Health inspection·June 14, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on facility policy review, clinical record review, and staff interview, it was determined that the facility failed to notify the resident's physician of a change in condition for one of 14 sampled residents. (Resident 34) Findings include: Review of facility policy entitled, Change in a Resident's Condition or Status, last reviewed January 30, 2023, revealed that the facility would promptly notify the resident's physician of changes in medical condition or status. Notification was to be made within 24 hours of a change occurring in the resident's medical condition or status. Clinical record review revealed that Resident 34 had diagnoses that included dislocation of left hip, anxiety, and depression. Review of a physical therapy evaluation dated October 20, 2022, revealed that the resident had pain and there was a length discrepancy to the left leg. Review of an x-ray report dated October 21, 2022, revealed that the resident had a dislocation to the left hip. Review of an undated staff statement revealed that the x-ray results were available and at the nursing unit for review on the evening of October 21, 2022. Review of a staff statement dated October 23, 2022, revealed that the x-ray results were reviewed with the certified nurse practitioner (CRNP) at 3:00 p.m., on October 23, 2022, and the resident was transferred to the hospital on the same date. There was no evidence that the CRNP was notified of the results of the x-ray report until October 23, 2022, more than 24 hours after the facility received the results. In an interview on June 14, 2023, at 12:51 p.m., the Assistant Director of Nursing confirmed that there was no evidence that the CRNP was notified of the x-ray results until October 23, 2022, and staff should have notified the CRNP within 24 hours. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 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: 396096 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 396096 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Moravian Village of Bethlehem 634 East Broad Street Bethlehem, PA 18018 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)