Inspection visit
Inspection
12 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 12 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0625
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Notify the resident or the resident’s representative in writing how long the nursing home will hold the
resident’s bed in cases of transfer to a hospital or therapeutic leave.
Based on review of clinical records, as well as staff interviews, it was determined that the facility failed to
ensure that the resident and/or the responsible party was notified about the facility's bed-hold policy upon
transfer to the hospital for two of 42 residents reviewed (Residents 3, 5).
Findings include:
A facility policy for Bed Holds and Returns, dated November 1, 2022, included that all
residents/representatives are provided written information regarding the facility and state bed-hold policies,
which address holding or reserving a resident's bed during periods of absence (hospitalization or
therapeutic leave). Residents, regardless of payor source, are provided written notice about these policies.
A Quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and
care needs) for Resident 3, dated September 20, 2023, revealed that the resident was cognitively impaired,
required supervision with daily care needs, and had diagnosis that included chronic respiratory failure.
Nurses' notes for Resident 3, dated December 22, 2022, at 6:45 p.m., revealed that the resident was
admitted to the hospital for a right hip fracture.
There was no documented evidence that the resident and/or the responsible party was notified about the
facility's bed-hold policy at the time of the above transfers to the hospital for Resident 3.
Interview with the Nursing Home Administrator on November 15, 2023, at 11:08 a.m. confirmed that there
was no documented evidence that a bed hold notice was issued to Resident 3 or her responsible party and
that it should have been.
A quarterly MDS assessment for Resident 5, dated September 3, 2023, indicated that the resident was
cognitively intact, required extensive assistance from staff for personal care needs, and had diagnosis that
included Cerebral Palsy (disability that effects movement, posture, and coordination).
A nurse's note for Resident 5, dated March 4, 2023, at 4:55 p.m., revealed that the resident was transferred
to the hospital. There was no documented evidence that a bed hold notice was issued to Resident 5 or his
responsible party at the time of the transfer to the hospital.
Interview with the Nursing Home Administrator on November 16, 2023, confirmed that there was no
documented evidence that a bed hold notice was provided to Resident 5 or his responsible party at the
(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 18
Event ID:
395652
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
395652
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/16/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ridgeview Healthcare and Rehabilitation Center
30 Fourth Avenue
Curwensville, PA 16833
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 0625
time of a transfer to the hospital on March 4 and should have been.
Level of Harm - Minimal harm
or potential for actual harm
28 Pa. Code 201.29(d) Resident rights.
28 Pa. Code 211.5(f) Clinical records.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395652
If continuation sheet
Page 2 of 18
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
395652
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/16/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ridgeview Healthcare and Rehabilitation Center
30 Fourth Avenue
Curwensville, PA 16833
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 0641
Ensure each resident receives an accurate assessment.
Level of Harm - Minimal harm
or potential for actual harm
Based on a review of the Resident Assessment Instrument User's Manual and clinical records, as well as
staff interviews, it was determined that the facility failed to complete accurate Minimum Data Set
assessments for three of 42 residents reviewed (Residents 3, 11, 56).
Residents Affected - Few
Findings include:
The Resident Assessment Instrument (RAI) User's Manual, which gives instructions for completing
Minimum Data Set (MDS) assessments (required assessments of a resident's abilities and care needs),
dated October 2019, revealed that Section N0410H Opioid Medications (narcotic medications used to treat
pain) was to be coded for the number of days the resident used an opioid during the seven-day assessment
period.
Physician's orders for Resident 3, dated June 28, 2023, included an order for the resident to receive 50
micrograms Fentanyl (an opioid used for pain) every three days. The resident's Medication Administration
Record (MAR) for September 2023 revealed that the resident received Fentanyl three out of the seven-day
look-back assessment period.
A quarterly MDS for Resident 3, dated September 20, 2023, revealed that Section N0401H was coded (0),
indicating that the resident did not receive opioid medication during the seven-day look-back assessment
period.
The RAI User's Manual, dated October 2019, revealed that Section O0100J (1) was to be checked if the
resident received dialysis within the last 14 days while not a resident and (2) was to be checked if the
resident received dialysis within the last 14 days while a resident.
Physician's orders for Resident 11, dated August 9, 2023, included an order for the resident to receive
hemodialysis every Monday, Wednesday, and Friday.
A quarterly MDS for Resident 11, dated September 27, 2023, revealed that Section O0100J(2) was not
checked, indicating that the resident did not receive dialysis during the 14-day assessment period.
