F 0580
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room,
etc.) that affect the resident.
Based on clinical record reviews and staff interviews, it was determined that the facility failed to ensure that
the physician was notified about medications not being available for administration on multiple days for one
of 10 residents reviewed (Resident 6).
Findings include:
A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and
care needs) for Resident 6, dated September 24, 2023, indicated that the resident was cognitively intact,
required limited to extensive assistance from staff for daily care needs, was incontinent of bladder, and had
diagnoses that included a urinary tract infection within the past 30 days and end-stage renal (kidney)
disease.
Physician's orders for Resident 6, dated September 14, 2023, included an order for the resident to receive
500 milligrams (mg) of cefuroxime axetil (antibiotic) twice a day for five days for a urinary tract infection.
The Medication Administration Record (MAR) for Resident 6, dated September 2023, indicated that the
resident did not receive cefuroxime axetil on September 14, 2023, at 8:00 a.m. and 8:00 p.m. and
September 18, 2023, at 8:00 a.m. due to not being available from the pharmacy.
There was no documented evidence that the physician was notified that cefuroxime axetil was not available
from the pharmacy and that the cefuroxime axetil was not administered to Resident 6 twice a day for five
days.
Physician's order for Resident 6, dated September 14, 2023, included an order for the resident to receive
800 mg of Sevelamer HCl (used to control high blood levels of phosphorus in people with chronic kidney
disease) with meals (8:00 a.m., 12:00 p.m., 5:00 p.m.) for end-stage renal failure.
The MAR for Resident 6, dated September 2023, indicated that the resident did not receive Sevelamer from
September 14, 2023, through September 18, 2023.
There was no documented evidence that the physician was notified that the Sevelamer was not available
and not administered to Resident 6 with meals September 14 through 18, 2023.
Interview with the Director of Nursing on September 20, 2023, at 1:40 p.m. confirmed that there was no
documented evidence that the physician was notified that the cefuroxime axetil and Sevelamer for Resident
6 were not available and not administered as ordered.
(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 9
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
09/20/2023
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)
F 0580
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396035
If continuation sheet
Page 2 of 9
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
09/20/2023
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)
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 clinical record reviews, as well as staff interviews, it was determined that the facility failed to
ensure that a resident's care plan was updated regarding fall precaution interventions for two of 10
residents reviewed (Residents 3, 8)
Findings include:
A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and
care needs) for Resident 3, dated August 2, 2023, indicated that the resident was cognitively intact, was
independent with bed mobility and transfers, and had a history of falls.
A nursing note, dated August 12, 2023, at 3:41 p.m. revealed that Resident 3 was observed sitting in his
wheelchair in the bathroom. Blood was noted on the floor next to his bed, on his bed sheets, and on his
clothing. A laceration was observed on the resident's forehead that measured 9.0 x 0.5 centimeters (cm) as
well as a skin tear on his right forearm. When asked what happened, the resident stated he was sitting on
his bed and leaned over to reach for something and fell off the bed and hit his head on the floor. He then
got himself up into his wheelchair and wheeled into the bathroom. The Certified Registered Nurse
Practitioner (CRNP) was notified and an order was received to send the resident to the hospital. A
physician's order, dated August 14, 2023, included an order for a perimeter mattress (mattress with raised
edges to prevent rolling out) to decrease the risk of falling from bed.
Observations on September 20, 2023, at 2:45 p.m. revealed that a perimeter mattress was on Resident 3's
bed.
There was no documented evidence that Resident 3's care plan regarding fall prevention was revised to
reflect the use of a perimeter mattress on his bed.
Interview with the RNAC (Registered Nurse Assessment Coordinator - responsible for developing and
revising care plans) on September 28, 2023, at 2:52 p.m. confirmed that she was not aware that Resident 3
had a perimeter mattress ordered and the care plan should have been updated.
A quarterly MDS assessment for Resident 8, dated June 25, 2023, revealed that the resident was
confused, required extensive assistance with mobility, and was not ambulatory.
A nursing note for Resident 8, dated August 6, 2023, indicated that on August 5, 2023, at 11:25 p.m. the
resident rolled out of bed.
The CRNP note for Resident 8, dated August 7, 2023, indicated that her current bed had a bolster but an
additional wedge was needed for her to maintain her bed positioning.
