Inspection·August 22, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical records and staff interview, it was determined that the facility failed to notify the family of a change in condition in a timely manner for one of four residents (Resident R1). Findings include: Review of the facility policy Notification of Change Condition: Responsible Party/Guardian dated 5/1/24, indicated the responsible party or guardian is to be notified when there has been any break in the resident's skin integrity. Review of the clinical record indicated that Resident R1 was admitted to the facility on [DATE], with diagnoses that included dementia and a fractured left leg. Review of the Minimum Data Set (MDS - a periodic assessment of care needs) dated 7/4/24, indicated the diagnoses remain current. Review of Resident R1's admission assessment dated [DATE], indicated the resident had a skin alteration to the coccyx (lower back) 0-0.3 cm (centimeters) with light exudate (abrasion) and granulated (healing) tissue. Review of Resident R1's nurse progress note dated 7/8/24, indicated possible Kennedy Wound (pressure ulcer that has a sudden onset and rapid progression) to coccyx 6.5 cm X 7 cm, dressing applied and wound care CRNP (certified registered nurse practitioner) sent to assist in treatment plan. There was no evidence in the clinical record that the resident's family was notified of this change in condition. During an interview on 8/22/24, at 3:0 p.m. the Director of Nursing confirmed that the facility failed to notify the family of a change in condition in a timely manner for one of four residents (Resident R1). 28 Pa. Code: 201.29(a)(b)(c)(d)(j)(m) Resident rights. 28 Pa. Code: 201.14(a)(c)(d)(e) Responsibility of licensee. 28 Pa. Code: 211.12(d)(1)(2)(3)(5) Nursing services. (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 3 Event ID: 395948 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 395948 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center at Jefferson Hills, The 540 Coal Valley Road Jefferson Hills, PA 15025 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)