Health inspection·August 13, 2025

F 0600 Level of Harm - Actual harm Residents Affected - Few indicated that Resident 1 was at risk for alterations in psychosocial well-being. The risk was related to unsettled relationships and conflicts, verbal and physical agitation, and aggression toward other residents and roommates. The care plan documented that Resident 1 had a history of making rude or hostile comments directed toward staff and others, being verbally abusive to roommates, and having previously struck a roommate. These behaviors were identified as being associated with the resident's cognitive impairment and history of substance abuse.A review of a nursing progress note dated August 7, 2025, at 10:35 PM revealed documentation that a fall code had been announced. The note indicated that nursing staff entered Resident 1's room and observed Resident 1 lying on her left side on the floor while yelling out. Resident 2 was documented as ambulating near the doorway of the room. The note further indicated that Resident 1 stated Resident 2 had been in her bathroom, and when she stood from her wheelchair and approached the bathroom, Resident 2 exited and pushed her, causing her to fall. The documentation indicated Resident 1 complained of pain in her left shoulder and hip, with vital signs noted to be stable. Staff separated the residents, initiated neurological checks (series of assessments performed at regular intervals to monitor a resident's nervous system) along with every 15-minute observation checks, notified the physician and guardian, and ordered diagnostic x-rays.A review of facility investigative documentation dated August 8, 2025, at 10:30 AM revealed that the facility classified the incident as physical abuse. The documentation indicated that Resident 1, identified as the victim of the aggression, was in her room when Resident 2, identified as the aggressor, exited the bathroom, pushed Resident 1, and caused her to fall to the floor. Resident 1 was noted to have called for help, and staff responded to find her sitting on the floor. Resident 1 was assessed, assisted to bed, and complained of pain in her left shoulder and left hip. The documentation further indicated that the residents were separated. Both residents placed on every 15 minute observation checks. The physician and resident representatives were notified, and x-rays were ordered. The documentation reflected that the incident was reported to appropriate protective authorities, and an abuse investigation was initiated by the facility.Resident 1 was transferred to the emergency department on August 8, 2025, where she was diagnosed with an acute (sudden) fracture of the left humeral neck (upper arm bone, near the shoulder joint) and an acute fracture of the left femoral neck (upper portion of the thigh bone). Review of the x-ray report dated August 8, 2025, revealed Resident 1 sustained an acute, displaced (bone moves out of normal alignment),transverse (type of bone break where the fracture line runs horizontally across the bone) fracture through the neck of the proximal femur and an acute, displaced, comminuted (bone breaks into three or more pieces) fracture through the neck of the proximal humerus as a result of the fall. On August 10, 2025, Resident 1 underwent a left hip hemiarthroplasty (surgical procedure where only the femoral head [the ball portion of the hip joint] is replaced with a prosthetic implant). At the time of the survey ending August 13, 2025, Resident 1 remained hospitalized . The above findings regarding the incident and the facility's classification of the event as physical abuse were reviewed with the Nursing Home Administrator on August 13, 2025, at 10:45 AM.This deficiency was cited as past non-compliance.The facility's corrective action plan included the following:1. Resident obtained a fracture from a resident-to resident altercation over the bathroom.2. Director of Nursing (DON)/designee to conduct an audit to identify residents with wandering behaviors. Those identified will have individualized interventions implemented with care plans updated. Residents will be discussed at weekly IDT (Interdisciplinary Team) meetings. 3. DON/designee to educate the nursing staff on the Abuse Policy and behavioral intervention suggestions to assist staff with re-directing behavioral residents. 4. DON/designee to conduct random weekly audits on residents with wandering behaviors to implement individualized interventions weekly (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395464 If continuation sheet Page 2 of 3 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 08/13/2025 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)

F 0600 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete x 4 weeks then monthly x 2 months. Results will be reviewed at monthly QAPI. The facility's compliance date was August 11, 2025, and completion of the corrective action plan noted above was confirmed during the survey ending August 13, 2025. 28 Pa. Code 201.14 (a) Responsibility of licensee 28 Pa. Code 201.18 (e)(1) Management 28 Pa. Code 201.29 (a)(c) Resident Rights 28 Pa. Code 211.10(d) Resident care policies. 28 Pa. Code 211.12 (c)(d)(5) Nursing Services Event ID: Facility ID: 395464 If continuation sheet Page 3 of 3