Health inspection·April 25, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on observation and staff interview, it was determined that the facility failed to ensure that care and services were provided in a manner that enhanced resident dignity for one of 15 residents sampled (Resident 28). Findings include: Clinical record review for Resident 28 revealed a Minimum Data Set Assessment (MDS, an assessment completed at specific intervals to determine care needs) dated April 1, 2025, that noted facility staff assessed the resident as having a BIMS (Brief Interview for Mental Status) of 6, which indicated cognitive impairment. Clinical record review for Resident 28 revealed the resident had current physician orders for an indwelling urinary foley catheter (a tube inserted into the bladder that drains urine) and associated care. Resident 28's current care plan revealed that the resident had a foley catheter due to obstructive uropathy (when the urine cannot flow properly through the body). An intervention included always having a dignity bag (a device such as a cover to promote dignity that conceals the urine in the collection bag). Review of Resident 28's task list (located in the electronic health record where staff document specific care related events for a resident) revealed the resident is to have a dignity bag at all times. Observation of Resident 28 on April 25, 2025, at 10:16 AM, 10:46 AM, and 11:31 AM revealed the resident was seated in his wheelchair in the main hallway located in front of the nurse's station. Resident 28's foley catheter collection bag was attached to the frame of the wheelchair and urine was visible. Several staff members and other residents were observed passing by Resident 28 as he sat in the hallway. An interview with Employee 2, licensed practical nurse, on April 25, 2025, at 11:31 AM revealed that Resident 28's foley catheter bag should be covered. The above information for Resident 28 was reviewed with the Nursing Home Administrator during an interview on April 25, 2025, at 1:08 PM. 28 Pa. Code 201.18(b)(1) Management (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 8 Event ID: 395756 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 395756 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Juniper Village at Brookline-Rehabilitation and Sk 1950 Cliffside Drive State College, PA 16801 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)