Health inspection·October 11, 2024

F 0678 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the American Heart Association (AHA) Guidelines, clinical records, facility policies, and staff interviews it was determined that the facility failed to ensure consistent care by initiating Cardio Pulmonary Resuscitation (CPR) to an unresponsive resident for one of eighty-seven residents (Resident R1), resulting in immediate jeopardy. Findings include: The Pennsylvania Code Title 49, Professional and Vocational Standards through the Department of State indicates under Responsibilities of the Registered Nurse 21.11 General functions (a) The registered nurse assesses human responses and plans, implements, and evaluates nursing care for individuals or families for whom the nurse is responsible. In carrying out this responsibility, the nurse performs all the following functions: (4) Carries out nursing care actions which promote, maintain, and restore the well-being of individuals. Review of AHA Guidelines dated 2024, indicated if a person is unresponsive with no breathing and has no pulse for more than 10 seconds, start CPR. The facility's CPR policy titled. Cardiac and/or Respiratory Arrest reviewed [DATE], indicated the following guidelines are available and are to be utilized in the event of a resident emergency. If a witnessed or unwitnessed arrest for patients without a Do Not Resuscitate (DNR) First, the licensed nurse will evaluate the patient for obvious clinical signs of irreversible death unless not permitted by state regulation. If at least ONE obvious clinical sign of irreversible death is present, do not initiate CPR (Obvious clinical signs of irreversible death include: lividity or pooling of blood in dependent body parts, hardening of muscles or rigidity (rigor mortis) or injuries incompatible with life). If there are no obvious clinical signs of irreversible death, initiate CPR/AED, call 911 and notify primary physician, designate an individual to record events, continue CPR until EMS arrives, notify family health care decision maker of patient's status. Review of Resident R1's clinical record indicated an admission date of [DATE], with diagnoses that included high blood pressure, muscle weakness, atrial fibrillation (irregular, often rapid heart rate that commonly causes poor blood flow), chronic obstructive pulmonary disease (a group of diseases that block airflow and make it difficult to breathe, emphysema and chronic bronchitis are most common conditions). Review of Resident R1's Minimum Data Set (MDS-a periodic assessment of care needs) dated [DATE], indicated the diagnoses were current. (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 5 Event ID: 395743 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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)