Inspection·February 4, 2026

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of resident records, facility policy, and staff interviews, it was determined that the facility failed to provide discharge instructions and prescription medication upon discharge (Resident R1). Findings:Review of the Facility's Policy titled Discharge Transition Packet Instruction, last revised 6/2025 revealed, The facility will complete discharge transition instruction when the resident/patient is anticipating discharge to a private residence, or personal care/assisted living. The instruction will assist the resident/patient to adjust to returning to his/her previous living environment safely or to a new living environment in a safe manner.A review of the clinical record for Resident R1 revealed a admission date October 14, 2025, with diagnosis of cervical disc degeneration, radiculopathy lumbar, hemiplegia, end stage renal disease, muscle wasting atrophy, difficulty in walking, need for assistance with personal care, chronic diastolic, thrombocytopenia, A review of Resident R1's admission Minimum Data Set (MDS), dated [DATE], indicated a Brief Interview for Mental Status (BIMS) score of 15, reflecting cognitive intact. A clinical progress note dated January 29, 2026, stated that on January 27, 2026, and January 29, 2026, the social worker contacted the resident's family members via email to clarify prior communication and provide follow-up regarding referrals initiated by social services for potential facility-to-facility transfers to other rehabilitation facilities. At that time, Resident R1 had not been accepted for transfer to another facility. Due to the exhaustion of Resident R1's Medicare benefits as of January 29, 2026, and because provisions for an extended stay had not been secured, the facility planned to proceed with discharge on [DATE]. Referrals were initiated for skilled home care services, including physical therapy, occupational therapy, and nursing services. Referrals for custodial home care services could also be made upon request. A post-discharge appointment with Resident R1's primary care provider was to be scheduled. Transportation was arranged for 10:00 a.m. on January 30, 2026.A separate clinical progress note dated January 29, 2026, at 1:42 p.m. revealed that a resident's family member responded that the family had already submitted medical necessity forms on behalf of the resident and that a durable medical equipment (DME) referral from [NAME] was not needed at that time.Another clinical progress note dated January 30, 2026, was written by Licensed Nurse Employee E6, stating that the resident was discharged to home at 9:35 a.m., first going to dialysis and then transferring home. All personal belongings remained at the facility, awaiting family pickup and receipt of discharge instructions and prescriptions.Further review of the clinical file revealed a copy of the discharge summary signed by Registered Nurse Employee E4 on January 30, 2026. The medication section of the discharge summary indicated the following:Glucosamine-Chondroitin oral tablet: 1 tablet by mouth every 8 hours. The last dose was administered on January 30, 2026, at 6:00 a.m., with the next dose due at 2:00 p.m.Auryxia oral tablet 1 g/210 mg (Fe): 1 tablet by mouth three times daily. The last dose was administered on January 30, 2026, at 9:00 a.m., with the next dose due at 2:00 p.m.Gabapentin oral tablet 100 mg: (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 3 Event ID: 395380 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 395380 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/04/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Saunders Nursing and Rehabilitation Center 100 Lancaster Avenue Wynnewood, PA 19096 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)