Health inspection·September 18, 2024

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on review of facility policies and residents' clinical records, as well as staff interviews, it was determined that the facility failed to review and revise care plans for two of five residents reviewed (Residents 2, 4). Findings include: The facility's policy regarding care plans, dated February 22, 2024, indicated that the comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychological and functional needs is developed and implemented for each resident. Assessments of residents are ongoing and care plans are revised as information about the residents and the resident's conditions change. A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 2, dated August 9, 2024, indicated that the resident was cognitively impaired, required assistance with care needs, had a weight gain, and had diagnoses that included anemia (blood disorder in which the blood has a reduced ability to carry oxygen) and gastroesophageal reflux disorder (a digestive disorder that causes heartburn and aid indigestion). Physician's orders for Resident 2, dated September 15, 2024, included an order for the resident to receive a carbohydrate-controlled diet, mechanical soft texture diet and be provided large/double portions and no eggs. A physician's order, dated September 16, 2024, included an order for the resident to receive Ensure with meals. There was no documented evidence that Resident 2's nutrition care plan reflected his specialized diet, large/double portions, preference for no eggs, and his order to receive Ensure. A quarterly MDS assessment for Resident 4, dated August 16, 2024, revealed that the resident was cognitively impaired, was usually understood and usually able to understand others, required assistance with some care needs, and had a diagnosis of that included dysphagia (difficulty swallowing). Physician's orders for Resident 4, dated August 28, 2024, included an order for the resident to receive a no added salt, regular texture diet. Observations during the facility tour on September 18, 2024, at 9:07 a.m. revealed that Resident 4 did not have teeth and did not have dentures in. The resident indicated that she had upper and lower dentures and that they were in the bathroom. Observations at that time revealed that the resident's upper and lower dentures were in the resident's bathroom soaking in a denture cup. (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: 395439 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 395439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Ridge Senior Living at Johnstown 807 Goucher Street Johnstown, PA 15905 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)