Inspection visit
Inspection
12 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 12 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or
her rights.
Based on resident and staff interviews, it was determined that the facility failed to provide care in a manner
and environment that promotes each resident's quality of life and assures that each resident is treated with
dignity by failing to respond timely to residents' requests for assistance, as evidenced by experiences
reported by one of 35 residents sampled (Resident 240) and three of the six residents interviewed during a
group meeting (Residents 61, 160, and 171).
Findings include:
During interview with Resident 240 on October 11, 2023, at 8:25 AM the resident stated that she often
waits an extended period (greater than 15 minutes) for the call bell to be answered or that staff answer the
call bell, turn the call bell off stating that they will be back soon, but then forget to come back to provide the
needed assistance. Resident 240 stated that she rang the call bell at 8:00 AM on this date due to a need for
the bed pan. Resident 240 further stated that staff responded, turned off the call bell, and stated they would
be back shortly but had still not come back to provide the needed assistance.
Interview with employee 2 (nurse aide) on October 11, 2023, at approximately 8:35 AM confirmed that call
bells should not be turned off until the resident's need is met. Employee 2 (nurse aide) then provided the
needed assistance to Resident 240.
During a resident group interview on October 11, 2023, at 10:00 a.m. with six alert and oriented residents,
three residents (Residents 61, 160, and 171) stated that they often experience long wait times for staff to
respond to their requests for assistance. Residents 61, 160, and 171 also stated that on the night shift and
weekend shifts, the wait times are longer.
During interview on October 11, 2023, at 10:00 a.m., Resident 61 stated that it often takes 20 minutes or
longer before a staff member responds to a request for assistance. Resident 61 stated that it can be
embarrassing waiting to be changed after soiling a brief.
During the interview on October 11, 2023, at 10:00 a.m., Resident 171 stated that it often takes 25 to 30
minutes or longer for a staff member to respond to a call for assistance. Resident 171 stated that he or she
is independent but sometimes needs assistance with activities of daily life. Resident 171 indicated that
recently he waited over an hour for a nurse to provide Tylenol when requested.
During the interview on October 11, 2023, at 10:00 a.m., Resident 160 stated that it often takes 20 minutes
or longer before a staff member responds to a call for assistance. Resident 160 indicated that he needs
staff for assistance with activities of daily living such as transferring to the toilet.
(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
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Event ID:
396074
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
396074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allied Services Skilled Nursing Center
303 Smallacombe Drive
Scranton, PA 18501
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 0550
Level of Harm - Minimal harm
or potential for actual harm
During an interview on October 13, 2023, at 9:00 a.m., the Nursing Home Administrator (NHA) confirmed
that the facility staff is responsible for addressing the needs of residents in a manner that promotes each
resident's quality of life and assures that each resident is treated with dignity. The NHA confirmed that call
bells were to be timely answered and that the call bell should not be turned off until the resident's need is
met.
Residents Affected - Few
28 Pa. Code 201.29(a) Resident Rights
28 Pa. Code 201.18 (e)(1) Management
28 Pa. Code 211.12 (c)(d)(4)(5) Nursing services
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Facility ID:
396074
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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
396074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allied Services Skilled Nursing Center
303 Smallacombe Drive
Scranton, PA 18501
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 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited
to receiving treatment and supports for daily living safely.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observations and staff interview, it was determined that the facility failed to provide housekeeping services
to maintain a sanitary environment on one of the six resident units (Units 2 North)
Findings include:
Observation of room [ROOM NUMBER]P on October 10, 2023, at approximately 10:40 AM revealed that
the wall to the right of the head of the resident's bed was heavily coated with a brown substance, which
resembled enteral feeding formula.
The resident's nightstand was heavily soiled with a creamy white substance and dust.
These observations were confirmed by Employee 3, licensed practical nurse. Employee 3 further confirmed
that the resident in the bed was dependent on facility staff for all activities of daily living.
