Inspection·June 6, 2023

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 facility policies, clinical records, and staff interview, it was determined that the facility failed to provide adequate bed mobility supervision for one of three residents (Resident R6). Findings include: Review of American Congress of Rehabilitation Medicine - Caregiver Guide and Instructions for Safe Bed Mobility published 4/28/17, indicated bed mobility refers to activities such as scooting in bed, rolling, side-lying to sitting, and sitting to lying down. The Resident Assessment Instrument (RAI) User's Manual, which gives instructions for completing Minimum Data Set (MDS) assessments (mandated assessments of a resident's abilities and care needs), dated October 2018, indicated that Section G: Functional Status, Question G0110 A indicates Bed Mobility is how the resident moves to and from lying position, turns side to side, and positions body while in bed. The RAI User's Manual further defines bathing as solely how the resident takes a full body bath, shower or sponge bath, including transfers in and out of the tub or shower. Review of the facility policy Falls - Clinical Protocol dated 10/31/22, indicated The staff and practitioner will review each resident's risk factors for falling and document in the medical record. Review of Resident R6's admission record indicated she was admitted to the facility on [DATE]. Review of Resident R6's Minimum Data Set (MDS) assessments (mandated assessment of a resident's abilities and care needs) dated 3/6/23, indicated diagnoses of heart failure (a progressive heart disease that affects pumping action of the heart muscles), abnormalities of gait and mobility, and muscle weakness. Review of Resident R6's admission MDS assessments dated 1/2/23, and 3/6/23, Section G - Functional Status, indicated that Resident R6 required extensive physical assistance of two or more persons for bed mobility. Review of Resident R6's current plan of care for ADL self-care performance initiated 12/9/22, failed to reveal any goals or interventions related to bed mobility, or the staff assistance level required. (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: 395742 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 395742 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southwestern Nursing and Rehabilitation Center 500 North Lewis Run Road Pittsburgh, PA 15122 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)