Health inspection·December 14, 2023

F 0661 Level of Harm - Minimal harm or potential for actual harm Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. Based on clinical record review, it was determined that the facility failed to ensure that a discharge summary was completed in a timely manner for one of three closed records reviewed (Resident 94). Residents Affected - Few Findings include: Review of Resident 94's clinical record revealed the resident discharged home on October 23, 2023. Interview with the social worker Employee E8 on December 14, 2023, at 11:25 a.m. confirmed Resident 94's discharge home was a planned discharge. Review of Resident 94's clinical record revealed the resident's discharge summary was not completed by the physician until November 15, 2023. The above findings were confirmed with the Nursing Home Administrator on December 14, 2023, at approximately 12:15 p.m. 28 Pa Code 211.5 (f) Clinical records FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395173 If continuation sheet Page 2 of 10 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 395173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westgate Hills Rehabilitation and Nursing Ctr 2050 Old West Chester Pike Havertown, PA 19083 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy and clinical records, observations, and interviews, it was determined that the facility failed to ensure proper assessments and treatments were in place for two of five residents reviewed for pressure ulcers (Residents 26 and 89). Residents Affected - Few Findings include: Review of facility policy and procedure titled Pressure Ulcers dated August 29, 2023 revealed the effectiveness of interventions will be monitored through ongoing assessment of the resident and/or wound. Review of Resident 26's progress notes revealed a nursing entry on June 30, 2023 at 1:25 p.m. stating resident noted with DTI (deep tissue injury- injury to tissue due to prolonged exposure to pressure that is under a layer of intact skin) black color to left heel. Resident verbalizes no complaints of pain or discomfort to the area at this time heel boots was put on and treatment to the heel administered Further review of Resident 26's clinical record revealed there was no full assessment of the wound other what was described in the nursing note above upon discovery of the wound. There were no further assessments of the wound until seen by the Wound CRNP on August 14, 2023. Interview with the Director of Nursing on December 14, 2023 at 12:23 p.m. confirmed a complete assessment of the wound was not completed upon discovery and June 30, 2023 and wound assessments should have been completed at least weekly until healed. Review of Resident 89's clinical record revealed the resident was admitted to the facility on [DATE], with a stage 3 pressure ulcer (wound where subcutaneous fat may be visible, but bone, tendon or muscle are not exposed) to the sacrum. Review of Resident 89's physician's orders revealed an order dated November 24, 2023, to cleanse sacrum with wound cleanser, pat dry, apply medihoney (honey-based product used for the management of wounds) and calcium alginate (non-woven, absorbent dressing made from seaweed that promotes wound healing) and cover with bordered gauze (sterile gauze with adhesive surrounding to hold to the skin) two times a day and as needed. Review of Resident 89's wound consult dated November 28, 2023, revealed the wound provider recommended changing the resident's treatment order from twice daily to three times daily and as needed. Review of Resident 89's December 2023 Treatment Administration Record (TAR) revealed the wound provider's recommendations were not implemented until December 2, 2023. Review of Resident 89's wound consult dated December 12, 2023, revealed the wound provider recommended changing the resident's treatment order to cleanse the wound with 0.25% Dakins (antiseptic used to cleanse wounds to prevent infection) solution, apply Dakins moistened fluffed gauze to the base of the wound, and secure with bordered gauze three times daily and as needed. Review of Resident 89's progress notes revealed a nursing progress note dated December 12, 2023, at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395173 If continuation sheet Page 3 of 10 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 395173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westgate Hills Rehabilitation and Nursing Ctr 2050 Old West Chester Pike Havertown, PA 19083 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 7:02 a.m., which stated: Resident seen on wound rounds today with [wound provider.] Plan reviewed with [medical director] and agreed with recommendations. Review of Resident 89's December 2023 TAR revealed the resident's order was not updated, and the resident continued to receive the treatment of cleansing the wound with wound cleanser and applying medihoney and calcium alginate through December 14, 2023. Observation of Resident 89's wound treatment on December 14, 2023, at 1:00 p.m. revealed licensed nurse Employee E7 cleansed the wound with wound cleanser and applied medihoney and calcium alginate. The facility's failure to implement recommendations made by the wound provider for Resident 89 was discussed with the Nursing Home Administrator and Director of Nursing on December 14, 2023, at approximately 1:40 p.m. