Inspection·June 13, 2023

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on review of policies and clinical records, as well as observations and staff interviews, it was determined that the facility failed to revise residents' care plans with individualized interventions to address their care needs for one of three residents reviewed (Resident 2). Findings include: The facility's policy regarding minimum data set completion, dated November 17, 2023, indicated that the care plan shall include measurable objectives with interventions based on the resident's care needs and means of achieving each goal. The care plan shall be based on oral and written communication resident, family interviews, and assessments provided by nursing, dietary, resident activities, and social work staff when ordered by the physician or advanced practice nurse, and assessments shall also be provided by other health care professionals. A quarterly Minimum Data Set (MDS) assessment (mandated assessment of a resident's abilities and care needs) for Resident 2, dated March 15, 2023, indicated that the resident was cognitively intact, understood, could understand, and required assistance from staff for his daily care tasks. A consult telemedicine note for Resident 2, dated June 7, 2023, revealed the resident stated he would harm others and has a plan to do so. Resident 2 planned to get a gun through his window from a neighbor friend that had a motorcycle. His planned to get the gun on a good day when he had the time. The resident has a history of violence toward women and his wife. This information was reported to the facility with the recommendation to 302 (involuntary commitment is an application for emergency evaluation and treatment for persons who are a danger to themselves or others due to a mental illness) the resident. An interview with the Social Services Director on June 13, 2023, at 1:29 p.m. confirmed that Resident 2, had recently made threats of harm against staff and had a history of harm against staff in the past by choking a staff member. The crisis team determined that he did not meet the criteria for involuntary commitment, due to his plan had changed. A concern grievance report for Resident 2, dated June 9, 2023, revealed that the resident reported that he did not receive care all night long when the call light on. Upon investigation Resident 2 confirmed that care was given and he changed his story. Interviews with staff determined that all care was provided and the concern was not founded. A nursing note dated June 9, 2023, indicated that the nurse aide staff did not feel comfortable interacting with Resident 2 due to resident's previous documented threat, for which the crisis team was (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 2 Event ID: 396035 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 396035 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scottdale Healthcare & Rehabilitation Center 900 Porter Avenue Scottdale, PA 15683 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)