Pennsylvania Department of Health
SUNNYVIEW NURSING AND REHABILITATION CENTER
Patient Care Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

SUNNYVIEW NURSING AND REHABILITATION CENTER
Inspection Results For:

There are 134 surveys for this facility. Please select a date to view the survey results.

Surveys don't appear on this website until at least 41 days have elapsed since the exit date of the survey.


SUNNYVIEW NURSING AND REHABILITATION CENTER - Inspection Results	Scope of Citation Number of Residents Affected By Deficient Practice

Initial comments:

Based on an Abbreviated survey in response to three complaints completed on May 14, 2025,, it was determined that Sunnyview Nursing and Rehabilitation Center was not in compliance with the following requirements of 42 CFR Part 483, Subpart B, Requirements for Long Term Care Facilities and the 28 PA Code, Commonwealth of Pennsylvania Long Term Care Licensure Regulations.

Plan of Correction:

483.60(i)(1)(2) REQUIREMENT Food Procurement,Store/Prepare/Serve-Sanitary:

This is a less serious (but not lowest level) deficiency but was found to be widespread throughout the facility and/or has the potential to affect a large portion or all the residents. This deficiency is one that results in minimal discomfort to the resident or has the potential (not yet realized) to negatively affect the resident's ability to achieve his/her highest functional status.

§483.60(i) Food safety requirements.
The facility must -

§483.60(i)(1) - Procure food from sources approved or considered satisfactory by federal, state or local authorities.
(i) This may include food items obtained directly from local producers, subject to applicable State and local laws or regulations.
(ii) This provision does not prohibit or prevent facilities from using produce grown in facility gardens, subject to compliance with applicable safe growing and food-handling practices.
(iii) This provision does not preclude residents from consuming foods not procured by the facility.

§483.60(i)(2) - Store, prepare, distribute and serve food in accordance with professional standards for food service safety.

Observations:
Based on a review of facility policies, observations and staff interviews it was determined that the facility failed to make certain that dietary employees properly restrained hair their hair by wearing hair nets and beard guards which created the potential for food borne illness in the Main Kitchen. (Main Kitchen/Cook Employee E2)

Findings include:

A review of facility policy " Personal Hygeine" dated 4/1/25, indicated that dietary staff is to properly restrain their hair by wearing hair nets and beard guards.

During an observation on 5/13/25, at 12:30 pm Cook Employee E2 was observed failing to properly restrain his facial hair (beard) by wearing a beard guard as required.

During an interview on 5/13/25, at 2:30 pm Food Service Manager Employee E1 confirmed that Cook Employee E2 failed to properly restrain his facial hair which created the potential for food borne illness.

Pa Code: 211.6(f) Dietary services

Plan of Correction - To be completed: 06/10/2025

Cook E2 was re-educated for appropriate hair net/beard guard usage as per policy.

Re-education being conducted by dietary designee to dietary employees related to Personal Hygiene policy.

The food service manager/designee will audit working dietary employees' personal hygiene practices 5 x's weekly for 6 weeks to ensure hair nets and beard guards are used per policy. Findings of audits will be reported to QAA.

483.60(d)(1)(2) REQUIREMENT Nutritive Value/Appear, Palatable/Prefer Temp:

This is a less serious (but not lowest level) deficiency and affects more than a limited number of residents, staff, or occurrences. This deficiency is one that results in minimal discomfort to the resident or has the potential (not yet realized) to negatively affect the resident's ability to achieve his/her highest functional status. This deficiency was not found to be throughout this facility.

§483.60(d) Food and drink
Each resident receives and the facility provides-

§483.60(d)(1) Food prepared by methods that conserve nutritive value, flavor, and appearance;

§483.60(d)(2) Food and drink that is palatable, attractive, and at a safe and appetizing temperature.

Observations:
Based on a review of facility policies, standardized recipes, observations, test tray audits, and resident and staff interviews it was determined that the facility failed to follow standardized recipes, and serve food products at palatable temperatures for the lunch meal served on May 13, 2025. ( Lunch meal 5/13/25).

Findings include:

A review of facility "Food Temperatures and Test Tray Audits" policy dated 4/1/25, indicated trays will be audited for food temperature, food quality and overall dining experience. Minimum temperatures at the time of service are defined as: soups > (greater than) 135 F (Farenheit), milk and milk products <(less than) 45cold entrees<55hot entrees >135starches>135hot vegetables >135cold desserts <55cold beverages <55and hot beverages >142

During an interview on 5/13/25, at 11:30 am Resident R1 voiced concerns regarding food being served cold and that the food was not good at all.