28 Pa. Code 201.18 (e)(2.1) Management
FORM CMS-2567 (02/99)
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Event ID:
Facility ID:
396074
If continuation sheet
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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
396074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allied Services Skilled Nursing Center
303 Smallacombe Drive
Scranton, PA 18501
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 0640
Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
Level of Harm - Minimal harm
or potential for actual harm
Based on review of the Resident Assessment Instrument Manual and clinical records and staff interview, it
was determined that the facility failed to timely submit Minimum Data Set (MDS) assessments to the
required electronic system, the CMS Quality Improvement and Evaluation System (QIES) Assessment
Submission and Processing (ASAP) System, for two of 35 residents reviewed (Residents 78 and 166).
Residents Affected - Few
Findings include:
The Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual, which provides
instructions and guidelines for completing Minimum Data Set (MDS) assessments (mandated assessments
of a resident's abilities and care needs), dated October 2019, indicated that comprehensive assessments
must be transmitted electronically within 14 days of the Care Plan Completion Date (Section V0200C2 + 14
days), and all other assessments must be submitted within 14 days of the MDS Completion Date (Section
Z0500B + 14 days).
A Quarterly MDS assessment of Resident 78 with an ARD (assessment reference date) of August 26,
2023, was not transmitted/submitted until October 12, 2023, and was noted to be 32 days late.
A Discharge Return not Anticipated MDS assessment of Resident 78 with an ARD of August 30, 2023, was
not transmitted/submitted until October 12, 2023, and was noted to be 28 days overdue.
A Quarterly MDS assessment of Resident 166 with an ARD of August 30, 2023, was not submitted until
October 12, 2023, and was noted to be 28 days late.
Interview with the administrator on October 12, 2023 at 9:00 AM confirmed the above MDS's were not
submitted within the required time frame.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396074
If continuation sheet
Page 4 of 15
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
396074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allied Services Skilled Nursing Center
303 Smallacombe Drive
Scranton, PA 18501
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 0641
Ensure each resident receives an accurate assessment.
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 clinical records and staff interview, it was determined that the facility failed to ensure that the
Minimum Data Set Assessments (MDS - a federally mandated standardized assessment conducted at
specific intervals to plan resident care) accurately reflected the status of two residents out of 35 sampled
(Resident 209 and 252).
Residents Affected - Few
Findings include:
A review of Resident 209's Quarterly MDS assessment dated [DATE], revealed in Section P0100. Physical
Restraints, Part A through H, that the resident used restraints less than daily.
A review of Resident 209's clinical record revealed that the resident did not require the use of restraints nor
did the resident use restraints daily/less than daily.
A review of Resident 252's Discharge MDS assessment dated [DATE], revealed in Section A2100.
Discharge Status, that the resident was discharged to an acute hospital.
A review of Resident 252's clinical record revealed that the resident did not discharge to an acute hospital
but was transferred to another nursing home.
Interview with the Nursing Home Administrator (NHA) on October 13, 2023, at 2:20 PM confirmed that the
Discharge MDS Assessment Section A2100. Discharge Status and Restraint Status were inaccurate.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396074
If continuation sheet
Page 5 of 15
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
396074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allied Services Skilled Nursing Center
303 Smallacombe Drive
Scranton, PA 18501
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 0655
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being
admitted
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
clinical record reviews and resident and staff interviews, it was determined that the facility failed to provide
two of the 35 residents sampled with summary of their baseline care plan (Residents 47 and 457)
Findings:
A clinical record review revealed that Resident 457 was admitted to the facility on [DATE], with diagnoses
including epilepsy (a chronic brain disorder in which groups of nerve cells, or neurons, in the brain
sometimes send the wrong signals and cause seizures) and diabetes (a chronic disease that occurs either
when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it
produces).
The resident's baseline care summary form dated September 26, 2023, included the resident's anticipated
length of stay, physician orders, and goals. The form indicated that the resident was not provided a baseline
care plan summary due to the resident being transferred to the hospital.
