Sunbury Skilled Nursing and Rehabilitation Center

In the surveyor’s words

From the most serious findings on record at Sunbury Skilled Nursing and Rehabilitation Center, in the surveyor’s own words.

• Actual harm, isolatedF686Aug 18, 2023

  Based on clinical record review, staff interview, and observation, it was determined that the facility failed to timely identify and treat a pressure ulcer for one of seven residents reviewed, which resulted in actual harm (Resident 10). Findings include: Resident 10's clinical record revealed the resident had a diagnosis of Type 1 Diabetes Mellitus (failure of the body to produce insulin to enable sugar to pass from the blood stream to the cells for nourishment) and a Stage IV (full thickness tissue loss with exposed bone, tendon, or muscle; slough or eschar (dead tissue) may be present on some parts of the wound bed; often includes undermining and tunneling) Pressure Ulcer of the Sacral Region (low back) on admission to the facility on [DATE]. […]

• No harm, potential for more than minimal, widespreadF812Jul 10, 2024

  Based on observation and staff interview, it was determined the facility failed to store food and maintain food service/storage equipment in a safe and sanitary manner in the facility's main kitchen. Findings include: An observation of the facility's main kitchen on July 7, 2024, at 9:28 AM revealed a large gray garbage can in the dishwashing area. The exterior lid and sides were covered in dried food and liquid spills. The wall behind the garbage can was covered in dried food and liquid spills. Dried food splatter was observed over the dish machine area on the ceiling. The ceiling beside the dish machine area was observed with visible dust hanging from the light covers, on the ceiling, and surrounding the ceiling vent. […]

• No harm, potential for more than minimal, widespreadF812Aug 18, 2023

  Based on observation and staff interview, it was determined that the facility failed to store food items in a safe and sanitary manner and maintain equipment in a safe and sanitary condition in the facility's main kitchen. Findings included: Initial tour of the facility's main kitchen on August 15, 2023, between 9:09 AM and 9:50 AM with Employee 4, Dietary Manager, revealed the following: A package of yellow cake mix, fudge brownie mix, tortilla shells, and a bag of toasted oats located in the dry goods storage area were all open with no open date noted on the packages. A clear plastic storage container with a lid on it had several items that included straws and various snack food items (cookies and oatmeal creme pies). […]

• No harm, potential for more than minimal, patternF628May 8, 2026

  Based on clinical record review and resident and staff interview it was determined that the facility failed to provide a written notice of transfer that included all the necessary contents to residents' responsible parties at the time of transfer for three of four residents reviewed for hospitalizations (Residents 1, 2, and 79); and failed to provide timely written notice of the facility bed-hold policy to residents' responsible parties at the time of transfer that included all the necessary contents for two of four residents reviewed for hospitalizations (Residents 2 and 79).Findings include: Interview with Resident 2 on May 5, 2026, at 1:02 PM revealed that it was necessary for him to go to the hospital because of his indwelling urinary catheter. […]

• No harm, potential for more than minimal, patternF684May 8, 2026

  Based on clinical record review, observation, and resident and staff interview, it was determined that the facility failed to implement range of motion devices for two of four residents reviewed for range of motion concerns (Residents 3 and 12).Findings include: Clinical record review for Resident 3 revealed a diagnoses list that included contracture (A medical condition characterized by the shortening and stiffening of soft tissues, such as muscles, tendons, and ligaments. This leads to a loss of elasticity and a reduced range of motion in the affected area, which can significantly impact daily activities), left hand, and contracture, right hand, since November 21, 2025. […]