During a review of the facility's grievance log for 4/3/25, Resident R2 voiced a concern regarding the temperature of food products.

A review of the facility's "Cycle Menu Recipe Book" Sunnyview Fall Winter 2024 - 2025 Day 17 standardized recipes revealed the following:
* Coffee was to be held at 185for service
* Apple bread stuffing ingredients included brown sugar, cinnamon applesauce, celery, white bread.
* Beef and Rice Stuffed Pepper Casserole ingredients included white rice, red and green pepper strips, onions, ground beef . Method for preparation included steaming the rice until cooked, cook peppers and onions with ground beef. Mix rice and beef mixture together and place in a greased 2 inch hotel pan packing firmly. Bake.
* Broccoli method instructions indicated that if steamed the product is to be steamed no longer than 9 minutes to maintain color and texture.
* Carrots method instructions state to slice carrots or purchase slice carrots add melted margarine after steaming.
* Herb Rubbed Pork method incudes seasoning pork loin with spices before roasting, after roasting slice and shingle in hotel pan, pour broth over to maintain temperature.

During a test tray audit on 5/13/25, the following temperatures were taken by the Food Service Manager utilizing a facility thermometer:
* Herb rubbed pork 92.8F
* Beef and rice stuffed pepper casserole 110.8F
* Mashed Potatoes 110.4F
* Apple bread stuffing 94.1F
* Broccoli 108.6 F
* Carrots 108.5 F
* Fruit Cup 66.3F
* Milk 59.3F
* Coffee 133.5F

During an interview on 5/16/25 at 2:00 pm the Food Service manager Employee E1 confirmed that the temperatures recorded of food products sampled during the test tray audit failed to meet point of service temperatures which created the potential for unpalatable food products.

During a test tray audit on 5/13/25, food products being served for the lunch meal were evaluated for appearance and taste by the state agency surveyor revealing the following:
* Herb rubbed pork failed to have the appearance of being oven roasted and seasoned with herbs. The pork sliced were pale in color and curled indicating that it was boiled or steamed during the cooking process.
* Apple bread stuffing failed to have the flavor of apples, brown sugar and cinnamon
* Beef and rice stuffed casserole was scooped portion was present on the plate. The product failed to contain green peppers and minimal ground meat. The presentation of this product failed to represent a casserole product
* Broccoli failed to maintain a green color and was overcooked and mushy.

During an interview on 5/16/25, at 2:00 pm the Food Service Manager Employee E 1 confirmed that the food products sampled for appearance and palatability failed to meet acceptable standards which created the potential for residents to be served unpalatable food products.

PA Code: 201.14 (a) Responsibility of licensee

Plan of Correction - To be completed: 06/10/2025

Food Committee scheduled and held on May 27, 2025 to review concerns brought up during the survey.

Grievances will be monitored for any dietary concerns related to temperature and palatability.

Re-education is being conducted by dietary designee to dietary employees related to Food Temp and Test Tray audit policy and facility's Cycle Menu Recipe Book.

The food service manager/designee will audit dietary trays on each nursing unit at least 1 meal per day 5 days/week for 2 weeks, then each nursing unit for 2 meals/week for 4 weeks to ensure palatable temperatures are maintained at time of service. Findings of audits will be reported to QAA.

483.60(d)(4)(5) REQUIREMENT Resident Allergies, Preferences, Substitutes:

§483.60(d) Food and drink
Each resident receives and the facility provides-

§483.60(d)(4) Food that accommodates resident allergies, intolerances, and preferences;

§483.60(d)(5) Appealing options of similar nutritive value to residents who choose not to eat food that is initially served or who request a different meal choice;

Observations:
Based on a review of facility policies, observations and resident and staff interviews it was determined that the facility failed to provide residents food products based on their preferences for four out of four residents (Resident R1, R3, R4, and R5).

Findings include:

A review of facility " Accuracy and Quality of Tray Line Service" dated 4/1/25, indicated that trays are checked for accuracy and resident dislikes.

During an interview on 5/13/25, at 11:30 am Resident R1 voiced a concern that she does not receive food products that she requests on her menu.

