Health inspection·May 11, 2023

F 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, observation, and resident and staff interview, it was determined that the facility failed to ensure each resident received timely treatment and services to maintain visual abilities for one of 36 sampled residents. (Resident 222) Residents Affected - Few Findings include: Clinical record review revealed that Resident 222 had diagnoses that included diabetes and hypertension. Review of the Minimum Data Set assessment, dated March 9, 2023, revealed that the resident had vision problems and needed corrective lenses. Review of the care plan revealed that the resident had a potential for falls due to visual impairment and staff was to provide the resident with eyeglasses. On May 9, 2023, at 10:55 a.m., Resident 222 was observed sitting in her wheelchair and her eyeglasses were on the bedside table. The right lens was missing from the eyeglasses. The resident stated that her eyeglasses have been broken for several weeks. On May 10, 2023, at 08:52 a.m., Resident 222 was observed sitting in her chair eating breakfast, she was wearing her eyeglasses that were missing the right lens. In an interview at that time, the resident stated she had notified staff that her eyeglasses were broken. Review of facility documentation revealed that the resident requested eye care services on February 23, 2023. There was no documented evidence that the resident received eye care as requested since February 23, 2023. In an intervew on May 11, 2023, at 1:45p.m., Assistant Director of Nursing 1 (ADON1) stated that the resident should have been seen for eyecare services prior to May 11, 2023. 28 Pa Code 211.12(d)(1)(3)(5) Nursing services. 28 Pa. Code 211.16(a) Social services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395465 If continuation sheet Page 2 of 4 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 395465 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Senior Care and Rehabilitation 350 S. Cedarbrook Road Allentown, PA 18104 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observation, and staff and resident interview, it was determined that the facility failed to provide enteral nutrition (delivery of nutrition by a feeding tube) in accordance with the physician's order for one of 36 sampled residents. (Resident 248) Findings include: Clinical record review revealed that Resident 248 had diagnoses that included stroke, paralysis to the right side, and anorexia. Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed that the resident required extensive assistance for activities of daily living. Further review of the MDS assessment revealed that the resident received more than 51% of nutrition through an enteral feeding tube. A physician's order dated April 25, 2023, directed staff to administer Osmolite 1.5 (a tube feeding formula) at a rate of 100 milliliters (ml) per hour starting at 6:00 p.m., and to continue until a total volume of 1200 ml was infused. On May 9, 2023, at 10:23 a.m., the resident was observed in bed. A bottle of tube feed formula was on the pole and was labeled and dated May 8, 2023, at 6:00 p.m. The tube feeding was not infusing at the time of the observation. Formula remained in the bottle, just below the 200 ml line. The bottle contained 1000 ml of formula when full. In an interview on May 9, 2023, at 10:48 a.m., Licensed Practical Nurse 1 (LPN 1), stated that the total volume of tube feed as ordered was typically infused during the night shift and the order required two bottles of tube feed formula. In an interview on May 9, 2023, at 11:05 a.m., Registered Nurse 1 (RN 1), stated that there was no evidence that the resident had refused administration of a second bottle of tube feed formula during the night shift. In an interview on May 9, 2023, at 12:29 p.m., Resident 248 stated that he is awoken during the night shift when staff changed the tube feed bottle and staff did not wake him during the night shift on May 8, 2023, to administer the second bottle of tube feed. There was no evidence that staff administered a second bottle of tube feed formula that would have been required to complete the total volume of 1200 ml per the physician's order. In an interview on May 11, 2023, at 8:31 a.m., the Director of Nursing confirmed that staff did not administer the second bottle of tube feed formula to provide the total volume of 1200 ml per the physician's order. 28 Pa. Code 211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395465 If continuation sheet Page 3 of 4 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 395465 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarbrook Senior Care and Rehabilitation 350 S. Cedarbrook Road Allentown, PA 18104 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, it was determined that the facility failed to store and serve food under sanitary conditions in the main kitchen. Residents Affected - Many Findings include: Observation of the main kitchen on May 9, 2023, at 9:22 a.m., revealed the following: The inside of the microwave was soiled. The lids of the bulk bins that contained flour, sugar and thickener powder were soiled. There were various particles of debris on the windowsill and on the bottom shelf in the food preparation area. The base and sides of the floor mixer were soiled. There were multiple particles of debris on the floor of the walk in freezer. There was a bag of frozen omelets that was not sealed and was open to air. There was an uncovered garbage can that contained waste in a food preparation area near uncovered food. There was a large accumulation of an orange substance on the floor at the drain under the pot wash dish machine. There was a large accumulation of small, black, winged insects on the racks that contained hot plate hats in the dish washing area. There were containers of fruit salad in the walk in refrigerator with use by dates of April 24 and 25, 2023. There was a mop bucket that contained dirty mop water in the dry storage room. Review of the holding food temperature logs revealed no evidence that staff measured holding food temperatures for the dinner meal on May 1, the lunch meals on May 6, and 8, or the breakfast meals on May 6, 7, 8, of 2023. 28 Pa. Code 201.18 (b)(3) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395465 If continuation sheet Page 4 of 4