Inspection·December 3, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, clinical and facility record review, facility provided documents, and staff interviews, it was determined that the facility failed to provide adequate supervision during bathing for one of three residents (Resident R1). This failure was determined to be past non-compliance. Findings include: Review of the facility policy Bath, Mechanical Lift dated November 2024, indicated before helping resident into or out of chair, lock the wheels of the carrier. Lock the carrier onto patient transfer lift. Be sure belts are tight on chair. Before moving resident, fasten seat belt onto resident. Review of the facility's Resident Bathing Safety: Quick Reference Guide dated November 2024, indicated review care plan for bathing assistance level. Stay with resident at all times. If you must step away: call another aide or nurse to stay with the resident. Never rely on just telling them to wait. Use proper lifting/transfer equipment as needed. Use all available safety mechanisms, i.e. bars, seatbelts, etc. Unsupervised bathing is a serious violation of resident rights, facility policy and federal regulations. Review of the admission Record indicated Resident R1 was admitted to the facility on [DATE]. Review of R1's Minimum Data Set (MDS - a periodic assessment of care needs) dated 8/13/25, indicated the diagnoses of high blood pressure, arthritis (inflammation and pain in the joints), and Schizophrenia (characterized by thoughts or experiences that seem out of touch with reality, disorganized speech or behaviors, and decreased participation in activities of daily living). Section C0500 - Brief Interview for Mental Status (BIMS -is a screening test that aids in detecting cognitive impairment) indicated a score of thirteen - cognitively intact. Review of Resident R1's current care plan, indicated resident needs assistance with activities of daily living (ADL's). Staff will assist her into the tub twice weekly. Review of Resident R1's progress note dated 9/29/25, at 7:50 a.m. indicated staff was informed that Resident R1 was in the bathing room yelling for help. At the time staff heard yelling, they ran into bathing room and found resident sliding down in the bath chair. They immediately pulled resident up in the chair and secured the safety belt. Review of facility provided documentation dated 9/29/25, at 7:35 a.m. indicated the household supervisor arrived on unit and heard screaming coming from the bathing room. Resident R1 was in bath chair sliding down and water was up to the collarbone/neck and resident was yelling, Help me, help me. Bath chair belt was not strapped, handlebar was not in front of resident, and the bath chair wheels were unlocked. When asked who put resident in the tub, resident responded The agency girl. The supervisor and another Nurse Aide (NA) drained some water and used a towel to sit resident up and strapped resident into bath chair. Once secure, the bath was completed and hair washed. Resident denied going under the water. No noted injuries. Assessment of resident: respirations easy and unlabored, lungs clear throughout, vital signs stable, and afebrile. Interview on 10/28/25, at 9:35 a.m. Resident R1 indicated recalling the episode in the bathtub. Resident indicated feeling temporarily terrified at the time of being left alone in the tub. Resident believes it was overall about ten minutes because the (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 7 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 12/03/2025 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)