Health inspection·December 1, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and review of clinical records, it was determined that the facility failed to provide care to residents that promote, maintain, or enhance dignity and respect for one of 35 residents observed (Resident R98 and Resident R9) Findings include: Observation conducted on November 29, 2023, at 9:25 a.m., revealed that Resident R98 was taken out of his room by nurse aide and was wheeled to the main dining room. Further observation revealed that Resident R98 was wearing a hospital gown and was unshaven. Follow-up observation conducted on November 29, 2023, at 12:48 p.m. revealed that Resident R98 was in the dining room in his wheelchair waiting for lunch. Further observation revealed that Resident R98 was still wearing a hospital gown. Review of Resident R98's Quarterly MDS dated (Minimum Data Set- a federally required resident assessent completed at a specific interval) November 9, 2023, section E0800. Rejection of Care - Presence & Frequency revealed that Resident R98 did not exhibit behaviors, Section GG0130 (Self-Care) F (Upper body dressing: The ability to dress and undress above the waist; including fasteners, if applicable) revealed that Resident R98 required Substantial/Maximum Assistance, Section G. Lower body dressing: The ability to dress and undress below the waist, including fasteners; does not include footwear revealed that Resident R98 was dependent. Review of Resident R98's care plan revealed that Resident R98 had ADL (Activities of Daily Living) Self-care deficit related to deconditioning and recent hospitalization Date Initiated: July 21, 2023. Care plan goals was for Resident R98 to receive assistance necessary to meet ADL needs. Care Plan Interventions was but not limited to Assist with dressing. Further review of Resident R98's clinical record revealed no documented evidence that Resident R98 refused care. Observation of Unit Four Main Resident Lounge conducted on November 28, 2023, at 11:07 am revealed that Resident R9 was sitting on a wheelchair, in front of the table, wearing a hospital gown and barefoot. Follow-up observation of Resident R9 conducted on November 28, 2023, at 2:05 p.m. in the Fourth Floor Main Resident Lounge Revealed that Resident R9 was in the lounge together with other residents. Page 1 of 15 395282 395282 12/01/2023 St Francis Center for Rehabilitation & Healthcare 1412 Lansdowne Avenue Darby, PA 19023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Further observation revealed that Resident R9 was in a wheelchair, in front of the table, wearing a hospital gown and barefoot. Follow-up observation of Resident R9 conducted on November 29, 2023, at 9:15 a.m. in Unit Four Main Resident Lounge revealed that Resident R9 was in a wheelchair eating her breakfast. Further observation revealed that Resident R9 was wearing a hospital gown and was barefoot. Follow-up observation on Resident R9 conducted on November 29, 2023, at 10:48 a.m. in Unit Four Main Resident Lounge, revealed that Resident R9 was sitting on a wheelchair, in front of the table, wearing a hospital gown and barefoot. Follow-up observation conducted on November 29, 2023, at 12:38 p.m. revealed that that Resident R9 was the in lounge eating lunch wearing a hospital gown and barefoot. Review of Resident R9's Annual MDS dated [DATE], section E0800 (Rejection of Care - Presence & Frequency) revealed that Resident R9 did not exhibit behaviors. Section G0110 (Activities of Daily Living (ADL) Assistance), G (Dressing - how resident puts on, fastens and takes off all items of clothing, including donning/removing a prosthesis or TED (Thrombo-Embolic Deterrent) hose. Dressing includes putting on and changing pajamas and housedresses), revealed that Resident R9 required extensive assistance with two persons assist. Review of Resident R9's clinical record revealed that resident had a care plan for ADL self-care deficits related to cognitive decline. Review of care plan goals revealed that Resident R9 will receive assistance necessary to meet ADL needs. Care plan interventions were Assist with daily hygiene, grooming, and oral care as needed, assist with dressing. Review of Resident R9's clinical record revealed no documented evidence that resident refused care. 28 Pa. Code 201.29(j) Residents rights 28 Pa. Code 211.10(d) Resident care policies 28 Pa. Code 211.12(c) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services 395282 Page 2 of 15 395282 12/01/2023 St Francis Center for Rehabilitation & Healthcare 1412 Lansdowne Avenue Darby, PA 19023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record reviews, resident and staff interviews, it was determined that the facility failed to provide appropriate ADL (activities of daily living) care such as trimming facial hair, shaving and incontinent care for three of 35 residents reviewed who were unable