Inspection visit

Health inspectionDecember 1, 2023

ROSE VIEW REHAB AND CARE CENTERCMS #3957679 citations on this visit

9 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 9 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to ensure accurate completion of assessments for three of 25 residents reviewed (Residents 4, 30, and 66). Residents Affected - Few Findings include: Clinical record review for Resident 4 revealed a Level I PASRR (Preadmission Screen and Resident Review, assessment used to identify evidence of serious mental illness and/or intellectual or developmental disabilities in all individuals seeking admission to Medicaid- or Medicare-certified nursing facilities) dated November 16, 2018, that indicated Resident 4 had a positive screen for serious mental illness in Section II-D and Section VII indicated that Resident 4 was in a Target Group requiring approval from the Program Office prior to admission. A letter from Office of Mental Health Department of Human Services program offices dated November 20, 2018, determined that Resident 4 had evidence of a mental health condition that met the criteria for a Program Office review and the resident may be admitted or continue to reside in a nursing facility. An annual MDS (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) dated September 15, 2023, assessed Resident 4 as not considered by the state Level II PASRR process to have serious mental illness and/or intellectual disability or a related condition. The surveyor reviewed the above findings for Resident 4 during a meeting with the Nursing Home Administrator and Director of Nursing on November 29, 2023, at 2:15 PM. During an interview with Employee 3, licensed practical nurse, on November 30, 2023, at 11:23 AM who completed the above section of the MDS confirmed that the annual assessment was incorrect, and Resident 4 was considered by the State Level II PASRR process to have a serious mental illness. Clinical record review for Resident 30 revealed a MDS (Minimum Data Set, an assessment tool completed at specific interval to determine care needs) dated July 15, 2023, indicating staff assessed Resident 30 as having no lower extremity impairment. Further review of Resident 30's clinical record revealed an MDS dated [DATE], noting staff assessed Resident 30 as having lower extremity impairment on both sides. Interview with the Nursing Home Administrator and Director of Nursing on November 30, 2023, at 2:42 PM confirmed there was no evidence of a decline in Resident 30's range of motion in her lower (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 13 Event ID: 395767 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 395767 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rose View Rehab and Care Center 1201 Rural Avenue Williamsport, PA 17701 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)

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few extremities. The Director of Nursing and Nursing Home Administrator confirmed Resident 30's August 29, 2023, MDS was inaccurate. Clinical record review for Resident 66 revealed MDS assessments dated May 25, and July 21, 2023, indicating staff assessed Resident 66 as having no lower extremity impairment. Further review of Resident 66's clinical record revealed an MDS dated [DATE], noting staff assessed Resident 66 as having lower extremity impairment on both sides. Interview with the Nursing Home Administrator and Director of Nursing on November 30, 2023, at 2:42 PM confirmed there was no evidence of a decline in Resident 66's range of motion in her lower extremities. The Director of Nursing and Nursing Home Administrator confirmed Resident 66's November 8, 2023, MDS was inaccurate. 28 Pa. Code 211.5(v) Medical records 28 Pa. Code 211.12(c)(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395767 If continuation sheet Page 2 of 13 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 395767 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rose View Rehab and Care Center 1201 Rural Avenue Williamsport, PA 17701 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)

