Inspection visit
Inspection
28 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 28 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or
her rights.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a
review of facility policy, clinical record review, observations, and resident, family and staff interviews, it was
determined that the facility failed to provide privacy during medication administration for one of five
residents (R51), failed to provide an environment that maintained and enhanced each resident's quality of
life for one of two residents (Resident R75), and failed to treat resident with respect by failing to address a
resident by their preferred name for one of three residents (Resident R93).
Findings include:
Review of facility policy Dignity dated 5/18/24, indicated that each resident shall be cared for in a manner
that promotes and enhances his or her sense of well- being, level of satisfaction with life, and feelings of
self-worth and self-esteem. Residents are treated with dignity and respect at all times. Demeaning practices
and standards of care that compromise dignity is prohibited. Staff are expected to promote dignity and
assist residents.
Review of facility policy Resident Rights dated 5/18/24, indicated that employees shall treat all residents
with kindness, respect, and dignity which includes providing privacy and confidentiality.
Review of facility policy Translation and/or Interpretation of Facility Services dated 5/18/24, indicated that
the facility's language access program will ensure that individuals with limited English proficiency (LEP)
shall have meaningful access to information and services provided by the facility. It is understood that
providing meaningful access to services provided by this facility requires also that the LEP resident's needs
and questions are accurately communicated to the staff. Oral interpretation services therefore included
interpretation from the LEP resident's primary language back to English. It is understood that in order to
provide meaningful access to services provided by this facility, translation and/or interpretation must be
provided in a way that is culturally relevant and appropriate to the LEP individual.
Review of the clinical record indicated that Resident R51 was admitted to the facility on [DATE].
Review of Resident R51's Minimum Data Set (MDS - periodic assessment of care needs) dated 5/2/24,
indicated diagnoses of hypertension (high blood pressure in the arteries), diabetes (a metabolic disorder in
which the body has high sugar levels for prolonged periods of time), and cerebral infarction (necrotic tissue
in the brain resulting loss of blood and oxygen to the brain). Section K0520, Nutritional Approaches
indicated feeding tube (a tube inserted through the wall of the abdomen into the stomach and can be used
to provide liquid food, medication, or liquids).
(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 71
Event ID:
395790
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0550
Level of Harm - Minimal harm
or potential for actual harm
During an observation on 7/10/24, at 8:15 a.m. Resident R51 was given medication through a feeding tube
with a housekeeper standing at the foot of resident ' s bed in his room.
During an interview on 7/10/24, at 8:20 a.m. Registered Nurse Employee E14 stated I did not ask the
housekeeper to leave before I gave resident his medication.
Residents Affected - Some
Review of Resident R51's physician orders on 7/10/24, at 8:45 a.m. indicated:
· Aspirin 81 mg one time a day for coronary artery disease (damage or disease in the heart's major
blood vessels)
· Duloxetine 30 mg one time a day for depression
· Flomax 0.4mg one time a day for Urinary Retention
· Repaglinide 1 mg three times a day for Diabetes
· FiberLaxative one tab one time a day for supplement
· Losartan Potassium 50 mg one time a day for hypertension
· Metoprolol 50 mg twice a day for hypertension
During an interview on 7/10/24, at 3:15 p.m. Director of Nursing confirmed that the facility failed to provide
privacy during medication administration for one of five residents (R51).
Review of the clinical record indicated that Resident R75 was admitted to the facility on [DATE].
Review of Resident R75's MDS dated [DATE], indicated diagnoses of hypertension, heart failure (a
progressive heart disease that affects pumping action of the heart muscles), and anemia (too little iron in
the body causing fatigue). Section A1110 Language stated preferred language is Spanish.
During an attempted interview on 7/8/24, at 9:30 a.m. with Resident R75 indicated resident speaking in a
different language other than English when asked a question.
During an observation on 7/8/24 through 7/12/24, Resident R75 was unable to communicate in a language
that could be understood by staff.
Review of Resident R75's plan of care failed to include a communication care plan with obtainable goals
and interventions related to Resident R75's language barrier.
During an interview on 7/8/24, at 1:28 p.m. Licensed Practical Nurse Employee E14 stated that Resident
R75's son and daughter visit every day. When they are not in the facility, she uses common signs like
pointing to belly and I show her medications to her. I can't understand her though.
During an interview on 7/8/24, at 2:38 p.m. Nurse Assistant (NA) Employee E25 stated I have never been
assigned to take care of Resident R75 however if I would have to care for her, I would need help to
communicate with her.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 2 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
During an interview on 7/8/24, at 2:39 p.m. NA Employee E26 stated I understand a little Italian and
Spanish but don ' t speak it. Sometimes she will point to something but I ' m not really sure if she
understands, and I don ' t understand what she says back.
During an interview on 7/8/24, at 2:42 p.m. NA Employee E27 stated I understand Spanish a little but no
Italian. I try to use gestures with her. I know what bathroom means. She was speaking Italian and pointed to
her neck. I asked her if she is in pain, and she stated Yes in Spanish. I don't know if she understood that I
asked her if she is in pain. Her roommate helps a little. If we had a translator, it would be great, so I don't
get confused about what she wants. We can only use personal phones to help with translation. There is no
translation device that we can use for her.
During an interview on 7/10/24, at 9:10 a.m. Registered Nurse Employee R28 stated I point and tell her
what medication I give her. Sometimes I wait to give her medication until her son gets here at noon. He kind
of plays the [NAME]. I never seen any equipment in her room to help communicate with her.
During an interview on 7/12/24, at 2:10 p.m. Resident R75's Representative stated Me and my sister are
the only ones that can communicate with her because she mixes Italian with Spanish. Every time staff have
a problem, they call me because I only live fifteen minutes from here. When she was at an acute hospital
they had a translator for her. She doesn't understand the English language.
During an interview on 7/8/24, at 3:15 p.m. the Director of Nursing confirmed that the facility failed to
provide an environment that maintained and enhanced each resident's quality of life by failing to provide
readily accessible interpretive services for a limited English proficiency resident.
Review of clinical record revealed that Resident R93 was admitted to the facility on [DATE].
Review of Resident 93's MDS (Minimum Data Set, periodic assessment of resident care needs) dated
5/11/24, indicated diagnoses of high blood pressure, chronic kidney disease, and hyponatremia (low
sodium level in the blood). Section A1300 D under the question Name by which resident prefers to be
addressed, was left blank.
During an interview on 7/8/24, at 1:12 p.m. when State Agency asked Resident R93 what name she
preferred to be called, Resident R93 stated her preferred name and added that no staff members refer to
her by her preferred name and have not asked her what name she prefers.
During an interview on 7/10/24, at 2:02 p.m. Social Service Director Employee E5 confirmed that Resident
R93's preferred name choice was not documented, and the facility failed to ensure that the facility
respected Resident R93's preferences in her name choice.
28 Pa. Code: 201.29(j) Resident rights.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 3 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0558
Reasonably accommodate the needs and preferences of each resident.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of facility policy, observations, and staff interview, it was determined that the facility failed to
accommodate the call bell needs for one of five residents (Resident R38).
Residents Affected - Few
Findings include:
Review of facility policy Call System, Resident dated 5/18/24, indicated residents are provided with a
means to call staff for assistance through a communication system that directly calls a staff member or a
centralized work station. Each resident is provided with a means to call staff directly for assistance from
his/her bed, from toileting/bathing facilities and from the floor. The resident call system remains functional at
all times.
Review of the clinical record indicated Resident R38 was admitted to the facility on [DATE].
Review of Resident R38's Minimum Data Set (MDS - a periodic assessment of care needs) dated 4/7/24,
indicated diagnoses of high blood pressure, muscle wasting, and dementia (a group of symptoms that
affects memory, thinking and interferes with daily life).
During an observation on 7/8/24, at 10:16 a.m. Resident R38 was observed lying in bed with her call bell
placed at the top of the mattress, behind her pillow, completely out of the resident's visual sight and reach.
During an interview on 7/8/24, at 10:18 a.m. Licensed Practical Nurse Employee E1 confirmed Resident
R38's call bell was not accessible and unavailable for use to the resident.
During an interview on 7/8/24, at 3:05 p.m. the Director of Nursing confirmed that the facility failed to
accommodate the call bell needs for one of five residents (Resident R38).
28 Pa. Code: 201.29(j) Resident rights.
28 Pa. Code: 211.10(d) Resident care policies.
28 Pa. Code: 211.12(d)(3)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 4 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0578
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to
participate in experimental research, and to formulate an advance directive.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of facility policy, clinical records, and staff interview, it was determined that the facility failed to
provide the opportunity to formulate an advance directive (a written instruction such as a living will or
durable power of attorney for health care for when the individual is incapacitated) for one of three residents
reviewed (Resident R43).
Review of the facility policy Advanced Directives, dated 5/18/24, indicated that upon admission, the resident
will be provided with written information concerning the right to refuse or accept medical or surgical
treatment and to formulate an advanced directive if he or she chooses to do so. Information about whether
or not the resident has executed an advanced directive shall be displayed prominently in the medical chart.
Review of the clinical record revealed that Resident R43 was admitted to the facility on [DATE].
Review of Resident 43's MDS dated [DATE], indicated diagnoses of quadriplegia (paralysis of all four
limbs), high blood pressure, and dry eyes.
Review of clinical record conducted on 7/10/24 failed to reveal any documentation that Resident R43 was
offered an opportunity to complete Advanced directives
During an interview on 7/10/24, at 1:52 p.m. Social Worker Director Employee E5 confirmed that the clinical
record did not include documentation that Resident R43 was afforded the opportunity to formulate
Advanced Directives.
28 Pa. Code: 201.29(b)(d)(j) Resident rights.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 5 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0583
Keep residents' personal and medical records private and confidential.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of facility policy, observation, and staff interview it was determined that the facility failed to maintain
the confidentiality of residents' medical information on one of three nursing units (Third Floor) and two of
nine residents (Resident R9 and R285).
Residents Affected - Few
Findings include:
Review of facility policy Confidentiality of Information and Personal Privacy dated 5/18/24, indicated the
facility will safeguard the personal privacy and confidentiality of all resident personal and medical records.
Access to resident personal and medical records will be limited to authorized staff and business associates.
During an observation on 7/8/24, at 12:21 p.m. the Third Floor [NAME] Medication Cart at the nurse's
station was left unattended with the computer screen open with identifiable information any passerby could
see resident personal and confidential information.
During an interview on 7/8/24, at 12:24 p.m. Licensed Practical Nurse (LPN) Employee E2 confirmed the
above observation.
During an interview on 7/8/24, at 3:05 p.m. the Nursing Home Administrator confirmed that the facility failed
to maintain the confidentiality of residents' medical information on one of three nursing units (Third Floor).
Review of the clinical record indicated that Resident R9 was admitted to the facility on [DATE].
Review of Residents R9's Minimum Data Set (MDS - a periodic assessment of care needs) dated 5/8/24,
indicated diagnoses of multiple sclerosis (a potentially disabling disease of the brain and spinal cord
(central nervous system), depression, and osteoarthritis (occurs when the protective cartilage that cushions
the ends of the bones wears down over time.)
Review of Resident R9's physician order dated 2/7/24, indicated to apply a splint with left hand palm
protector at all times, remove for hygiene and skin checks.
During an observation on 7/10/24, at 9:46 a.m. a sign was observed posted on the resident's wall and bed
that stated the resident is to have boots on at all times (AAT) please remove for bathing and put back on
after bathing, blue wedge with strap between lower legs to prevent crossing of ankles left palm guard.
During an interview on 7/10/24, at 9:47 a.m. Registered Nurse, Employee E4 confirmed the facility failed to
maintain the confidentiality of Resident R9's medical information.
Review of the clinical record indicated that Resident R285 was admitted to the facility on [DATE].
Review of Residents R285's MDS dated [DATE], indicated the diagnoses of respiratory failure (not enough
oxygen in the blood) and heart failure (a progressive heart disease that affects pumping action of the heart
muscles, which causes fatigue and shortness of breath.).
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 6 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0583
Level of Harm - Minimal harm
or potential for actual harm
Review of Resident R285's physician order dated 6/23/24, indicated the resident requires a pureed (a
smooth, creamy substance or thick liquid suspension) texture, mildly thick consistency regular diet.
During an observation on 7/8/24, at 10:24 a.m. a sign was observed posted on the wall behind Resident
R285's bed that stated Nectar Thick.
Residents Affected - Few
During an interview on 7/8/24, at 10:26 a.m. Licensed Practical Nurse, Employee E14 confirmed the facility
failed to maintain the confidentiality of Resident R285's medical information.
28 Pa. code: 211.5(b) Clinical records.
28 Pa. Code: 201.29(i) Resident Rights.
28 Pa. Code: 211.12(d)(3) Nursing Services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 7 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0607
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of facility policy, grievance records, reports submitted to the state, and staff interviews, it was
determined that the facility failed to implement the facility abuse and neglect policy for two of four
allegations (Resident R15 and Resident R38).
Residents Affected - Few
Findings include:
Review of facility policy Abuse, Neglect, Exploitation or Misappropriation- Reporting and Investigating dated
5/18/24, indicated all reports of resident abuse, neglect, exploitation, or theft, misappropriation of resident
property are reported to local, state, and federal agencies and thoroughly investigated by facility
management. Findings of all investigations are documented and reported. If abuse or neglect is suspected,
the suspicion must be reported immediately to the administrator and to other officials according to state
law.
Immediately is defined as:
* within two hours of an allegation involving abuse or results in serious bodily injury; or
* within 24 hours of an allegation that does not involve abuse or result in serious bodily injury.
Review of Title 42 Code of Federal Regulations (CFR) §483.12(c) states in response to allegations of
abuse, neglect, exploitation, or mistreatment, the facility must ensure that all alleged violations involving
abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of
resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the
events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if
the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the
administrator of the facility and to other officials (including to the State Survey Agency and adult protective
services where state law provides for jurisdiction in long-term care facilities) in accordance with State law
through established procedures.
Review of the clinical record indicated Resident R15 was admitted to the facility on [DATE], and readmitted
[DATE].
Review of Resident R15's Minimum Data Set (MDS - a periodic assessment of care needs) dated 4/30/24,
indicated diagnoses of quadriplegia (paralysis of all four limbs), aphasia (difficulty speaking), and anxiety.
Review of facility provided grievance dated 7/9/24, at 12:04 p.m. indicated the facility was notified that
Resident R15 wanted to get out of bed before breakfast and was not gotten out of bed before lunch.
A review of incidents submitted to the State on 7/11/24, at 12:50 p.m. did not include the neglect allegation
involving Resident R15.
During an interview on 7/12/24, at 8:31 a.m. the Director of Nursing (DON) and Nursing Home
Administrator (NHA) confirmed Resident R15's allegation of neglect was not reported within 24 hours.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 8 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0607
Review of the clinical record indicated Resident R38 was admitted to the facility on [DATE].
Level of Harm - Minimal harm
or potential for actual harm
Review of Resident R38's MDS dated [DATE], indicated diagnoses of high blood pressure, anxiety, and
blindness in one eye.
Residents Affected - Few
During a review of facility provided grievances on 7/11/24, at 10:24 a.m. revealed an allegation of neglect
for Resident R38 that was submitted by resident's daughter on 7/4/24.
During a review of the facility provided grievances on 7/11/24, at 10:35 a.m. revealed an allegation of
neglect for Resident R38. The grievance completed states that her daughter visited Resident R38 on
7/4/24, at 1:55 p.m. and stated mom's cold, untouched lunch tray was still on bedside. Resident R38's
daughter stated If I hadn't shown up, mom would not have eaten. Mom needs help eating and no one
helped or fed her. She ate a lot and even ate her snacks later that was provided with my assistance and
mom reeked of urine and her roommate's clothing and bedding were filthy with spilled meals and drinks.
These women were not taken care of properly today. The aide was neglectful of her duties.
During a review of a witness statement on 7/11/24, at 10:45 a.m. revealed that Resident R38's daughter
spoke with Unit Manager Employee E22 on 7/4/24, at 3:00 p.m. Employee E2 wrote The resident wasn't
rounded on all day. I kept telling the aide to do her rounds. She came in at 8:15 a.m., and was seen sitting
in different areas on the floor instead of doing her rounds.
A review of incidents submitted by the facility to the State Agency on 7/11/24, at 12:45 p.m., did not include
the neglect allegation involving Resident R38.
During an interview on 7/11/24, at 12:50 p.m. the Nursing Home Administrator (NHA) stated that she
followed up on this grievance and we just figured there were other staff on the floor that day and we just
thought that she would have been cared for. The aide is on the DNR (Do not return) list.
During an interview on 7/11/24, at 12:53 p.m. the NHA confirmed that a thorough investigation was not
completed or reported and they will get the report submitted today.
During an interview on 7/11/24, at 12:58 p.m. the NHA confirmed that the facility failed to report an
allegation of abuse or neglect in the required timeframe and failed to implement the facility abuse and
neglect policy for two of four allegations (Resident R15 and Resident R38).
28 Pa Code: 201.14 (a) Responsibility of Management
28 Pa Code: 201.18 (e )(1) Management.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 9 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0609
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper
authorities.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of facility policy, facility grievances, reports submitted to the State, and staff interviews, it was
determined that the facility failed to report an allegation of abuse or neglect for one of four residents
(Resident R38).
Findings include:
Review of facility policy Abuse, Neglect, Exploitation or Misappropriation- Reporting and Investigating dated
5/18/24, indicated all reports of resident abuse, neglect, exploitation, or theft, misappropriation of resident
property are reported to local, state, and federal agencies and thoroughly investigated by facility
management. Findings of all investigations are documented and reported. If abuse or neglect is suspected,
the suspicion must be reported immediately to the administrator and to other officials according to state
law.
