Health inspection·June 6, 2025

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. Based on review of facility policy and clinical records, and resident and staff interviews, it was determined that the facility failed to promote resident choices about aspects of his or her life in the facility that are significant to the resident regarding medication administration for two of 16 residents reviewed (Residents R11 and R51). Findings include: The facility policy entitled Medication Administration-General Guidelines, dated 12/11/24, indicated that medications are administered within 60 minutes of scheduled time. Resident R11's clinical record revealed an admission date of 3/27/23, with diagnoses that included diabetes (condition of improper blood sugar control), anxiety (a condition that causes a person to be nervous, uneasy, or worried about something or someone), and chronic obstructive pulmonary disease (a progressive lung disease with chronic respiratory symptoms). During an interview with Resident R11 on 6/4/25, at 10:30 a.m. the resident shared that he/she had received medications late on 5/28/25, and had filed a grievance against Licensed Practical Nurse (LPN) Employee E5. Resident R11 indicated that receiving medications at 9:30 p.m. is too late and prefers to have the medications administered closer to 8:00 p.m. Review of Resident R11's May Medication Administration Record (MAR) revealed that on 5/28/25, seven medications that were ordered for 8:00 p.m. were administered at 9:25 p.m. Resident R51's clinical record revealed an admission date of 5/23/24, with diagnoses that included protein-calorie malnutrition, anxiety, and bipolar disorder( a mental disorder with periods of depression and abnormally elevated moods). During an interview with Resident R51 on 6/3/25, at 11:00 a.m. the resident shared that he/she had received medications late on a few days from LPN Employee E5 and prefers to have the medications administered closer to 8:00 p.m. Review of Resident R51's May MAR revealed that on 5/28/25, five medications that were ordered for 8:00 p.m. were administered at 9:06 p.m. and on 5/30/25, five medications that were ordered for 8:00 p.m. were administered at 9:24 p.m. During an interview on 6/04/25, at 1:00 p.m. the Infection Control Preventionist confirmed that Residents R11 and R51 medications were not administered timely for the above dates and in accordance (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 6 Event ID: 395901 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 395901 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Titusville Nursing and Rehab 81 Dillon Drive Titusville, PA 16354 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)