Health inspection·March 5, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policies, clinical records, and staff interviews, it was determined that the facility failed to develop comprehensive care plans to meet resident care needs for two of five residents (Residents R13 and R23). Findings include: Review of facility policy SRC-Resident Centered Care Plan-6.0, dated 2/7/25, indicated that the facility will develop a plan of care that is tailored to the resident's specific wishes and clinical care needs and in keeping with the resident and family's overall goals of care; to structure and guide therapeutic interventions to meet resident's needs and achieve expected outcomes. The care plan will be individualized for each resident based upon all available resident-specific information. The care plan is formally reviewed and completed within 21 days after admission at the Interdisciplinary Care Plan Conference and communicated to appropriate staff. The care plan is reviewed and updated at least quarterly, and is based on ongoing assessment and evaluation of resident needs and goals of care. It may specifically be reviewed and updated as the resident's condition changes. A review of the clinical record revealed Resident R13 was admitted to the facility on [DATE], with diagnoses that included diabetes (a long-term condition in which the body has trouble controlling blood sugar and using it for energy), high blood pressure, and stroke (damage to the brain from an interruption of blood supply). A review of the Minimum Data Set (MDS - a periodic assessment of care needs) dated 11/27/24, indicated the diagnoses remain current. Review of Resident R13's physician order dated 11/18/24, indicated Dexcom G7 Receiver Device (Continuous Glucose System Receiver) inject one device subcutaneously (fat layer) in the morning every 10 days. May change every 12 hours as needed for dislodgement or malfunction. A review of the clinical record failed to reveal a person-centered care plan was developed for Resident R13 to address goals and interventions relating to Dexcom G7 Receiver Device (Continuous Glucose System Receiver) as required. Interview on 3/4/25, at 2:40 p.m. the Director of Nursing confirmed the clinical record failed to reveal a person-centered care plan for Resident R13 to address goals and interventions relating to Dexcom G7 Receiver Device (Continuous Glucose System Receiver) as required. (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 7 Event ID: 395549 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 395549 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sherwood Oaks 100 Norman Drive Cranberry Township, PA 16066 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)