Inspection·July 17, 2024

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility documents, facility policy, clinical records, and staff interviews, it was determined that the facility failed to implement written policies and procedures to ensure a complete and thorough investigation of an allegation of verbal abuse for four of four residents (Residents R2, R3, R4, and R5). Residents Affected - Some Findings include: Review of facility policy Abuse, Neglect, and Exploitation dated 1/2/24, indicated it is the facility's policy to investigate all allegations, suspicions and incidents of abuse, neglect, involuntary seclusion, intimidation, exploitation or residents, misappropriation of resident property and injuries of unknown source. If a staff member is accused or suspected of abuse the facility immediately remove staff member from resident care area and request a written statement from accused staff member. The person investigating the incident should interview the resident, the accused, and all witnesses and obtain written statements from the resident, if possible, the accused, and each witness. Review of the clinical record indicated Resident R2 was admitted to the facility on [DATE]. Review of Resident R1's Minimum Data Set (MDS - a periodic assessment of care needs) dated 5/22/24, indicated diagnoses of anxiety (a feeling of worry, nervousness, or unease), anemia (too little iron in the blood causing fatigue), and presence of left artificial hip joint. Review of the clinical record indicated Resident R3 was admitted to the facility on [DATE]. Review of Resident R3's MDS dated [DATE], indicated diagnoses of high blood pressure, anxiety, and hyperlipidemia (high levels of fat in the blood). Review of a facility submitted event dated 6/23/24, stated, Registered Nurse (RN) supervisor on 3 p.m. to 11 p.m. reported to the RN supervisor that Resident R2 stated that Nurse Aide (NA) Employee E1 told Resident R3 to shut up and she can't stand her voice. Resident R2 also reported that NA Employee E2 called her a liar. Review of a facility grievance form dated 6/22/24, stated, Resident R2 was talking with Resident R3 about what a nice time she had at a different facility and NA Employee E2 called her a liar. Facility response stated, NA Employee E2 reports she never called resident a liar. She may have responded with the remark that statement is a lie, that's not true. Review of facility investigation documentation failed to indicate that a written witness statement was obtained from NA Employee E1 and NA Employee E2. The facility provided a screenshot of a text (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 10 Event ID: 395986 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 395986 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kittanning Health & Rehab Center 120 Kittanning Care Drive Kittanning, PA 16201 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)