Health inspection·March 21, 2025

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 review of facility policy, observations, and resident and staff interviews, it was determined that the facility failed to make accessible grievance boxes to residents on three of three locations, nursing units (A and C Wings) and across from the social service department. Findings include: A review of the facility policy Resident and Family Grievances reviewed 1/31/25, support each resident's and family member's right to voice grievances without discrimination, reprisal or fear of discrimination or reprisal. grievance boxes in skilled nursing facilities. However, CMS mandates that grievance procedures be accessible to all residents, including those with disabilities, in compliance with the Americans with Disabilities Act (ADA). In Pennsylvania, the Department of Health incorporates by reference the federal requirements outlined in 42 CFR Part 483, Subpart B, which pertain to long-term care facilities. These regulations emphasize the importance of accessibility but do not provide additional specifications regarding grievance box placement. To ensure accessibility, the ADA Standards for Accessible Design recommend that operable parts, such as slots on grievance boxes, be mounted between 15 and 48 inches above the floor. This range accommodates individuals using wheelchairs and ensures usability for a broad range of residents. During an observation on 3/19/25, at 11:25 a.m., the grievance box were not accessible on nursing units (A and C Wings) and across from the social service department. The grievance boxes had been mounted at approximately 57 inches above the floor, out of the reach of residents in wheelchairs. During rounds on 3/19/25, at 12:40 p.m. the Nursing Home Administrator and surveyor measured the height of the grievance boxes on nursing units (A and C Wings) and across from the social service department and confirmed the grievance boxes had been mounted at approximately 57 inches above the floor, out of the reach of residents in wheelchairs. During an interview on 3/19/25, at 1:00 p.m. the Nursing Home Administrator confirmed the facility failed to make accessible grievance boxes to residents on three of three locations, nursing units (A and C Wings) and across from the social service department. Page 1 of 7 395675 395675 03/21/2025 Waynesburg Nursing and Rehab 300 Center Avenue Waynesburg, PA 15370

F 0585 28 PA Code: 201.18(e)(4) Management. Level of Harm - Minimal harm or potential for actual harm 28 PA Code: 201.29(a)(b)(c) Resident rights. Residents Affected - Some 395675 Page 2 of 7 395675 03/21/2025 Waynesburg Nursing and Rehab 300 Center Avenue Waynesburg, PA 15370

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Based on a review of facility policy, federal regulation and staff interview, it was determined that the facility failed to provide transfer notices to representatives of the Office of the Long-Term Care Ombudsman Division for 10 of 11 months from April 2024 through February 2025. (April, May, June, July, August, September, October, November, December 2024 and January 2025). Findings include: Review of the facility policy Transfer or Discharge Documentation dated 1/31/25, indicated that when a resident is transferred appropriate notice will be provided to the resident and/or legal representative and others as appropriate or necessary. Review of Title 42 Code of Federal Regulations §483.15(c)(3) Notice Before Transfer: indicates, before a facility transfers or discharges a resident, the facility must (i) Notify the resident and the resident's representative(s) of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand. The facility must send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman. Federal Regulations further define emergency transfers as, When a resident is temporarily transferred on an emergency basis to an acute care facility, this type of transfer is considered to be a facility-initiated transfer. During an interview on 3/21/24 at 12:45 p.m., the Nursing Home Administrator confirmed the facility failed to provide transfer notices to representatives of the Office of the Long-Term Care Ombudsman Division from April 2024 through January 2025. 28 Pa. Code 201.18(b)(3)(e)(2) Management. 395675 Page 3 of 7 395675 03/21/2025 Waynesburg Nursing and Rehab 300 Center Avenue Waynesburg, PA 15370

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 observations and staff interview, it was determined that the facility failed to provide a safe environment for residents in four areas of the facility (Beauty Shop, Lift Rom, Shower Room, and Boiler Rom). Findings include: During an observation on 3/17/25, at 2:25 p.m. the Beauty Shop was observed unlocked. The door was noted to have a locking mechanism. Within the Beauty Shop were observed scissors, hair dryers, curling irons, and disinfecting solution. During an observation on 3/17/25, at 2:29 p.m. the Lift Room door was noted to have a sign reading, Keep door closed at all times posted on it. The door was noted to have a locking mechanism, but the door was not closed. Within the Lift Room was noted exhaust fan panels, circuit breaker boards, charging stations for the lift batteries, and three needles used to draw blood. During an observation on 3/17/25, at 2:35 p.m. the Shower Room cabinet was observed to have a disengaged padlock on it. Within the cabinet was observed a spray bottle without a front label describing the contents, and the back label provided directions on how the use the contents as a virucide (any physical or chemical agent that deactivates or destroys viruses). During an interview on 3/17/25, at 2:40 p.m. Registered Nurse (RN) Employee E1 confirmed the above observations. During the interview (which took place at the Beauty Shop door) Beautician Employee E2 approached RN Employee E1, who asked why the door was open. Beautician Employee E2 stated that the visiting dentist had used it last Friday (3/14/25), and it must have been open since then. During an observation on 3/18/25, at 11:21 a.m. the Boiler Room door was noted to be unlocked. Signage on the door indicated authorized personnel only. Additional to the boilers in the room, were noted various tools, degreasers, personal drinks. Upon walking through the boiler room, the rear door to the room was open all the way, allowing access to the grassy area behind the building. During an interview on 3/18/25, at 11:30 a.m. the Director of Nursing confirmed Boiler Room door was open, allowing residents to access an unsafe area. During an interview on 3/21/25, at approximately 12:45 p.m. the Nursing Home Administrator confirmed that the facility failed to provide a safe environment for residents. 28 Pa. Code 201.18(e)(1) Management. 28 Pa. Code 201.20(a)(b) Staff development. 28 Pa. Code 201.29(a)(c)(d) Resident rights. 395675 Page 4 of 7 395675 03/21/2025 Waynesburg Nursing and Rehab 300 Center Avenue Waynesburg, PA 15370

