Health inspection·August 11, 2023

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on observations and resident and staff interviews, it was determined that the facility failed to note or update menu changes and notify Residents of a change to the posted menu for one of one meals observed (August 10, 2023, lunch meal). Findings include: During an interview with Resident 1 on August 10, 2023, at 11:05 AM, they indicated that they do not always get their preferences, and that they have not been getting dinner rolls as listed on the menu. During an interview with Resident 3 on August 10, 2023, at 12:10 PM, they indicated that they do not always get what is listed on the menu. Observation of Resident 3's lunch tray on August 10, 2023, at 12:15 PM, revealed that they had not received their roll or margarine as indicated on their tray ticket. Observation of Resident 4's lunch tray on August 10, 2023, at 12:25 PM, revealed that they had not received their dinner roll or unsweetened tea as indicated on their tray ticket. In addition, the tray ticket stated Send 2 butter cups with all meals. There were no butter cups noted on the tray. During an interview with Employee 1 (Director of Dietary) on August 10, 2023, at 12:25 PM, during observation and temperature check of Resident 4's tray items, he confirmed that the Resident did not have the dinner roll, the two butter cups, or unsweetened tea as indicated on their tray ticket. During an interview with the Nursing Home Administrator (NHA) on August 10, 2023, at 12:41 PM, he confirmed that the Residents should have received the dinner rolls as indicated on the menu and their tray tickets, and that he was not sure why they did not received them. He further indicated that he would look into the concern. In an email communication received from the NHA on August 11, 2023, at 12:13 PM, the NHA indicated that the facility did not have rolls because there were shipping logistic issues on the part of their supplier, and that the supplier was addressing the issue. In a follow-up email communication received from the NHA on August 11, 2023, at 1:58 PM, the NHA confirmed that the Residents had not been informed about the non-availability of the dinner rolls. During an interview with the NHA on August 11, 2023, at 3:30 PM, the NHA confirmed that 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 4 Event ID: 395915 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 395915 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Transitions Healthcare Allens Cove 25 Cove Road Duncannon, PA 17020 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)