Inspection·January 15, 2025

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records, the facility's abuse prohibition policy, information provided by the facility, and staff interviews, it was determined that the facility failed to promptly conduct a thorough investigation to rule out abuse and implement corrective action for one of 6 residents reviewed (Resident 4). Residents Affected - Few Findings included: A facility policy entitled Allegation, Suspicion, or Witnessed Abuse, Neglect, Misapplication, or Exploitation Intervention and Reporting, last reviewed by the facility on May 10, 2024, indicated that staff will immediately report the incident to the Charge Nurse or immediate supervisor of the area. Upon receiving a report of abuse or alleged abuse, the Charge Nurse or supervisor or the area shall immediately notify the RN Supervisor, who will respond to the location, examine the resident, and begin the investigation. The following information should be included in the initial verbal and subsequent written report: name of the resident(s) involved, the date and time of the incident, the exact location of the incident, the name(s) of the alleged perpetrator and contact information, the name(s) of any witnesses to the incident and contact information, a statement will be obtained from the resident(s) if he/she are interviewable (The RN Supervisor and/or Social Service will interview the resident) a description of the incident as witnessed, and any other pertinent information which may be useful to the investigation. The RN Supervisor will notify the appropriate personnel of the incident and shall include, but not limited to the following: Director of Nursing (DON) or Assistant Director of Nursing (ADON) immediately, Administrator (NHA) immediately, attending physician or as directed by the NHA, DON, or ADON (e.g., next day, if immediate notification is not warranted based upon the allegation, signs of injury, time, and type of allegation made), Resident Representation (RP) immediately or as directed by the NHA, DON, ADON (e.g., next day if immediate notification is not warranted based upon the allegation, signs of injury, time, and type of allegation made). A review of Resident 4's clinical record revealed the Resident was admitted to the facility on [DATE], with diagnoses that included adjustment disorder with anxiety (a mental and behavioral disorder defined by a maladaptive response to a psychosocial stressor. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual, considering contextual and cultural factors, causing marked distress, preoccupation with the stressor and its consequences, and functional impairment). A significant change Minimum Data Set assessment (Minimum Data Set - a federally mandated (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 2 Event ID: 395717 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 395717 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Linwood Nursing and Rehabilitation Center 100 Florida Avenue Scranton, PA 18505 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)