Health inspection·July 13, 2023

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of information from the facility regarding the resident's referenced bruise included only one witness statement from the nursing assistant (Employee E14) who noticed the bruise during the 11:00 p.m. through 7:00 a.m. nursing shift while providing morning care to the resident. Review of a nursing note dated February 27, 2023 at 7:22 a.m. indicated that the nursing assistant assigned to Resident R43 reported to the licensed nursing staff (Employee E15) of a bruise that the nursing assistant noticed on the resident's right arm. Continued review of the nursing note indicated that upon Employee E15 assessing the resident, a medium sized bruise was on the resident's right arm. Review of a nursing note by licensed nursing staff (Employee E17) on February 27, 2023 at 12:18 p.m. indicated that the resident reported that she was unsure as to how the bruised occurred, but stated, but may have bumped it. Review of information from the facility regarding the resident's referenced bruise included only one statement from the nursing assistant who noticed the bruise during the 11:00 p.m. through 7:00 a.m. nursing shift. Review of the investigation regarding both referenced incidents where bruises of unknown origin were found on Resident R43 offered no other witness statement from staff members (e.g. nurses, nursing assistants, activity staff) on other shifts to see if any other staff members witnessed or heard anything regarding Resident R43 during their work shift that may have aided the facility in ensuring a complete and through investigation to rule out resident abuse and/or neglect into the unknown origin of the resident's bruises that were found on the resident who is cognitively impaired. Review of information in the State Survey agency system included no evidence that the facility reported the two referenced bruises of unknown origin as required. During an interview on July 13, 2023, at 11:45 a.m. with the Director of Nursing, and two Unit Mangers (Employee E5 and Employee E18), it was confirmed that During the above referenced interview it was discussed that no evidence could be found that the facility reported the incident to the State Survey Agency, as required for two bruises of unknown origin. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.14(a) Responsibility of licensee FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395321 If continuation sheet Page 2 of 11 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 395321 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rydal Park of Philadelphia Presbytery Homes, Inc 1515 the Fairway Rydal, PA 19046 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 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, review of clinical records and facility documentation, it was determined that the facility failed to ensure a complete and accurate investigation to rule out abuse for two bruises of unknown origin for one out of 28 residents reviewed (Resident R43). Residents Affected - Some Findings include: Review of the facility policy, Elder Abuse Prevention, Identification, Response, Reporting, with a revision date of June 30, 2023 indicated that the identification of abuse, exploitation, neglect, mistreatment and misappropriation included witnessed events, resident or family report of abuse, verbal reports from other residents or family members, and injury of an unknown origin. Continued review of the policy indicated that the facility would respond to allegations or witnessed events by taking steps which included, protecting the resident and preventing further potential abuse, conducting a thorough investigation of the alleged violation, and reporting the alleged violation and investigation within required timelines. The policy also stated that allegations of abuse, exploitation, neglect or misappropriation of resident property investigation would include the assessment of the resident's immediate environment, review of the resident's assessment, and review of the resident's record. Review of the current plan of care for Resident R43 included the following diagnosis: anxiety (physical and mental response that occurs when the mind and body encounter stressful, dangerous, or unfamiliar situations); dementia (the loss of thinking, remembering, and reasoning to such an extent that it interferes with a person's daily life and activities); constipation, and dysphagia (difficulty swallowing). Review of Resident R43's Quarterly Minimum Data Set Assessment (MDS-a periodic assessment of a resident's need) dated June 23, 2023 indicated that the resident was cognitively impaired. Review of a nursing note dated November 5, 2022 at 5:46 a.m. written by licensed nursing staff (Employee E16) indicated that the resident's nursing assistant (Employee E14) was completing morning care on the resident on November 5, 2022 when she noticed a bruise on the resident's forehead. Review of the nursing notes indicated that when Employee E16 assessed the resident , A quarter sized bruise was noted at the top right corner of the resident's head. When Resident