Health inspection·August 11, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on a resident group meeting and individual resident and staff interviews, it was determined that the facility failed to provide care in an environment, which promotes each resident's quality of life by failing to respond timely to residents' request for assistance by not responding to call bells for nine of nine residents (Resident R255, R800, R801, R802, R803, R804, R805, R806 and R807) and provide prompt assistance to meet residents care needs for three of five residents who require incontinence care (Residents R28, R33, and R54). Findings included: During the resident group meeting on 8/9/23, from 10:00 a.m., through 10:50 a.m., Residents R800, R801, R802, R803, R804, R805, R807 and R807 indicated that staff do not respond to their call bells timely and they often have to wait for assistance. They stated that staff tell them that they are busy. The residents also stated that they are told that when food trays are on the unit, no call bell will be responded to until all food trays are passed and that they will have to hold it if they need assistance at those times. They were also told that between shifts, staff are busy giving report and they will not receive care then either. Review of the previous resident council meetings within the last three months, on three occasions, residents identified that staff are not providing care timely, responding to care needs timely or not at all. During an observation on 8/9/23, at 11:12 a.m., the call bell illuminated above Resident R255's room, the call bell was not responded to until 11:27 a.m., 15 minutes later. During an interview on 8/8/23, at 11:00 a.m., Resident R28 stated They don't come when you put the call bell on. You have to wait too long and it is not good. During an interview on 8/8/23, at 10:00 a.m., Resident R33 stated I never get to the bathroom on time. It is terrible how long you have to wait to get help. During an interview on 8/8/23, at 11:30 a.m., Resident R54's family member FM1 stated Call bells are not answered timely and it takes way too long for someone to come and help when Resident R54 needs to go to the bathroom. During an interview on 8/9/2, at 11:27 a.m., Nurse Aide Employee E8 confirmed that the call bell should have been responded to before that long and confirmed that the facility failed to respond to resident needs promptly. Page 1 of 14 395674 395674 08/11/2023 Uniontown Nursing and Rehab 129 Franklin Avenue Uniontown, PA 15401

F 0550 Level of Harm - Minimal harm or potential for actual harm During an interview on 8/11/23 at 3:00 p.m., the Nursing Home Administrator confirmed the above findings and that the facility failed to respond to call bells timely and provide prompt assistance to meet residents care needs for residents R255, R800, R801, R802, R803, R804, R805, R806 and R807 and provide prompt assistance to meet residents care needs for residents who require incontinence care for residents R28, R33, and R54. Residents Affected - Some 28 Pa. Code: 211.10(a)(b)(c)(d) Resident care policies. 28 Pa. Code: 211.12(d)(1)(2)(3)(5) Nursing services. 395674 Page 2 of 14 395674 08/11/2023 Uniontown Nursing and Rehab 129 Franklin Avenue Uniontown, PA 15401

F 0565 Honor the resident's right to organize and participate in resident/family groups in the facility. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy, resident council meeting minutes, resident group and staff interview, it was determined that the facility failed to demonstrate their response to resident concern and grievances identified during Resident Council Meeting for six of six meetings (5/25/23, 6/12/23, 6/26/23, 7/10/23, 7/24/23 and 8/9/23). Residents Affected - Some Findings include: Review of facility policy Grievance Policy,, last reviewed on 9/14/22, indicated the facility will make certain prompt resolution to all grievances within five working days and implement a resolution. A review of the facility Resident Council Meeting minutes for 6/12/23, 7/10/23 and 7/24/23, revealed concerns the residents voiced in reference to the staff not responding to call bells, especially during meals and between shift changes and had been told that trays have to be passed an they have to wait or it is shift change and they have to wait for next shift staff as they are receiving report. A review of the facility Resident Council Meeting minutes for 6/12/23, 6/26/23, 7/10/23 and 7/24/23, revealed concerns the residents voiced in reference to dietary issues with condiments, soups, breakfast items, pizza and fries/potato wedges. During a group interview on 8/9/23, from 10:00 a.m. through 10:50 a.m., eight of eight residents in the group confirmed that staff stated that when trays are being passed, toileting and care will not happen until all trays are passed. Staff told residents that they will not provide care at the end of their shift as they are busy and have to give report to he next shift. Residents stated that the facility has not responded to the residents asking for condiments on trays, knives on trays, more menu options, and actual menus being provided so they know what is available. The residents indicated that they are served whatever is offered and do not have choices offered until after they get what is served and often have to wait for something different and at times never get heir alternative. The residents indicated that residents have quit coming to council because nothing gets done about their grievances anyway. The facility doesn't do anything. During an interview on 8/10/23, at 12:40 p.m., the Nursing Home Administrator could not provide any documentation to demonstrate that there was a response to the resident concerns. 28 Pa. Code: 201.29 (1) Resident Rights. 28 Pa. Code: 211.12 (d)(3) Nursing Services. 395674 Page 3 of 14 395674 08/11/2023 Uniontown Nursing and Rehab 129 Franklin Avenue Uniontown, PA 15401