to carryout Activites of Daily Living independently. (Resident R346, R171, R71 and R77) Residents Affected - Few Findings include: A review of Resident R346's clinical record revealed that he was admitted on [DATE], with a diagnosis of orthopedic aftercare following surgical amputation of right upper limb. Review of the MDS (Minimum Data Set-Assessment of resident care needs) for Resident R346 dated August 31, 2023, revealed that the resident required extensive physical assistance from one staff for personal hygiene and dressing, and was totally dependent on assistance from one staff for bathing. The MDS also revealed that the resident had a BIMS (Brief Interview for Mental status) score of 15 which indicated that the resident's cognitive status for daily decision making was intact. Observations during the initial tour of the two main floor on November 28, 2023, at 11:55 a.m. revealed Resident R346 had a heavy beard and that his mustache hair hung well below his lower lip. He indicated that his mustache was so long that it was difficult to eat, stating that the other day when he tried to put a spoon full of corn into his mouth it fell off onto his shirt. He further indicated that when he asked for help shaving and trimming his facial hair he was told that when a male aide was on they will have him provide this help, but this was days ago and he was still waiting. He further stated that his hair was much longer than he liked and that he wanted a haircut. Interview with the Unit Manager on November 29, 2023, at 1:30 p.m. revealed that Resident R346 should not have to wait for a male aide, that any of his aides could do this for him, and that she would talk to the resident about seeing the barber for a haircut. Observation of Resident R171 conducted on November 29, 2023, at 9:15 a.m. during tour of unit Four Main, revealed that Resident R171 was sitting up in bed eating his breakfast. Review of Resident R171's clinical record revealed that Resident R171 was admitted to the facility on [DATE], with diagnoses of but not limited to Dementia, Anxiety Disorder, and Unilateral Inguinal Hernia. Review of Resident R171's Annual MDS dated [DATE], section H0300. Urinary Continence revealed that resident was occasionally incontinent. G0110. Activities of Daily Living (ADL) Assistance, G Dressing (how resident puts on, fastens and takes off all items of clothing, including donning/removing a prosthesis or TED (Thrombo-Embolic Deterrent) hose. Dressing includes putting on and changing pajamas and housedresses) revealed that Resident R171 required extensive assistance with one person physical assist, I Toilet use (how resident uses the toilet room, commode, bedpan, or urinal; transfers on/off toilet; cleanses self after elimination; changes pad; manages ostomy or catheter; and adjusts clothes. Do not include emptying of bedpan, urinal, bedside commode, catheter bag or ostomy bag) revealed that Resident R171 required supervision with one person assist, J Personal hygiene (how resident maintains personal hygiene, including combing hair, brushing teeth, shaving, applying makeup, washing/drying face and hands (excludes baths and showers) revealed that Resident R171 required extensive assistance with one person physical assist. 395282 Page 3 of 15 395282 12/01/2023 St Francis Center for Rehabilitation & Healthcare 1412 Lansdowne Avenue Darby, PA 19023

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident R171's care plan for ADL self-care deficit revealed that the goal was for Resident R171 to receive assistance necessary to meet ADL needs, interventions were for toileting- Supervision, assist to transfer as needed, assist with daily hygiene, grooming, and oral care as needed, and assist with dressing. Review of Resident R171's clinical record revealed no documented evidence that Resident R171 refused ADL care. Further observation revealed that Resident R171 was wearing an incontinece brief and a hospital gown. Further, Resident R171 was noted to be incontinent, the sheets that he was sitting on was also wet and had brownish stain on it and with asmelled of urine. Further observation revealed that there were flies in Resident R171's room. Follow-up observation of Resident R171 conducted on November 29, 2023, at 11:24 a.m. revealed that Resident R171 was in bed asleep. Further observation revealed that resident was still wet, the bed sheet was still soaked in urine and smelled of urine. Further observation revealed that flies were observed in Resident R171's room Observation of Resident R171's room conducted on November 29, 2023, at 11:44 a.m. revealed that flies were in his room and a strong odor of urine was detected. Follow-up observation on Resident R171 conducted on November 29, 2023, at 12:44 p.m. with unit manager Employee E21 revealed that Resident R171was in bed sleeping, still wearing a hospital gown and incontinence brief