Health inspection·November 30, 2023

F 0675 Honor each resident's preferences, choices, values and beliefs. Level of Harm - Minimal harm or potential for actual harm Based on review of PAHAN 694, and resident and staff interviews, it was determined that the facility failed to provide care in a manner that maintained the resident's psychosocial well-being for six of 24 residents reviewed (Residents R68, R26, R53, R56, R57, and R65). Residents Affected - Some Findings include: Review of the 2023 PAHAN 694 5-11-UPD UPDATE encourages the use of masks until no new cases of SARS-CoV-2 infection have been identified for 14 days. From 11/27/23, through 11/28/23, during resident interviews, the following residents complained of an inability to communicate with masked staff members: During interview on 11/27/23, at 11:10 a.m. Resident R68 expressed frustration with difficulties communicating with staff members as their masks inhibited the resident's ability to hear what the staff were saying to them. During interview on 11/27/23, at 1:35 p.m. Resident R26 complained that on several occasions they avoided communicating with staff as it was too hard to understand what the staff were saying while they were wearing masks and wasn't worth the trouble. During interview on 11/27/23, at 2:15 p.m. Resident R53 disclosed that it was difficult to communicate with the staff due to their wearing masks and that they were made to feel as though the staff were afraid that they had some sort of a disease. During interview on 11/28/23, at 11:20 a.m. Resident R56 indicated he/she could not hear conversation and was noted with confusion about the mask being worn; making motion to remove mask. During interview on 11/27/23, at 2:30 p.m. Resident R57 indicated he/she asks staff to repeat themselves several times and eventually requests staff to pull the mask down so he/she can understand conversation. During interview on 11/27/23, at 3:00 p.m. Resident R65 indicated he/she has a difficult time hearing staff and consistently asks them to repeat themselves and/or pull the mask down to understand and hear what they are saying. During interview on 11/27/23, at 4:00 p.m. Nursing Staff Employee E5 revealed that it was very difficult' to communicate with residents while wearing a mask. (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 3 Event ID: 396081 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 396081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lecom at Asbury Ridge Dba Saint Mary's Asbury Ridg 4855 West Ridge Road Erie, PA 16506 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)