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy and clinical records and staff interview, it was determined that the facility failed to provide the opportunity to formulate an advance directive (a written instruction such as a living will or durable power of attorney for health care for when the individual is incapacitated) for three of eight residents reviewed (Residents R23, R102 and R255). Findings include: A review of the facility policy Advanced Directive last reviewed 9/14/22, indicated if the resident indicates that he or she has not established advance directives, the facility staff will offer assistance in establishing advance directives. A review of the medical record indicated Resident R23 was admitted to the facility on [DATE], with diagnoses that included diabetes, depression, and high blood pressure. A review of the clinical record failed to reveal an advanced directive or documentation that Resident R23 was given the opportunity to formulate an Advanced Directive. A review of the clinical record indicated Resident R102 was admitted to the facility on [DATE], with diagnoses that included cancer, difficulty swallowing, and muscle weakness. A review of the clinical record failed to reveal an advanced directive or documentation that Resident R102 was given the opportunity to formulate an Advanced Directive. A review of the clinical record indicated Resident R255 was admitted to the facility on [DATE], with diagnoses that included difficulty walking, high blood pressure, and shortness of breath. A review of the clinical record failed to reveal an advance directive or documentation that Resident R255 was given the opportunity to formulate an Advance Directive. During an interview on 8/10/23, at 11:20 a.m. Social Worker Employee E6 confirmed that the clinical record did not include documentation that Resident R23, R102, and R255 were afforded the opportunity to formulate Advanced Directives. 28 Pa. Code: 201.29(b)(d)(j) Resident rights. 395674 Page 4 of 14 395674 08/11/2023 Uniontown Nursing and Rehab 129 Franklin Avenue Uniontown, PA 15401

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. Based on the facility policy, review of resident council minutes from May through July 2023, group and staff interview, it was determined that the facility failed to provide the right to file grievances anonymously and failed to provide the name of the Grievance Official for residents to file a grievance orally (meaning spoken) for eight of 109 residents at the facility (R800, R801, R802, R803, R804, R805, R806 and R807). Review of the faciliy policy Grievances last reviewed on 9/14/22, indicated that the Nursing Home Administrator is the Grievance Officer, all residents have a right to voice grievances to the facility, the Grievance Officer oversees the process with receiving and tracking grievances to conclusions. Grievance forms are available near the locked boxes. Findings include: Review of the resident council minutes from May 2023 through July 2023, which included six meetings as they are held twice per month, did not include review of the grievance process, where grievance boxes and forms are located and who the Grievance Officer is. During the Resident Council meeting on 8/10/23, from 10:00 a.m. thorough 10:50 a.m., eight of eight residents did not indicate knowing who the Grievance Officer was, how to file a grievance anonymously, where to locate and boxes. During an interview on 8/10/23, at 12:40 p.m., the Nursing Home Administrator could not provide any documentation to demonstrate that the the facility provided information to the residents of the grievance process, identity of the Grievance Officer and location of the grievance boxes and forms to allow opportunities to file an anonymous grievance. 28 Pa. Code: 201.29(l) Resident rights. 395674 Page 5 of 14 395674 08/11/2023 Uniontown Nursing and Rehab 129 Franklin Avenue Uniontown, PA 15401

