Inspection·August 12, 2025

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, policy review, review of facility documentation, observation, and staff interviews, it was determined that the facility failed to provide necessary supervision to monitor a resident's whereabouts and prevent an elopement (unauthorized departure from the facility) by one of four sampled residents at risk for elopement. (Resident 1) This failure resulted in an Immediate Jeopardy situation. The incident has been identified as past non-compliance. Findings include:Review of the facility policy entitled, Elopement, last reviewed on July 1, 2025, revealed that staff was to monitor residents' whereabouts who were at risk for unsafe wandering and elopement. The policy further indicated that facility staff was to initiate the missing resident action plan if unable to locate a resident.Clinical record review revealed that Resident 1 was admitted to the facility on [DATE], and had diagnoses that included bipolar disorder, depression, and anxiety disorder. According to the Minimum Data Set assessment (a periodic evaluation of resident care needs), dated April 28, 2025, the resident had memory impairments, could walk without physical assistance, and required supervision when walking. According to the comprehensive care plan, the facility identified that the resident had impaired decision making and required supervision. On July 22 and 24, 2025, nurses noted that the resident was seen walking a lot and pacing. On August 2, 2025, a nurse noted that he was anxious and confused. On August 6, 2025, a nurse noted that local police called the facility at 4:15 p.m. to inform the facility that they located Resident 1 walking and were taking him to the hospital for evaluation. According to the officer's statement, the resident was located approximately two miles away from the facility. The resident was assessed at the hospital where he was found to have no injuries related to the elopement after an evaluation by a specialist. Review of the facility investigation revealed that he was last seen by staff at approximately 2:30 p.m. near the entrance and likely walked out the front door when it was opened for visitors. The investigation further revealed that the receptionist, who was responsible for controlling who enters and leaves through the front door, did not see the resident leave despite opening the door. The investigation indicated that both a nurse and an aide noticed that the resident was not on the unit at approximately 3:15 p.m., however neither staff member initiated the missing resident action plan. The facility was not aware that Resident 1 had left the facility until approximately 90 minutes after he left when the police notified the facility. He returned to the facility on August 7, 2025, at 7:00 p.m. with no related injuries.In an interview on August 11, 2025, at 2:00 p.m., the Administrator stated that the receptionist is responsible for ensuring only authorized people enter and leave the building, and that nursing staff was to ensure all residents were present at the start of their shifts. On August 12, 2025, at 4:30 p.m., the Administrator was notified that the failure to provide adequate supervision to prevent elopement constituted an Immediate Jeopardy situation at F689-J, and the Immediate Jeopardy template was provided. The facility was informed that a corrective action plan was required.The facility identified (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: 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 08/12/2025 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)