Inspection·March 1, 2024

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to ensure that the Minimum Data Set (MDS) assessment was completed to accurately reflect the resident's current status for one of 19 sampled residents. (Resident 55) Residents Affected - Few Findings include: Clinical record review revealed that Resident 55 had diagnoses that included end-stage renal (kidney) disease and dependence on renal dialysis (the process of removing water and toxins from the blood in people whose kidneys can no longer perform those functions). Resident 55's care plan indicated that the resident had dialysis scheduled three times per week. Nursing documentation noted that the resident attended dialysis during the assessment period. The MDS assessment dated [DATE], did not identify Resident 55 as receiving dialysis under section O, Special Treatments and Programs. In an interview on March 1, 2024, at 11:28 a.m., the Nursing Home Administrator confirmed that Resident 55's MDS assessment was inaccurate. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395176 If continuation sheet Page 2 of 4 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 395176 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ambler Extended Care Center 32 South Bethlehem Pike Ambler, PA 19002 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, clinical record review, observation, and resident and staff interview, it was determined that the facility failed to assess and implement safety measures related to smoking for two of four sampled residents who smoke. (Residents 37, 49) Findings include: Review of the facility policy entitled, Resident Smoking Policy, last reviewed January 26, 2024, revealed that any resident who smoked or had the desire/intent to smoke would be assessed for smoking safety awareness and the need for reasonable physical or safety accommodations on admission, readmission, quarterly, and with any significant change in condition. Clinical record review revealed that Resident 37 had diagnoses that included diabetes, chronic obstructive pulmonary disease, and [NAME]-Danlos Syndrome (a disorder that affects the connective tissues of the body). According to the Minimum Data Set (MDS) assessment, dated November 22, 2023, the resident had no cognitive impairment. In an interview on February 27, 2024, at 12:30 p.m., Resident 37 reported smoking on a regular basis. Observations on February 27, 2024, at 1:30 p.m., and February 28, 2024, at 11:30 a.m., revealed Resident 37 outside the back of the building, in the designated smoking area, smoking. There was no documentation in the clinical record to support that the resident's smoking safety was evaluated by the facility. Clinical record review revealed that Resident 49 had diagnoses that included hemorrhagic thrombocythemia (chronic blood disorder), tobacco use, and hypertension (high blood pressure). According to the MDS assessment, dated December 13, 2023, the resident had cognitive impairment. Review of Resident 49's care plan revealed he was a supervised smoker with an intervention for staff to complete smoking assessments to ensure safety. There was no documentation in the clinical record to support that the resident's smoking safety was evaluated quarterly per facility policy after June 23, 2023. In an interview on February 29, 2024, at 1:48 p.m., the Nursing Home Administrator confirmed that smoking assessments should be completed at least quarterly. 28 Pa. Code 211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395176 If continuation sheet Page 3 of 4 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 395176 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ambler Extended Care Center 32 South Bethlehem Pike Ambler, PA 19002 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 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observation, and resident and staff interview, it was determined that the facility failed to provide therapeutic diets as ordered by the physician for two of 19 sampled residents. (Residents 37, 61) Findings include: Clinical record review revealed that Resident 37 had diagnoses that included diabetes, chronic obstructive pulmonary disease, and [NAME]-Danlos Syndrome (a disorder that affects the connective tissues of the body). A physician's order dated December 1, 2022, directed staff to provide a low concentrated sweets and no added salt diet. Review of the care plan revealed a potential for nutritional problems related to diabetes. The intervention was for staff to provide the diet as ordered. Observation on February 28, 2024, at 12:44 p.m., revealed that the resident was provided regular sugar with his meal tray. In an interview at that time, Resident 37 stated that he had not received any sugar substitute in over a week and was given regular sugar packets instead. Observation on February 29, 2024, at 12:39 p.m., revealed that the resident was again served his lunch with no sugar substitute provided on the meal tray and given regular sugar packets. Review of the resident's meal tray ticket revealed that he was to receive four sugar substitute packets with his coffee. Clinical record review revealed that Resident 61 had diagnoses that included diabetes, chronic kidney disease, hyperglycemia (high blood sugar), and dysphagia (difficulty with swallowing). A physician's order dated March 31, 2023, directed staff to provide a low concentrated sweets and no added salt diet. Review of the care plan revealed a risk for unstable blood glucose (sugar) and a potential for nutritional problems related to diabetes. The intervention was for staff to provide the diet as ordered. Observation on February 28, 2024, at 12:20 p.m. revealed that Resident 61 was provided regular sugar with his meal. In an interview at that time, Resident 61 stated he frequently received sugar instead of sugar substitute with his meals. During a confidential group interview on February 28, 2024, at 10:30 a.m., the resident group stated that the facility often does not have sugar substitute packets for their drinks. The residents stated that sugar packets were given to them in place of a sugar substitute. In an interview on February 29, 2024, at 12:15 p.m., the Registered Dietitian stated that residents on a low concentrated sweets diet were to receive sugar substitute with their meals and that regular sugar packets should not have been given as a replacement for sugar substitute. 201.14(a) Responsibility of licensee. 211.12(d)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395176 If continuation sheet Page 4 of 4