Health inspection·May 8, 2024

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observation, review of facility policy and documents, and staff interviews, it was determined that the facility failed to provide foods and beverages that are palatable, and at a safe and appetizing temperature for one of one meal observed on the Arcadia unit. Residents Affected - Few Findings include: Review of facility policy titled Food Handling dated May 1, 2023, indicated 24. During transportation of food from the kitchen to the dining rooms, resident rooms, or other dining locations, care is taken to keep hot food hot and cold food cold and protected from contamination. Review of HACCP (Hazard Analysis Critical Control Point) Food Flow Chart, undated, provided by the facility indicated that ground meats and portioned meats should be maintained at a temperature of 145 degrees Fahrenheit or above. Observation on May 6, 2024, at 12:47 PM, revealed that two food delivery carts arrived on the Arcadia unit. A test tray was completed on May 6, 2024, at 1:05 PM on the Arcadia Unit from cart 2. Test tray temperatures were taken by Employee 1 (Dietary Manager) on the tray. Findings were as follows: Milk 47.6 degrees Fahrenheit (per facility Food and Nutrition Services Test Tray Evaluation form should be less than or equal to 45 degrees Fahrenheit); Salisbury Steak 137.6 degrees Fahrenheit (per facility Food and Nutrition Services Test Tray Evaluation form should be greater than 140 degrees Fahrenheit); Mashed Potatoes 130.8 degrees Fahrenheit (per facility Food and Nutrition Services Test Tray Evaluation form should be greater than 140 degrees Fahrenheit); and California Blend Vegetables 133.1 degrees Fahrenheit (per facility Food and Nutrition Services Test Tray Evaluation form should be greater than 140 degrees Fahrenheit). During an immediate interview on May 6, 2024, at 1:10 PM, with Employee 1, he indicated that the aforementioned food and beverage temperatures did not meet the specified guidelines. Employee 1 also indicated that the goal for passing trays was 15 minutes after arrival to the unit to ensure food temperatures are maintained for point of service. During an interview with Nursing Home Administrator (NHA) and the Director of Nursing (DON) on May (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: 395746 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 395746 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carlisle Skilled Nursing and Rehabilitation Center 940 Walnut Bottom Road Carlisle, PA 17013 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)