The Resident Assessment Instrument (RAI) User's Manual, which gives instructions for completing
Minimum Data Set (MDS) assessments (required assessments of a resident's abilities and care needs),
dated October 2019, revealed that Section N0410H Opioid Medications (narcotic medications used to treat
pain) was to be coded for the number of days the resident used an opioid during the seven-day assessment
period.
Physician's orders for Resident 56, dated June 28, 2023, included an order for the resident to receive 9
milligrams of Xtampza (an opioid used for pain) two times a day. The resident's Medication Administration
Record (MAR) for October 2023 revealed that the resident received Xtampza every day during the
seven-day look-back assessment period.
An annual MDS for Resident 56, dated October 31, 2023, revealed that Section N0401H was coded (0),
indicating that the resident did not receive opioid medication during the seven-day look-back assessment
period.
An interview with the Registered Nurse Assessment Coordinator (RNAC- a registered nurse who is
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395652
If continuation sheet
Page 3 of 18
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
395652
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/16/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ridgeview Healthcare and Rehabilitation Center
30 Fourth Avenue
Curwensville, PA 16833
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 0641
Level of Harm - Minimal harm
or potential for actual harm
responsible for the completion of MDS assessments) confirmed on November 16, 2023, at 1:11 p.m. that
the assessments for Residents 3, 11 and 56 were coded incorrectly.
28 Pa. Code 211.5(f) Clinical records.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395652
If continuation sheet
Page 4 of 18
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
395652
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/16/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ridgeview Healthcare and Rehabilitation Center
30 Fourth Avenue
Curwensville, PA 16833
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 0656
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Develop and implement a complete care plan that meets all the resident's needs, with timetables and
actions that can be measured.
Based on review of facility policies, clinical records, and staff interviews, it was determined that the facility
failed to develop a comprehensive care plan that included specific and individualized interventions to
address the care needs of residents for one of 42 residents reviewed (Resident 11).
Findings include:
A facility's policy regarding care plans, dated November 1, 2022, included that a comprehensive,
person-centered care plan that includes measurable objectives and timetables to meet the resident's
physical, psychosocial and functional needs is developed and implemented for each resident.
An annual Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and
care needs) for Resident 11, dated October 31, 2023, revealed that the resident was cognitively intact and
required assistance from staff for daily care needs and had diagnosis that included hypertension and
end-stage renal disease.
A physician note for Resident 11, dated October 19, 2023, at 4:17 p.m., stated that the resident had
presence of a cardiac pacemaker. Physician's orders for Resident 11, dated July 13, 2023, included an
order to make sure Medtronic Carelink Monitor (used to monitor pacemaker function) is turned on, check
will occur automatically as long as monitor is on. This check will occur in his room at night.
There was no documented evidence that a care plan was developed to address Resident 11's individual
care and treatment needs related to his use of a cardiac pacemaker.
An interview with the Registered Nurse Assessment Coordinator (RNAC- a registered nurse who is
responsible for the completion of care plans) confirmed on November 16, 2023, at 1:11 p.m. that there was
no care plan in place for Resident 11's care and treatment needs related to his use of a cardiac pacemaker
and there should be a care plan in place.
28 Pa. Code 211.11(d) Resident care plans.
28 Pa. Code 211.12(d)(1)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395652
If continuation sheet
Page 5 of 18
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
395652
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/16/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ridgeview Healthcare and Rehabilitation Center
30 Fourth Avenue
Curwensville, PA 16833
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 0658
Ensure services provided by the nursing facility meet professional standards of quality.
Level of Harm - Minimal harm
or potential for actual harm
Based on review of Pennsylvania's Nursing Practice Act, clinical records, and staff interviews, it was
determined that the facility failed to clarify physician's orders for one of 42 residents reviewed (Residents
51) and failed to ensure that a professional (registered) nurse assessed a resident after a change in
condition for one of 42 residents reviewed (Residents 69).
Residents Affected - Few
Findings include:
The Pennsylvania Code, Title 49, Professional and Vocational Standards, State Board of Nursing, 21.11
(a)(1)(2)(4) indicated that the registered nurse was to collect complete and ongoing data to determine
nursing care needs, analyze the health status of individuals and compare the data with the norm when
determining nursing care needs, and carry out nursing care actions that promote, maintain, and restore the
well-being of individuals.
