Health inspection·May 22, 2025

F 0917 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure each resident has 1) at least one window to the outside in a room; 2) a room at or above ground level; 3) adequate bedding; 4) furniture that meets the resident's needs; or 5) adequate closet space. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, it was determined the facility failed to provide a bed frame, a mattress and functional furniture in resident rooms on one of three units (Third Floor). Findings include: Review of the Code of Federal Regulations (CFR) 483.90(e)(2) -The facility must provide each resident with-(i) A separate bed of proper size and height for the safety and convenience of the resident; (ii) A clean, comfortable mattress; (iii) Bedding, appropriate to the weather and climate; and (iv) Functional furniture appropriate to the resident's needs. Observation on 5/19/25, at 3:00 p.m., of the Third-Floor nursing unit indicated the following: - room [ROOM NUMBER] (dual occupancy room) was missing one bed frame, two mattresses, and furniture. - room [ROOM NUMBER] (dual occupancy room) was missing one bed frame, two mattresses, and furniture. - room [ROOM NUMBER] (single occupancy room) was missing one bed frame, one mattress, and furniture. - room [ROOM NUMBER] (single occupancy room) was missing one bed frame, one mattress, and furniture. - room [ROOM NUMBER] (dual occupancy room) was missing two bed frames, two mattresses, and furniture. - room [ROOM NUMBER] (single occupancy room) was missing one mattress, and furniture. (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 2 Event ID: 395883 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 395883 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Burgh Care Center 909 West Street Pittsburgh, PA 15221 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)