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policies, clinical record review and staff interview, it was determined that the facility failed to assess and implement interventions to promote bowel and bladder continence for five of seven residents reviewed for incontinence (Residents R28, R33, R54, R57 and R93). Findings include: A review of the facility policy Bowel and Bladder Management-Continence and Incontinence Assessment and Management dated 9/14/22, indicated the staff and practitioner will screen and manage individuals with incontinence and staff will document the results of toileting in the resident's medical record. Review of Resident R28's clinical record indicated the resident was admitted to the facility on [DATE], with diagnoses that included kidney disease, diabetes, and difficulty walking. A review of the MDS (Minimum data set-resident assessment and care screening) dated 7/20/23, indicated Resident R28 was alert an oriented, incontinent of urine and had a prompted toileting schedule. During an interview on 8/8/23 at 10:00 a.m. Resident R28 stated I have to wait too long when I put my call bell on to go to the bathroom and it's not good. Sometimes they do not come. Review of Resident R28's physician order dated 7/10/23, indicated prompted toileting program for bowel and bladder. Review of Resident R28's care plan revised 7/21/23, indicated prompted toileting program for bowel and bladder after meals, upon rising, and at bedtime. Review of the task prompted toileting program for bladder: after meals, upon arising and at bedtime. indicated Resident R28 was not toileted as ordered on 7/14, 7/22, 7/25, 7/28, 8/2, 8/5, and 8/9/23. Review of the task prompted toileting program for bowel: after meals, upon rising and at bedtime. Indicated Resident R28 was not toileted as ordered on 7/14, 7/21, 7/25, 7/28, 7/31, 8/2, 8/5, and 8/8/23. Review of Resident R33's clinical record indicated the resident was admitted to the facility on [DATE], with diagnoses that included stroke, paralysis on the left side, and overactive bladder. A review of the MDS dated [DATE], indicated Resident R33 was able to make needs known, frequently incontinent of urine and had a prompted toileting schedule. During an interview on 8/8/23 at 11:00 a.m., Resident R33 stated They don't come to take me to the bathroom. You put the bell on, and it takes an hour for someone to come. Review of Resident R33's physician order dated 7/8/23, indicated prompted toileting program for bowel and bladder. Review of Resident R33's care plan initiated 3/20/23, indicated assist with toileting upon request 395674 Page 6 of 14 395674 08/11/2023 Uniontown Nursing and Rehab 129 Franklin Avenue Uniontown, PA 15401

F 0690 and every two hours. Level of Harm - Minimal harm or potential for actual harm Review of the task prompted toileting program for bladder: assist with toileting upon request and every two hours indicated Resident R33 was not toileted as ordered on 7/13, 7/15, 7/16, 7/20, 7/26, 7/29, 7/30, 7/31, 8/4, and 8/9/23. Residents Affected - Some Review of the task prompted toileting program for bowel: upon request and every two hours. Indicated Resident R33 was not toileted as ordered on 7/15, 7/16, 7/20, 7/21, 7/26, 7/29, 7/30, 7/31, 8/4, and 8/9/23. Review of Resident R54's clinical record indicated the resident was admitted to the facility on [DATE], with diagnoses that included heart failure, diabetes, and kidney disease. A review of the MDS dated [DATE], indicated Resident R54 was able to make needs known, frequently incontinent of bowel and had a prompted toileting schedule. During an interview on 8/8/23 at 11:30 a.m., Resident family member RF1 stated Call bells are not answered timely, there are long waits for anyone to come. Resident R54 is not toileted timely. Review of Resident R54's physician order initiated 8/1/22 and active 7/1/23, indicated prompted toileting program for bowel and bladder. Review of Resident R54's care plan revised 1/17/23, indicated assist with toileting upon rising in AM, after meals, activities, therapy, an at bedtime. Review of the task prompted toileting program for bladder: offer toileting during all rounds, before and after meals, upon rising and at bedtime indicated Resident R54 was not toileted as ordered on 7/13, 7/14, 7/21, 7/28, 7/30, 8/2, 8/5, and 8/8/23. Review of the task prompted toileting program for bowel: offer toileting during all rounds, before and after meals, upon rising and at bedtime indicated Resident R54 was not toileted as ordered on 7/13, 7/14, 7/21, 7/28, 7/30, 8/2, 8/5, and 8/8/23. Review of Resident R57's clinical record indicated the resident was admitted to the facility on [DATE], with diagnoses that included kidney disease, diabetes, and difficulty walking. MDS dated [DATE], indicated Resident R57 was alert with some confusion, incontinent of urine and had a prompted toileting schedule. Review of Resident R57's care plan revised on 7/21/23, indicated assist with toileting upon request: before and after breakfast lunch and supper and at bedtime and on first and second rounds on 11-7 shift and early in a.m. Review of the task prompted toileting program for bladder and bowel: toilet upon request: before and after meals and bedtime on 7-3 and 3-11 shifts and on first and second rounds on 11-7 shift and in early a.m. indicated that Resident R57 was not toileted as care planned on any date from 7/12/23, through 8/10/23. During the resident council meeting, Resident R93 had attended and indicated that she is not toileted as per her care plan and that she has prompted grievances several times with no change with care from staff. She indicated that she had been left soiled and told she'd have t hold it until trays 395674 Page 7 of 14 395674 08/11/2023 Uniontown Nursing and Rehab 129 Franklin Avenue Uniontown, PA 15401

