Health inspection·September 19, 2024

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and staff interviews, it was determined that the facility failed to ensure the resident assessment accurately reflected the resident status for one of 19 residents reviewed (Resident 36). Residents Affected - Few Findings Include: Review of Resident 36's clinical record revealed diagnoses that included diabetes mellitus (a metabolic disorder in which the body has high sugar levels for prolonged periods of time), psychosis (a mental disorder when a person has trouble telling the difference between what's real and what's not), and muscle weakness. Review of Resident 36's Quarterly 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 ARD (assessment reference date- last day of the assessment period) of May 3, 2024, revealed it was coded that the Resident received one insulin injection in the past 7 days and that an insulin order had changed in the past 7 days. Review of Resident 36's Quarterly MDS with ARD of August 2, 2024, revealed it was coded that the Resident received one insulin injection in the past 7 days Review of Resident 36's physician orders revealed a once weekly injection for diabetes, but failed to reveal any orders for insulin during the ARD lookback period for the aforementioned assessments. Further review of Resident 36's Quarterly MDS with ARD of August 2, 2024, revealed in Section N0450. Antipsychotic Medication Review it was coded no under Has a gradual dose reduction (GDR) been attempted? (GDR- stepwise decreasing of a dose of medication to determine if symptoms, conditions, or risks can be managed by a lower dose). Also, that the next section Date of last attempted GDR was disabled due to the response to the previous section. Review of Resident 36's clinical record revealed a Psychiatry Note dated September 10, 2024, noting a GDR of Resident 36's Seroquel (antipsychotic medication) had been completed on July 17, 2024. During an email correspondence with the Nursing Home Administrator and Director of Nursing (DON) on September 17, 2024, at 1:43 PM, the surveyor questioned if Resident 36's MDS assessments were accurate related to insulin use and GDR. Follow-up interview with the DON on September 18, 2024, at 10:32 AM, revealed Resident 36's MDS assessments were coded inaccurately for those sections, and she would expect resident MDS assessments (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 5 Event ID: 395518 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 395518 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyard Gardens Nursing and Rehab Ctr 999 West Harrisburg Pike Middletown, PA 17057 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)