Health inspection·August 3, 2023

F 0567 Honor the resident's right to manage his or her financial affairs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon clinical record review and staff interviews it was determined that Aventura at Pembrooke failed to ensure Resident R3 was informed and consented to decisions related to financial resources for one of one residents (Resident R3) reviewed. Residents Affected - Few Findings include: Review of Resident R3's clinical record revealed Resident R3 was admitted to the facility on [DATE]. Review of Resident R3's clinical record revealed a quarterly MDS Assessment (periodic assessment of resident needs and abilities) dated December 20, 2022 revealed Resident R3 BIMS (Brief Interview for Mental Score) score was 15 of 15 indicating full functioning cognitive ability. Review of Resident R3's clinical record revealed form MA 51 (medical evaluation) conducted by attending physician which indicated Resident R3's admitting diagnoses including SEpsis; Diabetes Mellitus, Acute Kidney Failure, Anemia, and Arthritis. Further review of the medical evaluation form revealed the attending physician signed/dated it on September 27, 2021. Review of facility documentation including application for resident representative payee dated January 6, 2023 completed and signed by facility staff. Review of Resident R3's clinical record failed to reveal conversation or discussion between facility staff and resident notifying Resident R3 of intent to apply to be resident's financial representative to receive Resident R3's social security administration payments. Interview with Resident R3 on July 31, 2023 at approxiately 4 PM revealed the resident was not aware of facility's intent to apply for social security adminsitration representative payee on his/her behalf. Resident denied knowledge of conversation(s) with facility staff regarding becoming representative payee prior to the application being filed on January 6, 2023. Interview conducted with Nursing Home Administrator on July 31, 2023 at approximately 7:15 p.m. when the above information was presented. The facility failed to ensure that Resident R3 was informed of and consented to facility's intent to apply for representative payee status through Social Security Administration. 28 Pa Code 201.18(e)(1) Management Page 1 of 2 395166 395166 08/03/2023 Aventura at Pembrooke 1130 West Chester Pike West Chester, PA 19380

F 0567 Previously cited 03/16/23 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 395166 Page 2 of 2