Pine Run Health Center

In the surveyor’s words

From the most serious findings on record at Pine Run Health Center, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Mar 12, 2026

  Based on policy review, observation, and staff interview, it was determined that the facility failed to properly store food and maintain sanitary conditions in the dietary department and in two of three country kitchens. (Second and Third floors) Findings include:Observations during the tour of the dietary department and in the country kitchen on the second floor on March 10, 2026, at 10:25 a.m., revealed the following:In the Emergency Food Storage section, there was one box of six large cans of green beans that was expired on December 25, 2025, nine cans of corned beef that were labeled with a use by date of July 1, 2025, four large boxes of oatmeal that were labeled with a use by date of September 8, 2025, four large boxes of apple juice dated use by date of December 9, 2025, two large… […]

• No harm, potential for more than minimal, widespreadF812Mar 22, 2024

  Based on observation, it was determined that the facility failed to store food under sanitary conditions in the kitchen. Findings include: Observation of the kitchen on March 19, 2024, at 11:50 a.m. revealed the following: The bottom row of shelves in the reach-in freezer were missing. Multiple food items were stored on the bottom floor of the freezer. There was a box of raw chicken cheesesteak meat that was open, other food items were stored on top of the box. There was an open bag of French fries that was not dated. The slicer handle was broken. There was a muffin tin and round cake pan stored on top of a transformer. There were two muffin tins on the floor between the storage shelf and the transformer. […]

• No harm, potential for more than minimal, patternF550Mar 12, 2026

  Based on clinical record review, group interview, resident interviews, and review of electronic call bell logs, it was determined that the facility failed to answer call bells in a timely manner to provide care and services respectful of each resident's dignity and preferences to promote the quality of life for six of 18 sampled residents. (Residents 3, 6, 56, 68, 83, 96)Findings include:Review of the facility policy entitled Call Bell Response, dated January 5, 2026, revealed that all nursing personnel must be aware of call lights/alerts at all times, and answer bell/alert promptly. During an interview on March 11, 2026, at 1:17 p.m., the Administrator stated that staff were expected to respond to call bells in less than 20 minutes. […]

• No harm, potential for more than minimal, patternF684Mar 12, 2026

  Based on clinical record review and staff interview, it was determined that the facility failed to implement physicians' orders for six of 21 sampled residents. (Residents 3, 11, 29, 37, 42, and 56) Findings include: Clinical record review revealed that Resident 3 had diagnoses that included hypotension (low blood pressure) and chronic kidney disease. A physician's order dated February 26, 2026, directed staff to administer 5 milligrams (mg) of a blood pressure medication (midodrine) two times daily. The physician ordered that staff was not to administer the medication if the resident's systolic blood pressure (SBP, the first measurement of blood pressure when the heart beats and the pressure is at its highest) was higher than 130 millimeters of mercury (mm/Hg). […]

• No harm, potential for more than minimal, isolatedF689Aug 5, 2026

  Based on clinical record review and staff interview, it was determined that the facility failed to ensure that staff provided adequate supervision in order to prevent wandering and accidents for one of five sampled residents. (Resident 1) In addition, the facility failed to conduct an investigation into an incident.Findings include: Clinical record review revealed that Resident 1 was admitted to the facility on [DATE], with diagnoses that included metabolic encephalopathy (brain dysfunction), dementia, panic disorder, and anxiety. The Minimum Data Set assessment dated [DATE], indicated that the resident was cognitively impaired and required supervision for ambulation (walking). […]