Immediately is defined as:
- within two hours of an allegation involving abuse or result in serious bodily injury; or
- within 24 hours of an allegation that does not involve abuse or result in serious bodily injury.
Review of Title 42 Code of Federal Regulations (CFR) §483.12(c) states in response to allegations of
abuse, neglect, exploitation, or mistreatment, the facility must ensure that all alleged violations involving
abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of
resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the
events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if
the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the
administrator of the facility and to other officials (including to the State Survey Agency and adult protective
services where state law provides for jurisdiction in long-term care facilities) in accordance with State law
through established procedures.
Review of the clinical record indicated Resident R38 was admitted to the facility on [DATE].
Review of Resident R38's Minimum Data Set (MDS - a periodic assessment of care needs) dated 1/25/24,
indicated diagnoses of high blood pressure, anxiety, and blindness in one eye.
During a review of facility provided grievances on 7/11/24, at 10:24 a.m. revealed an allegation of neglect
for Resident R38 that was submitted by resident's daughter on 7/4/24.
During a review of the facility provided grievances on 7/11/24, at 10:35 a.m. revealed an allegation of
neglect for Resident R38. The grievance completed states that her daughter visited Resident R38 on
7/4/24, at 1:55 p.m., and stated mom's cold, untouched lunch tray was still on bedside. Resident R38's
daughter stated If I hadn't shown up, mom would not have eaten. Mom needs help eating and no one
helped or fed her. She ate a lot and even ate her snacks later that was provided with my assistance and
mom reeked of urine and her roommate's clothing and bedding were filthy with spilled meals and drinks.
These women were not taken care of properly today. The aide was neglectful of her duties.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 10 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0609
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
During a review of a witness statement on 7/11/24, at 10:45 a.m. revealed that Resident R38's daughter
spoke with Unit Manager Employee E22 on 7/4/24, at 3:00 p.m. Employee E2 wrote The resident wasn't
rounded on all day. I kept telling the aide to do her rounds. She came in at 8:15 a.m., and was seen sitting
in different areas on the floor instead of doing her rounds.
A review of incidents submitted to the State on 7/11/24, at 12:45 p.m., did not include the neglect allegation
involving Resident R38.
During an interview on 7/11/24, at 12:50 p.m. the Nursing Home Administrator (NHA) stated that she
followed up on this grievance and we just figured there were other staff on the floor that day and we just
thought that she would have been cared for. The aide is on the DNR (Do not return) list.
During an interview on 7/11/24, at 12:53 p.m. the NHA confirmed that a thorough investigation was not
completed or reported and they will get the report submitted today.
During an interview on 7/11/24, at 12:58 p.m. the NHA confirmed that the facility failed to report an
allegation of abuse or neglect for one of four residents in a timely manner, as required (Resident R38).
28 Pa Code: 201.14 (a) Responsibility of Management
28 Pa Code: 201.18 (e )(1) Management.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 11 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0610
Respond appropriately to all alleged violations.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of facility policy, facility grievances, investigation documentations, and staff interviews, it was
determined that the facility failed to conduct a thorough investigation involving an allegation of neglect for
one out of four residents (Resident R38).
Residents Affected - Few
Findings include:
Review of facility policy Abuse, Neglect, Exploitation or Misappropriation- Reporting and Investigating dated
5/18/24, indicated all reports of resident abuse, neglect, exploitation, or theft, misappropriation of resident
property are reported to local, state, and federal agencies and thoroughly investigated by facility
management. Findings of all investigations are documented and reported. If abuse or neglect is suspected,
the suspicion must be reported immediately to the administrator and to other officials according to state
law.
Immediately is defined as:
- within two hours of an allegation involving abuse or result in serious bodily injury; or
- within 24 hours of an allegation that does not involve abuse or result in serious bodily injury.
Review of Title 42 Code of Federal Regulations (CFR) §483.12(c) states in response to allegations of
abuse, neglect, exploitation, or mistreatment, the facility must ensure that all alleged violations involving
abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of
resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the
events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if
the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the
administrator of the facility and to other officials (including to the State Survey Agency and adult protective
services where state law provides for jurisdiction in long-term care facilities) in accordance with State law
through established procedures.
Review of the clinical record indicated Resident R38 was admitted to the facility on [DATE].
Review of Resident R38's Minimum Data Set (MDS - a periodic assessment of care needs) dated 1/25/24,
indicated diagnoses of high blood pressure, anxiety, and blindness in one eye.
During a review of facility provided grievances on 7/11/24, at 10:24 a.m. revealed an allegation of neglect
for Resident R38 that was submitted by resident's daughter on 7/4/24.
During a review of the facility provided grievances on 7/11/24, at 10:35 a.m. revealed an allegation of
neglect for Resident R38. The grievance completed states that her daughter visited Resident R38 on
7/4/24, at 1:55 p.m. and stated mom's cold, untouched lunch tray was still on bedside. Resident R38's
daughter stated If I had not shown up, mom would not have eaten. Mom needs help eating and no one
helped or fed her. She ate a lot and even ate her snacks later that was provided with my assistance and
mom reeked of urine and her roommate's clothing and bedding were filthy with spilled meals and drinks.
These women were not taken care of properly today. The aide was neglectful of her duties.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 12 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0610
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
During a review of a witness statement on 7/11/24, at 10:45 a.m., revealed that daughter spoke with Unit
Manager Employee E22 on 7/4/24, at 3:00 p.m. Employee E2 wrote, The resident was not rounded on all
day. I kept telling the aide to do her rounds. She came in at 8:15 a.m. and was seen sitting in different areas
on the floor instead of doing her rounds.
A review of incidents submitted to the State on 7/11/24, at 12:45 p.m. did not include the neglect allegation
involving Resident R38.
During an interview on 7/11/24, at 12:50 p.m. the Nursing Home Administrator (NHA) stated that she
followed up on this grievance and we just figured there were other staff on the floor that day and we just
thought that she would have been cared for. The aide is on the DNR (Do not return) list.
During an interview on 7/11/24, at 12:53 p.m. the NHA confirmed that a thorough investigation was not
completed or reported, and they will get the report submitted today.
During an interview on 7/11/24, at 12:58 p.m. the NHA confirmed the facility failed to complete a thorough
investigation to rule out abuse and neglect as required for one out of four residents (Resident R38).
28 Pa Code: 201.18 (e)(1)(2) Management
28 Pa Code: 201.29 (a )(c)(d) Resident Rights
28 Pa Code: 211.12 (a)(c)(d)(1)(3)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 13 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0622
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Not transfer or discharge a resident without an adequate reason; and must provide documentation and
convey specific information when a resident is transferred or discharged.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of facility policies, resident records and staff interview, it was determined that the facility failed to
acquire and document a physician's discharge order for one out of three resident records (Resident R133)
reviewed, and failed to make certain that the necessary resident information was communicated to the
receiving health care provider for five out of six residents sampled with facility initiated transfers (Residents
R28, R43, R64, R75, and R83).
Finding include:
The facility Discharge Summary and Plan policy dated 5/18/24, indicated that when a resident's discharge
is anticipated, a discharge summary and post-discharge plan will be developed to assist the resident to
adjust to his/her new living environment. The discharge summary will include a recapitalization of the
resident's stay at this facility and a final summary of the resident's status at the time of discharge in
accordance with established regulations governing release of resident information and as permitted by the
resident.
Review of the facility policy Transfer Form dated 5/18/24, indicated that should it become necessary to
transfer a resident from the facility, a Transfer Form will be executed and forwarded with the resident. The
Transfer Form will be completed by Nursing Service and will include:
·
Current medical findings
·
Diagnosis
·
Medications at time of discharge
·
Rehabilitative potential
·
Nursing/dietary information
·
ADL (activities of daily living) function
·
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 14 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0622
Ambulation status
Level of Harm - Minimal harm
or potential for actual harm
·
Summary of the course of treatment followed
Residents Affected - Some
·
Basis for the transfer
·
Contact information of the practitioner responsible for the care of the resident
·
Resident representative information including contact information
·
Advanced Directive information
·
All special instructions or precautions for ongoing care
·
Comprehensive care plan goals
·
All other necessary information, including a copy of the residents discharge summary, and any other
documentation
A copy of the Transfer Form will be filed in the resident's medical record.
Review of the clinical record indicated that Resident R28 was admitted to the facility on [DATE].
Review of Resident 28's Minimum Data Set (MDS - a periodic assessment of care needs) dated 5/8/24,
indicated diagnoses of muscle weakness, high blood pressure, and diabetes.
Review of clinical record revealed that Resident R28 was sent out to the hospital on 6/29/24,at 10:57 a.m.
and returned to the facility on 6/29/24, at 5:40 p.m
Review of Resident R28's clinical record revealed no documented evidence that the facility had
communicated specific information to the receiving health care provider for the residents transferred and
expected to return, which included the resident's care plan goals, advanced directive information, specific
instructions for ongoing care, resident representative information, and all information
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 15 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0622
necessary to meet the resident's specific needs at the receiving facility.
Level of Harm - Minimal harm
or potential for actual harm
Review of the clinical record indicated that Resident R43 was admitted to the facility on [DATE].
Residents Affected - Some
Review of Resident 43's MDS dated [DATE], indicated diagnoses of quadriplegia (paralysis of all four
limbs), high blood pressure, and dry eyes.
Review of clinical record revealed that resident was sent out to the hospital on 6/26/24, and returned to the
facility on 6/27/24.
Review of Resident R43's clinical record revealed no documented evidence that the facility had
communicated specific information to the receiving health care provider for the residents transferred and
expected to return, which included the resident's care plan goals, advanced directive information, specific
instructions for ongoing care, resident representative information, and all information necessary to meet the
resident's specific needs at the receiving facility.
Review of the clinical record indicated that Resident R64 was admitted to the facility on [DATE].
Review of Resident 64's MDS dated [DATE], indicated diabetes, high blood pressure, and cerebral palsy
(group of disorders that affect a person's ability to move and maintain balance and posture).
Review of clinical record revealed that Resident R64 was sent out to the hospital on 1/27/24 and returned
to the facility on 2/8/24.
Review of Resident R64's clinical record revealed no documented evidence that the facility had
communicated specific information to the receiving health care provider for the residents transferred and
expected to return, which included the resident's care plan goals, advanced directive information, specific
instructions for ongoing care, resident representative information, and all information necessary to meet the
resident's specific needs at the receiving facility.
Review of the clinical record indicated that Resident R75 was admitted to the facility on [DATE].
Review of Resident R75's MDS dated [DATE], indicated diagnoses of high blood pressure, heart failure (a
progressive heart disease that affects pumping action of the heart muscles), and anemia (too little iron in
the body causing fatigue).
Review of clinical record indicated that Resident R75 was sent out to the hospital on 5/16/24, and returned
to the facility on 5/17/24.
Review of Resident R75's clinical record revealed no documented evidence that the facility had
communicated specific information to the receiving health care provider for the residents transferred and
expected to return, which included the resident's care plan goals, advanced directive information, specific
instructions for ongoing care, resident representative information, and all information necessary to meet the
resident's specific needs at the receiving facility.
Review of the clinical record indicated Resident R83 was admitted to the facility on [DATE].
Review of Resident R83's MDS dated [DATE], indicated diagnoses of high blood pressure, septicemia (a
serious infection that occurs when bacteria enter the bloodstream), and dementia (a group of
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 16 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0622
symptoms that affects memory, thinking, and interferes with daily life).
Level of Harm - Minimal harm
or potential for actual harm
Review of the clinical record indicated Resident R83 was transferred to the hospital on 4/16/24 and
returned to the facility on 4/20/24.
Residents Affected - Some
Review of Resident R83's clinical record revealed no documented evidence that the facility had
communicated specific information to the receiving health care provider for the residents transferred and
expected to return, which included the resident's care plan goals, advanced directive information, specific
instructions for ongoing care, resident representative information, and all information necessary to meet the
resident's specific needs at the receiving facility.
During an interview on 7/11/24, at 12:44 p.m. the Director of Nursing (DON) confirmed that there was no
evidence that the necessary information was communicated to the receiving health care institution or
provider upon transfer for six out of six residents sampled with facility initiated transfers (Residents R28,
R43, R51, R64, R75 and R83).
Review of the clinical record indicated Resident R133 was admitted to the facility 3/16/24.
Review of Resident R133's MDS dated [DATE], indicated diagnosis that included peripheral vascular
disease (blood circulation disorder that affects the blood vessels outside the brain and heart), diabetes
(endocrine disease that affects how the body uses blood sugar), and hypothyroidism (condition resulting
from decrease production of thyroid hormones).
Review of Resident R133's clinical physician progress note dated 4/11/24, indicated that today, she will be
returning to her prior Independent Living Facility.
Review of Resident R133's clinical progress note dated 4/11/24, indicated that Resident R133 is scheduled
for discharge this afternoon with all personal belongings and balance of medications; will proceed with
discharge plan per orders.
Review of Resident R133's clinical record did not include a physician's order to discharge home from the
facility.
During an interview on 7/9/24, at 12:52 p.m., the Director of Nursing (DON) confirmed that the facility failed
to acquire and document a physician's discharge order for one of three resident records (Resident R133),
and failed to make certain that the necessary resident information was communicated to the receiving
health care provider for five out of six residents sampled with facility initiated transfers (Residents R28,
R43, R64, R75, and R83).
28 Pa. Code 201.29 (a)(c.3)(2) Resident rights.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 17 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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
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
review of facility policy, clinical record review, and staff interviews, it was determined that the facility failed to
make certain that resident assessments were accurate for seven of 23 residents (Resident R2, R6, R21,
R38, R64, R68, and R285).
Residents Affected - Some
Findings include:
Review of facility policy Certifying Accuracy of the Resident Assessment, dated 5/18/24, indicated the
information captured on the assessment reflects the status of the resident during the observation
(look-back) period for that assessment.
Review of the clinical record indicated Resident R2 was admitted to the facility on [DATE].
Review of Resident R2's Quarterly Minimum Data Set (MDS - a periodic assessment of care needs) dated
5/26/24, indicated diagnoses of high blood pressure, hemiplegia (paralysis on one side of the body), and
muscle weakness. Review of Section GG - Functional Abilities and Goals indicated Resident R2 was coded
as 1 dependent upon staff for roll left and right.
Review of a physician order dated 2/22/24, indicated the usage of bilateral upper quarter side rails for
mobility and positioning every shift.
During an observation on 7/12/24, at 11:26 a.m. Licensed Practical Nurse (LPN) Employee E1 confirmed
there were bilateral upper side rails on Resident R2's bed. During this observation, LPN Employee E1
stated, Resident R2 is able to use the side rails during bed mobility, he is able to hold on to the bars while
care is being provided.
Review of Resident R2's MDS - Optional State assessment dated [DATE], Section G - Functional Status,
Question G0110 indicated Resident R2 was coded 3 extensive assistance to complete bed mobility.
During an interview on 7/12/24, at 12:24 p.m. MDS Coordinator Employee E9 stated, Resident R2 uses the
side rails for turning assistance, he should not be coded as dependent on his quarterly MDS.
During an interview on 7/12/24, at 12:24 p.m. MDS Coordinator Employee E9 confirmed that the facility
failed to make certain Resident R2's resident assessment was accurate.
Review of the clinical record indicated Resident R6 was admitted to the facility on [DATE].
Review of Resident R6's MDS dated [DATE], indicated diagnoses of depression, anemia (too little iron in
the body causing fatigue), and post traumatic stress disorder (a disorder in which a person has difficulty
recovering after experiencing or witnessing a terrifying event). Section P, Restraints and Alarms, MDS was
coded 2, side rails used daily.
Review of a physician order dated 2/22/24, indicated the usage of bilateral upper quarter side rails for
mobility and positioning while in bed.
During an observation on 7/12/24, at 10:03 a.m. bilateral side rails were observed on bed. Resident R6
stated I use them to help me in bed.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 18 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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
During an interview on 7/12/24, at 12:25 p.m. MDS Coordinator Employee E9 confirmed the upper side rails
were not being used as a restraint on R6's bed.
During an interview on 7/12/24, at 12:27 p.m. MDS Coordinator Employee E9 confirmed there were
bilateral upper side rails on Resident R6's bed for positioning.
Residents Affected - Some
During an interview on 7/12/24, at 12:29 p.m. MDS Coordinator Employee E9 confirmed that the facility
failed to make certain Resident R6's resident assessment was accurate.
Review of the clinical record indicated Resident R21 was admitted to the facility on [DATE].
Review of Resident R21's MDS dated [DATE], indicated diagnoses of high blood pressure, dementia (a
group of symptoms that affects memory, thinking and interferes with daily life), and muscle wasting. Review
of Section GG - Functional Abilities and Goals indicated Resident R21 was coded as 2 substantial/maximal
assistance from staff for roll left and right. Review of Section P - Restraints and Alarms, Question P0100
indicated Resident R21 was coded as 2 for bed rail used daily.
Review of a physician order dated 1/31/24, indicated the usage of bilateral upper side rails.
During an observation on 7/8/24 at 10:25 a.m. no side rails were observed on Resident R21's bed.
During an interview on 7/12/24, at 12:22 p.m. MDS Coordinator Employee E9 stated, (Resident R21) had
his bed switched over the weekend, that's why he does not currently have side rails on his bed. He did
previously use the side rails for mobility and positioning, but he has been performing bed mobility well
without them. His MDS is coded incorrectly for restraint usage.
During an interview on 7/12/24, at 12:22 p.m. MDS Coordinator Employee E9 confirmed that the facility
failed to make certain Resident R21's resident assessment was accurate.
