Inspection·July 8, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on facility policy review and clinical record review, it was determined that the facility failed to notify a resident's physician of changes in clinical condition for one of three sampled residents. (Resident 3) Residents Affected - Few Findings include: A review of the facility policy entitled, Notification of Changes, last reviewed November 1, 2023, revealed that staff were to notify the physician and resident representative if there was a change in clinical condition. Clinical record review revealed that Resident 3 had diagnoses that included dementia, difficulty walking, and osteoporosis. According to the pain evaluation documentation during May 2024, the resident had either no pain or a pain rated as a 1 on a scale of one to ten. On May 13, 2024, at 7:30 p.m., a nurse noted that the resident fell and was found on her left side. That night at 11:17 p.m., a nurse noted that the resident's pain was rated a 3. The following morning at 6:03 a.m., the nurse noted that the pain level increased to a 6. At 7:18 a.m., the nurse noted that the resident was having pain in her left hip when she moved. There was no documentation that the facility notified the resident's physician of the increase in hip pain following the fall. 28 Pa. Code 211.12(d)(1)(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: 395409 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 395409 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Liberty Pointe Rehabilitation and Healthcare Ctr 252 Belmont Avenue Doylestown, PA 18901 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)