Health inspection·March 3, 2025

F 0600 Further review of Resident R1's care plan revealed an intervention, dated February 2, 2025, for the resident to have quarter side rails for mobility and repositioning. Level of Harm - Actual harm Residents Affected - Few Review of Resident R1's Lift Transfer Evaluation, dated February 3, 2025, revealed the resident weighed 365 pounds and the resident required extensive/total assistance to turn/reposition in bed of more than two staff. Review of facility documentation, submitted to the Pennsylvania Department of Health on February 11, 2025, at 2:48 p.m. revealed on February 10, 2025, Resident R1 rolled out of bed and fell to the floor while Employee E4, nurse aide, was providing care. Resident R1 was subsequently transferred to the hospital. The hospital evaluation revealed Resident R1 sustained a left humerus fracture (breakage of the upper arm bone) and a T11 wedge compression fracture (breakage of the spine bone between the upper and lower back areas). The facility substantiated neglect and terminated Employee E4, nurse aide. Continued review of the facility documentation revealed a written statement from Employee E4, nurse aide, dated February 10, 2025, which indicated, [Resident R1] fell off the bed when I gave (him/her) care, it was about 7:30 p.m. When I finished to clean one side of (his/her) body, then (he/she) tried to roll onto the other side (he/she) fell with the side rail of the bed. I immediately called the charge nurse and the supervisor to let them know about the incident. Continued review of facility's documentation revealed an interview statement, dated February 11, 2025, in which Employee E4, nurse aide, stated to the Director Nursing, I went to change [Resident R1], (he/she) can roll (himself/herself) over and grab side rail. I was changing (him/her) and asked (him/her) to roll to left side, (he/she) quickly rolled over, grabbed the siderail and (he/she) kept going, rolling off the bed onto the floor. Employee E4, nurse aide, continued, I do (him/her) myself cause (he/she) can roll over. Employee E4, nurse aide, confirmed to the Director of Nursing the employee did not have anyone with him while he was providing care to Resident R1. Review of Employee E4's personnel file revealed that Employee E4 was hired by the facility as a nurse aide on March 13, 2012. Review of the facility job description for nurse aides revealed, nurse aides assist residents with activities of daily living and implement care according to residents' care plans. Continued review of Employee E4's personnel file revealed the employee completed Safe Resident Handling training on July 25, 2024. Review of Resident R1's hospital records, dated February 18, 2025, revealed the resident was admitted to the hospital on [DATE], after having a fall from bed. The hospital records indicated the resident sustained three injuries as a result of the fall: left humerus fracture, T11 wedge compression fracture and right shin contusion (type of hematoma - collection of blood under the skin). Continued review revealed the resident was not allowed to apply any weight to the left arm due to the humerus fracture and the resident had to remain on bedrest due to the T11 fracture. Review of Resident R1's wound consultant evaluation, dated February 19, 2025, revealed the resident was assessed for the wound on his right shin (contusion). The wound consultant noted the wound was a complicated hematoma that encompassed the lateral (side) calf. The hematoma had evidence of extravasation (leakage from blood vessels causing damage to the surrounding tissues) and visible eschar (dead tissue) with moderate oozing of sanguinous drainage (blood), moderate amount of induration (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395342 If continuation sheet Page 2 of 3 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 395342 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hopkins Center 8100 Washington Lane Wyncote, PA 19095 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 0600 Level of Harm - Actual harm (hardening of the skin) and fluctuance (fluid under the skin) with concern for expansion. The wound consultant recommended to send the resident to the hospital for urgent surgical and vascular evaluation out of concern for vascular compromise due to the size and expansion of the hematoma. The resident was subsequently transferred to the hospital and returned to the facility on February 24, 2025. Residents Affected - Few Review of Resident R1's wound consultant evaluation, dated February 26, 2025, revealed the resident was assessed for the wound on (his/her) right shin. The wound consultant noted the hematoma continued with evidence of extravasation, eschar, oozing of sanguinous drainage, induration and fluctuance. The wound consultant recommended wound care consisting of Xeroform (non adherent dressing), absorbent pad, kling and ace wrap from toes to knees to provide compression and to monitor the area for vascular compromise. Interview conducted on March 3, 2025, at 9:32 a.m. with Resident R1 confirmed that (he/she) fell from bed while Employee E4, nurse aide, was providing care. Resident R1 also confirmed Employee E4, nurse aide, provided the care by alone and no other staff were present in the room to assist with care or repositioning. Resident R1 confirmed the injuries to (his/her) arm, back and shin were caused by the fall. Facility documentation and details of the incident were reviewed with the Director of Nursing on March 3, 2025, at 1:30 p.m. The Director of Nursing confirmed the facility substantiated the incident as neglect and terminated Employee E4, nurse aide. The facility failed to ensure that Resident R1 was free from neglect during provision of care, which resulted in actual harm to Resident R1 who fell out of bed, required transfer to the hospital and sustained fractures to the left humerus, and to vertebrate T11 of the spine and a contusion to the right shin. 28 Pa Code 201.18(b)(1) Management 28 Pa Code 211.10(d) Resident care policies 28 Pa Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395342 If continuation sheet Page 3 of 3