Inspection·May 29, 2025

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical record review, and staff interview, it was determined that the facility failed to make certain that residents are free of significant medication errors for one of three residents (Resident R1). Residents Affected - Few Review of facility policy Medication Monitoring dated 3/14/25, indicated staff monitor and document events including medication error. Review of the clinical record indicated Resident R1 was admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS - periodic assessment of resident care needs) dated 3/12/25, included diagnoses of peritoneal abscess (abscess near the large bowel), colitis (inflammation in the colon), and high blood pressure. Review of the provider orders reveal the residents Total Parenteral Nutrition (TPN) is to run a cycle for twelve hours from 9 p.m. to 9 a.m. daily. Review of the clinical record on 5/9/25 revealed Resident R1 received the incorrect TPN. This was reportedly discovered and hour later when Resident R4 was to have TPN prepared and administered. The infusion was stopped, the provider was notified. During an interview with the Resident R1 on 5/29/25 at 11:30 a.m., she reported no ill effects or concerns with her daily TPN infusions. During an interview on 5/29/21 at 2:20 p.m., Licensed Practical Nurse (LPN) Employee E1 confirmed the wrong TPN was administered to the resident. During an interview with LPN Employee E1 on 5/29/25 at approximately 2:20 p.m., stated the TPN was administered by the shift supervisor, Registered Nurse (RN) Employee E2 on 5/10/25. The TPN is to run a cycle for twelve hours from 9 p.m. to 9 a.m. At approximately 5:00 a.m. the infusion pump read complete, and the pump stopped the infusion with medication remaining. The pump was reported to be set at the incorrect rate. Review of employee statement 5/29/25 at 2:46 p.m. RN Employee E 3 confirmed she mixed the incorrect TPN. Review of the TPN storage on 5/29/25 at 3:30 p.m. revealed the TPN products are packaged, labeled, sealed, and in a dedicated bin for the individual residents on TPN. (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: 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 05/29/2025 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)