that was still wet. Further Resident R 171's sheets were still wet and stained. Further a smell of urine was still noted. Further observation revealed that Resident R171 was unshaven, hair was disheveled. Further, flies were observed flying around the room and around Resident R171. Interview with Licensed nurse, Employee E24 conducted at the time of the observation confirmed that Resident R171 was unshaven, diaper was wet, the sheet he was lying on was wet, stained and smelled of urine. Further, Employee E24 also confirmed that flies were observed flying around the room and around Resident R171. Further interview with Licensed nurse, Employee E24 revealed that she will have housekeeping take care of the flies and that she will have someone clean resident. Observation of Resident R71 conducted on November 28, 2023, at 1:38 pm revealed that Resident R71 was in a geri-chair in front of the nurse's station. Further observation revealed that Resident R71 was unshaven. Follow-up observation on Resident R71 conducted on November 29, 2023, at 11:14 a.m. revealed that Resident R71 was sitting in a geri-chair, Further observation revealed that Resident R71 was still unshaven. 395282 Page 4 of 15 395282 12/01/2023 St Francis Center for Rehabilitation & Healthcare 1412 Lansdowne Avenue Darby, PA 19023

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident R71's clinical records revealed that Resident R71 was admitted to the facility on [DATE]. Further, Resident R71's diagnoses were but not limited to Aphasia (a language disorder that affects a person's abillity to communicalte), Anxiety Disorder, Contracture (a condition of shortening and hardening of musclesm tendons, or other tissues, often leading to deformity and rigidity of joints) of the Right Knee, Dementia, Psychosis, and Blindness to the Left Eye. Review of Resident R71's Quarterly MDS (Minimum Data Set- a federally required resident assessment completed at a specific interval) dated November 13, 2023, section E0800. Rejection of Care - Presence & Frequency revealed that Resident R71 did not exhibit behaviors. Section GG0130. Self-Care, I Personal hygiene: (The ability to maintain personal hygiene, including combing hair, shaving, applying makeup, washing/drying face, and hands. excludes baths, showers, and oral hygiene) revealed that Resident R71 was coded as 01 Dependent - (Helper does all of the effort. Resident does none of the effort to complete the activity, or the assistance of 2 or more helpers is required for the resident to complete the activity. Review of Resident R71's care plan revealed that resident had an ADL self-care deficit related to disease process, left eye blindness, physical limitations contractures. The Care Plan Goal was for Resident R71 to be clean, dressed and well groomed, Interventions were to assist with daily hygiene, grooming, and oral care as needed. Further review of Resident R71's clinical record revealed no documented evidence that that resident refused to be shaved. Review of Resident R77's clinical record revealed the resident was admitted to the facility on [DATE], from the hospital due to a fall from home. Diagnosis on admission included high blood pressure muscle weakness, chronic kidney disease and metabolic encephalopathy (a reversible disease caused by a chemical imbalance in the blood that can effect the brain). Review of Resident R77's care plan revealed she was at risk for falls due to her alteration in her activities of daily living with interventions for the staff to meet and anticipate the residents needs, dated October 9, 2023. Continue review of the care plan revealed the resident showed potential to be discharged from the facility to home. The resident was care planned with working with occupational therapy (OT) to meet those goals. Upon OT recertification, the resident presented with deficits impeding her independence with activities of daily living and functional mobility. The care plan stated the resident's goals were to complete all aspects of toileting task including toilet transfer and perineal hygiene with supervision in order to maximize her independence with functional tasks. initiated on October 10, 2023, with a target date of January 11, 2024. Interventions included the resident receiving therapy five times a week. Review of Resident R77's physician note dated November 27, 2023, indicated the resident was alert, oriented, forgetful at times with her gait improving with therapy. The physician's plan was to continue with physical therapy and occupational therapy. Further review of Resident R77's clinical record and facility incident documentation revealed the resident sustained three falls at the facility, twice on October 11, 2023, attempting to use the bathroom in her room and in the dayroom while being supervised she stood from her wheelchair to ambulate without asking for assistants. The third fall occurred on November 29, 2023, in her room and stated 395282 Page 5 of 15 395282 12/01/2023 St Francis Center for Rehabilitation & Healthcare 1412 Lansdowne Avenue Darby, PA 19023