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and staff interview, it was determined that the facility failed to implement interventions to promote acceptable parameters of nutrition for one of two residents reviewed (Resident 30). Residents Affected - Few Findings include: A clinical record review revealed the facility admitted Resident 30 on July 21, 2021. Further review of Resident 30's clinical record revealed the following weight assessments: July 18, 2023, 137 pounds August 14, 2023, 127.4 pounds (a 9.6 pound, a 7.1 percent significant weight loss) A nutrition progress note dated August 15, 2023, recommended staff monitor Resident 30's weights weekly, and administer Ensure Clear (a nutrition drink that contains high-quality protein and essential nutrients) three times a day with her meals. Further review of Resident 30's weight assessments revealed staff did not complete weekly weights as recommended by the registered dietician. A review of Resident 30's MAR (Medication Administration Record, a form utilized by the facility to document the administration of medications) dated August 2023, revealed no evidence the facility implemented the Ensure Clear as recommended by the registered dietician to address Resident 30's significant weight loss. Further review of Resident 30's September 2023 MAR revealed the facility did not start Resident 30's Ensure Clear until September 7, 2023, (24 days after identified weight loss) An interview with the Nursing Home Administrator on December 1, 2023, at 11:23 AM confirmed these findings and stated the facility had no further documentation addressing Resident 30's significant weight loss. 28 Pa. Code 211.10(d) Resident care policies 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395767 If continuation sheet Page 3 of 13 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 395767 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rose View Rehab and Care Center 1201 Rural Avenue Williamsport, PA 17701 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)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, clinical record review, and staff interview, it was determined that the facility failed to provide appropriate respiratory care and services for one of one resident reviewed (Resident 56). Residents Affected - Few Findings include: Review of a physician's order for Resident 56 dated August 21, 2023, indicated staff to administer oxygen 2 liters per minute (lpm) via nasal cannula (flexible plastic tubing with small prongs inserted into the nostrils to deliver supplemental oxygen) continuously. Review of a nursing progress note for Resident 56 dated November 5, 2023, at 6:13 AM revealed the resident had an oxygen saturation (percentage of oxygen in the blood, normal usually is 95-100 percent) of 64 percent. Resident 56's oxygen was bumped up to 4 lpm and his oxygen saturation came up to 90 percent. Review of the treatment administration records for Resident 56 dated November 2023, revealed that the oxygen was administered continuously at 2 lpm. Observation of Resident 56 on November 28, 2023, at 1:45 PM revealed that the resident's oxygen was set at 3.5 lpm. Concurrent interview with Employee 2, licensed practical nurse, confirmed the oxygen was set at the incorrect level and decreased the oxygen to 2 lpm minute and that Resident 56 is unable to change the oxygen level. Review of the current plan of care for Resident 56 revealed that the use of oxygen was not addressed. The surveyor reviewed the incorrect oxygen flow rate for Resident 56 during an interview with the Nursing Home Administrator and Director of Nursing on November 29, 2023, at 2:10 PM and the lack of oxygen being addressed in the care plan on December 1, 2023, at 1:30 PM. 483.25(i) Respiratory/Tracheostomy care and Suctioning Previously cited 1/10/23 28 Pa. Code 211.12(d)(1)(2)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395767 If continuation sheet Page 4 of 13 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 395767 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rose View Rehab and Care Center 1201 Rural Avenue Williamsport, PA 17701 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)

F 0730 Observe each nurse aide's job performance and give regular training. Level of Harm - Minimal harm or potential for actual harm Based on review of active nurse aides and staff interview, it was determined that the facility failed to complete a performance evaluation of every nurse aide at least once every 12 months for two of three nurse aides reviewed (Employees 5 and 6). Residents Affected - Few Findings Include: Review of the facility's list of nurse aide staff revealed Employee 5 with a hire date of June 1, 2007, and Employee 6 with a hire date of July 7, 2015. A request to review the annual performance evaluations for Employees 5 and 6 revealed no documented evidence that the facility is completing the evaluations at least once every 12 months. Interview with the Nursing Home Administrator on December 1, 2023, at 10:24 AM confirmed that performance evaluations were not completed. 28 Pa. Code 201.19 Personnel policies and procedures FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395767 If continuation sheet Page 5 of 13 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 395767 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rose View Rehab and Care Center 1201 Rural Avenue Williamsport, PA 17701 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)

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Based on clinical record review, review of select facility policies and procedures, and staff interview, it was determined that the facility failed to ensure a resident's medication regime was free from potentially unnecessary medications for two of six residents reviewed (Residents 3 and 102). Findings include: The policy entitled Psychotropic Medication Use, last reviewed January 18, 2023, indicates that residents will not receive medications that are not clinically indicated to treat a specific condition. Non-pharmacological approaches are used to minimize the need for medications, permit the lowest possible dose, and allow for discontinuation of medications when possible. The policy does not include measures the facility will implement to monitor the target behaviors for the as needed use of a psychotropic medication. Review of Resident 3's clinical record revealed a physician's order dated October 27, 2023, that indicated nursing staff were to monitor Resident 3's behaviors and make a progress note regarding her behaviors and interventions every shift. The order did not specify what behaviors nursing staff were monitoring. The behavioral monitoring order was discontinued on November 17, 2023, despite Resident 3 continuing to receive an as needed psychotropic medication for anxiety or agitation. A physician's order dated October 30, 2023, indicated that nursing staff can administer Ativan (a medication used to treat anxiety) 0.5 mg (milligrams) half a tablet every 12 hours as needed for anxiety. A physician's order dated November 4, 2023, indicated that nursing staff can administer Ativan 0.5 mg one tablet every 12 hours as needed for anxiety. A physician's order dated November 7, 2023, indicated that nursing staff can administer Ativan 0.5 mg one tablet every day at 2:00 PM as needed for anxiety or agitation. A physician's order dated November 13, 2023, indicated that nursing staff can administer Ativan 0.5 mg one tablet every eight hours as needed for anxiety or agitation. Review of Resident 3's MAR (Medication Administration Record, a form used to document the administration of medications) dated November 2023, indicated that nursing staff administered the Ativan to Resident 3 12 times, according to the physician orders listed above. There was no documented evidence in Resident 3's clinical record to indicate that nursing staff attempted non-pharmacological interventions or documented behavioral monitoring when administering the Ativan twice on November 4, 2023, twice on November 5, 2023, once on November 6, 2023, once November 10, 2023, twice on November 15, 2023, once on November 18, 2023, once on November 20, 2023, once on November 24, 2023, and once on November 25, 2023. Interview with the Director of Nursing on December 1, 2023, at 10:35 AM acknowledged the above findings for Resident 3. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395767 If continuation sheet Page 6 of 13 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 395767 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rose View Rehab and Care Center 1201 Rural Avenue Williamsport, PA 17701 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)

