Inspection·December 5, 2024

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on policy review, staff interview, and observation, it was determined that the facility failed to properly store food and maintain sanitary conditions in the dietary department. Residents Affected - Many Findings include: Review of the facility's policy entitled, Labeling and Dating, dated October 29, 2024, revealed that leftovers were to be labelled with the date that they were prepared and the use-by date. Prepared foods were to be discarded after seven days. Review of the facility's policy entitled, Staff Attire, dated October 29, 2024, revealed that all staff with facial hair were to have it properly restrained. Observations during the tour of the dietary department on December 3, 2024, at 10:12 a.m., revealed the following: In dry storage, there was food and paper debris on the floor under two sets of shelves storing food items. There was flour on the floor below the bulk container of flour. There were two bulk containers of cereal that had food debris and/or a dried liquid ring on the lids. In reach-in freezer #7, there was an accumulation of a frozen liquid on the bottom of the freezer. In reach-in freezer #6, there was an opened, uncovered box of green beans. There was a layer of food debris along the inside bottom of the freezer. In reach-in cooler #5, there was dried white liquid on the floor under the milk storage. In reach-in cooler #4, there were two opened containers with yogurt that had dripped onto the containers and the shelf below. In reach-in coolers #3 and #5, there was a layer of food debris along the bottom of the inside of the coolers. In reach-in cooler #2, there was an opened bag of shredded carrots that was not dated. There was a large bowl coleslaw labeled use-by November 30 and an opened container of bulk applesauce that was dated November 22, 2024. There was a container with leftover pancakes stored directly on top of bread that was not dated. There was a layer of food debris on the bottom of the cooler. In reach-in cooler #1, there was a large container of cooked green beans that was not dated. There were two containers and one metal lid on the floor under a storage rack of pans and containers. Inside the microwave, there were multiple areas of dried food debris. In an interview on December 3, 2024, at 11:10 a.m., the District Manager of the dietary department (DM 1) confirmed the previously mentioned foods should have been dated and expired items removed. Observation during of the lunch meal service tray line on December 4, 2024, from 12:25 p.m. to 12:43 p.m., revealed Dietary Employee 1 (DE 1) and Dietary Employee 2 (DE 2) were both observed to have facial hair of a full beard and mustache that were not covered. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395047 If continuation sheet Page 2 of 4 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 395047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Pointe Rehabilitation and Healthcare Ctr 400 South Main Street Doylestown, PA 18901 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 0812 Level of Harm - Minimal harm or potential for actual harm In an interview on December 4, 2024, at 12:50 p.m., the DM 1 confirmed that DE 1 and DE 2 should have been wearing beard guards during meal tray line. 28 Pa. Code 201.14(a) Responsibility of licensee. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395047 If continuation sheet Page 3 of 4 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 395047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Pointe Rehabilitation and Healthcare Ctr 400 South Main Street Doylestown, PA 18901 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 0814 Dispose of garbage and refuse properly. Level of Harm - Potential for minimal harm Based on observation, it was determined that the facility failed to dispose of trash and refuse properly. Findings include: Residents Affected - Many Observation of the trash compactor area on December 3, 2024, at 10:30 a.m., revealed various items on the ground next to the trash compactor, including a full bag containing three used briefs, used gloves, used gauze, and several pieces of crushed plastic items. There was a plastic bag containing garbage items that was sticking out from below the trash compactor. 28 Pa Code 201.18(b)(3) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395047 If continuation sheet Page 4 of 4