Health inspection·May 20, 2025

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 policies and clinical records, as well as staff interviews, it was determined that the facility failed to complete safety assessments for one of 36 residents reviewed who used siderails (Resident 3) and two of 36 residents reviewed (Residents 9, 25) who used an air mattress. Findings include: A facility policy for siderails dated May 14, 2025, indicated that an assessment will be made to determine the resident's symptoms or reason for using siderails. The use of siderails will be evaluated in terms of risk and benefit for each individual resident. A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 3, dated February 21, 2025, indicated that the resident was cognitively intact, required assistance from staff for daily care needs, and had diagnoses that included infection of a right knee prosthesis (artificial replacement). A side rail/assist bar evaluation/assessment for Resident 3, dated March 21, 2025, indicated that the resident was being assessed for an assist bar. Section D was not completed to identify if side rails/assist bars were indicated or not indicated. However, observations of Resident 3 on May 17, 2025, at 10:30 a.m., on May 18, 2025, at 10:17 a.m., and on May 18, 2025, at 9:17 a.m. revealed that the resident was lying in bed with bilateral upper siderails up on her bed. Interview with the Director of Nursing on May 20, 2025, at 1:20 p.m. confirmed that the last two siderail assessments for Resident 3 were not fully completed to identify whether siderails were indicated or not. A quarterly MDS assessment for Resident 9, dated February 2, 2025, revealed that the resident was cognitively intact, was dependent on staff for personal care needs, and had diagnoses that included chronic deep vein thrombosis (blood clot in a deep vein that has lasted for at least a month). Physician's orders for Resident 9, dated February 21, 2025, indicated that the resident was to have an air mattress that was checked for function every shift. A care plan for Resident 9, dated May 24, 2025, indicated that the resident had potential for impaired skin integrity and that he should have an air mattress that was checked for function every shift. Observations of Resident 9 on May 17, 2025, at 10:40 a.m. revealed that the resident was lying in bed, and the bed was equipped with an air mattress; however, there was no documented evidence that the use of an air mattress was assessed for potential safety hazards prior to being placed on the resident's bed. (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: 395892 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 395892 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Latrobe 576 Fred Rogers Drive Latrobe, PA 15650 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)