Health inspection·December 2, 2024

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility documents, facility policy, clinical records, facility tour, and staff interviews, it was determined that the facility failed to make certain each resident received adequate supervision that resulted in an elopement (leaving an area without permission) for one of six residents (Resident R1). Findings include: Review of facility policy Wandering and Elopements last reviewed 5/18/24, indicated that the facility will identify residents who are at risk of unsafe wandering and strive to prevent harm while maintaining the least restrictive environment for residents. Review of the clinical record revealed that Resident R1 was admitted to the facility on [DATE]. Review of Resident R1's MDS (Minimum Data Set, periodic assessment of resident care needs) dated 11/5/24, indicated diagnoses of high blood pressure, dementia (neuro-cognitive disorder impacting reasoning, judgment, and memory), and psychotic disorder (a mental disorder characterized by a disconnection from reality). Review of clinical record revealed that on 5/13/24, Resident R1's care plan included a problem that Resident R1 was identified as an elopement risk/wanderer related to a history of attempts to leave facility unattended, and has impaired safety awareness. Review of clinical record revealed that on 9/23/24, a physician's order was written for Resident R1 to receive a Security Bracelet (a device applied to the resident that alerts staff when they leave a safe area) underneath the wheelchair seat. Review of the clinical record revealed a progress note dated 11/6/24, that Resident R1 attempted to leave facility twice, becoming very combative and hostile towards staff both times. Began swinging at and scratching this writer when I attempted to keep her from getting on the elevator, began swearing loudly, stated she has no problem hitting anyone and that she would punch me in the head. A nurse aide came and convinced her to go to her room to get a few things hoping it would calm her down for a while. Review of the clinical record revealed a progress note dated 11/24/24, that Resident R1 brought back to the unit at 8:30 p.m. by nurse aide after being found in the parking lot in her wheelchair. Resident R1 with a Wanderguard (security bracelet) attached to her wheelchair due to the resident repetitively in the past removing it from her wrist and ankle. Incident reported to nurse supervisor. (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 4 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 12/02/2024 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)