Health inspection·April 5, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical record and review of facility policy, it was determined that the facility failed to develop a person-centered care plan to meet one resident's needs for one of three resident records reviewed (Resident R2). Finding include: Review of the facility's policy titled, Care Plan-Comprehensive stated that an individualized comprehensive care plan that includes measurable objectives and timetables to meet the resident's medical, nursing, mental and psychological needs is developed for each resident. Review of Resident R2's physician orders revealed the resident was admitted on [DATE], with the diagnosis of with Type Two Diabetes (failure of the body to produce insulin). Continued review of physician orders revealed an order for 4 units of the insulin Lispro injection solution 100 unit/ml to be administer subcutaneously (describes a needle that is inserted below the skin) before meals and to hold if the resident's blood sugar is less than 70 and to notify the physician. Further review of Resident R2's care plan revealed the facility failed to develop a care plan for Resident R2 diagnosis of Diabetes. Interview with the Nursing Home Administration on April 5, 2023 at 3:00 p. m. confirmed that Resident R2 didn ot have a care plan developed for the diagnosis of Diabetes. 28 Pa Code 211.11(d) Resident care plan 28 Pa. Code 211.12(d)(1)(5) Nursing services 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: 395019 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 395019 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aristacare at Meadow Springs 845 Germantown Pike Plymouth Meeting, PA 19462 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)