Inspection·January 28, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy and clinical records and staff interviews it was determined that the facility failed to make certain controlled substances were accounted for accurately for four of seven residents (Resident R1, R2, R3, and R4). Findings include: Review of the facility policy, Administering Medications dated 11/1/24, indicated, Medications are administered in a safe and timely manner, and as prescribed. Review of the clinical record indicated Resident R1 was admitted to the facility 11/27/24. Review of the Minimum Data Set (MDS, periodic assessment of resident care needs) dated 11/29/24, included diagnoses of emphysema (a lung disease which results in shortness of breath due to over-swelling of the alveoli) and lung cancer. Review of a physician order dated 12/6/24, discontinued 12/10/24, indicated Resident R1 was to receive oxycodone ER (extended release) 20 mg every twelve hours. Review of a physician order dated 12/6/24, discontinued 12/10/24, indicated Resident R1 was to receive oxycodone (an opioid pain medication) 5 mg, every four hours, as needed for pain. Review of the pharmacy shipping manifest dated 12/6/24, indicated at 5:20 p.m. Registered Nurse (RN) Employee E1 signed that 28 tablets of oxycodone 5 mg were received by the facility. Prescription number 7571023.00. Review of the pharmacy shipping manifest dated 12/7/24, indicated Licensed Practical Nurse (LPN) Employee E2 signed that 30 tablets of Oxycontin (trade name for oxycodone hydrochloride) ER (extended release) 20 mg were received by the facility. This document did not include a time the medication was signed for. Prescription number 7571278.00. Review of the December 2024 Medication Administration Record (MAR) indicated Resident R1 received Oxycodone ER 20 mg on: -12/7/24, 9:00 a.m. scheduled time. -12/8/24, 9:00 a.m. scheduled time. (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 5 Event ID: 395826 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 395826 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Hills Post Acute 1105 Perry Highway Pittsburgh, PA 15237 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)