F 0690 were passed or because it was between shifts and hey were too busy. Level of Harm - Minimal harm or potential for actual harm Review of the facility Grievance Log dated from 3/23 through 7/23, indicated three separate occasions when Senior Life staff, resident council and resident herself had reported toileting as an issue with no documented indication of resolution. Residents Affected - Some Review of the clinical record indicated that Resident R93 was admitted to the facility on [DATE], with diagnoses which included heart failure, high blood pressure, history of lung blood clots and falls. An MDS dated [DATE], indicated the diagnoses remained current. The MDS indicated that Resident R93 was alert and oriented, incontinent and prompted a toileting program. Review of Resident R93's care plan revised on 8/24/22, indicated adjust toileting times to meet the needs of the resident, provide assistance for toileting during all rounds, before and after meals upon arising and at bedtime. Review of the task prompted toileting program: offer toileting during all rounds, before and after meals, upon rising and at bedtime indicated that Resident R93 was not toileted as care planned on any days from 7/12/23, through 8/10/23. During an interview on 8/11/23 at 12:00 p.m., the Nursing Home Administrator (NHA) confirmed the above findings and that the facility failed to assess and implement interventions to promote bowel and bladder continence for Residents R28, R33, R54, R57 and R93. 28 Pa. Code 211.11(d) Resident care plan. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395674 Page 8 of 14 395674 08/11/2023 Uniontown Nursing and Rehab 129 Franklin Avenue Uniontown, PA 15401

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 facility policy clinical records, and staff interview, it was determined that the facility failed to make certain that residents who require dialysis (hemodialysis-treatment to filter wastes and water from the blood) receive such services, consistent with professional standards of practice for one of three residents receiving dialysis (Resident R20). Residents Affected - Few Findings include: A review of the facility policy Hemodialysis catheters-access and care of dated 9/14/22, indicates that the access site will be checked at regular intervals. A review of the clinical record revealed that Resident R20 was admitted to the facility on [DATE], with diagnoses that included chronic kidney disease. A review of the MDS (minimum data set-resident assessment and care screening) dated 7/12/23, indicated the diagnosis remained current and Resident R20 received dialysis. A review of a physician order dated 7/26/23, indicated dialysis (artificial cleansing of the blood) three times a week. A review of Resident R20's care plan dated 7/31/23, indicated to assess the access site on the left groin every shift and document. During on observation on 8/8/23, at 11:15 a.m. revealed Resident R20 with a dialysis access site to the left groin. During an interview on 8/11/23, at 12:45 p.m. The Nursing home administrator (NHA) revealed there was no evidence in the clinical record that Resident R20's access site was assessed every shift and confirmed that the facility failed to make certain that Resident R20 received required dialysis services related to monitoring the dialysis access site. 28 Pa. Code: 211.12(d)(1)(5) Nursing services. 28 Pa. Code: 211.12(3) Nursing services. 395674 Page 9 of 14 395674 08/11/2023 Uniontown Nursing and Rehab 129 Franklin Avenue Uniontown, PA 15401