F 0677 she was trying to go to the bathroom. Level of Harm - Minimal harm or potential for actual harm On November 30, 2023 at 12:00 p.m. an interview was conducted with Resident R77 and her former caretaker/friend both voiced concerns that her falls had to do with her needing to use the bathroom. Resident R77 stated she tries to use the call bell for assistants but stated, They are busy doing other things and take too long and I try to go by myself. The friend stated At home she uses a cane, and she is continent I know because I used to take care of her. Immediately afterwards, the surveyor spoke with the resident's Nursing Assistant (NA) Employee E19. The NA stated, Now I have gotten to know her I take her to the bathroom three times a shift. She always goes to the bathroom, even when she doesn't feel like she does. She stays dry for me. Surveyor then spoke to Unit Manager Employee E20 and asked how the NAs know what residents needed to be assisted to the bathroom on a timely basis. The unit manager explained those residents were care planned to be on a toileting schedule and thought Resident R77 was already on the toileting schedule. The Unit Manager stated she would add Resident R77 to the schedule and update her care plan. Residents Affected - Few 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.12(d)(5) Nursing services 395282 Page 6 of 15 395282 12/01/2023 St Francis Center for Rehabilitation & Healthcare 1412 Lansdowne Avenue Darby, PA 19023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of facility records and interview with staff, it was determined that the facility failed to provide care, services and devices in accordance with professional standard of practice related to positioning and bowel management for two of 35 residents reviewed (Resident R9 and R94 ). Residents Affected - Few Findings included: Observation of Unit Four Main Resident Lounge conducted on November 28, 2023, at 11:07 a.m. revealed that Resident R9 was sitting on a wheelchair, in front of the table, wearing a hospital gown and barefoot. Further observation revealed that Resident R9 was slouched, Resident R9's torso was leaning forward and towards the right with her armpits resting on the right arm rest and right arm hanging. Further, Resident R9's head was at the level of the table. Follow-up observation of Resident R9 conducted on November 28, 2023, at 2:05 p.m. in the Fourth Floor Main Resident Lounge Revealed that Resident R9 was in a wheelchair, in front of the table, wearing a hospital gown and barefoot. Further observation revealed that Resident R9 was still slouched, Resident R9's torso was leaning forward both arms on the table the Resident R9's at the same level as the tabletop. Follow-up observation of Resident R9 conducted on November 29, 2023, at 9:15 a.m. in Unit Four Main Resident Lounge revealed that Resident R9 was in a wheelchair eating her breakfast. Further observation revealed that Resident R9 was wearing a hospital gown and was barefoot. Further, Resident R9's trunk was bent forward with her head slightly above the table. Further observation revealed that Resident R9 was slowly feeding herself. Further, because her body was bent forward, in order for her head not to be right over the plate, Resident R9's wheelchair was positioned further away from the table. Further, Resident R9's plate was a full arm's length resulting in Resident R9's difficulty scooping food out of the plate. Follow-up observation on Resident R9 conducted on November 29, 2023, at 10:48 a.m. in Unit Four Main Resident Lounge, revealed that Resident R9 was sitting on a wheelchair, in front of the table, wearing a hospital gown and barefoot. Further observation revealed that Resident R9 was slouched, Resident R9's torso was leaning forward and towards the right with her armpits resting on the right armrest and right hand resting on the right wheelchair wheel. Further, Resident R9's head bent forward with right side of her face resting on the arm rest rail. Review of Multidisciplinary Therapy Screen dated February 22, 2023, revealed that Resident R9's sitting/positioning/positioning revealed that Resident R9 appears adequate. Review of rehab communication (Rehab referral for treatment)/ rehab notification) from nursing dated March 22, 2023, revealed that a referral was made due to poor positioning in wheelchair. Review of section for comment revealed that Resident is always sliding to edge of chair, has to be repositioned several times during shift to prevent fall. Review of Resident R9' clinical record revealed that Resident R9 was started on OT (Occupational Therapy) on March 24, 2023. Review of OT evaluation and plan of treatment for the certification period of March 24, 2023 to April 22, 2023 revealed that Resident R9's Sitting Balance was poor+(Maintains balance with moderate support and upper extremity support) Initial Assessment, Tone and Posture 395282 Page 7 of 15 395282 12/01/2023 St Francis Center for Rehabilitation & Healthcare 1412 Lansdowne Avenue Darby, PA 19023