According to the resident's clinical record Resident 457 was transferred to the hospital for evaluation on
September 28, 2023, at approximately 2:45 p.m. and returned to the facility on the same date at
approximately 6:28 p.m.
A second baseline care summary form dated October 3, 2023, for Resident 457 revealed no indication that
the summary of the resident's baseline plan of care had been reviewed with the resident. The form was not
signed as completed.
A review of an admission comprehensive Minimum Data Set assessment (MDS - a federally mandated
standardized assessment process conducted periodically to plan resident care) dated October 10, 2023
revealed that Resident 457 was cognitively intact with a BIMS score of 15 (Brief Interview for Mental Statusa tool to assess cognitive function; a score of 13-15 indicates cognition is intact).
During an interview on October 10, 2023, at 10:40 a.m., Resident 457 stated that the lack of
communication about his care and facility services was upsetting. Resident 457 stated that the facility did
not provide him a summary of his initial (baseline) care plan. At the time of the interview, Resident 457
indicated that he was not aware of his initial care plan goals and was not yet provided with care plan
summary during his stay at the facility
A clinical record review revealed that Resident 47 was admitted to the facility on [DATE], with diagnoses
that included sepsis (a condition in which the body has an overactive and extreme response to an infection)
and a urinary tract infection (an infection in part of the urinary system).
A baseline care plan summary form dated September 22, 2023, for Resident 47 included the resident's
stated goals, physician orders, and anticipated length of stay. The form was blank in the area indicating the
signature of the resident and the date and time the resident received the baseline care summary.
A review of an admissions comprehensive Minimum Data Set assessment dated [DATE] revealed that
Resident 47 is cognitively intact with a BIMS score of 13.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396074
If continuation sheet
Page 6 of 15
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
396074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allied Services Skilled Nursing Center
303 Smallacombe Drive
Scranton, PA 18501
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 0655
Level of Harm - Minimal harm
or potential for actual harm
During an interview on October 10, 2023, at 11:30 a.m., Resident 47 stated that she was frustrated
because the facility was not providing her information about her care, treatment, and services. Resident 47
stated that the facility did not provide or review with her an initial care summary or plan for her services. At
the time of the interview, Resident 47 indicated that she was not aware of her initial care plan goals,
discharge plans, or an individualized schedule of facility treatment services and care.
Residents Affected - Few
During an interview on October 12, 2023, at approximately 1:00 p.m., the Nursing Home Administrator was
unable to provide evidence that the facility provided Residents 47 and 457 with a summary of their
individualized baseline care plans.
28 Pa Code 211.12 (c)(d)(3)(5) Nursing Services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396074
If continuation sheet
Page 7 of 15
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
396074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allied Services Skilled Nursing Center
303 Smallacombe Drive
Scranton, PA 18501
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
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a
review of select facility policy/protocols and clinical records and resident and staff interview it was
determined that the facility failed to provide nursing services consistent with professional standards of
practice by failing to follow physician orders for bowel protocol for one resident out of 35 sampled (Resident
118) to promote normal bowel activity to the extent practicable.
Residents Affected - Few
Findings include:
According to the American Academy of Family Physicians {The American Academy of Family Physicians is
one of the largest medical organizations in the US founded to promote the science and art of family
medicine}the primary goal of constipation management should be symptom improvement, and the
secondary goal should be the passage of soft, formed stool without straining at least three times per week).
The facility policy titled Bowel Elimination Protocol, last reviewed by the facility, August 20, 2023, indicated
the purpose is to maintain regular bowel movements using dietary fiber and bowel medications. Any
resident who has not had a bowel movement in three (3) days will be given Milk of Magnesia
(MOM)/Lactulose on the 11-7 shift (in the AM of the fourth day). If no bowel movement by the end of day
shift, a Dulcolax suppository will be given at the end of shift. If suppository is not effective, a Fleets enema
will be given by 3-11 shift. If no results from enema, the physician will be informed.
A review of the clinical record revealed that Resident 118 was admitted to the facility on [DATE], with
diagnoses to include, cerebral infarction (stroke), diseases of the digestive system, and chronic obstructive
pulmonary disease.
