Health inspection·November 22, 2023

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on review of facility policy and clinical records and staff interview, it was determined that the facility failed to review and/or revise resident care plans for seven of 10 residents reviewed (Residents R1, R2, R7, R8, R10, R11, and R12). Findings include: Review of facility policy entitled Care Plans dated 8/9/23, indicated The care plan will be reviewed, evaluated, and updated at a minimum of every 90 - days. Resident R1's clinical record revealed an admission date of 4/23/23, with diagnoses that included Multiple Sclerosis (MS - a degenerative disease that affects the nerves disrupting the signals between the brain and body), Traumatic Brain Injury (TBI - injury to the brain caused by trauma), and Epilepsy (neurological disorder resulting in seizures). Review of Resident R1's comprehensive care plan revealed that of the eight care plans present, eight had an outstanding target date (a date that the resident's care plan must be updated by) of 7/23/23. Resident R2's clinical record revealed an admission date of 11/18/23, with diagnoses that included Metabolic Encephalopathy (condition when brain function is disturbed due to disease), Hypothyroidism (disorder when the thyroid gland does not produce enough thyroid hormone), and Kidney Failure. Review of Resident R2's comprehensive care plan revealed that of the 15 care plans present, 15 had an outstanding target date of 10/17/23. Resident R7's clinical record revealed an admission date of 11/18/21, with diagnoses that included Epilepsy, Multiple Sclerosis, and Dysphagia (difficulty swallowing food and/or liquids). Review of Resident R7's comprehensive care plan revealed that of the 17 care plans present, 17 had an outstanding target date of 9/25/23. Resident R8's clinical record revealed an admission date of 3/15/11, with diagnoses that included Dementia (condition that affects the brains ability to think, remember, and function normally), Peripheral Vascular Disease (disorder that affects the blood flow to your legs), and Cirrhosis of the Liver (a degenerative disease of the liver) Review of Resident R8's comprehensive care plan revealed that of the 17 care plans present, 17 had (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 3 Event ID: 395728 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 395728 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lecom at Snyder Memorial 156 Snyder Memorial Rd Marienville, PA 16239 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)