Inspection visit
Health inspection
2 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 2 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
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, clinical records, and staff interviews, it was determined that the facility failed to notify
physicians of increased and decreased Capillary Blood Glucose (CBG) levels and failed to assess
residents for hyperglycemia (high blood glucose) and hypoglycemia (low blood glucose), for four of seven
residents reviewed (Residents R9, R10, R24, and R33).
Residents Affected - Some
Findings include:
The Centers for Disease Control defines diabetes as: Diabetes Mellitus is a chronic (long-lasting) health
condition that affects how your body turns food into energy. Most of the food you eat is broken down into
sugar (also called glucose) and released into your bloodstream. When your blood sugar goes up, it signals
your pancreas to release insulin. Insulin acts like a key to let the blood sugar into your body's cells for use
as energy. If you have diabetes, your body either doesn't make enough insulin or can't use the insulin it
makes as well as it should. When there isn't enough insulin or cells stop responding to insulin, too much
blood sugar stays in your bloodstream. Over time, that can cause serious health problems, such as heart
disease, vision loss, and kidney disease. Hypoglycemia is a condition that occurs when blood glucose is
lower than normal, usually below 70 milligrams per deciliter (mg/dl). If left untreated, hypoglycemia may
lead to weakness, confusion, unconsciousness, arrhythmias and even death. People with Diabetes Mellitus
may be prescribed injectable insulin to assist in maintaining acceptable levels of CBG's. Hyperglycemia, or
high blood glucose, occurs when there is too much sugar in the blood. This happens when your body has
too little insulin. Hyperglycemia is blood glucose greater than 125 mg/dL while fasting (not eating for at least
eight hours, or a blood glucose greater than 180 mg/dL one to two hours after eating. If you have
hyperglycemia and it ' s untreated for long periods of time, you can damage your nerves, blood vessels,
tissues and organs. Damage to blood vessels can increase your risk of heart attack and stroke, and nerve
damage may also lead to eye damage, kidney damage and non-healing wounds.
Review of the facility policy Diabetes - Clinical Protocol reviewed 3/6/23, indicated the physician will order
desired parameters for monitoring and reporting information related to diabetes ot blood sugar
management. The staff will identify and report complications.
Review of the facility policy Nursing Care of the Resident with Diabetes Mellitus reviewed 3/6/23, indicated
documentation should reflect the carefully assessed diabetic resident and include vital signs, level of
consciousness, assessment of the skin, blood sugar results. The approximate reference ranges for
hypoglycemia are:
Mild hypoglycemia - 55-70
(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 6
Event ID:
395633
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
395633
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/26/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Havencrest Rehabilitation and Healthcare Center
1277 Country Club Road
Monongahela, PA 15063
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
Moderate hypoglycemia - 40-55
Level of Harm - Minimal harm
or potential for actual harm
Severe hypoglycemia - <40
Residents Affected - Some
Review of the facility policy Obtaining a Fingerstick Glucose Level reviewed 3/623, indicated to report
results promptly to the supervisor and physician and report other information in accordance with facility
policy and professional standards of practice.
Review of the facility policy Change in Resident ' s Condition or Status reviewed 3/6/23, indicated the facility
shall promptly notify the resident, his/her doctor, and representative of changes in the resident ' s
medical/mental condition and/or status. The nurse will notify the doctor or the doctor on call when there has
been a significant change in the resident ' s physical/emotional/mental condition, and when specific
instructions to notify the doctor of changes in the resident ' s condition. The nurse will record in the resident
' s medical record information relative to changes in the resident ' s medical/mental condition or status.
Review of the facility policy Charting and Documentation reviewed 3/6/23, indicated all services provided to
the resident, progress toward the care plan, or any changes in the resident ' s medical, physical, functional,
or psychosocial condition shall be documented in the resident ' s medical record. Documentation of
procedures and treatments will include care-specific details, including the date and time
procedure/treatment was provided, assessment data and/or any unusual findings, and notification of family,
physician, or other staff if indicated.
Review of the clinical record indicated Resident R9 was re-admitted to the facility on [DATE], with
diagnoses that included diabetes, high blood pressure, and muscle weakness.
Review of Resident R9 ' s Minimum Data Set (MDS - a mandated assessment of a resident's abilities and
care needs) dated 12/23/23, indicated the diagnoses remain current.
Review of a physician ' s order dated 12/28/21, indicated to inject Novolog insulin per sliding scale, if blood
glucose less than 70 or greater than 400 call the doctor. Further review of a physician ' s order dated
3/17/23, indicated to call the doctor if blood sugar is less than 70 or greater than 400.
Review of the clinical record electronic Medication Administration Record (eMAR) revealed that the
resident's CBG's were as follows:
On 11/5/23, at 5:37 p.m. CBG was noted to be 447.
On 12/21/23, at 12:09 p.m. CBG was noted to be 65
Review of Resident's eMAR and clinical progress notes indicated the resident was not assessed for
hyper-/hypoglycemia, the blood glucose was not monitored for effectiveness of treatment, failed to follow
interventions of the care plan, failed to follow facility protocol, and the physician was not notified of
abnormal results on the above listed dates.
