Inspection visit
Health inspection
8 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 8 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0636
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every
12 months.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of the Resident Assessment Instrument User's Manual and clinical records, as well as staff
interviews, it was determined that the facility failed to ensure that comprehensive admission Minimum Data
Set assessments were completed in the required time frame for six of 37 residents reviewed (Residents 2,
16, 24, 52, 70, 71). Findings include:The Long-Term Care Facility Resident Assessment Instrument (RAI)
User's Manual, which provides instructions and guidelines for completing required Minimum Data Set
(MDS) assessments (mandated assessments of a resident's abilities and care needs), dated October 2025,
indicated that an admission MDS assessment was to be completed no later than 14 days (admission date +
13 calendar days) following admission.An admission MDS assessment for Resident 2 revealed that the
resident was admitted to the facility on [DATE], and the resident's admission MDS assessment was dated
as completed on September 3, 2025, which was 21 days after admission.An admission MDS assessment
for Resident 16 revealed that the resident was admitted to the facility on [DATE], and the resident's
admission MDS assessment was dated as completed on September 3, 2025, which was 15 days after
admission.An admission MDS assessment for Resident 24 revealed that the resident was admitted to the
facility on [DATE], and the resident's admission MDS assessment was dated as completed on November
10, 2025, which was 15 days after admission.An admission MDS assessment for Resident 52 revealed that
the resident was admitted to the facility on [DATE], and the resident's admission MDS assessment was
dated as completed on September 24, 2025, which was 15 days after admission.An admission MDS
assessment for Resident 70 revealed that the resident was admitted to the facility on [DATE], and the
resident's admission MDS assessment was dated as completed on August 8, 2025, which was 17 days
after admission.An admission MDS assessment for Resident 71 revealed that the resident was admitted to
the facility on [DATE], and the resident's admission MDS assessment was dated as completed on
November 10, 2025, which was 27 days after admission.Interview with the Nursing Home Administrator on
December 2, 2025, at 3:48 p.m. confirmed that the above comprehensive MDS assessments were not
completed in the required time frames.28 Pa. Code 211.5(f) Clinical records.
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 8
Event ID:
395592
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
395592
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/04/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Haida Nursing and Rehab
397 Third Avenue Extension
Hastings, PA 16646
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)
F 0641
Ensure each resident receives an accurate assessment.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of the Resident Assessment Instrument User's Manual and clinical records, as well as staff
interviews, it was determined that the facility failed to complete accurate Minimum Data Set assessments
for three of 37 residents reviewed (Resident 4, 12, 68). Findings include:The Long-Term Care Facility
Resident Assessment Instrument (RAI) User's Manual, which provides guidance and instructions for the
completion of Minimum Data Set (MDS) assessments (mandated assessments of a resident's abilities and
care needs), dated October 2025, indicated that Section N0415K1 (Anticonvulsant-medications medication
used to prevent or treat seizures) was to be coded (1) was taking, if the resident received an anticonvulsant
medication during the seven day look back period.A quarterly MDS assessment for Resident 4 dated
October 2, 2025, revealed that Section N0415K Anticonvulsant was coded that the resident received
anticonvulsants during the lookback period. However, a review of the MAR for Resident 4 for September
and October 2025 revealed that the resident did not receive an anticonvulsant during the look back
period.An interview with the Nursing Home Administrator on December 3, 2025, at 9:48 a.m. confirmed that
Resident 4's MDS assessment was coded inaccurately, and the resident did not receive anticonvulsants
during the seven-day lookback period.Physician's orders for Resident 12, dated April 2, 2025, included an
order for the resident to receive 750 milligrams (mg) of Keppra (an anticonvulsant) two times a day for
seizures. A quarterly MDS assessment for Resident 12, dated October 30, 2025, revealed that Section
N0415K1 was not coded (1) indicating that the resident did not receive an anticonvulsant during the
seven-day look-back period. However, a review of the MAR for Resident 12 for October 2025 revealed that
the resident received Keppra two times a day every day in October. Interview with the Director of Nursing
on December 3, 2025, at 3:15 p.m. confirmed that Resident 12's MDS dated [DATE], was not coded
correctly for anticonvulsant medication use. The Long-Term Care Facility RAI User's Manual, dated October
2025, indicated that Section N0415F Antibiotic was to be coded (1) was taking, if the resident received an
antibiotic medication during the seven day look back period.Physician's orders for Resident 68 dated
October 28, 2025, included an order for the resident to receive 500 mg of Levofloxacin (antibiotic)
intravenously (inserted through the vein) once a day.A quarterly MDS assessment for Resident 68 dated
November 1, 2025, revealed that Section N0415F1 Antibiotic was not coded (1), indicating that the resident
did not receive an antibiotic during the lookback period. However, a review of the MAR for Resident 68 for
October 2025, revealed that the resident received an antibiotic intravenously on October 28-31, 2025,
during the look back period.An interview with the Nursing Home Administrator on December 3, 2025, at
9:48 a.m. confirmed that Resident 68's MDS assessment was coded inaccurately and that the resident
received an antibiotic during the seven-day lookback period.28 Pa. Code 211.5(f) Clinical records.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395592
If continuation sheet
Page 2 of 8
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
395592
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/04/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Haida Nursing and Rehab
397 Third Avenue Extension
Hastings, PA 16646
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)
F 0656
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Develop and implement a complete care plan that meets all the resident's needs, with timetables and
actions that can be measured.