A CRNP order for Resident 8, dated August 7, 2023, included an order to add an extra bolster to the right
side of her bed.
There was no documented evidence that Resident 8's care plan regarding fall prevention/positioning in bed
was revised to reflect the use of an extra bolster on the right side of her bed.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396035
If continuation sheet
Page 3 of 9
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
09/20/2023
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)
F 0657
Level of Harm - Minimal harm
or potential for actual harm
Interview with the Assistant Director of Nursing on September 20, 2023 at 12:26 p.m. confirmed that the
plan of care was not updated related to the resident's additional bolster to be in use and that it should have
been updated.
28 Pa. Code 211.11(d) Resident care plan.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396035
If continuation sheet
Page 4 of 9
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
09/20/2023
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)
F 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Minimal harm
or potential for actual harm
Based on clinical records reviews and staff interviews, it was determined that the facility failed to ensure
that physician's orders for medications were followed for one of 10 residents reviewed (Resident 6).
Residents Affected - Few
Findings include:
A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and
care needs) for Resident 6, dated September 24, 2023, indicated that the resident was cognitively intact,
required limited to extensive assistance from staff for daily care needs, was incontinent of bladder, and had
diagnoses that included a urinary tract infection within the past 30 days and end-stage renal (kidney)
disease.
Physician's orders for Resident 6, dated September 14, 2023, included an order for the resident to receive
500 milligrams (mg) of cefuroxime axetil (antibiotic) twice a day for five days for a urinary tract infection.
The Medication Administration Record (MAR) for Resident 6, dated September 2023, indicated that the
resident did not receive cefuroxime axetil on September 14, 2023, at 8:00 a.m. and 8:00 p.m. and
September 18, 2023, at 8:00 a.m. due to not being available from the pharmacy.
There was no documented evidence that the cefuroxime axetil was administered to Resident 6 twice a day
for five days as ordered by the physician.
Physician's order for Resident 6, dated September 14, 2023, included an order for the resident to receive
800 mg of Sevelamer HCl (used to control high blood levels of phosphorus in people with chronic kidney
disease) with meals (8:00 a.m., 12:00 p.m., 5:00 p.m.) for end-stage renal failure.
The MAR for Resident 6, dated September 2023, indicated that the resident did not receive Sevelamer from
September 14, 2023, through September 18, 2023.
A nursing note, dated September 18, 2023, at 3:12 p.m. revealed that the Sevelamer was discontinued and
the resident ordered calcium acetate as per the pharmacy's recommendation.
There was no documented evidence that the Sevelamer was administered to Resident 6 with meals as
ordered by the physician September 14 through 18, 2023.
Interview with the Director of Nursing on September 20, 2023, at 1:40 p.m. confirmed that Resident 6 did
not receive the cefuroxime axetil and Sevelamer as ordered by the physician.
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396035
If continuation sheet
Page 5 of 9
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
09/20/2023
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)
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.
Based on clinical record reviews, observations, and staff interviews, it was determined that the facility failed
to attempt new interventions for fall prevention for one of the 10 residents reviewed (Resident 3) and failed
to ensure that fall prevention interventions were in place as ordered for one of 10 residents reviewed
(Resident 8).
Findings include:
A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and
care needs) for Resident 3, dated August 2, 2023, indicated that the resident was cognitively intact, was
independent with bed mobility and transfers, and had a history of falls.
A nursing note, dated June 24, 2023, at 4:45 a.m. revealed that Resident 3 was found on the floor with both
legs bent at the knees. He said that he was getting out of bed and slid down to his knees. He had an
abrasion on the left knee measuring 4.0 x 3.0 centimeters (cm) and two abrasions noted on the right knee
measuring 1.0 x 1.0 cm and 4.0 x 2.5 cm.
There was no documented evidence that any new interventions were put into place to prevent falls for
Resident 3.
Interview with the RNAC (Registered Nurse Assessment Coordinator - responsible for developing and
revising care plans) on September 28, 2023, at 2:52 p.m. confirmed that there was no evidence that any
new fall interventions were put into place following the resident's fall on June 24, 2023.