A quarterly Minimum Data Set (MDS) assessment (mandated to assess the resident abilities and care
needs) for Resident 51, dated August 30, 2023, indicated that he was cognitively impaired, was dependent
on staff for personal care needs, had an indwelling catheter (a tube inserted into the bladder to drain urine),
and had diagnoses that included obstructive neuropathy (condition in which the flow of urine is blocked).
A urology consult for Resident 51, dated August 29, 2023, included a recommendation that in one month
the foley (a type of indwelling catheter) catheter was to be removed and a trial of voiding (removing an
indwelling catheter and assessing for the ability to urinate) completed. Post-void residual (PVR- the amount
of urine left in the bladder after urinating) was to be monitored and the urology office notified if the result
was greater than 250 milliliters (ml).
Review of clinical records for Resident 51, including progress notes and Treatment Administration Records
(TAR), revealed no documented evidence that post-void residual was being monitored.
Interview with Registered Nurse Supervisor 1 on November 15, 2023, at 1:03 p.m. revealed that the
physician's order for the PVR was not entered because the facility did not have a functioning bladder
scanner (used to measure the amount of urine in the bladder) to monitor the PVR. She did not recall calling
the urology office to inform them or clarifying the order.
Interview with the Nursing Home Administrator on November 15, 2023, at 3:07 p.m. confirmed that the
urologist was not notified that the facility was unable to monitor PVR as ordered, and should have been.
An annual MDS assessment for Resident 69, dated October 10, 2024, indicated the resident was
cognitively impaired, was dependent on staff for personal care needs, had a history of falls, and had
diagnoses that included dementia.
A nurse's note for Resident 69, dated May 13, 2023, at 6:19 p.m., revealed that the resident's responsible
party was aware of the incident that had occurred that morning. A review of the incident report for Resident
69, dated May 13, 2023, revealed that there was a fall. There was no documented evidence of the fall in the
permanent clinical record and no documented evidence of a registered nurse assessment at the time of the
fall.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395652
If continuation sheet
Page 6 of 18
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
395652
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/16/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ridgeview Healthcare and Rehabilitation Center
30 Fourth Avenue
Curwensville, PA 16833
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 0658
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
A nurse's note for Resident 69, dated July 31, 2023, at 2:42 p.m., revealed that the resident hit the corner of
his right eye on his tray table and received a 0.5-centimeter (cm) laceration. There was no documented
evidence in the clinical record that a registered nurse assessed the laceration when it occurred.
Interview with the Director of Nursing on November 15, 2023, at 11:12 a.m. confirmed there was no
documented evidence of a registered nurse assessment at the time of Resident 69's fall on May 13 and no
registered assessment at the time the resident received a laceration to his left eye on July 31, 2023, and
there should have been.
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395652
If continuation sheet
Page 7 of 18
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
395652
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/16/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ridgeview Healthcare and Rehabilitation Center
30 Fourth Avenue
Curwensville, PA 16833
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
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Minimal harm
or potential for actual harm
Based on review of facility policies, clinical records, and staff interviews, it was determined that the facility
failed to ensure that physician's orders were followed for one of 42 residents reviewed (Resident 51)
Residents Affected - Some
Findings include:
A facility policy for the management of hypoglycemia, dated November 1, 2022, indicated that for
asymptomatic (no symptoms) responsive residents with hypoglycemia (blood sugar less than 70 milligrams
per deciliter (mg/dl)) staff were to give the resident an oral form of rapidly absorbed glucose (sugar),
recheck the blood sugar in 15 minutes, and notify the physician for further orders.
A quarterly Minimum Data Set (MDS) assessment (mandated to assess the resident abilities and care
needs) for Resident 51, dated August 30, 2023, indicated that he was cognitively impaired, was dependent
on staff for personal care needs, and had diagnoses that included diabetes.
Review of the September and October 2023 Medication Administration Record (MAR) for Resident 51
revealed that on September 2, 2023, at 8:00 a.m. the resident's blood sugar was 69 milligrams per deciliter
(mg/dL); on September 9, 2023, at 8:00 a.m. the resident's blood sugar was 68 mg/dL; on September 27,
2023, at 8:00 a.m. the resident's blood sugar was 69 mg/dL; on September 30, 2023, at 8:00 a.m. the
resident's blood sugar was 65 mg/dL; on September 9, 2023, at 12:30 p.m. the resident's blood sugar was
68 mg/dL; and October 10, 2023, at 8:00 a.m. the resident's blood sugar was 63 mg/dL. There was no
documented evidence that glucose was administered to the resident, that the resident's blood sugar was
rechecked in 15 minutes, or that the physician was notified per facility policy on the dates and times
identified.
