Health inspection·July 2, 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 interviews, it was determined that the facility failed to ensure that the resident assessment accurately reflected the resident's status for three of 19 residents reviewed (Residents 5, 23, and 47). Residents Affected - Few Findings include: Review of Resident 5's clinical record revealed diagnoses that included diabetes mellitus (chronic condition that affects the way your body metabolizes sugar [glucose], leading to high blood sugar levels) and hereditary and idiopathic neuropathy (a group of inherited disorders that affect the peripheral nervous system and a type of nerve damage where the cause remains unknown despite thorough testing, leading to symptoms like numbness, pain, and balance issues). Review of Resident 5's Comprehensive MDS (Minimum Data Set - an assessment tool to review all care areas specific to the resident such as a resident's physical, mental or psychosocial needs) with the assessment reference date (last day of the assessment period) of October 4, 2024, indicated in Section N. Medications that she was not coded as receiving an anticonvulsant medication during the assessment period. Review of Resident 5's October 2024 Medication Administration Record (MAR) revealed that she had received gabapentin (an anticonvulsant medication used to treat neuropathy) during the assessment period. Email communication received from the Nursing Home Administrator (NHA) on July 2, 2025, at 10:38 AM, indicated that Resident 5's MDS had been corrected. During a staff interview with the NHA and the Director of Nursing (DON) on July 2, 2025, at 11:35 AM, the NHA indicated that she would expect a resident's MDS's to be completed accurately. Review of Resident 23's clinical record revealed diagnoses that included dementia (a chronic disorder of the mental processes caused by brain disease, and marked by memory disorders, personality changes, and impaired reasoning) and anxiety disorder (a mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities). Review of Resident 23's Quarterly MDS with the assessment reference date of February 21, 2025, revealed in Section N. Medications that he was coded as receiving a hypnotic medication in the assessment period. (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 9 Event ID: 395375 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 395375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Swaim Health Center 210 Big Spring Road Newville, PA 17241 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)