Health inspection·October 23, 2024

F 0839 Employ staff that are licensed, certified, or registered in accordance with state laws. Level of Harm - Minimal harm or potential for actual harm Based on a review of facility documentation, personnel records and interviews with staff, it was determined that the facility failed to ensure that staff completing the MDS (Minimum Data Set, comprehensive resident assessment) were properly licensed and registered to practice nursing in Pennsylvania for one of ten personnel files reviewed. (Employee E15) Residents Affected - Few Findings include: Review of documentation submitted by the facility on October 23, 2024, revealed that Employee E15, who works at the facility remotely from outside the United States of America, revealed no license to review that showed that she was licensed to practice nursing in the state of Pennsylvania. Review of the Pennsylvania Licensing System Verification website revealed that Employee E15's name was not found in the database for nurses licensed to practice in Pennsylvania. Review of the Quarterly MDS submitted on August 14, 2024, for Resident R5 revealed that Employee E15 completed and signed Section Z0400 for assessments completed for sections A, GG, H, I J, L, M, N, O and P. Review of the Quarterly MDS submitted on September 23, 2024, for Resident R7 revealed that Employee E15 completed and signed Section Z0400 for assessments completed for sections A and M. Review of the Quarterly MDS submitted on August 6, 2024, for Resident R8 revealed that Employee E15 completed and signed Section Z0400 for assessments completed for sections A, B, GG, H, I, J, L, M, N, O, P and Q. Review of the Quarterly MDS submitted on June 27, 2024, for Resident R9 revealed that Employee E15 completed and signed Section Z0400 for assessments completed for sections A, H, I J, L, M, N, O and P. Review of the Quarterly MDS submitted on August 3, 2024, for Resident R10 revealed that Employee E15 completed and signed Section Z0400 for assessments completed for sections A, GG, H, I J, L and M. Interview on October 23, 2024, at 11:15 a.m. with the Director of Nursing (DON), revealed that they have two RNAC's who work at the facility who complete and sign MDS's. When asked about Employee E15's signatures on Section Z0400 of the above MDS's, she replied that Employee E10 works remotely. When asked about getting a copy of her License to practice nursing in Pennsylvania she said that she did not have a copy of any license for Employee E10, and that she would have to talk to the administrator and possibly the corporate office. (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: 395256 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 395256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harborview Rehabilitation and Care Center at Lansd 25 West Fifth Street Lansdale, PA 19446 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)