Inspection visit
Health inspection
2 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 2 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0656
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Develop and implement a complete care plan that meets all the resident's needs, with timetables and
actions that can be measured.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of facility policies and clinical records, and staff interview, it was determined that the facility failed to
develop a comprehensive care plan for one of one residents reviewed regarding an elopement (Resident
R30).
Findings include:
Facility policy entitled, Care Plans, Comprehensive Person-Centered revised March 2022, included: the
comprehensive, person-centered care plan includes measurable objectives and timetables to meet the
resident's physical, psychosocial, and functional needs is developed and implemented for each resident;
care plan interventions are chosen only after data gathering, proper sequencing of events, careful
consideration of the relation ship between the resident's problem areas and their causes, and relevant to
clinical decision making.
Resident R30's clinical record revealed an admission date of 1/12/24, with diagnoses that included
dementia, weakness, unsteady on feet, abnormalities of gait and mobility, and repeated falls.
Resident R30's clinical record revealed the following departmental progress notes:
-8/07/24, at 2:08 a.m. indicated the lounge alarm going off, notified nursing staff and registered nurse, back
door alarm went off, began bed checks and staff left to search outside and on the unit. Found resident by
bridge outside, licensed practical nurse and staff was able to bring him/her back inside. Resident claimed
he/she went outside because he/she didn't want to miss his/her appointment.
- 8/07/24, at 2:29 p.m. indicated that Resident R30 was relocated to room [ROOM NUMBER]B (Memory
Care Unit).
Further review on 8/14/24, of Resident R30's current care plans lacked evidence that a comprehensive
person-centered plan of care was developed to address Resident R1's elopement from the facility on
8/07/24.
During an interview on 8/14/24, at 1:56 p.m. the Director of Nursing confirmed that the facility should have
developed a comprehensive person-centered care plan to address Resident R30's recent elopement from
the facility.
28 Pa. Code 211.12(d)(1)(5) Nursing services
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:
395853
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
395853
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
08/14/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Crawford Care Center
20881 State Highway 198
Saegertown, PA 16433
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)
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.
Based on review of facility policy and documentation and clinical records, and staff interview, it was
determined that the facility failed to thoroughly investigate an elopement (unauthorized leave from a safe
area) for one of one residents reviewed for elopements (Resident R30).
Findings include:
A facility policy entitled, Wandering and Elopements revised March 2019, revealed that when the resident
returns to the facility, the Director of Nursing or charge nurse shall: examine the resident for injuries; contact
the attending physician and report findings and conditions of the resident; notify the resident's legal
representative; complete and file an incident report; and document relevant information in the resident's
medical record.
Resident R30's clinical record revealed an admission date of 1/12/24, with diagnoses that included
dementia, weakness, unsteady on feet, abnormalities of gait and mobility, and repeated falls. The most
recent Quarterly Minimum Data Set (federally mandated process that assesses the clinical needs and
functional capabilities of residents in nursing homes) with a reference date or 5/09/24, Section C0500
(cognitive patterns) indicated Resident R30's Brief Interview for Mental Status score was 13 (cognitively
intact).
Resident R30's clinical record revealed the following departmental progress notes:
-8/07/24, at 2:08 a.m. indicated the lounge alarm going off, notified nursing staff and registered nurse, back
door alarm went off, began bed checks and staff left to search outside and on the unit. Found resident by
bridge outside, licensed practical nurse and staff was able to bring him/her back inside. Resident claimed
he/she went outside because he/she didn't want to miss his/her appointment.
-8/07/24, at 8:35 a.m. phone message left for granddaughter to return call, ensured via phone message all
was well and to just return call to discuss resident care.
-8/07/24, at 1:41 p.m. this author tried to notify granddaughter of elopement issue, left two messages.
Resident R30's clinical record lacked evidence that the facility examined the resident for injuries; contacted
the attending physician and reported findings and conditions of the resident; successfully notified the
resident's legal representative; completed and filed an incident report; and documented relevant information
in the resident's medical record.
During an interview on 8/14/24, at 11:00 a.m. the Director of Nursing confirmed there was no evidence that
the facility examined the resident for injuries; contacted the attending physician and reported findings and
conditions of the resident; successfully notified the resident's legal representative; completed and filed an
incident report; and documented relevant information in Resident R30's clinical record.
28 Pa. Code 201.14(a) Responsibility of Licensee
28 Pa. Code 201.18(b)(1) Management
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395853
If continuation sheet
Page 2 of 3
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
395853
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
08/14/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Crawford Care Center
20881 State Highway 198
Saegertown, PA 16433
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)
F 0689
28 Pa. Code 201.18(e)(1) Management
Level of Harm - Minimal harm
or potential for actual harm
28 Pa. Code 211.12(d)(1)(5) Nursing Services
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395853
If continuation sheet
Page 3 of 3
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Back to topCitations
2 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
FAQ · About this visit
Common questions about this visit
What happened during the August 14, 2024 survey of CRAWFORD CARE CENTER?
This was a inspection survey of CRAWFORD CARE CENTER on August 14, 2024. The surveyor cited 2 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at CRAWFORD CARE CENTER on August 14, 2024?
Yes, 2 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be ..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.