Health inspection·April 19, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on a review of facility policies and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that a resident's dignity was maintained for two of 25 residents reviewed (Residents 10, 22). Findings include: The facility's policy regarding call lights indicated that staff members who are alerted of an activated call light are responsible for responding. An annual Minimum Data Set (MDS) assessment (a federally-mandated assessment of a resident's abilities and care needs) for Resident 10, dated March 14, 2023, revealed that the resident was alert and oriented; able to make his needs known; required extensive assistance from staff for daily care needs including toileting, hygiene, and transfers; and was occasionally incontinent of bladder. Interview with Resident 10 on April 17, 2023, at 11:00 a.m. revealed that that he had to wait up to 45 minutes for staff to respond to his call bell. A call bell log for Resident 10, dated March 20 through April 18, 2023, revealed that it took staff 27 to 44 minutes to respond to the resident's call bell. A quarterly MDS for Resident 22, dated February 17, 2023, revealed that the resident was alert and oriented; able to make her needs known; required extensive assistance from staff for daily care needs including toileting, hygiene, and transfers; and was occasionally incontinent of bladder. Interview with Resident 22 on April 17, 2023, at 10:15 a.m. revealed that she had to wait up to an hour or longer for staff to respond to her call bell, which had caused her to be incontinent. A call bell log for Resident 22, dated March 14 through April 18, 2023, revealed that it took staff 22 to 65 minutes to respond to the resident's call bell. Interview with the Director of Nursing and Nursing Home Administrator on April 19, 2023, at 11:51 a.m. revealed that the call bell wait times were excessive and not acceptable. The Director of Nursing stated that she believed 10-15 minutes would be an appropriate wait time. 28 Pa. Code 201.29(j) Resident rights. Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 395012 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395012 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookview Health Care Center 1000 Northfield Drive Chambersburg, PA 17201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)