F 0628
Level of Harm - Potential for
minimal harm
Residents Affected - Some
Provide the required documentation or notification related to the resident's needs, appeal rights, or
bed-hold policies.
Based on clinical record review and staff interview, it was determined that the facility failed to notify the
resident and the resident's representative(s) of transfer(s), including the reasons for the moves and
Ombudsman information, in writing upon transfer from the facility for two of three sampled residents who
were transferred to the hospital. (Residents 7, 16)
Findings include:
Clinical record review revealed that Resident 7 was transferred to the hospital on March 22, 2025, after a
change in condition. There was no documentation to support that the resident and the resident's
responsible party or legal representative were provided with written information regarding the transfer to the
hospital.
Clinical record review revealed that Resident 16 was transferred to the hospital on December 23, 2024,
after a change in condition. There was no documentation to support that the resident and the resident's
responsible party or legal representative were provided with written information regarding the transfer to the
hospital.
In an interview on May 21, 2025, at 12:20 p.m., the Administrator confirmed that there was no evidence that
the residents and residents' representatives were given written notices regarding the identified transfers.
28 Pa. Code 201.14(a) Responsibility of licensee.
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:
395800
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
395800
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/21/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Highlands at Wyomissing
2000 Cambridge Avenue
Wyomissing, PA 19610
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)
F 0640
Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
Level of Harm - Minimal harm
or potential for actual harm
Based on clinical record review and staff interview, it was determined that the facility failed to electronically
transmit encoded Minimum Data Set (MDS) data to the Centers for Medicare and Medicaid Services (CMS)
within 14 days after the facility completed the resident assessment for one of three sampled residents who
were discharged from the facility. (Resident 45)
Residents Affected - Few
Findings include:
Clinical record review revealed that Resident 45's discharge MDS assessment was completed on
December 20, 2024, but had not been exported as of May 20, 2025.
In an interview on May 21, 2025, at 11:00 a.m., Registered Nurse 1 confirmed that the MDS assessment
had not been exported.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395800
If continuation sheet
Page 2 of 3
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
395800
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/21/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Highlands at Wyomissing
2000 Cambridge Avenue
Wyomissing, PA 19610
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)
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
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, facility policy review, and staff and resident interview, it was determined that the facility failed
to ensure that hot beverages were monitored and served at a safe temperature on the nursing units.
([NAME] Court, units 100, 200, and 300) Findings include:Review of documentation by the American Burn
Association's Burn Prevention Committee entitled, Scald Injury Prevention, revealed that a scald injury
occurred when a hot liquid damaged one or more layers of skin and hot beverages were a frequent source
of scald burns. Older adults were the most frequent victims of scald injuries due to thin skin, reduced
mobility, and reduced ability to feel heat. Hot liquid at a temperature of 155 degrees Fahrenheit (F) could
result in a scald injury in one second.Review of the facility policy entitled, Service Temperatures, last
reviewed July 2024, revealed that staff were to ensure that temperatures were within critical limits and that
coffee was to be a minimum of 150 degrees F and a maximum 180 degrees F. The policy indicated that hot
beverages could be served at temperatures greater than 155 degrees F, contrary to the safety parameters
outlined by the American Burn Prevention Committee.Observation during a test tray audit conducted on
May 20, 2025, at 11:53 a.m., at the time the last resident meal tray was served, it was determined that the
coffee provided on the tray was 179 degrees F. In an interview during the tray audit, Dietary Manager (DM)
1 confirmed the temperature of the coffee was 179 degrees F and that temperature was excessively hot for
coffee at the point of service.In an interview on May 20, 2025, at 12:04 p.m., Dietary Aide (DA) 1 stated that
she did not test the temperature of the coffee before the start of service or before the trays left the kitchen.
She also stated that she did not typically test the temperature of the coffee before service to residents.
There was a lack of evidence to support that any staff were testing the temperature of the coffee before
service to residents.In an interview on May 20, 2025, at 1:20 p.m., DM 1 stated that Residents 1, 3, 4, 8,
14, and 23 typically ordered and drank coffee from the dietary department on a regular basis.In an
interview on May 20, 2025, at 1:30 p.m., the Administrator stated that the facility did not have a procedure
in place to assess a resident's ability to safely manage hot beverages.In interviews on May 20, 2025, at
4:10 p.m., and 4:22 p.m., Residents 4 and 8 stated that the coffee was often served hot and they could not
drink it when served.28 Pa. Code 201.14(a) Responsibility of licensee.28 Pa. Code 201.18(b)(1)(3)
Management.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395800
If continuation sheet
Page 3 of 3
