Health inspection·July 8, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on a review of clinical records, information submitted to the State Survey Agency through the Electronic Reporting System, facility email communication, and staff interviews, it was determined the facility failed to ensure that all allegations of resident abuse and misappropriation were thoroughly investigated and that complete investigation results were submitted to the State Survey Agency within five working days of the incident, as evidenced by one of one allegation of misappropriation reviewed involving two residents of six residents sampled (Residents CR1 and CR2). Findings include: A review of the facility's policy titled Abuse Protection, last reviewed by the facility in February 2024, revealed that it is the policy of the facility to submit the required investigative documentation through the Electronic Event Reporting System within five working days of a reported allegation when an alleged perpetrator is identified. A review of incidents of alleged abuse, neglect, and misappropriation showed that the facility reported the following incident through the Electronic Reporting System but failed to submit a complete investigation report and documentation of corrective actions within the required timeframe: On May 25, 2025, the facility reported an incident involving an alleged misappropriation of property. According to the report, Resident CR1 had been discharged home from the facility on May 24, 2025, with a prescription for 28 tablets of Oxycodone 5 mg (narcotic medication) tablets. Upon arrival home, Resident CR1's responsible party (RP) discovered that 11 tablets were missing. The RP contacted the facility and spoke with Employee 1 (Licensed Practical Nurse), who had been assigned to Resident CR1 on the day of discharge. Employee 1 informed the RP that she had the remaining pills in a prescription bottle and offered to deliver them directly, however, the RP instead notified the facility administration. It was noted the facility's standard practice is to dispense prescription medications on a unit-dose card, not in a bottle. An internal review was initiated and further revealed that Resident CR2, who had recently been discharged to the hospital, was also missing 32 remaining Hydrocodone 10 mg tablets. In addition, the required controlled substance sign-out sheets for both residents' medications were missing. Although the facility initiated an investigation, the submitted investigative report was incomplete and did not include required supporting documentation such as witness statements or confirmation that the investigation contained all necessary components. The incomplete report was rejected by the State Survey Agency on June 5, 2025, due to insufficient detail, and the facility failed to submit a revised, complete investigation for review. Page 1 of 2 395936 395936 07/08/2025 Wayne Woodlands Manor 37 Woodlands Drive Waymart, PA 18472

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of the State Agency's Electronic Reporting System confirmed that no complete investigation report was resubmitted after June 5, 2025. During an interview with the Director of Nursing and the Nursing Home Administrator on July 8, 2025, at approximately 1:30 PM, the facility was unable to provide documented evidence the investigation was completed in full and submitted to the State Survey Agency within the required five working days. These findings were reviewed with the Nursing Home Administrator and Director of Nursing during the exit conference. 28 Pa Code 201.1 (a) Responsibility of licensee. 28 Pa Code 201.18 (e)(1) Management. 395936 Page 2 of 2