Health inspection·October 11, 2023

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and interview with staff, it was determined that the facility failed to provide wound treatment related to a resident's wound for one of two residents reviewed. (Resident R1) Residents Affected - Few Findings include: Review of Resident R1's clinical record revealed that Resident R1 was admitted to the facility on [DATE] with the diagnoses of Peripheral Vascular Disease (a systemic disorder that involves the narrowing of peripheral blood vessels) and open wound on the lower leg. Review of Resident R1's quarterly MDS (Minimum data set-a federally required resident assessment completed at a specific interval) dated September 15, 2023, revealed that Section C0500 BIMS (brief interview for mental status) scored 13 suggesting that Resident R1 was cognitively intact. Review of MDS section M (skin conditions) revealed that Resident R1 was at risk for pressure ulcer, had venous or arterial ulcers and skin tears. Further review of Resident R1's quarterly MDS dated [DATE], section M1200 (I) Application of dressing to feet (with or without topical medications) was coded NO indicating that resident did not have dressing applied to his feet during the observation period of the MDS assessment. Review of clinical documentation from the wound clinic dated September 1, 2023, revealed a recommendation to change band aid on left foot toe daily with an antibiotic ointment and a bandaid. Review of Resident R1's documentation from the wound clinic dated September 15, 2023, revealed a recommendation to wash toes on both feet daily. Please change the left foot dressing daily with Aquacel Ag and gauze until the drainage decreases. Review of Resident R1's Treatment Administration Record for September 2023 revealed a treatment as follow: Cleanse left foot great & 2nd toes wound w/cleanser, apply calcium alginate and gauze and kling wrap until the drainage decreases every day shift for wound care with discontinue date of Septemebr 20, 2023. Further, there were no licensed nurse initial/signature indicating that the treatment was performed thoughout the duration of the treatment for the month of September 2023. Review of Resident R1's physician's order dated September 20, 2023, revealed an order for: Cleanse left foot great & 2nd toes wound w/cleanser, apply Xeroform and gauze 4x4 and kling wrap until the drainage decreases every day shift for wound care and as needed for wound care soiled/missing (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: 395193 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 395193 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosemont Center 35 Rosemont Avenue Rosemont, PA 19010 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)