Inspection·December 9, 2023

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, review of select facilities policies and procedures, and staff interview, it was determined that the facility failed to store food, prepare, and distribute food, and ensure temperature monitoring was in place to prevent the potential spread of food-borne illness in the facility's main kitchen. Findings included: The current facility policy entitled Food Preparation and Service, revealed potentially hazardous foods are cooled rapidly. This is defined as cooling from 135°F (Fahrenheit) to 70°F within two hours and then to a temperature of 41°F or below within the next 4 hours. The total cooling time between 135°F and 41°F should not exceed 6 hours. Proper hot and cold temperatures are maintained during food distribution and service. Foods that are held in the temperature danger zone are discarded after 4 hours. The temperatures of foods held in steam tables are monitored throughout the meal service by food and nutrition services staff. The current facility policy entitled Food Receiving and Storage, revealed all foods stored in the refrigerator or freezer are covered, labeled, and dated (use by date). Refrigerated foods are labeled, dated, and monitored so they are used by their use by date, frozen, or discarded. Observation of Employee 1 (cook) and Employee 2 (cook) in the main kitchen preparing breakfast trays on the tray line on December 9, 2023, from 7:20 to 7:50 AM revealed that they failed to monitor temperatures during this meal service. An interview with Employee 2 on December 9, 2023, at 7:55 AM confirmed these findings. Observation of the walk-in refrigerator in the facility's main kitchen on December 9, 2023, at 8:10 AM revealed the following items past their use-by date: Container of leftover vegetable soup with a use-by date of December 1, 2023. Container of leftover tater tot casserole with a use-by date of December 8, 2023. Container of leftover cheesesteaks with a use-by date of December 1, 2023. Container of leftover sloppy joe meat with a use-by date of December 1, 2023. Container of leftover egg salad with a use-by date of December 8, 2023. (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: 395683 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 395683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Rehabilitation and Healthcare 918 Main Street Laporte, PA 18626 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)