Health inspection·May 21, 2025

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to complete an accurate Minimum Data Set (MDS) assessment for two of 12 sampled residents. (Residents 19 and 29) Residents Affected - Few Findings include: Clinical record revealed that Resident 19 had diagnoses that included cognitive communication deficit and major depressive disorder. Review of the MDS assessment dated [DATE], revealed that Sections C (the Brief Interview for Mental Status) and D (the Mood assessment/interview) were incomplete. Clinical record review revealed that Resident 29 had diagnoses that included dementia and nontraumatic intracranial hemorrhage (bleeding within the brain in the absence of trauma or surgery). On December 21, 2024, the physician ordered that the facility provide hospice services. Review of the MDS assessment dated [DATE], revealed no documentation that resident had hospice services in place during the review period. The MDS assessment inaccurately reflected that the resident was not receiving hospice services. In an interview on May 21, 2025, at 12:50 p.m., the Registered Nurse Assessment Coordinator (RNAC) confirmed that Resident 19's and 29's MDS assessments were inaccurate. 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: 395105 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 395105 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mosser Nursing Home 1175 Mosser Road Trexlertown, PA 18087 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)