Review of the clinical record indicated Resident R38 was admitted to the facility on [DATE].
Review of Resident R38's MDS dated [DATE], indicated diagnoses of high blood pressure, dementia, and
muscle wasting. Review of Section O - Special Treatments, Procedures, and Programs indicated the
Resident R38 was not receiving hospice care during the 14-day assessment period.
Review of a physician order dated 1/28/24, indicated to admit Resident R38 to hospice services.
During an interview on 7/8/24, at 10:48 a.m. Health Unit Coordinator (HUC) Employee E22 confirmed
Resident R38 receives hospice services on Mondays and Wednesdays.
During an interview on 7/8/24, at 12:03 p.m. Registered Nurse Assessment Coordinator (RNAC) Employee
E7 confirmed Resident R38's resident assessment was not accurately completed to reflect hospice care.
Review of the clinical record indicated Resident R64 was admitted to the facility on [DATE].
Review of Resident R64's MDS dated [DATE], indicated diagnoses of high blood pressure, diabetes (a
metabolic disorder in which the body has high sugar levels for prolonged periods of time), and cerebral
palsy (group of disorders that affect a person's ability to move and maintain balance and
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 19 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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
posture). Section P, Restraints and Alarms, MDS was coded 2, side rails used daily.
Level of Harm - Minimal harm
or potential for actual harm
Review of a physician order dated 3/1/24, indicated the usage of bilateral upper quarter side rails.
Residents Affected - Some
During an observation on 7/8/24, at 10:10 a.m. bilateral upper side rails were observed on Resident R64's
bed. Resident R64 stated I use them to help me move in bed.
During an interview on 7/12/24, at 12:25 p.m. MDS Coordinator Employee E9 confirmed the upper side rails
were not being used as a restraint on R64's bed.
During an interview on 7/12/24, at 12:27 p.m. MDS Coordinator Employee E9 confirmed there were
bilateral upper side rails on Resident R64's bed for positioning.
During an interview on 7/12/24, at 12:28 p.m. MDS Coordinator Employee E9 confirmed that the facility
failed to make certain Resident R64's resident assessment was accurate.
Review of the clinical record indicated Resident R68 was admitted to the facility on [DATE].
Review of Resident R68's MDS dated [DATE], indicated diagnoses of high blood pressure, asthma (a
condition where the airways narrow and swell), and Post-Traumatic Stress Disorder (PTSD - a disorder in
which a person has difficulty recovering after experiencing or witnessing a terrifying event and may have
triggers that can bring back memories of trauma accompanied by intense emotional and physical
reactions). Review of Section O - Special Treatments, Procedures, and Programs indicated Resident R38
did not receive oxygen therapy during the 14-day assessment period.
Review of Resident R68's Oxygen Saturations Summary revealed that the resident had received
supplemental oxygen for five days of the 14-day look-back period.
Review of Resident R68's care plan dated 5/15/24, indicated the resident has oxygen therapy related to
respiratory illness and the resident will have no signs or symptoms of poor oxygen absorption through the
review date.
During an interview on 7/10/24, at 2:50 p.m. RNAC Employee E7 confirmed Resident R68's resident
assessment was not accurately completed to reflect oxygen therapy.
Review of the clinical record indicated that Resident R285 was admitted to the facility on [DATE].
Review of Resident R285's MDS dated [DATE], indicated diagnoses of stage 3 pressure ulcer (localized
injury to the skinand underlying tissue, as a result of pressure, which involves full thickness tissue loss),
anxiety, and dementia. Section M- Skin Conditions indicated the resident had no unhealed pressure
ulcers/injuries.
Review of Resident R285's progress note dated 6/21/24, at 8:28 p.m. indicated the resident arrived by
ambulance to the facility. It was indicated the resident had a stage 3 on the coccyx.
During an interview on 7/10/24, at 12:01 p.m. RNAC Employee E7 confirmed that the facility failed to make
certain Resident R285's resident assessment was accurate.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 20 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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
28 Pa. Code 211.5(f) Clinical records.
Level of Harm - Minimal harm
or potential for actual harm
28 Pa. Code 211.12(d)(5) Nursing services.
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 21 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of facility policy, clinical record review, and staff interview, it was determined that the facility failed to
timely recheck and notify the physician of decreased Capillary Blood Glucose (CBG) levels for one of three
residents (Resident R284).
Residents Affected - Few
Findings include:
Review of facility policy Management of Hypoglycemia dated 5/18/24, indicated if a resident's blood sugar
is less than 70 milligrams per deciliter (mg/dl), but greater than 54 mg/dl then give the resident an oral form
of rapidly absorbed glucose (15-20 grams). Notify the provider immediately, remain with the resident, and
recheck the resident's blood glucose in 15 minutes. It was indicated to document the resident's blood
glucose before intervention, note the blood sugar after each administration of rapid-acting glucose and
follow-up blood sugar, record the resident's level of consciousness before and after intervention, document
provider instructions.
Review of the clinical record indicated Resident R284 was admitted to the facility on [DATE], with diagnoses
diabetes mellitus (a chronic (long-lasting) health condition that affects how your body turns food into
energy), anxiety, and depression.
Review of Resident R284's physician order dated 3/1/24, indicated to monitor the resident's blood glucose
in the evening for diabetes.
Review of Resident R284's care plan dated 5/3/24, indicated the resident has diabetes and interventions
included to monitor, document, and report as needed any signs and symptoms of hypoglycemia.
Review of Resident R284's Minimum Data Set (MDS - a periodic assessment of care needs) dated 6/17/24,
indicated diagnoses diabetes were current.
Review of Resident R284's progress note dated 7/8/24, at 9:08 p.m. indicated the resident's blood glucose
was 62. Resident R284 was eating a peanut butter and jelly sandwich, it was indicated her blood glucose
would be checked after snack. Review of the resident's clinical record failed to indicate the physician was
notified, and the resident's blood glucose was rechecked in 15 minutes as per the facility policy.
Review of Resident R284's progress note dated 7/8/24, at 11:34 p.m. indicated the resident's blood glucose
was 169. The facility failed to timely recheck Resident R284's blood glucose.
During an interview on 7/9/24, at 1:35 p.m. Licensed Practical Nurse (LPN), Employee E16 indicated if a
resident's blood glucose is less than 70 mg/dl then the hypoglycemia protocol is implemented. It was
indicated if the blood glucose is between 50-69 mg/dl then 15 grams of an oral carb such as 4 ounces of
apple juice, non-diet soft drink, or three graham crackers are provided to the resident. The resident's blood
glucose is then rechecked within 15 minutes, and the physician must be notified by the next business day. It
was indicated documentation of notification to the physician, interventions, and any new orders are entered
in the resident's clinical record.
During an interview on 7/9/24, at 1:40 p.m. LPN, Employee E10 stated Resident R284 is a brittle diabetic.
LPN, Employee E10 confirmed the facility failed to notify the physician of decreased
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 22 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0684
Capillary Blood Glucose (CBG) levels, and timely recheck Resident R284's blood glucose on 7/8/24.
Level of Harm - Minimal harm
or potential for actual harm
28 Pa. Code 201.18 (b)(1) Management
28 Pa. Code 201.29(d) Resident Rights
Residents Affected - Few
28 Pa. Code 211.10 (c)(d) Resident Care policies
28 Pa. Code 211.12 (d)(1)(2)(3)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 23 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0686
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of clinical records, facility policy, observations, and staff interviews, it was determined that the facility
failed to provide prescribed treatment and services related to the care of pressure ulcers for four of six
residents (Resident R4, R9, R83, R243) that resulted in worsening and new pressure area for one resident
(Resident R83) and failed to prevent avoidable pressure ulcer development that of a new pressure ulcer for
two of six residents (Resident R9).
Residents Affected - Some
Findings include:
Review of facility policy Prevention of Pressure Injuries, dated 5/18/24, indicated that the facility will conduct
a comprehensive skin assessment upon (or soon after) admission with each risk assessment, as indicated
according to the resident's risk factors, and prior to discharge. Use a standardized pressure injury
screening tool to determine risk factors. Inspect skin on a daily basis when performing or assisting with
personal care. Identify any signs of developing pressure injuries. Inspect pressure points sacrum (lower
back above the tailbone), heels, buttocks, ischium (the lower and back sides of the hip bone), etc.
Prevention includes:
· Keep the skin clean and hydrated.
· Clean promptly after episodes of incontinence.
· Avoid alkaline soaps and cleansers.
· Use a barrier product to protect skin from moisture.
· Use incontinence products with high absorbency.
· Do not rub or otherwise cause friction on skin that is at risk of pressure injuries.
Use facility approved protective dressings for at risk individuals.
Review of the United States Department of Health and Human Services, Agency for Healthcare Research
& Quality's, Safety Program for Nursing Home: On-Time Pressure Ulcer Prevention dated May 2016,
indicated that Pressure ulcers cause pain, disfigurement, and increased infection risk and are associated
with longer hospital stays and increased morbidity and mortality. Three critical components in preventing
pressure ulcers were listed: comprehensive skin assessments, standardized pressure ulcer risk
assessments, and care planning and implementation to address areas of risk.
Review of the National Library of Medicine, The Braden Scale for Predicting Pressure Sore Risk indicated
the scale was developed to foster early identification of patients at risk for forming pressure ulcers.
The scale consists of six subscales and the total range from 6-23, with the following distributions:
-Severe Risk: Less than or equal to 9.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 24 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0686
-High Risk: 10-12.
Level of Harm - Minimal harm
or potential for actual harm
-Moderate Risk: 13-14.
-Mild Risk: 15-18.
Residents Affected - Some
Review of the clinical record indicated that Resident R4 was admitted to the facility on [DATE], and
readmitted [DATE], with the diagnoses of end stage kidney disease (a condition where the kidney reaches
advanced state of loss of function), dependence on dialysis (a blood purifying treatment given when kidney
function is not optimum), and high blood pressure.
Review of Resident R4's physician order dated 3/20/24, indicated to complete a skin check weekly every
evening shift every Monday for monitoring.
Review of R4's physician order dated 4/15/24, indicated to cleanse abdominal wound with antibacterial
soap and water, pat dry. Then cleanse with Vashe (wound cleaning solution to prevent bacteria growth), and
let dry. Do not rinse. Place full strength Dakins (antibiotic solution that fights bacteria) moistened gauze
loosely into the wound and cover with abdominal pad (wound dressing used for wounds requiring high
absorbency) and secure with tape daily, every evening shift for wound care.
Review of Resident R4's care plan dated 4/28/24, indicated the resident receives wound management.
Interventions indicated to measure ulcer on at regular intervals, monitor for signs of declination, and provide
wound care treatment as ordered. The care plan failed to identify the wound's location and dressing change
order.
Review of Resident R4's Minimum Data Set (MDS- a periodic assessment of care needs) dated 5/8/24,
indicated the diagnoses were current.
Review of a Skin/Wound Note 6/20/24, revealed that the note was entered by Wound Care Nurse Employee
E4 on 7/9/24, at 10:21 a.m., 19 days later.
Review of a Skin/Wound Note dated 6/27/24, revealed that the note was entered by Wound Care Nurse
Employee E4 on 7/9/24, at 10:23 a.m., 12 days later.
During an observation and interview on 7/9/24 10:33 a.m. LPN, Employee E16 confirmed Resident R4's
dressing to her right lower abdomen was not dated or initialed.
During an interview on 7/12/24, at 8:54 a.m. the Director of Nursing confirmed the facility failed to create a
resident-centered personalized care plan for Resident R4's wound, and ensure the resident received
weekly skin assessments as ordered.
Review of the clinical record indicated that Resident R9 was admitted to the facility on [DATE], with
diagnoses of multiple sclerosis (a potentially disabling disease of the brain and spinal cord (central nervous
system), depression, and osteoarthritis (occurs when the protective cartilage that cushions the ends of the
bones wears down over time.)
Review of Resident R9's Braden Scale assessment dated [DATE], indicated Resident R9 was at low risk
(score of 15) for pressure ulcer development.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 25 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0686
Level of Harm - Minimal harm
or potential for actual harm
Review of Residents R9's Minimum Data Set (MDS - a periodic assessment of care needs) dated 2/9/24,
Section M: Skin Conditions indicated the resident did not have one or more unhealed pressure ulcers.
Review of a physician order dated 2/27/24, indicated to complete a skin check weekly every evening shift
every Tuesday for monitoring.
Residents Affected - Some
Review of Resident R9's progress note dated 3/3/24, entered by Registered Nurse RN, Employee E23
indicated the resident had an open sore on left heel and was slightly bleeding. It was indicated the resident
heels were elevated on a pillow and frequent positioning was rendered.
Review of Resident R9's Wound Assessment report dated 3/4/24, indicated the resident developed a facility
acquired Stage 2 pressure ulcer that measured 2.4 cm x 2.2 cm x 0.1 cm.
Review of Resident R9's clinical record failed to include a weekly wound assessment for Resident R9's left
heel the week of 4/2/24 and 4/9/24. The facility failed to monitor Resident R9's skin weekly as ordered.
Review of Resident R9's progress note dated 4/16/24, entered by Wound Care Nurse, Employee E4 stated
This RN in to assess wound measuring 2.0 x 1.5 x 0.2 cm. drainage lessening, pain lessening, very small
amount of slough remains, same treatment continues. Wound Care Nurse, Employee E4 failed to indicate
that location and stage of the resident's wound.
Review of Resident R9's clinical record failed to include a weekly wound assessment for Resident R9's left
heel the week of 4/23/24, and 4/30/24.
Review of Resident R9's care plan dated 5/6/24, indicated the resident was at risk for impaired skin integrity
due to multiple sclerosis. Interventions included to evaluate skin for redness or excoriation, monitor skin for
redness specifically over bony prominences, position resident to reduce causes of friction or shear, and
perform Braden Scale assessment.
Review of Resident R9's progress note dated 5/7/24, entered by Wound Care Registered Nurse, Employee
E4 indicated the resident left heel wound measures 1.1 x 0.9. Wound Care Registered Nurse, Employee E4
failed to document the depth and stage of the resident's left heel pressure ulcer.
Review of Residents R9's MDS dated [DATE], Section M: Skin Conditions, indicated Resident R9 was at
risk of pressure ulcer development, and at the time of the assessment the resident had one Stage three
pressure ulcer (full-thickness skin loss potentially extending into the subcutaneous tissue layer).
Review of Resident R9's progress note dated 5/16/24, entered by Wound Care Registered Nurse,
Employee E4 indicated the resident left heel wound measures 1.3 x 1 cm. Wound Care Registered Nurse,
Employee E4 failed to document the depth and stage of the resident's left heel pressure ulcer. The wound
increased in size.
Review of Resident R9's progress note dated 5/21/24, entered by Wound Care Registered Nurse,
Employee E4 indicated the resident left heel wound measures 0.8 x 0.8 shows slight greenish drainage.
Wound Care Registered Nurse, Employee E4 failed to document the depth and stage of the resident's left
heel pressure ulcer.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 26 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0686
Level of Harm - Minimal harm
or potential for actual harm
Review of Resident R9's physician order dated 5/28/24, indicated to cleanse the left heel with Vashe
(wound cleanser), apply collagen paste (a wound paste that contains protein that plays a role in each
phase of wound healing and encourages new tissue growth), mix small amount of normal saline solution
with powder to form paste, and cover with abdominal pad (wound dressing used for wounds requiring high
absorbency) and kerlix (rolled gauze commonly used to wrap extremity wounds) daily for wound care.
Residents Affected - Some
Review of Resident R9's progress note dated 5/28/24, entered by Wound Care Registered Nurse,
Employee E4 indicated the resident left heel wound measures 0.8 x 0.8, shows scant greenish drainage on
dressing. Wound Care Registered Nurse, Employee E4 failed to document the depth and stage of the
resident's left heel pressure ulcer.
Review of Resident R9's progress note dated 6/4/24, entered by Wound Care Registered Nurse, Employee
E4 indicated the resident left heel wound measures 0.8 x 0.8 Wound Care Registered Nurse, Employee E4
failed to document the depth and stage of the resident's left heel pressure ulcer.
Review of Resident R9's clinical record failed to indicate a weekly skin assessments was completed for
Resident R9's left heel pressure ulcer for the week 6/10/24.
Review of Resident R9's progress note dated 6/20/24, entered by Wound Care Registered Nurse,
Employee E4 indicated the resident left heel wound measures 0.5 x 0.5. Wound Care Registered Nurse,
Employee E4 failed to document the depth and stage of the resident's left heel pressure ulcer.
Review of Resident R9's clinical record failed to indicate a weekly skin assessments was completed for
Resident R9's left heel pressure ulcer for the week of 7/1/24.
Review of Resident R9's Skin and Wound Evaluation V7.0 dated 6/27/24, indicated the resident had a
stage 2 pressure ulcer that measured 2.2 cm x 2.1 cm x 1.4 cm. It was indicated the surrounding tissue had
black/blue discoloration. It stated the resident's pressure ulcer was almost healed and then the resident
developed a Deep Tissue Injury (DTI) on new periwound skin (refers to tissue surrounding a wound). It was
indicated the wound was deteriorating.
Review of Resident R9's care plan on 7/9/24, at 1:52 p.m. failed to include Resident R9's left pressure
ulcer.
During an interview on 7/9/24, at 2:50 p.m. the Director of Nursing (DON) confirmed Resident R9 does not
have a care plan for his left heel pressure ulcer.
Review of the clinical record indicated Resident R38 was admitted to the facility on [DATE].
