Health inspection·February 21, 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 facility policy, clinical record review, and staff interview, it was determined that the facility failed to obtain and monitor weights for one of three residents reviewed for nutrition (Resident 20). Residents Affected - Few Findings include: Review of facility policy, Weight Management/Weight Loss, revised July 12, 2022, revealed that monthly weights will be taken by qualified staff during the first 5 days of each month and documented in the electronic medical record after being verified by licensed staff. If a +/- 5 lb [pound] discrepancy exists, the resident should be reweighed immediately with nurse verifying weight. If unable to verify immediately reweight will be obtained on the following day. Additionally, if a weight loss/gain of 5 or more pounds is noted, dietitian is to be notified in a timely manner for follow up and recommendations. Review of Resident 20's clinical record revealed recorded weights of 121.4 pounds on January 4, 2025; 121.4 pounds on January 5, 2025; 108.4 pounds on February 5, 2025, with a reweight on February 6, 2025, of 107.6 pounds. (loss of 13.8pounds or11.37% in one month) Further review of Resident 20's clinical record revealed a dietary note dated February 10, 2025, indicating the resident's weight. Further review of the same dietary note failed to reveal recommendations to address the weight loss. Interview with Employee E3 on February 21, 2025 at 11:30 a.m. confirmed that further dietary interventions should have been implemented to address Resident 20's weight loss. 28 Pa. Code 211.5(f) Clinical Records 28 Pa. Code 211.10(c) Resident Care Policies 28 Pa. Code 211.12(d)(1)(3)(5) Nursing Services 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: 395720 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 395720 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Homestead Village, Inc 1800 Village Circle Lancaster, PA 17604 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)