Inspection·June 13, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 a review of clinical records, facility provided documentation, and staff interviews, it was determined that the facility failed to timely consult with the physician about the potential need to alter treatment in response to a change in condition of a resident's wound and failed to notify the resident and the resident's interested representative of the signs of declining condition of the resident's wound for one resident out nine sampled (Resident CR1). Findings include: A review of the clinical record revealed that Resident CR1 was readmitted to the facility on [DATE], with diagnoses to include diabetes, depression, chronic obstructive pulmonary disease (COPD), fracture of left pubis, and peripheral vascular disease (PVD - a common condition in which narrowed arteries reduce blood flow to the arms or legs). An admission Minimum Data Set assessment (MDS-standardized assessment completed at specific intervals to identify specific resident care needs) dated February 10, 2023, revealed the Brief Interview for Mental Status (BIMS section of the MDS which assesses cognition, a tool to assess the resident's attention, orientation, and ability to register and recall new information, a score of 13-15 equates to being Cognitively Intact) revealed that the resident scored a 13, which indicated that he was cognitively intact. Resident CR1's clinical record indicated the resident was his own responsible party but had an interested family member, as an emergency contact. The resident's February 2023 Treatment Administration Record (TAR indicated that on February 22, 2023, a new treatment was ordered to cleanse bilateral shins with normal saline solution, apply A+D Ointment, and cover with Comfort foam border gauze, every day shift for Protection/Prevention. A review the interdisciplinary and nursing progress notes in the resident's clinical record dated from February 21, 22, 23, and 24, 2023, revealed no reference to skin concerns on both the resident's shins which prompted the new physician order for treatment. A nursing note dated February 25, 2023, at 2:45 PM, revealed that while completing resident's treatment to his bilateral lower extremities, staff observed green drainage from wounds and reddened skin around the wound that appeared macerated. Nursing applied the ointment as ordered, and also skin prep area around and wrapped the resident's lower extremities with kerlix. (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 4 Event ID: 395701 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 395701 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Abington Manor 100 Edella Road Clarks Summit, PA 18411 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)