Inspection·February 5, 2025

F 0804 Level of Harm - Minimal harm or potential for actual harm In an interview on February 5, 2025, at 12:20 p.m., Resident 2 stated that the food, including today, was often served cold and was not palatable. Observation revealed that Resident 2 did not eat much of her meal. 28 Pa. Code 201.14(a) Responsibility of licensee. Residents Affected - Few 28 Pa. Code 201.18(b)(3) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395277 If continuation sheet Page 2 of 4 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 02/05/2025 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)

F 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident interview, and staff interview, it was determined that the facility failed to provide a working call bell for four of six residents (Residents 1, 2, 5, 6) on one of three nursing units. (First Floor) Residents Affected - Some Findings include: Clinical record review revealed that Resident 1 had diagnoses that included heart disease and diabetes. The Minimum Data Set (MDS) assessment dated [DATE], indicated that the resident was alert and oriented. Observation on February 5, 2025, at 11:00 a.m. through 12:15 p.m., revealed that the call light above resident room [ROOM NUMBER] was lit, but there was no audible alert. In an interview at 11:00 a.m., Resident 1 stated that his call bell did not work and that staff did not respond to the light because there was no sound. Clinical record review revealed that Resident 5 had diagnoses that included adult failure to thrive and diabetes. Review of nursing documentation dated February 1, 2025, indicated that the resident was alert and oriented and able to make his needs known to staff. Observation on February 5, 2025, at 12:15 p.m., revealed that the call light above resident room [ROOM NUMBER] was lit, but there was no sound when activated. In an interview at 12:10 p.m., Resident 5 stated that his call bell did not work. Clinical record review revealed that Resident 6 had diagnoses that included major depressive disorder and anxiety. The MDS assessment dated [DATE], indicated that the resident was alert and oriented. Observation on February 5, 2025, at 11:10 a.m. through 12:15 p.m., revealed that the call light above resident room [ROOM NUMBER] was lit, but there was no call bell sounding from the room. In an interview at 11:10 a.m., Resident 6 stated that the call bell did not work, that the light stayed on all the time, and that it had not worked for a while. Clinical record review revealed that Resident 2 had diagnoses that included sepsis (infection). Review of nursing documentation dated January 30, 2025, indicated that the resident was alert and oriented and able to make her needs known to staff. Observation on February 5, 2025, at 11:20 p.m., revealed that in resident room [ROOM NUMBER], the call bell for the bed by the window was unplugged and laying on the floor near the heating vent. In an interview at that time, Resident 2 stated, that the call bell did not work even if it was plugged in to the wall. In an interview on February 5, 2025, at 10:35 a.m., the Director of Nursing stated that there had been an issue with the call bell system not working on a consistent basis on the First Floor nursing unit for a while. 28 Pa. Code 201.18(b)(3)(e)(2.1) Management. 28 Pa. Code 211.12(d)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395277 If continuation sheet Page 3 of 4 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 02/05/2025 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)

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, it was determined that the facility failed to provide a sanitary, functional, and comfortable environment for residents on one of three nursing units. (First Floor) Findings include: Observations on February 5, 2025, from 11:00 a.m through 12:20 p.m., on the First Floor nursing unit revealed the following environmental issues: In resident room [ROOM NUMBER], there was a large hole in the wall behind the toilet in the bathroom. There was a ceiling tile near the vent in the bathroom that was damaged. There were stained and missing floor tiles throughout the bathroom floor. The floor tiles around the bottom of the toilet and under the sink were stained. The toilet bowl was soiled. There was a bath tub in the bathroom of room [ROOM NUMBER] that had a basin on top of it. The basin was filled with a bag of soiled linen. There was no paper towel holder in the bathroom. In resident room [ROOM NUMBER], there were two boxes of wound dressing pads, two gallon jugs of sterile water, a box of gloves, a reacher, and other personal hygiene items stored on the window sill. In addition, the dresser near the window bed was overflowing with miscellaneous items on the top of the dresser and in the drawers. In an interview, the resident stated that he needed help to clean out the dresser and the window sill. The over-the-bed table for the first bed in room [ROOM NUMBER] was cracked and damaged. The bottom rungs of the table were soiled with a black substance. The sheets and comforter on the second bed in room [ROOM NUMBER] were stained. In the first floor dining room there were six stained ceiling tiles and one ceiling tile with a hole. There was also a large ceiling tile that was missing which exposed rusted pipes and wires. The tiles around the toilet in the bathroom of room [ROOM NUMBER] were stained. There were seven bathroom wall tiles that had fallen off the wall and were laying on the floor of the bathroom. The toilet bowl in this bathroom was soiled. The toilet seat was crooked and broken. The ceiling tile near the vent in the bathroom was damaged. The tiles on the bathroom floor of room [ROOM NUMBER] were damaged. The lower wall behind the toilet was damaged. The tiles in the bathroom of room [ROOM NUMBER] were stained and there was no paper towel holder in place. 28 Pa.Code 201.18(b)(1)(e)(2.1) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395277 If continuation sheet Page 4 of 4