A quarterly MDS assessment for Resident 8, dated June 25, 2023, revealed that the resident was
confused, required extensive assistance with mobility, and was not ambulatory,
A nursing note for Resident 8, dated August 6, 2023, indicated that on August 5, 2023, at 11:25 p.m. the
resident rolled out of bed.
The Certified Registered Nurse Practitioner( CRNP- registered nurse with specialized training) note for
Resident 8, dated August 7, 2023, indicated that her current bed had a bolster but an additional wedge was
needed for her to maintain her bed positioning.
CRNP order for Resident 8, dated August 7, 2023, included an order to add an extra bolster to the right
side of her bed.
Observations of Resident 8 on September 20, 2023, at 9:51 a.m. during care and at 11:28 a.m. revealed
that the resident was in bed and that there was no extra bolster placed on the right side of the bed. There
was a bolster noted in her room on her chair.
Interview with Licensed Practical Nurse 1 on September 20, 2023, at 11:28 a.m. indicated that the resident
should have the bolster in use when in bed because she tends to lean to the right.
Interview with the Nursing Home Administrator on September 20, 2023, at 12:09 p.m. indicated that the
bolster should have been in place.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396035
If continuation sheet
Page 6 of 9
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
09/20/2023
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)
F 0689
28 Pa. Code 211.12(d)(5) Nursing services.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396035
If continuation sheet
Page 7 of 9
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
09/20/2023
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)
F 0842
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in
accordance with accepted professional standards.
Based on clinical records reviews and staff interviews, it was determined that the facility failed to ensure
that a resident's clinical record was complete and accurately documented for one of 10 residents reviewed
(Resident 6).
Findings include:
A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and
care needs) for Resident 6, dated September 24, 2023, indicated that the resident was cognitively intact,
required limited to extensive assistance from staff for daily care needs, did not receive bathing during the
review period, and received dialysis. Physician's orders, dated July 12, 2023, revealed that the resident
received dialysis every Tuesday, Thursday and Saturday.
A shower/bathing record, dated December 21, 2022, revealed that Resident 6 was to receive a bath/shower
during the evening on non-dialysis days. Nurse aide documentation for August and September 2023
revealed no documented evidence that Resident 6 received a shower from August 1 through 14 and
September 1 through September 7, 2023.
Interview with Resident 6 on September 20, 2023, at 8:43 a.m. revealed that she was receiving her
scheduled showers/baths.
Interview with the Assistant Director of Nursing on September 20, 2023, at 4:16 p.m. confirmed that there
was no documentation of Resident 6's bathing/showers during the mentioned time frames.
28 Pa. Code 211.5(f) Clinical records.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396035
If continuation sheet
Page 8 of 9
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
09/20/2023
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)
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
Based on review of facility policies and clinical records, as well as observations and staff interviews, it was
determined that the facility failed to use proper infection control practices during care for one of 10
residents reviewed (Resident 8).
Residents Affected - Few
Findings include:
The facility policy for handwashing/hygiene, dated November 17, 2022, indicated that the use of gloves do
not replace handwashing/hygiene. Hand hygiene is the final step after removing and disposing of personal
protective equipment.
A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and
care needs) for Resident 8, dated June 5, 2023, revealed that the resident was frequently incontinent of
bowel and bladder and required extensive assistance of two for hygiene.
Physician's orders for Resident 8, dated September 6, 2023, indicated that she had a pressure ulcer on her
right and left buttocks and the wounds were to be cleaned with soap and water, apply zinc, and then apply
a foam dressing three times a day and as needed.
Observations of Resident 8 during hygiene and wound care on September 20, 2023, at 9:51 a.m. revealed
that the resident was removed from a bedpan, she had smeared bowel on her buttocks and with gloves on
Licensed Practical Nurse 1 cleaned the resident. After providing her care she removed her gloves, and
without performing hand hygiene, she donned new gloves and proceeded to provide wound care to the
resident's right and left buttocks.
Interview with Licensed Practical Nurse 1 on September 20, 2023, at 10:11 a m. revealed that she should
have washed her hands after removing her gloves.
Interview with the Nursing Home Administrator on September 20, 2023, at 12:09 p.m. confirmed that
Licensed Practical Nurse 1 should have washed her hands after providing hygiene care to Resident 8 and
removing her gloves.
28 Pa. Code 211.12(d)(1)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396035
If continuation sheet
Page 9 of 9