Health inspection·June 18, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on review of facility policy, review of clinical records, interview with staff, it was determined that the facility failed to ensure comprehensive care plans were developed to address resident care needs related to a significant weight loss for one of three residents reviewed. (Resident R169) Findings include: Review of facility policy titled Unintended Weight Loss ensures residents will maintain acceptable body weight unless a clinical condition demonstrates that this is not possible residents with unintended weight loss will be assessed by the interdisciplinary team and interventions will be implemented to prevent further weight loss and promote weight gain. The director of wellness and director dietary manager are responsible for managing the processes for prediction or prevention, treatment, monitoring and calculation of unintended weight loss. Compliance includes developing a care plan that includes measurable objectives and time frames to meet the residents needs as identified in the residence assessment, the disciplinary team assesses residents with identified weight loss, develops care plan, implements, evaluates and reevaluates to treat and prevent weight loss and maintain adequate nutritional status of the resident, and communicate of weight changes to attending provider and residents' family. The licensed nurse documents the note of vacations in the medical record. Review of facility document titled Care Plan revealed the purpose of care plan is to write activity goals and approaches for each resident based on MDS (minimum data set , a federal mandated assessment tool), triggers and current needs of the resident. The process of care planning involves identifying the problem common need and strength of each resident then determine goals that are measurable specific and have a target date lastly determine approaches or interventions which are specifically what will be done to assist the resident in meeting the goal considering physical cognitive emotional abilities monitoring approaches will be numbered and will be recorded in care plan progress notes. Review of Resident R169's clinical record revealed that this resident entered the facility on May 29, 2025, after hospital discharge. Resident R169 was discharged back to the hospital for gastrointestinal bleeding, on June 3, 2025. There resident remained NPO (no food). Resident was received back at the facility June 10, 2025. Further review of resident R169's clinical record revealed a significant weight loss of 18.8 pounds in a period of eleven days. Review of Resident R169's clinical record weight history revealed that Resident R169 was documented as being weighed June 1, 2025, at 143.8 pounds, June 10, recorded weight was 144.0 pounds upon returned to the facility, June 11, 2025, recorded weight was 125.0 pounds. Interview with dietician employee E3 on June 16, 2025, revealed that she was made aware of the (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 6 Event ID: 395864 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 395864 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Juniper Village at Bucks County Rehab and Skd Care 3200 Bensalem Boulevard Bensalem, PA 19020 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)