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.5(f) Clinical records 28 Pa. 211.12(c)(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395173 If continuation sheet Page 4 of 10 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 395173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westgate Hills Rehabilitation and Nursing Ctr 2050 Old West Chester Pike Havertown, PA 19083 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 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. Level of Harm - Minimal harm or potential for actual harm Based on a review of job descriptions it was determined that the Nursing Home Administrator (NHA) and the Director of Nursing (DON) did not effectively manage the facility to ensure proper infection prevention procedures were followed to protect residents from the spread of COVID-19 in the facility. Residents Affected - Some Findings include: Review of the job description for the Nursing Home Administrator revealed the primary purpose of the job position is to direct day-to-day functions of the Facility in accordance with current federal, state, and local standards guidelines, and regulations that govern nursing facilities to assure that the highest degree of quality care can be provided to our residents at all times. Review of the job description for the Director of Nursing revealed the purpose of the job position is to plan, organize, develop, and direct the overall operation of our Nursing Service Department in accordance with current federal, state, and local standards, guide[lines, and regulations that govern our Facility and as may be directed by the Administrator or the Medical Director to ensure that the highest degree of quality car in maintained at all times. The findings in this report identified the facility failed to monitor their staff to ensure they were wearing all required PPE while caring for COVID-19 positive residents which resulted in a COVID-19 outbreak on the second-floor nursing unit. The Nursing Home Administrator and Director of Nursing failed to fulfill their essential job duties to ensure that the federal and state guidelines and regulations were followed. Refer to F tag 880 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(1)(3) (e)(3) Management. 28 Pa. Code 207.2(a) Administrator's responsibility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395173 If continuation sheet Page 5 of 10 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 395173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westgate Hills Rehabilitation and Nursing Ctr 2050 Old West Chester Pike Havertown, PA 19083 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 0842 Level of Harm - Minimal harm or potential for actual harm Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on interview and clinical record review, it was determined that the facility failed to ensure complete and accurate clinical records for one of 22 residents reviewed (Resident 91). Residents Affected - Few Findings include: Interview with Resident 91 on December 12, 2023, at 10:55 a.m. revealed the resident was admitted to the facility with a foley catheter (thin, flexible tube placed in the bladder through the urethra to drain urine) but it had recently been discontinued. Review of Resident 91's clinical record revealed a nursing progress note dated December 6, 2023, which stated that the resident's foley catheter had been discontinued. Further review of Resident 91's clinical record revealed nursing progress notes dated December 8, 9, 10, and 11, 2023, which stated: Has Foley catheter. Urinary device is patent and draining; free from complications. Catheter care provided. The inaccurate documentation regarding Resident 91's foley catheter was discussed and confirmed with the Nursing Home Administrator and Director of Nursing on December 14, 2023, at 1:35 p.m. 28 Pa. Code: 211.5 (f) Clinical records 28 Pa. Code: 211.12 (d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395173 If continuation sheet Page 6 of 10 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 395173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westgate Hills Rehabilitation and Nursing Ctr 2050 Old West Chester Pike Havertown, PA 19083 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Immediate jeopardy to resident health or safety Based on observations, facility policy and clinical record review, and interview with staff, it was determined the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases which resulted in an Immediate Jeopardy for 60 residents on the second floor nursing unit. Residents Affected - Some Findings include: Review of facility policy titled COVID-19 Prevention, Response and Reporting with a revision date of December 7, 2023, revealed It is the policy of this facility to ensure that appropriate interventions are implemented to prevent the spread of COVID-19 and promptly respond to any suspected or confirmed COVID-19 infections. Review of facility documentation revealed the facility experienced a COVID-19 outbreak beginning on