R9's January 2026 Medication Administration Record (MAR) revealed Registered Nurse, Employee E1 documented see nurses note on 1/12/26, at 8:00 p.m. Review of Resident R9's progress note dated 1/13/26, at 2:11 a.m. revealed the resident's medication was Residents Affected - Few (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: 395534 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 395534 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Quality Life Services - Sarver 126 Iron Bridge Road Sarver, PA 16055 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)