Health inspection·September 10, 2024

F 0623 Level of Harm - Potential for minimal harm Residents Affected - Some Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility documentation, clinical record reviews, and interviews with staff, it was determined that the facility failed to notify the Office of the State Long-Term Care Ombudsman of facility-initiated emergency transfers as required for six of six records reviewed related to hospital transfers (Residents R4, R7, R8, R9, R10, and R11) Findings include: Review of facility documentation, Transfer Log, received September 10, 2024, revealed a list of residents transferred to the hospital from [DATE], through September 9, 2024. Review of facility documentation Transfer Log revealed Resident R7 had an unplanned transfer to the local hospital on March 1, 2024, at 11:00 p.m. for wound evaluation. Review of progress notes for Resident R8 revealed a note, dated April 5, 2024, at 9:30 p.m., which indicated that the resident had pain and numbness of the left arm and was transferred to a local hospital emergency department for evaluation. Review of progress notes for Resident R4 revealed a note, dated May 8, 2024, at 9:49 p.m. which indicated the that the resident had abdominal pain and distended abdomen and was transferred to a local hospital for evaluation. Review of progress notes for Resident R9 revealed a note dated, June 5, 2024, at 11:00 a.m., which indicated that the resident was noted to be lethargic, unable to swallow food or medicine and was transferred to a local hospital for evaluation. Review of progress notes for Resident R10 revealed a note dated, July 5,2024, at 5:17 p.m., which indicated that the resident had abnormal lab results and was transferred to a local hospital for evaluation. Review of progress notes for Resident R11 revealed a note dated, August 2, 2024, at 1:14 p.m., which indicated that the resident had abnormal lab results and was transferred to a local hospital for evaluation. Further review revealed that there was no indication that the Office of the State Long-Term Care Ombudsman was notified of the above facility-initiated emergency transfers Residents R4, R7, R8, R9, R10, and R11. Page 1 of 6 395446 395446 09/10/2024 Ivory Wellness Center 2004 Old Arch Road Norristown, PA 19401

F 0623 Level of Harm - Potential for minimal harm Interview on September 10, 2024, at 3:00 p.m. the Nursing Home Administrator confirmed they were unable to provide evidence that the Office of the State Long-Term Care Ombudsman was not notified in a timely manner as required of facility-initiated emergency transfers. 28 Pa. Code 201.14(a) Responsibility of licensee Residents Affected - Some 28 Pa. Code 201.18(b)(2) Management 395446 Page 2 of 6 395446 09/10/2024 Ivory Wellness Center 2004 Old Arch Road Norristown, PA 19401

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observations, and resident and staff interviews it was determined that the facility failed to provide food and drink that was served palatable temperatures for three of four residents interviewed (Resident R2, R3, and R4). Residents Affected - Few Findings Include: Interview on September 10, 2024, at 1:40 p.m. with alert and oriented Resident R2 revealed the coffee and food is served cold. Interview with September 10, 2024, at 1:42 p.m. with alert and oriented Resident R3 revealed the food is served cold and on September 9, 2024, Resident R3 did not eat lunch because the food was so cold and not palatable. Interview on September 10, 2024, at 1:45 p.m. with alert and oriented Resident R4 revealed the food is always served cold. A test tray was completed during the lunch time meal on September 10, 2024, at approximately 1:25 p.m. with the Food Service Director, Employee E3, which revealed the following temperatures: [NAME] 114 degrees Fahrenheit (F), Baked Chicken 111.8 degrees F, Pureed Ziti 96.3 degrees F, Pureed Vegetable 96.6 degrees F, and Mashed potatoes 100 degrees F. A taste test of the above food items and an interview with the Food Service Director, Employee E3, confirmed the food items were not served at palatable temperatures. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(3) Management 395446 Page 3 of 6 395446 09/10/2024 Ivory Wellness Center 2004 Old Arch Road Norristown, PA 19401

