Health inspection·January 2, 2025

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on review of select facility policy and clinical records, and staff interview it was determined the facility failed to timely monitor the nutritional parameters of a resident with an identified significant weight loss for one of six residents sampled (Resident CR1). Residents Affected - Few Findings include: Review of the facility Weight Assessment and Intervention Policy last reviewed March 4, 2024, indicated that residents are monitored for undesirable or unintended weight loss or weight gain. Residents are weighed upon admission and at intervals established by the interdisciplinary team. Weights are recorded in each unit's weight record chart and in the individual's medical record. Any weight change of 5% or more since the last weight assessment is retaken the next day for confirmation. If the weight is verified, nursing will immediately notify the dietitian in writing. Unless notified of significant weight change, the dietitian will review the unit weight record monthly to follow individual weight trends over time. The threshold for significant unplanned and undesired weight loss will be based on the following criteria: 1 month- 5% weight loss is significant; greater than 5% is severe; 3 months- 7.5% weight loss is significant, greater than 7.5% is severe; 6 months- 10% weight loss is significant, greater than 10% is severe. If the weight change is desirable, this is documented. A review of Resident CR1's clinical record revealed admission to the facility on November 25, 2024, with diagnoses to include dementia (the loss of thinking, remembering, and reasoning to such an extent that it interferes with a person's daily life and activities) and fracture of the right foot. A review of the resident's weights noted the following: November 25, 2024- 165 pounds November 26, 2024- 165 pounds December 2, 2024- 152.2 pounds December 3, 3024- 152.2 pounds indicating a 12.8 pound weight loss or 7.8 % loss of body weight within eight days. Review of a dietary note dated December 12, 2024 (nine days after the weight loss occurred), noted the resident was at the facility for short-term rehabilitation. The note indicate the resident had a significant weight loss for one month which was unplanned and unfavorable. However, the note questioned the validity of the resident's initial weight. The note further indicated weight loss may be related to adjustment to facility and recent hospitalization. Physician, interdisciplinary team, and resident representative aware of weight change. The note recommended to continue weekly weights to monitor trend and add fortified foods to optimize PO (by mouth) intakes. Further review of the clinical record revealed no documented evidence that a weekly weight was obtained following the weight obtained on December 3, 2024. The resident was discharged from the facility to home on December 16, 2024. Interview with the Registered Dietitian on January 2, 2025, at approximately 11:30 AM confirmed the resident's weight loss was not timely addressed, a weekly weight was not obtained following the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395651 If continuation sheet Page 2 of 3 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 395651 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Rehabilitation & Healthcare Center 395 Middle Road Nanticoke, PA 18634 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)

F 0692 weight loss on December 3, 2024, and failed to provide documented evidence the resident's physician and resident representative were timely notified of the significant weight loss. Level of Harm - Minimal harm or potential for actual harm 28 Pa Code 211.5(f)(ix) Medical records Residents Affected - Few 28 Pa. Code 211.12 (c)(d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395651 If continuation sheet Page 3 of 3