Health inspection·July 25, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on observation, medical record review, and interviews with residents and staff, it was determined the facility failed to provide a dignified existence for 1 of 1 (Resident 98) by not allowing the resident to transfer to a more appropriate unit. Findings include: Review of Resident 98's medical records revealed the following diagnosis: unspecified dementia, unspecified severity, with other behavioral disturbance (confusion or mild cognitive impairment can't be clearly diagnosed as a specific type of dementia), major depressive disorder (mood disorder that causes a persistent feeling of sadness and loss of interest), mood disorder due to known physiological condition with depressive features (prominent and persistent period of depressed mood or markedly diminished interest/pleasure thought to be related to the direct physiological effects of another medical condition). Review of Resident 98's Minimum Data Set (standardized assessment tool that measures health status in nursing home residents) revealed Resident 98 possesses a Brief Interview for Mental Status (BIMS, a points-based assessment that helps identify cognitive impairment in older adults) of 15 out of 15 (indicating intact cognition). Interview conducted with Resident 98 on July 22, 2024, at 10:15 a.m. revealed Resident 98 has requested multiple times to transfer off Nursing unit 3 (Memory care unit) due to being cognitively intact and not being able to interact with other residents with the same cognition level. Review of a grievance list revealed Resident 98 filed a grievance report on May 31, 2024. Review of grievance detail revealed the following Resident is upset that he is located on the dementia unit and wants to move units. Further review of Resident 98's grievance revealed section Actions Taken To Address which states Resident to remain on the 3rd floor - Resident's behaviors and medical diagnosis support, resident remaining on 3rd floor at this time. Interview conducted with Licensed Practicable Nurse (LPN) employee 4 (E4) on July 24, 2024, at 1:26 p.m. reported Resident 98 is a high functioning resident and does not belong in the memory care unit. Interview conducted with employee 3 (E3) on July 25, 2024, at 11:17 a.m. reported Resident 98 does (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 6 Event ID: 395166 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 395166 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Pembrooke 1130 West Chester Pike West Chester, PA 19380 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)