Health inspection·January 6, 2025

F 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Allow resident to participate in the development and implementation of his or her person-centered plan of care. Based on review of facility policies and clinical records, and staff interviews, it was determined that the facility failed to ensure the resident and/or resident representative was offered the opportunity to participate in the development, review, and/or revision of their person-centered care plan for three of three residents reviewed (Residents R1, R2, and R3). Findings include: Facility policy entitled Care Planning - Interdisciplinary Team, dated 1/18/24, indicated the interdisciplinary team is responsible for the development of resident care plans. Resident care plans are developed according to the timeframes and criteria established by 483.21. The resident, the resident's family and/or resident's legal representative/guardian or surrogate are encouraged to participate in the development of and revisions to the resident's care plan. Facility policy entitled Quarterly Assessments and Care Plan, dated 1/18/24, indicated Quarterly MDS assessments are conducted to track the resident's status between comprehensive assessments to ensure critical indicators of gradual change in a resident's status are monitored. Quarterly and annual care plan conferences invites are to be mailed to responsible party and resident to participate in plan of care with interdepartmental team. Resident R1's clinical record revealed an admission date of 9/23/20, with diagnoses that included heart disease, bronchitis, obstructive and reflux uropathy (a condition where the flow of urine is blocked and flows backward from the bladder and sometimes into the kidneys), and maxillary sinusitis (a condition when the sinuses behind the cheekbones become inflamed or infected). Resident R1's clinical record revealed an Annual MDS (Minimum Data Set - federally mandated standardized assessment conducted at specific intervals to plan resident care needs) assessment, with an Assessment Reference Date (ARD - a look back period of time for the MDS assessment) of 9/20/24. The clinical record lacked any evidence that the resident or resident representative was invited to or attended a care plan meeting in conjunction with the 9/20/24, Annual MDS. Resident R2's clinical record revealed an admission date of 10/29/21, with diagnoses that included Alzheimer's disease (a disease that affects the brain resulting in mood disturbances, behaviors, and poor decision making), high blood pressure, high cholesterol, and hypothyroidism (a condition where the thyroid does not produce enough thyroid hormone). Resident R2's clinical record revealed a Quarterly MDS assessment, with an ARD of 9/13/24. The clinical record lacked any evidence that the resident or resident representative was invited to or (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: 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 01/06/2025 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)