Inspection·July 18, 2023

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of food committee minutes, review of weekly menus, resident and responsible party interviews and clinical record reviews, it was determined that the facility failed to accomodate each resident's food preferences for six of 33 sampled residents. (Residents 4, 69, 71, 121, 142, 165) Findings include: Review of the monthly food committee minutes revealed that in April 2023, the residents had a concern that items were missing from their food trays. In May 2023, the residents had a concern that they were not getting condiments on the trays with their meals. In June and July 2023, the residents had a concern that they were not getting the items that they had selected from their menus on the trays. Review of the menu for this week, (listed as the Week 3 regular menu), revealed that a juice of the day was listed to be offered at lunch time every day of the week. Clinical record review revealed that Resident 4 was admitted to the facility on [DATE], with diagnoses that included vitamin D deficiency, anemia, and anxiety. Review of the admission assessment dated [DATE], revealed the resident was alert and oriented. In an interview on July 17, 2023, at 8:34 a.m., Resident 4 stated he wanted juice with his meals but that he did not receive it. Review of Resident 4's meal ticket revealed he was to receive a juice of choice. No juice was observed on Resident 4's meal tray. Clinical record review revealed that Resident 69 had diagnoses that included anemia and hypercalcemia (low calcium). Review of the Minimum Data Set (MDS) dated [DATE], revealed that the resident was alert and oriented and required set up help for eating. In an interview on July 16, 2023, at 11:18 a.m., the resident stated that he selected his menu, but did not always receive the items that he had selected. Observations on July 17, 2023, at 12:43 p.m., revealed that staff delivered his lunch to him in his room. Review of the tray card revealed that he had selected a roll with butter. Observation and an interview with the resident at this time, confirmed that he did not receive the roll with butter on his lunch tray. Clinical record review revealed that Resident 71 had diagnoses that included multiple sclerosis. Review of the MDS dated [DATE], revealed that the resident was alert and oriented and required set up help for eating. In an interview on July 16, 2023, at 11:17 a.m., the resident stated that she selected her menu but did not always receive the items that she had selected. Observation on July 16, 2023, at 12:18 p.m., revealed that staff delivered lunch to the resident in her room. Review of the tray card revealed that she had selected a roll with butter. She received a slice of regular bread with no butter. Further observation revealed that she had received a tea bag but did not receive a mug of hot water for the tea. Clinical record review revealed that Resident 121 had diagnoses that included dementia and adult failure to thrive. Review of the MDS dated [DATE], revealed that the resident had memory impairment and required set up help for eating. In an interview on July 16, 2023, at 12:21 p.m., the resident's responsible party stated that she did not always get the food items that were listed on her tray card served on her meal trays. Observation on July 16, 2023, at 12:21 p.m., revealed that staff deliverd (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396077 If continuation sheet Page 2 of 4 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 396077 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Northampton Post Acute 4100 Freemansburg Avenue Easton, PA 18045 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few her lunch to her room. Review of the tray card revealed that she was to receive the juice of the day for lunch. Observation of the lunch tray revealed that she had not received any kind of juice. Observation on July 17, 2023, at 12:25 p.m., revealed that staff had delivered her lunch to her room and again revealed that she had not received any kind of juice on her tray. Clinical record review revealed that Resident 142 had diagnoses that included diabetes. Review of the MDS dated [DATE], revealed that the resident was alert and oriented and required set up help for eating. Observation on July 17, 2023, at 12:30 p.m., revealed that staff delivered his lunch to his room. Review of the tray card revealed that he had selected an alternate meal that consisted of potato salad and a ham and cheese sandwich. He had received a turkey and cheese sandwich with no potato salad. At this time, the resident stated, I asked for ham not turkey and I didn't get my potato salad. Clinical record review revealed that Resident 165 was admitted to the facility on [DATE], with diagnoses that included femur fracture, muscle wasting, and deficiency of other specified group B vitamins. Review of the admission assessment dated [DATE], revealed the resident was alert and oriented. In an interview on July 17, 2023, at 8:36 a.m., Resident 165 stated he wanted salt and pepper with his meal and sugar for his coffee. No salt, pepper or sugar were observed on Resident 165's meal tray. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396077 If continuation sheet Page 3 of 4 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 396077 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Northampton Post Acute 4100 Freemansburg Avenue Easton, PA 18045 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 observation, it was determined that the facility failed to maintain sanitary conditions in the dietary department. Residents Affected - Many Findings include: During an environmental tour on July 16, 2023, at 9:56 a.m., of the dietary department revealed the following observations: In the main cooking area, the upper and lower convection ovens were soiled with grease and a black substance on the inside, on the bottom of the ovens, and there was a build up of grease on the inside of the doors. Observation of the stove top oven had a steel backsplash that was stained with a black substance behind the burners. Observation of the steel wall behind the convection ovens and the stove top oven was splattered with food substances and was soiled in the main cooking area. 28 Pa. Code 201.18(b)(1)(3) Management. 28 Pa. Code 207.2(a) Administrator's responsibility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396077 If continuation sheet Page 4 of 4