Review of the care plan revised 7/8/20, indicated to administer diabetic medications per physician ' s
orders. Obtain glucometer readings and report abnormalities as ordered. Report symptoms of
hyper-/hypoglycemia.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395633
If continuation sheet
Page 2 of 6
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
395633
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/26/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Havencrest Rehabilitation and Healthcare Center
1277 Country Club Road
Monongahela, PA 15063
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
Level of Harm - Minimal harm
or potential for actual harm
Review of a clinical record indicated Resident R10 was re-admitted to the facility on [DATE], with diagnoses
that included diabetes, heart failure (progressive heart disease that affects pumping action of the heart
muscles), and high blood pressure.
Review of the MDS dated [DATE], indicated the diagnoses remain current.
Residents Affected - Some
Review of physician ' s orders dated 3/17/23, indicated to call doctor for hypo/hyperglycemic episodes or if
blood sugar is less than 70/greater than 400. Further review of a physician order dated 8/17/22 indicated to
inject Novolog (a fast-acting insulin that starts to work about 15 minutes after injection, peaks in about 1
hour, and keeps working for 2 to 4 hours.) insulin per sliding scale, If blood sugar is 401 or greater give 10
units, call doctor if blood glucose is less than 70 or greater than 400.
Review of Resident R10's eMAR revealed that the resident's CBG's were as follows:
On 12/7/23, at 8:42 a.m. CBG was noted to be 63.
On 1/14/24, at 8:32 a.m. CBG was noted to be 63.
A review of Resident R10's eMAR and clinical progress notes indicated the resident was not assessed for
hypoglycemia, failed to follow interventions of the care plan, blood sugar was not rechecked, and the
physician was not notified of abnormal results.
A review of Resident R10's care plan dated 12/12/18, indicated to administer insulin medications per
physician orders. Report symptoms of hypo-/hyperglycemia. Further review of the care plan dated 11/23/23,
indicated to obtain glucometer readings and report abnormalities as ordered.
Review of the clinical record indicated Resident R24 was re-admitted to the facility on [DATE], with
diagnoses that included diabetes, dementia (group of symptoms affecting memory, thinking and social
abilities), and anxiety.
Review of Resident R24 ' s MDS dated [DATE], indicated the diagnoses remain current.
Review of physician orders dated 4/13/23, indicated to call the doctor if blood sugar is less than 70/greater
than 400. For symptomatic hypoglycemia and responsive, give rapidly absorbed glucose (juice, soda)
recheck in 15 minutes and repeat if indicated.
Review of the clinical record electronic Medication Administration Record (eMAR) revealed that the
resident's CBG's were as follows:
On 12/24/23, at 8:49 a.m. CBG was noted to be 53.
Review of Resident R24's eMAR and clinical progress notes indicated the resident was not assessed for
hypoglycemia, the blood glucose was not monitored for effectiveness of treatment, failed to follow
interventions of the care plan, and the physician was not notified of abnormal results on the above listed
dates.
Review of the care plan dated 10/15/22, indicated to administer diabetic medications per physician orders.
Obtain glucometer readings and report abnormalities as ordered. Report symptoms of
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395633
If continuation sheet
Page 3 of 6
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
395633
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/26/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Havencrest Rehabilitation and Healthcare Center
1277 Country Club Road
Monongahela, PA 15063
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
hypoglycemia.
Level of Harm - Minimal harm
or potential for actual harm
Review of the clinical record indicated Resident R33 was re-admitted to the facility on [DATE], with
diagnoses that included diabetes, depression, and muscle weakness.
Residents Affected - Some
Review of Resident R33' s MDS dated [DATE], indicated the diagnoses remain current.
Review of physician orders dated 1/4/24, indicated to call the doctor if blood sugar is less than 70/greater
than 400. Inject Admelog (Lispro) per sliding scale if greater than 400 give 12 units and notify doctor.
Review of the clinical record electronic Medication Administration Record (eMAR) revealed that the
resident's CBG's were as follows:
On 1/5/24, at 12:17 p.m. CBG was noted to be 429.
On 1/5/24, at 4:40 p.m. CBG was noted to be 403.
On 1/5/24, at 5:14 p.m. CBG was noted to be 403.
On 1/22/24, at 9:30 a.m. CBG was noted to be 49.
Review of Resident R33's eMAR and clinical progress notes indicated the resident was not assessed for
hypo-/hyperglycemia, the blood glucose was not monitored for effectiveness of treatment, and the physician
was not notified of abnormal results on the above listed dates and failed to follow the physician ' s order.
Review of the care plan dated 1/4/24, indicated to administer medications per physician orders. Obtain
glucometer readings and report abnormalities as ordered. Report symptoms of hypo-/hyperglycemia.
