Health inspection·November 2, 2023

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 policy and records, and staff interviews, it was determined that the facility failed to provide adequate supervision that resulted in an resident elopement resident exits to an unsupervised or unauthorized area without the facility's knowledge) for one of three residents reviewed (Resident R64). This was identified as past non-compliance for one resident (Resident R64). Findings include: A review of the facility policy Elopement, reviewed 9/27/23, indicated the residents are assessed upon admission, quarterly, and change in condition by staff members to determine if they are at risk for elopement. The following may be used for residents identified as high risk for elopement: frequent monitoring of resident ' s whereabouts, individual to maintain interest level, environmental controls such as secure units with appropriate Code Alert device, alarmed doors, and restricted window openings. A review of the facility document Code Alert Procedure for the Secured Unit (Second Floor) reviewed 9/27/23, indicated the elevator on the second floor is equipped with an electronic system that will prevent a resident with a special alert bracelet (code alert) from exiting the unit via elevator. When a resident with the code alert bracelet appears in proximity to the elevator, the elevator will not close the doors unless a special code is entered into the keypad next to the elevator. The Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual, which provides instructions and guidelines for completing required Minimum Data Set (MDS) assessments (mandated assessments of a resident's abilities and care needs), dated October 2019, indicated that a BIMS (Brief Interview of Mental Status) is a brief screener that aids in detecting cognitive impairment. Scores from a BIMS assessment suggests the following distributions: 13 - 15: cognitively intact 8 - 12: moderately impaired 0 - 7: severe impairment Review of the clinical record indicated Resident R64 was admitted to the facility on [DATE], with diagnoses that included high blood pressure, dementia (loss of cognitive functioning, thinking, remembering, and reasoning, to such an extent that it interferes with a person's daily life and activities), and right hip fracture (partial or complete break in the bone). (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 7 Event ID: 395823 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 395823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Townview Health and Rehabilitation Center 300 Barr Street Canonsburg, PA 15317 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)