December 7, 2023, and continues as of December 15, 2023, located on the second floor effecting 60 residents. Interview conducted on December 11, 2023 at 9:30 a.m. with the Director of Nursing (DON) and Acting IP (infection Preventionist) revealed all staff and visitors must wear full PPE (personal protective equipment) on the second floor while in a room with a resident who is positive for COVID-19 or who has been exposed to COVID-19. Interview further revealed that staff were to remove PPE prior to leaving a COVID-19 positive resident's room and wash their hands after leaving the resident's room and before entering a resident room. Observations conducted on December 11, 2023, at 10:15 a.m. on the second-floor nursing unit revealed Employee E1 entering a resident's room who was deemed positive with COVID 19 virus wearing only a surgical mask and not washing his/her hands. Approximately three minuets later, Employee E1 was observed exiting the resident's room without washing his/her hands. Employee E1 then proceeded to enter a resident room who was noted to be COVID-19 negative without washing his/her hands. Additional observations conducted on December 11, 2023, at 10:15 a.m. on the second-floor nursing unit revealed housekeeping Employee E2 cleaning a room noted to have COVID-19 positive residents wearing only a surgical mask. Housekeeping Employee E2 was further observed leaving the room of COVID-19 positive residents without washing his/her hands before entering a COVID-19 negative resident's room. Interview conducted with Housekeeping Employee E2 on December 11, 2023, at 10:25 a.m. revealed Employee E2 knew he/she was to wear full PPE while in a COVID-19 positive room. Housekeeping Employee E2 was unable to provide surveyor with a reason why Employee E2 did not wear full PPE while cleaning the room of the COVID 19 positive resident. Observations conducted on December 12, 2023, at 8:23 a.m. revealed Licensed Employee E3 standing at a medication cart on the second-floor nursing unit with a N95 mask positioned below the nose. Additional observation on the second-floor nursing unit at 11:16 a.m. revealed Licensed Employee E3 sitting behind the nurses station with a N95 mask again positioned below his/her nose. Licensed Employee (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395173 If continuation sheet Page 7 of 10 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 395173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westgate Hills Rehabilitation and Nursing Ctr 2050 Old West Chester Pike Havertown, PA 19083 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 0880 Level of Harm - Immediate jeopardy to resident health or safety E3 further observed speaking with nursing staff saying, This is stupid, I don't want to wear this mask, it doesn't even work. Licensed Employee E3 was further observed to wear the mask below his/her nose for the remainder of the day. Observation conducted on December 12, 2023 at 8:26 a.m. on the second-floor nursing unit revealed Housekeeping Employee E2 cleaning a COVID-19 positive resident's room wearing only a surgical mask. Residents Affected - Some Observation conducted on December 13, 2023, at 8:25 a.m. of the second-floor nursing unit revealed Employees E4, E5, and E6 enter into COVID-19 positive rooms wearing a surgical mask and without washing hands. Observations conducted on December 13, 2023, at 8:26 a.m. revealed Housekeeping Employee E2 cleaning a COVID-19 positive patient's room wearing a surgical mask positioned below his/her chin. Observations conducted on December 13, 2023, at 9:35 a.m. of the second-floor nursing unit revealed the Director of Nursing educating staff on wearing appropriate PPE, required while caring for COVID-19 positive residents. The Director of Nursing was further observed educating staff how to properly wear a surgical and N95 mask, covering both the mouth and nose. The Director of Nursing was observed exiting the second-floor nursing unit at approximately 9:45 a.m. Observations conducted after the Director of Nursing exited the unit revealed, staff were observed shaking their heads then pulling their surgical and N95 masks below the nose. Interview conducted with the Director of Nursing on December 13, 2023, at 10:50 p.m. provided the surveyor with documentation listing all residents and staff members who tested positive for COVID-19. The list noted as follows: On December 7, 2023: 7 residents tested positive for COVID-19; December 8, 2023: 1 resident tested positive for COVID-19; December 11, 2023: 6 residents tested positive for COVID-19; and on December 12, 2023, 1 resident tested positive for COVID-19. Further review of COVID positive list including staff revealed COVID positive staff as follows: December 4, 2023: 2 staff tested positive for COVID-19; December 10, 2023: 1 staff member tested positive for COVID-19; and December 11, 2023: 1 staff member tested positive for COVID-19. Interview with the Medical Director on December 13, 2023, at 11:05 p.m. confirmed there was COVID-19 virus outbreak on the second-floor nursing unit and staff were not wearing appropriate personal protective equipment while caring for COVID-19 positive residents. An Immediate