Inspection·September 22, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the front cover was hanging off the heater/air conditioner unit. The inside mechanism including wiring was exposed. The front cover was partially sitting on the floor in front of the unit. Further observation revealed, the room smelled heavily of urine. Subsequent observations on September 20, 2023, at 09:21 a.m. of room [ROOM NUMBER] revealed that the front cover was hanging off the heater/air conditioner unit. The inside mechanism including wiring was exposed. The front cover was sitting on the floor in front of the unit. Further observation revealed brown stains on the wall, wire hanging from the headboard light and a broken nightlight cover in the bathroom. Subsequent observations on September 20, 2023, at 09:25 a.m. of room [ROOM NUMBER] revealed a hole in the wall near bed B, a broken cover on the bathroom nightlight, and the heater/air conditioner unit cover hanging off. Subsequent observations on September 20, 2023, at 09:29 a.m. of room [ROOM NUMBER] revealed the bathroom nightlight had no cover on it. The bulb was exposed. Subsequent observations on September 20, 2023, at 09:30 a.m. of third floor lounge area revealed a large red stain on the carpet and multiple black stains throughout the carpet. Further observation of the lounge area revealed cigarette butts in the heating/air conditioner unit vents. Furthermore, subsequent observations on September 21, 2023, between 10:37 a.m. and 10:53 a.m. revealed that the above conditions remained the same. On September 21, 2023, at 01:04 p.m. in the company of the NHA, the above observations were confirmed. Interview with the NHA revealed that the permanent maintenance worker was recently terminated due to poor work performance. The NHA stated the facility was in the process of hiring a new maintenance worker. Per the NHA the facility recently hired a special projects person to assist with floor care and other special projects. Further interview with the NHA revealed that the facility has been ordering three to four new heating/air conditioning units per month. The NHA stated that units which are not working properly have taken priority for replacement. The NHA also stated that new carpet is on order for the facility. An observation of the ground floor medication room was conducted on September 21, 2023, at 9:35 a.m., in the presence of licensed nurse Employee E5. The observation revealed five panels on the ceiling were observed with brown stain. One panel ceiling near the wall was missing. The wall facing the door was observed with multiple drips of dried brown substance. The above was discussed with the Nursing Home Administrator on September 22, 2023, at 10:30 a.m. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(3) Management 28 Pa. Code 207.2(a) Administrator's responsibility FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395284 If continuation sheet Page 2 of 13 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 395284 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix Center for Rehabilitation and Nursing,the 833 South Main Street Phoenixville, PA 19460 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 0623 Level of Harm - Potential for minimal harm Residents Affected - Many Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon clinical record review and staff interview, it was determined the facility failed to notify the State Ombudsman's office of hospitalization of a resident for four of four residents reviewed (Residents 21, 25, 34, and 69). Findings include: Review of Resident 34's clinical record revealed the resident was hospitalized on [DATE]. Review of Resident 21's clinical record revealed the resident was hospitalized on [DATE]. Review of Resident 25's clinical record revealed the resident was hospitalized on [DATE], August 21, 2023, August 13 2024 and June 14, 2023. Review of Resident 69's clinical records revealed resident was hospitalized on [DATE]. Interview with the Nursing Home Adminstrator on September 22, 2023 at 12:20 p.m confirmed the State Ombudsman's office was not notified of Resident's hospitalization. This interview further confirmed the facility failed to notify the State Ombudsman's office of any hospitalizations or discharges of any resident from September 2022 through August, 2023. 28 Pa. Code 201.18(a)(b)(1)(3) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395284 If continuation sheet Page 3 of 13 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 395284 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix Center for Rehabilitation and Nursing,the 833 South Main Street Phoenixville, PA 19460 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 0657 Level of Harm - Minimal harm or potential for actual harm Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on clinical record review and staff interview it was determined the facility failed to update care plans to accurately reflect the resident's current status for 2 of 24 residents reviewed. (Residents 29 and 37) Residents Affected - Few Findings Include: Review of resident 29's Diagnosis list included diagnosis for depression and dementia. Review of Resident 29's physician orders revealed an order for Buspar (anti-anxiety medications) 10 milligrams, three times a day for anxiety. Review of Resident 29's care plan revealed a care plan for the resident being on an antidepressant medication. Review of resident 29's physician orders revealed the resident was not on any antidepression medications. Further