Inspection·April 3, 2025

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to ensure that the Minimum Data Set (MDS) assessment was completed to accurately reflect the current status of two of 15 sampled residents. (Residents 47, 57) Residents Affected - Few Findings include: Clinical record review revealed that Resident 47 had a diagnosis of diabetes. Section N of the MDS assessment dated [DATE], indicated that Resident 47 was injected with insulin once during the seven-day review period. Review of Resident 47's clinical record revealed that Resident 47 did not have a physician's order for and was not administered insulin during the seven-day review period, as inaccurately identified on the MDS assessment. Clinical record review revealed that Resident 57 was admitted to the facility on [DATE], for short term rehabilitation. A nursing note dated February 4, 2025, indicated the resident was discharged back to her home in a personal care setting with memory support. The MDS assessment dated [DATE], indicated the resident discharged to a long term care hospital. In an interview on April 3, 2025, at 9:11 a.m., the Nursing Home Administrator confirmed that Resident 47's and 57's MDS assessments were inaccurate. 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: 395752 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 395752 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Moravian Hall Square Health and Wellness Center 175 West North Street Nazareth, PA 18064 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)