Review of Resident R38's MDS dated [DATE], indicated diagnoses of high blood pressure, dementia (a
group of symptoms that affects memory, thinking and interferes with daily life), and muscle wasting. Section
M: Skin Conditions indicated Resident R38 was at risk of pressure ulcer development, and at the time of
the assessment the resident had one unhealed Stage 3 pressure ulcer.
Review of Resident R38's Braden Scale assessment dated [DATE], indicated Resident R39 was at high risk
(score 11) for pressure ulcer development.
Review of Resident R38's Braden Scale assessment dated [DATE], indicated Resident R38 was at high
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 27 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0686
risk (score 10) for pressure ulcer development.
Level of Harm - Minimal harm
or potential for actual harm
Review of Resident R38's care plan dated 4/26/24, indicated the resident had a potential for pressure ulcer
development related to immobility. Interventions included to inform the resident/family/caregivers of any new
area of skin breakdown and do not massage over bony prominences and use milder cleansers for
peri-care/washing.
Residents Affected - Some
Review of Resident R38's Wound Assessment report dated 2/7/24, indicated the resident developed a
facility acquired right heel Stage 2 pressure ulcer that measured 1.3 cm x 2.0 cm x 0.1 cm.
Review of Resident R38's Wound Assessment report dated 3/29/24, indicated the resident's right heel
Stage 2 pressure ulcer measured 0.8 cm x 2.0 cm x 0.1 cm.
Review of Resident R38's Skin & Wound Evaluation V7.0 dated 4/4/24, completed by Wound Care Nurse
Employee E4 indicated the resident's right heel pressure ulcer was now a Stage 3 and measured 4.6 cm x
3.9 cm. Education was documented as, educated resident on keeping bunny boots on and heels off of bed.
Wound Care Nurse Employee E4 failed to document the depth of the resident's right heel pressure ulcer.
Review of Resident R38's care plan on 7/9/24, at 10:00 a.m. failed to include Resident R38's right heel
pressure ulcer and interventions for heel protector boots.
During an interview on 7/10/24, at 11:39 a.m. Wound Care Nurse Employee E4 stated, I don't touch the
care plans, I don't know anything about them.
During an interview on 7/10/24, at 2:44 p.m. Registered Nurse Assessment Coordinator (RNAC) Employee
E7 confirmed Resident R38 did not have a care plan for her right heel pressure ulcer or heel protector
boots.
Review of Resident R38's active physician orders on 7/10/24, at 10:00 a.m. failed to include an order for
heel protector boots.
During an interview on 7/10/24, at 2:35 p.m. the Director of Nursing (DON) confirmed Resident R38 did not
have a physician order for heel protector boots.
Review of a physician order dated 4/11/24, indicated to cleanse right heel with Vashe wound cleanser,
apply Medihoney (a wound gel) over wound base, cover with alginate (an absorbent dressing) and foam
every day shift.
Review of Resident R38's Treatment Administration Record (TAR) for May 2024, revealed the treatment
was not documented as completed on 5/1/24, 5/2/24, 5/3/24, 5/4/24, 5/5/24, and 5/8/24.
Review of a physician order dated 5/9/24, indicated to cleanse right heel with Vashe wound cleaner, apply
Medihoney over wound base, cover with foam every day shift.
Review of Resident R38's TAR for May 2024 revealed the treatment was not documented as completed on
5/9/24, 5/14/24, 5/15/24, 5/17/24, 5/19/24, 5/24/24, and 5/29/24.
During an interview on 7/10/24, at 11:05 a.m. the Director of Nursing (DON) confirmed the treatment
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 28 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0686
was not documented as completed on the dates listed above.
Level of Harm - Minimal harm
or potential for actual harm
Review of Resident R38's clinical record failed to include a weekly wound assessment and measurements
for the resident's right heel the week of 5/19/24.
Residents Affected - Some
Review of a Skin/Wound note dated 6/14/24, completed by Wound Care Nurse Employee E4 stated, This
RN in to assess residents wound to right heel. Wound is closed, small scab covering area measuring 0.4
cm x 0.2 cm. Received new order to apply skin prep (a treatment used to form a barrier between the skin to
help preserve skin integrity) daily until scab resolves.
Review of a physician order dated 6/12/24, indicated to apply skin prep to right heel every day and evening
shift.
Review of Resident R38's TAR for June 2024 revealed the treatment was not documented as completed on
6/15/24 during the day shift, 6/15/24 during the day shift, 6/17/24 during the day shift, 6/18/24 during the
evening shift, and 6/19/24 during the day shift.
During an interview on 7/10/24, at 11:05 a.m. the DON confirmed the treatment was not documented as
completed on the dates listed above.
Review of a Skin/Wound note dated 6/20/24, completed by Wound Care Nurse Employee E4 stated, This
RN to see resident right heel, area shows worsening. Original area healing 0.2 cm x 0.2 cm, also has new
area beside it that also measures 0.2 cm x 0.2 cm skin between wounds and below is macerated, resident
has no complain of pain, treatments ongoing, with assess more frequently. Wound Care Nurse Employee
E4 failed to document the depth and stage of the resident's right heel pressure ulcer. The wound worsened
and developed a second open area.
Review of a Skin/Wound note dated 6/27/24, completed by Wound Care Nurse Employee E4 stated, This
RN in to see resident right heel, area healing 0.2 cm x 0.2 cm, are beside it that also measures 0.2 cm x
0.2 cm skin between wounds and below had been macerated but shows improvement. No complain of pain,
no signs/symptoms of infection. Treatment of medical grade honey ongoing. Wound Care Nurse Employee
E4 failed to document the depth and stage of the resident's right heel pressure ulcer.
Review of a Skin/Wound note dated 7/5/24, completed by Wound Care Nurse Employee E4 stated, This RN
in to assess residents right heel wound. Area surrounding wounds show improvement. 2 small wounds
persist. Measuring 0.5 cm x 0.3 cm and 0.2 cm x 0.3 cm. No signs/symptoms of infection and no complain
pain. Treatments ongoing. Wound Care Nurse Employee E4 failed to document the depth and stage of the
resident's right heel pressure ulcer.
During an interview on 7/10/24, at 11:30 a.m. Wound Care Nurse Employee E4 stated, I don't document
depth and staging never changes, if it's a Stage 3, it stays a Stage 3 and doesn't become a Stage 2.
(Resident R38) is a tough one because her pressure ulcer gets better, then worsens, then gets better, then
worsens.
During an interview on 7/12/24, at 1:21 p.m. Nurse Aide (NA) Employee E29 indicated the nurses would
inform the nurse aides if a resident was at risk for developing a pressure ulcer. NA Employee E29 stated the
nurse aides look in the resident charts while they are documenting to see if the residents are ordered
preventative measures, such as protective heel boots and a schedule for turning and repositioning. NA
Employee E29 stated if she knew a resident was ordered protective heel boots and
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 29 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0686
they were not applied, she would apply the boots and notify the nurse.
Level of Harm - Minimal harm
or potential for actual harm
During an interview on 7/12/24, at 1:23 p.m. NA Employee E30 indicated the nurses notify the nurse aides
if a resident is at risk for developing a pressure ulcer. NA Employee E30 stated the preventative measures
displays in the resident charts in the task section for the nurse aides to document. NA Employee E30 stated
if she knew a resident was ordered protective heel boots and they were not applied, she would go to the
wound nurse and ask if they are supposed to be there, and if so, where are they?
Residents Affected - Some
Review of the clinical record revealed that Resident R243 was admitted to the facility on [DATE].
Review of Resident 243's MDS dated [DATE], indicated diagnoses of fractured acetabulum (socket of hip
bone), fractured fibula (calf bone), and fractured talus (large bone in ankle). Section GG0170 A indicated
that Resident R243 required partial/moderate assistance (helper lifts or holds trunk or limbs and provides
less than half the effort) to be able to roll left to right.
Review of clinical record indicated that Resident R243 had intact skin at time of admission per 6/26/24,
Total Body Skin Assessment.
Review of Resident R243's clinical record revealed a Skin/Wound Note dated 7/2/24, that stated This RN
(Registered Nurse) in to assess residents left buttock wound. Was informed by nurse aide resident had
wound. Wound presents as unstageable (an ulcer that has full thickness tissue loss but is either covered by
extensive nonviable tissue or a scab) to left buttocks. Covered with yellow slough, (a specific type of
nonviable tissue that presents as a yellowish, moist, stringy substance) measures 1 cm (centimeter length)
by 0.5 cm, (width), depth unknown.
Review of Resident R243's clinical record revealed that a care plan for wound care and prevention was not
implemented until 7/2/24.
During an interview on 7/10/24 at 11:15 a.m. Wound Nurse Registered Nurse Employee E4 stated that she
did not order any preventative wound care measures for Resident R243, and that Wound Care Registered
Nurse Employee E4 does not develop any preventative wound care plans for new admissions. Wound Care
Registered Nurse Employee E4 stated that when a new admission comes into the facility, she looks over
their orders and admission paperwork to determine if someone is at risk. She also explained that each
nursing floor has a binder where the other nurses can document any skin concerns with the residents, and
that Wound Care Registered Nurse Employee E4 rounds each day to review binders for any concerns.
Review of the binder where nurses document any skin concerns did not include any information for
Resident R243.
During an interview on 7/12/24, at 2:31 p.m. Unit Manager Employee E12 confirmed that the facility failed to
implement a pressure injury prevention care plan for Resident R243 that resulted in an unstable pressure
injury.
During an interview on 7/10/24, at 8:57 a.m. the DON stated Wound Care Registered Nurse, Employee E4
completes the resident's dressing changes dressing throughout week.
During an interview on 7/10/24, at 9:02 a.m. Wound Care Registered Nurse, Employee E4 stated she
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 30 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0686
completes weekly skin assessments once a week.
Level of Harm - Minimal harm
or potential for actual harm
During an observation of Resident R9's left heel dressing change on 7/10/24, at 9:32 a.m. Wound Care
Registered Nurse, Employee E4 failed to complete Resident R9's dressing as ordered. Wound Care
Registered Nurse, Employee E4 failed to cleanse the wound with vashe cleaning solution prior to applying
the resident's wound paste and completing the resident's wound dressing. Wound Care Registered Nurse,
Employee E4 indicated Resident R9's left heel pressure ulcer measured 1.5 centimeters (cm) x 0.5 cm x
0.2 cm. Wound Care Registered Nurse, Employee E4 stated it's a stage two, part of it was unstageable, it
was confusing, now stage 2.
Residents Affected - Some
During an interview on 7/10/24, at 10:56 a.m. the DON confirmed the facility failed to prevent an avoidable
pressure ulcer development that resulted in the actual harm of a new pressure ulcer, complete a Braden
Assessment after the resident was identified as a pressure ulcer risk, obtain an order for bunny boots,
initiate a care plan for a resident's pressure ulcer, stage pressure ulcers correctly, complete weekly skin
assessments as ordered, and complete a dressing change as ordered for Resident R9.
During an interview on 7/10/24, at 11:40 a.m. Wound Care Registered Nurse, Employee E4 stated a stage
three pressure ulcer you would see bone and tendon and a stage 2 pressure ulcer is an opening of the skin
to the tissue or muscle, that doesn't reach the bone.
Review of the clinical record revealed that Resident R285 was admitted to the facility on [DATE], with
diagnoses of stage 3 pressure ulcer, anxiety, and dementia.
Review of Resident R285's progress note dated 6/21/24, at 8:28 p.m. indicated the resident arrived by
ambulance to the facility. It was indicated the resident had a stage 3 on the coccyx. No documentation of
wound measurements or description was documented.
Review of Resident R285's clinical record from 6/21/24, to 6/22/24, failed to include a physician order for
Resident R285's stage 3 coccyx pressure ulcer.
Review of Resident R285's physician order dated 6/23/24, indicated to cleanse open area to coccyx with
soap and water, apply foam dressing every evening shift.
Review of Resident 285's MDS dated [DATE], Section M- Skin Conditions failed to indicate the resident was
receiving skin and ulcer treatments such as pressure ulcer care, turning and repositioning program, and
pressure reducing device for chair.
Review of Resident R285's care plan dated 6/28/24, indicated the resident is at risk for skin integrity.
Interventions included to consult wound care nurse as appropriate, evaluate skin integrity, position resident
to reduce causes of friction or shear, provide skin care per facility guidelines and as needed, utilize pillow or
foam wedges to avoid direct contact with bony prominences, and utilize pressure relieving devices on
appropriate surfaces. It was indicated to provide wound management and interventions indicated to
measure ulcer on regular intervals, monitor ulcer for signs of progression or declination, provide wound
care per treatment order, and notify provider if no signs of improvement on current wound regimen. The
facility failed to include the location and stage of Resident 285's pressure ulcer.
Review of Resident R285's June 2024 Treatment Administration Record revealed the resident's coccyx
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 31 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0686
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
dressing change was not signed off for completion for three of eight days. The resident's dressing change
was left blank and not signed off for completion on 6/25/24, 6/28/24, and 6/29/24.
Review of Resident R285's clinical record from 6/21/24, through 6/30/24, failed to include documentation of
Resident R285's Stage 3 coccyx pressure ulcer. The facility failed to monitor Resident R285's pressure
ulcer.
Review of Resident R285's progress note dated 7/1/24, entered by Wound Care Registered Nurse,
Employee E4 at 1:24 p.m. indicated this RN was called to the resident's room by a nurse aide. Resident had
wound measuring 4 cm x 3 cm x 0.7 cm. The wound bed was pink/red with 20% yellow slough. It was
indicated a new order for Santyl (type of medication that helps remove dead skin tissue and aid in healing)
and a foam dressing was ordered. The resident is now safe in bed and spends time in both chair and bed to
redistribute pressure.
During an interview on 7/10/24, at 11:30 a.m. Wound Care Registered Nurse, Employee E4 confirmed the
facility failed to assess Resident R285's stage 3 coccyx pressure ulcer upon admission. Wound Care
Registered Nurse, Employee E4 stated she was first made aware of Resident R285's coccyx wound on
7/1/24, when the Registered Nurse Assessment Coordinator told her he came in with it. It was indicated
upon admission Wound Care Registered Nurse, Employee E4 will look at referral, discharge instructions, or
rely on the floor nurse's official assessment to see if they found any skin concerns. If they find something,
the wound care nurse is notified via the Skin Concern binder that is located on each floor. Wound Care RN,
Employee E4 stated she rounds every day on the binder, and she also has protocols in there if they find
one so they know what they can order.
Review of the facility's Skin Concerns list for the month of June 2024 and July 2024 failed to include
Resident R285's stage 3 coccyx wound.
Review of Resident R285's clinical record on 7/10/24, at 11:28 a.m. failed to include documentation of the
resident's coccyx wound, a total of 9 days since the last wound assessment. The facility failed to monitor
Resident R285's wound.
Review of Resident R285's physician orders on 7/10/24, at 11:31 a.m. failed to include any interventions
related to the resident's pressure ulcer risk.
During an interview on 7/12/24, at 1:30 p.m. Registered Nurse, Employee E15 indicated if a resident is
always in bed, always refuse to sit in chair, not changed, always wet, then they are identified as a pressure
ulcer risk. RN, Employee E15 stated Braden Assessments are completed upon admission, and skin checks
are completed weekly. RN, Employee E15 indicated pressure ulcers develop over bony prominences,
especially those who are very skinny, in the coccyx area sacrum, heels. Interventions to prevent skin
breakdown included skin prep every shift for those at risk. Bunny boots are used for some of the residents,
and the physician order will be entered in the resident's clinical record. If it is discovered a resident does not
have an order for pressure ulcer interventions such as bunny boots, then the doctor will be notified and an
order is obtained. Pressure ulcer interventions must be entered in the resident's care plan. RN, Employee
E15 indicated if there is a concern for wounds, the wound care nurse is notified in the skin concerns binder
located at the nursing station.
During an interview on 7/12/24, at 1:36 p.m. Registered Nurse, Employee E24 stated a resident's pressure
ulcer risk depends on their level of mobility, if they had recent surgery, or if they are malnourished. It was
indicated interventions such as turning and repositioning are entered and pushed
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 32 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0686
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
over to the care plan for nurse aides to document. RN, Employee E24 indicated dietary will look at weights,
and add supplements if needed. It was indicated other pressure ulcer interventions include obtaining an air
mattress, cushions for chairs, and barrier cream. It was indicated staff are required to document in the
pressure ulcer interventions that were implemented in the resident's clinical record. RN, Employee E24
stated the wound care nurse evaluates all newly identified wounds and follows up within 24 hours. The
wound care nurse is responsible for staging the wounds.
28 Pa. Code:211.10(a)(c)(d) Resident care policies.
28 Pa. Code: 211.12(d)(1)(2)(3)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 33 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0690
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate
catheter care, and appropriate care to prevent urinary tract infections.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review facility polices, observations, clinical records, and staff interviews it was determined that the facility
failed to make certain that appropriate treatments and services were provided for the use of a urinary
catheter as required for three of four residents (Resident R53, R93, and R129).
Findings include:
Review of facility policy Catheter Care, Urinary dated 5/18/24, indicated that the facility should ensure that
the catheter tubing and drainage bag are kept off the floor.
Review of facility policy Resident Rights dated 5/18/24, indicated that residents have the right to a dignified
existence.
Review of facility policy Dignity dated 5/18/24, indicated that each resident shall be cared for in a manner
that promotes and enhances his or her sense of well- being, level of satisfaction with life, and feelings of
self-worth and self-esteem. Residents are treated with dignity and respect at all times. Demeaning practices
and standards of care that compromise dignity is prohibited. Staff are expected to promote dignity and
assist residents, for example: Helping the resident to keep urinary catheter bags covered.
Review of Resident R53's clinical record indicated the resident was admitted to the facility on [DATE].
