Health inspection·September 4, 2024

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, facility policy review, and staff interviews, it was determined that the facility failed to prepare and store food and equipment in accordance with professional standards for food service safety in the main kitchen area. Findings Include: Review of facility policy, titled Food Storage, dated 2021, revealed All foods should be covered, labeled, and dated and routinely monitored to assure that foods (including leftovers) will be consumed by their safe use by dates, or frozen (where applicable), or discarded. Review of facility policy, titled General Food Preparation and Handling, dated 2021, revealed The kitchen will be kept neat and orderly. The kitchen surfaces and equipment will be cleaned and sanitized as appropriate. Upon entering the kitchen on September 4, 2024, at 9:29 AM, with the Nursing Home Administrator (NHA) and Employee 1 (Food Service Director), Employees 2 (Cook) and 3 (Dietary Aide) were observed working in the kitchen without hairnets. Employee 1 immediately provided hairnets to Employees 2 and 3. Observation of the dry storage area in the kitchen on September 4, 2024, at 9:32 AM, revealed an open bottle of stir fry sauce, over halfway empty, sitting on a shelf. Further observation revealed the bottle did not have an open date and, on the back of the bottle, it stated refrigerate after opening. Employee 1 confirmed that the bottle was not dated with an open date and Employee 1 immediately discarded the bottle. Observation of the main kitchen area with the NHA and Employee 1 on September 4, 2024, at 9:35 AM, revealed a drawer with clean utensils stored inside, with numerous dried food particles laying inside of the drawer with the clean utensils. The lip of the drawer, as well as the outside of the drawer and cabinet, had what appeared to be dried food stuck on it. During an immediate interview with the NHA and Employee 1, both confirmed the presence of the dried food particles. During a follow-up interview with the NHA on September 4, 2024, at 12:46 PM, he stated that Employees 2 and 3 should have been wearing hairnets in the kitchen, food should be labeled and stored appropriately, and utensils should be clean and stored in a clean area. (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 2 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 09/04/2024 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)