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 Page 1 of 4 395915 395915 08/11/2023 Transitions Healthcare Allens Cove 25 Cove Road Duncannon, PA 17020

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents should have been notified that dinner rolls were not available, that substitutions should have been offered, and that Resident's should receive all items and preferences as indicated on their tray tickets. Pa code 211.6(a)(b) - Dietary Services Residents Affected - Few 395915 Page 2 of 4 395915 08/11/2023 Transitions Healthcare Allens Cove 25 Cove Road Duncannon, PA 17020

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 observation, review of facility policy, service line temperature log, and resident and staff interviews, it was determined that the facility failed to provide food and beverage that are palatable and at a safe and appetizing temperature for five of 13 meals reviewed. Residents Affected - Some Findings include: Review of facility policy, titled Food: Quality and Palatability with a last revised date of September 2017, revealed Food will be palatable, attractive, and served at a safe and appetizing temperature. Review of the facility's Service Line Checklist revealed that Hot Food Temperatures should be equal to or greater than 135 degrees Fahrenheit, and Cold food temperatures should be less than or equal to 41 degrees Fahrenheit. Review of these checklists from July 28, 2023, through August 9, 2023, revealed the following concerns: July 28, 2023, dinner meal: the grilled cheese temperature was documented as 130 degrees Fahrenheit, not palatable temperature; July 29, 2023, lunch meal: the french fries temperature was documented as 134 degrees Fahrenheit, not palatable temperature; July 30, 2023, lunch meal: the peas temperature was documented as 112 degrees Fahrenheit, not palatable temperature; and August 6, 2023, lunch meal: the egg salad temperature was 46 degrees Fahrenheit, not palatable temperature; the macaroni salad temperature was 46 degrees Fahrenheit, not palatable temperature; the tomato salad temperature was 50 degrees Fahrenheit, not palatable temperature; the tuna salad temperature was 46 degrees Fahrenheit, not palatable temperature, the broccoli salad temperature was 44 degrees Fahrenheit, not palatable temperature; and that the pureed versions of these salads ranged from 45-46 degrees Fahrenheit, not palatable temperature (the checklist did not specify which puree food item the temperature was indicative of). During an with the Nursing Home Administrator (NHA) on August 10, 2023, at 12:41 PM, the above Service Line Checklist temperature concerns and the test tray findings were shared. He confirmed that all food items should be served at a palatable temperature. He also indicated that he would follow up with the Director of Dietary to see what was done to address the temperature concerns on the aforementioned dates. During an interview with Resident 1 on August 10, 2023, at 11:05 AM, they indicated that their food was often cold. During an interview with Resident 2 on August 10, 2023, at 11:35 AM, they indicated that, occasionally, their hot food was cold, and that sometimes the juice was still frozen. Interview with Resident 3 on August 10, 2023, at 12:10 PM, they indicated that their food was often 395915 Page 3 of 4 395915 08/11/2023 Transitions Healthcare Allens Cove 25 Cove Road Duncannon, PA 17020

F 0804 cold, but that they do not usually ask for it to be reheated. Level of Harm - Minimal harm or potential for actual harm A test tray was completed on August 10, 2023, in the North Hall. Test tray temperatures were taken by Employee 1 (Director of Dietary) on the tray that had been prepared for Resident 4, at approximately 12:25 PM, on the North Hall, and revealed the following: Residents Affected - Some Beef Pepper Steak 134.5 degrees Fahrenheit, not palatable temperature Mashed Potatoes 133.7 degrees Fahrenheit, not palatable temperature Broccoli Florets 126.8 degrees Fahrenheit, not palatable temperature Chocolate Cream Pie 49.6 degrees Fahrenheit, not palatable temperature Coffee 128.7 degrees Fahrenheit, not palatable temperature Cranberry Juice 54.7 degrees Fahrenheit, not palatable temperature. During an immediate interview with Employee 1 on August 10, 2023, at 12:25 PM, at the time of the temperature check of the tray items, he confirmed that the temperatures of all items checked were not palatable. During a follow-up interview with the NHA on August 11, 2023, at 3:30 PM, the NHA again confirmed that all food items should be served at a palatable temperature, and further indicated that the Director of Dietary could not say what steps were taken on the aforementioned dates to correct the food temperatures. 28 Pa code 211.6(b)- Dietary Services 395915 Page 4 of 4