Inspection visit
Health inspection
1 citation recorded
Inspector’s narrative
What the inspector wrote
This survey cited 1 deficiency. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0842
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in
accordance with accepted professional standards.
Based on clinical record review and interview with staff, it was determined that the facility did not maintain
complete and accurate clinical records related to medication and treatment administration records during
the month of July 2023, for seven of seven records reviewed (Residents R1, R2, R3, R4, R5, R6, R7).
Findings include:
Review of clinical documentation for Resident R1 revealed that administration documentation was missing
for the dates and times indicated for orders including, but not limited to, the following: Budesonide (a
respiratory medication) inhalation suspension 0.5mg/2mL .2mL via trach two times a day was not signed
out as administered on July 10 and 13, 2023 at 7:00 p.m. on July 10 and 13. Formoterol fumarate (a
respiratory medication) inhalation nebulization solution 20mcg/2mL .2mL via trach two times a day was not
signed out as administered on July 10 and 13, 2023 at 8:00 p.m. Cleanse right flank with NSS (normal
saline solution) apply border gauze daily and PRN (as needed) every day shift was not signed out as
administered on July 13 or 14, 2023.
Review of clinical documentation for Resident R2 revealed that administration documentation was missing
for the dates and times indicated for orders including, but not limited to, the following: B/L resting hand
splints and B/L elbow extension splints to be worn up to 6 hrs .every night shift was not signed out as
administered on July 7, 2023. Enteral feed order up 1200, down at 6:00 a.m. Glucerna 1.5 via feeding tube
pump was not signed out as administered on July 8, 2023 at 6:00 a.m. (Enteral feeds are when nutrient
solutions, such as Glucerna or Jevity, are given to a resident enterally, that is via a gastric tube, which can
be inserted through the nose, the mouth on through a tube placed directly into the stomach through a hole
surgically made in the abdomen). Renacidin irrigation solution .use 1 application via irrigation every shift for
foley patency was not signed out as administered on night shift (11:00 p.m.-7a.m.) on July 7, 2023.
(Renacidin is a solution made to keep urinary catheters, such as a foley, which is inserted through the
urethra, or a suprapubic which is inserted through a surgically created hole in the abdomen just above the
pubic bone.) Heparin sodium (porcine) solution 5000 unit/mL Inject 1mL subcutaneously every 8 hours was
not signed out as administered on July 8, 2023 at 5:00 a.m. (Heparin is a blood thinner which protects a
patient from potentially harmful clots.) Metoprolol tartrate (a medication for lowering blood pressure) oral
tablet 25mg .1 tablet enterally every 8 hours was not signed out as administered on July 8, 2023 at 6:00
a.m. Tizanidine hcl (a muscle relaxer) 4mg tablet give 4mg enterally every 8 hours was not signed out at
5:00 a.m. Skin prep bilateral heels daily. Every day shift was not signed out as administered on July 13, 23
or 27, 2023.
Review of clinical documentation for Resident R3 revealed that administration documentation was
(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 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
07/31/2023
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)
F 0842
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
missing for the dates and times indicated for orders including, but not limited to, the following: Cleanse left
posterior (back) neck with NSS apply Nystatin powder (an antifungal), pack with calcium alginate (a type of
dressing made to absorb excess fluid), apply zinc oxide ointment to periwound (area around the wound)
and cover with ABD pad (a large, absorbent dressing) daily was not signed out as administered on July 11
or 19, 2023. Cleanse suprapubic [catheter] site with NSS apply calcium alginate and drainage sponge (a
piece of gauze with a hole cut out to go around a tube) daily was not signed out as administered on July 11
or 19, 2023. Cleanse left plantar (bottom surface) foot and apply xeroform (a medicated wound dressing)
cover tx (treatment) with CDD (clean dry dressing)/bordered gauze every day was not signed out as
administered on July 11 or 19, 2023. Nystatin powder apply to left posterior neck topically every day shift
was not signed out as administered on July 8, 9, 14, 18, 19, 20, 29 or 30, 2023.
