Health inspection·May 14, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to provide prescribed treatment necessary to manage constipation and promote normal bowel activity to prevent related complications and demonstrate timely and thorough assessment of a resident for one resident out of seven sampled (Resident 1). Residents Affected - Few Findings include: According to the American Academy of Family Physicians {The American Academy of Family Physicians is one of the largest medical organizations in the US founded to promote the science and art of family medicine}the primary goal of constipation management should be symptom improvement, and the secondary goal should be the passage of soft, formed stool without straining at least three times per week). A review of the clinical record revealed that Resident 1 was admitted to the facility on [DATE], with diagnoses to include stage 3 kidney disease, urinary retention, a history of constipation and fecal impaction and anxiety. An admission history and physical dated January 17, 2024, completed prior to the resident's the facility revealed that she was hospitalized for multiple health issues to include having severe constipation, not having a bowel movement at home for 2 weeks. She had a fecal impaction, was disimpacted and Miralax (laxative) daily was initiated. An admission MDS Assesment (Minimum Data Set - a federally mandated standardized assessment process conducted periodically to plan resident care) January 21, 2024, revealed that the resident was mildly cognitively impaired, required staff assistance with activities of daily living, including toileting, and was always incontinent of bowel. A review of a care plan dated January 15, 2024 revealed that the resident was at risk for constipation with a goal for the resident to have a normal bowel movement at least every 3 days. Planned interventions were to follow facility bowel protocol for bowel movements and record bowel movement pattern each day. A physician order dated January 15, 2024, was noted for a bowel regimen that included Milk of Magnesia (MOM - a laxative to relieve occasional constipation) 30 ml by mouth every 72 hours as needed for no bowel movement (BM), Dulcolax suppository (Bisacodyl a stimulant laxative) 10 mg, one rectally as needed after MOM is administered and Fleets enema (rectal enema combination medicine used to treat constipation) 7-19 gms, one application rectally as needed after MOM and Dulcolax if no BM, which (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: 395602 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 395602 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wesley Village 209 Roberts Road Pittston, PA 18640 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)