Inspection visit

Health inspectionJune 8, 2023

LAUREL VIEW VILLAGECMS #3958919 citations on this visit

9 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 9 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on review of policies and clinical records, as well as staff interviews, it was determined that the facility failed to complete an investigation into an injury of unknown origin for two of 27 residents reviewed (Residents 3, 34) to rule out abuse/neglect as a possible cause. Residents Affected - Few Findings include: The facility's policy regarding abuse prevention, dated November 2022, indicated that staff will report all alleged violations involving neglect or abuse, including injuries of unknown source. All alleged violations are thoroughly investigated and must prevent further potential abuse while the investigation is in process. A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 3 dated, May 9, 2023, indicated that the resident was cognitively impaired, required extensive assistance with daily care needs including transfers, and had diagnoses that included Alzheimer's disease. A nursing note for Resident 3, dated May 9, 2023, at 2:24 p.m. revealed that her left knee was reddened and painful. A nursing note for Resident 3, dated May 16, 2023, at 9:11 a.m. revealed that her left knee remained swollen and that she was complaining of pain and guarding her knee. She had yellow/green bruising noted from her knee to her inner thigh. X-ray results revealed an acute fracture of Resident 3's distal femur (thigh bone near the knee). There was no documented evidence that the facility conducted an investigation to rule out abuse or neglect as a cause of Resident 3's leg fracture. An interview with the Nursing Home Administrator on June 8, 2023, at 9:45 a.m. confirmed that the facility did not conduct an investigation to rule out abuse or neglect as a cause of Resident 3's fracture. A quarterly MDS for Resident 34, dated May 16, 2023, indicated that the resident was cognitively impaired, required extensive assistance with daily care needs including transfers, and had diagnosis that included Alzheimer's disease, osteoarthritis, and abnormal posture. A nursing note for Resident 34, dated June 3, 2023, revealed that the resident had a witnessed fall in her room while using the sit-to-stand lift machine. The resident was attached to the right side of the lift with the sling underneath the resident when she slid out of her chair and onto the floor (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 12 Event ID: 395891 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 395891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928 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 0607 underneath the lift machine. Level of Harm - Minimal harm or potential for actual harm There was no documented evidence that the facility conducted a thorough investigation to rule out abuse or neglect as the cause of Resident 34's fall while using the sit-to-stand lift. Residents Affected - Few An interview with the Nursing Home Administrator on June 8, 2023, at 1:47 p.m. confirmed that the facility did not conduct a thorough investigation to rule out abuse or neglect as the cause of Resident 34's fall while using the sit to stand lift. 42 CFR 483.13 - Resident Behavior and Facility Practices, 10-1-1998 edition. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(e)(1) Management 28 Pa. Code 201.29(j) Resident rights 28 Pa. Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395891 If continuation sheet Page 2 of 12 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 395891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on review of state laws, facility policies and residents' clinical records, as well as staff interviews, it was determined that the facility failed to ensure that all alleged violations involving abuse were reported to the State Survey Agency (Department of Health) and to other state agencies in accordance with state law for two of 27 residents reviewed (Residents 3, 34). Findings include: The Older Adult Protective Services Act of November 6, 1987, amended by Act 1997-13, Chapter 7, Section 701, requires that all administrators or employees who have reasonable cause to suspect that a resident was a victim of sexual abuse, that abuse/neglect resulted in serious physical injury and/or serious bodily injury, or that a death was suspicious, were to make an immediate report to the Protective Services Agency, the Pennsylvania Department of Aging (PDA), and to law enforcement officials. The facility's policy regarding abuse, dated November 2022, revealed that allegations of actual or suspected abuse with injuries of unknown origin would be immediately reported to the registered nurse supervisor, attending physician, Director of Nursing, Nursing Home Administrator, and to other officials in accordance with state law, including the State Survey and Certification Agency (Department of Health). A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 3 dated, May 9, 2023, indicated that the resident was cognitively impaired, required extensive assistance with daily care needs including transfers, and had diagnoses that included Alzheimer's disease. A nursing note for Resident 3, dated May 9, 2023, at 2:24 p.m. revealed that her left knee was reddened and painful. A nursing note for Resident 3, dated May 16, 2023, at 9:11 a.m. revealed that her left knee remained swollen and that she was complaining of pain and guarding her knee. She had yellow/green bruising noted from her knee to her inner thigh. X-ray results revealed an acute fracture of Resident 3's distal femur (thigh bone near the knee). There was no documented evidence that the Department of Health was notified about Resident 3's fall with fracture. An interview with the Nursing Home Administrator on June 8, 2023, at 9:45 a.m. confirmed that the incident with Resident 3's fall with fracture should have been reported to the Department of Health. A quarterly MDS for Resident 34, dated May 16, 2023, indicated that the resident was cognitively impaired, required extensive assistance with daily care needs including transfers, and had diagnoses that included Alzheimer's disease, osteoarthritis, and abnormal posture. A nursing note for Resident 34, dated June 3, 2023, revealed that the resident had a witnessed fall in her room while using the sit-to-stand lift machine. The resident was attached to the right side of the lift with the sling underneath the resident when she slid out of her chair and onto the floor (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395891 If continuation sheet Page 3 of 12 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 395891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928 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 0609 underneath the lift machine. Level of Harm - Minimal harm or potential for actual harm There was no documented evidence that a thorough investigation was completed in order to determine what caused Resident 34 to slide out of her chair while using the lift machine. Residents Affected - Few An interview with the Nursing Home Administrator on June 8, 2023, at 1:47 p.m. confirmed that the facility did not investigate the incident regarding Resident 34 sliding to the floor during a transfer with a sit-to-stand lift. She stated she did not feel this incident should have been a reportable to the Department of Health. 42 CFR 483.13 - Resident Behavior and Facility Practices, 10-1-1998 edition. 