Health inspection·October 12, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on review of facility policy, observations, staff interviews, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for five of 16 resident records reviewed (Residents 13, 24, 33, 102, and 202). Findings Include: Review of facility policy, titled Care Plans, Comprehensive Person-Center, not dated, read, in part, comprehensive person-centered care plans describe services to be furnished to attain or maintain resident highest practicable physical, mental, and psychosocial wellbeing. Review of Resident 13's clinical record on October 10, 2023, at approximately 10:55 AM, revealed diagnoses that included retention of urine (a condition in which you are unable to empty all the urine from your bladder) and bulbous urethral stricture (narrowing of the urethra tube that transports urine out of the body, impeding the body's ability to pass urine). Observation of Resident 13 on October 10, 2023, at 10:34 AM, revealed the Resident lying in bed with a catheter inserted and hanging on his bed frame. Review of Resident 13's physician orders revealed an order for a foley catheter, written on September 12, 2023. Review of Resident 13's comprehensive plan of care revealed Resident 13 did not have a care plan developed or implemented that addressed the foley catheter. During an interview with the Nursing Home Administrator (NHA) on October 12, 2023, at approximately 10:50 AM, it was revealed that it was the facility's expectation that Resident 13's comprehensive plan of care would include the foley catheter. Review of Resident 24's clinical record revealed diagnoses that included congestive heart failure (CHF chronic condition in which the heart doesn't pump blood as well as it should), dementia (a condition characterized by progressive loss of intellectual functioning, impairment of memory and abstract thinking), and Parkinson's disease (a progressive disease of the nervous system marked by tremor, muscular rigidity, and slow imprecise movement). Review of Resident 24's October 2023 physician orders included oxygen at 2 Liters/Minute (rate of oxygen flow) on in HS (hour of sleep - at bedtime) and remove in AM, with a start date May 23, 2023. (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 5 Event ID: 395998 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 395998 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Misericordia Nursing & Rehabilitation Center 998 South Russell Street York, PA 17402 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)