During an interview on 1/25/24, at 8:13 a.m. Licensed Practical Nurse (LPN) Employee E2 stated for blood
sugar under 60-70, they would notify the doctor and provide a snack. If the blood sugar was over 200, they
would check the orders for parameters, and call the doctor accordingly.
During an interview on 1/25/24, at 8:17 a.m. Registered Nurse (RN) Employee E3 stated for blood sugars
over 400, they would check the parameters, give the baseline insulin, complete an assessment, and call the
provider. If the blood sugar was less than 70 they would offer a snack, call the doctor, and monitor the
resident.
During an interview on 1/25/24, at 8:20 a.m. RN Employee E4 stated for blood sugars over 300-400, they
would check the orders for parameters, give the ordered insulin, complete an assessment and call the
doctor. If the blood sugar was less than 60, follow protocol, offer snack, complete assessment, and recheck
in 15 minutes.
During an interview on 1/25/24, at 2:08 a.m. LPN Employee E5 stated for blood sugars less than 70 they
would give snack, notify the doctor if needed and recheck in 15 minutes. For blood sugars over 400, they
would give the ordered insulin, notify the doctor, and recheck in 30 minutes.
During an interview on 1/26/24, at 10:30 a.m. the Director of Nursing confirmed the facility failed
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395633
If continuation sheet
Page 4 of 6
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
395633
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/26/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Havencrest Rehabilitation and Healthcare Center
1277 Country Club Road
Monongahela, PA 15063
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
to notify the doctor of a change in condition related to blood glucose, failed to follow the care plan
interventions, and failed to recheck blood sugars for Residents R9, R10, R24, and R33.
Level of Harm - Minimal harm
or potential for actual harm
28 Pa. Code: 201.18 (b)(1) Management.
Residents Affected - Some
28 Pa. Code: 201.29(d) Resident rights.
28 Pa. Code: 211.10 (c)(d) Resident care policies.
28 Pa. Code: 211.12 (d)(1)(2)(3)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395633
If continuation sheet
Page 5 of 6
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
395633
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/26/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Havencrest Rehabilitation and Healthcare Center
1277 Country Club Road
Monongahela, PA 15063
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 0698
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of clinical records and staff interviews, it was determined that facility staff failed to maintain ongoing
communication with the dialysis (a machine filters wastes, salts and fluid from your blood when your
kidneys are no longer healthy enough to do this work adequately) center for one of 12 residents reviewed
(Resident R43).
Residents Affected - Few
Findings include:
Review of the facility policy End-Stage Renal Disease, Care of a Resident with last reviewed on 3/6/23,
indicated residents with end-stage renal disease (ESRD) will be cared for according to currently recognized
standards of care. Staff caring for residents with ESRD, including residents receiving dialysis care outside
of the facility, shall be trained in the care and special needs of these residents.
A review of the clinical record indicated that Resident R43 was admitted to the facility on [DATE], with
diagnoses that included ESRD (the kidneys permanently fail to work), cancer, and dependence on renal
dialysis.
A review of the Minimum Data Set (MDS - periodic assessment of care needs) date 11/17/23, indicated the
diagnoses remain current.
A review of a physician ' s order dated 12/18/23, indicated Resident R43 was to receive dialysis three days
a week on Monday, Wednesday, and Fridays.
Review of a care plan dated 12/6/23, indicated arrange for transportation to and from dialysis facility on
dialysis days. Confer with physician and/or dialysis treatment facility regarding changes in medication
administration times/dosage pre-dialysis as needed. Check access site for lack of thrill/bruit, evidence of
infection, swelling, or excessive bleeding. Report abnormalities to physician. Coordinate dialysis care with
dialysis treatment facility.
Review of the dialysis communication sheets from 12/18/23 through 1/22/24, indicated eight of eight
communication sheets not completed pre-dialysis treatment, and nine communication sheets were not
located.
During an interview on 1/26/24, at 10:45 a.m. Registered Nurse Employee E1 confirmed the dialysis
communication sheets Communication for Transition of Care between Dialysis and Skilled Nursing Facility
sheets are received from the dialysis center. They are not the facility ' s communication sheets.
During an interview on 1/26/23, at 10:48 a.m. the Director of Nursing confirmed the facility failed to ensure
the dialysis communication forms for Resident R43 were completed following each dialysis treatment day.
28 Pa. Code: 211.12(d)(1)(3)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395633
If continuation sheet
Page 6 of 6
Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.
Back to topCitations
2 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
F698 - Dialysis
Provide safe, appropriate dialysis care/services for a resident who requires such services.
FAQ · About this visit
Common questions about this visit
What happened during the January 26, 2024 survey of HAVENCREST REHABILITATION AND HEALTHCARE CENTER?
This was a inspection survey of HAVENCREST REHABILITATION AND HEALTHCARE CENTER on January 26, 2024. The surveyor cited 2 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at HAVENCREST REHABILITATION AND HEALTHCARE CENTER on January 26, 2024?
Yes, 2 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide appropriate treatment and care according to orders, resident’s preferences and goals."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.