Health inspection·June 4, 2024

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, closed clinical record review, review of facility documents, and staff interview, it was determined that the facility failed to to provide the services necessary to prevent accidents resulting in multiple sustained fractures for one of five residents reviewed resulting in actual harm (Resident CR1). Findings include: Closed clinical record review for Resident CR1 revealed a nursing note dated [DATE], at 9:09 PM noting the resident was being turned by a nurse aide and rolled off the bed onto the floor. It was noted the resident had a left dorsal head bump and complaints of severe left hip pain. A follow up nursing note for Resident CR1 dated [DATE], at 9:23 PM indicated the physician had provided a verbal order to send the resident to the emergency room due to the severe left hip pain. Nursing documentation dated [DATE], at 11:34 PM summarized the incident that occurred prior to being transferred to the hospital. The writer noted they heard a loud thump outside of Resident CR1's room and entered the room to find Resident CR1 on the floor between the resident's bed and the first bed in the room. It was noted a hematoma (bruise) was observed on the back of the resident's head on the left side, and the resident had complaints of hip pain. A nurse aide in the room was questioned as to how the incident occurred and what side the resident landed on. The nurse aide in the room replied with, I don't know. The nurse aide was halfway between the resident's bed and bathroom when the writer entered. The writer indicated that based on experience, the resident is unable to roll independently and will continue to roll if she is rolled by the nurse aide and let go. The writer noted the resident left the facility at 9:35 PM to go to the emergency room. A review of Resident CR1's documents from the emergency room visit revealed the resident received several tests in the emergency room dated [DATE], to include x-rays of her bilateral hips, chest, and left shoulder as well as CT scans of her cervical spine, head/brain, chest/abdomen, and pelvis. Review of the resident's emergency department provider summary of the visit revealed the resident was diagnosed with a scalp hematoma (bruise), right hip fracture, multiple left-sided rib fractures, and a left scapular (shoulder blade) fracture. It was noted the residents responsible party declined surgery for the resident's hip fracture. A nursing note dated [DATE], at 5:55 AM for Resident CR1 indicated the resident returned to the facility from the emergency department at 5:00 AM and staff were not able to complete a full skin assessment due to the resident being in too much pain. Nursing staff administered Morphine (an opioid medication used to treat severe pain). (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 3 Event ID: 395825 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 395825 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Watsontown Rehabilitation and Nursing Center 245 East Eighth Street Watsontown, PA 17777 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)