During an observation of tray line services on 5/13/25, it was revealed that Resident R3 and R4 tray cards indicated that the resident was to be served pureed broccoli, the facility failed to provide the resident the vegetable of their choice by serving pureed carrots. Following the tray being checked for accuracy it was placed into the tray delivery cart for delivery.

During an interview on 5/13/25, Resident R5 voiced a concern that she prefers not to receive gravy on her food products and always receives gravy on her food. A review of Resident R5's tray card for the lunch meal indicated NO GRAVY. An observation of the food products served Resident R5 revealed that the facility served food products with gravy failing to follow Resident R5's food preferences by providing an inaccurate meal tray to Resident R5.

During an interview of 5/16/25, at 2:30 pm the information regarding inaccurate meal service and failure to follow and provide food products of resident's choice was addressed with Food Service Manager Employee E1.

Pa Code: 201.14(a) Responsibility of licensee

Plan of Correction - To be completed: 06/10/2025

Food preferences will be reviewed with the dietary supervisors to ensure tickets are followed during tray line.

The dietary manager/designee will review preferences and tickets with the supervisors to ensure accuracy for the residents.

Re-education being conducted by dietary designee to dietary employees related to Accuracy and Quality of Tray Line Service policy.

The food service manager/designee will audit tray line service for accuracy of resident preferences 5 x's weekly for 2 weeks, then 2 x's weekly for 4 weeks. Meals audited will be alternated between breakfast, lunch and dinner to ensure observation of all meals are done. Findings of audits will be reported to QAA.

483.60(f)(1)-(3) REQUIREMENT Frequency of Meals/Snacks at Bedtime:

§483.60(f) Frequency of Meals
§483.60(f)(1) Each resident must receive and the facility must provide at least three meals daily, at regular times comparable to normal mealtimes in the community or in accordance with resident needs, preferences, requests, and plan of care.

§483.60(f)(2)There must be no more than 14 hours between a substantial evening meal and breakfast the following day, except when a nourishing snack is served at bedtime, up to 16 hours may elapse between a substantial evening meal and breakfast the following day if a resident group agrees to this meal span.

§483.60(f)(3) Suitable, nourishing alternative meals and snacks must be provided to residents who want to eat at non-traditional times or outside of scheduled meal service times, consistent with the resident plan of care.

Observations:
Based on a review of facility policies, observations and resident and staff interviews it was determined that the facility failed to provide the lunch meal on 5/13/25, in a timely manner which created an undignified dining experience for the residents of five of five nursing units (Roseview, Dogwood, Sunflower, Rehab Unit, and Cardinal Nursing units)

Findings include:

A review of facility policy "Meal Times and Frequency" dated 4/1/25 indicate that meals are served in a timely manner.

During an interview on 5/13/15, at 11:30 am Resident R1 voiced a concern that her meal tray is always late and that her meal is not delivered until around 1:00 pm which is often a hour after the other residents on the unit are served there tray.

A review of the facility's "Meal Delivery Log" revised on 1/4/24, indicated a lapse in time of approximately 50 minutes from when the first delivery cart arrives on the unit until the second cart arrives.

During an observation of the Roseview Nursing unit on 5/13/25, at 11:50 am it was revealed that the first tray delivery cart for the lunch meal had arrived on the unit and residents were being served their lunch meal. At 1:26 pm the second cart arrived on the unit. The last resident was served their meal tray at 1:47 pm. This was approximately two hours later.

During an interview on 5/13/25, Resident R5 voiced a concern that her meals are always late.

During an interview on 5/13/25, at 2:00 pm the Food Service Manager Employee E1 confirmed that the facility failed to deliver the tray delivery carts to the nursing units ina timely manner which created an undignified dining experience for the residents.

PA Code: 201.14(a) Responsibility of licensee.

Plan of Correction - To be completed: 06/10/2025

5 of 5 nursing units were affected and will be reviewed for the timeliness between deliveries to each unit.

A review of the meal delivery schedule will be conducted by the NHA and facility team to improve the timeliness of cart delivery schedule and to promote dignified dining experiences.

Re-education being conducted by dietary designee to dietary employees related to Mealtime and Frequency policy.

The food service manager/designee will audit meal delivery times for dignified dining, 5 x's weekly for 2 weeks, then 2 x's weekly for 4 weeks. Findings of audits will be reported to QAA.

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