Inspection·January 8, 2026

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, clinical record review, and staff interviews, it was determined that the facility failed to provide care and services to meet the needs of the residents for three of three residents reviewed for the use of hipsters (Residents 1, 2, and 3).Findings include: Review of the clinical record for Resident 1 revealed clinical diagnoses that included depressive disorder (mood disorder causing persistent sadness and loss of interest affecting daily activities) and adjustment disorder (extreme emotional or behavioral reaction to a specific, identifiable stressor impacting daily functioning) and a history of falls. Review of Resident 1's Quarterly Minimum Data Set (periodic assessment and care screening) dated December 18, 2025, revealed a BIMS (brief interview of mental status) score of 11, indicating moderate cognitive impairment. Review of Resident 1's current physician orders revealed the order to encourage to wear hipsters every shift, document refusals with an effective date of November 3, 2025, and reentry of same order on January 5, 2026, because initial order was missed when reviewed by Administration. Resident 1 was care planned for risk of falls and encouraged to wear hipsters every shift, effective November 3, 2025. Observation on January 5, 2026, at approximately 11:00 AM, revealed Resident 1 not wearing any hipsters while in the resident lounge/dining area. Review of the clinical record for Resident 2 revealed clinical diagnoses that included dementia (cognitive decline of memory, thinking, and behavior interfering with daily life), atrial fibrillation (fast, irregular heartbeat), and a history of falls. Review of Resident 2's Quarterly Minimum Data Set, dated [DATE], reveals a BIMS score of 99, indicating the Resident was unable to complete interview for cognitive status. Review of Resident 2's current physician orders revealed an order to encourage to wear hipsters, document refusals with an effective date of December 5, 2025. Resident 2 was care planned for risk of falls and encouraged to wear hipsters every shift effective, August 13, 2025. Observation on January 5, 2026, at approximately 11:00 AM, revealed Resident 2 not wearing any hipsters while in the resident lounge/dining area. Review of the clinical record for Resident 3 revealed clinical diagnoses that included dementia, depressive disorder (mood disorder causing persistent sadness and loss of interest affecting daily activities), and a history of falls. Review of Resident 3's Quarterly Minimum Data Set, dated [DATE], reveals a BIMS score of 2, indicating severe cognitive impairment. Review of Resident 3's current physician orders revealed an order to encourage to wear hipsters at all times with an effective date of February 17, 2025. On January 5, 2026, a second order was written stating encourage resident to wear hipsters. Resident 3 was care planned for risk of falls and encourage to wear hipsters at all times, effective February 17, 2025. Observation on January 5, 2026, at approximately 11:00 AM, revealed Resident 3 not wearing any hipsters while in the resident lounge/dining area. During an interview with Employee 1 (Nursing Assistant) on January 5, 2026, she stated that residents do not have any hipsters in their rooms to apply. Employee 1 was asked if any of the residents refused hipsters and she replied no. Employee 1 added that she didn't get Resident 3 out of bed this Residents Affected - Few (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: 395270 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 395270 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Forest Park Nursing and Rehabilitation 700 Walnut Bottom Road Carlisle, PA 17013 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)