An interview with the Director of Nursing on November 16, 2023, at 8:38 a.m. confirmed that the
hypoglycemia policy was not followed when the Resident 51 had a blood sugar below 70 on the
above-mentioned dates and times and should have been.
28 Pa. Code 211.12(d)(1)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395652
If continuation sheet
Page 8 of 18
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
395652
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/16/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ridgeview Healthcare and Rehabilitation Center
30 Fourth Avenue
Curwensville, PA 16833
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 0689
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to
prevent accidents.
Based on clinical record reviews, observations, and staff interviews, it was determined that the facility failed
to ensure that a resident had effective interventions in place for fall prevention for one of 42 residents
reviewed (Resident 18), failed to safely transfer one of 42 residents reviewed (Resident 20) who required
assistance from staff for transfers, and failed to complete safety assessments for one of 42 residents
reviewed (Resident 37) who used an air mattress.
Findings include:
The facility's policy regarding falls, dated November 1, 2022, indicated that the staff will identify
interventions related to the resident's specific risks and causes to try to prevent the resident from falling and
to try to minimize complications from falling.
A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and
care needs) for Resident 18, dated October 31, 2023, revealed that the resident was cognitively intact,
required assistance from staff for daily care needs, and had diagnoses that included high blood pressure. A
fall care plan, dated October 28, 2023, revealed that the resident's bed was to be in the lowest position.
A nursing note for Resident 18, dated October 28, 2023, revealed that the resident had a fall out of bed and
the new intervention was for the resident to have bed in lowest position.
Observations on November 15, 2023, at 9:18 a.m. and at 12:50 p.m. revealed that Resident 18's bed was
not in the lowest position.
Interview with Nurse Aide 2 on November 15, 2023, at 12:50 p.m. confirmed that Resident 18's bed was not
in the lowest position.
Interview with the Director of Nursing on November 15, 2023, at 1:03 p.m. confirmed that Resident 18 was
care planned for the bed to be in the lowest position to prevent falls and the bed should have been in the
lowest position.
An annual MDS assessment for Resident 20, dated September 8, 2023, indicated that the resident was
cognitively intact, required extensive assistance for personal care needs, and had diagnoses that included
Multiple Sclerosis (disease that impacts the brain and spinal cord).
Physician's orders for Resident 20, dated November 7, 2023, included an order for the resident to be
transferred using a Hoyer lift (allows a person to be lifted and transferred with a minimum of physical effort)
with assist of two staff.
A care plan for Resident 20, dated January 6, 2020, indicated that the resident had a self-care deficit. An
intervention, dated November 6, 2023, revealed that the resident was to be transferred using a Hoyer lift
and the assistance of two staff.
A review of nurse aide documentation for November 2023 indicated that on November 8, 9, 10, 12, and 13
Resident 20 was transferred from a wheelchair to the toilet and the wheelchair to a bed using a
stand-and-pivot transfer. Documentation included the resident tolerated the transfer poorly.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395652
If continuation sheet
Page 9 of 18
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
395652
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/16/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ridgeview Healthcare and Rehabilitation Center
30 Fourth Avenue
Curwensville, PA 16833
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 0689
Level of Harm - Minimal harm
or potential for actual harm
Observations of Resident 20 on November 13, 2023, at 12:02 p.m. and November 15, 2023, at 12:15 p.m.
revealed that the resident sitting in her wheelchair beside her bed in her room.
An interview with Resident 20 on November 15, 2023, at 12:15 p.m. confirmed that staff were not using a
Hoyer lift for any transfers with the resident.
Residents Affected - Some
Interview with the Director of Nursing on November 15, 2023, at 2:09 p.m. at 4:47 p.m. confirmed that there
was no documented evidence that Resident 20 was being transferred using a Hoyer lift as ordered on the
dates identified and she should have been.
The facility's policy regarding guidelines for support surfaces, dated November 1, 2022, indicated that staff
were to provide assessment of appropriate pressure-reducing and relieving devices for residents at risk for
skin breakdown. Elements of support surfaces that were critical to pressure ulcer prevention and general
safety include pressure redistribution, moisture control, shear reduction heat dissipation, temperature
control, friction control, flammability, and life expectancy.
