Health inspection·April 3, 2025

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical record, facility documentation, facility policy and interviews with staff, it was determined the facility failed to protect the resident's right to be free from physical abuse by Employee E1 which resulted in actual harm to Resident R1 who sustained a bruise and hematoma (collection of blood outside of a blood vessel) to right hand and wrist for one of three residents reviewed (Resident R1). Findings include: Review of facility policy titled Abuse Policy, revised 2023, revealed abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. Physical abuse includes, but is not limited to, hitting, slapping, pinching, and kicking. Review of Resident R1's clinical record revealed Resident R1 was admitted to the facility on [DATE] with a diagnosis of Alzheimer's Disease (brain disease that causes memory loss and other cognitive impairment), Hypothyroidism (thyroid gland does not produces enough hormones), and Anxiety disorder. Review of Resident R1's quaterly Minimum Data Set (MDS) assessment (mandated assessment of a resident's abilities and care needs), dated January 20, 2025, revealed Resident R1 had a Brief Interview for Mental Status (BIMS) score of 4 indicating severe cognitive impairment. Review of Resident R1's care plan, initiated on March 03, 2023, revealed Resident R1 can be resistive to care as evident by refusing care and refusing to get dressed related to Alzheimer's disease and Dementia mild with psychotic disturbance. One intervention included if Resident R1 resists ADL's (activities of daily living), reassure resident, leave and return 5-10 minutes later and try again. Review of Resident R1's nursing note, dated March 21, 2025, at 11:41 a.m, indicated Resident R1 was in the lounge and staff observed a hematoma measuring 4.7 centimeters (cm) x 3.8 cm to right dorsal (back) hand. Area is tender to touch and purple in color. Resident frequently attempts to self transfer from bed and from wheel chair. Resident at times can be combative with staff during care, (she/he) will attempt to swat away and refuse care. Provider notified of new finding. Review of Resident R1's physician note, dated March 21, 2025, at 2:13 p.m., revealed physician assessed Resident R1's hematoma on right hand and wrist. Hematoma measured 7 to 8 cm in diameter, raised, and slightly tender to touch. Continued review of physician note dated March 21, 2025, revealed it was reported Resident R1 was (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: 395473 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 395473 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pennswood Village Route 413 Newtown, PA 18940 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)