Inspection·March 19, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on clinical records review, and interviews with resident and staff interviews, it was determined that the facility failed to ensure an order for NPO (nothing per mouth) before a procedure was followed for one of the two residents reviewed (Resident R1). Residents Affected - Few Findings include: Review of Resident R1's clinical record revealed Resident R1 was admitted to the facility with a diagnosis of Atrial Fibrillation (irregular heartbeat), awaiting hip surgery, and Intellectual disability. Review of Resident R1's admission Minimum Data Set (MDS- A standardized assessment tool that measures health status in long-term care residents) dated January 3, 2024, revealed resident's cognition was intact. Review of the nursing progress notes dated February 22, 2024, at 2:39 p.m., revealed resident returned from a Cardiologist (A physician who specializes in heart conditions) appointment. The note revealed that the resident was scheduled for a Transesophageal Echocardiogram (TEE- An ultrasound that provides highly detailed images of the heart and its internal structure) on February 28, 2024, at [Hospital Name]. NPO 12 hours before the procedure. Review of the physician's order dated February 23, 2024, revealed an order for NPO at midnight, may take all morning medications on February 28, 2024, with water every shift until 10:00 a.m. review of the nursing progress notes dated February 28, 2024, at 3:35 p.m., revealed resident's echocardiogram will be rescheduled, nurse practitioner is aware. Interview with Resident R1 was conducted on March 19, 2024. Resident R1 reported that on the morning of February 28, 2024, a female staff came to her/his room and provided her/him with a breakfast tray. Resident R1 reported that she/he consumed a cup of orange juice and 2-3 spoons of cereal when the nurse came and told her/him about the NPO order. Resident R1 reported that she was previously made aware of the NPO order but forgot about it on the day of the procedure. Interview with licensed nurse Employee E3 was conducted on March 19, 2024. Employee E3 reported that she/he was the nurse working on the morning of February 28, 2024. Employee E3 reported that at around 7:00 a.m. while receiving a report from the previous shift, an agency nurse aide provided Resident 1 a breakfast tray. Employee E3 reported talking to the resident and was informed that she/he consumed a few sips of orange juice. The doctor/procedure place was notified and ordered to reschedule the echocardiogram. (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: 395078 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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)