R43 was asked to explain what happened, the resident stated, I don't remember when it happened, but I think it happened when I was driving my automobile. Review of information from the facility regarding the resident's referenced bruise included only one witness statement from the nursing assistant (Employee E14) who noticed the bruise during the 11:00 p.m. through 7:00 a.m. nursing shift while providing morning care to the resident. Review of a nursing note dated February 27, 2023 at 7:22 a.m. indicated that the nursing assistant assigned to Resident R43 reported to the licensed nursing staff (Employee E15) of a bruise that the nursing assistant noticied on the resident's right arm. Continued review of the nursing note indicated that upon Employee E15 assessing the resident, a medium sized bruise was on the resident's right arm. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395321 If continuation sheet Page 3 of 11 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 395321 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rydal Park of Philadelphia Presbytery Homes, Inc 1515 the Fairway Rydal, PA 19046 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of a nursing note by licensed nursing staff (Employee E17) on February 27, 2023 at 12:18 p.m. indicated that the resident reported that she was unsure as to how the bruised occurred, but stated, but may have bumped it. Review of information from the facility regarding the resident's referenced bruise included only one statement from the nursing assistant who noticed the bruise during the 11:00 p.m. through 7:00 a.m. nursing shift. Review of the investigation regarding both referenced incidents where bruises of unknown origin were found on Resident R43 offered no other witness statement from staff members (e.g. nurses, nursing assistants, activity staff) on other shifts to see if any other staff members witnessed or heard anyting regarding Resident R43 during their work shift that may have aided the facility in ensuring a complete and through investigation to rule out resident abuse and/or neglect into the unknown origin of the resident's bruises that were found on the resident who is cogntively impaired. During an interview on July 13, 2023, at 11:45 a.m. with the Director of Nursing, and two Unit Mangers (Employee E5 and Employee E18), it was confirmed that no additional documentation regarding the interview of additional staff members on the same shift and previous shifts could be provided to show evidence that a complete and through investigation was completed to rule out neglect for Resident R43 who was found with two bruises of unknown origin on November 5, 2022 and February 27, 2023. 28 Pa. Code 201.14(a)(e) Responsibility of licensee 28 Pa. Code 201.18(b)(1)(3)(e)(1) Management 28 Pa. Code 201.29(c) Resident rights 28 Pa. Code 211.10(d) Resident care policies FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395321 If continuation sheet Page 4 of 11 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 395321 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rydal Park of Philadelphia Presbytery Homes, Inc 1515 the Fairway Rydal, PA 19046 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on the review of the clinical record an interviews with staff it was determined that the facility failed to ensure complete and accurate resident assessments for one out of 28 residents reviewed (Resident R12) Residents Affected - Few Findings Include: Review of the July 2023 physician orders for Resident R12 included the following diagnosis: irritable bowel syndrome; hypertension (high blood pressure); osteoporosis (a disease that weakens the bones), and depression (a mood disorder that causes a persistent feeling of sadness and loss of interest). During an observation on July 10, 2023, at 11:12 a.m. Resident R12 was observed in her room during an interview. Review of the Quarterly Minimum Data Set (MDS-a periodic assessment of a resident's needs) dated November 4, 2022, January13, 2023, and March 30, 2023 indicated that the resident had a restraint (any manual method, physical or mechanical device/equipment or material that is attached or adjacent to a resident's body, cannot be removed easily by the resident and restricts the resident's freedom of movement or normal access to his/her body. Review of the resident's person-centered plan of care and physician orders during the above reference dates and time did not include a physician's order or a person-centered plan of care that Resident R12 care required the use of a restraint. During an interview with the Unit Manager (Employee E, Ros) on July 13, 2023 at 11:40 a.m. reported that that facility has not had to utilize any restraints on Resident R12, and that the MDS coordinator made an error in coding. