Inspection·April 4, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on a review of the facility's policy, clinical records review, and staff interview, it was determined that the facility failed to notify the physician of a change in the condition of a resident's urinary status for one of the three residents reviewed (Resident 39). Findings include: A review of the facility's policy titled Change in Resident status Notification, revised on May 17, 2023, revealed that the charge nurse will notify the resident's physician or on-call physician when there has been a significant change in the resident physical/mental/emotional condition, and a need to alter the resident's medical treatment. Notification will be made promptly with the exemption of non-emergency incidents on the 11-7 shift. Notification of non-emergent incidents on the 11-7 shift may be passed on to the 7-3 shift for a morning notification. Clinical record review revealed Resident 39 had an Indwelling Urethral Catheter (A thin, flexible tube inserted into the bladder through the urethra to collect and drain urine) for diagnosis of urinary retention and neuromuscular dysfunction of the bladder. A review of the Resident laboratory report dated March 5, 2025, revealed a normal WBC (White Blood Cell count) result (Normal range 4.8-10.8). (a blood test that measures the number of white blood cells in your blood, helping to identify infections, inflammation, and other conditions.) A review of the nursing progress notes dated March 9, 2025, at 1:47 a.m., revealed that during the start of the shift, resident's family member reported feeling something was off with the resident. Further assessment revealed no urine output in the urine drainage bag, but the resident's brief was wet twice. The same note revealed that the catheter (tube) was outside the body more than normally should be. The same note revealed the following, Indwelling cath (catheter) removed and new 18Fr/10cc (size of the tube) placed with immediate frank red bloody urine, then odorous amber colored urine, ending with tan sludge - 1700 cc. The responsible party was notified. The review of the clinical records failed to reveal that the physician was notified of the significant change in the resident's urinary status and change in the condition of urine. A review of the physician's note dated March 13, 2025, at 4:55 p.m., revealed that during the visit, the resident was noted to be somnolent (sleepy, lethargic, drowsy), not as vocal as his baseline. The condition was discussed with the wife and nursing, urine, and blood work was ordered. A review of Resident 39's blood work dated March 15, 2025, revealed WBC was 21.6 and the urine had (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 5 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 04/04/2025 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)