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Asymmetrical, Kyphotic posture, head forward, Assessment Summary, Impression Patient presents with decreased core stability and poor wheelchair positioning Review of OT DC (discharge) note dated April 11, 2023, revealed that resident continue to slide in chair despite all possible modification being made. Further, OT discharge summary revealed that a new chair has been ordered and will continue to assess seating with new wheelchair. Review of discharge status and recommendation was 24-hour care. RNP (Restorative Nursing Program) was not recommended (not indicated). Review of PT (Physical Therapy) Evaluation and Plan of Treatment for certification period of June 14, 2023, to July 13, 2023, revealed that Resident R9's baseline for ability to reposition self in the wheelchair was total dependence for reposition in wheelchair. Initial Assessment, Tone and Posture Head forward, Head down. Review of PT Treatment Encounter note dated June 26, 2023 revealed that Summary of Skills revealed a plan to obtain new costume wheelchair due resident's to current on-optimal seating solution. Review of PT Treatment Encounter Note dated June 28, 202, Summary of Skills revealed that seating evaluation to obtain custom wheelchair to improve sitting posture was requested. Review of PT Discharge summary dated [DATE], revealed that upon discharge from PT services on June 28, 2023, Resident R9's remained totally dependent in her ability to reposition self in wheelchair. Discharge Recommendations were as follow: 24-hour care and there was no recommendation for RNP (not indicated). Further review of Rresident R9's clinical record reveled no documented evidence that Resident R9 was provided with the modified wheelchair to improve her positioning. Interview with Employee 8 conducted on December 1, 2023, at 10:09 a.m. revealed that the facility ordered a modified wheelchair for Resident R9 however, the insurance did not pay for a new wheelchair. Further interview with Rehab Director, Employee E8 conducted on December 1, 2023, at 10:09 a.m. confirmed that resident was improperly positioned on her wheelchair because her wheelchair was too big for her. Interview with OT (Occupational Therapy) Employee E23,conducted on December 1, 2023, at 11:47 a.m. revealed that Resident R9 was on her case load. Further Employee E23 confirmed that Resident R9 leans to her right when she is on her wheel chair. Further, Employee E23 also revealed that Resident R9 had a wheelchair that had a lateral support that positioned resident properly, but it broke. Further interview with Employee E23 revealed that Resident R9's current wheelchair, was not modified to prevent leaning forward or leading to the sides. Review of Resident R94's clinical record revealed the resident was alert and oriented, admitted to the facility on [DATE], with the diagnoses with acute kidney disease, and a history of rectal/anal cancer and gastrointestinal bleed. On November 29, 2023, at 1:00 p.m. Resident R94 stated, I have had loose stools for over a week and 395282 Page 8 of 15 395282 12/01/2023 St Francis Center for Rehabilitation & Healthcare 1412 Lansdowne Avenue Darby, PA 19023

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few have been complaining that I want medication for it. Nursing keeps telling me they need an order from the doctor. When I ask them again, they say they're waiting on the doctor. This has been very uncomfortable, and I am getting sore. Review of Resident R94's care plan revealed as of October 17, 2022, the resident was dependent on staff to assist her with toileting and as of October 21, 2021 was incontinent of bowel and bladder with interventions to report any changes in output, color or consistency of urine/stool. Further review of Resident R94's clinical record revealed the nursing assistants (NA) documented the resident having loose stools every day from November 1 through November 28, 2023 (except for November 8 and 18 was noted with a formed stool and on November 14, 2023 the information was not available review). Continuing review of the clinical record revealed no documented evidence nursing further assessed the resident for having loose stools. On December 1, 2023, at 2:30 p.m. the Director of Nursing indicated nursing was not aware of Resident R94's loose stools. 28 Pa code 211.10(c)(d) Patient care policies 28 Pa. Code 211.12 (d)(3)(5) Nursing services 395282 Page 9 of 15 395282 12/01/2023 St Francis Center for Rehabilitation & Healthcare 1412 Lansdowne Avenue Darby, PA 19023

