Inspection·August 5, 2024

F 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. Based on a review of policies and clinical records, as well as observations and staff interviews, it was determined that the facility failed to ensure that a therapeutic diet was provided as ordered by the physician for one of three residents reviewed (Resident 1). Findings include: The facility's policy regarding thickened liquids, dated April 11, 2024, indicated that the definition for thickened liquids are liquids where the consistency has been altered to facilitate safe, oral intake. They are ordered as part of treatment for a disease or clinical condition, such as dysphagia (a medical term for difficulty swallowing) due to stroke, cancer, multiple sclerosis (a chronic disease of the central nervous system) or other neuromuscular disease. Thickened liquids are provided only when ordered by a physician/practitioner, or when ordered by a dietitian or speech-language pathologist who has been delegated to write diet orders, to the extent allowed by state law. The facility utilizes standard liquid categories. Category 0: Thin; Category 1: Slightly thick (naturally thick); Category 2 Mildly thick (nectar thick); Category 3: Moderately thick (honey thick), and Category 4: Extremely thick (spoon thick). A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 1, dated June 19, 2024, revealed that the resident was usually understood, could usually understand, had a diagnosis which included dysphagia, and was on a mechanically altered diet (foods that are easy to swallow because they are blended, chopped, ground, or mashed so that they are easy to chew and swallow). A care plan for the resident, dated May 31, 2024, revealed that the resident has a swallowing problem. Staff were to provide the resident's diet as ordered, and she was to have nectar thick liquids (have slightly more body than thin liquids, but still can pour easily). Physician's orders for Resident 1, dated April 5, 2024, included an order for the resident to receive 237 milliliters (ml) of Ensure Plus (a nutritional supplement) three times a day. Physician's orders for Resident 1, dated May 31, 2024, included an order for the resident to receive a liberal geriatric diet (tailored to a person's preferences and health needs) with chopped meats and nectar/mildly thick consistency for her liquids. A nursing note for Resident 1, dated June 19, 2024, at 12:11 p.m. revealed that the resident went to a luncheon off the unit and was given thin water instead of a thickened drink. The resident's lungs were clear and her temperature. range was within normal limits. The resident had no coughing or signs of respiratory distress. (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: 395944 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 395944 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chambers Pointe Health Care Center 1425 Philadelphia Avenue Chambersburg, PA 17201 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)