Review of Resident R53's MDS (Minimum Data Set, periodic assessment of resident care needs) dated
6/16/24, indicated diagnoses of spina bifida (a birth defect in which a spinal cord fails to develop properly),
hypertension (high blood pressure in the arteries), and depression. Section H-Bladder and Bowel indicated
the utilization of an urostomy (a surgical procedure that creates a stoma for the urinary system).
Review of the clinical record revealed that Resident R53 had a physician's order dated 3/8/24, for urostomy
care.
During an observation on 7/8/24, at 10:30 a.m. Resident R53 was observed lying in bed with his urinary
catheter bag laying on the floor without a dignity bag.
During an interview on 7/8/24, at 10:35 a.m. Licensed Practical Nurse Employee E14 stated, No, he doesn't
have one. I'll take care of that now.
During an interview on 7/8/24, at 10:19 a.m. Licensed Practical Nurse Employee E14 confirmed that
Resident R53 urinary bag was laying on the floor without a dignity bag.
Review of clinical record revealed that Resident R93 was admitted to the facility on [DATE].
Review of Resident 93's MDS (Minimum Data Set, periodic assessment of resident care needs) dated
5/11/24, indicated diagnoses of high blood pressure, chronic kidney disease, and hyponatremia (low
sodium level in the blood). Section H-Bladder and Bowel indicated the utilization of an indwelling
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 34 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0690
catheter.
Level of Harm - Minimal harm
or potential for actual harm
Review of the clinical record revealed that Resident R93 had a physician's order dated 2/18/24, for an
indwelling urinary catheter.
Residents Affected - Some
Review of the above physician's order did not include a diagnosis for the urinary catheter as required.
During an interview on 7/12/24, at 8:52 a.m. Director of Nursing confirmed that the facility failed to include a
diagnosis for the urinary catheter as required.
Review of the clinical record revealed that Resident R129 was admitted to the facility on [DATE], and
readmitted on [DATE].
Review of Resident 129's MDS dated [DATE], indicated diagnoses of high blood pressure, muscle wasting,
and dysphagia (difficulty swallowing). Section H-Bladder and Bowel indicated the utilization of an indwelling
catheter.
Review of clinical record revealed that Resident R129 had a physician's order dated 6/17/24, for an
indwelling urinary catheter.
During an observation on 7/8/24, at 11:25 a.m. urinary drainage bag was hanging from Resident R129's
bed frame with no dignity bag.
During an interview on 7/8/24, at 1:19 p.m. Licensed Practical Nurse Employee E10 confirmed that the
facility failed to make certain that appropriate treatments and services were provided for Resident R129's
catheter.
During an interview on 7/8/24, at 3:15 p.m. the Director of Nursing confirmed that the facility failed to make
certain that appropriate treatments and services were provided for the use of a urinary catheter as required
for three of four residents (Resident R53, R93, and R129).
28 Pa Code: 201.14 (a) Responsibility of licensee.
28 Pa code: 211.10 (c)(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:
395790
If continuation sheet
Page 35 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
facility policy, medical record review, observations, and staff interviews, it was determined that the facility
failed to provide necessary services and properly monitor and assess weight and nutrition status for five of
seven residents reviewed (Resident R28, R83,R91, R129, and R243).
Residents Affected - Some
Findings include:
Review of facility policy Weight Assessment and Intervention dated 5/18/24, indicated that residents are to
weighed upon admission and at intervals established by the interdisciplinary team. Any weight change of
5% or more since the last weight assessment is retaken the next day for confirmation. If the weight is
verified nursing will immediately notify the dietitian in writing. Unless notified of significant weight change,
the dietitian will review the unit weight record monthly to follow individual weight trends over time. The
threshold for significant unplanned and undesired weight loss will be based on the following criteria:
a) 1 month: 5% weight loss is significant; greater than 5% is severe.
b) 3 months: 7.5% weight loss is significant; greater than 7.5% is severe.
c) 6 months: 10% weight loss is significant greater than 10% is severe.
If the weight change is desirable, this is documented. Undesirable weight change is evaluated by the
treatment team whether or not the criteria for significant weight change has been met.
Review of the clinical record indicated Resident R28 was admitted to the facility on [DATE].
Review of Resident R28's Minimum Data Set (MDS - a periodic assessment of care needs) dated 5/8/24,
indicated diagnoses of high blood pressure, hemiplegia (paralysis on one side of the body), and dementia
(a group of symptoms that affects memory, thinking and interferes with daily life).
Review of clinical record revealed that Resident R28's weight history was as follows:
12/1/23 150.1 pounds
1/6/24 141.6 pounds (5.66% loss in one month)
2/4/24 142.8 pounds
3/8/24 138.8 pounds
4/12/24 138.8 pounds
4/18/24 126.5 pounds (8.86% loss in 6 days)
4/25/24 138.8 pounds
5/9/24 138.8 pounds
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 36 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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
5/21/24 122.0 pounds (12.10% loss in 12 days)
Level of Harm - Minimal harm
or potential for actual harm
6/3/24 116.0 pounds (11.94% loss in one month, 22.72% loss in six months)
Residents Affected - Some
Review of Resident R28's clinical record revealed a current physician order dated 2/6/24, indicated staff to
feed family request.
Review of Resident R28's clinical record revealed a current physician order dated 2/14/24, indicated the
resident is to have a regular diet, easy-to-chew texture, section plate, staff to feed, and a diabetic snack.
Review of Resident R28's care plan dated 4/22/24, indicated the resident requires set up assistance with
eating. The care plan failed to indicate the resident is a staff feed. Resident R28's care plan was updated on
5/24/24, and indicated the resident had unplanned/unexpected weight loss due to poor food intake and
poor prognosis as evidence by 16.4% weight loss in three months. Interventions indicated to monitor and
evaluate any weight loss, determine percentage lost and follow facility protocol for weight loss. It was
indicated if weight decline persists, contact physician and dietician immediately.
Review of Resident R28's progress note dated 7/1/24, at 10:26 a.m. entered by Registered Nurse,
Employee E4 indicated team met to discuss residents weight loss. Over a 6 month period resident has lost
weight but has since stabilized, ensure was provided but refused by resident, resident is a staff feed but
refuses at times. Will continue to monitor.
During an observation on 7/8/24, at 12:54 p.m. the third lunch cart (Cart 7) arrived to the second floor and
staff began passing lunch trays.
During an observation on 7/8/24, at 1:00 p.m. Nurse Aide, Employee E31 dropped off Resident R28's lunch
tray and stated I will be back to feed you, I'll be right back.
During an observation on 7/8/24, at 1:04 p.m. Resident R28's lunch tray was no longer on the resident's
bedside table.
During an observation on 7/8/24, at 1:16 p.m. Resident R28's lunch tray was observed in Cart 7 with the lid
cover not completely on. The resident's lunch was untouched.
During an interview on 7/8/24, at 1:31 p.m. Nurse Aide, Employee E25 stated each floor has a list of
resident who need fed. NA, Employee E25 stated we try to get residents who need fed in the dining room,
however today is a little different, a lot of agency, not a realistic day today.
Review of the facility provided feeding list on 7/8/24, at 1:40 p.m. indicated Nurse Aide, Employee E31 was
assigned to feed Resident R28 on 7/8/24, for lunch.
During an observation on 7/8/24, at 1:41 p.m. staff were observed picking up trays from resident's rooms on
the [NAME] Hall.
During an observation on 7/8/24, at 1:43 p.m. Cart 7 still contained Resident R28's lunch tray uncovered
with other resident's finished trays on it. A staff member was observed taking the cart to the elevator to be
picked up.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 37 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
During an interview and observation on 7/8/24, at 1:45 p.m. Nurse Aide, Employee E31 was observed
sitting in another resident's room, not actively feeding the resident. NA, Employee E31 confirmed she did
not feed Resident R28.
Review of Resident R28's clinical record on 7/8/24, at 1:50 p.m. from 7/1/24, to 7/8/24, failed to indicate the
resident was fed for all meals each shift.
During an interview on 7/8/24, at 1:52 p.m. the Director of Nursing confirmed the facility failed to provide
necessary services and feed Resident R28 as ordered.
Review of Resident R28's clinical record on 7/10/24, at 10:30 a.m. failed to include an updated monthly
weight for July.
During an interview on 7/10/24, at 12:55 p.m. Assistant Director of Nursing (ADON) Employee E4 indicated
residents are weighed monthly, and if significant weight loss is identified they should be reweighed.
Review of the clinical record revealed that Resident R83 was admitted to the facility on [DATE], and
readmitted on [DATE].
Review of Resident R83's MDS dated [DATE], indicated diagnoses of high blood pressure, dementia (a
group of symptoms that affects memory, thinking and interferes with daily life), and hypernatremia (high
sodium levels in the blood often due to water loss). Section K0710 A indicated that proportion of total
calories the resident received through tube feeding (nutrition provided via a tube that is inserted into the
stomach when inadequate nutrition is able to be obtained through eating) was 26-50% of total caloric intake
for the past seven days.
Review of clinical record revealed that Resident R83's weight history was as follows:
10/6/23 133.4 pounds
11/2/23 132.2 pounds
12/8/23 134.0 pounds
1/5/24 136.2 pounds
2/26/24 135.4 pounds
3/8/24 133.6 pounds
4/8/24 119.0 pounds (11% loss in one month, 12.6% loss in three months, and 10.8% loss in six months)
4/10/24 119.0 pounds (same weight loss indicators as above)
4/24/24 118.5 pounds (11.3% loss in one month, 13% loss in three months, and 11.2% in six months)
Review of Resident R83's clinical record revealed a physician's order dated 2/21/24, for an oral
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 38 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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
diet of easy to chew, and an order dated 3/31/24, for Liquacel (a liquid protein) two times per day by mouth.
Level of Harm - Minimal harm
or potential for actual harm
Review of Resident R83's clinical record revealed a physician's order dated 3/20/24, to provide Jevity 1.2 (a
tube feeding formula to provide liquid nutrition via a feeding tube) at 60 milliliters (ml) per hour for 12 hours
per day, as well as an order for 100 ml of water flush every four hours during tube feedings. This provides
864 calories per day and 881 ml of water.
Residents Affected - Some
Review of the clinical record revealed a physician's order dated 3/30/24, to flush tube feeding with 100 ml of
water every 4 hours during feeds (same as above).
During an interview on 6/8/24, at 8:40 a.m. Director of Nursing informed that the facility switched over to a
new electronic charting system on 4/1/24, when new owners took over the facility.
Review of clinical record revealed that Resident R83 did not have an order for tube feeding on 4/1/24, and
4/2/24.
Review of clinical record revealed that Resident R83's had a physician's order for Jevity 1.2 @ 60 ml per
hour for 12 hours written on 4/3/24. This along with the water flush order written on 3/30/24, provided 864
calories and 881 ml of water.
After weights were obtained on 4/8/24, and 4/10/24, at 119.0 pounds with a significant weight loss as
stated above, clinical record review revealed a note in Nutrition Progress notes dated 4/12/24, that stated
the following: Diabetisource AC (a tube feeding formula to provide liquid nutrition via a feeding tube) at 60
ml per hour (8pm up and 4 am down) with water flush 50 ml every three hours starting 4/12/24.
Review of the above documentation revealed that this new change provided 576 calories per day and 541
ml of water day, which is reduction of 288 calories and 340 ml of water from the previous order.
Documentation did not reveal an explanation for the tube feed change or why calories and fluid were
reduced.
Review of 4/12/24 Nutrition Progress notes did not reveal any indication that Resident R83's weights
obtained on 4/8/24, and 4/10/24 had been reviewed for significant weight loss.
Review of Resident R83's clinical record revealed that the physician's order for Jevity 1.2 tube feeding
formula written on 4/3/24, and the water flush order written on 3/30/24 were discontinued on 4/12/24.
Review of clinical record revealed Resident R83 had lab work completed on 4/16/24, that included a
sodium level result of 156 mmol/L (millimoles per liter- a measure of the amount of a substance), which is
considered to be a high value and is hypernatremia.
Review of clinical record revealed that Resident R83 was sent to the hospital on 4/16/24, and returned on
4/20/24.
Review of clinical record revealed that Resident R83 had a Nutrition Assessment completed on 4/22/24,
that stated that weight was 119 pounds and that Resident R83 had an unplanned weight loss of 10.9% in
one month, and that resident was receiving an easy to chew diet, Diabetisource AC at 60 ml per
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 39 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
hour for eight hours per day, Liquacel twice per day (by mouth) and Glucerna (a nutrition supplement) twice
per day (by mouth).
Review of clinical record revealed Resident R83 had a Nutrition Progress note completed on 4/24/24, that
stated the following: April weight is 119 pounds. Resident triggered for a 10.9% weight loss in one month
and 10.8% decrease in 6 months. Current diet is regular easy to chew consistency. Resident refuses meal
trays and supplement. Recently she starts to accept fluid. Resident is also on tube feeding which only
provides 42.6% of daily needs. Weight loss is due to poor oral meal and supplement intake. Speech
therapist is monitoring safety intake of meals. Will continue to encourage intake and monitor intake.
Review of the above note concluded that current intake is not adequate, weight loss had occurred, and tube
feeding did not meet estimated caloric needs, but did not include any strategy to increase the calories, or
increase the tube feeding to meet Resident R83's nutrition needs.
During an interview on 7/12/24 at 2:20 p.m. Registered Dietitian (RD) Employee E11 confirmed that the
facility failed to provide an order for tube feeding on 4/1/23, and 4/2/24, and failed to appropriately address
Resident R83's weight loss that occurred on 4/8/24, and that a change in tube feeding order on 4/12/24
was a reduction of calories and water for Resident R83.
Review of the clinical record revealed that Resident R91 was admitted to the facility on [DATE].
Review of Resident 91's MDS dated [DATE], indicated diagnoses of high blood pressure, repeated falls,
and underweight.
Review of Nutrition Assessment completed on 6/26/24, indicated that weight of 116 pounds was used to
complete the nutritional evaluation and that this weight of 116 pounds was obtained from the hospital
records and indicated that Resident R91 had a BMI (body mass index - a tool used to screen for weight
categories) of 21 which indicated that Resident R91 had a BMI which is considered to be normal. This
Nutrition Assessment stated that the plan of care was to continue with a regular diet/thin liquids, to maintain
current level of function. Will continue to monitor PRN (as needed).
Review of clinical record revealed that resident was not weighed at the facility until 7/8/24, when her weight
was recorded at 107.4 pounds, which indicated a BMI of 19.6 which also considered to be normal, and an
additional weight was obtained on 7/10/24, of 100.2 pounds which indicated a BMI of 18.3 which is
considered to be underweight.
During an interview on 7/10/24, at 12:47 p.m. RD Employee E11 confirmed that the facility failed to weigh
Resident R91 upon admission, and that use of a hospital weight could be inaccurate, therefore, failed to
accurately assess Resident R91's nutrition and weight status.
Review of the clinical record revealed that Resident R129 was admitted to the facility on [DATE], and
readmitted on [DATE].
Review of Resident 129's MDS dated [DATE], indicated diagnoses of high blood pressure, muscle wasting,
and dysphagia (difficulty swallowing).
Review of Resident R129's clinical record revealed that weight upon 6/5/24 admission was 120.0 pounds.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 40 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Review of clinical record revealed that Resident R129 was transferred to the hospital on 6/11/24, and
returned on 6/16/24.
Review of clinical record revealed that Resident R129 had Nutrition Assessment completed on 6/17/24, at
2:06 p.m. that stated re-admission weight has not been obtained yet. Requested weight from nursing. Using
hospital weight of 116.6 pounds to estimate weight. Height was recorded at 60 inches and BMI was
reported to be within normal limits. Ensure Plus (an oral nutritional formula) was added twice per day.
Review of clinical record revealed that weight was obtained on 6/17/24, at 8:35 p.m. at 111.0 pounds, which
reflects a significant loss of 7.5% in less than one month.
Review of clinical record revealed a care plan dated 6/17/24, that stated resident has potential nutritional
problem (calorie/protein malnutrition) related to inadequate oral intake and that the goal is Resident will
comply with recommended diet for weight reduction daily through review date.
Review of clinical record revealed that Resident R129 had a Nutrition progress note recorded on 6/24/24,
that indicated that diet was changed to pureed texture, but that intake remains poor. Current weight is 111
pounds.
Review of 6/24/24 Nutrition progress note failed to identify that weight of 111 pounds indicated that
Resident R129 had a significant weight loss of 7.5% in less than one month.
During an interview on 7/10/24, at 12:37 p.m. RD Employee E11 confirmed that the facility failed to identify
a significant weight loss for Resident R129, and that a goal for continued weight loss was not appropriate.
Review of the clinical record revealed that Resident R243 was admitted to the facility on [DATE].
Review of Resident 243's MDS dated [DATE], indicated diagnoses of fractured acetabulum (socket of hip
bone), fractured fibula (calf bone), and fractured talus (large bone in ankle).
Review of clinical record revealed a Nutritional Assessment for Resident R243 dated 6/27/24, that included
a weight of 198 pounds.
Review of clinical record revealed recorded weighs for Resident R243 were 166.1 pounds on 7/5/24, and
166.1 pounds on 7/8/24.
During an interview on 7/10/24 at 12:52 p.m. RD Employee E11 confirmed that Resident R243 was not
weighed upon admission, and that the weight used in Nutritional assessment dated [DATE], of 198 pounds
was not accurate.
28 Pa. Code: 201.18(b)(1)(e)(1) Management.
28 Pa. Code: 211.12(d)(1)(3)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 41 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0693
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and
provide appropriate care for a resident with a feeding tube.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
clinical record review, observations, and staff interview, it was determined the facility failed to provide to
provide appropriate care and services to residents receiving tube feedings for two of two residents reviewed
(Residents R51 and R83).
