Health inspection·September 13, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on review clinical records, facility provided documentation, and resident and staff interviews it was determined that the facility failed to provide care in a manner and environment, which promotes each resident's quality and assures each resident is treated with dignity as evidenced by experiences reported by 11 residents out of 20 interviewed (Residents 8, 36, 26, 38, 34, 110, 115, 120, 128, 165, and 166). Findings include: A review of resident clinical records, and a facility provided BIMS (brief interview mental status - to assess cognitive status) report, and random interviews conducted on September 13, 2023, with 20 alert and oriented residents, to include 8 residents residing on the 100 unit, 1 resident residing on the 200 unit, 7 residents residing on the 300 unit, and 4 residents residing on the 400 unit, revealed that 11 residents' interviews voiced concerns regarding staff behavior towards residents and while providing direct care. During interviews the residents relayed that while providing care to residents, nursing staff speak to each other in their primary language of Spanish, which is not the residents primary language and the residents do not understand what is being said between the employees while caring for the resident. The residents stated that this makes them uncomfortable and uneasy because they do not understand the employees and what they may possibly being saying in front of the residents. The residents also reported that nursing staff speak on their personal cell phones while performing direct hands on care to residents. The residents stated that they feel the facility is not adequately staffed because they wait extended periods of time for staff to respond to their requests for assistance, including untimely responses to their requests via the nurse call bell system. Of those residents interviewed on September 13, 2023, 5 of 8 residents residing on the 100 unit, 4 of 7 residents residing on the 300 unit, and 2 out of 4 residing on the 400 unit, expressed similar concerns as described above. Interview with Resident 36 on September 13, 2023, at approximately 9:38 AM, revealed that the resident stated that he believes that the facility could use more help, stating that he waits 30 - 45 minutes for staff to respond to his bell and provide assistance. The resident stated that these waits occur on all shifts of nursing duty. Interview with Resident 8 on September 13, 2023, at approximately 9:50 AM, revealed that the resident stated he waits a pretty long time for staff to answer his call bell at times. The resident stated that these waits occur mostly on 1st shift (dayshift), and that there have been times he has (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 3 Event ID: 395464 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 395464 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Forest Hills Rehabilitation & Healthcare Center 1000 Evergreen Avenue Weatherly, PA 18255 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)