Inspection·July 31, 2025

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on review of the Resident Assessment Instrument User's Manual and residents' clinical records, as well as staff interviews, it was determined that the facility failed to complete accurate Minimum Data Set assessments for three of 28 residents reviewed (Residents 3, 38, 52). Findings include:The Resident Assessment Instrument (RAI) User's Manual, which gives instructions for completing Minimum Data Set (MDS) assessments (mandated assessments of a resident's abilities and care needs), dated October 2024, revealed that Section N0415F1 (antibiotic medication) was to be checked if the resident received an antibiotic medication during the seven-day assessment period and Section N0415K1 was to be checked if the resident received an anticonvulsant medication during the seven-day assessment period.Physician's orders for Resident 3 dated May 1, 2025, included an order for the resident to receive 300 milligrams (mg) of Gabapentin two times a day for diabetic neuropathy (nerve damage that can cause pain, numbness, tingling, and weakness in the hands and feet, and sometimes other parts of the body). The resident's Medication Administration Record (MAR) for May 2025 revealed that the resident received Gabapentin twice a day from May 1 through 28, 2025.A quarterly MDS assessment for Resident 3, dated May 24, 2025, revealed that Section N0415K1 was not checked, indicating that the resident did not receive any anticonvulsant medications during the seven days of the assessment period. Physician's orders for Resident 38 dated March 18, 2024, included an order for the resident to receive 100 mg of Pregabalin three times a day for neuropathy. The resident's Medication Administration Record (MAR) for May 2025 revealed that the resident received Pregabalin three times a day from May 1 through 31, 2025.A quarterly MDS assessment for Resident 38, dated May 9, 2025, revealed that Section N0415K1 was not checked, indicating that the resident did not receive any anticonvulsant medications during the seven days of the assessment period. Physician's orders for Resident 53 dated May 1, 2025, included an order for the resident to have 1% Silvadene External Cream (antibiotic) applied to the sacrum gluteal fold (horizontal crease or fold located at the base of the buttocks) every day and evening shift for wounds. The resident's Treatment Administration Records (TAR's) for May 2025 revealed that the resident received Silvadene External Cream every day and evening from May 2 through 10, 2025.A quarterly MDS assessment for Resident 53, dated May 9, 2025, revealed that Section N0415F1 was not checked, indicating that the resident did not receive any antibiotic medications during the seven days of the assessment period. An interview with the Director of Nursing on July 30, 2025, at 2:59 p.m. confirmed that assessments for Residents 3, 38, and 53 were coded incorrectly.28 Pa. Code 211.5(f) Medical records. 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 7 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 07/31/2025 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)