Health inspection·April 3, 2024

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records and select resident incident/accident reports and staff interview, it was determined that the facility failed to provide adequate staff supervision to timely identify a resident's unauthorized absence from the facility to assure the safety of one resident (Resident 1) and failed to consistently implement planned safety measures, including necessary staff supervision, to prevent a fall for one resident out of four sampled (Resident 2) Findings include: A review of the clinical record revealed that Resident 2 was admitted to the facility on [DATE], with diagnoses of Alzheimer's disease (decline in brain function which causes memory loss and causes brain tissue to breakdown) and mild dementia ( a condition in which a person loses the ability to think, remember, learn, make decisions, and solve problems) with behavior disturbance A review of a quarterly Minimum Data Set Assessment (MDS - a federally mandated standardized assessment completed at specific times to identify resident care needs) dated December 15, 2023, revealed that the resident was severely cognitively impaired with a BIMS of 3 (brief interview for mental status, a tool to assess the residents attention, orientation and ability to register and recall new information, a score of 00 - 07 equates to severe cognitive impairment) and required extensive assistance of two staff for activities of daily living. A fall risk assessment dated [DATE], indicated that the resident was at high risk for falls. Care planned interventions on this date were the use of bed alarm while in bed, call bell in reach, encourage to transfer and change positions slowly, fall mats to both sides of bed, provide assistance to transfer and ambulate as needed. Staff were to check the resident's bed alarm and chair alarm every shift and as needed. Documentation in Resident 2's clinical record dated February 26, 2024, at 3:00 PM revealed a nurse aide, Employee 7 heard a loud yell and a bang and responded to the resident dining/day room. Employee 7 found Resident 2 on the floor, on the resident's left side, bleeding from his right hand and blood on the floor. Upon nursing assessment, the resident was identified to have an an open area to his right hand on his fourth finger with tendons exposed measuring 1 cm x 1.5 cm x 0.1 cm. The resident was sent to the hospital, received three sutures to close the wound and returned to the facility. A review of the facility's investigation into the resident's fall, revealed a statement from Employee 8, the nurse aide responsible for Resident 2's care on February 26, 2024, indicating that she, along with another staff member, assisted the resident into his wheelchair because he was climbing out (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 9 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 04/03/2024 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)