Health inspection·March 11, 2025

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of select facility grievances, review of the menu and select facility recipes, observation, completion of one meal test tray, and resident and staff interviews, it was determined that the facility failed to provide foods that are palatable, attractive, and at appetizing temperatures at one of one meal observed. Residents Affected - Few Findings include: Review of facility grievance log from January 2025, revealed a grievance filed on January 16, 2025, that stated, Resident stated meals are frequently cold. Chicken noodle soup last evening was cold, and bowl was only half full. Also stated tomato soup Monday evening was cold and watery. Review of facility grievance log from January 2025, revealed another grievance filed on January 16, 2025, on behalf of another resident, that states, French toast and bacon was cold when received this morning. Resident stated food is frequently cold. Review of facility menu on March 11, 2025, revealed the lunch menu consisted of Chicken with Lemon Pepper, Fluffy Steamed Rice, Peas & Carrots, and Fruit Jello & Topping. Review of the recipe that was provided for Lemon Pepper Chicken, read, in part, Place chicken in a roasting pan, brush with oil and rub well with seasoning, bake at 350 [degrees Fahrenheit - F] for 45-60 minutes until chicken begins to brown. Review of the recipe that was provided for Steamed Rice, read, in part, Place rice in stock pot or kettle, add water. Bring water to a boil, reduce heat, cover pot & simmer rice 20-25 minutes until done, rice tender, water absorbed & internal temperature of 140 [degrees Fahrenheit]. Fluff rice with service fork, add margarine & season with salt & pepper. The recipe also contained an alternate steamer method for the cooking process. A test tray was completed on March 11, 2025, at 1:17 PM, with Employee 10 (Food Service Director) that included the Chicken with Lemon Pepper, Fluffy Steamed Rice, Peas &Carrots, Fruit Jello (without topping), Milk, and Coffee. The test tray was placed on a meal cart and delivered to [NAME] 3 unit with other trays being delivered at that time; 18 minutes had elapsed between with the test tray was prepared from the service line and presented for evaluation. Employee 10 took temperatures of the food items at the time the test tray was served for evaluation. At that time, the chicken had a recorded highest temperature of 121.4 degrees F and the rice had a recorded highest temperature of 114.7 F; both the chicken and rice were not at appetizing (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 2 Event ID: 395074 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 395074 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Creek Rehabilitation and Nursing Center 1205 South 28th Street Harrisburg, PA 17111 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)