Health inspection·July 26, 2024

F 0836 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure the facility is licensed under applicable State and local law and operates and provides services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards. Based on a review of the results of facility water testing for safe drinking water and interviews with laboratory staff and facility staff it was determined the facility failed to comply with requirements from the Environmental Protection Agency (EPA) and Pennsylvania Department of Agriculture and Pennsylvania Drinking Water Information System (PADWIS) in conjunction with the Title 25 Pa. Code Chapter 109 Subchapter C Monitoring Requirements relating to Title 40, Code of Federal regulations 40 CFR. Findings included: According to the PADWIS the facility received violations regarding the failure to monitor/report routine samples for specific contaminates for 30 types of contaminates resulting in a violation for each contaminant on July 23, 2024. Interview with the Certified Water Systems Operator/Laboratory Director on July 26, 2024, at 10:30 AM revealed that the facility was required to have SOC (synthetic organic chemical) testing of their drinking water. The SOC samples were to be performed once every three years during the second quarter of the year. The Lab Director stated that the SOC testing was not completed because the facility did not submit payment for the tests. A review of the facility laboratory results of water testing for the SOC tests revealed that they were last performed on April 20, 2021. As of July 26, 2024, the facility was overdue for the required 2024 SOC testing of the facility's drinking water. Interview with the facility's Chief Operating officer via telephone on July 26, 2024 at 12:30 PM revealed that the facility was making payments to the laboratory for outstanding balances and did not submit an additional payment for the required tests. According to the Commonwealth of Pennsylvania Title 25 Pa. Code § 109.301. General monitoring requirements: (B) The Department may decrease the quarterly monitoring requirement specified in clause (A) provided it has determined that the system is reliably and consistently below the MCL. For an initial detection of a SOC, the Department will not make this determination until the water system obtains results from a minimum of four consecutive quarterly samples that are reliably and consistently below the MCL. (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: 395466 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 395466 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milford Rehabilitation and Healthcare Center 264 Route 6 & 209 Milford, PA 18337 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)