A quarterly MDS assessment for Resident 37, dated October 12, 2023, revealed that the resident was
severely cognitively impaired, was dependent on staff for all care areas, and had a Stage 3 pressure ulcer.
A fall care plan for Resident 37, dated November 5, 2019, indicated she was to have an alternating air
mattress with bolsters as a fall prevention. Physician's orders for Resident 37, dated January 26, 2023, and
discontinued July 2, 2023, included an order for an alternating air mattress. Current physician's orders for
Resident 37, dated July 2, 2023, included an order for an alternating air mattress with bolsters.
A nursing note for Resident 37, dated July 1, 2023, revealed that the resident was found lying on the floor
with a bruised to the right eye. Staff attempted to examine her pupils, but the resident closed her eyes
tightly and was very rigid. An orbital x-ray would be obtained in the morning.
A nursing note for Resident 37, dated July 1, 2023, revealed that there was a possible non-displace fracture
of the nasal bone. A new order was received to replace the mattress with a perimeter mattress.
Observations on November 13, 2023, at 12:36 p.m. revealed that Resident 37 was lying in bed. The air
mattress had bolsters, with the head of bed elevated. Observations on November 16, 2023, at 9:47 a.m.
revealed that Resident 37 was lying in bed flat. The air mattress had bolsters in place.
There was no documented evidence that Resident 37 was provided air mattress safety assessments.
Interview with the Director of Nursing on November 16, 2023, at 10:51 a.m. confirmed that air mattress
assessments should have been completed for Resident 37, who fell out of bed and fractured her nose.
28 Pa. Code 211.12(d)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395652
If continuation sheet
Page 10 of 18
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
395652
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/16/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ridgeview Healthcare and Rehabilitation Center
30 Fourth Avenue
Curwensville, PA 16833
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 0694
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
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, as well as staff interviews, it was determined that the facility failed to ensure that
a peripherally-inserted central catheter (PICC - a long, thin tube that is inserted through a vein in the arm
and passed through to the larger veins near the heart) was flushed as ordered by the physician for one of
42 residents reviewed (Resident 76).
Residents Affected - Few
Findings include:
admission records for Resident 76 revealed that she was admitted on [DATE], was cognitively intact, and
had diagnoses that included chronic respiratory failure and bacteremia (presence of bacteria in the
bloodstream).
Physician's orders for Resident 76, dated November 3, 2022, included an order for the resident's PICC line
to be flushed with 10 cubic centimeters (cc) of normal saline solution (NSS) every shift to maintain patency.
Review of the November 2023 Medication Administration Record (MAR) for Resident 76 revealed no
documented evidence that the resident's PICC line was flushed as ordered on November 6 on evening
shift; November 7 on day shift; November 9 on evening and night shift; on November 11, 13, and 14 on
night shift; and on November 15 on day shift.
An interview with the Nursing Home Administrator on November 16, 2023, at 2:29 p.m. confirmed that there
was no documented evidence that Resident 76's PICC line was flushed as ordered on the
above-mentioned dates and times and that it should have been.
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395652
If continuation sheet
Page 11 of 18
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
395652
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/16/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ridgeview Healthcare and Rehabilitation Center
30 Fourth Avenue
Curwensville, PA 16833
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 0755
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a
licensed pharmacist.
Based on review of policies and clinical records, as well as staff interviews, it was determined that the
facility failed to maintain accountability for controlled medications (drugs with the potential to be abused) for
one of 42 residents reviewed (Resident 325).
Findings include:
The facility's policy regarding the administration of oral medications, dated November 1, 2022, indicated
that the nurse will document on the Medication Administration Record (MAR) with their initials, at the
appropriate date and time for the medication administered, after witnessing the ingestion of the medication.
A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and
care needs) for Resident 325, dated August 3, 2022, revealed that the resident was cognitively intact,
required assistance from staff for daily care needs, and had diagnoses that included a Stage 3 pressure
ulcer and acute myeloblastic leukemia in remission.
Physician's orders for Resident 325, dated July 23, 2023, included an order for the resident to receive 5
milligrams (mg) of Oxycodone (a controlled pain medication) every six hours as needed for moderate pain
and 10 mg of Oxycodone every six hours as needed for severe pain.
A review of the controlled drug record (a form that accounts for each tablet/pill/dose of a controlled drug) for
Resident 325, dated August 30, 2023; October 12, 2023; October 25, 2023; and October 27, 2023,
indicated that one 5 mg tablet of Oxycodone was signed-out for administration to the resident. However, the
resident's clinical record, including the MAR and nursing notes, contained no documented evidence that the
signed-out tablet of Oxycodone was administered to the resident on these dates.
