Health inspection·September 29, 2023

F 0699 Provide care or services that was trauma informed and/or culturally competent. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records, and staff interviews, it was determined that the facility failed to provide culturally competent, trauma care in accordance with professional standards of practice, accounting for the resident's past experiences and preferences in order to eliminate and/or mitigate triggers that may cause re-traumatization of the resident for eight of 12 residents (Resident R1, R2, R3, R4, R5, R6, R7, and R8). Residents Affected - Some Findings include: Review of the clinical record revealed that Resident R1 was admitted to the facility on [DATE]. Review of the facility diagnosis list included diagnoses of schizophrenia (a mental disorder characterized by delusions, hallucinations, disorganized speech and behavior) and diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time). Review of Resident R1's Social History Assessment completed on 9/21/23, at 8:58 a.m. indicated Resident R1 was a retired veteran. Further review of the Social History Assessment revealed the section titled PTSD (post-traumatic stress disorder, mental health condition triggered by experiencing or witnessing a terrifying event) was blank. During an interview on 9/29/23, at 2:03 p.m. Resident R1 confirmed that he was not asked about PTSD by facility staff. When asked if he felt traumatized by previous life events, Resident R1 began crying and stated his mother had committed suicide. Review of the clinical record revealed that Resident R2 was admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS, periodic assessment of resident care needs) dated 9/17/23, included diagnoses of diabetes and chronic obstructive pulmonary disease (COPD, a group of progressive lung disorders characterized by increasing breathlessness). Review of Resident R2's Social History Assessment completed on 9/12/23, at 11:33 a.m. revealed the section titled PTSD was blank. During an interview on 9/29/23, at 2:07 p.m. Resident R2 confirmed that she was not asked about PTSD by facility staff, and further stated that she felt she had PTSD but was not triggered by her current environment. Review of the clinical record revealed that Resident R3 was admitted to the facility on [DATE]. Page 1 of 4 395977 395977 09/29/2023 Terrace Health & Rehab Center 410 Terrace Drive Uniontown, PA 15401

F 0699 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the facility diagnosis list included diagnoses of Asperger's syndrome (a developmental disorder affecting ability to effectively socialize and communicate) and diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time). Review of Resident R3's Social History Assessment completed on 9/26/23, at 11:37 a.m. revealed the section titled PTSD was blank. During an interview on 9/29/23, at 2:11 p.m. Resident R3 confirmed that he was not asked about PTSD by facility staff. When asked if he felt traumatized by previous life events, Resident R3 stated he recurrently worries about falling again. Review of the clinical record revealed that Resident R4 was admitted to the facility on [DATE]. Review of the MDS dated [DATE], included diagnoses of chronic kidney disease (gradual loss of kidney function) and heart failure (a progressive heart disease that affects pumping action of the heart muscles). Review of Resident R4's Social History Assessment completed on 9/5/23, at 8:29 a.m. revealed the section titled PTSD was blank. During an interview on 9/29/23, at 2:16 p.m. Resident R4 confirmed that she was not asked about PTSD by facility staff. Review of the clinical record revealed that Resident R5 was admitted to the facility on [DATE]. Review of the facility diagnosis list included diagnoses of diabetes and a seizure disorder. Review of Resident R5's Social History Assessment completed on 9/5/23, at 11:44 a.m. revealed the section titled PTSD was blank. During an interview on 9/2623, at 2:23 p.m. Resident R5 confirmed that she was not asked about PTSD by facility staff. When asked if she felt traumatized by previous life events, Resident R5 described a previously experienced car accident. Review of the clinical record revealed that Resident R6 was admitted to the facility on [DATE]. Review of the MDS dated [DATE], included diagnoses of a pulmonary embolism (a sudden blockage in the pulmonary arteries) and arthritis (inflammation of one or more joints, causing pain and stiffness). Review of Resident R6's Social History Assessment completed on 9/12/23, at 10:51 a.m. revealed the section titled PTSD was blank. Review of the clinical record revealed that Resident R7 was admitted to the facility on [DATE]. Review of the MDS dated [DATE], included diagnoses of atrial fibrillation (disease of the heart characterized by irregular and often faster heartbeat) and chronic kidney disease. Review of Resident R7's Social History Assessment completed on 9/25/23, at 1:07 p.m. revealed the 395977 Page 2 of 4 395977 09/29/2023 Terrace Health & Rehab Center 410 Terrace Drive Uniontown, PA 15401

F 0699 section titled PTSD was blank. Level of Harm - Minimal harm or potential for actual harm Review of the clinical record revealed that Resident R8 was admitted to the facility on [DATE]. Review of the MDS dated [DATE], included diagnoses of cancer and diabetes. Residents Affected - Some Review of Resident R8's Social History Assessment completed on 9/22/23, at 2:20 p.m. revealed the section titled PTSD was blank. During an interview on 9/29/23, at 3:00 p.m. the Director of Nursing and the Director of Social Services confirmed that the facility failed to provide culturally competent, trauma care in accordance with professional standards of practice, accounting for the resident's past experiences and preferences in order to eliminate and/or mitigate triggers that may cause re-traumatization of the resident for 12 of eight residents. 28 Pa. Code 211.10 (a) Resident care policies. 28 Pa. Code 211.12(d)(3)(5) Nursing services. 395977 Page 3 of 4 395977 09/29/2023 Terrace Health & Rehab Center 410 Terrace Drive Uniontown, PA 15401

F 0745 Provide medically-related social services to help each resident achieve the highest possible quality of life. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and staff interview, it was determined that the facility failed to accurately assess residents for social services needs for eight of 12 residents (Resident R1, R2, R3, R4, R5, R6, R7, and R8). Residents Affected - Some Review of the facility Social Service Director job description dated 9/18/23, previously reviewed 3/2/22, indicated the Social Service Director provides planning, assessing, coordinating, and implementation of services to enhance each resident's social and psychological well being. The job description further stated the Social Service Director prepares, evaluates, and charts social service documentation, including the initial social service assessment. During a review of the Social Service Assessments completed on Resident R1, R2, R3, R4, R5, R6, R7, and R8 failed to include documentation for previous substance abuse and post-traumatic stress disorder. During an interview on 9/29/23, at 11:00 a.m. the Social Services Director confirmed the she completes the Social Service Assessment using the information provided in the hospital referral and discharge paperwork, and did not complete an in-person interview with the residents or the resident's representative(s). During an interview on 9/29/23, at 3:00 p.m. the Director of Nursing and the Director of Social Services confirmed that the facility failed to accurately assess residents for social services needs for eight of 12 residents. 28 Pa.Code 211.10(a)(d) Resident care policies. 28 Pa. Code 211.16(a) Social services. 395977 Page 4 of 4