Inspection·October 17, 2024

F 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Based on a review of facility policy, observations, and staff interviews it was determined that the facility failed to make certain that residents are served food products that meet their dietary needs for one of eight residents (Resident R7). Findings include: A review of facility Therapeutic Diets policy last reviewed 9/25/24, indicated that diets will be determined in accordance with the resident's informed choices, preferences, treatment goals, and wishes. Review of the facility undated Therapeutic Diet Descriptions indicated an easy to chew ground diet consistency is a transition to the regular consistency and is appropriate for residents with mild to moderate dysphagia (difficulty swallowing). The meats are ground and served with a sauce or gravy. Vegetables are cooked until very tender/soft. Difficult to chew fruits, stringy fruits, fresh vegetables, corn, seeds, nuts, coconut, dried fruits, crispy and fried potatoes, dry/tough/crusty breads are avoided. During an observation and interview on 8/16/24, at 10:16 a.m. Resident R1 breakfast meal ticket indicated an easy to chew diet order and white toast. Resident R1 did not have white toast as ordered, a rye toast was provided. An unopened bowl of cornflakes was observed on the resident's tray. Resident R1 stated her food was difficult to eat. During an interview on 8/16/24, at 10:20 a.m. Licensed Practical Nurse Employee E1 confirmed the facility failed to provide Resident R1 with an easy to chew diet. Pa Code: 211.6(b) Dietary 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 3 Event ID: 395732 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 395732 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Care Center 5701 Phillips Avenue Pittsburgh, PA 15217 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)