Health inspection·October 30, 2024

F 0760 Ensure that residents are free from significant medication errors. 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 that residents are free of significant medication errors for one of four residents reviewed (Resident 4). Residents Affected - Few Findings include: Clinical record review for Resident 4 revealed nursing documentation dated October 26, 2024, at 1:38 PM, noting Employee 1 (licensed practical nurse) went into the resident room to administer medications to Resident 3 in bed A. Documentation revealed Resident 3 was being assisted to the bathroom by staff. Documentation further noted Employee 1 put Resident 3's medications on her bedside table when Resident 4 (resident in bed B) requested a pain pill, and she left the room to obtain the pain medication from the medication cart. When Employee 1 returned with the pain medication, Resident 4 had ingested the medications she put on Resident 3's bedside dresser. The registered nurse notified the on call provider and received a new order to check vital signs every shift for 24 hours. Nursing documentation dated October 26, 2024, at 3:52 PM noted the registered nurse supervisor was notified of Resident 4's most recent blood pressure reading of 74/34 mmHg (millimeters of mercury). The registered nurse was in the room and took a manual blood pressure with systolic (pressure in the arteries when the heart beats) pressure of 76 and she was unable to hear diastolic (pressure in the arteries when the heart is at rest between beats). Documentation revealed the on-call provider was notified immediately and the facility received a new order to send Resident 4 to the emergency department for further evaluation. Review of Resident 4's Minimum Data Set (an assessment completed at specific intervals to determine resident care needs) dated October 24, 2024, noted staff assessed Resident 4 as independent in his wheelchair. The assessment indicated that Resident 4's BIMS (Brief Interview for Mental Status, which indicates cognition) score was 15, which indicated he was cognitively intact. Review of facility documentation revealed Resident 4 took the following medications in error: Amlodipine (medication to treat high blood pressure) 10 milligram (mg), one tablet Ferrous Sulfate (iron supplement) 325 mg, one tablet Lisinopril (medication used to treat high blood pressure) 20 mg, two tablets Magnesium Oxide (medication to treat heart burn) 400 mg, one tablet (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: 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 10/30/2024 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)