Inspection·August 12, 2025

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical record review, and staff interviews, it was determined that the facility failed to properly monitor weight and nutrition status by failing to address weight loss for one of three residents (Residents R1).Finding include: Review of the facility policy, Weight Monitoring dated 1/7/25, indicated that a weight monitoring schedule will be developed upon admission for all residents. Weights should be recorded at the time obtained. Monitor weight monthly. A significant change in weight is defined as: 5% change in weight in 1 month7.5% change in weight in 3 months10% change in weight in 6 months Review of Resident R1's admission record indicated admission to the facility on 9/19/24, and readmitted on [DATE]. Review of Resident R1's Minimum Data Set (MDS-periodic assessment of care needs) assessment dated [DATE], included diagnoses of high blood pressure, hyperlipidemia (high fat in the blood) and low back pain. Review of Resident R1's clinical record revealed that weight were recorded as followed:11/12/24 = 177.5 pounds12/16/25 = 171.5 pounds1/14/25 = 183.0 pounds2/4/25 = 175.5 pounds3/5/25 = 170.0 pounds4/2/25 =170.0 pounds5/4/25 = 157.0 pounds , loss of 7.6% in one month, loss of 10.5% in three months, and 11.5% loss in six months Review of Resident R1's clinical record did not reveal any documentation or interventions for May 2025 significant weight loss. During an interview completed on 8/12/25, at 2:31 p.m. Registered Dietitian Employee E5 confirmed that the facility failed to properly monitor weight and nutrition status by failing to address Resident R1's May 2025 significant weight loss. 28 Pa. Code: 201.18(b)(1)(e)(1) Management.28 Pa. Code: 211.12(d)(5) Nursing services. Residents Affected - Few 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: 395751 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 395751 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rochester Residence and Care Center 174 Virginia Avenue Rochester, PA 15074 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)