Review of clinical documentation for Resident R4 revealed that administration documentation was missing
for the dates and times indicated for orders including, but not limited to, the following: Docu liquid (a laxative
medication to relieve constipation) 50 mg/mL .give 10 mL enterally every 12 hours was not signed out as
adminstered at 9:00 a.m. on July 21, 2023. Enteral feed order up 1200, down at 0600 Glucerna 1.2 via
G-tube feeding tube pump was not signed out as administered at 12:00 p.m. on July 21, 2023. Ventilator
settings: .wean per protocol every shift was not signed out as administered on day shift on July 4 or 21,
2023, or on night shift on July 12 or 20, 2023. Cleanse right heel with NSS apply dakin's (a dilute bleach
solution used to prevent bacterial growth in wounds) moistened gauze and cover with ABD and Kerlix
(rolled gauze) daily .every day shift was not signed out as administered on July 13 on 21, 2023. Left
anterior thigh: apply antifungal powder after soap and water cleanse .every day shift was not signed out as
administered on July 13 or 17, 2023. Sodium chloride solution 0.9% (normal saline solution) use 10 mL via
irrigation every shift was not signed out as administered on day shift on July 4, 8,9, 14, or 21, or on night
shift on July 25, 2023.
Review of clinical documentation for R5 revealed that administration documentation was missing for the
dates and times indicated for orders including, but not limited to, the following: Apply skin prep to B/L hand
knuckles every day every day shift was not signed out on July 10, 15. 16, 20, or 25. Apply skin prep to B/L
heels and ankles every day shift was not signed out on July 10, 15. 16, 20, or 25. Skin prep to heels every
shift was not signed out on day shift on July 10, 15. 16, 20, or 25, or on night shift on July 25.
Review of clinical documentation for R6 revealed that administration documentation was missing for the
dates and times indicated for orders including, but not limited to, the following: Insulin aspart (medication
given to control blood sugar levels in diabetics) solution 100unit/mL inject as per sliding scale
.subcutaneously three times a day was not signed out at 6:00 p.m. on July 10, 19, 20, 21, or 27. Monitor
blood sugar every 8 hours was not signed out nor a blood sugar value recorded at 6:00 p.m. on July 10, 19,
20, 21, or 27. Apply Xeroform to penile shaft post NSS cleanse and cover with border gauze every day was
not signed out on July 7, or 10.
Review of clinical documentation for Resident R7 revealed that administration documentation was missing
for the dates and times indicated for orders including, but not limited to, the following: Amlodipine
(medication given to lower blood pressure) 5mg tab give one tablet enterally one time a day was not signed
out on July 29 or 30. Clobetasol propionate cream 0.05% (a topical steroid used to control itching and other
symptoms) apply to face topically one time a day was not signed out on July 29 or 30, 2023. Docu liquid
50mg/5mL .give 200 mg enterally one time a day was not signed out on July 29 or 30, 2023. Dulcolax
suppository (a laxative) 10 mg .insert 1 suppository rectally at bedtime was not signed out on July 26, 27 or
28, 2023. Nystatin powder apply to right ear topically every day
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395019
If continuation sheet
Page 2 of 3
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
07/31/2023
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)
F 0842
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
shift was not signed out on July 29 or 30, 2023. Potassium chloride (a supplement) liquid 20 mEq/15mL
(10%) give 15 mL enterally one time a day was not signed out on July 29 or 30, 2023. Enteral feed order up
1200, down at 0600 Jevity 1.5 via G feeding tube pump was not signed out at 6:00 a.m. on July 27, 28, or
29, 2023 or at 12:00 p.m. on July 29 or 30, 2023. Methylphenadate hcl (a stimulant medication) tablet 5 mg
give 3 tablet enterally two times a day was not signed out at 9:00 a.m. or 6:00 p.m. on July 29 or 30, 2023.
Baclofen (a muscle relaxer) tablet 10 mg give 1 tablet enterally every 8 hours was not signed out at 5:00
a.m. on July 27, 28, or 29, at 1:00 p.m. on July 29 or 30, or at 9:00 p.m. on July 26, 27 or 28, 2023. Apply
calcium alginate to right lateral ankle post NSS cleanse and cover with border gauze everyday was not
signed out on July 7, or 13, 2023.
Interview with Employee E1, the Nursing Home Administrator, and Employee E2, the Director of Nursing,
on July 31, 2023, at 2:00 p.m. confirmed that these and other missing documentation of administration were
not appropriate and did not constitute a complete and accurate clinical record.
28 Pa. Code 211.12(c) Nursing service
28 Pa. Code 211.12(d)(1) Nursing service
28 Pa. Code 211.12(d)(2) Nursing service
28 Pa. Code 211.12 (d)(5) Nursing service
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395019
If continuation sheet
Page 3 of 3
Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.
Back to topCitations
1 citation recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F842 - Resident-identifiable information
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
FAQ · About this visit
Common questions about this visit
What happened during the July 31, 2023 survey of ARISTACARE AT MEADOW SPRINGS?
This was a inspection survey of ARISTACARE AT MEADOW SPRINGS on July 31, 2023. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at ARISTACARE AT MEADOW SPRINGS on July 31, 2023?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.