Jeopardy (IJ) situation was identified on December 13, 2023, at 1:51 p.m. and an immediate action plan was requested. The Immediate Jeopardy template was provided to the facility. On December 13, 2023 at 4:35 p.m. an acceptable immediate action plan was approved which included the following interventions: 1. The facility took the following actions to address the citation and prevent any additional residents from suffering an adverse outcome (Completion Date: 12/13/23). a. ALL COVID-19 positive residents were reviewed to assure that they were on Transmission based precautions. b. The DON/designee (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395173 If continuation sheet Page 8 of 10 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 395173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westgate Hills Rehabilitation and Nursing Ctr 2050 Old West Chester Pike Havertown, PA 19083 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 0880 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some reviewed the 24-hour report to ensure there were no residents exhibiting signs and symptoms to ensure all symptomatic residents were identified. 2. The facility took the following actions to prevent an adverse outcome from reoccurring. (Completion Date: 12/13/23). a. COVID-19 facility policies and procedures related to PPE and hand hygiene were reviewed. b. The Infection Preventionist/Staff development/designee provided education to housekeeping, laundry. Maintenance, social services and nursing staff regarding facility policies and procedures related to COVID-19 transmission-based precautions (e.g. PPE) and hand hygiene. c. The Plant Ops director/designee provided education to all housekeeping staff on cleaning high-touch areas doorknobs, handrails to ensure sanitary conditions. d. The infection Preventionist or designee will oversee infection prevention and control education for all new hires. e. The employee call-off log for last 24 hours were reviewed by staffing coordinator to review for any COVID-19 illness. Any staff call-offs secondary to COVID-19 illness will be reported by staffing Coordinator/HR to the Infection Preventionist to insure appropriate tracking. f. The Infection Preventionist or designee will randomly will randomly monitor hand hygiene practices and proper PPE utilization amongst staff daily x 3 days then 3 times a week for 1 month and then weekly for 3 months. g. The Administrator implemented a QAPI PIP as a means to gather and process information from the audits/monitoring process. Findings will be reported at the monthly QAA meeting for a minimum of 3 months. Observations conducted on December 14, 2023 revealed staff using appropriate PPE and hand hygiene practices while caring for COVID-19 positive residents on the second-floor and first-floor nursing units, 15 staff interviews, the implementation of the action plan was confirmed on December 14, 2023, at 12:42 p.m. and the Nursing Home Administrator and Director of Nursing were informed that the Immediate Jeopardy situation was lifted. 28 Pa Code 201.14(a) Responsibility of Licensee 28 Pa Code 201.18(b)(1) Management 28 Pa Code 201.18(e)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395173 If continuation sheet Page 9 of 10 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 395173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westgate Hills Rehabilitation and Nursing Ctr 2050 Old West Chester Pike Havertown, PA 19083 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 0921 Level of Harm - Minimal harm or potential for actual harm Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observations and staff interview it was determined the facility failed to provide a safe environment on one of two units. (2nd Floor) Residents Affected - Some Findings Include: Observation on December 11, 2023 at 10:30 a.m. revealed the tub room which was currently being use for storage due to renovation and was storing buckets of paint revealed the door to the room which had a keypad was unsecured and able to be opened by the surveyor without inputting the keycode. Further observation on December 11, 2023 at 10:35 a.m. revealed an unmarked door at the end of the north hallway was able to be opened allowing access to a small room containing waterpipes and an air duct. Observations on December 12, 2023 at 12:30 p.m. revealed the doors to the dirty utility room, clean utility closet, and a linen closet all had numerical keypads. All three doors were able to be opened by the survey without inputting the keycode. Additional observations conducted on December 12, 2023 at 12:30 p.m. and December 14, 2023 at 10:46 a.m. revealed the unmarked door at the end of the north hallway to the small containing waterpipes and an air duct was able to be opened without keycode. Interview with the Nursing Home Administrator on December 14, 2023 at 11:00 a.m. confirmed that all the doors that were opened by the surveyor should have been secured to prevent access to those areas by the residents. 28 Pa Code: 201.18(b)(1)(3) Management 28 Pa Code: 207.2(a) Administrator's responsibility FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395173 If continuation sheet Page 10 of 10