F 0758 Level of Harm - Minimal harm or potential for actual harm Clinical record review for Resident 102 revealed that she was seen by a consultant specializing in psychogeriatrics (mental health treatment for older people for the purpose of improvement in functional status, behavior, and quality of life) on July 25, 2023, and September 13, 2023. The resident was diagnosed with major depressive disorder (depression), unspecified dementia (loss of memory, language, problem solving that interfere with daily life) with anxiety, and anxiety disorder. Residents Affected - Some A physician's order for Resident 102 dated September 28, 2023, indicating the nurse can administer Ativan 0.5 mg one tablet every 12 hours as needed for anxiety/agitation for 14 days. A physician's order for Resident 102 dated October 27, 2023, indicating the nurse can administer Ativan 0.5 mg one tablet every 12 hours as needed for anxiety/agitation for 14 days. A physician's order for Resident 102 dated November 15, 2023, indicating the nurse can administer Ativan 0.5 mg one tablet every 12 hours as needed for anxiety/agitation for 14 days. Review of Resident 102's MAR for October 2023, revealed nursing staff administered Ativan three times according to the physician orders above. Review of Resident 102's MAR for November 2023, revealed nursing staff administered Ativan eight times according to the physician orders above. There was no documented evidence in Resident 102's clinical record to indicate that nursing staff attempted non-pharmacological interventions prior to administering the Ativan on October 3, 10, and 27, 2023 (three of three times), and on November 9, 17, 19. 22, 23, and 29, 2023 (six of eight times). Interview with the Director of Nursing on December 1, 2023, at 1:00 PM acknowledged the above findings for Resident 102. 483.45 Psychotropic Medications Previously cited 1/10/23 28 Pa. Code 211.9(k) Pharmacy services 28 Pa. Code 211.10(a) Resident care policies 28 Pa. Code 211.12(c)(d)(2)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395767 If continuation sheet Page 7 of 13 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 395767 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rose View Rehab and Care Center 1201 Rural Avenue Williamsport, PA 17701 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)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observations and staff interview, it was determined that the facility failed to properly store resident medications on one of two nursing units reviewed (Second Floor Nursing Unit). Findings include: Observation of the Second Floor Nursing Unit medication cart with Employee 7 (licensed practical nurse) on November 30, 2023, at 8:40 AM revealed an accumulation of debris and dirt in the bottoms of the drawers on the cart. There were multiple unsecured and unidentified medication tablets on the bottom of several of the drawers that included: a small blue oblong pill, a large white capsule, two round white pills, an oblong white pill, half of a white tablet, two oblong pills, and two beige round pills. The above findings were discussed in a meeting with the Nursing Home Administrator and Director of Nursing on November 30, 2023, at 2:30 PM. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.12(d)(1) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395767 If continuation sheet Page 8 of 13 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 395767 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rose View Rehab and Care Center 1201 Rural Avenue Williamsport, PA 17701 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)

