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
review of facility policy and investigative documents, it was determined that the facility failed to provide
quality of care with an unlicensed employee providing medications to six residents. This was identified as a
past non-compliance for six of six residents (Resident R1, R2 R3, R4, R5 and R6).
Residents Affected - Few
Findings include:
Quality of care is a fundamental principle that applies to all treatment and care provided to facility residents.
Based on the comprehensive assessment of a resident, the facility must ensure that residents receive
treatment and care in accordance with professional standards of practice, the comprehensive
person-centered care plan, and the residents' choices.
Review of the job description for NA (Nursing Assistant) indicated job functions to include: duties and
responsibilities, administrative, committee, personnel, and specific job function, staff development,
competency, safety, equipment & safety functions, financial responsibilities, customer service and resident
rights. Giving medications to residents was not included on the nurse Assistant job description.
Review of the job description for LPN (Licensed Practical Nurse) indicated: Drug Administration Function:
Prepare and administer medications as ordered by the physician. Ensure that direct nursing care is
provided by a licensed nurse. Education: Must possess at a minimum a Nursing degree from an accredited
college or university, or graduate from an approved LPN/LVN/RNM program.
Review of facility documentation submitted to the State Survey Agency indicated: It was reported to the
DON (Director of Nursing ) on [DATE], by an agency nurse that over the weekend a co-worker, NA
Employee E1, who has been function as an agency NA made the comment if there is a call-off they are not
taking a cart . The DON initiated an investigation and discovered that NA Employee E1, had worked at the
facility as an LPN on [DATE], and [DATE]. The DON then contacted the agency and was told that NA
Employee E1 was employed as a Nurse Aide through the agency. The agency confirmed that they were
scheduled to work on [DATE], and [DATE].
During an on-site investigation [DATE], the following was documented on the facility investigation: Employee
E2 LPN states that NA Employee E1 kept saying that they did not want to take a cart on the next shift as a
nurse. Employee E2 LPN questioned about why NA Employee E1 would say that, and NA Employee E1
said she had worked here before as a Nurse and that they are a LPN. After the conversation DON pulled
staffing sheets for the past month and found out that NA Employee E1 was handwritten into the schedule
as a nurse on [DATE], 3pm to 11pm and was also on the schedule [DATE], 11pm - 7am. Agency for NA
Employee E1 was contacted and confirmed they had her as a Nurse Aide, but did not have
(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:
395620
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
395620
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/28/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Cedar Hill Healthcare and Rehabilitation Center
951 Brodhead Road
Coraopolis, PA 15108
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)
F 0684
her listed as an LPN.
Level of Harm - Minimal harm
or potential for actual harm
Results of investigation failed to show that NA Employee E1 had a LPN current or expired.
On [DATE], the facility initiated a plan of correction that included:
Residents Affected - Few
Investigation determined that NA Employee E1 misinformed the scheduler that they were a nurse. Agency's
providing staff to the facility were reduced from 7 to three staffing agencies.
Resident were assessed by Unit Manager and DON and no adverse effects noted. Reviewed with Medical
Director.
Interim scheduler and unit managers educated that the schedule could not be changed without approval by
DON/NHA.
All agency nursing personnel credentials have been audited to ensure the professional capacity in which
they are working g matches the credentials in their file. No further issues were found.
All credentials are checked by scheduler and nursing prior to them working in facility.
The Moon Twp Police were notified and report was filed. The Board of Nursing was contacted via phone
and email.
Audits were conducted for agency staff credentials 3x peer week for 4 weeks then weekly x 4 weeks to
ensure the practice does not recur. Audits started on [DATE], and were completed on [DATE].
During an interview on [DATE], at approximately 10:30 a.m. The DON confirmed that the facility failed to
provide quality of care with an unlicensed employee providing medications to six of six residents reviewed.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395620
If continuation sheet
Page 2 of 2