Health inspection·October 28, 2022

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, employee personnel records, grievance and abuse investigation documents, reports submitted to the State field office, resident interview and staff interview it was determined that the facility failed to make certain that all allegations of verbal abuse are reported to the State Agency as required for one of five residents (Resident R96). Findings include: The facility Abuse: protection from abuse policy dated [DATE], indicated that the facility every resident with consideration, respect and full recognition of his/her dignity and individuality. Verbal abuse is defined as the use of oral, written or gestured language that willfully includes disparaging and derogatory terms to residents or their families, or within their hearing distance. Alleged violations, whether or not confirmed, must be reported to the Administrator, PA Department of Health, the Area Agency on Aging, Compliance Officer, and to the Executive Director. Review of Resident R96's admission record indicated she was originally admitted on [DATE], with diagnoses that included Dementia (group of conditions characterized by impairment of at least two brain functions such as memory and loss of judgement). Review of Resident R96's MDS assessment (MDS-Minimum Data Set assessment: periodic assessment of resident care needs) dated [DATE], indicated that the diagnoses were current. Review of Grievances documentation dated [DATE], indicated that a visiting family member for a Resident in the 4B nursing wing submitted an allegation of verbal abuse. The allegation indicated that staff NA Employee E10 was yelling in the hallway about Resident R96Stop bothering us, she died a month ago and we tell you every day that they're dead! Review of interview form from investigation dated [DATE], indicated that the staff Nurse Aide(NA) Employee E10 said How many times do I have to tell you she is dead, dead, dead! I am not going to listen to this all night, go back to your room, in a loud tone. During an interview on [DATE], at 10:57 a.m. the Director of Nursing confirmed that the facility failed to make certain that an allegation of verbal abuse regarding Resident R96 was reported to the State Agency as required. During an interview on [DATE], at 11:06 a.m. the Nursing Home Administrator confirmed that the facility failed to make certain that an allegation of verbal abuse regarding Resident R96 was reported (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 2 Event ID: 395617 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 395617 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE John J Kane Regional Center-SC 300 Kane Boulevard Pittsburgh, PA 15243 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)