review of Resident 29's care plan revealed there was no care plan developed for the resident having anxiety or being on an anti-anxiety medication and a care plan for the resident having depression and taking anti-depression medications. Review of Resident 37's care plan revealed a care plan for the resident having anxiety but states the resident doesn't take any medication for it. Further review of Resident 37's care plan revealed a care plan for depression and the resident receiving anti-depression medications. Review of Resident 37's physician orders revealed the resident is currently receiving Buspar 15 milligrams twice a day for anxiety and fluoxetine 10mg daily for anxiety disorder. Further review of Resident 37's physician orders revealed there was no orders for anti-depression medications. Interview with the Director of Nursing on September 22, 2023 at 11:30 a.m. confirmed the care plans for Residents 29 and 37 did not accurately reflect the medications they were prescribed at the time. 28 Pa. Code 211.5(f) Clinical Records 28 Pa. Code 211.12(d)(3)(5) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395284 If continuation sheet Page 4 of 13 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 395284 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix Center for Rehabilitation and Nursing,the 833 South Main Street Phoenixville, PA 19460 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 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 clinical records review, and resident and staff interviews, it was determined that the facility failed to ensure physician's orders were followed for four of 19 residents reviewed (Resident 31, 51, 59, and 67). Residents Affected - Some Findings include: A review of Resident 31's diagnosis list includes End end-stage renal Failure, dependence on hemodialysis (A procedure where a dialysis machine and a filter called an artificial kidney, or a dialyzer, are used to clean your blood), and rotator cuff tear of the right shoulder. An interview with Resident 31 conducted on September 19, 2023, at 10:00 a.m., revealed that the resident goes out to dialysis every Monday, Wednesday, and Friday from around 10:30 a.m., until 3:00 p.m. A review of Resident 31's September 2023 Medication Administration Record revealed an order for Acetaminophen (A medication to treat mild pain) 500mg two tablets three times a day, and Gabapentin (A medication to treat nerve pain) 300mg 1 capsule three times a day. Both medications were scheduled to be administered at 8:00 a.m., 12:00 noon, and 4:00 p.m. The MAR review revealed that both medications were not administered on the following dates: September 1, 4, 6, 8, 11, 13, 15, 18, and 20. Documentations revealed medications were not administered due to the resident being out of the center. An interview was conducted with licensed employee E4 on September 21, 2023, at 10:00 a.m. Employee E4 reported that the medications mentioned above were not administered due to Resident 31 being out on dialysis. Clinical records review failed to reveal that the physician was notified of the missed Acetaminophen and Gabapentin medication on the above-mentioned dates. The above findings were discussed with the Director of Nursing (DON) on September 22, 2023, at 11:00 a.m. A review of Resident 51's diagnosis list revealed Osteomyelitis (infection of the bone), and chronic venous insufficiency. Clinical records review, and admission assessment dated [DATE], revealed resident was admitted to the facility with a vascular wound (A wound in the skin that developed because of a problem with blood circulation) to both legs and heels. A review of the September 2023 MAR revealed an order to cleanse bilateral lower extremities with normal saline solution, pat dry, apply Xeroform (A wound dressing used to cover and protect low to non-draining wounds), Aquacel AG (A dressing used in wounds that are infected or at risk for infection), 4x4 gauze, kerlix, then wrap with ace bandage one time a day every two days. MAR review revealed wound treatment for Resident 51's bilateral leg wounds was not done on September 16, and September 18. A review of the nursing progress notes dated September 16, 2023, at 2:49 p.m., revealed wound care was not done due to awaiting supplies. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395284 If continuation sheet Page 5 of 13 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 395284 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix Center for Rehabilitation and Nursing,the 833 South Main Street Phoenixville, PA 19460 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A review of the nursing progress notes dated September 18, 2023, at 4:39 p.m., revealed wound care was not done due to no xeroform available awaiting delivery. An interview was conducted with Resident 51 on September 19, 2023, at 1:00 p.m. Resident 51 confirmed that wound care to his/her bilateral legs was last done by the wound doctor on September 14, 2023, and treatment has not been done since then because there were no supplies available to treat his/her wounds. The resident reported that supplies came in this morning (pointed to boxes of wound supplies on the table) and was informed that wound treatment would be done today. The clinical records review failed to reveal that the physician was notified of the missed wound treatments for Resident 51's bilateral lower extremity wounds. An interview with the DON on September 22, 2023, at 11:00 a.m., confirmed that Resident 51's vascular wounds