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395321 If continuation sheet Page 5 of 11 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 395321 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rydal Park of Philadelphia Presbytery Homes, Inc 1515 the Fairway Rydal, PA 19046 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, review of clinical records, and interviews with residents and staff, it was determined that the facility failed to ensure residents received care and services to maintain or improve mobility for two of four residents reviewed for positioning/mobility (Resident R24 and R16). Findings Include: Review of facility policy Restorative Nursing Services revealed residents will receive restorative nursing care as needed to help promote optimal safety and independence. Review of Resident R24's comprehensive Minimum Data Set (MDS) dated [DATE], revealed the resident was cognitively intact and had diagnoses of arthritis (the swelling and tenderness of one or more joints) and difficulty in walking. Interview on July 11, 2023, at 10:55 a.m. with Resident R24 revealed the resident is supposed to be receiving restorative nursing services but it has not been getting completed. Resident R24 reports staff used to walk her in the hallway to the dining room. Review of Resident R24's clinical record revealed the resident received physical therapy services from March 13, 2023, through June 15, 2023. Review of the physical therapy Discharge summary dated [DATE], revealed a restorative ambulation program was developed for Resident R24. Continued review of the discharge summary revealed Resident R24's prognosis to maintain current level of functioning was deemed excellent with participation in restorative nursing program. Review of Restorative Nursing Program Initial Note revealed restorative goals for Resident R24 indicated the resident will ambulate 125-150 feet with rolling walker, stand by assistance, and wheelchair follow. Interview on July 12, 2023, at 1:30 p.m. with Licensed Nurse, Employee E5, revealed Resident R24 was started on the Restorative Nursing Program on June 27, 2023, for walking. Continued interview revealed daily completion of the restorative nursing program gets documented in the resident's electronic medical record. Review of the Activities of Daily Living (ADL) Verification Sheet for the restorative nursing program revealed daily completion of the recommended walking was inconsistent. Between June 27, 2023, and July 12, 2023, staff failed to ambulate Resident R24 on 6 out of 16 days. Interview on July 12, 2023, at 1:55 p.m. with Licensed Nurse, Employee E5, confirmed services for the restorative nursing program were inconsistent. Review of Resident R16's comprehensive MDS dated [DATE], revealed the resident was admitted to the facility on [DATE], was cognitively intact, and had diagnoses of unsteadiness on feet and muscle weakness. Review of Resident R16's clinical record revealed the resident was lowered to the ground on November 14, 2022, during an unsuccessful, one-person assisted transfer from the wheelchair to the bed due (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395321 If continuation sheet Page 6 of 11 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 395321 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rydal Park of Philadelphia Presbytery Homes, Inc 1515 the Fairway Rydal, PA 19046 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 0688 to Resident R16 being unable to stand holding the siderail. Level of Harm - Minimal harm or potential for actual harm Review of Resident R24's clinical record revealed the resident received physical therapy services from September 24, 2022, through October 31, 2022. Review of physical therapy Discharge summary dated [DATE], revealed Resident R16 was deemed appropriate for 1-person physical assistance during transfers and a restorative nursing program was developed for range of motion, standing tolerance, and transfers. Residents Affected - Few Continued review of the discharge summary revealed Resident R16's prognosis to maintain current level of functioning was deemed excellent with participation in restorative nursing program and good with consistent staff follow-through. Continued review of Resident R16's clinical record revealed a physical therapy assessment dated [DATE], that Resident R16 was referred to therapy for a change in functional mobility status and lower extremity strength weakness. Further review of the assessment revealed Resident [R16] reports she has not been out of bed since DC [discharge] from rehab services in 10/31/2022. Review of Resident R16's ADL Verification Worksheet between October 31, 2022, and December 29, 2022, revealed no documented evidence the restorative program for range of motion, standing tolerance, and transfers was initiated as recommended by therapy on October 31, 2022. Interview on July 13, 2023, at 1:36 PM with Employee E2, Director of Nursing, confirmed no documented evidence was available to ensure the restorative nursing program was initiated for Resident R16. 