Health inspection·November 12, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **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 notify physicians of increased capillary blood glucose (CBG) levels for three of seven residents (Resident R2, R3, and R4). Findings include: Review of the facility policy Physician Communication/Change in Condition dated 8/9/24, indicated to notify a physician for glucose levels if: 1. Follow specific physician orders if present; or 2. Greater than 300 mg/dl (milligrams per deciliter) in a diabetic patient not using sliding-scale insulin; or 3. Greater than 450 mg/dl (or machine registers hi) in a diabetic patient using sliding scale insulin. Review of the clinical record indicated Resident R2 was admitted to the facility on [DATE]. Review of Resident R2's facility diagnoses list included heart failure (a progressive heart disease that affects pumping action of the heart muscles) and diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time). Review of a physician's orders dated 9/18/24, indicated for Resident R2 to receive insulin Degludec (long-acting injectable medication to lower blood sugar), 12 units in the evening. Review of Resident R2's physician's orders did not include an order for sliding scale insulin. Review of Resident R2's plan of care for diagnosis of diabetes mellitus dated 9/19/24, indicated for staff to Administer diabetes medication as ordered by doctor and Monitor labs as ordered and report abnormalities to medical provider. Review of the Resident R2's blood sugar level record for 9/18/24, through 9/21/24, revealed the following blood sugar levels: 9/18/24, at 8:27 p.m. the CBG was 111 mg/dl. (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 7 Event ID: 395695 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 395695 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenery Center for Rehab and Nursing 2200 Hill Church-Houston Road Canonsburg, PA 15317 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)