Health inspection·August 17, 2023

F 0580 Interview conducted with the Director of Nursing and Nursing Home Administrator on August 17, 2023, at approximately 11:50 a.m. confirmed the above weights were not communicated to the physician. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12(d)(3) Nursing services Residents Affected - Few 28 Pa. Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395454 If continuation sheet Page 2 of 6 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 395454 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkhouse Rehabilitation and Nursing Center 1600 Black Rock Road Royersford, PA 19468 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy and clinical records, it was determined that the facility failed to adequately monitor weight loss for one of seven residents reviewed for nutrition (Resident 277). Residents Affected - Few Findings include: Review of facility policy, Weight Assessment and Intervention, dated February 15, 2022, revealed: Any weight change of greater than or less than 5 pounds within 30 days will be retaken for confirmation. Review of Resident 277's weights revealed on June 23, 2023, the resident was recorded as weighing 134 pounds. On July 7, 2023, the resident was recorded as weighing 125.2 pounds, an 8.8 pound loss or 6.57% loss in two weeks. Review of Resident 277's progress notes revealed a weight change note from the dietitian on July 10, 2023, where the dietitian requested a reweight. Review of Resident 277's weights revealed the next weight taken was not until August 2, 2023. Interview with the dietitian, Employee E4, on August 17, 2023 at approximately 11:30 a.m. confirmed Resident 277's reweight was not obtained in a timely manner. 28 Pa. Code 211.5(f) Clinical Records 28 Pa. Code 211.12(d)(1)(5) Nursing Services 28 Pa Code: 211.10(c) Resident care policies FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395454 If continuation sheet Page 3 of 6 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 395454 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkhouse Rehabilitation and Nursing Center 1600 Black Rock Road Royersford, PA 19468 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based upon review of facility policies and procedures, observation and review of clinical documentation, it was determined the facility failed to ensure fluid restrictions were followed for three out of five dialysis residents reviewed and one resident with a diagnosis of heart failure reviewed (Resident 108, Resident 148, Resident 191 and Resident 298). Residents Affected - Some Findings include: Review of facility policy and procedure titled Dialysis revealed There will be ongoing communication and collaboration between the nursing home and dialysis staff for the development and implementation of the dialysis care plan. Further review of this policy and procedure revealed There will be ongoing communication between the facility and the dialysis center reflected in the medical record. This communication may include but not be limited to: Nutritional/fluid management including documentation of weights, resident compliance with food/fluid restrictions or the provision of meals before, during and/or after dialysis and monitoring intake and output measurements as ordered. Review of facility policy and procedure titled Restricting Fluids, revised April 1, 2022, revealed Verify that there is a physician's order for this procedure. Review the resident's care plan and/or your daily assignment sheet to assess for any special needs of the resident. Further review of this policy and procedure revealed When a resident has been placed on restricted fluids, remove the water pitcher and cup from the room. If the resident refuses to have the water pitcher removed, notify the supervisor and in turn, the physician. Be sure an intake and output record is maintained. Review of Resident 108's diagnosis list revealed diagnoses including acute kidney failure and dependence on renal dialysis (process of removing waste products and excess water from the body). Review of Resident 108's current physician orders revealed an order for Daily Fluid Restriction of 2000 ml (milliliters) daily as follows: Nursing 560 ml/day; 7-3 shift 240 ml; 3-11 shift 240 ml; 11-7 shift 80 ml; dietary daily 1440 ml/day every evening shift 3-11 shift to provide 240 mls. Review of Resident 108's Nutrition-Fluid Task sheet revealed Resident 108 exceeded the daily fluid restriction allotment as follows: July 19, 2023 - 640 ml; July 20, 2023 - 1450 ml; July 27, 2023 - 1360 ml; July 29, 2023 - 980 ml; July 30, 2023 - 940 ml; August 1, 2023 - 820 ml; August 8, 2023 - 1120 ml; August 9, 2023 - 880 ml; August 10, 2023 - 652 ml; August 13, 2023 - 620 ml. Review of Resident 148's diagnosis list revealed diagnoses including heart failure. Review of Resident 148's physician's orders revealed an order for daily fluid restriction of 1500 ml daily as follows: Nursing 7-3 shift 180 ml; 3-11 shift 180 ml; 11-7 shift 180 ml; dietary daily 960 ml. Review of Resident 148's Nutrition-Fluid Task sheet revealed Resident 149 exceeded the daily fluid restriction allotment as follows: August 3, 2023 - 900 ml; August 5, 2023 - 1920 ml; August 10, 2023 - 1320 ml; August 12, 2023 - 1420 ml; August 13, 2023 - 960 ml; August 15, 2023 - 1180 ml. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395454 If continuation sheet Page 4 of 6 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 395454 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkhouse Rehabilitation and Nursing Center 1600 Black Rock Road Royersford, PA 19468 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 0698 Review of Resident 191's diagnosis list revealed diagnoses including dependence on renal dialysis. Level of Harm - Minimal harm or potential for actual harm Review of Resident 191's current plan of care revealed Resident 191 to have a daily fluid restriction from nursing of 540 mls. Residents Affected - Some Review of Resident 191's Nutrition- Fluid Task sheet revealed Resident 191 exceeded the daily fluid restriction allotment as follows: July 20, 2023 - 1280 ml; July 21, 2023 - 930 ml; July 22, 2023 - 1320 ml; July 26, 2023 - 720 ml; July 27, 2023 - 980 ml; July 28, 2023 - 660 ml; July 29, 2023 - 980 ml; July 30, 2023 - 940 ml; August 1, 2023 - 960 ml; August 2, 2023 - 640 ml; August 4, 2023 - 716 ml; August 8, 2023 - 1020 ml; August 13, 2023 - 600 ml. Review of Resident 298's diagnosis list revealed diagnoses including dependence on renal dialysis. Review of Resident 298's current plan of care revealed a daily fluid restriction of 540 ml/day allotted to nursing. Review of Resident 298's Nutrition-Fluid Task sheet revealed Resident 298 exceeded the daily fluid restriction allotment as follows: July 18, 2023 - 700 ml; July 21, 2023 - 1000 ml; July 22, 2023 - 840 ml; July 23, 2023 - 1150 ml; July 24, 2023 - 1150 ml; July 26, 2023 - 600 ml; July 27, 2023 - 1160 ml; July 29, 2023 1080 ml; August 8, 2023 - 1080 ml; August 9, 2023 - 960 ml; August 10, 2023 - 752 ml; August 12, 2023 1400 ml; August 13, 2023 - 600 ml; August 14, 2023 - 660 ml. Observation of all resident rooms mentioned above revealed multiple cups of fluid and assorted beverages on the residents' bedside tables. Interview with the Regional Clinical Nurse on August 16, 2023, at 11:00 a.m. confirmed that the milliliters listed on residents' Nutrition-Fluid Task sheet contains only the milliliters consumed and recorded by the nursing department and does not include any fluids consumed or maintained by the dietary department. The above information was conveyed to the Nursing Home Administrator on August 17, 2023, at 11:00 a.m. The facility failed to ensure residents on fluid restrictions adhere to the fluid restrictions as set forth in either the residents' physician orders or current plan of care to enable them to maintain an adequate fluid balance. 28 Pa. Code 211.12(a)(c)(d)(1)(2)(3)(5) Nursing Services Previously cited 9/21/2022, 10/12/2022, 2/6/2023, 3/22/2023 FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395454 If continuation sheet Page 5 of 6 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 395454 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkhouse Rehabilitation and Nursing Center 1600 Black Rock Road Royersford, PA 19468 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on Observations and staff interview it was determined the facility failed to dispose of trash properly. Findings Include: Residents Affected - Many Observation of the trash compacter area on August 14, 2023 at 10:00 a.m. revealed two large construction dumpsters overloaded with bags of trash that was uncovered. Observations around the loading dock on August 14, 2023 at 10:00 a.m. revealed a large cart overflowing with bags of trash and approximately 15 bags of trash laying on the ground next to the loading dock. Interview with dietary employee E3 at the time of the observations revealed the trash compactor had been broken for a week and the dishwasher had broken on August 11, 2023 requiring the facility to use Styrofoam for meals and increasing the amount of trash. 28 Pa. Code: 201.18(b)(3) Management 28 Pa. Code 211.6(d) Dietary services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395454 If continuation sheet Page 6 of 6