Inspection·May 3, 2024

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 Based on review of facility policy and clinical record review, it was determined that the facility failed to ensure one of 18 residents was treated for constipation in a timely manner (Resident 12). Residents Affected - Few Findings include: Review of facility policy, Bowel Protocol, last reviewed/revised June 2, 2022, revealed: If a resident has not moved their bowels for 6 shifts .the 3-11 charge nurse is to give Milk of Magnesia at [bedtime] to the resident with an order. Review of Resident 18's physician's orders revealed an order dated April 4, 2024, for Milk of Magnesia 400mg/5ml - give 30ml by mouth every 24 hours as needed for constipation. Review of Resident 18's bowel records revealed the resident had no recorded bowel movement from April 22, 2024, through April 26, 2024, for a total of 15 shifts. Review of Resident 18's April 2024 Medication Administration Record revealed the resident was not given Milk of Magnesia until April 27, 2024. Interview with Licensed Nurse Employee E3 confirmed the facility failed to administer Resident 12's Milk of Magnesia after 6 shifts with no bowel movement. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.5(f) Clinical records 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 395329 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 395329 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/03/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE William Hood Dunwoody Care Ctr 3500 West Chester Pike Newtown Square, PA 19073 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)