Finding include:
Review of facility policy Enteral Nutrition (nutrition provided via a tube inserted into the stomach) dated
5/18/24, indicated adequate nutritional support through enteral nutrition is provided to residents as ordered.
The nurse confirms that orders for enteral nutrition are complete. Complete orders include the enteral
nutrition product, and instructions for flushing.
Review of the clinical record revealed that Resident R51 was admitted to the facility on [DATE], with
diagnoses of high blood pressure, anxiety, depression, and stroke (occurs when the blood supply to part of
the brain is blocked or reduced. This prevents brain tissue from getting oxygen and nutrients.)
Review of Resident R51's care plan dated 5/3/24, indicated the resident requires a tube feeding due to
dysphagia (difficulty swallowing). It was indicated the resident is dependent with tube feeding and water
flushes. See physician orders for current feeding orders.
Review of Resident R51's physician order dated 6/3/24, indicated the resident is to have 95 cc tube feeding
flush every four hours, six times a day.
Review of Resident R51's MDS dated [DATE], indicated the diagnoses were current. Section K: Nutritional
Approaches indicated the resident received a feeding tube while a resident.
Review of Resident R51's physician order dated 6/14/24, indicated to administer Glucerna 1.2 (a high
calorie/high protein specialized liquid medical food) at 60ml/hr, three times a day, continuously.
During an observation on 7/8/24, 10:14 a.m. Resident R51's water flush bag was observed empty.
During an interview on 7/8/24, at 10:26 a.m. Licensed Practical Nurse, Employee E14 confirmed the facility
failed to administer Resident R51's water flush as ordered.
Review of the clinical record revealed that Resident R83 was admitted to the facility on [DATE], and
readmitted on [DATE].
Review of Resident R83's MDS dated [DATE], indicated diagnoses of high blood pressure, dementia (a
group of symptoms that affects memory, thinking and interferes with daily life), and hypernatremia (high
sodium levels in the blood often due to water loss). Section K0710 A indicated that proportion of total
calories the resident received through tube feeding (nutrition provided via a tube that is inserted into the
stomach when inadequate nutrition is able to be obtained through eating) was 26-50% of total caloric intake
for the past seven days
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 42 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0693
Level of Harm - Minimal harm
or potential for actual harm
Review of Resident R83's clinical record revealed a physician's order written on 4/12/24, under the
category Enteral Feed that stated 60 ml per hour 8pm up 4am down total 8 hours, as well as an order for
tube feeding flushes with 50 ml water every three hours (during feeds).
Review of the above order did not include the name of the formula to be used.
Residents Affected - Few
During an interview on 7/12/24 at 2:20 p.m. Registered Dietitian (RD) Employee E11 confirmed that the
facility failed to identify the type of tube feeding to be used in 4/12/24 enteral feeding order.
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:
395790
If continuation sheet
Page 43 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of facility policy, observations, interviews, and clinical record review, it was determined that the
facility failed to provide appropriate respiratory care for three of three residents (Residents R68, R285, and
R334).
Residents Affected - Some
Findings include:
Review of facility policy Oxygen Administration dated 5/18/24, indicated prior to administering oxygen verify
there is a physician's order and review the resident's care plan to assess for any special needs of the
resident. It was indicated to check the mask, tank, and humidifying jar to be sure they are in good working
order. Be sure there is water in the humidifying jar and the water level is high enough that the water bubbles
as oxygen flows through.
Review of the clinical record indicated Resident R68 was admitted to the facility on [DATE].
Review of Resident R68's Minimum Data Set (MDS - a periodic assessment of care needs) dated 6/2/24,
indicated diagnoses of high blood pressure, asthma (a condition where the airways narrow and swell), and
Post-Traumatic Stress Disorder (PTSD - a disorder in which a person has difficulty recovering after
experiencing or witnessing a terrifying event and may have triggers that can bring back memories of trauma
accompanied by intense emotional and physical reactions).
Review of Resident R68's care plan dated 5/15/24, indicated the resident has oxygen therapy related to
respiratory illness and the resident will have no signs or symptoms of poor oxygen absorption through the
review date.
During an observation on 7/8/24, at 10:34 a.m. Resident R68's nasal cannula tubing was dated 6/29 and
the humidification bottle (a medical device used to enhance moisture and reduce dryness of supplemental
oxygen) did not have a date.
During an interview on 7/8/24, at 10:42 a.m. Licensed Practical Nurse (LPN) Employee E1 confirmed there
was no date on Resident R38's humidification bottle.
Review of Resident R68's active physician orders on 7/10/24, failed to reveal an order for oxygen therapy.
During an interview on 7/10/24, at 12:22 p.m. the Director of Nursing (DON) confirmed that Resident R68
did not have a physician order for oxygen therapy.
Review of the clinical record indicated that Resident R285 was admitted to the facility on [DATE].
Review of Residents R285's MDS dated [DATE], indicated the diagnoses of respiratory failure (not enough
oxygen in the blood), heart failure (a progressive heart disease that affects pumping action of the heart
muscles, which causes fatigue and shortness of breath.), and hypostatic pneumonia (pneumonia (infection
of the air sacs in one or both lungs) that usually results from the collection of fluid in the lungs and occurs
especially in those lying supine (face upward) for extended periods.)
Review of Resident R285's care plan dated 6/28/24, indicated the resident has impaired gas exchange
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 44 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
and to administer oxygen as per prescribed or per standing order. Resident R285 failed to have a care plan
for oxygen.
During an observation on 7/8/24, at 10:22 a.m. Resident R285 was observed using 2 liter of oxygen via
nasal cannula (device that gives you additional oxygen through your nose). Resident R285's humidification
bottle was observed to be empty.
During an interview on 7/8/24, at 10:26 a.m. LPN Employee E14 confirmed Resident R285's humidification
bottle was empty.
Review of Resident R285's physician orders on 7/10/24, at 11:19 a.m. failed to include an order for
Resident R285's oxygen.
During an interview on 7/10/24, at 12:21 p.m. the DON confirmed Resident R285 failed to have a physician
order and care plan for oxygen.
Review of the clinical record indicated Resident R334 was admitted to the facility on [DATE].
Review of Resident R334's MDS dated [DATE], indicated diagnoses of high blood pressure, End-Stage
Renal Disease (ESRD - an inability of the kidneys to filter blood), and Chronic Obstructive Pulmonary
Disease (COPD - a group of progressive lung disorders characterized by increasing breathlessness).
Review of a physician order dated 7/4/24, indicated to provide oxygen at two liters per minute via a nasal
cannula at bedtime.
During an observation on 7/8/24, at 10:34 a.m. no date was noted on Resident R334's nasal cannula tubing
or humidification bottle.
During an interview on 7/8/24, at 10:42 a.m. LPN Employee E1 confirmed there was no date on Resident
R334's nasal cannula tubing and humidification bottle.
Review of Resident R334's current comprehensive care plan failed to indicate a plan of care by the facility
for supplemental oxygen usage.
During an interview on 7/10/24, at 2:35 p.m. the DON confirmed Resident R334 did not have a care plan for
supplemental oxygen use.
During an interview on 7/10/24, at 2:35 p.m. the DON confirmed that the facility failed to provide appropriate
respiratory care for three of three residents (Residents R68, R285, and R334).
28 Pa. Code: 201.14(a) Responsibility of licensee.
28 Pa. Code: 211.10(c)(d) Resident care policies.
28 Pa. Code: 211.11 (a)(c)(d) Resident care plan.
28 Pa. Code 211.12(d)(1)(2)(3)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 45 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0698
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of resident clinical records, facility policy and staff interview it was determined the facility failed to
provide consistent and complete communication with the dialysis center for two of two residents reviewed
(Residents R4 and R334), and failed to implement a dialysis care plan for one of two resident's (Resident
R4).
Residents Affected - Few
Findings include:
Review of the facility policy End-Stage Renal Disease (ESRD), Care of Resident with dated 5/18/24,
indicated agreements between the facility and the contracted ESRD facility include all aspects of how the
resident's care will be managed including how the care plan will be developed and implemented, and how
information will be exchanged between facilities.
Review of the clinical record indicated that Resident R4 was admitted to the facility on [DATE].
Review of Resident R4's Minimum Data Set (MDS- a periodic assessment of care needs) dated 5/8/24,
indicated with the diagnoses of end stage kidney disease (a condition where the kidney reaches advanced
state of loss of function), dependence on dialysis (a blood purifying treatment given when kidney function is
not optimum), and high blood pressure.
Review of R4's physician order dated 3/20/24, indicated the resident has dialysis one time a day every
Monday, Wednesday, and Friday.
Review of Resident R4's care plan dated 5/13/24, failed to include a care plan for the resident's dialysis.
Review of Resident R4's Dialysis Treatment Record communication forms for the Month of June and July
revealed eight forms were incomplete on 6/12/24, 6/17/24, 6/28/24, and 7/1/24, and four forms failed to
include a date.
During an interview on 7/9/24, at 1:11 p.m. Licensed Practical Nurse (LPN), Employee E16 indicated each
resident that receives dialysis has a binder for dialysis communication that is kept at the nurses station.
LPN, Employee E16 stated that the resident's take the binder to dialysis, we fill in above and they fill in
below.
During an interview on 7/9/24, at 1:15 p.m. LPN, Employee E16 confirmed Resident R4 did not have a care
plan for care plan for dialysis.
During an interview on 7/9/24, at 1:17 p.m. LPN, Employee E6 confirmed Resident R4's Dialysis Treatment
Record communication forms were not completed for eight of 11 forms.
Review of the clinical record indicated Resident R334 was admitted to the facility on [DATE].
Review of Resident R334's MDS dated [DATE], indicated diagnoses of high blood pressure, ESRD, and
Chronic Obstructive Pulmonary Disease (COPD - a group of progressive lung disorders characterized by
increasing breathlessness).
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 46 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0698
Level of Harm - Minimal harm
or potential for actual harm
Review of a physician order dated 7/4/24, indicated renal dialysis every Monday, Wednesday, and Friday,
however failed to include which dialysis facility or a time.
During an interview on 7/11/24, at 12:32 p.m. the Director of Nursing (DON) confirmed that Resident
R334's dialysis order was incomplete and did not include which dialysis facility or a time.
Residents Affected - Few
Review of Resident R334's Dialysis Treatment Record communication forms failed to reveal facility staff
provided communication to the dialysis facility for 11 of 15 days on 5/17/24, 5/20/24, 5/22/24, 5/24/24,
5/27/24, 5/29/24, 6/10/24, 6/14/24, and 6/24/24, and two forms failed to include a date.
During an interview on 7/9/24, at 2:47 p.m. the DON confirmed Resident R334's Dialysis Treatment Record
communication forms were not completed for 11 of 15 days.
28 Pa. Code: 211.12(d)(1)(2)(3)(5) Nursing services.
28. Pa. Code: 211.10(a)(c)(d) Resident care policies.
28 Pa. Code: 201.18(b)(e)(1)(2) Management
28 Pa. Code: 201.29(a)(b)(c)(d)(j)(m) Resident rights.
28 Pa. Code: 201.14(a)(c)(d)(e) Responsibility of licensee.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 47 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0699
Provide care or services that was trauma informed and/or culturally competent.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of facility policy, resident record review, and staff interviews, it was determined that the facility failed
to provide a trauma survivor with trauma informed care to eliminate or mitigate triggers that may cause
re-traumatization of the resident for two of two residents (Resident R6 and R68).
Residents Affected - Few
Findings include:
Review of facility policy Trauma-Informed and Culturally Competent Care dated 5/18/24, indicated resident
assessment involves an in-depth process of evaluating the presence of symptoms, their relationship to
trauma, as well as the identification of triggers. The facility will develop individualized care plans that
address past trauma in collaboration with the resident and family, identify and decrease exposure to
triggers that may re-traumatize the resident, and recognize the relationship between past trauma and
current health conditions.
Review of the clinical record indicated Resident R6 was admitted to the facility on [DATE].
Review of Resident R6's MDS (Minimum Data Set, periodic assessment of resident care needs) dated
5/6/24, indicated diagnoses of high blood pressure, diabetes (a metabolic disorder in which the body has
high sugar levels for prolonged periods of time), and Post-Traumatic Stress Disorder (PTSD - a disorder in
which a person has difficulty recovering after experiencing or witnessing a terrifying event and may have
triggers that can bring back memories of trauma accompanied by intense emotional and physical
reactions).
Review of Resident R6's care plan on 4/22/24, did not include a plan of care developed with goals and
interventions related to post-traumatic stress disorder.
During an interview on 7/10/24, at 2:05 p.m. Social Service Director (SSD) Employee E5 stated, Resident
R6 must have screened negative on our trauma-informed care screen. If they screen negative, then it
doesn ' t generate me to put in a careplan but she does have a diagnoses of PTSD.
During an interview on 7/10/24, at 2:13 p.m. SSD Employee E5 confirmed that the facility failed to provide a
trauma survivor with trauma informed care to eliminate or mitigate triggers that may cause re-traumatization
of the resident for Resident R6.
Review of the clinical record indicated Resident R68 was admitted to the facility on [DATE].
Review of Resident R68's MDS dated [DATE], indicated diagnoses of high blood pressure, asthma (a
condition where the airways narrow and swell), and Post-Traumatic Stress Disorder (PTSD - a disorder in
which a person has difficulty recovering after experiencing or witnessing a terrifying event and may have
triggers that can bring back memories of trauma accompanied by intense emotional and physical
reactions).
Review of Resident R68's care plan on 7/9/24, did not include a plan of care developed with goals and
interventions related to post-traumatic stress disorder.
During an interview on 7/10/24, at 1:52 p.m. Social Service Director (SSD) Employee E5 stated, Resident
R68 screened negative on our trauma-informed care screen. If she would have answered yes, it
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 48 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0699
would have triggered the care plan. It was probably just an oversite.
Level of Harm - Minimal harm
or potential for actual harm
During an interview on 7/10/24, at 1:56 p.m. SSD Employee E5 confirmed that the facility failed to provide a
trauma survivor with trauma informed care to eliminate or mitigate triggers that may cause re-traumatization
of the resident for Resident R68.
Residents Affected - Few
28 Pa. Code: 201.14(a) Responsibility of licensee.
28 Pa. Code: 201.18(b)(1) Management.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 49 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0700
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a
resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed
consent; and (4) Correctly install and maintain the bed rail.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observations, review of facility policy, clinical record review, and staff interview, it was determined that the
facility failed to maintain accurate resident care plans and conduct ongoing accurate assessments to
ensure that bedrails were used to meet residents' needs and the risks associated with bedrail usage for five
of five residents (Residents R2, R6, R21, R28, and R64).
Findings include:
Review of Title 42 Code of Federal Regulations (CFR) §483.25(n) - Bed Rails states that the facility
must assess the resident for risk of entrapment from bed rails prior to installation. Additionally, there should
be evidence in the resident's records that the facility performed ongoing assessments to assure that the
bed rail is used to meet the resident's needs and that there is an ongoing evaluation of risks associated
with bed rail usage.
Review of facility policy Bed Safety and Bed Rails dated 5/18/24, indicated the use of bed rails or side rails
(including temporarily raising the side rails for episodic use during care) is prohibited unless the criteria for
use of bed rails have been met, including attempts to use alternatives, interdisciplinary evaluation, resident
assessment, and informed consent.
Review of the clinical record indicated Resident R2 was admitted to the facility on [DATE].
Review of Resident R2's Minimum Data Set (MDS - a periodic assessment of care needs) dated 5/26/24,
indicated diagnoses of high blood pressure, hemiplegia (paralysis on one side of the body), and muscle
weakness.
Review of a physician order dated 2/22/24, indicated the usage of bilateral upper quarter side rails for
mobility and positioning every shift.
Review of Resident R2's care plan dated 5/30/24, indicated restraint use: bilateral upper side rails while in
bed for positioning, Resident R2 will be evaluated for restraint reduction. Interventions included complete
initial restraint evaluation and reevaluate at least monthly, complete initial side rail evaluation and reevaluate
at least monthly, resident and family request for bilateral upper side rails for positioning and comfort, and
two top side ails while in bed for safety, security, and bed mobility for comfort and positioning.
During an observation on 7/12/24, at 11:26 a.m. Licensed Practical Nurse (LPN) Employee E1 confirmed
there were bilateral upper side rails on Resident R2's bed. During this observation, LPN Employee E1
stated, Resident R2 is able to use the side rails during bed mobility, he is able to hold on to the bars while
care is being provided.
During an interview on 7/12/24, at 12:24 p.m. MDS Coordinator Employee E9 confirmed that Resident R2's
side rails are used for mobility and positioning and are not used as restraints. During this interview, MDS
Coordinator Employee E9 confirmed that Resident R2's care plan was inaccurate and should not reflect
restraint usage.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 50 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0700
Level of Harm - Minimal harm
or potential for actual harm
Review of Resident R2's clinical record on 7/12/24, at 11:00 a.m. failed to reveal an initial and ongoing
assessments for side rails.
During an interview on 7/12/24, at 1:20 p.m. MDS Coordinator Employee E9 confirmed that side rail
assessments were not completed for Resident R2.
Residents Affected - Some
Review of the clinical record indicated Resident R6 was admitted to the facility on [DATE].
Review of Resident R6's MDS dated [DATE], indicated diagnoses of depression, anemia (too little iron in
the body causing fatigue), and post-traumatic stress disorder (a disorder in which a person has difficulty
recovering after experiencing or witnessing a terrifying event). Section P, Restraints and Alarms, MDS was
coded 2, side rails used daily.
