Health inspection·December 20, 2023

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview held with licensed nurse, Employee E5 on 12:11 p.m. on December 20, 2023. When asked about the incident that occurred with Resident R1 on November 29, 2023 Employee E5, licensed practical nurse stated, I was not really aware when discussed Resident R1's fall. Employee E5 stated there were no reports of her falling during my shift. He stated she was having lower extremity pain during the shift in the area where she had surgery and was given Tylenol for this. [Employee E5] stated that this was to be reported to the nurse in the morning. Review of nursing progress note from November 30, 2023 at 12:41 a.m. for Resident R1 written by licensed practical nurse, Employee E5 states, Resident request for lower extremity pain 5/10. Review of witness statement from licensed nurse Employe E7 I was Resident R1's nurse today. When I did my rounds around 7:15 a.m., she was lying in bed. When I entered the room, she said good morning but didn't complain of any pain. Later, when therapy came, she told them she can not get up because she was in pain. I went to check on her and she stated, I had fall last night and I am in very bad pain. She gave me her pain level 8 but she looked very calm and relaxed from her face. I asked her what exactly happened, she said she was in the bathroom and when she bent over to pull her pants up, she felt severe pain and she lost her balance. There was no documenation of any fall. I went back to ask her if Tylenol the one was given at 6:30 was effective, she said a little bit. She had a whole conversation with me. Her face was not showing signs of pain. Call placed to MD, new recommendations to get x-rays done. MD came and evaluated the resident. Review of witness statement from nurses aide Employee E6 from November 29, 2023 second shift, The resident was toileted around 10:30 p.m As I was bringing her in her room for bed. She replied she needed to go to the bathroom. I transferred her from the wheelhair to the toilet. I stayed with still giving her privacy I was right out the bathroom door. She rang the call bell for assistance I then when and got my [charge nurse, Employee E3] she aided me in pulling her pull up and I didnt want to pull anything then we both transferred her to the wheelchair, the nurse left and I transferred her from the wheelchair to the bed. Review of witness statement from license nurse Employee E3 from November 29, 2023 second shift, Resident received to room [ROOM NUMBER]-A on November 29, 2023 around 8:30 p.m.- 9:00 p.m. from room [ROOM NUMBER]-A. Per report, resident has a wound vac to right hip I need to amen [sic] the the wound vac site therefore at 10:30 p.m. me and [nurses aid Employe E6] assisted resident to toilet. I amended the wound site, and I left the bathroon. After ten minutes [nurses aide Employee E6] call me, that she needs me to pull up reisdent's brief over wound vac, so I went to resident's bahtroom and noted resident was sitting on toilet, me and [nurses aide Employee E6] assisted resident with pulling up her brief over wound vac, and then we placed the resident to her wheelchair. No fall noted or reported during that time the I am aware of. Interview held with Director of Nursing, Employee E2 in regard to licensed nurse, Employee E5 and timeliness of reporting. Employee E2 confirmed the above findings and stated, [licensed practical nurse, Employee E5] was a new nurse and was educated on reported falls and suspected falls. 28 Pa. Code 211.11(c) Nursing services 28 Pa. Code 211.11(d)(1) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395413 If continuation sheet Page 2 of 5 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 395413 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wesley Enhanced Living Pennypack Park 8401 Roosevelt Boulevard Philadelphia, PA 19152 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observations, and staff interviews, it was determined that the facility failed to ensure that a resident receive treatment and care in accordance with professional standards of practice by failing to notify a physician timely of a change in condition. (Resident R1). Residents Affected - Few Findings Include: Review of Resident R1's clinical record revealed that the resident was admitted to the facility on [DATE] with a diagnoses of Raynaud's syndrome (blood vessels in your fingers and toes temporarily overreact to low temperatures or stress) without gangrene, presence of right artificial hip joint, muscle weakness, essential hypertension, rheumatoid arthritis, Sjogren syndrome (a long term autoimmune disease that affects the body's moisture-producing glands) and osteoarthritis. Review of Resident R1's admission Minimum Data Set (MDS) showed a Brief Interview for Mental Staff (BIMS) dated December 12, 2023, revealed that the resident was assessed with severe cognitive impairment. Review of Resident R1's nursing notes dated November 30, 2023 revealed that the resident reported to a nurse that she had a fall last night on November 29, 2023. The resident stated that she was in her bathroom on the toilet, she went to pull up her brief and slipped off the toilet onto the floor. She stated that two nurses came in and picked her up, she described the nurse as small Indian, Employee E3 and the aid was a tall black woman, Employee E4. At this time on November 30, 2023 the resident was assessed and she was alert, moves extremities without difficulty expect her right leg, she had difficulty turning to her side but could lift hip to get on the bed pan. No visible injuries noted, previous bruise noted to right hip/thigh from previous fall/surgery. Review of witness statement from nursing assistant, Employee E6 taken on December 6, 2023 states, I did not witness a fall. When I came in at 11:00 p.m. and started to do my rounds went into her room and she