Health inspection·May 23, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and staff interviews, it was determined that the facility failed to ensure care and services are provided in accordance with professional standards of practice that will meet each resident's physical, mental, and psychosocial needs for one of four residents reviewed (Resident 4). Residents Affected - Few Findings include: Review of Resident 4's clinical record revealed diagnoses that included Alzheimer's disease (a progressive disease that destroys memory and other important mental functions) and Nontraumatic Intracerebral hemorrhage (a type of stroke in which a ruptured blood vessel causes bleeding inside the brain). Further review of Resident 4's clinical record revealed that she had a fall on May 13, 2024, at 9:00 PM. Review of Resident 4's nursing progress note on May 14, 2024, at 11:00 AM revealed that Resident 4 was complaining of some tenderness to the right side of her forehead on palpation, with skin slightly raised in the area. Physician was notified with orders received for a head CT (computed tomography- a medical imaging technique used to obtain detailed internal images of the body). Review of Resident 4's nursing progress note dated May 14, 2024, at 3:35 PM revealed that the unit manager and provider rounded on the resident. Resident was at neurological baseline, Strength more evident in right side verses left side but per clinicals on admission, she favors the right side. Transport for CT sent. Orders for alert charting x 3 days placed for changes to mental status. Review of Resident 4's physician orders revealed an order, dated May 15, 2024, for a CT scan of the head, related to her fall on May 13. Review of Resident 4's clinical record on May 21, 2024, revealed no evidence that the CT scan had been completed. In an email correspondence from the Nursing Home Administator (NHA) on May 21, 2024, at 3:55 PM, he provided documentation that Resident 4's CT scan appointment was made on May 15, 2024 and it wasn't scheduled until June 21, 2024. During an interview with the NHA on May 22, 2024, at 9:39 AM, the surveyor questioned why the CT scan, which was ordered after Resident 4's fall, wasn't scheduled until June 21, 2024, over one month after the fall occurred. The NHA stated that the CT scan was not ordered stat. The surveyor also (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 4 Event ID: 395223 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 395223 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at West Shore, The 770 Poplar Church Road Camp Hill, PA 17011 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)