The resident had physician orders dated July 29, 2019, for the following bowel regimen:
- Lactulose Solution 20 GM/30 ML, give 30 ml by mouth as needed for constipation if no BM in 3 days.
-Bisacodyl Suppository 10 MG, insert 1 suppository rectally as needed for constipation if Lactulose is
ineffective by end of day shift, give suppository by 3:00 PM.
-Fleet Bisacodyl Enema 7-19 GM/118 ML (Sodium Phosphates), Insert 1 unit rectally as needed for
constipation. Administer on evening shift of day 4, if Dulcolax suppository is ineffective.
Review of Resident 118's report of bowel activity from the Documentation Survey Report v2 for September
2023, revealed that the resident did not have a bowel movement on September 27, 28, 29, and 30, 2023.
Review of Resident 118's Medication Administration Record (MAR) for September 2023, revealed no
documented evidence that staff implemented and administered the prescribed bowel protocol as prescribed
during the above time period without a bowel movement to promote bowel activity.
A further review of Resident 118's clinical record, progress notes, failed to reveal the physician was notified
of the four (4) consecutive days without a bowel movement.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396074
If continuation sheet
Page 8 of 15
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
396074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allied Services Skilled Nursing Center
303 Smallacombe Drive
Scranton, PA 18501
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
Level of Harm - Minimal harm
or potential for actual harm
During an interview with the Director of Nursing (DON) on October 13, 2023, at 8:40 AM, the DON was
unable to provide evidence that physician ordered bowel protocol was followed for resident 118 during the
period without bowel activity stated above, nor that the physician was notified.
28 Pa. Code 211.12 (d)(1)(3)(5) Nursing services
Residents Affected - Few
28 Pa. Code 211.5(f) Clinical records
FORM CMS-2567 (02/99)
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Facility ID:
396074
If continuation sheet
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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
396074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allied Services Skilled Nursing Center
303 Smallacombe Drive
Scranton, PA 18501
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 0686
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
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 clinical records and select facility incident reports, observation and resident and staff interview it
was determined that the facility failed to consistently provide care and services to prevent the development
and promote healing of a pressure sore for one of six residents sampled (Resident 246).
Residents Affected - Few
Findings include:
According to the US Department of Health and Human Services, Agency for Healthcare Research &
Quality, the pressure ulcer best practice bundle incorporates three critical components in preventing
pressure ulcers: Comprehensive skin assessment, Standardized pressure ulcer risk assessment and care
planning and implementation to address areas of risk.
ACP (The American College of Physicians is a national organization of internists, who specialize in the
diagnosis, treatment, and care of adults. The largest medical-specialty organization and second-largest
physician group in the United States) Clinical Practice Guidelines indicate that the treatment of pressure
ulcers should involve multiple tactics aimed at alleviating the conditions contributing to ulcer development
(i.e., support surfaces, repositioning and nutritional support); protecting the wound from contamination and
creating and maintaining a clean wound environment; promoting tissue healing via local wound
applications, debridement and wound cleansing; using adjunctive therapies; and considering possible
surgical repair.
Interview with Resident 246 on October 10, 2023, at 11:30 AM revealed that she had some discomfort due
to a sore on her left heel. Observation at this time revealed that heel booties were in place.
A review of the clinical record revealed that Resident 246 was admitted to the facility on [DATE], with
diagnoses to include a right femur fracture (break in the thigh bone).
The resident's most recent Braden scale (a tool for predicting pressure sore risk, scores range 6 to 23)
dated September 13, 2023 indicated the resident's score was 18 (score 15 to 18 low risk) and was a low
risk for pressure sores.
A review of an admission Minimum Data Set assessment dated [DATE], (MDS - a federally mandated
standardized assessment process completed periodically to plan resident care) revealed that the resident
required extensive assistance of two people with bed mobility (how the resident moves about in bed), and
one person physical assistance with dressing, toilet use, and transfers (how the resident moves between
the bed and the chair), had no pressure sores, was at risk for developing pressure sores, and current
interventions included a pressure reducing device for the bed and chair.
