Inspection·November 17, 2025

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Combined with and order for Enteral feed water (Flushes To maintain hydration and keep the tube patent (clear) up at 1200 down when TV feeding pump flushes set to 30ML per hour 540 mL of water or normal saline (NSS 0.9%) over the course of the feeding schedule. NSS 0.9% when total volume infused 540MLReview of Resident R1's progress notes, including notes authored by physician assistant Employee E3 dated 10/28/2025 revealed the patient was seen at bedside for follow up of Tachycardia (increased heart rate) and nursing reports no acute concerns. The resident was assessed as having tachycardia and fever, she was ordered labs CBC (complete blood count), BMP (basic metabolic panel), urinalysis ((urine test) and cultural and a chest X ray to rule out infection.Review of Resident R1's laboratory results dated [DATE], revealed the resident's sodium level was 150 mmol/L (normal 135-145), consistent with hypernatremia related to inadequate fluid status. The resident's blood urea nitrogen (BUN) was 52 mg/dL (normal 8-23) and the BUN/creatinine ratio was 110.6 (normal 12-20), which is significantly elevated and consistent with prerenal azotemia commonly associated with dehydration. The resident's chloride level was 108 mmol/L (normal 98-107), which may also be seen in dehydration. Review of Resident R1's nursing progress notes dated 10/29/2025 @8:35 a.m. revealed, after review of laboratory results (Employee E3) ordered fluids to be administered via IV at 60ML per hour for one liter related to hypernatremia. Review of Resident R1's nursing note dated 10/29/2025 revealed an order for Sodium Chloride 0.45 % to be infused (via IV) over one day was inserted and fluids began to be infused at 04:13 p.m. approximately 8 hours after the order was placed. Further review of Resident R1's progress notes revealed on 10/30/2025 at 8:12 a.m., the resident's peripheral IV line became dislodged, resulting in the cessation of all fluid infusions. Interview with Licensed Nurse Employee E4 on November 17, 2025, at 10:20 a.m. confirmed that she was the nurse who inserted Resident R1's peripheral IV on 10/29/2025. Employee E4 stated that she did not know why the IV fluids were not started until after 4:00 p.m., approximately eight hours after the order, and had no explanation for the delay. She further reported that on the morning of 10/30/2025, she was made aware that the IV had become dislodged. Employee E4 contacted the contracted IV team to place a midline and confirmed that she did not attempt to reinsert the IV herself. She stated that although a new order was placed to continue the saline infusion over two days, she relied on the contracted team because the resident also required antibiotics. Employee E4 noted that the resident was a hard stick, making IV insertion very difficult. She further stated that she did not perceive the resident to be in danger or failing at that time. Review of nursing dated October 29th, 2025, at 3:33p.m. authored by Employee E4 directly contradicts her statement of resident being difficult to insert and IV. This note revealed patient was assessed for peripheral IV access related to IV fluid resuscitation therapy. The right hand was selected for the first attempt after assessing for the most suitable vein, the area was cleaned using CHG wipes, and a 24 GIV catheter was inserted using aseptic technique. Flashback was observed and catheter was advanced. The tourniquet was removed and dressing applied to secure the site. The resident tolerated the procedure well, with minimal discomfort and no signs of complications such as bleeding, hematoma, or infiltration. Further review of resident's progress notes revealed a nursing note dated 10/30/25 at 11:32 am. indicating an order was placed for IV contracted company to come to the facility to insert a midline for resident R1 to receive fluids and antibiotics, thus delaying fluids and nutrition for this resident. Further review of resident's clinical record progress note revealed that October 30th, 2025, at approximately 2:30 PM the resident was sent to the hospital via 911 services, as requested the resident's guardian and was admitted with septic shock and multifocal pneumonia. The facility failed to ensure continuous intravenous fluid administration for Resident R1. The resident did not receive timely reinsertion of the IV line, and prescribed medications were not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395019 If continuation sheet Page 2 of 3 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 395019 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aristacare at Meadow Springs 845 Germantown Pike Plymouth Meeting, PA 19462 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 0684 Level of Harm - Minimal harm or potential for actual harm administered as ordered. 28 pa. Code 201.18(b)(1) management 28 Pa. Code 210.20(a)(1) Staff Development 28 Pa. Code 211.9 (a)(1)(d) Pharmacy Services28 Pa. Code 211.12 (b)(c)(d)(1)(2)(3)(5) Nursing Services Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395019 If continuation sheet Page 3 of 3