to the bilateral lower leg were not treated on September 16, and 18, 2023, due to unavailability of the wound treatment supply. The facility failed to ensure wound care orders for Resident 51's vascular wounds to the bilateral lower leg were followed. A review of Resident 59's diagnosis list revealed hypertension (Elevated blood pressure), and Chronic congestive heart failure (A weakened heart condition that causes fluid buildup in the feet, arms, lungs, and other organs). A review of the September 2023 MAR revealed an order for Lasix (A medication used to treat fluid retention and swelling caused by CHF) 20 mg Give one tablet in the morning for edema, and Valsartan 160 mg Give one tablet in the morning for hypertension. The MAR review revealed Lasix was not administered to Resident 59 on the following dates: September 5, 8, 11, 15, 18, 19, and 20, 2023. The MAR review also revealed that the Valsartan was not administered to the resident on the following dates: September 5, 6, 8, 11, 15, 18, 19, and 20, 2023. A review of the progress notes revealed that Lasix and Valsartan medications were not administered on the above-mentioned dates due to having blood pressure ranging from 100/54 to 106/64 mm Hg. Clinical records review failed to reveal a physician's order to hold medications for blood pressure ranging from 100/54 to 106/64 mm Hg. An interview was conducted with licensed nurse Employee E4 on September 21, 2023, at 10:00 a.m. Employee E4 confirmed that the physician did not order blood pressure parameters when administering Resident 59's Lasix and Valsartan medications. Clinical records review failed to reveal that the physician was notified of omitting Resident 69's ordered Lasix and Valsartan on the above-mentioned dates due to her/his blood pressure result. A review of Resident 67's diagnosis list includes CHF and hypertension. A review of the September 2023 MAR revealed the following orders: Lasix 40 mg one tablet Given one time a day for edema; Spironolactone (A medication to treat high blood pressure and heart failure) 25 mg Given 0.5 mg one time daily for edema and blood pressure; Valsartan 40mg Give one tablet one time a day for hypertension; and Toprol XL 25mg Give 0.5mg every 12 hours for blood pressure. MAR (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395284 If continuation sheet Page 6 of 13 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 395284 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix Center for Rehabilitation and Nursing,the 833 South Main Street Phoenixville, PA 19460 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some review revealed Lasix, Spironolactone, Valsartan, and Toprol XL were not administered on September 11, 15, 18, and 20, 2023. Clinical records review, and nursing progress notes revealed medications were not administered due to blood pressure of 99/53 mm Hg on September 11, 2023, 106/57 mm Hg on September 15, 2023, 106/63 mm Hg on September 18, 2023, and 101/56 mm Hg on September 20, 2023. Clinical records review failed to reveal an order for a blood pressure parameter for Lasix, Spironolactone, Valsartan, and Toprol XL medications. An interview was conducted with licensed nurse Employee E4 on September 21, 2023, at 10:00 a.m. Employee E4 confirmed that the physician did not order blood pressure parameters when administering Resident 67's Lasix, spironolactone, Valsartan, and Toprol XL medications. The clinical records review failed to reveal that the physician was notified that the above medications were not administered due to blood pressure results. The above was discussed with the DON on September 22, 2023, at 11:00 a.m. The DON confirmed documentation of physician notifications regarding holding Resident 59 and 69's medications due to blood pressure results was not done until after concerns were brought up by the surveyor. The facility failed to ensure Resident 59 and 67's medication orders were followed by the facility. 28 Pa. Code §211.12(d)(1)(3)(5) Nursing services Previously cited 9/15/22. 28 Pa. Code: 211.5 (f) Clinical records FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395284 If continuation sheet Page 7 of 13 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 395284 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix Center for Rehabilitation and Nursing,the 833 South Main Street Phoenixville, PA 19460 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical records review and staff interview, it was determined that the facility failed to appropriately monitor and assess pressure ulcers for one of the four residents reviewed (Resident 51). Residents Affected - Few Findings include: A review of Resident 51's diagnosis list revealed Osteomyelitis (infection of the bone), and chronic venous insufficiency. A review of the skin care plan initiated on September 7, 2023, revealed a resident with a stage 3 (Full-thickness skin loss) to the sacrum (tailbone), and interventions were provided. A review of the clinical records and admission assessment revealed a skin check was done upon admission on [DATE], and revealed resident was admitted with a pressure wound to the sacrum. Additional review failed to reveal the sacral wound size, description of the wound bed, drainage, and surrounding skin. A review of the September 2023, Treatment Administration Record revealed an order to cleanse the sacral wound with normal saline solution, pat dry, and apply foam cushion dressing daily and as needed. A review of the weekly skin assessment dated [DATE], revealed no information regarding Resident 51's sacral stage 3 wound. A review of the weekly skin assessment dated [DATE], revealed a sacral pressure wound. The assessment failed to reveal the description of the sacral wound (stage, size, drainage, wound bed, etc.) An interview conducted with the Director of Nursing (DON) on September 22, 2023, at 11:00 a.m., confirmed that there was no comprehensive assessment of Resident 51's sacral wound on admission and weekly. The facility failed to ensure Resident 51's stage 3 sacral wound identified upon admission was comprehensively assessed and appropriately monitored. 