Health inspection·March 13, 2025

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy and clinical records, and staff interview, it was determined that the facility failed to review and revise comprehensive care plans to reflect the current necessary care and services for one of 19 residents reviewed (Resident R60). Findings include: A facility policy entitled, Care Plans, Comprehensive Person-Centered dated 10/29/24, indicated that assessments of residents are on-going and care plans are revised as information about the resident and the resident's condition changes, and the interdisciplinary team must review and update the care plan at least quarterly, in conjunction with the required quarterly Minimum Data Set (MDS- standardized assessment tool that measures health status in nursing home residents). Resident R60's clinical record revealed an admission date of 4/09/24, with diagnoses that included long-term kidney disease, sudden kidney failure, and high blood pressure. Review of Resident R60's clinical record revealed a physician's order dated 6/18/24, for removal of his/her dialysis (a procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly) catheter (a soft, flexible tube used to access a patient's blood for hemodialysis). A departmental progress note dated 6/21/24, indicated that the dialysis catheter was removed due to Resident R60 no longer requiring dialysis treatment. A care plan entitled end stage renal disease initiated 6/05/24, with the most recent target date of 11/16/24, included interventions to transport Resident R60 to dialysis on Tuesdays and Saturdays at 10:30 a.m., coordinate dialysis care with the dialysis treatment facility, arrange for transportation to and from dialysis, and confer with physician and/or dialysis treatment facility regarding changes in medication administration times/dosages pre-dialysis as needed. Review of Resident R60's MDS's revealed the following: Quarterly MDS dated [DATE], Section O - Special Treatments and Programs, O0110-J2 was coded as not receiving dialysis services. Quarterly MDS dated [DATE], Section O - Special Treatments and Programs, O0110-J2 was coded as not receiving dialysis services. Quarterly MDS dated [DATE], Section O - Special Treatments and Programs, O0110-J2 was coded as not (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 6 Event ID: 395594 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 395594 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oil City Nursing and Rehab 1293 Grandview Road Oil City, PA 16301 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)