Health inspection·December 5, 2024

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, resident observations, resident and staff interviews, and grievance review, it was determined that the facility failed to have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being for six of eight residents (Residents R2, R4, R5, R6, R7 and R8). Findings Include: Review of the facility policy Call Lights last reviewed 2/21/24, indicates all residents have a call light or alternative communication device within their reach at all times when unattended. Facility personnel will answer a call light as soon as possible. To ensure safety and communication between staff and residents in order to timely meet their needs. Respond to emergency call lights immediately. Respond to call lights and communication devices promptly and in person whenever possible. Review of the facility policy Resident Rights last reviewed 2/21/24, indicates a resident has the right to receive the services and items included in the resident's plan of care. A resident has the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences. A resident has the right to have grievances promptly resolved, in accordance with law. Review of the facility policy Nursing Service last reviewed 2/21/24, indicates nursing care includes the provision of all prescribed medications and treatments, personal care, hygiene, and nursing interventions in response to physical, emotional, or behavioral needs/problems. All nursing care is directed at attaining and maintaining optimal levels of health and functioning. To safely and effectively meet the nursing needs of the resident. Review of facility provided grievance dated 10/31/24, indicates received a phone call from Resident R2's son with concerns that Resident R2 called him the morning of 10/31/24, to report that no one is answering her call bell. Son stated that my mother previously fell in the bathroom and he is concerned that extended call bell responses times add to her potential for falls. Further review revealed that on 11/15/24, son again reported continued issues with call bell response via e- mail at approximately 9:55 p.m. yesterday evening my mother phoned me from her bed to say she needed to urinate, but no one was responding to her calls for assistance. Review of Resident R2's clinical record indicated she was admitted to the facility on [DATE], current room [ROOM NUMBER]. (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 13 Event ID: 395549 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 395549 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sherwood Oaks 100 Norman Drive Cranberry Township, PA 16066 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)