Inspection·December 7, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of clinical record and staff and resident interviews, it was determined that the facility failed to ensure that residents were provided with showers for one of eight residents reviewed (Resident R1). Residents Affected - Few Findings include: Review of Resident R1's clinical record revealed that Resident R1 was admitted to the facility on [DATE]. Further review of Resident R1's clinical record revealed that Resident R1 had the diagnoses of Cerebral Infarction (a condition that occurs as a result of disrupted blood flow to the brain due to problems with blood vessels that supply it. A lack of blood supplies to the brain cells deprives them of Oxygen and vital nutrients which can cause parts of the brain to die off), Hemiplegia (Paralysis of one side of the body)/Hemiparesis (weakness of one side of the body) and Aphasia (a language disorder that affects a person's ability to communicate. It can occur suddenly after a stroke) following cerebral infarction. Review of Resident R1's admission Minimal Data Set (MDS- assessment of resident care needs) dated November 16, 2023, section C - Cognitive Patterns, C0500 (BIMS Summary Score) revealed a score of 15 suggesting that Resident R1 was cognitively intact. Section GG - Functional Abilities and Goals Admission, E. Shower/bathe self: The ability to bathe self, including washing, rinsing, and drying self (excludes washing of back and hair). Does not include transferring in/out of tub/shower was coded 02 indicating that Resident R1 required Substantial/maximal assistance. Further review of Resident R1's clinical record revealed that under section task (documentation completed by the nurse aide) revealed that for the Bathing Task, there was no entry for November 28, 29 and 30. Further, there was no entries for Bed Bath for November 28, 29 and 30 indicating that Resident R1 was not bathed on November 28, 29 and 30, 2023. Further review of Resident R1's clinical record revealed that there was no documented evidence that Resident R1 refused to be bathed or that there was any reason for Resident R1 not being bathed. Interview with Resident R1 conducted on December 7, 2023, at 10:48 a.m. revealed that Resident R1 was not washed regularly. 28 Pa. Code 211.10(d) Resident care policies (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 2 Event ID: 395459 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 395459 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Center 262 Toll Gate Road Langhorne, PA 19047 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)