Health inspection·October 10, 2024

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interviews, it was determined that the facility failed to serve food timely and at a palatable temperature on four of four resident hallways (Maple, Marble, Oak, and [NAME] hallways). Residents Affected - Some Findings include: Observation of the posted meal serving times revealed the residents would receive their lunch trays at the following times: Early trays at 11:45 AM Marble Hall at 12:00 PM Oak Hall at 12:10 PM [NAME] Hall at 12:18 PM Maple Hall at 12:35 PM Observation of lunch meal on October 10, 2024, revealed that the meal carts arrived on the resident hallways at the following times: Early trays arrived at 12:30 PM (45 minutes late) Marble Hall trays arrived at 1:20 PM (an hour and 20 minutes late) [NAME] Hall trays arrived at 1:00 PM (42 minutes late) Oak Hall trays arrived at 1:35 PM (an hour and 25 minutes late) Maple Hall trays arrived at 1:42 PM (an hour and seven minutes late) Observation of meal service on the Maple Hall on October 10, 2024, at 12:30 PM revealed that the early tray cart arrived at 12:30 PM and staff began immediately serving meals. At 12:39 PM staff passed the last tray, and the surveyor pulled the test tray from the cart and began testing tray temperatures. The shepherd's pie was 122.7 degrees Fahrenheit and tasted lukewarm. (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 2 Event ID: 395589 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 395589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mount Carmel Senior Living Community 2616 Locust Gap Highway MT Carmel, PA 17851 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)