A nurses note dated September 22, 2023, indicated that the resident was complaining of pain to heels
when taking socks her off. A blister was found on the resident's second toe on right foot. Bilateral (both)
heels were pink and boggy as well. Treatment of Skin Prep (a skin protective wipe) and Allevyn dressing
(protective covering) were applied to the blister. Heel pillows were applied while in bed. Physician and
resident representative made aware.
The resident's Dermatological Flow Sheet dated September 22, 2023, noted that the blister to the
resident's right toe measured 0.5 cm x 0.5 cm x 0 cm.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396074
If continuation sheet
Page 10 of 15
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
396074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allied Services Skilled Nursing Center
303 Smallacombe Drive
Scranton, PA 18501
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 0686
Level of Harm - Minimal harm
or potential for actual harm
An incident report dated September 22, 2023, at 12:00 PM noted that a blister was present on the
resident's right second toe and bilateral heels were pink. Immediate interventions included skin prep to the
heels and applied heel pillows. Allevyn dressing applied to blister until evaluation (by wound nurse).
Assessed footwear and it was noted that the shoes were rubbing on the toe and slightly tight. Float heels
was noted to be in place at time of incident.
Residents Affected - Few
A wound nurse assessment dated [DATE], indicated that upon assessment of the resident's right second
toe, Allevyn dressing removed and no area present, flesh tone. Upon assessment of bilateral heels both
flesh tone and intact. Will continue heel pillows for protection.
Further review of the resident's clinical record revealed no further documented monitoring of the resident's
heels after the resident's blister and heel skin impairments had healed.
Interview with the director of nursing (DON) on October 12, 2023, at approximately 12:00 PM confirmed
there was no documented evidence of further monitoring of the resident's heels by licensed nursing staff to
timely identify any similar impairments.
A skin/wound note dated October 12, 2023, at 4:17 PM indicated that the resident was evaluated, as per
nursing request, and a left heel deep tissue injury (intact skin with localized area of persistent
non-blanchable deep red, maroon, purple discoloration due to damage of underlying soft tissue. This area
may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent
tissue) 2 cm x 3.8 cm x 0 cm dark purple discoloration with flesh tone surrounding was found. The resident
denies pain or discomfort to same.
A physician order dated October 12, 2023, was noted for a left heel suspension boot in bed. Remove for
skin checks and hygiene every shift.
A physician order dated October 13, 2023 noted an order for Skin Prep to left heel every shift for wound
healing.
During an interview on October 13, 2023, at approximately 11:00 AM the director of nursing (DON) was
unable to provide documented evidence that the facility had consistently conducted effective skin
monitoring, assessment, and implemented timely interventions and treatment to prevent the deep tissue
injury to Resident 246's left heel.
28 Pa. Code 211.5 (f) Medical records
28 Pa. Code 211.12 (c)(d)(1)(3)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396074
If continuation sheet
Page 11 of 15
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
396074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allied Services Skilled Nursing Center
303 Smallacombe Drive
Scranton, PA 18501
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 0695
Provide safe and appropriate respiratory care for a resident when needed.
Level of Harm - Minimal harm
or potential for actual harm
Based on review of clinical records, observation, and staff interview, it was determined that the facility failed
to follow physician orders for oxygen therapy and failed to maintain oxygen equipment in a functional and
sanitary manner for two residents out of 35 sampled (Residents 73 and 193).
Residents Affected - Few
Findings include:
Clinical record review revealed that Resident 73 had a current physician's order, initially dated July 13,
2023, for continuous oxygen therapy administration via nasal cannula (flexible plastic tubing with small
prongs inserted into the nostrils to deliver supplemental oxygen) at four liters per minute.
An observation conducted on October 10, 2023, at 10:08 AM revealed that Resident 73 was lying in bed
with supplemental oxygen in place via an oxygen concentrator (bedside machine that concentrates ambient
air to supply an oxygen-rich gas stream) with the liter flow set at 2.5 liters per minute.