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and staff interview, it was determined that the facility failed to store and prepare food in a safe and sanitary manner to prevent the potential for food borne illness in the main kitchen. Residents Affected - Some Findings include: A tour of the facility's main kitchen on November 28, 2023, at 8:25 AM revealed the following: Two three-tiered red plastic carts in the dish room had a build-up of a black removable substance on the storage surface. The attached trash receptacles had a build-up of splatter on the inside and outside surfaces. Concurrent interview with Employee 1, dietary manager, revealed these carts were power washed on a regular basis and the carts are used to pick up dirty dishes on the units after meals. The perimeter of the floor edges in the main kitchen had a build-up of debris. A metal dish caddy was uncovered, exposing the upright stored dishes to contaminants. There were crumbs and debris on the dish surfaces. The drain in front of the ice machine had a rusty build-up and had water pooling around the drain. In the standup refrigerator near the ice machine was a serving bowl of lettuce that was uncovered, a covered bowl of lettuce labeled with a use by date of November 25, and two undated containers of salad dressing, two individual serving bowls of undated oatmeal, and a container of peanut butter and jelly sandwiches that were dated as made on November 26. Although, these sandwiches were acceptable for eating by the date, the crust was hard. On a three-tiered metal rack were two trays of pear crisp dated November 27. Employee 1 confirmed the pear crisp would be served at supper and should be refrigerated until the staff were ready to plate them. A container of plastic utensils was uncovered and had specks of debris. In the rolling refrigerator was a covered container of lettuce in which the lid was not tight, and the lettuce was wilted. Two trays of unfrosted chocolate cake dated November 26 were on a cart. Although the cake was within the acceptable date range for serving, the edges were hard. The cake was partially covered with parchment paper; however, the edges were not covered. Employee 1 indicated the cake would be frosted and served for lunch on this date. A build-up of food splatter was on the outside of the double oven, gas range, tilt skillet, and steamer. Two containers of margarine were undated and uncovered on top of the range and the range was not in use. A two-tiered cart containing mixing bowls were stored upright and uncovered. Crumbs were present in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395767 If continuation sheet Page 9 of 13 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 395767 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rose View Rehab and Care Center 1201 Rural Avenue Williamsport, PA 17701 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)

F 0812 one bowl. Level of Harm - Minimal harm or potential for actual harm A utility cart had rusty wheels and a build-up of splatter on the surface. On the cook's prep area was a container of thickener that was not labeled or dated. Residents Affected - Some During a meeting with the Nursing Home Administrator on November 30, 2023, at 11:15 AM the surveyor reviewed the findings for the kitchen. 483.60(i)(1)(2) Food Procurement, store/prepare/serve-Sanitary Previously cited 1/10/23 28 Pa. Code 201.14(a) Responsibility of licensee FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395767 If continuation sheet Page 10 of 13 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 395767 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rose View Rehab and Care Center 1201 Rural Avenue Williamsport, PA 17701 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)

F 0842 Level of Harm - Minimal harm or potential for actual harm Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on clinical record review and staff interview, it was determined that the facility failed to ensure accurate clinical documentation for three of 25 residents reviewed (Residents 6, 40, and 83). Residents Affected - Some Findings include: Clinical documentation review for Resident 40 revealed a Fall Risk Evaluation dated November 27, 2023, at 2:52 AM that indicated the resident was documented as having one to two falls in the past three months under the history of falls section. A review of clinical documentation for Resident 40 revealed no evidence of any falls within the past three months as the above Fall Risk Evaluation noted. A request by the surveyor for any fall investigations for Resident 40 during a meeting with the Nursing Home Administrator and Director of Nursing on November 29, 2023, at 2:30 PM revealed no evidence of any falls as indicated. An interview with the Director of Nursing on December 1, 2023, at 9:51 AM confirmed the resident did not have any falls as the Fall Risk Evaluation had indicated. The Director of Nursing further believed the documentation was an error in staff assessment. Clinical documentation for Resident 6 revealed a diagnoses list that included Type 2 Diabetes Mellitus (a condition where the body does not use insulin well, which results in elevated blood glucose levels). The current care plan for Resident 6 revealed the resident has diabetes and one of the interventions included Diabetes medication as ordered by doctor. A review of the physician orders for Resident 6 revealed the resident was ordered Humalog Insulin Lispro (a type of medication used to lower the blood sugar) and Insulin Glargine (a type of medication used to lower the blood sugar). Clinical documentation for Resident 6 revealed the resident was transferred to the hospital on November 21, 2023, and returned to the facility on November 29, 2023. Physician documentation dated November 29, 2023, at 3:38 PM revealed the resident was readmitted to the facility from the hospital. Multiple medications were ordered, which included Insulin Lispro (concentration of 100 units per milliliter injectable solution) administer five units beneath the skin before meals and at bedtime. Review of the current orders by the surveyor on November 30, 2023, at 2:00 PM revealed an order dated November 30, 2023, at 12:22 AM. The order was for Humalog Solution (concentration 100 units per milliliter) Insulin Lispro inject 100 units subcutaneously at bedtime for diabetes. The upcoming start date of the medication was noted as November 30, 2023, at 9:00 PM. An interview with the Nursing Home Administrator and Director of Nursing on November 30, 2023, at 2:30 PM revealed that this was most likely an error with the documentation and will be corrected (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395767 If continuation sheet Page 11 of 13 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 395767 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rose View Rehab and Care Center 1201 Rural Avenue Williamsport, PA 17701 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)

