Health inspection·December 6, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interviews, it was determined the facility failed to develop person-centered care plans that included management and refusal of a Wound Vacuum (a type of therapy to help wounds heal) for one resident out of 12 sampled (Resident 16). Findings include: A review of the clinical record revealed Resident 16 was admitted to the facility on [DATE], with diagnoses to include acquired absence of left toes, and end stage renal disease (a chronic kidney disease that occurs when the kidneys are permanently damaged and can no longer function) which required dialysis (a procedure that removes waste products and excess fluid from the blood when the kidneys are unable to function properly). A review of the clinical record revealed a physician order dated November 18, 2024, for continuous wound vac therapy to left medial foot with settings of 120 mmHg pressure intensity. Begin at 6 and decrease to 3 if resident is unable to tolerate (i.e. pain). A review of Resident 16's progress note dated November 21, 2024, revealed the resident refused to wear the wound vac when he needed to go out of the facility for dialysis, every Tuesday, Thursday, and Saturday. A review of Resident 16's care plan, last updated on October 24, 2024, revealed the care plan failed to address the resident's consistent refusals of the wound vac on his dialysis days and interventions on how to treat the wound when the resident left the facility. An interview with the Director of Nursing on December 4, 2024, at approximately 12:44 PM confirmed the facility failed to ensure that comprehensive care plans were developed to address this resident's specific needs. 28 Pa. Code 211.12 (d)(5) Nursing services 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: 396109 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 396109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heinz Transitional Rehabilitation Unit 150 Mundy Street Wilkes-Barre, PA 18702 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)