Further observation revealed Resident 73's oxygen concentrator vent was visibly covered with dust.
Clinical record review revealed that Resident 193 had a current physician's order, initially dated October 4,
2023, for continuous oxygen therapy administration via nasal cannula at two liters per minute.
An observation conducted on October 10, 2023, at 10:40 AM, revealed that Resident 193 was lying in bed
with supplemental oxygen in place via an oxygen concentrator with the liter flow set at 3.0 liters per minute.
Further observation revealed Resident 193's oxygen concentrator vent was visibly covered with dust.
Interview with Employee 1 (licensed practical nurse) on October 10, 2023, at 10:45 AM confirmed that
Resident 73 was prescribed four liters of oxygen continuously, but the resident was currently receiving 2.5
liters per minute. Employee 1 confirmed that Resident 73's oxygen concentrator vent was covered with
dust.
Employee 1 also confirmed that Resident 193 was prescribed two liters of oxygen continuously, but the
resident was currently receiving 3.0 liters per minute. Employee 1 confirmed Resident 193's oxygen
concentrator vent was covered with dust.
Interview with Nursing Home Administrator on October 12, 2023, at 11:30 AM confirmed the facility failed to
follow physician orders for the administration of oxygen and that the condition of the oxygen concentrators
were not consistent with facility policy for maintenance of oxygen delivery equipment.
28 Pa. Code 211.12 (d)(1)(3)(5) Nursing services
28 Pa. Code 211.10 (a)(c) Resident Care Policies
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396074
If continuation sheet
Page 12 of 15
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
396074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allied Services Skilled Nursing Center
303 Smallacombe Drive
Scranton, PA 18501
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 0812
Level of Harm - Minimal harm
or potential for actual harm
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on observation it was determined that the facility failed to maintain sanitary practices for the storage
of food in the resident pantry on one of six resident units (second floor south).
Residents Affected - Few
Findings included:
An observation conducted on October 10, 2023, at 12 PM revealed that inside the refrigerator in the
Second Floor South Resident Pantry an undated/unlabeled, clear plastic container covered by a blue lid
containing orange-yellow fruit that was covered with blue-green mold-like spots. An undated/unlabeled clear
plastic container covered by a blue lid containing red fruit.
Large yellow stains, dried yellow liquid, and food debris was observed on the interior base of the
refrigerator.
Black and gray stains, food pieces, and dried yellow-stained paper that had adhered to the shelf was
observed on the bottom shelf of the refrigerator.
Hair, brown stains, and an undated/unlabeled clear plastic container that contained a frozen tan substance
was observed on shelf of freezer door.
An unlabeled Medline white ice pack with strings was observed on the freezer door shelf.
A circular brown stain, food debris, broken Styrofoam pieces, and gray dust were observed on the freezer
base
An interview with the Nursing Home Administrator on October 13, 2023, at approximately 9:00 a.m.
confirmed that the refrigerator in the resident pantry should be maintained in a sanitary manner.
28 Pa. Code 201.18 (e)(2.1) Adminstrator responsibility
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396074
If continuation sheet
Page 13 of 15
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
396074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allied Services Skilled Nursing Center
303 Smallacombe Drive
Scranton, PA 18501
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 0849
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will
arrange for the provision of hospice services.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
clinical record review, and staff interview, it was determined that the facility failed to ensure coordination of
Hospice services with facility services to meet the resident's needs on a daily basis for one out of two
residents reviewed receiving hospice services (Resident 139).
Findings include:
A review of the clinical record revealed that Resident 139 was admitted to the facility on [DATE], with
diagnoses of alzheimer's disease.
The resident was admitted to hospice services on July 3, 2023 for end stage Alzheimer's disease.
Review of Resident 139's plan of care, during the survey ending October 13, 2023, revealed that the
resident's plan of care did not include the hospice care plan, to assure that nursing home staff coordinate
and monitor the delivery of resident care in conjunction with the hospice provider services to meet the
resident's needs.
