Health inspection·September 26, 2024

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, resident clinical records, documentation provided by the facility, facility investigation, resident interview, and staff interviews, it was determined that the facility failed to ensure that a resident was free from neglect, which resulted in actual harm as evidenced by a left distal femur (thigh bone closest to the knee bone) fracture for one of three residents (Resident R91) and a head injury for one of three residents (Resident R3). Findings include: Review of the facility policy Abuse- Resident last reviewed on 1/5/24, indicated that the facility treat every resident with respect and dignity. The failure of the facility to provide goods and services to a resident that are necessary to avoid or may result in physical harm is identified as neglect. All complaints/allegations of resident abuse/neglect shall be promptly reported to the administration and investigated. Alleged violations whether or not confirmed, must be reported. Review of the clinical record indicated Resident R91 was admitted to the facility on [DATE], with diagnoses which included right sided (dominant side) hemiplegia and hemiparesis (paralysis of one side of body) due to a stroke, morbid obesity and difficulty swallowing. An Minimum Data Set (MDS - a periodic assessment of resident care needs) dated 7/13/24, indicated the diagnoses remained current, Section GG 0170 Mobility identified Resident R91 as dependent (which requiring one staff to do all the effort or two staff ) for bed mobility. Review of an incident report dated 7/30/24, at 12:30 a.m., indicated that Resident R91 was being provided incontinence care by Nurse Aide (NA) Employee E9 and redness was identified on Resident R91's buttocks. The statement further indicated NA Employee E9 turned away from Resident R91 to get cream and Resident R91 slid off of the bed (away from NA Employee E9) and onto the floor causing a fractured left distal femur. Review of the statement that was attached to the investigation dated 7/30/24, from NA Employee E9 stated that I came into the room and Resident R91 told me she needed to be changed. As I am changing her brief and wiping her backside, I noticed redness in the area I asked her did she have any cream her response was yes, I asked her where was it she told me as I turned my left side to grab the cream she started to roll herself out of bed. I ran over to the other side of bed and sat with her until the ambulance came. Review of the facility investigation dated 7/31/24, contained the Staff Development Referral process dated 12/28/22, that was signed by NA Employee E9. This document includes the statement for (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 10 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 09/26/2024 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)