Health inspection·June 18, 2024

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on policy review, observation, and staff interview, it was determined that the facility failed to properly store food items and maintain sanitary conditions in the kitchen. Residents Affected - Many Findings include: Review of the facility's policy entitled, Labeling and Dating, last reviewed May 21, 2024, revealed that foods were to be discarded by the use-by date and all foods were to be dated. Observation during the tour of the kitchen on June 17, 2024, at 9:56 a.m., revealed the following: In the food preparation area, there were several flies observed around the hand sink area. There were two juice dispensers that had a dried sticky substance on the spouts. There was peeling paint on a ceiling tile above the meat slicer. There were several holes in the wall adjacent to the tile. There was a fan with a layer of dust on the fan shield, the fan was on at the time. There was an opened container of peanut butter with food debris outside of the lid and it was not dated. In the tray line cooler, there was an opened container of juice and jelly, seven cups of applesauce, and a poured apple juice that were not dated. The bottom of the cooler had a buildup of dried food and liquid. In the walk-in cooler, there was an opened bag of cheese and opened pie container stored on small cups of prune juice There was a lettuce leaf that was directly touching the shelf. There was a wrapped head of lettuce, opened container of hard cooked eggs, and a pan of peeled potatoes that were not dated. There were five containers of yogurt with a use-by date of April 21, 2024, six containers of yogurt with a use-by date of March 31, 2024, and two containers of cottage cheese with a use-by date of May 19, 2024. There was food and dried liquid on the floor under the shelves. In the freezer, there were two tubs of ice cream with sticky food debris on the top of each lid. In the dry storage area, there were nine bags of yellow cake mix that were removed from the original packaging and not dated. The window air conditioning (A/C) unit was on and there were several spider webs with debris and a dead fly on the window sill. There was a section of wall below the window A/C unit that was crumbling. There were several areas of peeling paint above food storage areas. There was food debris underneath and on top of the lids of the bulk bins of flour, sugar, and breadcrumbs. The scoops for each bulk bin had food debris on them. There was a banana on the floor under a shelf. There was a package of opened taco seasoning and croutons that were not dated. A fly was observed in the storage area. In the paper product storage area, there was paper debris on the floor and a garbage bag with items in it on the floor in the corner. There was an area of a dark, dried sticky substance on the floor. In an interview at 11:00 a.m., the Dining Services Director confirmed that the items should have been dated and were not and the expired items should have been removed and were not. CFR 483.60(i) Food Safety Requirement (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395217 If continuation sheet Page 2 of 3 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 06/18/2024 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)

F 0812 Previously cited 7/13/23 Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 201.14(a) Responsibility of licensee. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395217 If continuation sheet Page 3 of 3