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on review of standards of professional practice, review of facility policy, observations in the food and nutrition department, and interviews with staff, it was determined that the facility did not ensure that food was stored, prepared, and served in accordance with professional standards for food service safety. Findings Include: Review of the 2022 Food Code (a uniform system of provisions that address the safety and protection of food offered at retail and in food service), January 18, 2023 Version by the United States [U.S.] Food and Drug Administration [FDA] revealed epidemiological outbreak data repeatedly identified five major risk factors related to employee behaviors and preparation practices in retail and food service establishments as contributing to foodborne illness which included improper holding temperatures. Time/Temperature Control for Safety Food (TCS) means a food that requires time/temperature control for safety (TCS) to limit pathogenic microorganism growth or toxin formation. Per a review of the 2022 Food Code Time/Temperature control for food safety shall be maintained at 135 degrees Fahrenheit or above. Review of facility policy Food Safety Requirements revised May 2024 revealed Time/Temperature control for Safety (TCS) refers to food that requires time/temperature control for safety to limit the growth of pathogens or toxin information. Potentially hazardous foods require proper holding temperatures to reduce the rapid and progressive growth of illness producing microorganisms, such as Salmonellae (a group of bacteria that can cause gastrointestinal illness and fever) and Clostridium botulinum (organisms that may grow in foods producing toxins and, when consumed, can result in a severe form of food poisoning). Review of facility policy Food Preparation and Handling revised December 1, 2021, revealed it is the policy of the facility to ensure all food served by the facility is of good quality and safe for consumption, all food will be prepared and handled according to the current Federal and State Food codes and HACCP [Hazard Analysis and Critical Control Point] guidelines. Further review of facility policy revealed all hot foods must be held at 135 degrees Fahrenheit. Interview with the Food Service Director, Employee E3, on September 10, 2024, at 12:10 p.m. revealed the steam tables in the main kitchen were broken. Observations during the lunch time meal service on September 10, 2024, at 12:15 p.m. revealed dietary staff utilized a tray line meal system and plated resident meal trays in the main kitchen before delivering trays to the residents in their rooms. Observations confirmed the steam tables were broken and not being used. Continued observations revealed a flat top griddle directly next to the gas burners. On top of the flat top griddle staff had a large stainless steel steam table pan filled with hot water. Inside the large pan were six smaller pans filled with pureed foods items and baked regular chicken. Holding temperatures of the food was taken with the Food Service Director, Employee E3, on September 10, 2024, at 12:30 p.m. which revealed the following: Chicken 80 degrees Fahrenheit (F), Mashed 395446 Page 4 of 6 395446 09/10/2024 Ivory Wellness Center 2004 Old Arch Road Norristown, PA 19401

F 0812 Level of Harm - Minimal harm or potential for actual harm potatoes 129 degrees F, Gravy 115 degrees F, [NAME] 133.2 degrees F, Pureed Ziti 112 degrees F, Pureed Vegetable 110 degrees F. Interview on September 10, 2024, at 12:30 p.m. with the Food Service Director, Employee E3, confirmed the holding temperatures of the food should be at 135 degrees F for food safety purposes. Residents Affected - Many Interview on September 10, 2024, at 12:35 p.m. with the Cook, Employee E4, revealed the above food items were not maintained at appropriate holding temperatures because the griddle being used to hold the pans was also broken and not producing any heat to help keep the foods warm. 201.14 (a) Responsibility of licensee. 395446 Page 5 of 6 395446 09/10/2024 Ivory Wellness Center 2004 Old Arch Road Norristown, PA 19401

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observations of the food and nutrition department, and interviews with staff it was determined that the facility failed to ensure that essential mechanical dietary equipment was in safe operating condition. Residents Affected - Many Findings include: Interview with the Food Service Director, Employee E3, on September 10, 2024, at 12:10 p.m. revealed the steam tables in the main kitchen were broken. Continued interview with the Food Service Director, Employee E3, revealed the steam table has been broken since June 2024. Observations during the lunch time meal service on September 10, 2024, at 12:15 p.m. revealed dietary staff utilized a tray line meal system and plated resident meal trays in the main kitchen before delivering trays to the residents in their rooms. Observations confirmed the steam tables were broken and not being used. Continued observations revealed as an attempt to keep trays of food warm during tray line service, dietary staff had pans of food placed directly on top of the stove top gas burners with the gas burners turned on low. Continued observations revealed a flat top griddle directly next to the gas burners. On top of the flat top griddle staff had a large stainless steel steam table pan filled with hot water. Inside the large pan were six smaller pans filled with pureed foods items and baked regular chicken. Holding temperatures of the food was taken with the Food Service Director, Employee E3, on September 10, 2024, at 12:30 p.m. which revealed the following: Chicken 80 degrees Fahrenheit (F), Mashed potatoes 129 degrees F, Gravy 115 degrees F, [NAME] 133.2 degrees F, Pureed Ziti 112 degrees F, Pureed Vegetable 110 degrees F. Interview on September 10, 2024, at 12:30 p.m. with the Food Service Director, Employee E3, confirmed the holding temperatures of the food should be at 135 degrees F for food safety purposes. Interview on September 10, 2024, at 12:35 p.m. with the Cook, Employee E4, revealed the above food items were not maintained at appropriate holding temperatures because the griddle being used to hold the pans was also broken and not producing any heat to help keep the foods warm. Continued observations in the main kitchen on September 10, 2024, at 12:40 p.m. during tray line revealed staff were utilizing paper cups to serve juice. Subsequent interview with the Food Service Director, Employee E3, revealed the dietary department is unable to purchase enough individual pre-packaged juice cups because one of the refrigerators is down and the kitchen does not have enough refrigeration storage for the juice. Follow-up interview with the Food Service Director, Employee E3, on September 10, 2024, at 2:45 p.m. revealed the steam tables would intermittently stop working starting in June 2024. In the beginning of August 2024 is when the steam tables completely stopped working and were unable to be used. 201.14 (a) Responsibility of licensee. 395446 Page 6 of 6