28 Pa. Code §211.12(d)(1)(3)(5) Nursing services Previously cited 9/15/22. 28 Pa. Code: 211.5 (f) Clinical records FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395284 If continuation sheet Page 8 of 13 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 395284 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix Center for Rehabilitation and Nursing,the 833 South Main Street Phoenixville, PA 19460 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on a review of the facility's policy, clinical records review, and resident and staff interviews, it was determined that the facility failed to ensure appropriate supervision was provided during smoking for one of three residents reviewed (Resident 60) Findings include: A review of the facility's policy titled Tobacco-Restrictive Policy, undated revealed staff will dispense the resident's cigarettes, light the cigarette, and stay with the resident until the cigarette is properly extinguished. A review of the facility documentation, and list of residents that smoke revealed Resident 60 smokes. A review of Resident 60's smoking risk assessment completed on March 15, 2023, revealed resident was safe to smoke with supervision. A review of the nursing progress notes dated May 28, 2023, at 1:57 p.m., revealed while Resident 60 was attempting to light another resident's cigarette, another resident became impatient and grabbed Resident 60's cigarette to light their cigarette. When Resident 60 took back the cigarette, it fell into her leg causing a burn in her pants and a blister to the left thigh. The resident denied pain, the blister was intact, and the surrounding skin was within normal condition. The physician was notified with no new order was made. An interview was conducted with Resident 60 on September 21, 2023, at 10:00 a.m. A resident reported that on the day of the incident, a staff member handed her the lighter, after lighting her cigarette, she gave it to a male resident but did not work so she gave him her cigarette to light his. Resident 53 suddenly took Resident 60's cigarette, and when she tried to take it back, cigarette ash accidentally fell on her left thigh causing a burn. The resident denied experiencing discomfort. A review of the facility's investigation and staff statement from Employee E3 revealed that the lighter used was weak, and another cigarette was used to light cigarettes. While Resident 60 was helping (to light a cigarette) another male resident, Resident 53 became impatient and took Resident 60's cigarette causing cigarette ash to fall on Resident 60's pants and creating a dot on her thigh. An interview with Employee E3 on September 22, 2023, at 11:30 a.m., revealed that on the day of the incident, the lighter used did not work but she/he was unable to leave the residents to get another lighter. Employee E3 confirmed letting residents light their cigarettes using another cigarette instead of getting assistance from other staff to obtain an appropriate lighting material and lighting residents' cigarettes to ensure safety. The facility failed to ensure appropriate supervision and provide appropriate lighting material used during smoking time. 28 Pa. Code §201.14(a) Responsibility of licensee Previously cited 9/15/22. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395284 If continuation sheet Page 9 of 13 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 395284 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix Center for Rehabilitation and Nursing,the 833 South Main Street Phoenixville, PA 19460 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 0689 28 Pa. Code §201.18(b)(1)(3) Management Level of Harm - Minimal harm or potential for actual harm Previously cited 9/15/22. 28 Pa. Code §211.10(c)(d) Resident care policies Residents Affected - Few Previously cited 9/15/22. 28 Pa. Code §211.12(d)(1)(3)(5) Nursing services Previously cited 9/15/22. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395284 If continuation sheet Page 10 of 13 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 395284 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix Center for Rehabilitation and Nursing,the 833 South Main Street Phoenixville, PA 19460 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, facility policy review, and staff interview it was determined the facility failed to monitor the nutritional status of one of 3 residents reviewed. (Resident 37) Residents Affected - Few Findings Include: Review of facility policy Weight Assessment and Intervention, revised September 2008, revealed weights should be completed at least monthly. Review of Resident 37's weights revealed there was no weight completed for the month of August 2023. Further review of Resident 37's weights revealed a weight on September 6, 2023 of 218 pounds, a decrease of 8.6 pounds from the previous weight obtained on July 4, 2023 of 225.6 pounds. Review of resident 37's progress notes revealed this weight loss was addressed by the dietitian on July 14, 2023 by requesting staff to obtain another weight for accuracy. Further review of Resident 37's weights revealed there was no other weight obtained after the request from the dietitian on July 14, 2023 for another weight for accuracy. Interview with the Director of Nursing on August 22, 2023 at 11:30 a.m. confirmed Resident 37 had no weight obtained in August 2023 and no weight obtained as requested by the dietitian on July 14, 2023. 