Inspection·January 21, 2025

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 staff interviews, review of facility policy and the review of clinical records, it was determined that the facility failed to assess, monitor and notify the physician regarding an injury of unknown origin for one of two residents reviewed. (Resident R1) Residents Affected - Few Findings include: Review of facility policy on Assessment revealed that under section POLICY: The Center will conduct initially and periodically a comprehensive, standardized, reproducible assessment of each patient's functional capacity. The assessment must accurately reflect the patient's status at the time of assessment. Routine and focused assessments will be performed on an ongoing basis as needed. The assessment process must include direct observation and communication with the patient, as well as communication with licensed and non-licensed direct care staff members on all shifts. Under section PURPOSE: To determine patient's condition and clinical needs. Under section PRACTICE STANDARDS 4. Conduct a change in condition assessment as needed using the eInteract Change in Condition Evaluation. 5. Utilize assessment data to develop the care plan. 6. Notify physician/advanced practice provider (APP) of assessment results as indicated. 7. Document physician/APP notification and response if indicated. Review of Resident R1's clinical record revealed that Resident R1 was admitted to the facility on [DATE]. Resident R1's diagnoses included Cerebral Infarction, Aphasia, Vascular Dementia with other Behavioral Disturbance, and Anxiety Disorder. Review of Resident R1, most recent MDS (minimum data set- a federally required resident assessment completed at a specific interval) dated November 2, 2024, revealed a BIMS (brief interview for mental status) score of 3, indicating severe cognitive impairment. Review of Resident R1's nursing note dated January 9, 2025, time stamped at 12:03 p.m. reveled that Resident R1 was transferred to local hospital for, new onset strabismus left eye. Progress notes (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 01/21/2025 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)