Inspection·September 24, 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 Based on observations, and resident and staff interview, it was determined that the facility failed to provide food and drink that was palatable and served at palatable temperatures on one of three open nursing units (Evergreen, Residents 2 and 3).Findings include: Interview with Resident 2 on September 24, 2025, at 11:16 AM revealed the resident chooses to eat meals in his room. Resident 2 stated sometimes the coffee and food are cold. Interview with Resident 3 on September 24, 2025, at 11:40 AM revealed the resident chooses to eat meals in the dining room and stated the coffee is cold. Observation of the lunch meal service on the Evergreen unit on September 24, 2025, at 12:17 PM, where Residents 2 and 3 reside, revealed dietary and nursing staff serving resident's lunch in the unit dining room from a steam table located in the same room. Nursing staff were observed passing beverages to residents seated in the dining room from a beverage cart that had pitchers water, and iced tea, as well as plastic gallon containers of milk, and air pots (containers utilized to hold hot beverages and dispense them) of hot water, coffee, and decaffeinated coffee. As resident meal service for those seated in the dining room was nearing completion at 12:40 PM nursing staff in the dining room were observed setting up trays on three small carts in the dining room that held three trays in the interior of the cart. Staff were placing two resident meals on one tray beside one another in the cart. Trays were also placed on the top of the cart. The staff poured beverages into cups and placed them on the trays without covers. Staff were observed obtaining coffee from one of the air pots on the beverage cart with coffee only sputtering out of the air pot, half filling a coffee cup, and placing it uncovered on one of the trays on a cart. Staff were overheard stating to another staff member that all the coffee was gone. At 12:49 PM the coffee above was placed on the tray that was still being assembled with food that dietary staff were plating from the steam table. The plates of food were placed on trays in the cart and trays on top of the cart. Two trays on top of the cart were observed to have all food/beverages served in disposable foam items. The beverage cups did not have lids, nor did a foam bowl of tomato soup, a plastic lid was over the foam plate of the main meal. Hot food inside the cart was plated on non-disposable plates and placed on the trays, the last meal did not have a lid over the hot entree. At 12:51 PM Employee 1, nurse aide, was observed wheeling this cart to a hallway on the unit and began passing the trays to resident rooms with the trays containing foam products served first to isolation rooms. At 1:17 PM Resident 2's tray was taken off the cart as staff were obtaining it to pass to the resident. Resident 2's meal/side dishes and beverages were on the tray with another resident meal to the other side of the tray with no cover over the meal on the plate. Employee 1 indicated the meal was not covered as there were not enough plate covers in the dining room. Resident 2's meal was also observed to have plastic utensils. Employee 2 indicated there was not enough silverware in the dining room for all the trays, Employee 2 also indicated there were no lids available for the coffee mugs or cold beverage cups. Employee 2's meal was tested for temperature and palatability as follows, beef stroganoff was lukewarm at 104 degrees Fahrenheit (F), carrots 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 2 Event ID: 395283 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 395283 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Glen Healthcare and Rehabilitation Center 15 Ridgecrest Circle Lewisburg, PA 17837 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)