An interview with the Director of Nursing on November 16, 2023, at 1:05 p.m. confirmed that there was no
documented evidence that staff administered the controlled drugs to Resident 325 on the dates mentioned
above.
28 Pa. Code 211.9(h) Pharmacy services.
28 Pa. Code 211.12(d)(1)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395652
If continuation sheet
Page 12 of 18
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
395652
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/16/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ridgeview Healthcare and Rehabilitation Center
30 Fourth Avenue
Curwensville, PA 16833
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 0760
Ensure that residents are free from significant medication errors.
Level of Harm - Minimal harm
or potential for actual harm
Based on review of clinical records and staff interviews, it was determined that the facility failed to ensure
that it was free from significant medication errors for one of 42 residents reviewed (Resident 51).
Residents Affected - Some
Findings include:
A quarterly Minimum Data Set (MDS) assessment (mandated to assess the resident's abilities and care
needs) for Resident 51, dated August 30, 2023, indicated that he was cognitively impaired, was dependent
on staff for personal care needs, and had diagnoses that included diabetes (a disease that interferes with
blood sugar control), and received insulin.
Physician's orders for Resident 51, dated July 3, 2023, included an order for the resident to receive 2 units
of insulin aspart (fast acting) insulin if his blood sugar was between 111 milligrams per deciliter (mg/dL) and
149 mg/dl; 3 units of insulin aspart insulin if his blood sugar was between 150 mg/dL and 199 mg/dL; 4
units of insulin aspart insulin if his blood sugar was between 200 mg/dL and 249 mg/dL; 8 units of insulin
aspart insulin if his blood sugar was between 250 mg/dL and 299 mg/dL; 10 units of insulin aspart insulin if
his blood sugar was between 300 mg/dL and 349 mg/dL; and 12 units of insulin aspart insulin if his blood
sugar was between 350 mg/dL and 399 mg/dL. Insulin was to be given after the resident consumed his
meal and only half the dose administered insulin if the resident consumed zero percent to 25 percent of his
meal.
A review of the Medication Administration Records (MAR's) for Resident 5, dated September and October
2023, revealed that on September 11 at 5:30 p.m. the resident's blood sugar was 170 mg/dl, he consumed
15 percent of his meal and was administered 2 units of insulin aspart; on September 16 at 12:30 p.m. the
resident's blood sugar was 129, he consumed 25 percent of his meal and was not administered any insulin
aspart; on September 17 at 9:00 a.m. the resident's blood sugar was 194, he consumed zero percent of his
meal and was not administered any insulin aspart; on September 19 at 5:30 p.m. the resident's blood sugar
was 348 mg/dl, he consumed 25 percent of his meal and was administered 8 units of insulin aspart; on
September 20 at 5:30 p.m. the resident's blood sugar was 396 mg/dl, he consumed 25 percent of his meal
and was administered 12 units of insulin aspart; on September 21 at 5:30 p.m. the resident's blood sugar
was 279 mg/dl, he consumed 25 percent of his meal and was administered 8 units of insulin aspart; on
October 14 at 8:30 a.m. the resident's blood sugar was 163, his percentage of the meal consumed was not
documented and he was not administered any insulin aspart. There was no documented evidence that half
of the ordered dose of insulin was administered when the resident consumed zero to 25 percent of his meal
as ordered by the physician on these dates and times.
Interview with the Assistant Director of Nursing on November 16, 2023, at 11:02 p.m. confirmed that insulin
aspart was not administered to Resident 51 as ordered by the physician on the above-mentioned dates and
times and it should have been.
28 Pa. Code 211.12(d)(1)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395652
If continuation sheet
Page 13 of 18
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
395652
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/16/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ridgeview Healthcare and Rehabilitation Center
30 Fourth Avenue
Curwensville, PA 16833
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 0761
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted
professional principles; and all drugs and biologicals must be stored in locked compartments, separately
locked, compartments for controlled drugs.
Based on review of manufacturer's instructions, facility policies, and clinical records, as well as
observations and staff interviews, it was determined that the facility failed to label multi-dose containers of
insulin with the date they were opened in two of three medication carts reviewed (Walnut Medication Cart
on East Wing and Maple Medication Cart on [NAME] Wing).