28 Pa. Code 211.12 (d)(5) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395321 If continuation sheet Page 7 of 11 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 395321 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rydal Park of Philadelphia Presbytery Homes, Inc 1515 the Fairway Rydal, PA 19046 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on review of facility policy, observations, and staff interview, it was determined that the facility failed to ensure foods were stored in accordance with professional standards for food service safety and that dishes were cleaned under sanitary conditions. Findings Include: Review of facility policy Food and Supply Storage revealed all food shall be stored in such a manner as to prevent contamination to maintain the safety and wholesomeness of the food for human consumption. Staff should cover, label, and date unused portions and open packages. Foods past the use-by date should be discarded. Further review of facility policy revealed foods should be stored in their original packages. Foods that must be opened must be stored in NSF (National Sanitation Foundation) approved containers that have tight fitting lids. Label both the bin and the lid and hang scoops. Per standards of the United States Department of Agriculture, Food Safety and Inspection Service (Last Updated July 2020), regarding Left Overs and Food Safety revealed leftovers can be kept in the refrigerator for 3-4 days (https://www.fsis.usda.gov/food-safety/safe-food-handling-and-preparation/food-safety-basics/leftovers-and-food-safety#_S Review of facility policy Wash, Rinse, and Sanitize with Three-Compartment Sinks per standards of the Food and Drug Administration (FDA) revealed the third step in the three-sink method is arguably the most important. It ensures that all harmful microorganisms are killed. Chemical sanitizing means you use a chemical solution to kill bacteria. Review of manufacturer guidelines for the sanitizing solution utilized by the facility revealed the sanitizer is considered effective at levels between 200-400 ppm (parts per million). A tour of the Food Service Department conducted on July 10, 2023, at 10:00 a.m. with Employee E4, Food Service Director, revealed the following concerns: Observations in the main kitchen revealed three large plastic ingredient bins, one filled with sugar, one filled with flour, and one filled with rice. The bins were not labeled or dated and the bin with sugar had visible debris in the sugar, the bin with flour had the serving scoop directly in the flour, and the bins were visibly soiled from the outside and required cleanings. Observations of the chef's reach in refrigeration revealed fluid spillage under the stored food on the shelves. Further observations revealed a dark sauce in a reusable container with a use by date of 7/7, Crème Brulé base with a stored/made date 6/24 but no use-by date, pickled ginger in a reusable container with an open date of 6/7 but no use-by date, and cut up fresh lemons that had a slimy appearance in a reusable container with a date of 6/25. Observations of the walk-in refrigeration revealed smoked salmon and a spinach cream sauce in reusable containers with no open or use by dates. The walk-in refrigeration was also noted with debris on the floor. Observations of the 3-compartment sink revealed a dietary employee had just finished utilizing the sink to wash, rinse, and sanitize large pots. Subsequent testing of the sanitizing solution revealed that the sanitizing sink did not have adequate levels of sanitizing solution. When the sanitizing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395321 If continuation sheet Page 8 of 11 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 395321 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rydal Park of Philadelphia Presbytery Homes, Inc 1515 the Fairway Rydal, PA 19046 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 0812 compartment was tested with the sanitizing strips, the solution was less than 200 ppm. Level of Harm - Minimal harm or potential for actual harm Observations were confirmed by Employee E4, Food Service Director, along the duration of the tour. 28 Pa. Code 211.6 (f) Dietary Services Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395321 If continuation sheet Page 9 of 11 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 395321 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rydal Park of Philadelphia Presbytery Homes, Inc 1515 the Fairway Rydal, PA 19046 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm ased on observation, review of policies and procedures, review of the Centers for Disease Control (CDC) guidelines, and interviews with staff, it was determined that the facility failed to maintain an effective infection control program related to the appropriate hand hygiene techniques and cleaning techniques for medical equipment on three of the five Medication Administration Reviews (R26, R34, and R44). Residents Affected - Few Findings include: Review of the guidelines of the Centers for Disease Control and Prevention, for Health Care Disinfection reviewed on May 24, 2019, (https://www.cdc.gov/infectioncontrol/guidelines/disinfection) indicated as follows: Ensure hat workers wear appropriate PPE to preclude exposure to infectious agents or chemicals through the respiratory system, skin, or mucous membranes of the eyes, nose, or mouth. PPE can include gloves, gowns, masks, and eye protection .The exact type of PPE depends on the infectious or chemical agent and