Health inspection·January 5, 2024

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. Based on review of facility documentation and resident responsible party and staff interview, it was determined that the facility failed to resolve resident grievances related to respect, incontinence issues, and resident safety for one of five residents reviewed (Resident 1). Findings include: Review of the facility Concern Forms for the month of December 2023, revealed the Log for December 2023, had 5 concern forms submitted related to Resident 1. Review of the Resident Concern reports related to Resident 1 revealed that all 5 were filed by her daughter/responsible party. Review of the concern forms for Resident 1, filed by her daughter/responsible party revealed the following: December 12, 2023, Concern form filed related to the resident being in pants all day that had a dried urine mark on them suggesting that they did not put her in dry pants all day. The form indicated the findings and disposition that a toileting program would be evaluated, and a family meeting scheduled. The investigation was completed by Employee 1 (Social services) on December 14, 2023. The form was incomplete as the following information was left blank: was concern confirmed or not, was the responsible party notified and how the responsible party was notified, was a written concern follow-up requested, any follow-up (if applicable), and the Administrator's signature and date. December 12, 2023, Concern form filed related to the resident not being changed timely on December 7, 2023, and her clothes from that date were found in a plastic bag soaked on December 8, 2023, when the daughter came into the facility. Findings and disposition indicated that a family meeting was held with the daughter and Resident documentation was reviewed related to toileting and staff educated. The investigation was completed by Employee 1 (Social services) on December 13, 2023. The form was incomplete as the following information was left blank: was concern confirmed or not, was the responsible party notified and how the responsible party was notified, was a written concern follow-up requested, any follow-up (if applicable), and the Administrator's signature and date. December 17, 2023, Concern form filed related to a nurse aide and a supervisor being disrespectful to Resident 1's daughter/responsible party. There was no signature to indicate indicating what employee was investigating the concern. There were no findings/disposition noted on the form. The form was incomplete as the following information was left blank: was concern confirmed or not, was the responsible party notified and how the responsible party was notified, was a written concern follow-up Page 1 of 2 395825 395825 01/05/2024 Watsontown Rehabilitation and Nursing Center 245 East Eighth Street Watsontown, PA 17777

F 0585 requested, any follow-up (if applicable), and the Administrator's signature and date. Level of Harm - Minimal harm or potential for actual harm December 17, 2023, Concern form filed related to the resident being saturated with urine on the morning of December 16, 2023, a discolored area noted on her back her mother was missing another tooth on her bottom right. Employee 1 signed as the employee who investigated the concern on December 18, 2023. She indicated in findings that staff were educated, and interdisciplinary review was done. The form was incomplete as the following information was left blank: was concern confirmed or not, was the responsible party notified and how the responsible party was notified, was a written concern follow-up requested, any follow-up (if applicable), and the Administrator's signature and date. Residents Affected - Few December 17, 2023, Concern form filed related to the front door of the facility was propped open with a wet floor sign. The concern form was related to Resident 1's daughter/responsible party noting that the front door to the facility was propped open with a wet floor sign on at least three occasions. There was no signature to indicate what employee was investigating the concern. The findings indicated that a family meeting was completed with the Administrator and Director of Nursing. The form was incomplete as the following information was left blank: was concern confirmed or not, was the responsible party notified and how the responsible party was notified, was a written concern follow-up requested, any follow-up (if applicable), and the Administrator's signature and date Interview with Employee 1 on January 4, 2023, at 10:40 AM revealed that she was the grievance officer responsible for the concern form process. She indicated that she did not follow-up with Resident 1's daughter/responsible party related to the grievances filed on December 12, 2023, or December 17, 2023. Employee 1 indicated that there was a meeting scheduled with the daughter but that the employee did not attend the meeting. She also indicated that she had no written documentation related to the findings and disposition of the above noted grievances and that she did not ask Resident 1's daughter if she wanted a written concern form follow-up. On January 4, 2024, at 11:00 AM Employee 1 provided the surveyor with a copy of a progress note with an effective date of December 18, 2023, at 4:38 PM that was completed by the Nursing Home Administrator on January 4, 2024, at 10:58 AM (after the surveyor addressed the issues with the concern forms with Employee 1), that indicated a meeting was held with Resident 1's daughter related to her yelling at the staff and being disruptive and they discussed the concerns with incontinence care at the meeting. Interview with Resident 1's daughter/responsible party on January 4, 2024, at 12:40 PM revealed that she did not receive a response to her grievances that she filed on December 12, 2023, or December 17, 2023. She indicated that a meeting was held on December 18, 2023, concerning the altercation she had with two staff members on December 17, 2023, but the Nursing Home Administrator did not want to hear her side. He just indicated that he did not ever want to hear of another weekend like this past one again. Interview with the Nursing Home Administrator on January 4, 2023, at 1:20 PM confirmed that the facility failed to provide follow-up to concern forms filed by Resident 1's daughter/responsible party or to offer a written concern form follow-up to the concern forms. 28 Pa. Code: 201.14 (a) Responsibility of licensee 28 Pa. Code: 201.18 (b)(3) Management 395825 Page 2 of 2