Findings include:
Manufacturer's directions for the use of Levemir insulin (a long-acting insulin used to lower blood sugar
levels), dated December 2022, revealed that unused Levemir should be stored in a refrigerator between 36
degrees Fahrenheit (F) to 46 degrees F. After initial use it may be kept at temperatures below 86 degrees F
for up to 42 days.
Manufacturer's directions for the use of Lantus insulin (a long-acting insulin used to lower blood sugar
levels), dated December 2020, revealed that unused Lantus should be stored in a refrigerator between 36
degrees F to 46 degrees F. After initial use it may be kept at temperatures below 86 degrees F for up to 28
days.
Manufacturer's directions for the use of Humalog/Lispro insulin (a fast-acting insulin used to lower blood
sugar levels), dated July 2023, revealed that unused Humalog/Lispro should be stored in a refrigerator
between 36 degrees F to 46 degrees F. After initial use it may be kept at temperatures below 86 degrees F
for up to 28 days. Throw away all opened vials after 28 days of use, even if there is insulin left in the vial.
The facility's policy regarding medication labeling and storage, dated November 1, 2022, revealed that
multi-dose vials that have been opened or accessed were to be dated and discarded within 28 days unless
the manufacturer specifies a shorter or longer date for the open vial.
Physician's orders for Resident 54, dated May 30, 2023, included an order for the resident to receive 10
units of Levemir insulin every evening.
Physician's orders for Resident 57, dated September 21, 2022, included an order for the resident to receive
Humalog/Lispro insulin as per a sliding scale (the amount of insulin given is determined by the blood sugar
level) before meals and at bedtime.
Physician's orders for Resident 57, dated March 2, 2023, included an order for the resident to receive 10
units of Humalog/Lispro insulin two times a day with breakfast and lunch and 15 units one time a day in the
afternoon with supper.
Physician's orders for Resident 325, dated November 3, 2023, included an order for the resident to receive
15 units of Lantus one time a day in the evening.
Observations of the Walnut medication cart on the East Wing on November 14, 2023, at 9:22 a.m. revealed
a vial of Levemir insulin for Resident 54 that was opened and dated September 23, 2023.
Observations of the Maple Medication cart on the [NAME] Wing on November 14, 2023, at 10:05 a.m.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395652
If continuation sheet
Page 14 of 18
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
395652
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/16/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ridgeview Healthcare and Rehabilitation Center
30 Fourth Avenue
Curwensville, PA 16833
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 0761
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
revealed a Humalog/Lispro Kwik pen for Resident 57 and a Lantus vial for Resident 325 that were opened
and not dated.
Interview with Licensed Practical Nurse 3 for the Walnut medication cart at the time of observation
confirmed that the opened vial of Levemir insulin for Resident 54 was dated September 23, 2023, and
should have been discarded after 42 days per manufacturer's instructions.
Interview with Licensed Practical Nurse 4 for the Maple medication cart at the time of observation
confirmed that the opened Humalog/Lispro insulin Kwik pen for Resident 57 was not dated and should have
been and confirmed that the opened vial of Lantus insulin for resident 325 was not dated and should have
been.
Interview with the Nursing Home Administrator on November 16, 2023 at 10:10 a.m. confirmed that the
opened Levemir insulin, dated September 23, 2023, should have been discarded and it was not, and that
the opened Humalog/Lispro Kwik pen and opened Lantus insulin should have been dated and they were
not.
28 Pa. Code 211.12(d)(1) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395652
If continuation sheet
Page 15 of 18
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
395652
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/16/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ridgeview Healthcare and Rehabilitation Center
30 Fourth Avenue
Curwensville, PA 16833
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 0812
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on review of facility policies, as well as observations and staff interviews, it was determined that the
facility failed to store and prepare food in accordance with professional standards for food service safety by
not dating opened food items and not storing food under sanitary conditions.
Findings include:
The facility's policy regarding food labeling and dating, dated November 1, 2022, revealed that all foods
stored in the refrigerator or freezer will be covered, labeled and dated (use by date).
Observations in the walk-in freezer on November 13, 2023, at 9:55 a.m. revealed that a portion of frozen
ham was dated March 39, 2023, and a bag of frozen cheese was opened and exposed to air and not
sealed. The cheese had ice crystals throughout the portion of frozen cheese.
Interview with the Dietary Manager at the time of observation confirmed that the frozen ham was dated for
the time it was frozen and did not have a use by date and it should have. She also confirmed that the bag of
cheese should have been sealed and not open to air.
