Inspection·April 18, 2025

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. Based on a review of facility policy, resident choice menu selections, resident interviews, it was determined that the facility failed to provide resident selected menu items for 14 of 20 residents (Resident R2, R5, R6, R7, R8, R9, R10, R12, R13, R14, R15, R16, R17, R19, and R20). Findings include: Review of the facility policy, Food and Nutrition Services dated 9/9/24, indicated Food and nutrition services staff will inspect food trays to ensure that the correct meal is provided to each resident, the food appears palatable and attractive, and it is served at a safe and appetizing temperature. If an incorrect meal is provided to a resident, or a meal does not appear palatable, nursing staff will report it to the food service manager so that a new food tray can be issued. During a dinner meal observation, on 4/16/21, at beginning at 4:52 p.m. the following was observed: Resident R2 had requested two ginger ale and two puddings on his meal ticket, did not receive either. Resident R5 received one chocolate cookie, rather than the two listed on the meal ticket. Resident R6 did not receive her 4-ounce ice-cream. Resident R7 received one chocolate cookie, rather than the two listed on the meal ticket. Resident R8 did not receive her 4-ounce house supplement and 4-ounce cranberry juice. Resident R9 received one chocolate cookie, rather than the two listed on the meal ticket. Resident R10 did not receive her Ensure (nutritional supplement). Resident R12 had did not receive her requested ranch dressing for her tossed salad. Resident R13 received one chocolate cookie, rather than the two listed on the meal ticket, and received Italian dressing rather than ranch dressing. Resident R13 stated Italian dressing gives her heartburn. Resident R14 received one chocolate cookie, rather than the two listed on the meal ticket. (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: 395434 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 395434 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wecare at MT Lebanon Rehabilitation and Nrsg Ctr 350 Old Gilkeson Road Pittsburgh, PA 15228 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)