Health inspection·October 23, 2024

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few Based on facility policy review, clinical record review, review of facility investigation documentation, and resident and staff interviews, it was determined that the facility failed to ensure that residents were free from neglect, which resulted in actual harm, as evidenced by a 4.5 cm (centimeter) x 4 cm skin tear (a wound that occurs when the skin separates from itself, usually due to trauma or friction) for one of five residents reviewed (Resident 1). Findings include: Review of facility policy, titled Limited Lift Environment Standard, most recently dated August 7, 2015, revealed Resident Transfer- Responsibilities: When a mechanical lift is used, two (2) team members are required. Review of facility policy, titled Abuse/Neglect Exploitation Prevention Standard for Skilled Care, most recently revised October 4, 2017, revealed Residents have the right to be free from verbal, physical, mental, sexual abuse, neglect corporal punishment and involuntary seclusion and exploitation. Neglect: 483.13(c) failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness. (42 CRF 488.301). 28 Pa Code 201.3 Definitions - the deprivation by a caretaker of goods or services which are necessary to maintain physical or mental health. Act 13 of 1997 the willful deprivation by a caretaker of goods or services which are necessary to maintain physical or mental health. Review of Employee 1's (Nurse Aide Trainee) form titled Performance Checklists for Nurse Aide Trainees/Students in Pennsylvania revealed that Explains the responsibility to identify, prevent and report abuse, exploitation, and neglect as legislated in Act 14 of 1997 (P.L.), the Nurse Aide Resident Abuse Prevention Training Act, was documented as being demonstrated by Employee 1 on September 30, 2024. This was marked S, meaning satisfactory, and was signed off on by Employee 2 (Nurse Aide Trainee Instructor). Further review of Employee 1's performance checklist revealed Follows nursing care principles to prevent client abuse, neglect, exploitation .Provides appropriate restorative care to prevent abuse, neglect, and exploitation, was documented as being demonstrated by Employee 1 on September 30, 2024. These were also marked S and signed off on by Employee 2. Review of Resident 1's clinical record revealed diagnoses that included hemiplegia and hemiparesis following cerebral infarction affecting the left non-dominant side (hemiplegia refers to complete paralysis, while hemiparesis refers to partial weakness; cerebral infarction is a stroke), congestive heart failure (CHFa chronic condition in which the heart doesn't pump blood as well as it should), (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 5 Event ID: 395612 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 395612 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spiritrust Lutheran the Village at Sprenkle Drive 1801 Folkemer Circle York, PA 17404 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)