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, resident observations, resident resident council interview, a confidential staff interview and staff interviews, it was determined that the facility failed to have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of 33 of 109 residents (Residents R255, R42, R24, R44, R74, R73, R52, R43, R83, R54, R53, R155, R84, R600, R90, R601, R91, R19, R602, R70, R22, R5, R98, R603, R28, R800, R801, R802, R803, R804, R805, R806 and R807). Findings Include: Review of the facility policy Call System, Resident, last reviewed on 9/14/22, indicated that each resident is provided with a means to call staff for assistance and staff answer call lights as soon as possible, no later than five minutes. Review of the facility policy Food and Nutrition Services last reviewed on 9/14/22, indicated that each resident is provided a nourishing, palatable diet that meets the needs and preferences of each resident. If an incorrect meal is served, nursing staff will report this so that a new tray can be served. Meals are scheduled at regular times and nourishing snacks are available to residents 24 hours per day. During an observation on 8/9/23, at 11:12 a.m. the call light illuminated above resident room [ROOM NUMBER], the call light was not responded to until 11:27 a.m., 15 minutes later when Resident R255 requested ice. During an interview on 8/9/23, at 11:13 a.m., Nurse Aide Employee E8 confirmed that the call light was on and should have been responded to sooner. Nurse Aide Employee E8 stated that he had been on break and other staff were not available to respond. During the Resident Council meeting on 8/9/23 from 10:00 a.m., through 10:50 a.m., Residents R800, R801, R802, R803, R804, R805, R806 and R807 indicated that there are not enough staff to provide care between shifts and during tray service causing residents to wait for care and at times soil themselves. The lack of staff does not allow call lights to be responded to timely, also, causing residents to have to wait for services and toileting. Residents trays are late and at times served cold. Residents also stated that they do not receive snacks at night when requested and not provided for diabetics. During an observation on 8/10/23, from 6:30 a.m., through 8:15 a.m., the following was observed: Nurses coming on daylight shift were sitting at the nurses station. The midnight shift nurses were on the medication carts in halls. Housekeeping staff person was running a floor scrubber through the halls. Two staff were running the wheelchair cleaner and drying the wheelchairs in the halls causing water to lay in the hall by the shower room nearest the nurses station. 395674 Page 10 of 14 395674 08/11/2023 Uniontown Nursing and Rehab 129 Franklin Avenue Uniontown, PA 15401

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Food Cart for C wing arrived at 7:15 a.m., Nurse Aide Employee E9 began passing trays, call lights were illuminating, Nurse Aide Employee E9 would stop tray service to answer the call light and take care of the request or pass on what needed to be done, then go and restart tray service. At 7:20 a.m., Infection Control (IC) Nurse Employee E10 came to assist Nurse Aide Employee E9 but was unable to serve trays without Nurse Aide Employee E9 telling her who the resident was and they're specific assistance required to eat. During tray service, Nurse Aide Employee E9 had to call the dietary department three times, for condiments, for pancakes not waffle (per resident request) and for ginger ale(per resident request). The Speech therapist who was assisting a resident had to call the dietary department one time for a resident request. The first request took ten minutes and the IC Nurse Employee E10 to retrieve the request as dietary staff did not bring the request to the staff. The last meal tray was served at 8:15 a.m., an hour later when tray service began. Two residents requiring assistance had family members in the facility assisting them to eat, they indicated that they come in to help. During a staff interview on 8/10/23, at 7:34 a.m., Nurse Aide Employee E500 stated that there are not enough staff to assist tray passing, call bell response and provide care and front line staff do not assist them when call lights are on and trays are needing passed to provide timely care for residents. When asked about residents on toileting programs, Nurse Aide Employee E500 stated that residents are on programs but staff cannot follow the programs due to not enough help. Most nurses will not assist residents and sit at the desk. During an interview on 8/11/23, at 1:18 p.m., the Director of Nursing confirmed that staff are not assisting residents that are on toileting programs as they assessed to require and the facility failed to provide sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being. 28 Pa. Code: 201.14(a) Responsibility of licensee. 28 Pa. Code: 201.18(e)(6) Management. 28 Pa. Code: 211.12(a)(d)(4)(f)(1)(g)(h)(i)(j)(k)(l) Nursing services. 395674 Page 11 of 14 395674 08/11/2023 Uniontown Nursing and Rehab 129 Franklin Avenue Uniontown, PA 15401