F 0801 Level of Harm - Minimal harm or potential for actual harm Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Based on staff interviews and a review of employee credentials, it was determined that the facility failed to employ a qualified director of food and nutrition services. Residents Affected - Few Findings include: An interview on November 28, 2023, at 10:45 a.m. with Employee E 21, Food Service Director (FSD), revealed that his responsibilities included oversight of ordering, receiving, storing, preparation and service of food. Further interview with the FSD confirmed that he was not currently a certified dietary manager (CDM); or a certified food manager (CFM); or had a national certification for food service management and safety from a national certifying body; or had an associate's or higher degree in food service management or hospitality from an accredited institution; and that he had not received frequently scheduled consultations from a qualified dietitian. A review of Employee E21 's credentials revealed that Employee E21 did not meet the statutory qualifications of a director of food and nutrition services. During an interview on November 30, 2023, at 1:30 p.m. with Employee E1, the Nursing Home Administrator, acknowledged that the FSD did not possess the regulatory required qualifications to provide operational oversight of the dietary department. The Administrator confirmed that the FSD had been working at the facility since May 2022, and had not yet started the required course work to obtain certification. The Nursing Home Administrator was unable to provide evidence that the FSD was certified, and therefore unqualified to direct the dietary department. 28 Pa. Code 201.18(e)(6) Management 395282 Page 10 of 15 395282 12/01/2023 St Francis Center for Rehabilitation & Healthcare 1412 Lansdowne Avenue Darby, PA 19023

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. Based on observations, and resident and staff interviews, it was determined that the facility failed to honor resident food and drink preferences by providing food that was requested by and acceptable to the residents for 10 of 35 residents reviewed (Residents R4, R15, R23, R49, R31, R94, R118, R123, R128 and R168). Findings include: Interview during the tour of 2 Main unit with Resident R23 on November 28, 2023, at 11:35 a.m. revealed that she did not get the right food, not what she chose on the menu and that this happened several times a week. Interview during the tour of 2 Main unit with Resident R49 on November 28, 2023, at 11:40 a.m. revealed that the food was terrible, she was frustrated because she did not get the food that she asked for, they just sent her what they want to send. Interview during the tour of 2 Main unit with Resident R31 on November 28, 2023, at 11:45 a.m. revealed that her and her husband, who lives in the same room, feel the food has no taste, that they fill out their menu each day, but the kitchen sends different food. Interview during the tour of 2 Main unit with Resident R123 on November 28, 2023, at 11:50 a.m. revealed that the food is terrible, they feed us like dogs, they just slap it down, it not what you order, you don't get what you want, just what they send you. Group interview with six alert and oriented residents, Residents R4, R15, R94, R118, R128 and R168 on November 29, 2023 at 11:30 a.m. all agreed during mealtime they do not get the food they ordered, instead the kitchen gives them something different. The same residents also agreed this happens at least two times a week. Interview with the Food Service Director on November 30, 2023, at 12:45 p.m. revealed that there have been problems getting some food items that get substituted on resident trays, like right now we can't get whole or skim milk in the 8 ounce cartons due to a shortage of the cartons. When asked about other food items like why green beans were served at lunch when the vegetable list on the menu was winter blend, he stated that they did not have the winter blend. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(3) Management 28 Pa. Code 211.6(a) Dietary services 395282 Page 11 of 15 395282 12/01/2023 St Francis Center for Rehabilitation & Healthcare 1412 Lansdowne Avenue Darby, PA 19023

