Health inspection·May 21, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy and documentation, staff and resident interview it was determined that the facility failed to protect resident from neglect for one of three residents (Resident R1). Findings include: Review of facility policy Abuse, Neglect, Mistreatment and Misappropriation of Resident Property dated November 2024 through November 2025, indicated: Neglect is the failure of the home, its employees, or service providers to provide goods and services to a Resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress Resident R1 was admitted to the facility on [DATE]. Resident R1 MDS (minimum data set periodic assessment of resident needs) dated 4/14/25, indicated diagnosis of Parkinson's disease ( a brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance), bipolar disease (mental health condition causes extreme mood swings) and anxiety disorder. Review of facility documentation submitted to the state survey office dated 5/2/25, indicated Medical driver took 2 residents to AGH hospital for 2 different appointments, took one resident in hospital and went back to get Resident R1 out of the van when Medical Driver noticed he didn't have the lift up and tried to pull her back but she fell to the ground striking the left side. Resident R1 was immediately surrounded by paramedics and hospital staff and she was put into ER to be evaluated and treated. Review of facility documentation witness statement from Employee E1 Medical Driver indicated that the lift was not up and they confirmed that they failed to put the lift into the proper position. During an interview on 5/20/25, at 4:35 p.m. Director of Nursing (DON) confirmed that Employee E1 Medical Driver did fail to put the lift in the appropriate position, and Resident R1 did fall from the van. During an interview on 5/20/25, at 4:40 p.m. DON was informed that the facility failed to protect Resident R1 from neglect with the van lift not being in the appropriate position and Resident R1 failing form the van. (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: 396116 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 396116 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Little Sisters of the Poor 1028 Benton Avenue Pittsburgh, PA 15212 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)