Inspection·January 14, 2025

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy, observation, and staff interviews, it was determined that the facility failed to implement infection prevention and control monitoring policies for Respiratory Precautions for one of three residents (Resident R1), failed to prevent cross contamination by having dirty linens on the floor for one of eight residents (Resident R1), failed to maintain sanitary commodes in bathrooms for three of eight residents (Residents R2, R3, and R5), and failed to ensure floor mats were clean for four of eight residents (Residents R4, R6, R7, and R8). Residents Affected - Few Findings include: Review of the CDC (Center for Disease Control) Fact Sheet Use Personal Protective Equipment (PPE) When Caring for Patients with Confirmed or Suspected Covid-19 indicated doffing - (taking off the gear) Remove gloves and gown. Healthcare Personnel may now exit patient room. Next, remove face shield or goggles and remove and discard respirator. Perform hand hygiene after removing the respirator and applying a new one. Review of the facility policy Cleaning and Preventative Maintenance, Resident Rooms and Equipment dated 1/2/25, indicated it is the facility's policy to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable environment. This policy is part of the facility's overall Infection Prevention and Control Program. Review of the facility provided Precaution List dated January 2025, indicated the 3East unit had three residents in Respiratory Precautions for either being covid positive or still symptomatic of respiratory illness. During an interview on the 3 East unit, on 1/14/25, at 9:42 a.m. the following staff were asked what PPE was required with a Respiratory Precaution resident? Staff present were Registered Nurse (RN) Employee E1, Licensed Practical Nurse (LPN) Employee E2, LPN Employee E3, and LPN Employee E4. The response was appropriate until the doffing (removal) of the N95 respirator. The group indicated staff should remove the N95 mask inside the Respiratory Precautions room along with the other PPE (gown, gloves, and goggles/face shield), not immediately outside the room as required, and performing hand hygiene before donning (applying) a new N95. Interview on 1/14/25, at 9:44 a.m. RN Employee E1 indicated she was unaware of this practice and inquired if it was new. Observations during a tour of the 3 East unit on 1/14/25, at 10:10 indicated the following: -Resident R1 in 386W had a Precautions sign on the door. Inside the room across from the foot of (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: 395606 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 395606 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE John J Kane Regional Center-Ro 110 McIntyre Road Pittsburgh, PA 15237 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)