stated that she fell. Told 11-7 nurse. Interview held with nursing assistant on December 20, 2023 at 11:42 a.m. in regard to Resident R1 fall, Employee E6 stated, Working with her 11-7 I came in to do rounds and she was in bed and told me that she had fall on 3-11 around 8:30-9:00 p.m. I then reported this to [the shift supervisor, licensed nurse Employee E5]. The resident mentioned she was in excruciating pain, mentioned an aid picked her up and put her in bed after. I reported this to [the shift supervisor Employee E5 and Resident R1] was given pain medication. Review of witness statement from Employee E5 taken on December 7, 2023 states, I did not received report about her falling. I did give resident Tylenol that she requested for pain to right lower extremity. Resident stayed in bed during shift, she was never transfer in my shift to my knowledge. Review of nursing progress note from November 30, 2023 at 12:41 a.m. for Resident R1 written by licensed practical nurse, Employee E5 states, Resident request for lower extremity pain 5/10. Interview held with licensed nurse Employee E5 on 12:11 p.m. on December 20, 2023. When asked about the incident that occurred with Resident R1 on November 29, 2023 Employee E5, licensed practical nurse stated, I was not really aware when discussed Resident R1's fall. Employee E5 stated that were (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395413 If continuation sheet Page 3 of 5 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 395413 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wesley Enhanced Living Pennypack Park 8401 Roosevelt Boulevard Philadelphia, PA 19152 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few no reports of her falling during his shift. He stated she was having lower extremity pain and was given Tylenol for this. Employee E5 stated that this was to be reported to the nurse in the morning. Review of nursing progress note by licensed nurse Employee E8 from November 30, 2023 at 10:12 a.m. states, Resident reported to charge nurse this morning that she had a fall last night. I interviewed resident and she stated that around 8pm last night while she was in the bathroom on the toilet, she went to pull up her brief and slipped off the toilet onto the floor. She stated that 2 nurses came in and picked her up, she described the nurse as small and the aid was tall, no other description given. She stated, that since then she has had pain in her right hip. Resident is alert, moves extremities without difficulty except right leg. She had difficulty turning to her side but could lift hip to get on bed pan. No visible injuries noted, previous bruise noted to right hip/thigh from previous fall/surgery. Call placed to MD to evaluate right hip complaint of pain. Review of witness statement from licensed nurse Employe E7 I was [Resident R1's] nurse today. When I did my rounds around 7:15 a.m., she was lying in bed. When I entered the room, she said good morning but didn't complain of any pain. Later, when therapy came, she told them she can not get up because she was in pain. I went to check on her and she stated, I had fall last night and I am in very bad pain. She gave me her pain level 8 but she looked very calm and relaxed from her face. I asked her what exactly happened, she said she was in the bathroom and when she bent over to pull her pants up, she felt severe pain and she lost her balance. There was no documenation of any fall. I went back to ask her if Review of witness statement from nurses aide Employee E6 from November 29, 2023 second shift, The resident was toileted around 10:30 p.m As I was bringing her in her room for bed. She replied she needed to go to the bathroom. I transferred her from the wheelhair to the toilet. I stayed with still giving her privacy I was right out the bathroom door. She rang the call bell for assistance I then when and got my charge nurse, [Employee E3] she aided me in pulling her pull up and I didnt want to pull anything then we both transferred her to the wheelchair, the nurse left and I transferred her from the wheelchair to the bed. Review of witness statement from license nurse Employee E3 from November 29, 2023 second shift, Resident received to room [ROOM NUMBER]-A on November 29, 2023 around 8:30 p.m.- 9:00 p.m. from room [ROOM NUMBER]-A. Per report, resident has a wound vac to right hip I need to amen [sic] the the wound vac site therefore at 10:30 p.m. me and [nurses aid Employe E6] assisted resident to toilet. I amended the wound site, and I left the bathroon. After ten minutes [nurses aide Employee E6] call me, that she needs me to pull up reisdent's brief over wound vac, so I went to resident's bahtroom and noted resident was sitting on toilet, me and [nurses aide Employee E6] assisted resident with pulling up her brief over wound vac, and then we placed the resident to her wheelchair. No fall noted or reported during that time the I am aware of. Interview held with Director of Nursing Employee E2 in regards to Employee E5 and timeliness of reporting. Employee E2 confirmed the above findings and stated [licensed practical nurse Employee E5] was a new nurse and was educated on reported falls and suspected falls. An stat x-ray was ordered on November 30, 2023 and completed on December 1, 2023. The x-ray showed a right hip dislocation. The facility failed to notify the physician timely resulting in a delay of care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395413 If continuation sheet Page 4 of 5 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 395413 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wesley Enhanced Living Pennypack Park 8401 Roosevelt Boulevard Philadelphia, PA 19152 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 0684 28 Pa. Code 211.12 (d)(1)(5) Nursing Services Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395413 If continuation sheet Page 5 of 5