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on the resident group meeting, observations and staff interviews, it was determined that the facility did not ensure that menus were provided to residents, resident preferences were followed and did not ensure that all food items listed on the menu were made available according to resident preferences for eight of eight residents( R800, R801, R802, R803, R804, R805, R806 and R807). Findings include: During the resident council meeting on 8/9/23, from 10:00 a.m., through 10:50 a.m., the resident indicated that they are not provided menus and have requested them several times during the previous resident council meetings with no result of receiving them. The residents stated that the facility posts them in the hall but they don't remember their daily choices and if they don't want what they are brought, they have to have staff call and hour before breakfast, if the dietary department answers the phone to get alternate or wait and sometimes do not get anything or another item they don't want because they have no idea what is available. During an interview on 8/9/23, at 11:50 a.m. Director of Dietary Employee E11 confirmed the facility failed to provide residents with menus. 28 Pa. Code: 211.6(a)(b) Dietary services. 395674 Page 12 of 14 395674 08/11/2023 Uniontown Nursing and Rehab 129 Franklin Avenue Uniontown, PA 15401

F 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. Based on review of facility policy and resident and staff interviews, it was determined that the facility failed to routinely offer evening snacks for eight of eight residents (Resident R800, R801, R802, R803, R804, R805 R806 and R807). Findings include: The facility Food and Nutrition Services policy last reviewed on dated 9/14/22, indicated that a snack is any food item given to a resident/patient in additional to three planned meals. Nourishing snacks are available 24 hours a day. The resident may request snacks as desired. During the resident council meeting on 8/9/23, from 10:00 a.m., through 10:50 a.m., the resident consensus indicated that they are not consistently being offered an evening snacks. Residents reported that a concern regarding bedtime (HS) snacks had been identified as a concern a few months ago. Review of previous Resident Council Minutes dated from May 2023, through July 2023, after the current Activity Director started did not include documentation of not receiving snacks. During an interview on 8/9/23, at 11:10 a.m., the Activity Director Employee E12 indicated that she started in April and that she had not put in that concern, but that it may have been reported previous to her starting. During an observation on 8/9/23, at 11:00 a.m., the Director of Dietary Services(DDS) Employee E11 was observed placing items in cabinet in pantry and the DDS Employee E11 stated that they stock the cabinets after lunch every day. During an interview of 8/10/23, 12:11 p.m., the Nursing Home Administrator confirmed that the facility failed to routinely offer evening snacks for eight of eight residents (Residents R800, R801, R802, R803, R804, R805, R806 and R807). 28 Pa. Code: 211.6(b)(c) Dietary services. 395674 Page 13 of 14 395674 08/11/2023 Uniontown Nursing and Rehab 129 Franklin Avenue Uniontown, PA 15401

F 0865 Have a plan that describes the process for conducting QAPI and QAA activities. Level of Harm - Minimal harm or potential for actual harm Based on a review of the facility's policies, plans of corrections 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 make certain that plans to improve the delivery of care and services effectively addressed recurring deficiencies. Residents Affected - Few Findings include: A review of the facility policy QAPI last reviewed on 9/14/22, indicated that the facility program is ongoing to monitor and evaluate the quality and safety of resident care and pursue methods to improve quality care and resolve problems identified. The objectives include establishing and implementing plans to correct deficiencies and to monitor the effects of these action plans on resident outcomes. The facility's deficiencies and plans of correction for State Survey and Certification (Department of Health) survey ending September 30, 2022, revealed that the facility would maintain compliance with cited nursing home regulations. The results of the current survey ending August 11, 2023 identified repeated deficiencies related to failure to demonstrate responses to resident grievances and failure to provide facility failed to make certain that residents who require dialysis (hemodialysis-treatment to filter wastes and water from the blood) receive such services, consistent with professional standards of practice. The facility's plan of correction for a deficiency regarding a failure to respond to grievances from residents, cited during the survey ending on September 30, 2022, revealed that the facility developed a plan of correction that included completing audits and reporting the results of the audits to the QAPI committee for review. The results of the current survey, cited under F585 and F698, revealed that the facility's QAPI committee failed to successfully implement their plan to make certain ongoing compliance with regulations regarding the response to addressing grievances from residents and provide facility failed to make certain that residents who require dialysis (hemodialysis-treatment to filter wastes and water from the blood) receive such services, consistent with professional standards of practice. During an interview on 8/11/23, at 3:30 p.m., the NHA confirmed that the facility failed to develop a corrective action, implement and monitor the action as a good faith effort. Refer to F585 and F698. 28 Pa. Code: 201.14(a) Responsibility of licensee. 28 Pa. Code: 201.18(e)(1) Management. 395674 Page 14 of 14