Health inspection·April 10, 2023

F 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. Based on clinical record review, staff interview, and policy review, it was determined that the facility failed to provide appropriate documentation when transferring a resident to the hospital for one of three sampled residents. (Resident 1) Findings include: Review of the facility policy entitled, Transfer or Discharge Documentation, last reviewed on September 29, 2022, revealed that when a resident was transferred to another level of care, facility staff was to provide documentation to the receiving service that included (but is not limited to) relevant clinical information and advance directives. Clinical record review revealed that Resident 1 had diagnoses that included a history of respiratory failure. On March 31, 2023, the resident was transferred to the hospital via emergency medical services (EMS) due to a change in condition. There was no documented evidence that the facility provided any clinical information about the resident's condition to the EMS staff either in writing or verbally when they transported the residents. In an interview on April 10, 2023, at 12:15 p.m., the Director of Nursing stated that nursing staff gave a report to the hospital, but did not give any clinical information to the EMS staff. 28 Pa. Code 211.12(d)(1)(3)(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: 395077 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 395077 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden Spring Rehab and Care Center 1113 North Easton Road Willow Grove, PA 19090 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)