st anne's retirement community

In the surveyor’s words

From the most serious findings on record at st anne's retirement community, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF880Dec 7, 2023

  Based on review of facility policy and procedure, observation, review of facility documentation and clinical records, and staff interviews, it was determined that the facility failed to ensure infection control and prevention was implemented during a COVID-19 outbreak on two of two units observed (First and Second Floor Unit). Findings include: Review of facility policy and procedure titled Response to an Outbreak of COVID-19, revised November 20, 2023, revealed Identification of a single new case (resident or staff) 14 days after the last known case would meet the criteria for a new outbreak and prompt the need for an outbreak response. […]

• No harm, potential for more than minimal, isolatedF641Dec 24, 2025

  Based on clinical record review, review of information submitted by the facility, and staff interview, it was determined that the facility failed to ensure that assessments accurately reflected the resident's status for one of 24 residents (Resident 9).Findings include: Review of Resident 9's annual MDS (Minimum Data Set - periodic assessment of resident needs) dated October 22, 2025, section J1900 - Number of Falls since Admission/Entry or Reentry or Prior Assessment revealed that Resident 9 had one major injury. A major injury Includes, but is not limited to, traumatic bone fractures, joint dislocations/ subluxations, internal organ injuries, amputations, spinal cord injuries, head injuries, and crush injuries as per the Resident Assessment Instrument. […]

• No harm, potential for more than minimal, isolatedF697Dec 24, 2025

  Based on clinical record review, resident interview, and staff interview, it was determined that the facility failed to ensure pain management was consistent with professional standards and failed to attempt non-pharmacological interventions to alleviate pain prior to the administration of pain medication prescribed on an as needed basis for one of one resident. (Resident 1)Findings include:Clinical record review revealed that Resident 1 had diagnoses that included pneumonia due to pseudomonas (lung infection caused by bacteria), other chronic pain (persistent pain lasting or recurring for an indefinite period) and chronic respiratory failure with hypoxia (is a long-term condition where lungs cannot adequately exchange gases, leading to persistently low oxygen levels in the blood). […]

• No harm, potential for more than minimal, isolatedF880Dec 24, 2025

  Based upon review of facility policy and procedure, observation, and clinical record review, it was determined the facility failed to ensure enhanced barrier precautions were in place for residents requiring enhanced barrier precautions for one of 12 residents reviewed (Resident 2).Findings include:Review of facility policy, Enhanced Barrier Precautions, reviewed February 27, 2025, indicated that the facility will have the appropriate signage on how to communicate to staff which residents require the use of enhanced barrier precautions (EBP). […]

• No harm, potential for more than minimal, isolatedF578Dec 7, 2023

  Based on clinical record review and staff interviews it was determined that the facility failed to ensure the residents code status for one out of 24 residents reviewed (Resident 173). Findings include: Review of the clinical record revealed the resident was admitted to the facility on [DATE]. Further review revealed that the resident was sent to the hospital on November 25, 2023 for new symptoms of Congested Heart Failure (CHF-Heart does not pump blood effectively). The resident was readmitted to the facility on [DATE]. Review of Resident 173's clinical record revealed a POLST (Pennsylvania -Orders for Life Sustaining Treatment) was signed on November 3, 2023, stating the resident was a Do Not Resuscitate (DNR). Review of the physician orders revealed the DNR was not current. […]