F 0842 immediately. Further review on November 30, 2023, at 3:30 PM revealed the order was changed. Level of Harm - Minimal harm or potential for actual harm An interview with the Director of Nursing on December 1, 2023, at 9:45 AM confirmed the initial order to inject 100 units of insulin was a documentation error and it was corrected immediately upon the surveyor findings. Residents Affected - Some Clinical record review for Resident 83 revealed a Fall Risk Evaluation dated November 8, 2023, at 1:41 AM that indicated the resident was documented as having one to two falls in the past three months under the history of falls section. A review of clinical documentation for Resident 83 revealed no evidence of any falls within the past three months as the above Fall Risk Evaluation noted. A request by the surveyor for any fall investigations for Resident 83 during a meeting with the Nursing Home Administrator and Director of Nursing on November 29, 2023, at 2:30 PM revealed no evidence of any falls as indicated. An interview with the Director of Nursing and Nursing Home Administrator on December 1, 2023, at 9:51 AM confirmed Resident 83 did not have any falls as the Fall Risk Evaluation had indicated. They indicated the documentation was an error in staff assessment. 28 Pa. Code 211.5(i) Medical records 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395767 If continuation sheet Page 12 of 13 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 395767 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rose View Rehab and Care Center 1201 Rural Avenue Williamsport, PA 17701 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)

F 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and staff interview, it was determined that the facility failed to ensure the administration of a pneumococcal vaccine for one of five residents reviewed for immunization concerns (Resident 6). Residents Affected - Few Findings include: Clinical record review for Resident 6 revealed that the facility admitted him on December 3, 2018. Review of Resident 6's immunization history revealed no evidence of a recommended pneumococcal vaccine. Review of a Pneumococcal Immunization Informed Consent dated November 6, 2023, revealed Resident 6's responsible party gave the facility permission to administer the pneumococcal vaccination. During an interview with Employee 4 (infection preventionalist) on December 1, 2023, at 1:57 PM it was confirmed that there was no documented evidence that Resident 6 was offered the pneumococcal immunization. 28 Pa. Code 211.12(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395767 If continuation sheet Page 13 of 13

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Citations

9 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0758GeneralS&S Epotential for harm
F758 - Medication Errors
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
0692GeneralS&S Dpotential for harm
F692 - Assisted nutrition and hydration
Provide enough food/fluids to maintain a resident's health.
0641GeneralS&S Dpotential for harm
F641 - Accuracy of Assessments
Ensure each resident receives an accurate assessment.
0695GeneralS&S Dpotential for harm
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
0730GeneralS&S Dpotential for harm
F730 - Regular in-service education
Observe each nurse aide's job performance and give regular training.
0761GeneralS&S Dpotential for harm
F761 - Labeling of Drugs and Biologicals
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
0812GeneralS&S Epotential for harm
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
0842GeneralS&S Epotential for harm
F842 - Resident-identifiable information
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
0883GeneralS&S Dpotential for harm
F883 - Influenza and pneumococcal immunizations
Develop and implement policies and procedures for flu and pneumonia vaccinations.

FAQ · About this visit

Common questions about this visit

What happened during the December 1, 2023 survey of ROSE VIEW REHAB AND CARE CENTER?

This was a inspection survey of ROSE VIEW REHAB AND CARE CENTER on December 1, 2023. The surveyor cited 9 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at ROSE VIEW REHAB AND CARE CENTER on December 1, 2023?

Yes, 9 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiatin..."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.

Data from CMS Care Compare public records. Dataset last refreshed June 22, 2026. If you believe any information is inaccurate, report it here.

Health inspection·December 1, 2023