Health inspection·April 3, 2025

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on facility policy, clinical record review, and staff interviews, it was determined that the facility failed to provide services necessary to maintain adequate personal grooming of residents dependent on staff for assistance with these activities of daily living for two of six residents reviewed (Residents 3 and 4). Residents Affected - Few Findings Include: Review of the facility policy, titled Resident Bath/Showering/Scheduling Policy with a last revised date of September 9, 2022, revealed (A) Each resident will be asked about his/her bathing preferences upon admission (type of bath, preferred days and times), (H) If the bath/shower cannot be given or the resident refuses, the nursing assistant will promptly report this to the Charge Nurse, and (I) The Charge Nurse will speak with the resident who refuses to ascertain why they are refusing and to determine if alternate arrangement that suit the resident can be made. If the resident continues to refuse the Charge Nurse document the resident's refusal in the medical record. Review of Resident 3's clinical record revealed diagnoses that included chronic kidney disease (a long-term condition where the kidneys gradually lose their ability to filter waste products and excess fluid from the blood) and hypertension (high blood pressure). Review of Resident 3's clinical record revealed their shower days are on every Wednesday and Saturday. Review of Resident 3's clinical record failed to reveal their bathing preference. Review of Resident 3's current care plan revealed a problem area that the Resident is unable to effectively communicate related to dementia, hearing loss. Mostly non-verbal, speaks in non-sensical sentences, gibberish, unable to follow commands, unable to answer simple yes/no questions appropriately, created on August 14, 2024. Review of Resident 3's Activities of Daily Living (ADL's) type of bath task from March 1, 2025, through April 2, 2025, revealed that the Resident received a bed bath on their scheduled shower days on March 1, 5, 8, 15, 22, 26, 29, 2025, and on April 2, 2025. Review of Resident 3's progress notes from March 1, 2025, through April 2, 2025, failed to reveal any notes indicating a shower refusal on the dates listed above. Review of Resident 4's clinical record revealed diagnoses that included dementia (loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life) and hypertension. (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: 395785 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 395785 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stonebridge Health & Rehabilitation Center 102 Chandra Drive Duncannon, PA 17020 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)