Health inspection·February 27, 2026

F 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility documentation, review of clinical records, and interviews with staff, it was determined that the facility failed to notify the Office of the State Long-Term Care Ombudsman of facility-initiated emergency transfers to the hospital for three of six hospitalizations reviewed (Resident 1, 6, 11) and one of three closed records reviewed (Resident CR75), and failed to ensure that a discharge summary, including a recapitulation of the resident's stay, was completed for one of three closed records reviewed (Resident CR8). Findings include: Review of Resident 1's clinical record revealed a nursing progress note dated December 12, 2025, indicated the resident was transferred to the local hospital for evaluation. Review of documentation provided by the Nursing Home Administrator on February 26, 2026, revealed the Office of the State Long Term Care Ombudsman was not made aware of Resident 1's facility-initiated emergency transfers to the hospital. Interview conducted February 26, 2026, at 11:54 a.m. with Employee E4, confirmed that the office of the state long-term ombudsman was not made aware of Resident 1's hospital transfer. Review of Resident 6's clinical record revealed a nursing progress note dated January 17, 2026, indicating that the resident was transferred to the hospital for evaluation. Review of documentation provided by the Nursing Home Administrator on February 26, 2026, revealed the Office of the State Long Term Care Ombudsman was not made aware of Resident 6's facility-initiated emergency transfers to the hospital. Interview conducted February 26, 2026, at 11:54 a.m. with Employee E4, confirmed the ombudsman was not made aware of Resident 6's hospital transfer. Review of Resident 11's clinical record revealed Resident 11 was discharged to the hospital on January 1, 2026, and re-admitted to the facility on [DATE]. Further review of Resident 11's clinical record failed to reveal evidence that the office of the State Ombudsman was notified of Resident 11's admission to the hospital. Interview with the Director of Nursing on February 26, 2026, at 11:00 a.m. confirmed that the (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 8 Event ID: 395575 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 395575 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Stevens, The 400 Lancaster Avenue Stevens, PA 17578 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)