Health inspection·December 30, 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 and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that an assessment was completed by a professional (registered) nurse after an injury occurred for one of 10 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 facility policy, dated November 27, 2024, regarding accidents and incidents, indicated that falls require an incident and accident reports, with the nurse entering the information to the appropriate form or system within 24 hours of the occurrence and will document all pertinent information. The supervisors or other designee will be notified of the incident or accident. Any injuries will be assessed by the licensed nurse or practitioner, and the affected individual will not move until safe to do so. A quarterly minimum data set (MDS) assessment (mandated to assess the resident abilities and care needs) for Resident 2, dated October 30, 2024, revealed that the resident was usually understood and could usually understand others, was moderately cognitively impaired, required supervision and touch assistance with ambulation and transfers, and had wandering behaviors. A witnessed fall investigation and nurse's note completed by Licensed Practical Nurse 2, dated December 6, 2024, revealed that while receiving shift report Resident 2 attempted to sit in front of the piano in front of the nurse's station, but missed the stool and landed on her buttocks on the floor. There was no documented evidence in Resident 2's clinical record to indicate that a registered nurse assessment was conducted for Resident 2's fall. An interview with Licensed Practical Nurse 2 on December 30, 2024, at 5:40 p.m. revealed that he and the other licensed practical nurse who was going off shift witnessed the fall, and they responded immediately, but does not recall a registered nurse assessing Resident 2. An interview with Director of Nursing on December 30, 2024, at 2:27 p.m. confirmed that there was (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: 395552 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 395552 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bethlen Hm of the Hungarian Rf of America 66 Carey School Road Ligonier, PA 15658 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)