Inspection·April 27, 2023

F 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. 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 resident interview, it was determined that the facility failed to provide necessary care and services to to improve or maintain activities of daily living (walking) for two of four sampled residents on a restorative nursing program. (Residents 1, 2) Residents Affected - Some Findings include: Clinical record review revealed that Resident 1 had diagnoses that included cerebral infarction (stroke). According to the Minimum Data Set (MDS) assessment dated [DATE], the resident required assistance from staff to walk. There was a physician's order dated February 2, 2023, indicating that Resident 1 was on a restorative nursing program to ambulate two to five times per day, as tolerated, for 20 to 25 feet with a walker and staff assistance. Review of the clinical record revealed a lack of documentation to support that the resident was offered nursing assistance to walk 29 of 31 days in March 2023, and 19 of 26 days in April 2023. During an interview conducted on March 27, 2023, at 3:00 p.m., Resident 1 reported that nursing assistance for walking had not been offered daily. Clinical record review revealed that Resident 2 had diagnoses that included osteoarthritis, polyneuropathy (damage or disease affecting peripheral nerves), and difficulty in walking. According to the MDS assessment dated [DATE], the resident had not walked during the previous seven days. There was a physician's order dated May 27, 2022, indicating that Resident 2 was on a restorative nursing program to ambulate every day shift up to 100 feet, as tolerated, with a walker and followed with a wheelchair. Review of the clinical record revealed a lack of documentation to support that the resident was offered nursing assistance to walk 20 of 31 days in March 2023. During an interview conducted on March 27, 2023, at 4:30 p.m., Resident 2 reported that nursing assistance for walking had not being offered daily. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 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: 395277 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 395277 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harborview Rehabilitation Care Center at Doylestow 432 Maple Avenue Doylestown, PA 18901 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)