Health inspection·April 9, 2024

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, as well as staff and resident interviews, it was determined that the facility failed to ensure self-determination for resident's choices related to wake time schedules for 21 of 34 residents sampled (Residents 1, 9, 10, 11, 12, 13, 14, 16, 17, 18, 19, 20, 21, 22, 23, 24, 26, 27, 29, 30, and 31). Findings include: Clinical record review for Resident 1 revealed a diagnosis list that included dementia (a loss of cognitive function that is caused by the permanent damage or death of the brain's nerve cells, or neurons) and a quarterly Minimum Data Set Assessment (MDS, an assessment completed at specific intervals to determine care needs) dated March 11, 2024, that noted facility staff assessed the resident as having a BIMS (Brief Interview for Mental Status) of 7, which indicated severe cognitive impairment. Clinical record review for Resident 9 revealed a diagnosis list that included dementia and a significant change MDS dated [DATE], that noted facility staff assessed the resident as having a BIMS of 99, which indicated the resident was unable to complete the assessment interview. The MDS further noted the resident's cognitive skills for daily decision making were assessed as moderately impaired. Clinical record review for Resident 10 revealed a diagnosis list that included dementia and a quarterly MDS dated [DATE], that noted facility staff assessed the resident as rarely/never understood and severely impaired in cognitive skills for daily decision making. Clinical record review for Resident 11 revealed a diagnosis list that included dementia and a quarterly MDS dated [DATE], that noted facility staff assessed the resident as having a BIMS of 99, which indicated the resident was unable to complete the assessment interview. The MDS further noted the resident's cognitive skills for daily decision making were assessed as moderately impaired. Clinical record review for Resident 12 revealed a diagnosis list that included dementia and an annual MDS dated [DATE], that noted facility staff assessed the resident as having a BIMS of 99, which indicated the resident was unable to complete the assessment interview. The MDS further noted the resident's cognitive skills for daily decision making were assessed as moderately impaired. Clinical record review for Resident 13 revealed a diagnosis list that included dementia and an admission MDS dated [DATE], that noted facility staff assessed the resident as having a BIMS of 99, which indicated the resident was unable to complete the assessment interview. The MDS further noted the resident's cognitive skills for daily decision making were assessed as moderately impaired. (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 7 Event ID: 395779 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 395779 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Centre Care Rehabilitation and Wellness Services 250 Persia Road Bellefonte, PA 16823 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)