Health inspection·June 27, 2023

F 0559 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made. Based on clinical record review and resident and staff interviews, it was determined that the failed to provide reasonable notice to a resident in advance of facility initiated room changes and failed to ensure that in preparation for room change each resident/resident representative received written notice, including the reason for the change before the resident's room was changed for two of five sampled residents (Residents A1 and A2). Findings include: Federal regulatory guidance notes that moving to a new room or changing roommates is challenging for residents. A resident's preferences should be taken into account when considering such changes. When a resident is being moved at the request of facility staff, the resident, family, and/or resident representative must receive an explanation in writing of why the move is required. The resident should be provided the opportunity to see the new location, meet the new roommate, and ask questions about the move. Review of the facility admission Packet, provided to each resident upon admission to the facility, indicated that the facility reserves the right and discretion to transfer a resident to another room or bed within the facility, and the right and discretion to transfer residents and resident roommates, if any, at any time consistent with the needs of the facility, subject to resident's rights to roommates of choice where practicable and agreeable to both. At the time of the survey ending June 27, 2023, all beds in the facility were licensed and dually certified for participation in both the Medicare and Medicaid programs. During an interview on June 27, 2023 at 10:00 AM Resident A1, a cognitively intact resident, stated that her room was recently changed and that the facility did not inform her of why her room needed to be changed. Resident A1 stated that she resided in the window bed (which she preferred) in her prior room and was now in the bed by the door. Resident A1 stated that the facility did not provide any written advance notice of the need for her room to be changed. Review of Resident A1's clinical record revealed that the resident's room was changed from the South Hall to the North Hall on June 23, 2023. During an interview on June 27, 2023, at 2:00 PM Resident A2, a cognitively intact resident, confirmed that her room was recently changed. Resident A2 stated that she had no idea why her room needed to be changed. Resident A2 confirmed that she was not provided any written advance notice of the need for her room to be changed. (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 6 Event ID: 395462 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 395462 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookmont Healthcare and Rehabilitation Center 510 Brookmont Drive Effort, PA 18330 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)