Health inspection·December 11, 2025

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Potential for minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to complete and accurate Minimum Data Set (MDS) assessment for one of eight residents reviewed (Resident 21).Findings include: The Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual (dated October 2025) provides instructions and guidelines for completing the Minimum Data Set (MDS, a federally mandated standardized assessment conducted at specific intervals to plan resident care). The RAI manual requires the MDS 3.0 assessment accurately reflects the resident's status. A registered nurse conducts or coordinates each assessment with the appropriate participation of health professionals, and the assessment process includes direct observation, as well as communication with the resident and direct care staff on all shifts. According to the RAI manual, Section I of the MDS emphasizes that active diagnoses are to be included on the assessment. Specifically, items in Section I code diseases or active diagnosis that have a direct relationship to the resident's current functional, cognitive, mood or behavior status, medical treatments, nursing monitoring, or risk of death. Active diagnosis guides the plan of care since one of the important MDS functions is to present an accurate picture of the resident's current health status according to the RAI manual. A review of Resident 21's clinical record revealed Resident 21 was admitted to the facility on [DATE], with diagnoses including acute diastolic congestive heart failure (a condition where the heart cannot pump blood and fluid builds up in the lungs and other areas of the body). Further clinical record review revealed a physician order dated December 1, 2025, for Melatonin 3 milligrams (mg) by mouth at bedtime. Melatonin is an over-the-counter medication commonly used to help regulate sleep by supporting the body's natural sleep-wake cycle. Review of the electronic medication administration record confirmed Resident 21 received Melatonin 3 mg each evening beginning December 1, 2025. Additional review of the clinical record revealed an admission diagnosis of Circadian Rhythm Sleep Disorder, active as of November 28, 2025. Circadian Rhythm Sleep Disorder is a condition in which an individual's internal biological clock is disrupted, resulting in difficulty falling asleep, staying asleep, or achieving adequate restorative sleep. This diagnosis was consistent with the ordered and administered medication to facilitate sleep for Resident 21. Review of Resident 21's admission MDS dated [DATE], revealed that Section I was signed as completed by the Registered Nurse Assessment Coordinator (RNAC) on December 8, 2025. The MDS did not include the active diagnosis of Circadian Rhythm Sleep Disorder. The omission of this diagnosis resulted in the MDS not accurately reflecting Resident 21's current medical treatments, specifically the use of medication to facilitate sleep, and did not accurately represent the resident's mood or behavior status as it related to the inability to attain adequate rest. Further clinical review of the admission MDS revealed all MDS sections were complete and signed by the RNAC as complete on December 9, 2025. Subsequently, the admission MDS was successfully transmitted to the database on December 10, 2025, according to the assessment history. The MDS completed on December 9, 2025, and submitted on December 10, 2025, did not Residents Affected - Some (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: 396135 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 396135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allied Services Transitional Rehab Unit 475 Morgan Highway Scranton, PA 18508 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)