Health inspection·August 24, 2023

F 0825 Provide or get specialized rehabilitative services as required for a resident. 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 facility documents and clinical records, and staff interview, it was determined that the facility failed to provide specialized rehabilitative services for one of five residents (Resident R12). Residents Affected - Few Findings include: Review of the facility Rehabilitation Services Agreement: Skilled Nursing Facility last reviewed 5/29/23, indicated rehabilitation services will be provided in accordance with state and federal regulations and resident needs. Review of the clinical record revealed that Resident R12 was admitted to the facility on [DATE], with diagnoses that included fractured sacral (lower spine), heart failure, and anxiety. A review of the minimum data set (MDS-periodic assessment of care needs) dated 8/17/23, indicated the diagnoses remain current. Review of Resident R12's physician order dated 8/14/23, indicated physical therapy (PT) three times a week for four weeks. Review of the PT daily treatment notes dated 8/13/23 through 8/19/23, indicated Resident R12 received PT only two times. Review of Resident R12 ' s August 2023 PT therapy log indicated PT was initiated on 8/14/23 and from 8/14/23 through 8/20/23, Resident R12 received PT only two times. During an interview on 8/24/23, at 11:00 a.m., the Director of Physical Therapy Employee E2 confirmed the above findings and that the facility failed to provide specialized rehabilitative services as ordered for Resident R12. 28 Pa Code: 201.18(e)(1) Management. 28 Pa. Code: 211.10(c)(d) Resident care policies. 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 2 Event ID: 396124 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 396124 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Point Healthcare Residence 200 Adams Ave Pittsburgh, PA 15243 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)