Health inspection·October 20, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and resident interview, it was determined that the facility failed to ensure that meals were served in a manner that maintained each resident's dignity on one of six nursing units. ([NAME] Commons) Findings include: Observations of the lunch meal on [NAME] Commons nursing unit on Ocotber 18, 2023, between 12:18 p.m. and 1:05 p.m., revealed Residents 120 and 247 seated at a table, taking utensils and food off each other's meal trays. Resident 120 then proceeded to eat her meal using a folded piece of paper as a utensil. During the same observation period, Resident 299 was seated at the table next to Residents 120 and 247. Resident 299 was observed making comments like I'm hungry, where is the food, it's ridiculous to wait, and why are they eating? Resident 299 was not served her lunch tray until 1:05 p.m. Observation of the lunch meal on [NAME] Commons nursing unit on October 19, 2023, between 12:41 p.m. and 1:04 p.m., revealed residents 142, 282, and 296 seated at a table. The residents had been served and were eating their lunch meals. Residents 185 and 246 were seated in chairs, next to the table while residents 142, 282, and 296 ate their meals. Resident 246 was not served a lunch tray until 1:03 p.m. During the same observation period, Residents 100, 239, 134, and 82 were seated together at a table. Residents 100, 134, and 239 were served a lunch tray and were eating their meals. Resident 82 was not served a lunch tray until 1:04 p.m. 28 Pa. Code 201.29(a) 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 4 Event ID: 395094 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 395094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Berks County Home- Berks Heim 1011 Berks Road Leesport, PA 19533 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)