There was no evidence that the hospice and the nursing home collaborated in the development of a
coordinated plan of care for each resident receiving hospice services to identify the provider responsible for
performing each or any specific services/functions that have been agreed upon and the location of the
necessary plans.
During interview with the Nursing Home Administrator (NHA) on October 12, 2023, at 2:00PM she
confirmed that hospice care plans was not in place for Resident 139.
28 Pa. Code 211.12 (d)(3)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396074
If continuation sheet
Page 14 of 15
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
396074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/13/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allied Services Skilled Nursing Center
303 Smallacombe Drive
Scranton, PA 18501
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 observations and staff interview, it was determined that the facility failed to maintain infection
control practices to prevent spread of infection for two of 35 sampled residents. (Residents 146 and 111)
Residents Affected - Few
Findings include:
A review of the clinical record revealed that Resident 146 had a physician order dated September 29, 2023,
for staff to apply Santyl ointment to the right dorsal foot area topically every evening shift. Apply nickel thick
Santyl (an ointment that removes dead tissue from wounds so they can start to heal) to right dorsal foot
area, cover with gauze, and wrap with kerlix.
Observation of Resident 146's room on October 10, 2023, at approximately 10:40 AM revealed that there
was a 4 x 4 piece of gauze on the overbed table. The gauze had a nickel size amount of clear ointment in
the center. Next to the gauze, there was a piece of kling and tape. The tape was dated October 9, 2023,
and timed for the 3 PM to 11 PM shift. Observation of Resident 146's foot wound at that time revealed that
a treatment was in place and was dated October 10, 2023, and timed for the 11 PM to 7 AM shift.
Employee 3, licensed practical nurse, confirmed that the treatment supplies left on the overbed table were
not maintained in a sanitary manner and should have been discarded.
A review of the clinical record revealed that Resident 111 had a physician order dated September 27, 2023,
for staff to cleanse sacral ulcer and right ischial with NSS (normal saline solution), apply Santyl, and cover
with damp gauze and ABD (dressing used to absorb fluids from heavily draining wounds).
Observation of Resident 111's room on October 10, 2023, at approximately 11 AM revealed that there were
three opened and undated bottles of sterile normal saline solution. Further observation revealed that there
were opened packages of sterile 4 x 4 gauze with the gauze out and on top of the packaging.
Interview with Employee 4, registered nurse, on October 10, 2023, at 11:15 AM confirmed that the sterile
normal saline solutions should have been dated when opened and will need to be discarded. Employee 4
further confirmed that Resident 111's wound care supplies were not maintained in a sanitary manner.
During an interview with the Nursing Home Administrator and Director of Nursing on October 13, 2023, at 2
PM, it was confirmed that infection control practices were not followed for resident wound care supplies.
28 Pa. Code 211.10 (a)(d) Resident care policies
28 Pa. Code 211.12 (d)(1)(2)(5) Nursing Services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396074
If continuation sheet
Page 15 of 15
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Back to topCitations
12 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
- 0363GeneralS&S Epotential for harm
Install corridor and hallway doors that block smoke.
F550 - Resident Rights
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
F584 - Safe Environment
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
F640 - Automated data processing requirement-
Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
F641 - Accuracy of Assessments
Ensure each resident receives an accurate assessment.
F655 - Comprehensive Person-Centered Care Planning
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
F686 - Skin Integrity
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F849 - Hospice services
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
F880 - Infection Control
Provide and implement an infection prevention and control program.
FAQ · About this visit
Common questions about this visit
What happened during the October 13, 2023 survey of ALLIED SERVICES SKILLED NURSING CENTER?
This was a inspection survey of ALLIED SERVICES SKILLED NURSING CENTER on October 13, 2023. The surveyor cited 12 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at ALLIED SERVICES SKILLED NURSING CENTER on October 13, 2023?
Yes, 12 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Install corridor and hallway doors that block smoke."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.