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 Based on observation, review of facility policy and staff interviews, it was determined that the facility failed to ensure that residents call systems were maintained in proper working order for five residents out of 42 residents reviewed on the fourth-floor pavilion nursing unit. (Residents R40, R124, R19, R455 and R179). Residents Affected - Few Findings: Review of facility's call bell policy titled Policies and Procedures subject Call Bell System dated March 2020, states the facility uses a call bell system to allow residents to call for staff assistance. The call bell system will be answered by staff who are in the vicinity of the call bell alarm. Tour of the facility conducted on November 28, 2023, at 9:35 a.m. reveled that Resident R40's call bell was not within reach of Resident R40. The call bell was observed on the floor, under the bed. Interview with Employee E16, Nurse aide, at time of observation confirmed that this call bell was not in reach of Resident R40. Continued tour of the fourth-floor pavilion nursing unit November 28, 2023 at 10:31 a.m. revealed that Resident R124's call bell was not in reach of Resident R124, the call bell was observed in her night table drawer. Interview with Employee E16, Nurse Aide, at time of observation confirmed that Resident R124 did not have a call bell that could be reach. Continued tour of the fourth-floor pavilion nursing unit November 29, 2023, at 10:10 a.m. revealed Resident R19's call bell was not in reach of Resident R19, the call bell was observed on the floor. Interview with Employee E17, Nurse Aide, at time of observation confirmed that the call bell was not in reach of Resident R19 . Continued tour of the fourth floor pavilion nursing unit on November 28, 2023 at 10:40 a.m. revealed Resident R455 did not have a call bell. Interview with Employee E16, Nurse Aide, at time of observation confirmed that Resident R455 did not have a functioning call bell. Continued tour of the fourth floor pavilion nursing unit on November 28, 2023 at 10:00 a.m. revealed resident R179 call bell was not functioning . Interview with Interview with Employee E16, Nurse Aide, at time of observation revealed that Residents R179 did not have a call bell 28 Pa. Code 201.14 Responsibility of Licensee 28. Pa. Code 201.18 (b)(1)Management 395282 Page 12 of 15 395282 12/01/2023 St Francis Center for Rehabilitation & Healthcare 1412 Lansdowne Avenue Darby, PA 19023

F 0919 28 Pa. Code 211.12 (d)(1) Nursing Services Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 395282 Page 13 of 15 395282 12/01/2023 St Francis Center for Rehabilitation & Healthcare 1412 Lansdowne Avenue Darby, PA 19023

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and a review of facility documentation, it was determined that the facility was not maintaining an effective pest control program. Residents Affected - Some Findings include: Observations during the initial tour of the 2 Main nursing on November 28, 2023, at 11:35 a.m. in room [ROOM NUMBER], bed A revealed Resident R93 laying in bed with a fly buzzing around his head while attempting to interview him. Observations during the initial tour of the 2 Main nursing on November 28, 2023, at 11:45 a.m. in room [ROOM NUMBER], bed B revealed Resident R23 sitting up in her bed waving her hand at a fly buzzing around her. An interview on November 28, 2023, at 11:45 a.m. in room [ROOM NUMBER], bed B with Resident R23, who stated that the flies are common and this one is really bothering her. Observations on November 28, 2023, at 12:00 p.m. at the 2 Main nurse station revealed a fly buzzing around the desk. An interview on November 28, 2023, at 12:00 p.m. at the 2 Main nurse station with the unit manager, Employee E5, when asked about pest control and [NAME] on the unit, she pointed at a binder on the shelf and stated that all reported pests get logged in the pest binder and when the exterminator comes in they check the binder. She did not elaborate but rather kept walking. Observation of Resident R171 conducted on November 29, 2023, at 9:15 am during tour of unit Four Main, revealed that Resident R171 was sitting up in bed eating his breakfast. Further observation revealed that there were flies flying around the immediate vicinity of Resident R171. Follow-up observation of Resident R171 conducted on November 29, 2023, at 11:24 am revealed that Resident R171 was in bed asleep. Further observation revealed that flies were still observed in Resident R171's room. Follow-up observation of Resident R171's room conducted on November 29, 2023, at 11:44 am revealed that flies were still in his room. Follow-up observation on Resident R171 conducted with unit manager Employee E22 conducted on November 29, 2023, at 12:44 p.m. revealed that Resident R171 in bed sleeping and flies were observed flying around the vicinity of Resident R171. Further observation of Resident R171's room revealed that a fly was also on the over head light of Bed C. Interview with the Unit manager, Employee E24 conducted at the time of the observation confirmed 395282 Page 14 of 15 395282 12/01/2023 St Francis Center for Rehabilitation & Healthcare 1412 Lansdowne Avenue Darby, PA 19023

F 0925 Level of Harm - Minimal harm or potential for actual harm that flies were observed flying around the room and around Resident R171. Further, Employee E24 revealed that she will have housekeeping take care of the flies. 28 Pa. Code 201.18(b)(1)(3) Management Residents Affected - Some 395282 Page 15 of 15