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of facility policy, clinical record review, and staff interview, it was determined that the facility failed to make certain that each resident's drug regimen was free from unnecessary drugs used without adequate indications for use for two of three residents. (Resident R11 and R38). Findings include: Review of the facility policy, Antipsychotic Medication Use dated 1/31/25, indicated; Residents will not receive medications that are not clinically indicated to treat a specific condition. Diagnoses alone do not warrant the use of antipsychotic medication. In addition to the above criteria, antipsychotic medications will generally only be considered if the following conditions are also met: a. The behavioral symptoms present a danger to the resident or others; AND: (1) the symptoms are identified as being due to mania or psychosis (such as auditory, visual, or other hallucinations; delusions, paranoia or grandiosity); or (2) behavioral interventions have been attempted and included in the plan of care, except in an emergency. Review of Resident R11's admission record indicated he was initially admitted to the facility on [DATE], and readmitted on [DATE]. Review of Resident R11's Minimum Data Set (MDS- periodic assessment of care needs) assessment dated [DATE], included diagnoses of heart failure (a progressive heart disease that affects pumping action of the heart muscles), diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time), and dementia (a group of symptoms that affects memory, thinking and interferes with daily life). No psychotic diagnoses were present on the MDS. Review of Section N: Medications revealed Resident R11 received antipsychotic medications in the seven days prior to the assessment. Review of a physician order dated 1/30/25, indicated Resident R11 received Rexulti (an anti-psychotic medication) 0.5 mg daily for dementia without behavioral disturbance. This order was discontinued on 3/5/25. Review of a physician order dated 3/5/25, indicated Resident R11 received Rexulti 1.0 mg daily for dementia, mild, with agitation. Review of Resident R11's care plan for the use of antipsychotic medications and for behavioral disturbances, updated 2/19/25, failed to include goals and interventions for monitoring behaviors, except when a new medication is started or dosage change. Review of behavior monitoring documentation indicated that only symptoms of anxiety and depression 395675 Page 5 of 7 395675 03/21/2025 Waynesburg Nursing and Rehab 300 Center Avenue Waynesburg, PA 15370

F 0758 Level of Harm - Minimal harm or potential for actual harm were being monitored. Review of the documentation for, 12/1/24, through 3/17/24, failed to reveal any documented behaviors. Review of a nurse practitioner note created 10/20/24, at 8:38 p.m. indicated, Does not have significant dementia. Residents Affected - Some Review of a psychiatric evaluation on 1/23/25, indicated the provider documented that Per nursing collateral recent and frequent verbal agitation, physical aggression. Review of progress notes from 12/1/24, through 3/17/25, failed to reveal documentation of any behaviors. Review of Resident R38's admission record indicated he was initially admitted to the facility on [DATE]. Review of Resident R38's MDS assessment dated [DATE], included diagnoses of dementia, cancer, and a seizure disorder. Review of Section N: Medications revealed Resident R38 received antipsychotic medications in the seven days prior to the assessment. Review of a physician order dated 12/31/24, indicated Resident R38 received Quetiapine (an anti-psychotic medication) 25 mg twice daily for emotional lability. This order was discontinued on 1/28/25. Review of a physician order dated 1/28/25, indicated Resident R38 received Quetiapine 50 mg twice daily for dementia, unspecified severity, with agitation. Review of Resident R35's care plan for the use of psychotropic medications and for behavioral disturbances, updated 2/24/25, failed to include goals and interventions for monitoring behaviors, except when a new medication is started or dosage change. Review of behavior monitoring documentation indicated that only symptoms of anxiety and depression were being monitored. Review of the documentation for, 1/1/25, through 3/17/24, failed to reveal any documented behaviors. Review of a psychiatric evaluation on 1/28/25, indicated the provider documented that the patient reported paranoia. Review of progress notes from 1/1/25, through 3/17/25, revealed one progress note on 3/4/25, that Resident R38 had one episode of being agitated. During an interview 3/21/25, at approximately 12:45 p.m. Nursing Home Administrator confirmed the facility failed to make certain that each resident's drug regimen was free from unnecessary drugs used without adequate indications for use for two of three residents. 28 Pa. Code: 201.14(a) Responsibility of licensee. 28 Pa. Code: 211.2(a)(c) Physician services. 28 Pa. Code: 211.9(a)(1)(d)(k) Pharmacy services. 395675 Page 6 of 7 395675 03/21/2025 Waynesburg Nursing and Rehab 300 Center Avenue Waynesburg, PA 15370

F 0758 28 Pa. Code: 211.12(c)(d)(5) Nursing services. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 395675 Page 7 of 7