Review of a physician order dated 2/22/24, indicated the usage of bilateral upper quarter side rails for
mobility and positioning while in bed.
Review of Resident R6's care plan dated 6/21/24, indicated restraint use: bilateral upper side rails while in
bed for safety, security, and positioning. Resident R6 will be evaluated for restraint reduction. Interventions
included complete initial restraint evaluation and reevaluate at least monthly, and complete initial side rail
evaluation and reevaluate at least quarterly.
During an observation on 7/12/24, at 10:03 a.m. bilateral side rails were observed on bed. Resident R6
stated I use them to help me in bed.
During an interview on 7/12/24, at 12:25 p.m. MDS Coordinator Employee E9 confirmed the upper side rails
were not being used as a restraint on R6 ' s bed.
During an interview on 7/12/24, at 12:27 p.m. MDS Coordinator Employee E9 confirmed there were
bilateral upper side rails on Resident R6's bed for positioning and are not used as restraints. During this
interview, MDS Coordinator Employee E9 confirmed that Resident R6's care plan was inaccurate and
should not reflect restraint usage.
Review of Resident R6's clinical record on 7/12/24, at 11:05 a.m. failed to reveal an initial and ongoing
assessments for side rails.
During an interview on 7/12/24, at 1:20 p.m. MDS Coordinator Employee E9 confirmed that side rail
assessments were not completed for Resident R6.
Review of the clinical record indicated Resident R21 was admitted to the facility on [DATE].
Review of Resident R21's MDS dated [DATE], indicated diagnoses of high blood pressure, dementia (a
group of symptoms that affects memory, thinking and interferes with daily life), and muscle wasting.
Review of a physician order dated 1/31/24, indicated the usage of bilateral upper side rails.
Review of Resident R21's care plan dated 5/21/24, indicated restraint use: bilateral upper side rails for
comfort and positioning, Resident R21 will be evaluated for restraint reduction. Interventions included
complete initial restraint evaluation and reevaluate at least monthly, complete initial
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 51 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0700
Level of Harm - Minimal harm
or potential for actual harm
side rail evaluation and reevaluate at least monthly, resident and family request for bilateral upper side rails
for positioning and comfort, and two top side ails while in bed for safety, security, and bed mobility for
comfort and positioning.
During an observation on 7/8/24 at 10:25 a.m. no side rails were observed on Resident R21's bed.
Residents Affected - Some
During an interview on 7/12/24, at 12:22 p.m. MDS Coordinator Employee E9 stated, Resident R2 had his
bed switched over the weekend, that's why he does not currently have side rails on his bed. He did
previously use the side rails for mobility and positioning, but he has been performing bed mobility well
without them.
During an interview on 7/12/24, at 12:22 p.m. MDS Coordinator Employee E9 confirmed that Resident
R21's side rails are used for mobility and positioning and are not used as restraints. During this interview,
MDS Coordinator Employee E9 confirmed that Resident R21's care plan was inaccurate and should not
reflect restraint usage.
Review of Resident R21's clinical record on 7/12/24, at 11:15 a.m. failed to reveal an initial and ongoing
assessments for side rails.
During an interview on 7/12/24, at 1:20 p.m. MDS Coordinator Employee E9 confirmed that side rail
assessments were not completed for Resident R21.
Review of the clinical record indicated Resident R28 was admitted to the facility on [DATE].
Review of Resident R28's Minimum Data Set (MDS - a periodic assessment of care needs) dated 5/8/24,
indicated diagnoses of high blood pressure, hemiplegia (paralysis on one side of the body), and dementia.
Review of Resident R28's physician order on 7/10/24, failed to include an order for the resident's bilateral
upper quarter side rails.
Review of Resident R28's care plan dated 6/3/24, indicated positioning bars on bed-upper 1/4 rails at son's
request.
During an interview on 7/12/24, at 9:54 a.m. the DON confirmed Resident R28 did not have an order for
bed rails and the facility failed to complete bed rail assessment.
Review of the clinical record indicated Resident R64 was admitted to the facility on [DATE].
Review of Resident R64's MDS dated [DATE], indicated diagnoses of high blood pressure, diabetes (a
metabolic disorder in which the body has high sugar levels for prolonged periods of time), and cerebral
palsy (group of disorders that affect a person's ability to move and maintain balance and posture). Section
P, Restraints and Alarms, MDS was coded 2, side rails used daily.
Review of a physician order dated 3/1/24, indicated the usage of bilateral upper quarter side rails.
During an observation on 7/8/24, at 10:10 a.m. bilateral upper side rails were observed on Resident R64 ' s
bed. Resident R64 stated I use them to help me move in bed.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 52 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0700
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Review of Resident R64's care plan dated 5/10/24, indicated restraint use: bilateral upper side rails related
to need for bed mobility. Resident R64 will be evaluated for restraint quarterly. Evaluate and record
continuing risks and benefits of restraint, alternatives to restraint, need for ongoing use, and reason for
restraint use.
During an observation on 7/12/24, at 10:03 a.m. bilateral side rails were observed on bed. Resident R64
stated I use them to help me in bed.
During an interview on 7/12/24, at 12:25 p.m. MDS Coordinator Employee E9 confirmed the upper side rails
were not being used as a restraint on R64 ' s bed.
During an interview on 7/12/24, at 12:27 p.m. MDS Coordinator Employee E9 confirmed there were
bilateral upper side rails on Resident R6's bed for positioning and are not used as restraints. During this
interview, MDS Coordinator Employee E9 confirmed that Resident R64's care plan was inaccurate and
should not reflect restraint usage.
Review of Resident R64's clinical record on 7/12/24, at 11:05 a.m. failed to reveal an initial and ongoing
assessments for side rails.
During an interview on 7/12/24, at 1:20 p.m. MDS Coordinator Employee E9 confirmed that side rail
assessments were not completed for Resident R64.
28 Pa. Code: 201.14 (a) Responsibility of licensee.
28 Pa. Code: 211.12 (d) (1)(3)(5) Nursing services.
28 Pa. Code 211.10(c)(d) Resident care policies.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 53 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0759
Ensure medication error rates are not 5 percent or greater.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of facility policies and clinical records, observations and staff interviews, it was determined that the
facility failed to maintain a medication error rate of less than five percent for one of three residents
(Resident R51).
Residents Affected - Few
Findings include:
The observations listed below revealed seven medication errors out of 26 opportunities resulting in a
medication error rate of 25%.
Review of facility policy Administering Mediations through an Enteral Tube dated 5/18/24, indicated the
purpose of this procedure is to provide guidelines for the safe administration of medications through an
enteral tube (a tube inserted through the wall of the abdomen into the stomach and can be used to provide
liquid food, medications or liquids). General guidelines include administer each medication separately and
flush between medications.
.
Review of Resident R51's clinical record indicated resident was admitted to the facility on [DATE].
Review of Resident R51's Minimum Data Set (MDS - periodic assessment of care needs) dated 5/2/24,
indicated diagnoses of hypertension (high blood pressure in the arteries), diabetes (a metabolic disorder in
which the body has high sugar levels for prolonged periods of time), and cerebral infarction (necrotic tissue
in the brain resulting loss of blood and oxygen to the brain). Section K0520, Nutritional Approaches
indicated use of a feeding tube.
Review of Resident R51's physician orders on 7/10/24, at 8:45 a.m. indicated:
· Aspirin 81 mg one time a day for coronary artery disease (damage or disease in the heart's major
blood vessels)
· Duloxetine 30 mg one time a day for depression
· Flomax 0.4mg one time a day for Urinary Retention
· Repaglinide 1 mg three times a day for Diabetes
· FiberLaxative one tab one time a day for supplement
· Losartan Potassium 50 mg one time a day for hypertension
· Metoprolol 50 mg twice a day for hypertension
During an observation of Resident R51's medication administration on 7/10/24, at 8:15 a.m. with
Registered Nurse (RN) Employee E15 indicated she crushed medications after verifying them, put them all
into a medication cup and took them into resident's room.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 54 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0759
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
During an observation of Resident R51's medication administration on 7/10/24, at 8:16 a.m. with RN
Employee E15 indicated that she administered medications together via enteral feeding tube and flushed
tube afterwards.
During an interview on 7/10/24, at 8:20 a.m. RN Employee E15 confirmed that she gave Resident R51's
medications together instead of one by one and failed to flush in between medications.
During an interview on 7/10/24, at 3:15 p.m. the Director of Nursing confirmed the facility failed to maintain
a medication error rate of less than five percent for one of three residents (Resident R51).
28 Pa. Code 211.12(d)(1)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 55 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0760
Ensure that residents are free from significant medication errors.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of facility policy, clinical record review, observation and staff interview it was determined the facility
failed to ensure that residents were free from any significant medication errors for one of three residents.
(Resident R51).
Residents Affected - Few
Findings include:
Review of facility policy Administering Mediations through an Enteral Tube dated 5/18/24, indicated the
purpose of this procedure is to provide guidelines for the safe administration of medications through an
enteral tube (a tube inserted through the wall of the abdomen into the stomach and can be used to provide
liquid food, medications or liquids). General guidelines include administer each medication separately and
flush between medications.
.
Review of Resident R51 ' a clinical record indicated resident was admitted to the facility on [DATE].
Review of Resident R51's Minimum Data Set (MDS - periodic assessment of care needs) dated 5/2/24,
indicated diagnoses of hypertension (high blood pressure in the arteries), diabetes (a metabolic disorder in
which the body has high sugar levels for prolonged periods of time), and cerebral infarction (necrotic tissue
in the brain resulting loss of blood and oxygen to the brain). Section K0520, Nutritional Approaches
indicated use of a feeding tube.
Review of Resident R51's physician orders on 7/10/24, at 8:45 a.m. indicated:
· Aspirin 81 mg one time a day for coronary artery disease (damage or disease in the heart's major
blood vessels)
· Duloxetine 30 mg one time a day for depression
· Flomax 0.4mg one time a day for Urinary Retention
· Repaglinide 1 mg three times a day for Diabetes
· FiberLaxative one tab one time a day for supplement
· Losartan Potassium 50 mg one time a day for hypertension
· Metoprolol 50 mg twice a day for hypertension
During an observation of Resident R51's medication administration on 7/10/24, at 8:15 a.m. with
Registered Nurse (RN) Employee E15 indicated she crushed medications after verifying them, put them all
into a medication cup and took them into resident's room.
During an observation of Resident R51's medication administration on 7/10/24, at 8:16 a.m. with RN
Employee E15 indicated that she administered medications together via enteral feeding tube and
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 56 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0760
flushed tube afterwards.
Level of Harm - Minimal harm
or potential for actual harm
During an interview on 7/10/24, at 8:20 a.m. RN Employee E15 confirmed that she gave Resident R51's
medications together instead of one by one and failed to flush in between medications.
Residents Affected - Few
During an interview on 7/10/24, at 3:15 p.m. the Director of Nursing confirmed that the facility failed to
ensure that residents were free from any significant medication errors for one of three residents. (Resident
R51).
28 Pa. Code 211.12(d)(1)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 57 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of facility policies, observations, and staff interviews, it was determined that the facility failed to
properly store medications in two out of five medication carts (3 East Medication Cart and 4 East
Medication Cart), failed to monitor refrigerator temperatures utilized for medication storage in one of two
nursing units (Fourth Floor Medication Room), and failed to properly secure a medication cart while not in
use for one of five medications carts (2 North Medication Cart).
Findings include:
Review of facility policy Storage of Medications dated 5/18/24, indicated the facility stores all drugs and
biologicals in a safe, secure, and orderly manner. Drugs and biologicals used in the facility are stored in
locked compartments under proper temperature, light and humidity controls. Drugs and biologicals are
stored in the packaging, containers, or other dispensing systems in which they are received. The nursing
staff is responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary
manner. Compartments containing drugs and biologicals are locked when not in use. Unlocked medication
carts are not left unattended.
During an observation on 7/9/24, at 8:32 a.m. of the 3 [NAME] Medication Cart indicated the following
medications stored in one compartment without individual packaging or separation from other residents
medications and without proper labeling:
- Resident R5's aspart insulin pen (a prefilled pen to inject rapid-acting insulin under the skin), with the
resident's last name written on the cap with a black marker.
- Resident R335's lispro insulin pen (a prefilled pen to inject rapid-acting insulin under the skin), with the
resident's last name written on the cap with a black marker.
Continued observations of the 3 [NAME] Medication Cart revealed the following medications not dated
upon opening:
- Resident R5's aspart insulin pen, no date opened.
- Resident R68's Lantus pen (a prefilled pen to inject long acting insulin under the skin), no date opened.
- Resident R335's Lantus pen, no date opened.
- Resident R335's lispro insulin pen, no date opened.
During an interview on 7/9/24, at 8:45 a.m. Licensed Practical Nurse (LPN) Employee E3 confirmed the
above observations.
During an observation on 7/10/24, at 8:18 a.m. the 2 North Medication Cart was observed outside of
resident room [ROOM NUMBER] with the cart unlocked and unattended.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 58 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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
During an interview on 7/10/24, at 8:20 a.m. Registered Nurse Employee E15 confirmed 2 North
Medication Cart was unlocked and unattended.
During an observation of the Fourth Floor Medication Room on 7/11/24, at 8:23 a.m. failed to reveal a
temperature log for a medication refrigerator containing unopened prefilled insulin pens.
Residents Affected - Few
During an interview on 7/11/24, at 8:26 a.m. LPN Employee E8 confirmed that the refrigerator in the Fourth
Floor Medication Room did not have a temperature log.
During an observation on 7/11/24, at 8:44 a.m. of the 4 East Medication Cart revealed the following
medications stored in one compartment without individual packaging or separation from other residents
medications and without proper labeling:
- Resident R241's Lantus pen, with the resident's last name written on the cap with a black marker.
During an interview on 7/11/24, at 8:48 a.m. LPN Employee E10 confirmed the above observation.
During an interview on 7/11/24, at 2:58 p.m. the Director of Nursing confirmed that the facility failed to
properly store medications in two out of five medication carts (3 East Medication Cart and 4 East
Medication Cart), failed to monitor refrigerator temperatures utilized for medication storage in one of two
nursing units (Fourth Floor Medication Room), and failed to properly secure a medication cart while not in
use for one of five medications carts (2 North Medication Cart).
28 Pa. Code: 211.9(a)(1)(h)(k)(l)(1) Pharmacy services.
28 Pa. Code:211.12(d)(1)(2)(3)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 59 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 review of facility policy, observations and staff interview, it was determined the facility failed to
properly store food products in a manner to prevent foodborne illness in the Main Kitchen.
Residents Affected - Many
Findings include:
Review of facility policy Food Receiving and Storage dated 5/18/24, indicated foods shall be received and
stored in a manner that complies with safe food handling practices. Opened containers must be dated and
sealed or covered during storage.
During an observation on 7/8/24, at 9:36 a.m. in the Main Kitchen Dry storage area, an open box contained
a plastic bag of rice that was not sealed, and an additional open box that contained a plastic bag of pureed
bread mix that also was not sealed.
During an interview on 7/8/24, at 9:45 a.m. Dietary Director Employee E13 confirmed that the facility failed
to properly store products in a manner to prevent foodborne illness.
28 Pa. Code: 201.14(a) Responsibility of licensee
28 Pa. Code: 201.18(b)(1) Management.
28 Pa. Code: 211.6(c) Dietary services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 60 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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
Residents Affected - Some
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in
accordance with accepted professional standards.
**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 maintain complete and
accurate documentation for three of 16 residents (Resident R4, R9, and R38).
Findings include:
Review of facility policy Charting and Documentation dated 5/18/24, indicated all services provided to the
resident, progress toward the care plan goals, or any changes in the resident's medical, physical, functional
or psychosocial condition, shall be documented in the resident's medical record. The medical record should
facilitate communication between the interdisciplinary team regarding the resident's condition and response
to care. Documentation in the medical record will be objective (not opinionated or speculative), complete,
and accurate.
Review of Title 42 Code of Federal Regulations (CFR) §483.709(i) Medical records. In accordance
with accepted professional standards and practice, the facility must maintain medical records that are
complete, accurately documented, readily accessible, and systematically organized.
Review of the clinical record indicated that Resident R4 was admitted to the facility on [DATE], and
readmitted on [DATE].
Review of Residents R4's Minimum Data Set (MDS - a periodic assessment of care needs) dated 5/8/24,
indicated diagnoses of depression, high blood pressure, and diabetes a group of diseases that affect how
the body uses blood sugar (glucose).
Review of Resident R4's physician order dated 3/20/24, indicated to complete a skin check weekly every
evening shift every Monday for monitoring.
Review of a Skin/Wound Note 6/20/24, revealed that the note was entered by Wound Care Nurse Employee
E4 on 7/9/24, at 10:21 a.m.
Review of a Skin/Wound Note dated 6/27/24, revealed that the note was entered by Wound Care Nurse
Employee E4 on 7/9/24, at 10:23 a.m.
During an interview on 7/12/24, at 8:47 a.m. the Director of Nursing confirmed the facility did not maintain
complete and accurate documentation for Resident R4.
Review of the clinical record indicated that Resident R9 was admitted to the facility on [DATE].
Review of Residents R9's MDS dated [DATE], indicated diagnoses of multiple sclerosis (a potentially
disabling disease of the brain and spinal cord (central nervous system), depression, and osteoarthritis
(occurs when the protective cartilage that cushions the ends of the bones wears down over time.) Section
M: Skin Conditions, indicated Resident R9 was at risk of pressure ulcer development, and at the time of her
assessment the resident had one Stage three pressure ulcer (full-thickness skin loss potentially extending
into the subcutaneous tissue layers of the skin).