the anticipated duration of exposure The employer is responsible for making such equipment and training available. Disinfect noncritical medical devices (e.g., blood pressure cuff) with an EPA-registered hospital disinfectant using the label's safety precautions and use directions Exclude healthcare workers with weeping dermatitis of hands from direct contact with patient-care equipment Clean medical devices as soon as practical after use (e.g., at the point of use) because soiled materials become dried onto the instruments. Dried or baked materials on the instrument make the removal process more difficult and the disinfection or sterilization process less effective or ineffective Disinfect noncritical medical devices (e.g., blood pressure cuff) with an EPA-registered hospital disinfectant using the label's safety precautions and use directions. On July 11, 2023, at 8:51 a.m., during medication administration to Resident R44 , the Charge Nurse, a Licensed Practical Nurse (LPN), Employee E13, used the portable electronic oral thermometer (an instrument programmed to assess the body temperature via mouth), and after detecting the temperature of R44, the LPN withdrew the oral thermometer probe, and pulled out the cover of the probe by her bare hand, allowing to smear her fingers with the remains of mucous membranes of the mouth or the salivary remains of R44, for the reason that the LPN did not protect her hands with the use of gloves. On July 11, 2023, at 8:58 a.m., Employee E13, Licensed Nurse, confirmed the findings. On July 11, 2023, at 8:51 a.m., during medication administration to Resident R44. Employee E13, Licensed Nurse, used the Sphygmomanometer (an instrument for measuring Blood Pressure), without disinfecting it, before and after checking the Blood Pressure of R44. On July 11, 2023, at 8:58 a.m., E13 confirmed the findings. On July 11, 2023, at 9:14 a.m., during medication administration to Resident R26. Employee E9, Licensed Nurse used the Sphygmomanometer, without disinfecting it, before and after checking the Blood Pressure of R26. On July 11, 2023, at 9:47 a.m., E9 confirmed the findings. On July 11, 2023, at 9:37 a.m., during medication administration to Resident R34. Employee E9, Licensed Nurse, used the Sphygmomanometer, without disinfecting it, before and after checking the Blood Pressure of R34. On July 11, 2023, at 9:47 a.m., Employee E9 confirmed the findings. 28 Pa Code 211.12 (d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395321 If continuation sheet Page 10 of 11 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 395321 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rydal Park of Philadelphia Presbytery Homes, Inc 1515 the Fairway Rydal, PA 19046 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 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, and staff and resident interview, it was determined facility did not maintain an effective pest control program so that the facility is free of pests and rodents one one of four units observed (unit 2 East) Residents Affected - Few Findings include: Review of facility's policy 'Pest and Rodent Control,' indicates its purpose is to promote and provide the resources needed to prevent pest and rodent infestation. Review of 'Findings and Observations' from extermination company, for January 2023 through July 2023, revealed the following: On April 25, 2023,Observed numerous dead flies in and around trash room. On April 4, 2023, droppings in dining room are being swept into corners and need to be removed entirely. On March 21, 2023, Serviced 2282 for mice. Resident's closet has too much clutter creating harborage and needs to be cleaned and organized. Trash chute backed up and overflowing into trash room (chute door is wedged open). This needs to be addressed. Caught mouse in trash room. On February 28, 2023, Trash chute still backed up but lid was closed. On February 22, 2023, One mouse caught in trash room tin cat. [NAME] is still overflowing. On February 21, 2023, Trash chute next to kitchen is backed up and garbage overflowing, keeping [NAME] door lodged open. On February 13, 2023, Serviced 2272 for mice. Closet is very cluttered and is creating harborage for mice. Please have belongings removed or organized if possible. On January 24, 2023, Found heavy concentration of droppings in closet of 4251, need to be cleaned up. On January 3, 2023, checked rooms 4254, 4263. Baseboards still not fixed and mice continue to run from room to room. Observations of unit 2 East, on July 11th at 12:00 noon, revealed a mouse running across the hall. Finding confirmed by licensed nurse, employee E9. Interview with licensed nurse, E9, at 12:00 pm, on unit 2 East, revealed that pest issue started in January 2023. Interview on July 11, 2023, at 10:15 a.m. with Resident R91 revealed the resident complained of having mice in her room. Observations revealed the resident had open packages of food on her dresser and nightstand, including a pack of preztels and cookies, that were not stored in air-tight containers. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395321 If continuation sheet Page 11 of 11