Stroudsburg Post Acute Nursing & Rehabilitationllc

In the surveyor’s words

From the most serious findings on record at Stroudsburg Post Acute Nursing & Rehabilitationllc, in the surveyor’s own words.

• Immediate jeopardy, patternF880Oct 21, 2022

  Based on observations, a review of clinical records, select facility policy, current CDC (Centers for Disease Control and Prevention) and PAHAN (Pennsylvania Health Alert Network) infection control guidance and staff interview, it was determined that the facility failed to consistently implement infection control precautions necessary to deter the spread of the COVID-19 virus in the facility, which placed residents in immediate jeopardy due to the increased risk of likely spread of COVID-19 that may potentially cause serious illness, hospitalization and/or death. […]

• Actual harm, isolatedF600May 5, 2026

  Based on a review of the facility's Abuse Prohibition and Neglect Prevention policy, clinical records, physician orders, care plans, medication administration records, facility investigative documentation, and resident and staff interviews, it was determined the facility neglected to provide the care and services necessary to avoid physical harm and maintain physical health for one of nine residents reviewed (Resident 3), resulting in a Stage III pressure injury constituting actual harm due to neglect. […]

• Actual harm, isolatedF689Jul 25, 2025

  Based on a review of clinical records, select facility policies, documentation provided by the facility, and staff interviews, it was determined the facility failed to implement necessary safety interventions for one of 21 residents reviewed (Resident 90), who had been identified as at risk for falls which resulted in actual harm, bilateral periprosthetic knee fractures.Findings include:A review of the facility policy titled Falls and Fall Risk Management, last reviewed by the facility May 2025, revealed it is the facility's policy that based on previous evaluations and current data, staff will identify interventions related to the resident's specific fall risk and causes to try to prevent the resident from falling and to try to minimize complications from falling. […]

• Actual harm, isolatedF600Jul 25, 2023

  Based on a review of the facility's abuse prohibition policy, select investigative reports, and clinical records, and resident and staff interviews, it was determined that the facility neglected to provide the care and services necessary to avoid physical harm and maintain physical health for two residents out of the seven sampled (Residents 30 and 42) resulting in serious injuries including a fractured femur, scalp laceration, and multiple pressure injuries. Findings include: A review of the facility policy titled Resident Abuse & Neglect Prevention Program dated as last revised by the facility in November 2022, revealed that management and staff are jointly and individually responsible to ensure each resident shall be free from abuse, neglect and misappropriation of property. […]

• Actual harm, isolatedF689Oct 21, 2022

  Based on review of clinical records and select incident reports and staff interview it was determined that the facility failed to utilize safe technique and/or sufficient staff assistance with bed mobility and effectively secure safety devices to prevent a fall from bed resulting in serious injury, a fracture, for one resident out of 20 sampled residents (Resident 6). Findings include: A review of the clinical record revealed that Resident 6 was admitted to the facility on [DATE], with diagnoses of dementia with behavioral disturbances [Psychological symptoms and behavioral abnormalities are common and prominent characteristics of dementia that include symptoms such as depression, anxiety [CONDITION(S)], agitation, aggression, disinhibition, and sleep disturbances.] and history of falls. […]