Health inspection·July 13, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, it was determined that the facility failed to provide a safe, clean, and comfortable environment for residents on two of three nursing units (Front and Back) and in one of two resident dining rooms. (Shangri-La) Findings include: Observation on July 12, 2023 at 10:30 a.m., on the Front nursing unit, revealed there were several areas of marred and scratched walls along the hallway by resident rooms [ROOM NUMBERS]. Observations at various times between July 11, 2023, at 10:02 a.m., through July 12, 2023, at 12:05 p.m., on the Back nursing unit revealed that the walls were marred and scratched and the paint was chipped around the door frames in resident rooms 22, 23, 24, 25, 28, the hallway wall adjacent to 30, and 31. In resident room [ROOM NUMBER], the baseboard molding was peeling at the corner of the room and bathroom. In resident room [ROOM NUMBER] bed A, the bottom of the wall above the baseboard between the bathroom and the room was gouged and the ceiling tile in the bathroom had a brown stain. In resident rooms [ROOM NUMBERS], the bathroom walls were heavily marred. In resident room [ROOM NUMBER], underneath the sink in the bathroom, there was a large pink stained area with multiple black colored spots. In room [ROOM NUMBER], the walls were heavily marred on the side of bed A and there was peeling wall paper behind bed B. In room [ROOM NUMBER], the baseboard trim was missing by bed A. Observation on July 12, 2023, at 10:38 a.m. and at 12:02 p.m., on the Back unit hallway adjacent to resident rooms [ROOM NUMBER], revealed three dead insects on the floor. There was a cobweb on the inside of a window at the end of the hallway. Observation of the Shangri-La dining room on July 12, 2023, at 12:20 p.m., revealed marred and scratched walls next to the resident tables throughout the dining room. The floor was marred and scratched in the dining room area where the residents sit and at the entrance. CFR 483.10 (i) Safe Environment Previously cited 7/29/22 28 Pa. Code 201.14(a) Responsibility of licensee. 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: 395217 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 395217 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Richboro Rehabilitation & Nursing Center 253 Twining Ford Road Richboro, PA 18954 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)