Moravian Hall Square Health and Wellness Center

In the surveyor’s words

From the most serious findings on record at Moravian Hall Square Health and Wellness Center, in the surveyor’s own words.

• Actual harm, isolatedF689Jun 23, 2025

  Based on clinical record review, facility documentation review, and staff interview, it was determined that the facility failed to ensure resident safety and prevent an avoidable accident related to a fall for one of four sampled residents which resulted in actual harm of a laceration (a traumatic wound caused by sharp objects or blunt trauma) to the head and a skin tear (a wound caused by blunt force, friction, and/or shear). (Resident 1) Findings include: Clinical record review revealed that Resident 1 had diagnoses that included dementia (a group of symptoms affecting memory, thinking, language, and behavior) and anxiety (condition that involves excessive and persistent worrying that interferes with daily life). […]

• No harm, potential for more than minimal, patternF697Jun 4, 2021

  Based on clinical record review and staff interview, it was determined that the facility failed to ensure pain management included non-pharmacological interventions to alleviate pain prior to or in conjunction with the administration of pain medication prescribed on an as needed basis for two of 14 sampled residents. (Residents 6, 37) Findings include: Clinical record review revealed that Resident 6 had diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . The resident had a physician's orders [MEDICAL RECORD OR PHYSICIAN ORDER] . Review of medication administration records revealed that the resident was given the as needed pain medication 21 times in May 2021, and four times in June, 2021. […]

• No harm, potential for more than minimal, isolatedF810Mar 12, 2026

  Based on clinical record review, observation, and staff interview, it was determined that the facility failed to ensure that adaptive equipment was provided to one of two sampled residents who required adaptive equipment with meals. (Resident 42)Findings include: Clinical record review revealed that Resident 42 had diagnoses that included fracture of the third and fourth metacarpal bones (in the hand), chronic pain syndrome, and osteoarthritis. Review of the care plan revealed that the resident was at risk for nutrition problems with an intervention for adaptive equipment while eating. The intervention was for staff to provide built-up left angled utensils, a divided plate, and a cup with a lid and straw for all meals. […]

• No harm, potential for more than minimal, isolatedF641Apr 3, 2025

  Based on clinical record review and staff interview, it was determined that the facility failed to ensure that the Minimum Data Set (MDS) assessment was completed to accurately reflect the current status of two of 15 sampled residents. (Residents 47, 57) Findings include: Clinical record review revealed that Resident 47 had a diagnosis of diabetes. Section N of the MDS assessment dated [DATE], indicated that Resident 47 was injected with insulin once during the seven-day review period. […]

• No harm, potential for more than minimal, isolatedF656Apr 3, 2025

  Based on clinical record review and staff interview, it was determined that the facility failed to develop a comprehensive care plan that addressed individual residents' needs as identified in the comprehensive assessment for two of 15 sampled residents. (Residents 20, 56) Findings include: Clinical record review revealed that Resident 20 had diagnoses that included legal blindness, hearing loss, difficulty walking, and an enlarged prostate. The Minimum Data Set (MDS) assessment dated [DATE], noted the resident had vision difficulties, communication issues due to his impaired hearing, and continence issues. The MDS Care Area Assessment (CAA) summary noted that the resident's vision, communication, and urinary incontinence issues were to be addressed in the care plan. […]