Health inspection·March 24, 2025

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to ensure the resident record was complete and accurately documented for one of four residents reviewed (Resident 1). Findings include: Review of facility policy, titled Verbal Orders, Physician Orders and Diagnostic/Lab Results, updated November 30, 2018, revealed Upon receipt of a verbal diagnostic or laboratory test result, the nurse will document the results in PCC [Point Click Care-the facility's electronic medical record system] or appropriate form. Review of Resident 1's clinical record revealed diagnoses that included congestive heart failure (CHF- a chronic condition where the heart cannot pump blood effectively, leading to fluid buildup in the lungs, legs, and other parts of the body) and hypertension (high blood pressure). Review of Resident 1's physician orders revealed an order for labs dated March 8, 2025, for a CBC (complete blood count- a blood test used to look at overall health and find a wide range of conditions, including anemia, infection), a BMP (basic metabolic panel- a blood test that measures several important aspects of the blood, like electrolytes and blood sugar), and a urinalysis (urine test used to detect and manage a wide range of disorders, such as urinary tract infections [UTI], kidney disease, and diabetes). Review of Resident 1's clinical record revealed documentation of the CBC results and the urinalysis results. Further review failed to reveal documentation of the BMP results. Review of Resident 1's nursing progress note, written by Employee 1 (Licensed Practical Nurse) dated March 9, 2025, revealed that the CBC and the urinalysis results were received and reviewed and the provider was aware. Urinalysis results were positive for a UTI and the CBC showed a white blood cell count (WBC-help protect the body from infection) of 23.1 (normal is 3.9-9.5). Further review of the note failed to reveal any documentation regarding the BMP results. During an interview with Employee 1 on March 24, 2025, at 12:46 PM, Employee 1 stated that on March 9, 2025, she called the lab to get the results. She stated that the lab notified her of the positive urinalysis, elevated WBC, and that the BMP was not viable, as there was not enough blood to run the test. Employee 1 stated that Resident 1's provider was beside her when she was on the phone with the lab and the provider was aware at that time that the BMP was not viable. Employee 1 stated that since Resident 1 was showing symptoms of an infection and the CBC and urinalysis showed an infection, (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: 396122 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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)