Based on review of facility policies, clinical records, and staff interviews, it was determined that the facility
failed to develop a comprehensive care plan that included specific and individualized interventions to
address the care needs of residents for one of 37 residents reviewed (Resident 1 ). Findings include: The
facility's policy for care plans, dated October 15, 2025, indicated that the resident and his or her
representative were encouraged to participate in the development and implementation of the resident's
person-centered care plan. A quarterly Minimum Data Set (MDS) assessment (a federally mandated
assessment of a resident's abilities and care needs) for Resident 1, dated October 27, 2025, revealed that
the resident was severely cognitively impaired, required extensive assistance from staff with daily care
tasks, and had diagnoses that included chronic kidney disease, anemia and acute respiratory failure.
Physician's orders for Resident 1, dated October 22, 2025, included orders for the resident to receive
oxygen at 4 liters per minute, due to an onset of shortness of breath, and physician's orders, dated
November 14, 2025, indicated the resident was to begin hospice services due to a loss of appetite and
general decline of health. There was no documented evidence that care plans were developed to address
Resident 1's individual care and treatment needs related to the use of oxygen and hospice care. Interview
with the Registered Nurse Assessment Coordinator (RNAC- responsible for developing care plans) and
Nursing Home Administrator on December 3, 2025, at 10:12 a.m. and 11:15 a.m. respectively, confirmed
that care plans to address Resident 1's need for oxygen and hospice services were not developed, and
should have been. 28 Pa. Code 211.12(d)(1)(5) Nursing Services.
Event ID:
Facility ID:
395592
If continuation sheet
Page 3 of 8
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
395592
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/04/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Haida Nursing and Rehab
397 Third Avenue Extension
Hastings, PA 16646
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)
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, facility policies, clinical records, and facility
investigation documents, as well as staff interviews, it was determined that the facility failed to clarify
physician's orders for one of 37 residents reviewed (Resident 8).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 responsible for assessing human responses and plans, implementing nursing care,
analyzing/comparing data with the norm in determining care needs, and carrying out nursing care actions
that promote, maintain and restore the well-being of individuals. The facility's medication administration
policy, dated October 15, 2025, revealed that medications were administered by licensed nurses, or other
staff who were legally authorized to do so in this state, as ordered by the physician and in accordance with
professional standards of practice, in a manner to prevent contamination or infection. They will ensure the
six rights of medication administration were followed: right resident, right drug, right dosage, right route,
right time, and right documentation. A quarterly minimum data set (MDS) assessment (mandated to assess
the resident abilities and care needs) for Resident 8, dated October 1, 2025, revealed that the resident was
cognitively impaired, required assistance from staff for personal care needs, had a gastrostomy (feeding
tube) and had diagnoses that included a stroke. Physician's orders for Resident 8, dated July 10, 2025,
included an order for the resident to be NPO (nothing by mouth) and included orders for the resident to
receive 10 milligrams (mg) of Baclofen (muscle relaxant) 1 tablet by mouth one time a day, 325 mg of
Ferrous sulfate (medication used for low iron) 1 tablet by mouth one time a day, 300 mg of gabapentin
(medication used nerve pain) 1 capsule by mouth one time a day, and 400 mg of milk of magnesia
(medication used for constipation) by mouth as needed. A review of Resident 8's December 2025
Medication Administration Record revealed that staff signed off the medications listed above as given by
mouth. There was no documented evidence in the clinical record to indicate that the orders for Resident 8's
medications were clarified and written to be given via peg tube due to the resident's NPO status. Interview
with the Director of Nursing on December 3, 2025, at 3:22 p.m. confirmed that Resident 8's medications
were not clarified and that they should have been written to be administered through the feeding tube. 28
Pa. Code 211.12(d)(1)(3)(5) Nursing Services.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395592
If continuation sheet
Page 4 of 8
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
395592
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/04/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Haida Nursing and Rehab
397 Third Avenue Extension
Hastings, PA 16646
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)
F 0677
Provide care and assistance to perform activities of daily living for any resident who is unable.