28 Pa. Code 201.18(b)(1) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395891 If continuation sheet Page 4 of 12 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 395891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928 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 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 policies and clinical records, as well as observations and staff interviews, it was determined that the facility failed to develop comprehensive care plans that included specific and individualized interventions to address the care needs for one of 27 residents reviewed (Resident 16). Findings include: The facility's policy for care planning, dated April 2023, indicated that the facility develops and implemented a comprehensive, person-centered care plan for each resident. Care plans shall incorporate goals and objectives that lead to the promotion and or maintenance of the resident's highest level of independence. Each resident would be provided with individualized goals that were measurable and based on resident needs. A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 5, dated March 3, 2023, indicated that the resident was cognitively intact and required extensive assistance from staff with her bed mobility, transfers, dressing, toileting, and personal hygiene. An interview with Resident 16 on June 5, 2023, at 7:51 p.m. revealed that her toes were very painful and that she had an infection. A review of Resident 16's clinical record revealed a podiatry consult, dated May 30, 2023, indicating that the resident had a left toe wound infection and the resident and staff requested nail debridement. Physician's orders for Resident 16, dated May 30, 2023, included orders to administer 500 milligrams (mg) of Keflex (an antibiotic) every 8 hours for 21 administrations, apply betadine 10 percent external solution every evening shift until June 14, 2023, and to soak the left great toe in a half cup of Epsom salt and warm water, then swab with betadine solution every Monday, Wednesday and Friday until June 14, 2023. Review of Resident 16's care plan, initiated May 29, 2019, revealed that it did not include any information or interventions related to the care needs for the toe infection or use of antibiotic medication. An interview with the Director of Nursing on June 8, 2023, at 12:15 p.m. confirmed that Resident 16's care plan did not include anything regarding the care and treatment of the great left toe. 28 Pa. Code 211.11(d) Resident care plan. 28 Pa. Code 211.12(d)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395891 If continuation sheet Page 5 of 12 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 395891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on review of policies and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that the physician responded timely to a pharmacy recommendation for one of 27 residents reviewed (Resident 8). Findings include: The facility's policy regarding consultant pharmacist services provider requirements, dated May 2023, revealed that at least monthly the resident's medication regimen would be reviewed by the consultant pharmacist. The reviews would address standards of care which may include issues related to federal regulations, drug interactions, drug side effects, dosage adjustments or reductions, alternative therapy, and lab requirements. The documentation will be noted in the facility's electronic medical record and issues of note will be provided to the responsible provider, Director of Nursing, and Medical Director with a written summary. The facility has a process to ensure that issues are acted upon in a timely manner relative to the degree of significance. Physician's orders for Resident 8, dated September 7, 2022, included an order for the resident to receive one 25 milligram (mg) tablet of Seroquel (antipsychotic medication) daily for dementia with behavioral disturbance. A monthly pharmacy medication regimen review for Resident 8, dated March 13, 2023, revealed a recommendation for a gradual dose reduction of Seroquel from 25 mg to 12.5 mg daily. There was no documented evidence that a gradual dose reduction was completed. A monthly pharmacy medication regimen review for Resident 8, dated April 11, 2023, revealed a repeat recommendation for a gradual dose reduction of Seroquel from 25 mg to 12.5 mg daily. Physician's orders for Resident 8, dated April 12, 2023, included an order for the resident to receive one 12.5 mg tablet of Seroquel daily for dementia with behavioral disturbance. Interview with the Nursing Home Administrator on June 8, 2023, at 12:29 p.m. confirmed that there was no documented evidence in Resident 8's clinical record to indicate that the physician addressed the March 13, 2023, pharmacy recommendation for a gradual dose reduction of Seroquel until April 12, 2023, when it was recommended a second time. 28 Pa. Code 211.12(d)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395891 If continuation sheet Page 6 of 12 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 395891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Based on review of policies and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that the physician responded timely to pharmacy recommendations for one of 27 residents reviewed (Resident 8). Findings include: The facility's policy regarding consultant pharmacist services provider requirements, dated May 2023, revealed that at least monthly the resident's medication regimen would be reviewed by the consultant pharmacist. The reviews would address standards of care which may include issues related to federal regulations, drug interactions, drug side effects, dosage adjustments or reductions, alternative therapy, and lab requirements. The documentation will be noted in the facility's electronic medical record and issues of note will be provided to the responsible provider, Director of Nursing, and Medical Director with a written summary. The facility has a process to ensure that issues are acted upon in a timely manner relative to the degree of significance. A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 8, dated May 12, 2023, indicated that the resident was cognitively impaired and required extensive assistance from staff with her bed mobility, transfers, dressing, toileting, personal hygiene, and received antipsychotic medication. Physician's orders for Resident 8, dated September 7, 2022, included an order for the resident to receive one 25 milligram (mg) tablet of Seroquel (antipsychotic medication) daily for dementia with behavioral disturbance. A monthly pharmacy medication regimen review for Resident 8, dated March 13, 2023, revealed a recommendation for a gradual dose reduction of Seroquel from 25 mg to 12.5 mg daily. There was no documented evidence that a gradual dose reduction was completed. A monthly pharmacy medication regimen review for Resident 8, dated April 11, 2023, revealed a repeat recommendation for a gradual dose reduction of Seroquel from 25 mg to 12.5 mg daily. Physician's orders for Resident 8, dated April 12, 2023, included an order for the resident to receive one 12.5 mg tablet of Seroquel daily for dementia with behavioral disturbance. A review of the medication administration record for Resident 8 for March and April 2023 revealed that 25 mg of Seroquel was administered from March 13-24, 2023, and March 31 to April 11, 2023. Resident 8 was on hospital leave from March 25-30, 2023. Interview with the Nursing Home Administrator on June 8, 2023, at 12:29 p.m. confirmed that there was no documented evidence that Resident 8's physician addressed the pharmacist's recommendation from March 13, 2023, to decrease the resident's Seroquel and the resident continued to receive 25 mg daily until April 11, 2023. 28 Pa. Code 211.12(d)(3) Nursing services. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395891 If continuation sheet Page 7 of 12 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 395891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928 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 0758 28 Pa. Code 211.12(d)(5) Nursing services. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395891 If continuation sheet Page 8 of 12 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 395891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928 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 Based on a review of facility policy, resident interviews, observations, and staff interviews, it was determined that the facility failed to ensure that residents received foods that were served at appetizing temperatures. Residents Affected - Many Findings include: The facility's policy regarding Meal Temperatures, dated November 2022, revealed that all food and drinks should be palatable, attractive and served at a safe and appetizing temperature. Interview with Resident 44 on June 6, 2023, at 9:47 a.m. revealed that the food served by the facility at meal times was not served hot enough, tasted cold, and the plates were cold. Observations in the dining room kitchenette on June 7, 2023, at 11:53 a.m. revealed Dietary Worker 2 was plating food from the steam table and then placing the plate into microwave for 30 seconds prior to serving it to the residents. A test tray was requested from the kitchenette on June 7, 2023, at 12:30 p.m. after the last of the residents had been served. The test tray was served from the steam table and was not placed into the microwave as each of the other trays had been. At 12:34 p.m. the test tray temperature of the carrots was 101.9 degrees F, the temperature of the mashed potatoes with gravy was 112.1 degrees F, the temperature of the pork loin with gravy was 126.1 F, and these items were cold to taste and not appetizing at the temperatures they were served at. An interview with Dietary Worker 2 on June 7, 2023, at 12:34 p.m. revealed that she plates the food from the steam table but puts each plate in the microwave because the residents like their food hot. She did not know if the steam table was functioning properly or not. An interview with the Dietician on June 7, 2023, at 12:41 p.m. confirmed that the carrots, mashed potatoes and pork loin were not served at proper temperatures, and that she did not know if the steam table was functioning properly. An interview with the Dietary Manager on June 7, 2023, at 3:11 p.m. revealed that the steam table was not functioning properly and that they were going to get it repaired. She stated that the food temperatures at lunch were too low. 28 Pa. Code 201.18(b)(1)(e)(1) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395891 If continuation sheet Page 9 of 12 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 395891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations and staff interviews, it was determined that the facility failed to store and prepare food under sanitary conditions. Residents Affected - Many Findings include: Observations of the grill and deep fryer on June 5, 2023, at 6:58 p.m. revealed a large accumulation of a thick, blackened, removable substance on the grill, food debris and crumbs around the grill, and grease splashes down the sides of the grill. The deep fryer had food debris/crumbs piled up in the grease and grease stains around the fryer. Observations of the prep cooler on June 5, 2023, at 6:58 p.m. revealed three half-pint cartons of milk that expired on May 19, 2023, and eight half-pint cartons of milk that had no expiration date printed on them. Interview with the Dietary Manager on June 5, 2023, at 6:58 p.m. confirmed that the grill and deep fryer were in need of cleaning and that the expired milk and the milk cartons without an expiration date should have been thrown out. 28 Pa. Code 211.6(f) Dietary services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395891 If continuation sheet Page 10 of 12 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 395891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. Based on review of hospice contracts and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that the designated interdisciplinary team member obtained the required information from the contracted hospice provider for one of 27 residents reviewed (Resident 3) who was receiving hospice services. Findings include: An agreement between the facility and a hospice provider (provider of end-of-life services) indicated that the hospice provider would maintain medical records for each hospice patient. Such records will be prepared and maintained with federal and state law, rules, regulations, procedures, policies, guidelines, and generally accepted medical record practices. A record of all services provided to the patient and events regarding the patient's care will be located at the facility. A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 3 dated, May 9, 2023, indicated that the resident was cognitively impaired, required extensive assistance with daily care needs including transfers, was receiving hospice services, and had diagnosis that included Alzheimer's disease. Physician's orders for Resident 3, dated February 2, 2023, revealed that the resident was to receive hospice services from the facility's contracted hospice provider. As of June 9, 2023, there was no documented evidence in the resident's clinical record, or in the hospice provider's clinical record, that the facility obtained updated nursing notes from hospice. The last nursing note from hospice located on the resident's chart was dated February 7, 2023. Interview with Registered Nurse 1 on June 7, 2023, at 1:35 p.m. confirmed that there were no updated nursing notes on Residents 3 hospice binder and that the last note was dated February 7, 2023. Interview with the Nursing Home Administrator on June 7, 2023, at 3:29 p.m. confirmed that Resident 3 did not have updated nursing notes on the hospice chart and that there should have been. 28 Pa. Code 211.12(d)(3) Nursing services. 28 Pa. Code 211.12(d)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395891 If continuation sheet Page 11 of 12 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 395891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurel View Village 2000 Cambridge Drive Davidsville, PA 15928 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on review of the facility's plans of correction for previous surveys, and the results of the current survey, it was determined that the facility's Quality Assurance Performance Improvement (QAPI) committee failed to correct quality deficiencies and ensure that plans to improve the delivery of care and services effectively addressed recurring deficiencies. Findings include: The facility's deficiencies and plans of corrections for State Survey and Certification (Department of Health) survey ending July 7, 2022, revealed that the facility developed plans of correction that included quality assurance systems to ensure that the facility maintained compliance with cited nursing home regulations. The results of the current survey, ending June 8, 2023, identified repeated deficiencies related to sanitary food storage/preparation and food palatability. The facility's plan of correction for a deficiency regarding food palatability, cited during the survey ending July 7, 2022, revealed that the development and implementation of care plans would be monitored by QAPI. The results of the current survey, cited under F804, revealed that the QAPI committee was ineffective in maintaining compliance with regulation regarding food palatability. The facility's plan of correction for a deficiency regarding sanitary food storage/preparation, cited during the survey ending July 7, 2022, revealed that the development and implementation of care plans would be monitored by QAPI. The results of the current survey, cited under F812, revealed that the QAPI committee was ineffective in maintaining compliance with regulation regarding the sanitary food storage/preparation. Refer to F804, F812. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(e)(1) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395891 If continuation sheet Page 12 of 12

