Health inspection·June 27, 2025

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on review of facility policy and clinical records, and staff interview, it was determined that the facility failed to have complete and accurate documentation regarding Peripherally Inserted Central Catheter (PICC-a thin soft flexible tube placed in the vein of the upper arm also called an IV to deliver fluids and medications) dressing changes for two of three residents reviewed with PICC lines in the treatment record. (Residents R1 and R2) Findings include: Review of facility policy entitled Peripheral and Midline IV Dressing Changes dated 5/9/25, indicated Change the dressing if it becomes damp, loosened or visibly soiled and at least every 7 days . Review of Resident R1's clinical record revealed an admission date of 11/24/24, with diagnoses that included hypertension (high blood pressure), cellulitis (and infection of the skin), and diabetes (a health condition that is caused by the body's inability to produce enough insulin). Review of Resident R1's physician's orders for May 2025, revealed an order dated 5/5/25, to change PICC line dressing weekly. Review of Resident R1's treatment administration record for May 2025, lacked evidence that his/her PICC line dressing was changed on 5/12/25, 5/19/25, and 5/26/25. Review of his/her treatment administration record for June 2025, lacked evidence that his/her PICC line dressing was changed on 6/1/25. Review of Resident R2's clinical record revealed an admission date of 4/6/25, with diagnoses that included osteomyelitis (an infection in the bone), bacteremia (infection in the blood), and gastro esophageal reflux disease (a condition when stomach acid repeatedly flows back up into your throat). Review of Resident R2's physician's orders for April 2025, revealed an order dated 4/6/25, to change PICC line dressing weekly. Review of Resident R2's treatment administration record for April 2025, lacked evidence that his/her PICC line dressing was changed on 4/21/25, and 4/28/25. Review of his/her treatment administration record for May 2025, lacked evidence that his/her PICC line dressing was changed on 5/5/25. During an interview on 6/18/25, at 12:56 p.m. the Regional Clinical Director Employee E1 confirmed that Residents R1 and R2's treatment records did not have complete documentation regarding PICC line dressing changes. He/she also confirmed that the dressing changes should be completed per physician's orders and documented in the clinical record. (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 3 Event ID: 395777 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 395777 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sugar Creek Care Center 351 Causeway Drive Franklin, PA 16323 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)