Level of Harm - Minimal harm
or potential for actual harm
Based on review of facility policies, clinical records, and shower schedules, as well as staff interviews, it
was determined that the facility failed to ensure that residents were provided with showers as scheduled for
two of 37 residents reviewed (Residents 36 and 66).Findings include: The facility's policy for resident
showers, dated October 15, 2025, indicated that it was the practice of the facility to assist residents with
bathing to maintain proper hygiene, stimulate circulation and help prevent skin issues as per current
standards of practice. Residents would be provided showers as per request or as per facility schedule
protocols and based upon resident safety. An annual Minimum Data Set (MDS) assessment (a mandated
assessment of a resident's abilities and care needs) for Resident 36, dated November 11, 2025, indicated
that the resident was cognitively impaired, required assistance from staff for personal hygiene care
including showers, and had a diagnosis of dementia. A review of the shower records for Resident 36, dated
October 2025 and November 2025, revealed that resident was to receive a shower on Wednesdays and
Sundays during the evening shift. However, staff documented not applicable for providing showers on
October 3, 6, 13, 17, 20, 24, 27, 31 and November 3, 7, 10, 14, 17, 21, 24, 28. There was no documented
evidence that the resident was offered or refused a shower on these days or any days in between. A
quarterly MDS assessment for Resident 66, dated October 30, 2025, indicated that the resident was
cognitively impaired, required assistance from staff for personal hygiene care including showers, and had a
diagnosis of dementia. A review of the shower records for Resident 66, dated October 2025 and November
2025, revealed that the resident was to receive a shower on Wednesdays and Saturdays during the day
shift. However, staff documented not applicable for providing showers on October 3, 10, 14, 21, 24, 28, 31
and November 4, 7, 11, 14, 18, 25. There was no documented evidence that the resident was offered or
refused a shower on these days or any other days in between. Interview with the Director of Nursing on
December 3, 2025, at 3:05 p.m. confirmed there was no documented evidence that Residents 36 and 66
were provided with showers or baths on the above-mentioned dates and times. 28 Pa. Code 211.12(d)(5)
Nursing Services.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395592
If continuation sheet
Page 5 of 8
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
395592
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/04/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Haida Nursing and Rehab
397 Third Avenue Extension
Hastings, PA 16646
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)
F 0686
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Level of Harm - Minimal harm
or potential for actual harm
Based on review of clinical records, observations, and staff interviews, it was determined that the facility
failed to ensure that pressure relieving devices were in place as ordered by the physician for one of 37
residents reviewed (Resident 5).Findings include:A quarterly Minimum Data Set (MDS) assessment (a
federally mandated assessment of a resident's abilities and care needs) for Resident 5, dated November
21, 2025, revealed that the resident was cognitively impaired, required assistance from staff for daily care
needs, was at risk for developing pressure ulcers, and had diagnoses that included diabetes and heart
failure. Physician's orders for Resident 5, dated September 17, 2025, included orders for the resident to
wear Prevalon boots (a type of heel protector used in medical settings to prevent pressure injuries) on both
feet for heel protection. A care plan for Resident 5, dated September 18, 2025, indicated that the resident
was at risk for altered skin integrity and Prevalon boots were to be worn on both feet at all times when in
bed. Observations of Resident 5 on December 3, 2025, at 10:24 a.m. revealed the resident was resting in
bed without Prevalon boots on. A pillow was noted under her legs; however, her right heel, and left heel and
outer ankle were resting directly on the bed. Interview with Licensed Practical Nurse 1 on December 3,
2025, at 10:24 a.m. confirmed that Resident 5 should have had Prevalon boots on while she in
bed.Interview with the Director of Nursing on December 3, 2025, at 10:57 a.m. confirmed that Resident 5
should have had Prevalon boots on while in bed as ordered by the physician. 28 Pa. Code 211.12(d)(1)(5)
Nursing services.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395592
If continuation sheet
Page 6 of 8
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
395592
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/04/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Haida Nursing and Rehab
397 Third Avenue Extension
Hastings, PA 16646
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)
F 0690
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate
catheter care, and appropriate care to prevent urinary tract infections.