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Citations

9 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0607GeneralS&S Dpotential for harm
F607 - The facility must develop and implement written policies and procedures that:
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
0609GeneralS&S Dpotential for harm
F609 - The facility must develop and implement written policies and procedures that:
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
0656GeneralS&S Dpotential for harm
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
0756GeneralS&S Dpotential for harm
F756 - Drug Regimen Review
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
0758GeneralS&S Dpotential for harm
F758 - Medication Errors
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
0804GeneralS&S Fpotential for harm
F804 - Food and drink
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
0812GeneralS&S Fpotential for harm
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
0849GeneralS&S Epotential for harm
F849 - Hospice services
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
0867GeneralS&S Dpotential for harm
F867 - Program feedback, data systems and monitoring
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.

FAQ · About this visit

Common questions about this visit

What happened during the June 8, 2023 survey of LAUREL VIEW VILLAGE?

This was a inspection survey of LAUREL VIEW VILLAGE on June 8, 2023. The surveyor cited 9 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at LAUREL VIEW VILLAGE on June 8, 2023?

Yes, 9 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Develop and implement policies and procedures to prevent abuse, neglect, and theft."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.

Data from CMS Care Compare public records. Dataset last refreshed June 22, 2026. If you believe any information is inaccurate, report it here.

Health inspection·June 8, 2023