Inspection·December 19, 2024

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on review of facility policy, review of clinical record, and staff interview, it was determined that the facility failed to review and revise a care plan related to feeding assistance for one of 12 residents reviewed (Resident R34). Findings Include: Review of facility policy Interdisciplinary Care Planning revised 12/16/2024 revealed it is the responsibility of each discipline to add, revise, and discontinue care plan problems, goals, and interventions as needed. Review of Resident R34's comprehensive care plan revised December 13, 2024, revealed the resident had potential for alteration in nutrition status related, but not limited to, dementia, varied meal completion, and decline in self-feeding with need for adaptive feeding devices. Intervention dated February 12, 2024, and March 22, 2024, revealed to provide Resident R34 with a Kennedy cup for beverages and inner lip plate for food items with all meals. Observations in the dining room on December 18, 2024, at 12:00 p.m. revealed Resident R34 was not provided with adaptive equipment for the lunch meal service and was instead being fed by nurse aide, Employee E5. Interview on December 18, 2024, at 12:00 p.m. with Nurse Aide, Employee E5, revealed Resident R34 had a decline in self-feeding capabilities and was no longer able to use the adaptive equipment at meals. Further interview with nurse aide, Employee E5, revealed Resident R34 required 1:1 feeding assistance with meals. Review of Resident R34's comprehensive care plan revealed no evidence interventions were revised related to self-feeding capabilities. 28 Pa. Code 211.10 (d) Resident care policies 28 Pa. Code 211.12 (d)(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: 396120 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 396120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wyncote Care Center 208 Fernbrook Avenue Wyncote, PA 19095 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)