Health inspection·February 3, 2025

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Based on document review, policy review, and resident and staff interviews, it was determined that the facility failed to ensure sufficient nursing staff to provided nursing and related services to assure resident safety and maintain the highest practicable physical, mental, and psychosocial well-being of each resident as determined by individual plans of care for one of four residents reviewed (Resident 4). Findings Include: A review of the facility's policy, titled Care Plans-Comprehensive Person-Centered, revised September 2022, read, in part, A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. Review of the facility's policy, titled Resident Rights, revised October 2022, read, in part, Employees shall treat all residents with kindness, dignity and respect. The policy continued, residents have the right to have the facility respond to his or her grievances. Review of Resident 4's interdisciplinary plan of care revealed a shower scheduled on Tuesday and Friday during 7-3, day shift. A review of the facility's Grievance and Concern Form, dated December 12, 2024, revealed a documented concern initiated by Resident 4's daughter that he was not receiving his scheduled showers. According to documentation, Resident 4's shower days had been on the evening shift but were changed to the day shift and the nursing staff received education. An interview with Resident 4 on February 3, 2025, at 1:35 PM, revealed ongoing concerns with receiving showers and other hygienic cares. A review of Resident 4's bathing documentation x 30 days revealed a bed bath provided on January 7 and 28, 2025. The documentation also revealed no documentation of Resident 4 receiving neither a shower or bed bath on January 17 and 21, 2025. An interview with the Director of Nursing (DON) on February 3, 2025, at 2:15 PM, revealed an interview with the Nurse Aide (Employee 4), revealed she did not provide bathing to Resident 4 on January 17 or 21, 2025, due to being short staffed and unable to provide bathing to Resident 4 as per his person-centered plan of care. (continued on next page) 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 4 Event ID: 395016 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 395016 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hanover Hall for Nursing and Rehabilitation 267 Frederick Street Hanover, PA 17331 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)