F 0580
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room,
etc.) that affect the resident.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
policy review, clinical record review and staff interview, it was determined that the facility failed to notify a
resident's responsible party of a significant weight loss for one of two sampled residents with weight
changes. (Residents 35)
Findings include:
Review of the facility policy entitled, Weight Policy, dated August 17, 2022, revealed that any unplanned
significant weight changes were to be reported to the physician and the resident's representative.
Clinical record review revealed that Resident 35 had diagnoses that included dysphagia following cerebral
infarction and chronic kidney disease, stage 4. Review of the Minimum Data Set (MDS) assessment dated
[DATE], revealed the resident had cognitive impairment and received tube feedings for his nutritional
requirements. On April 26, 2023, the resident weighed 151 pounds (lbs). On May 25, 2023, Resident 35
weighed 138 lbs, an 8.61 percent weight loss in one month. There was no documented evidence that
Resident 35's responsible party was notified of the significant weight loss.
In an interview on July 7, 2023, at 12:18 p.m., the Director of Nursing stated there was no documented
evidence that Resident 35's responsible party was notified of the significant weight loss.
28 Pa. Code 201.29(c) Resident rights.
28 Pa. Code 211.12(d)(1)(5) Nursing services.
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 5
Event ID:
395305
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
395305
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/07/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Chandler Hall Health Services
99 Barclay Street
Newtown, PA 18940
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)
F 0584
Level of Harm - Potential for
minimal harm
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited
to receiving treatment and supports for daily living safely.
Based on observation, it was determined that the facility failed to provide a safe, sanitary, and comfortable
environment on three of three nursing units. (Nursing unit 1, 2 and 3)
Residents Affected - Many
Findings include:
Observation during all days of the survey revealed the following:
On unit 100 hall, one sit to stand transfer lift had diry wheels.
On unit 200 hall, a utility room accordion door panel was broken and a chair scale had dirty wheels.
On unit 300 hall, two sit to stand transfer lifts and one transfer lift equipment had dirty wheels.
In the dining area, the resident's refrigerator had dried spillage stains on the crisper drawer glass and in
one crisper drawer.
28 Pa Code: 201.18(b)(3) Management.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395305
If continuation sheet
Page 2 of 5
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
395305
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/07/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Chandler Hall Health Services
99 Barclay Street
Newtown, PA 18940
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)
F 0812
Level of Harm - Minimal harm
or potential for actual harm
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on observation, review of policy and staff interview, it was determined that the facility failed to
maintain sanitary conditions and store food properly in the kitchen. (Main Kitchen)
Residents Affected - Many
Findings include:
Review of the facility policy entitled, Food Storage, dated August 17, 2022, revealed that products in
storage were to be labeled with the date on delivery and once the product was opened the package was to
be labeled with an opened and discard date.
Observation during tour of the main kitchen dry storage room and refrigerator/freezers on July 5, 2023, at
11:10 a.m., revealed an open unwrapped 25 pound bag of whole grain brown rice received September 1,
2022, one open case of frozen egg rolls shipped September 15, 2022, one open case breaded chicken
tenderloin received September 29, 2022, one jar of capers with no expiration date. The following items were
past the expiration date: five boxes of grits, best by October 24, 2022, two bottles of white truffle oil with
expiration dates of September 28, 2018, and September 27, 2019, one open low fat cottage cheese use by
June 15, 2023, one low fat cottage cheese with best by date of June 23, 2023, two plastic containers of
dressing, use by May 11, 2023, butter and chive mix use by July 1, 2023, half gallon whole milk, expired
June 15, 2023, three wrapped beef packages, use by May 17, 2023. In the freezer there was a layer of frost
on the outside of the food packages and boxes.
Review of the policy entitled, Cleaning Instructions: Ovens, dated August 17, 2022, revealed that ovens
were to be cleaned as needed and according to the cleaning schedule at least once every two weeks. Spills
and food particles were to be removed after each use.
Observations on July 5, 2023, at 11:10 a.m., and July 6, 2023, at 11:05 a.m., revealed both ovens had a
grease buildup on the inside walls, the inside of the doors, and on the oven racks. There were three stained
oven racks stored on the floor behind a cookware rack and next to the ovens.
Review of the policy entitled, Cleaning Instructions: Deep Fat Fryer, dated August 17, 2022, revealed that
the deep fat fryer oil was to be changed at least every 10 times the fryer was used. When the oil color
changed to a dark brown, the oil should be changed. Food particles were to be removed from the oil after
each use. Further, the baskets were to be cleaned by running them through the dish machine and wiping
them dry prior to storage.
Observations on July 5, 2023, at 11:10 a.m., and July 6, 2023, at 11:05 a.m., revealed the deep fat fryer oil
was dark brown and contained debris. Two fryer baskets were coated with grease and were stored on a
stainless steel shelf that had grease and debris on it.
Observations on July 5, 2023, at 11:10 a.m., and July 6, 2023, at 11:05 a.m., revealed the table top under
the grill was wet with brown liquid spillage and debris.
In an interview on July 5, 2023, at 11:10 a.m., the Food Service Director stated that food was to be dated
prior to storage and disposed of when items expired. The Food Service Director stated there was no
documentation to support that cleaning was scheduled or being completed per facility policy.
28 Pa.Code 201.18(b)(1)(3) Management.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395305
If continuation sheet
Page 3 of 5
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
395305
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/07/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Chandler Hall Health Services
99 Barclay Street
Newtown, PA 18940
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)
F 0812
28 Pa. Code 207.2(a) Administrator's responsibility.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395305
If continuation sheet
Page 4 of 5
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
395305
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/07/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Chandler Hall Health Services
99 Barclay Street
Newtown, PA 18940
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)
F 0814
Dispose of garbage and refuse properly.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, it was determined that the facility failed to properly contain refuse in a sanitary
manner.
Residents Affected - Few
Findings include:
Observation on July 5, 2023, at 11:10 a.m., revealed that there was trash and debris, including clear plastic
bags and paper on the ground around the trash compactor.
The recycling dumpster contained cardboard and the lid was open.
28 Pa. Code 207.2(a) Administrator's responsibility.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395305
If continuation sheet
Page 5 of 5