Review of a physician order dated 2/27/24, indicated to complete a skin check weekly every evening
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 61 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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
shift every Tuesday for monitoring.
Level of Harm - Minimal harm
or potential for actual harm
Review of Resident R9's Skin and Wound Evaluation V7.0 dated 6/27/24, indicated the resident had a
stage 2(characterized by partial-thickness skin loss into but no deeper than the dermis (the second and
thickest layer of the three major layers of skin)) pressure ulcer that measured 2.2 cm x 2.1 cm x 1.4 cm. It
was indicated the surrounding tissue had black/blue discoloration. It stated the resident's pressure ulcer
was almost healed and then the resident developed a Deep tissue Injury (DTI-a type of subcutaneous
tissue damage that results from an externally applied mechanical pressure) on new periwound skin (refers
to tissue surrounding a wound). The facility failed to accurately stage Resident R9's pressure ulcer.
Residents Affected - Some
During an interview on 7/10/24, at 10:56 a.m. the DON confirmed the facility failed to accurately stage and
document Resident R9's pressure ulcer.
During an interview on 7/10/24, at 11:40 a.m. Wound Care Registered Nurse, Employee E4 stated a stage
three pressure ulcer you would see bone and tendon and a stage 2 pressure ulcer is an opening of the skin
to the tissue or muscle, that doesn't reach the bone.
Review of the clinical record indicated Resident R38 was admitted to the facility on [DATE].
Review of Resident R38's MDS dated [DATE], indicated diagnoses of high blood pressure, dementia (a
group of symptoms that affects memory, thinking and interferes with daily life), and muscle wasting.
Review of the clinical record revealed that Resident R38 had a stage three pressure ulcer (a skin and tissue
injury that extends through the skin and into deeper tissue and fat, but does not reach muscle, tendon, or
bone) to her right heel.
Review of a Skin/Wound Note dated 7/5/24, revealed that the note was entered by Wound Care Nurse
Employee E4 on 7/9/24, at 10:10 a.m.
Review of a Skin/Wound Note 6/27/24, revealed that the note was entered by Wound Care Nurse Employee
E4 on 7/9/24, at 10:07 a.m.
During an interview on 7/9/24, at 2:11 p.m. Wound Care Nurse Employee E4 stated, There is a delay in my
documentation because I am doing three jobs at once. I have a bunch of scratch papers in my piles, I write
weekly wound measurements down on those, but sometimes it will sit there because I'm backlogged. I do
not feel like I can do all of these tasks.
During an interview on 7/9/24, at 2:11 p.m. Wound Care Nurse Employee E4 confirmed that the facility
failed to maintain complete and accurate documentation for Resident R38.
Review of Resident R38's Weekly Skin Integrity Review revealed documentation indicating that Resident
R38's skin was documented as intact for nine of 13 weeks on 4/12/24, 4/21/24, 5/6/24, 5/20/24, 5/27/24,
6/4/24, 6/11/24, 6/18/24, and 7/10/24.
During an interview on 7/10/24, at 11:40 a.m. Wound Care Nurse Employee E4 stated, Staff should be
documenting that skin is not intact, she has a pressure ulcer.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 62 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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
During an interview on 7/10/24, at 11:40 a.m. Wound Care Nurse Employee E4 confirmed that the facility
did not maintain accurate documentation for Resident R38.
Level of Harm - Minimal harm
or potential for actual harm
28 Pa. Code 211.5(f) Clinical Records.
Residents Affected - Some
28 Pa. Code 211.12(d)(1)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 63 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0849
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will
arrange for the provision of hospice services.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a
review of facility policy, resident clinical records, and staff interview, it was determined the facility failed to
obtain a diagnosis for hospice services and to ensure the coordination of hospice services with facility
services to meet the needs of each resident for end of life care for two of two residents (Resident R38 and
R93).
Findings include:
Review of facility policy Hospice Program dated 5/18/24, indicated it is the responsibility of the facility to
meet the resident's personal care and nursing needs in coordination with the hospice representative, and
ensure that the level of care provided is appropriately based on the individual resident's needs, including
communicating with the hospice provider (and documenting such communication) to ensure that the needs
of the resident are addressed and met 24 hours per day. The coordinated care plan will reflect the resident's
goals and wishes, as stated in his or her advanced directives and during ongoing communication with the
resident or representative.
Review of the clinical record indicated Resident R38 was admitted to the facility on [DATE].
Review of Resident R38's Minimum Data Set (MDS - a periodic assesssment of care needs) dated 4/7/24,
indicated diagnoses of high blood pressure, dementia (a group of symptoms that affects memory, thinking
and interferes with daily life), and muscle wasting.
Review of a physician order dated 1/28/24, indicated to admit Resident R38 to hospice, but did not include
a diagnosis related to the need of hospice services.
During an interview on 7/8/24, at 10:48 a.m. Health Unit Coordinator (HUC) Employee E22 confirmed
Resident R38 receives hospice services on Mondays and Wednesdays.
Review of Resident R38's current comprehensive care plan failed to indicate a plan of care by the facility
that displayed the coordination of hospice services by failing to included contact information for the hospice
agency and how to access the hospice's 24 hour on-call system.
Review of clinical record revealed that Resident R93 was admitted to the facility on [DATE].
Review of Resident 93's MDS dated [DATE], indicated diagnoses of high blood pressure, chronic kidney
disease, and hyponatremia (low sodium level in the blood). Section O0100 question K1 indicated that
Resident R93 has received hospice care while a resident.
Review of clinical record revealed a physician's order dated 3/15/24, to admit Resident R93 to hospice.
Review of the above physician's order did not include a diagnosis related to the need of hospice services.
During an interview on 7/8/24, at 2:10 p.m. Resident R93 confirmed that she receives hospice services.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 64 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0849
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Review of Resident R93's current comprehensive care plan failed to indicate a plan of care by the facility
that displayed the coordination of hospice services by failing to included contact information for the hospice
agency and how to access the hospice's 24 hour on-call system.
During an interview on 7/12/24, at 11:51 a.m. the Director of Nursing confirmed the facility failed to obtain a
diagnosis for hospice services and to ensure the coordination of hospice services with facility services to
meet the needs of each resident for end of life care for two of two residents (Resident R38 and R93).
28 Pa. Code 211.2(a) Physician services.
28 Pa. Code 211.11(d) Resident care plan.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 65 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of facility policy, resident records, observations and staff interview it was determined that the facility
failed to implement an infection control program that included a system of surveillance to identify possible
communicable diseases or infections for four of 11 months (March 2024, April 2024, May 2024, and June
2024), failed to prevent cross contamination during a dressing change for one of two residents (Resident
R9), and failed to make certain that appropriate treatments and services were provided for the use of a
urinary catheter as required for one out of five residents (R53).
Residents Affected - Some
Findings include:
Review of facility policy Surveillance for Infections dated 5/18/24, indicated the Infection Preventionist will
conduct ongoing surveillance for Healthcare-Associated Infections (HAIs) and other epidemiologically
significant infections that have substantial impact on potential resident outcomes and that may require
transmission-based precautions and other preventative interventions. The purpose of the surveillance of
infections is to identify both individual cases and trends of epidemiologically significant organisms and
HAIs, to guide appropriate interventions, and to prevent future infections.
Review of the Quality Assurance/Infection Control Preventionist job description indicated responsibilities
include develops and implements an ongoing infection prevention control program to prevent, recognize,
and control the onset and spread of infections to provide a safe, sanitary, and comfortable environment,
and maintains documentation of infection prevention and control program activities.
Review of the facility policy Wound Care dated 5/18/24, indciated that the purpose of this policy is to
provide guidelines for the care of wounds to promote healing. Step one indicated to use disposable cloth
(paper towel is adequate) to establish a clean field on the resident's bedside table. Place all items to be
used during procedure on the clean field. Once completed with the dressing change, clean the bedside
table, and return it to it's proper position.
Review of facility policy Catheter Care, Urinary dated 5/18/24, indicated that the facility should ensure that
the catheter tubing and drainage bag are kept off the floor.
Review of facility policy Infection Control dated 5/18/24, states the facility's infection control policies and
practices are intended to facilitate maintaining a safe, sanitary, and comfortable environment and to help
prevent and manage transmission of diseases and infection.
Review of the facility's Infection Control documentation for the previous 11 months (August 2023 through
June 2024) failed to reveal surveillance for tracking infections for residents for four of 11 months (March
2024, April 2024, May 2024, and June 2024).
During an interview on 7/12/24, at 8:50 a.m. the Director of Nursing (DON) confirmed that the facility failed
to implement an infection control program that included a system of surveillance to identify possible
communicable disease or infections for four of 11 months (March 2024, April 2024, May 2024, and June
2024).
Review of the clinical record indicated that Resident R9 was admitted to the facility on [DATE].
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 66 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0880
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Review of Residents R9's Minimum Data Set (MDS - a periodic assessment of care needs) dated 2/9/24,
indicated diagnoses of multiple sclerosis (a potentially disabling disease of the brain and spinal cord
(central nervous system), depression, and osteoarthritis (occurs when the protective cartilage that cushions
the ends of the bones wears down over time.)
Review of Resident R9's physician order dated 5/28/24, indicated to cleanse the left heel with vashe
(wound cleanser), apply collagen paste (a wound paste that contains protein that plays a role in each
phase of wound healing and encourages new tissue growth), mix small amount of normal saline solution
with powder to form paste, and cover with abdominal pad (wound dressing used for wounds requiring high
absorbency) and kerlix (rolled gauze commonly used to wrap extremity wounds) daily for wound care.
During an observation of Resident R9's left heel dressing change on 7/10/24, at 9:32 a.m. Wound Care
Registered Nurse, Employee E4 failed to wash her hands prior to putting on gloves, failed to clean the
bedside table prior to placing a barrier on half of the table. The bottom of the pack of gauze was placed off
the clean barrier, and Wound Care RN, Employee E4 placed the pack of gauze back on the clean field.
Wound Care RN, Employee E4 placed scissors on the unclean bedside table and failed to clean them prior
to removing Resident R9's old dressing. Once Wound Care RN, Employee E4 completed Resident R9's
dressing change, she failed to clean the bedside table.
During an interview on 7/10/24, at 10:56 a.m. the Director of Nursing confirmed the facility failed to prevent
cross contamination during a dressing change for one of five residents (Resident R9).
Review of Resident R53's clinical record indicated the resident was admitted to the facility on [DATE].
Review of Resident R53's MDS dated [DATE], indicated diagnoses of spina bifida (a birth defect in which a
spinal cord fails to develop properly), hypertension (high blood pressure in the arteries), and depression.
Section H-Bladder and Bowel indicated the utilization of an urostomy (a surgical procedure that creates a
stoma for the urinary system).
Review of the clinical record revealed that Resident R53 had a physician's order dated 3/8/24, for urostomy
care.
During an observation on 7/8/24, at 10:30 a.m. Resident R53 was observed lying in bed with his urinary
catheter bag laying directly on the floor without a covering bag.
During an interview on 7/8/24, at 10:36 a.m. Licensed Practical Nurse Employee E14 stated, I'll take care of
that now.
During an interview on 7/8/24, at 3:15 p.m. the DON confirmed that the facility failed to make certain that
appropriate treatments and services were provided for the use of a urinary catheter as required for one out
of five residents (R53).
28 Pa. code: 201.14 (a) Responsibility of licensee.
28 Pa. Code: 201.18 (b) (1) (e) (1) Management.
28 Pa. Code: 211.10 (d) Resident care policies.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 67 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0880
28 Pa. Code: 211.12 (d) (1) (2) (5) Nursing services.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 68 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0881
Implement a program that monitors antibiotic use.
Level of Harm - Minimal harm
or potential for actual harm
Based on review of the facility's infection control policies and procedures and staff interview, it was
determined that the facility failed to implement an antibiotic stewardship program for three of 11 months
(March 2024, April 2024, May 2024, and June 2024).
Residents Affected - Some
Findings include:
Review of facility policy Antibiotic Stewardship dated 5/18/24, indicated the purpose of the Antibiotic
Stewardship Program is to monitor the use of antibiotics in our residents.
Review of the Quality Assurance/Infection Control Preventionist job description indicated responsibilities
include overseeing the community's antibiotic stewardship program.
Review of the facility's Infection Control surveillance for August 2023 through June 2024, failed to include
documentation to indicate that antibiotic monitoring was completed for March 2024, April 2024, May 2024,
and June 2024.
During an interview on 7/12/24, at 8:50 a.m. the Director of Nursing confirmed that the facility failed to
implement an antibiotic stewardship program for four of 11 months (March 2024, April 2024, May 2024, and
June 2024).
28 Pa. Code: 211.10(c)(d) Resident care policies.
28 Pa. Code: 211.12(d)(1)(2)(3)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 69 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0947
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in
dementia care and abuse prevention.
Based on review of facility in-service documentation, personnel records, and staff interviews it was
determined that the facility failed to ensure that all nurse aide staff received a minimum of twelve hours of
in-service education training each year, within 12 months of their hire date anniversary, as required for five
out of five personnel records (Nurse Aide Employee E17, Nurse Aide Employee E18, Nurse Aide Employee
E19, Nurse Aide Employee E20, and Nurse Aide Employee E21).
Findings include:
Review of facility policy titled Staffing, Sufficient and Competent Nursing, dated 5/18/24, indicated that the
facility provides sufficient numbers of nursing staff with the appropriate skills and competency necessary to
provide nursing and related care and services for all residents in accordance with resident care plans and
the facility assessment.
Review of Nurse Aide Employee E17's personnel record indicated she was hired on 1/30/06.
Review of Nurse Aide Employee E17's personnel record failed to include a minimum of 12 hours of nurse
aide training per year as required under §483.95(g)(1).
Review of Nurse Aide Employee E18's personnel record indicated she was hired on 11/20/22.
Review of Nurse Aide Employee E18's personnel record failed to include a minimum of 12 hours of nurse
aide training per year as required under §483.95(g)(1).
Review of Nurse Aide Employee E19's personnel record indicated she was hired on 8/15/22.
Review of Nurse Aide Employee E19's personnel record failed to include a minimum of 12 hours of nurse
aide training per year as required under §483.95(g)(1).
Review of Nurse Aide Employee E20's personnel record indicated she was hired on 9/4/23.
Review of Nurse Aide Employee E20's personnel record failed to include a minimum of 12 hours of nurse
aide training per year as required under §483.95(g)(1).
Review of Nurse Aide Employee E21's personnel record indicated she was hired on 10/24/22.
Review of Nurse Aide Employee E21's personnel record failed to include a minimum of 12 hours of nurse
aide training per year as required under §483.95(g)(1).
During an interview on 7/12/24, at 2:27 p.m., the Nursing Home Administrator revealed that the facility was
unable to provide documentation that 12 hours of annual in-service training was completed for Nurse Aide
Employees E17, E18, E19, E20, and E21, within 12 months of their hire date anniversary.
During an interview on 7/12/24, at 2:30 p.m., the Nursing Home Administrator (NHA) confirmed that the
facility failed to ensure that all nurse aide staff received a minimum of twelve hours of in-service education
training each year for five out of five personnel records (Nurse Aide Employee E17,
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 70 of 71
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
395790
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/12/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Seneca Place
5360 Saltsburg Road
Verona, PA 15147
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 0947
Nurse Aide Employee E18, Nurse Aide Employee E19, Nurse Aide Employee E20, and Nurse Aide
Employee E21).
Level of Harm - Minimal harm
or potential for actual harm
28 Pa. Code: 201.14(a) Responsibility of Licensee.
Residents Affected - Some
28 Pa. Code: 201.20(a)(d) Staff Development.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395790
If continuation sheet
Page 71 of 71
Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.
Back to topCitations
28 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.
F550 - Resident Rights
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
F558 - The right to reside and receive services in the facility with reasonable
Reasonably accommodate the needs and preferences of each resident.
F578 - The right to request, refuse, and/or discontinue treatment, to participate in or
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
F609 - The facility must develop and implement written policies and procedures that:
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
F610 - In response to allegations of abuse, neglect, exploitation, or mistreatment, the
Respond appropriately to all alleged violations.
F622 - Transfer and discharge-
Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.
F641 - Accuracy of Assessments
Ensure each resident receives an accurate assessment.
F692 - Assisted nutrition and hydration
Provide enough food/fluids to maintain a resident's health.
F693 - Assisted nutrition and hydration
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
F698 - Dialysis
Provide safe, appropriate dialysis care/services for a resident who requires such services.
F699 - Trauma-informed care
Provide care or services that was trauma informed and/or culturally competent.
F881 - Infection prevention and control program
Implement a program that monitors antibiotic use.
- 0353GeneralS&S Fpotential for harm
Inspect, test, and maintain automatic sprinkler systems.
F583 - Privacy and Confidentiality
Keep residents' personal and medical records private and confidential.
F607 - The facility must develop and implement written policies and procedures that:
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
F686 - Skin Integrity
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
F690 - Incontinence
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
F700 - Bed Rails
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
F759 - Medication Errors
Ensure medication error rates are not 5 percent or greater.
F760 - Residents are free of any significant medication errors
Ensure that residents are free from significant medication errors.
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.
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F842 - Resident-identifiable information
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
F849 - Hospice services
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
F880 - Infection Control
Provide and implement an infection prevention and control program.
F947 - Training Requirements
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
FAQ · About this visit
Common questions about this visit
What happened during the July 12, 2024 survey of SENECA PLACE?
This was a inspection survey of SENECA PLACE on July 12, 2024. The surveyor cited 28 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at SENECA PLACE on July 12, 2024?
Yes, 28 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her right..."
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 . If you believe any information is inaccurate, report it here.