28 Pa. Code 211.6(f) Dietary services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395652
If continuation sheet
Page 16 of 18
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
395652
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/16/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ridgeview Healthcare and Rehabilitation Center
30 Fourth Avenue
Curwensville, PA 16833
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 0867
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop
corrective plans of action.
Based on review of the facility's plans of correction for previous surveys, and the results of the current
survey, it was determined that the facility's Quality Assurance Performance Improvement (QAPI) committee
failed to correct quality deficiencies and ensure that plans to improve the delivery of care and services
effectively addressed recurring deficiencies.
Findings include:
The facility's deficiencies and plans of correction for a State Survey and Certification (Department of
Health) survey ending November 10, 2022, revealed that the facility developed plans of correction that
included quality assurance systems to ensure that the facility maintained compliance with cited nursing
home regulations. The results of the current survey, ending November 16, 2023, identified repeated
deficiencies related to accuracy of Minimum Data Sets (MDS), creating and implementing care plans,
quality of care, pharmacy services, food procurement/storage/preparation.
The facility's plan of correction for a deficiency regarding completing accurate MDS assessments, cited
during the survey ending November 10, 2022, revealed that the facility would complete audits and report
the results of the audits to the QAPI committee for review. The results of the current survey, cited under
F641, revealed that the facility's QAPI committee failed to successfully implement their plan to ensure
ongoing compliance with regulations regarding accurate MDS assessments.
The facility's plan of correction for a deficiency regarding developing and implementing care plans, cited
during the survey ending November 10, 2022, revealed that the facility would complete audits and report
the results of the audits to the QAPI committee for review. The results of the current survey, cited under
F656, revealed that the facility's QAPI committee failed to successfully implement their plan to ensure
ongoing compliance with regulations regarding developing and implementing care plans.
The facility's plan of correction for a deficiency regarding quality of care, cited during the survey ending
November 10, 2022, revealed that the facility would complete audits and report the results of the audits to
the QAPI committee for review. The results of the current survey, cited under F684, revealed that the
facility's QAPI committee failed to successfully implement their plan to ensure ongoing compliance with
regulations regarding quality of care.
The facility's plan of correction for a deficiency regarding pharmacy services, cited during the survey ending
November 10, 2022, revealed that the facility would complete audits and report the results of the audits to
the QAPI committee for review. The results of the current survey, cited under F755, revealed that the
facility's QAPI committee failed to successfully implement their plan to ensure ongoing compliance with
regulations regarding pharmacy services.
The facility's plan of correction for a deficiency regarding food procurement/storage/preparation, cited
during the survey ending November 10, 2022, revealed that the facility would complete audits and report
the results of the audits to the QAPI committee for review. The results of the current survey, cited under
F812, revealed that the facility's QAPI committee failed to successfully implement their plan to ensure
ongoing compliance with regulations regarding food procurement/storage/preparation.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395652
If continuation sheet
Page 17 of 18
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
395652
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/16/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ridgeview Healthcare and Rehabilitation Center
30 Fourth Avenue
Curwensville, PA 16833
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 0867
Refer to F641, F656, F684, F755, F812.
Level of Harm - Minimal harm
or potential for actual harm
28 Pa. Code 201.14(a) Responsibility of licensee.
28 Pa. Code 201.18(e)(1) Management.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395652
If continuation sheet
Page 18 of 18
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Back to topCitations
12 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.
F625 - Transfer and discharge-
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
F641 - Accuracy of Assessments
Ensure each resident receives an accurate assessment.
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
F658 - Comprehensive Care Plans
Ensure services provided by the nursing facility meet professional standards of quality.
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
F694 - Parenteral Fluids
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
F755 - Pharmacy Services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
F760 - Residents are free of any significant medication errors
Ensure that residents are free from significant medication errors.
F761 - Labeling of Drugs and Biologicals
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F867 - Program feedback, data systems and monitoring
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
FAQ · About this visit
Common questions about this visit
What happened during the November 16, 2023 survey of RIDGEVIEW HEALTHCARE AND REHABILITATION CENTER?
This was a inspection survey of RIDGEVIEW HEALTHCARE AND REHABILITATION CENTER on November 16, 2023. The surveyor cited 12 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at RIDGEVIEW HEALTHCARE AND REHABILITATION CENTER on November 16, 2023?
Yes, 12 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed i..."
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.