Inspection·July 2, 2025

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy, clinical records and facility investigative documents, as well as staff interviews, it was determined that the facility failed to ensure that residents were free from misappropriation of medications for one of five residents reviewed (Resident 3).Findings include:The facility's policy regarding controlled narcotics dated April 7, 2025, indicated that the facility complies with all laws, regulations, and other requirements related to handling, storage, disposal, and documentation of controlled medications (listed as Schedule II-V of the comprehensive drug abuse prevention and control act of 1976). Misappropriation was defined as the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident's belongings or money without the resident's consent example drug diversion (taking the residents medication).A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 3, dated May 29, 2025, revealed that the resident was cognitively intact, required assistance from staff for daily care needs, and had medical diagnoses that included peripheral vascular disease (affects blood circulation to lower legs).Physician's orders for Resident 3, dated March 27, 2025, included orders for the resident to receive 30 milligrams of Morphine (a controlled narcotic used for pain) every twelve hours for pain.The controlled drug record for Resident 3 for April 2025 indicated that three doses of Morphine were signed out on April 28, 2025 at 7:00 a.m.An investigation report, dated May 6, 2025, revealed that Resident 3's medication packet containing Morphine was missing three 30 mg doses and that Licensed Practical Nurse 1 misappropriated the Morphine tablets and had replaced them with other pills.Interview with the Director of Nursing on July 2, 2025, at 4:14 p.m. confirmed that Resident 3's Morphine was taken by Licensed Practical Nurse 1. She indicated that the police were notified and Licensed Practical Nurse 1 was referred to the Pennsylvania Department of State.28 Pa. Code 201.14(a) Responsibility of License.28 Pa. Code 201.18(b)(1)(e)(1) Management.28 Pa. Code 211.12(d)(3)(5) Nursing Services. Residents Affected - Few 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: 395661 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 395661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Casselman Healthcare and Rehabilitation Center 201 Hospital Drive Meyersdale, PA 15552 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)