Health inspection·June 22, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, observation, clinical record review and interview with staff and residents, it was determined that the facility did not develop comprehensive care plans related to hearing loss, non-compliance with care, and transmission-based precautions for three of 16 records reviewed (Residents R5, R22, R26). Findings include: Review of facility policy titled Comprehensive Plan of Care, dated March 6, 2023, revealed that the plan of care is continually reviewed and updated .to reflect the current needs of the resident, and the interdisciplinary team identifies and prioritizes resident care needs based on analysis of assessment data. Interview with Resident R5 on June 20, 2023, at 11:23 a.m. revealed that the resident has significant hearing loss, which required hearing aids and/or those to whom he has talked to raise their voice in order for them to be heard by the resident. Review of Resident R5's most recent MDS (Minimum Data Set, a periodic assessment of resident care needs), section B, Hearing, Speech, and Vision, completed on April 18, 2023, revealed that the resident utilized a hearing aid in order to understand others adequately. Review of the care plan for the resident revealed no care plan had been developed for his hearing loss as of June 21, 2023. Interview with the Director of Nursing, on June 21, 20233 at 9:50 a.m. confirmed that Resident R5 had hearing loss which had the potential to impact how he communicates and should have had a care plan developed for such. Review of Resident R22's MDS dated [DATE], revealed the resident had cognitive impairment and had diagnoses of dementia (disease that affects the brain's ability to think, remember, and function normally) and muscle weakness. Review of Resident R22's care plan revised May 30, 2023, revealed the resident was at risk for skin breakdown related to impaired mobility with history of skin tear to the plan of her right hand. Interventions dated July 14, 2022, included to encourage resident to keep gauze in right hand due to contracture (permanent tightening of the muscles, tendons, skin, and surrounding tissues that causes the joints to shorten and stiffen). Review of Resident R22's physician orders revealed an order dated August 4, 2022, to apply rolled (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: 395704 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 395704 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lafayette-Redeemer, The 8580 Verree Road Philadelphia, PA 19111 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)