F 0561
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to and the facility must promote and facilitate resident self-determination through
support of resident choice.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
clinical record review, resident interview, and staff interview, it was determined that the facility failed to
provide showers as scheduled/preferred to one of 22 sampled residents. (Resident 51)
Findings include:
Clinical record review revealed that Resident 51 had diagnoses that included muscle weakness. Review of
the Minimum Data Set assessment dated [DATE], revealed that the resident was totally dependent on staff
for bathing. In an interview on December 5, 2022, at 11:55 a.m., Resident 51 stated that he preferred a
shower and staff did not always offer to provide a shower per his schedule. Review of the bathing schedule
revealed that Resident 51 was scheduled to receive a shower every Wednesday and Saturday during the
evening shift. There was a lack of documentation to support that Resident 51 was offered a shower four of
nine times in October 2022, and two of nine times in November 2022.
In an interview on December 6, 2022, at 12:22 p.m., the Director of Nursing stated there was no evidence
that the resident was bathed/showered in accordance with the schedule.
28 Pa. Code 201.29(j) Resident rights.
28 Pa. Code 211.12(d)(1)(5) Nursing services.
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:
395521
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
395521
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/06/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Langhorne Gardens Health & Rehabilitation Center
350 Manor Avenue
Langhorne, PA 19047
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 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
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 interview, it was determined that the facility failed to ensure physician's
orders were implemented for one of 22 sampled residents. (Resident 97)
Residents Affected - Few
Findings include:
Clinical record review revealed that Resident 97 had diagnoses that included diabetes mellitus. Review of
the Minimum Data Set assessment dated [DATE], revealed that Resident 97 required extensive assistance
from staff for activities of daily living. A physician's order dated June 23, 2022, directed staff to administer
insulin lispro solution three units, three times daily for diabetes. Staff were to hold the medication if the
resident's blood sugar was below 150 milligrams per deciliter (mg/dl). Review of the medication
administration records for October, November, and December 2022, revealed that staff administered the
insulin 79 of 121 times when the resident's blood sugar was less than 150 mg/dl.
In an interview on December 6, 2022, at 10:29 a.m., the Director of Nursing confirmed that staff
administered the insulin outside of the established parameters.
CFR 483.25 Quality of care
Previously cited 9/6/22
28 Pa. Code 211.12(d)(1)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395521
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
395521
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/06/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Langhorne Gardens Health & Rehabilitation Center
350 Manor Avenue
Langhorne, PA 19047
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 0755
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a
licensed pharmacist.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
clinical record review, staff interview, and resident interview, it was determined that the facility failed to
ensure that a physician ordered medication was obtained from the pharmacy for one of 22 sampled
residents. (Resident 31)
Findings include:
Clinical record review revealed that Resident 31 had diagnoses that included diabetes. Review of the
Minimum Data Set assessment dated [DATE], revealed the resident had no memory impairment and
received insulin injections. On November 3, 2022, the physician ordered staff to administer Lantus insulin
50 units two times a day. The ongoing care plan revealed the resident was to be administered insulin as
ordered by the physician to control unstable blood sugar related to diabetes. During an interview on
December 4, 2022, at 12:55 p.m., the Resident stated the morning dose of insulin was not received and
that doses were missed in the past. Review of medication administration records revealed the resident did
not receive the Lantus insulin on November 19, 2022, at 9:00 a.m., and 5:00 p.m., and December 4, 2022,
at 9:00 a.m. During an interview on December 4, 2022, at 1:05 p.m., LPN 1 stated the insulin was ordered
from the pharmacy but was not delivered in time for that morning's dose. Review of nursing documentation
for the dates of the missed insulin doses revealed that the medication had not been delivered from the
pharmacy.
CFR 483.45 Pharmacy Services
Previously cited 1/12/22
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395521
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
395521
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/06/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Langhorne Gardens Health & Rehabilitation Center
350 Manor Avenue
Langhorne, PA 19047
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 and staff interview, it was determined that the facility failed to prepare, store, and
serve food under sanitary conditions in the kitchen.
Residents Affected - Many
Findings include:
Observations during the tour of the kitchen on December 4, 2022, at 9:44 a.m., revealed the following: an
open, unsealed bag of thickener powder and a bag of granola with a use by date of August 4, 2022. The
dispenser nozzle for the juice machine was directly on a box of cranberry juice and a wet substance had
dripped onto three boxes of food items below the nozzle.
During observation of the low temperature dish machine, a strip was utilized to test the sanitizer
concentration following three dishwashing cycles. The sanitizer concentration was less than 50 parts per
million (ppm) on each test.
Observations during a subsequent tour of the kitchen on December 4, 2022, at 10:55 a.m., revealed the
sanitizer concentration continued to be less than 50 ppm on repeat testing.
There were various particles of debris and a white substance on the floor of the walk-in refrigerator. There
was a frozen substance on the floor of the walk-in freezer.
In an interview on December 5, 2022, at 1:01 p.m., the Director of Dietary Services confirmed that the dish
machine did not dispense sanitizer or achieve the appropriate concentration of sanitizer solution during the
observations on December 4, 2022.
28 Pa. Code 201.18(b)(3) Management.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395521
If continuation sheet
Page 4 of 4