28 Pa. Code 211.5(f) Clinical Records 28 Pa. Code 211.10(c) Resident Care Policies 28 Pa. Code 211.12(d)(1)(3)(5) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395284 If continuation sheet Page 11 of 13 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 395284 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix Center for Rehabilitation and Nursing,the 833 South Main Street Phoenixville, PA 19460 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, clinical records review, and staff interview, it was determined that the facility failed to correctly administer medications for one of four residents observed in accordance with a physician orders, resulting in a medication error rate of 13.79% percent (Resident 69). Residents Affected - Few Findings include: A review of Resident 67's diagnosis list revealed hypertension (Elevated blood pressure), and Chronic congestive heart failure (CHF-A weakened heart condition that causes fluid buildup in the feet, arms, lungs, and other organs). A medication administration observation was conducted with licensed nurse Employee E4 on September 20, 2023, at 9:08 a.m. Before giving medication, Employee E4 checked the resident's blood pressure and reported that it was 101/56 mm Hg. Observation revealed Employee E4 did not administer the following scheduled morning medications to the resident: Lasix 40 mg (A medication used to treat fluid retention and swelling caused by CHF), Spironolactone (A medication to treat high blood pressure and heart failure) 25 mg, give 0.5 mg, Valsartan 40mg (A medication to treat high blood pressure), and Toprol XL (A medication to treat high blood pressure), 25mg, give 0.5 mg. Employee E4 reported that Lasix, Spironolactone, Valsartan, and Toprol XL were not administered due to low blood pressure. A review of Resident 67's physician's order and September 2023, Medication Administration Record revealed the following: Lasix 40 mg one tablet Given one time a day for edema; Spironolactone 25 mg Given 0.5 mg one time daily for edema and blood pressure; Valsartan 40mg Give one tablet one time a day for hypertension; and Toprol XL 25mg Give 0.5mg every 12 hours for blood pressure. MAR review revealed Lasix, Spironolactone, Valsartan, and Toprol XL were not administered during medication administration observation on September 20, 2023. Clinical records review failed to reveal a blood pressure parameter was ordered by the physician when administering Lasix, Spironolactone, Valsartan, and Toprol XL. Clinical records review failed to reveal that the physician was notified on September 20, 2023, that Resident 67's medications were held due to a blood pressure of 101/56 mm Hg. An interview with Employee E4 conducted on September 21, 2023, at 10:00 a.m., confirmed that there was no physician order to hold the Lasix, Spironolactone, Valsartan, and Toprol XL for a blood pressure of 101/56 mm Hg. The above was discussed with the Director of Nursing on September 22, 2023, at 11:00 a.m. The DON confirmed that physician notification documentation was made after concern was brought to the facility on September 21, 2023, at 10:00 a.m. 28 Pa. Code §211.12(d)(1)(3)(5) Nursing services Previously cited 9/15/22. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395284 If continuation sheet Page 12 of 13 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 395284 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix Center for Rehabilitation and Nursing,the 833 South Main Street Phoenixville, PA 19460 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview it was determined the facility failed to maintain records accurately reflecting the resident's status for one of 24 residents reviewed. (Resident 29) Findings Include: Review of Resident 29's progress notes revealed a nursing entry dated [DATE] stating CNA (Certified Nursing Assistant) came to this nurse to make aware of open area noted while giving care. Observed an open area to resident right hip measuring 1cm (centimeters) by 0.5cm. Review of Resident 29's physician orders revealed an order dated [DATE] to cleanse right hip with NSS (Normal Saline Solution-sterile salt water), apply triple antibiotic ointment, cover with clean dry dressing. one time a day for open area for 10 Days or until area resolved. Review of Resident 29's Medication Administration record Revealed the resident had the wound treatment ordered on [DATE] signed off as being completed as ordered until [DATE] when the 10 days of the order expired. Review of Resident 29's entire clinical record revealed there was no documentation of the type of wound the resident had sustained on [DATE] or when the wound had healed. Interview with the Director of Nursing on [DATE] at 11:30 a.m. revealed the resident had an abrasion that healed on [DATE] but was unable to provide where that was documented in Resident 29's clinical record. 28 Pa. Code: 211.5 (f) Clinical records 28 Pa. Code: 211.12 (d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395284 If continuation sheet Page 13 of 13