Health inspection·March 26, 2024

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on review of select policies and procedures and staff interview, it was determined that the facility failed to implement their abuse policy regarding reporting to the proper state agencies for misappropriation of resident property for five of 17 residents reviewed (Residents CR1, 4, 5, 6 and 7). Residents Affected - Few Findings include: The policy entitled Abuse, last reviewed on July 6, 2023, indicates that the facility will ensure that all alleged violations involving misappropriation of resident property are reported immediately to the state survey and certification agency. Further reporting to law enforcement agencies will be initiated for misappropriation of resident funds and/or property. Interview with Employee 4, assistant director of nursing, on March 26, 2024, at 8:45 AM confirmed that the facility just recently investigated an incident where a large number of narcotics went missing. Review of the facility's investigation indicated that on February 19, 2024, it was noted that 60 tablets of Resident 7's hydrocodone/acetaminophen (a narcotic pain reliever) and 60 tablets of Resident 4's Oxycodone (a narcotic pain reliever) was missing from the medication carts. On February 20, 2024, it was noted that Resident 5 had 120 tablets of Oxycodone missing from the medication cart. Further investigation revealed that Resident CR1 and Resident 6 were both was missing 60 tablets of Oxycodone. In total, the facility determined that 360 tablets of narcotic pain relievers went missing. There was no documented evidence in the facility's investigation to indicate that the Pennsylvania Department of Health was notified of the misappropriation of narcotics for Resident CR1, 4, 5, 6, and 7. The facility also did not notify local law enforcement until February 22, 2024, three days after the initial discovery of missing narcotics. Interview with the Administrator and Employee 4 on March 26, 2024, at 2:00 PM revealed that since the missing narcotics were replaced, the facility felt that they did not have report the incident to the Pennsylvania Department of Health. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 201.29(a)(c) Resident rights 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: 395616 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 395616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745 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)