Health inspection·December 12, 2024

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of facility policy, resident interview, observations, and staff interview it was determined the facility failed to assess the clinical appropriateness of medication self-administration for two of 14 residents (Resident R1 and R2). Residents Affected - Few Findings include: Review of facility policy Self-Administration of Medications last reviewed 1/30/24, indicated residents have the right to self-administer medications if the interdisciplinary team has determined that it is clinically appropriate and safe for the resident to do so. If it is deemed safe and appropriate for a resident to self-administer medications it is documented in the medical record and the care plan. Self-administered medications are stored in a safe and secure place, which is not accessible by other residents. Review of the clinical record indicated Resident R1 was admitted to the facility on [DATE], with diagnoses that included high blood pressure, muscle weakness, and chronic obstructive pulmonary disease (COPD caused by swelling and irritation in the airways that limit air going in and out of the lungs). Review of a physician order dated 11/18/24, instructed to give Trelegy Ellipta Inhalation aerosol (used to treat COPD) one puff inhale orally one time a day. During an interview and observation on 12/12/24, at 9:35 a.m. Resident R1 was in bed with her Trelegy inhaler on her over-the-bed table. Review of Resident R1's clinical record revealed it did not contain a physicians order for self-administration, a self-administration assessment, or care planning for self-administration of medications. Review of the clinical record indicated Resident R2 was admitted to the facility on [DATE], with diagnoses that included diabetes, muscle weakness, and high blood pressure. Review of a physician order dated 12/5/24, instructed Latanoprost ophthalmic solution 0.005% (eye drops used to treat certain kinds of glaucoma [eye condition that damages the optic nerve leading to vision loss or blindness]) one drop in right eye at bedtime. During an interview and observation on 12/12/24, at 9:40 a.m. Resident R2 was in sitting beside her bed, a bottle of opened Latanoprost eye drops and an open bottle of Muro 5% eye medication (used to (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 4 Event ID: 396066 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 396066 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Borough Post Acute 505 Weyman Road Pittsburgh, PA 15236 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)