Health inspection·December 28, 2023

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 clinical record review and staff interview, it was determined that the facility failed to develop a care plan and interventions to meet each resident's needs as identified in the comprehensive assessment for two of 13 sampled residents. (Residents 25, 154) Findings include: Clinical record review revealed that Resident 25 had diagnoses that included chronic obstructive pulmonary disease and congestive heart failure. Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed that the Care Area Assessment (CAA) summary triggered urinary incontinence and dental care as problem areas to be care planned. Resident 25's current care plan did not include interventions to address urinary incontinence and dental care. Clinical record review revealed that Resident 154 had diagnoses that included displaced left femur fracture, muscle weakness, and chronic obstructive pulmonary disease. Review of the MDS assessment dated [DATE], revealed that the CAA summary triggered pain and urinary incontinence as problem areas to be care planned. Resident 154's current care plan did not include interventions to address pain or urinary incontinence. In an interview on December 28, 2023, at 12:33 p.m., the Registered Nurse Assessment Coordinator confirmed there was no documented evidence that the care areas were addressed in the residents' current care plans. 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 3 Event ID: 395574 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 395574 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belle Terrace 1320 Mill Road Quakertown, PA 18951 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)