Based on review of policies and clinical records, as well as observations and staff interviews, it was
determined that the facility failed to ensure that a resident received proper care for an indwelling urinary
catheter for one of 37 residents reviewed (Residents 20).Findings include:The facility's policy regarding
urinary catheters (a tube inserted and held in the bladder to drain urine), dated October 15, 2025, indicated
that the purpose of the policy was to ensure safe handling of the urinary catheter in order to reduce the risk
of urinary tract infections. A quarterly Minimum Data Set (MDS) assessment for Resident 20, dated October
21, 2025, revealed that the resident was cognitively impaired, had an indwelling urinary catheter (a flexible
tube inserted and held in the bladder to drain urine) and had diagnoses that included obstructive and reflux
uropathy (blockage of urine and a condition where urine flows backward from the bladder up the
ureters).Physician's orders for Resident 20, dated September 23, 2025, included an order for the resident
to have an indwelling urinary catheter due to having obstructive uropathy.Observations on December 1,
2025, at 10:31 a.m. revealed that Resident 20 was in a low bed, and her catheter drainage bag was lying
on the floor on the right side of the bed.Observations on December 1, 2025, at 2:05 p.m. revealed that
Resident 20 was in her wheelchair self-propelling down the hall and her catheter tubing was sliding across
the floor. Interview with Nurse Aide 2, on December 1, 2025, at 10:51 a.m. confirmed that Resident 20's
catheter drainage bag should not have been touching the floor. Interview with Licensed Practical Nurse 3,
on December 1, 2025, at 2:06 p.m. confirmed that Resident 20's catheter tubing should not be sliding
across the floor, and that they used to have clips to help keep the tubing off the floor.Interview with the
Director of Nursing on December 1, 2025, at 2:10 p.m. confirmed that Resident 20's catheter drainage bag
should not have been touching the floor, and that the catheter tubing should not have been sliding across
the floor as the resident self- propelled herself down the hall. 28 Pa. Code 211.12(d)(3)(5) Nursing
Services.
Event ID:
Facility ID:
395592
If continuation sheet
Page 7 of 8
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
395592
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/04/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Haida Nursing and Rehab
397 Third Avenue Extension
Hastings, PA 16646
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)
F 0849
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will
arrange for the provision of hospice services.
Based on review of hospice contracts and clinical records, as well as staff interviews, it was determined
that the facility failed to ensure that the designated interdisciplinary team member obtained the required
information from the contracted hospice provider for one of 37 residents reviewed (Resident 9) who were
receiving hospice services. Findings include: A hospice contract, dated July 31, 2025, indicated that all
hospice assessments, plans of care, progress notes and services provided will be maintained in the
medical record and integrated with the facility plan of care. Nursing staff would ensure there was a current
physician's order, physician progress notes regarding hospice care, and hospice documentation that was
current and available on the medical record. A quarterly Minimum Data Set (MDS) assessment (a
mandated assessment of a resident's abilities and care needs) for Resident 9, dated October 18, 2025,
indicated that the resident was cognitively impaired, dependent on staff for daily care needs, had diagnoses
that included a cancerous tumor of the pelvic bones, and was receiving hospice (program of care and
support for individuals with a terminal illness) services. Physician's orders for Resident 9, dated April 3,
2025, included an order for the resident to receive hospice services. A care plan for Resident 9, revised
May 8, 2025, indicated that the resident was receiving Hospice for end-of-life care. As of December 3,
2025, there was no documented evidence in the resident's clinical record, or in the hospice provider's
clinical record, that the facility obtained updated hospice nurse aide charting (last communication was
October 2, 2025). Interview with the Director of Nursing on December 3, 2025, at 11:06 a.m. confirmed that
Resident 9's hospice nurse aide charting was not up to date in the resident's clinical record and/or in the
hospice provider's clinical record and should have been. 28 Pa. Code 211.12(d)(3)(5) Nursing Services.
Event ID:
Facility ID:
395592
If continuation sheet
Page 8 of 8
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Back to topCitations
8 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F636 - Resident Assessment
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
F641 - Accuracy of Assessments
Ensure each resident receives an accurate assessment.
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
F658 - Comprehensive Care Plans
Ensure services provided by the nursing facility meet professional standards of quality.
F677 - A resident who is unable to carry out activities of daily living receives
Provide care and assistance to perform activities of daily living for any resident who is unable.
F686 - Skin Integrity
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
F690 - Incontinence
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
F849 - Hospice services
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
FAQ · About this visit
Common questions about this visit
What happened during the December 4, 2025 survey of HAIDA NURSING AND REHAB?
This was a inspection survey of HAIDA NURSING AND REHAB on December 4, 2025. The surveyor cited 8 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at HAIDA NURSING AND REHAB on December 4, 2025?
Yes, 8 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.