Health inspection·September 22, 2023

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policies, clinical records, facility documents and staff interview, it was determined that the facility failed to ensure that a resident was free from an accident by not providing the appropriate amount of supervison needed for toileting, for one of three residents reviewed (Resident R75). Findings include: Review of the facility policy fall prevention plan last review on 9/18/23, with a previous review date of 3/2/22, indicated that post fall the resident is assessed by a licensed nurse, once the resident is safely transferred a fall investigation begins, any witnesses to the fall should provide a written statement and interventions should be put into place to prevent further falls. Review of the facility policy Occurrence Incident Reporting policy last reviewed on 9/18/23, with a previous review date of 3/2/22, indicated incidents will be investigated, reported and tracked. documentation will be placed in progress notes and reviewed for potential harm. An event report will be submitted to the state if identified to be appropriate. Review of the clinical record indicated that Resident R75 was admitted to the facility on [DATE], with diagnoses which included indicated diagnoses of Parkinson's disease( a disorder of the central nervous system which affects movement and often causes tremors, other symptoms include unsteadiness and stiffness) and a history of falls. A Minimum Data Set (MDS- a periodic review of resident care needs) dated 7/19/23, indicated the diagnoses remained current and Section G0110 indicated that Resident R75 required assistnace of two for transfers and toilet use. Section G 0300 indicated unsteadiness for stabilization with toileting. A current physician order dated 7/14/23, indicated Resident R75 was a two person transfer. Review of a progress note dated 8/20/23, at 18:24 indicated that Resident R75 was found on the floor in the bathroom by the Nurse Aide. The note indicated that the resident stated he was on the toilet, went to stand up and lost balance and fell. The note further indicated that the Nurse Aide stated she took the resident to the bathroom, assisted him to the toilet and instructed him to ring when he was done. During an interview on 9/19/23, at 1:46 p.m., the Director of Nursing stated that the facility failed to ensure that a resident was free from an accident by not providing the appropriate amount of supervison needed for toileting. (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: 395977 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 395977 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Terrace Health & Rehab Center 410 Terrace Drive Uniontown, PA 15401 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)