Inspection·March 12, 2025

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many above the window, there were stained ceiling tiles in the bathroom, and brown spotted stains scattered on the ceiling above bed 1. In room [ROOM NUMBER], there was a hole on the wall next to the PTAC unit (ductless air conditioning unit that heats and cools small areas), peeling paint by the window, stained ceiling tiles in the bathroom, and drywall without spackle or paint by the soap dispenser. In room [ROOM NUMBER], there was a hole in the wall next to bed 1, there was spackle without paint behind bed 2, brown spotted stains scattered on the ceiling above bed B, stained ceiling tiles in the bathroom, and pink coating on the walls in the bathroom with an earthy, musty odor. The vinyl plank floor in the corridor between room [ROOM NUMBER] and the nurses' station was cracked or missing. In room [ROOM NUMBER], the privacy curtain for bed 1 had dried white and brown stains, the ceiling had brown spotted stains scattered near the bathroom, stained ceiling tiles in the bathroom, one ceiling tile partially hanging from the ceiling, one broken ceiling tile, a broken toilet lid cover, and gouged wall around the soap dispenser. In room [ROOM NUMBER], there was a crack in the wall above the window, chipped paint on the wall by the window, stained ceiling tiles in the bathroom, one broken ceiling tile, a thick coating of dust on the vent, and spackle without paint. In room [ROOM NUMBER], there was a hole in the wall next to bed 1, a gouged wall with screws behind bed 2, brown spotted stains scattered on the ceiling above bed 2, pink coating the walls in the bathroom with an earthy, musty odor, and stained ceiling tiles. In room [ROOM NUMBER], there was a large hole in the wall behind the door, stained ceiling tiles in the bathroom, the light cover was broken, and the light was not working in the bathroom. In room [ROOM NUMBER], the transition between the corridor and the room was chipped and loose. In room [ROOM NUMBER], there was spackle without paint next to bed 2, the dresser was missing a drawer handle for bed 2, there were stained ceiling tiles in the bathroom, and an opening in the wall near the toilet with exposed pipe. In room [ROOM NUMBER], the bathroom doorknob was loose, a ceiling tile was missing above the toilet, and the wall was gouged around the soap dispenser. In room [ROOM NUMBER], the tub faucet was dripping while turned off, there was drywall without spackle or paint, stained ceiling tiles in the bathroom, and a thick coating of dust on the vent. Observation on the Third floor nursing unit on March 12, 2025, from 2:20 p.m. through 4:00 p.m. revealed the following: The third floor shower room was obsereved with hair and dirt covering the drain. In room [ROOM NUMBER], the window curtain was falling off the left side, the cover was broken off the PTAC unit, and the bathroom had crumbling drywall in the left corner. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395277 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 395277 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/12/2025 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 In room [ROOM NUMBER], the footboard was broken off bed 3, the toilet paper holder was broken, and there was drywall without spackle or paint surrounding the soap dispenser. In room [ROOM NUMBER], the transition was loose between the corridor and the room. In the bathroom, the toilet was running, tile was broken, and there was a hole in the wall above the baseboard. Residents Affected - Many In room [ROOM NUMBER], there was a large hole in the wall, broken tile by the PTAC unit, and the rubber baseboard molding was peeling off the wall below the window. In room [ROOM NUMBER], there were broken tiles below the window and next to the dresser for bed 2, the window blinds were broken, there was a dried tan substance splattered on the ceiling above bed 1, spackle unpainted near the bathroom, the bathroom had a hole in the wall below the sink, and there was a dark black ring around the base of the toilet. In room [ROOM NUMBER], there was unpainted spackle on the wall and the privacy curtain for bed 1 had brown stains. In the bathroom, the toilet was running. In room [ROOM NUMBER], there was a hole in the wall behind bed 1, the second drawer dresser handle was missing for bed 3, and there was drywall without spackle or paint surrounding the soap dispenser. In room [ROOM NUMBER], there was no sheet on the mattress on bed 2 and the resident was observed laying directly on the mattress. There was a gallon of sterile water, clean briefs, a package of wipes, and two gloves on floor. The toilet would not flush and was out of use. In room [ROOM NUMBER], the footboard for bed 2 was broken, there were no curtains or blinds for the window, there was a missing tile by bed 2, the bottom drawer dresser handle was missing for bed 2, and the toilet would not flush and was out of use. In room [ROOM NUMBER], the rubber baseboard molding was missing near the bathroom wall, the wall was gouged near the bathroom wall, and the window blinds were broken. In room [ROOM NUMBER], there was a hole in the wall with a magazine picture taped over it, a hole in the wall next to bed 1, broken tile in front of the bathroom, the toilet would not flush and was out of use, there was no soap dispenser in bathroom, and the baseboard heater in the bathroom had no cover, exposing the heating element. In room [ROOM NUMBER], there was no sheet on the mattress on bed 2 and the resident was observed laying directly on the mattress. The vents of the PTAC unit contained dirt and debris. CFR 482.90(i) Other Environmental Conditions. Previously cited 2/5/25 28 Pa. Code 201.14(a) Responsibility of licensee. 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 3 of 3