Health inspection·February 8, 2024

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. Based on review of facility documents, and resident and staff interview, it was determined that the facility failed to promote and facilitate resident self-determination through support of resident choice and make choices about aspects of his or her life in the facility that are significant to the resident for 11 of 11 residents reviewed for availability of food preferences (Residents R1-R11). Findings include: Review of Resident Council Meeting minutes dated 2/06/24, revealed: -resident concerns from two resident council members about having soup available daily. Review of the Results of the Investigation indicated that soup is offered on the current menus cycle, and one resident in the facility can receive soup for lunch and dinner per resident and family request. The Resolution lacked how the facility addressed the concerns how they directly related to the residents voicing the concerns and indicated that Resident is pleased with outcome but failed to indicate what the outcome was as it related to the residents voicing their concerns. -resident concerns from one resident council member about getting ice cream when he/she doesn't like the served dessert. Review of the Results of the Investigation indicated that ice cream is offered weekly on the current menu cycle. The Resolution indicated that the Activities Department will host an ice cream social, and lacked how the facility addressed the concerns how they directly related to the resident's voiced concerns. -resident concerns from one resident council member about the kitchen running out of eggs, having more fresh fruits and juice flavors. The Results of the Investigation lacked evidence that the facility investigated the resident's concern related to running out of eggs, and not getting enough fresh fruits and juices. The Resolution indicated that the Activities Department will host a breakfast bonanza including fresh fruits and eggs, and fresh fruit will be offered as a bingo prize, and fresh fruit will be offered in spring/summer menus and lacked how the facility how the facility addressed the concerns how they directly related to the resident's voiced concerns. Review of the four week menu cycle revealed that soup was offered twice (once during week one and once during week three), ice cream is offered once a week, and canned fruit is offered an average of three times per week. Observation on 2/07/24, at 9:45 a.m. revealed a sign posted on the kitchen access door in the resident dining room and indicated that as of 1/01/24, there was not pop/soda available to residents. (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 3 Event ID: 395853 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 395853 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crawford Care Center 20881 State Highway 198 Saegertown, PA 16433 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)