Preston Residence

In the surveyor’s words

From the most serious findings on record at Preston Residence, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF756Oct 18, 2022

  Based upon clinical record review, it was determined that the facility failed to ensure the physician provided clinical rationales for declining consultant pharmacist recommendations for 3 of five sampled residents reviewed (Resident 6, Resident 7, and Resident 8). Findings include: Review of Resident 6's Consultant Pharmacist Recommendation dated February 11, 2022 revealed a recommendation to reduce Resident 6's antidepressant medications from two medications to one medication. Review of Resident 6's physician response to the Consultant Pharmacist Recommendation was to continue current treatment and failed to provide a clinical rationale to do so. […]

• No harm, potential for more than minimal, patternF943Sep 15, 2021

  Based on review of personnel records and interview with staff, it was determined the facility failed to perform abuse training before hire for three of five newly hired employees reviewed (Employees E4, E7, and E8.) Findings include: Review of Employee E4's personnel record revealed a hire date of June 16, 2021. Further review of Employee E4's personnel record failed to reveal evidence of abuse training. Review of Employee E7's personnel record revealed a hire date of August 10, 2021. Further review of Employee E7's personnel record failed to reveal evidence of abuse training. Review of Employee E8's personnel record revealed a hire date of May 4, 2021. […]

• No harm, potential for more than minimal, isolatedF638Jul 30, 2026

  Based upon clinical record review, it was determined that the facility failed to ensure Minimum Data Set Assessments (MDS) were completed timely for three of 12 residents reviewed (Resident 23, Resident 33 and Resident 34).Findings include: Review of Resident 23's clinical record revealed Resident 23 was admitted to the facility on [DATE]. An admission Minimum Data Set Assessment (MDS -periodic assessment of resident needs) was completed upon admission on [DATE]. Further review of Resident 23's clinical record failed to reveal evidence that any further MDS were completed since March 13, 2026. Interview with Licensed Employee E3 on July 30, 2026, at 11:52 a.m. […]

• No harm, potential for more than minimal, isolatedF640Jul 30, 2026

  Based on clinical record review and interview with staff, it was determined that the facility failed to encode a subset of items upon a resident's reentry to the facility for one of 12 residents reviewed (Resident 34). Findings include:Review of Resident 34's discharge MDS (Minimum Data Set - periodic assessment of resident needs) of May 27, 2024, indicated that the resident was discharged with return anticipated. Review of Resident 34's late entry progress note of June 7, 2026, revealed that resident returned to the facility on June 6, 2026. Further review of the clinical record revealed no evidence that a reentry assessment was completed. Interview with Employee E3 on July 30, 2026, at 11:52 a.m. confirmed that a reentry assessment had not been completed.

• No harm, potential for more than minimal, isolatedF641Jul 30, 2026

  Based upon clinical record review, it was determined that the facility failed to ensure Minimum Data Set Assessments (MDS) were completed accurately for one of 12 residents reviewed (Resident 2).Findings include:Review of Resident 2's Quarterly Minimum Data Set (periodic assessment of resident needs) dated May 13, 2026, revealed Resident 2 to have had a significant weight loss.Review of Resident 2's Weight Summaries from October 1, 2025, through July 1, 2026, failed to reveal evidence of a significant weight loss.Interview with Licensed Employee E3 on July 30, 2026, at 12:27 p.m. revealed that Resident 2's Quarterly MDS dated [DATE], was completed inaccurately and further that Resident 2 did not have a significant weight loss. 28 Pa. Code 211.5 Medical Records