Health inspection·May 2, 2025

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Based on interview with staff and review of facility provided documentation, it was determined facility did not notify Long Term Care State Ombudsman of facility-initiated discharges for two of six months reviewed. (November 2024 and December 2024) Findings include: Review of facility policy 'Discharge and Transfer,' revised on March 24, 2025, indicates that copies of notices for emergency transfers must also be sent to the ombudsman, but they may be sent when practicable, such as in a list of patients on a monthly basis or per state requirements. Review of facility provided documentation revealed that facility's Social Services, Employee, E9, e-mailed long term care ombudsman on February 3, 2025 at 12:15 pm - forwarding monthly discharges from November 2024 - January 2025 stating I have been sending the discharges to another e-mail address which kept bouncing back. Review of e-mail response from Long Term Care Ombudsman on February 3, 2025, at 12:24 pm, revealed that only January 2025 and February 2025 notices are acceptable at this point and anything earlier, there's not much we can do for the resident. Please forward notices on monthly basis. 28 Pa Code 201.14(a)Responsibility of licensee 28 Pa Code 201.18(b)(2)Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395481 If continuation sheet Page 2 of 9 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 395481 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillcrest Center 1245 Church Road Wyncote, PA 19095 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record reviews, interviews with staff and reviews of policies and procedures, it was determined that the interdisciplinary care team failed to update or revised the care plan for activities of daily living for one of two residents reviewed. ( Resident R90) Findings include: Review of the policy titled Center Policies and Operations revealed that it was the interdisciplinary care teams' responsibility to revise and implement a care plan for each resident. The care plan was developed for each resident to attain their highest practicable physical, mental and psychosocial well being. The care plan for each resident was to indicate any services and treatments to be administered for the resident to achieve measurable goals of care. Clinical record review for Resident R90 revealed a quarterly assessment dated [DATE] that indicated this resident was cognitively impaired, and had bilateral upper and lower extremity impairments. The assessment indicated that this resident used a wheel chair for mobility and required maxium assistance provided by staff, for transfers from the chair to the bed and bed to the chair. Interview with the licensed practical nurse, Employee E4 at 11:00 a.m., on May 1, 2025 revealed that Resident R90 had been refusing to get out of bed for a shower or to participate in activities over the last three months. The licensed practical nurse, Employee E4 also mentioned during the interview that Resident R90 has a sister who lives in the facility on the third floor. The licensed practical nurse was planning to invite his sister to a group activity where both resident would be out of bed and socializing with each other as they did in the past. A review of Resident R90's activities of daily living care plan revealed that it was dated February 24, 2025. through March 3, 2025. Resident R90 had no current care plan revision and implementation to reflect a care plan for resident participation in activities and for refusal of showers. Interview with the Director of Nursing, Employee E2, at 10:00 a.m., on May 2, 2025 confirmed the lack of care planning for Resident R90. 28 Pa. Code 211.10(d) Resident care polices 28 Pa. Code 211.12 (c)(d)(1) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395481 If continuation sheet Page 3 of 9 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 395481 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillcrest Center 1245 Church Road Wyncote, PA 19095 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations of care and services, clinical record reviews, and interviews with staff, it was determined that the facility failed to ensure that a physician's order was obtained, for the use of resident care adapted equipment for one of two residents reviewed. (Resident R151) Residents Affected - Few Findings iclude: Review of Resident R151's quarterly Minimum Data Set (MDS- assessment of resident's needs) dated April 22, 2025 revealed that the resident only sometimes responded adequately to simple directions and had severe cognitive impaired. Continued review of the MDS revealed that the resident was functionally impaired on one side with the upper body extremity (shoulder, elbow, wrist and hand) and totally dependent on staff assistance for eating, personal hygiene and putting on and taking off foot wear. Clinical record review indicated that Resident R151 had diagnoses that included: left hemicraniectomy (brain surgery that removes part of the brain to reduce swelling), left sided hemiplegia (weakness to one side of the body) and aphasia (difficulty speaking and trouble understanding). Observations of Resident R151 throughout the days of the survey April 29, 30 and May 1, 2025 revealed that this resident was resting in bed. Observations with Employee E4, licensed practical nurse at 10:30 a.m., on May 2, 2025 of Resident R151's wardrobe and personal belongings confirmed resident care equipment of a (helmet with a buckle chin strap). Review of Resident R151's clinical record revealed that there was no documentation to indicate that the nursing staff obtained a physician's order for the use of adaptive resident care equipment (helmet with [NAME] chin strap) for Resident R151, when she was out of bed to the wheel chair. Interviews with licensed practical nurse, Employee E13 at 10:00 a.m., on April 30, 2025 revealed that Resident R151 wears a helmet when out of bed sitting in the wheel chair. This nurse reported that nursing staff will apply the helmet to the resident's head and secure the chin strap. 28 Pa. Code 211.10(d) Resident care policies 28 Pa. Code 211.12(d)(1)Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395481 If continuation sheet Page 4 of 9 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 395481 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillcrest Center 1245 Church Road Wyncote, PA 19095 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 0699 Provide care or services that was trauma informed and/or culturally competent. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records, staff and resident interviews, it was determined that the facility failed to provide culturally competent, trauma informed care in accordance with professional standards of practice, accounting for the resident's past experiences and preferences in order to eliminate and/or mitigate triggers that may cause re-traumatization of the resident for one of 33 residents sampled (Resident R 73) Residents Affected - Few Findings include: A review of the clinical record revealed that Resident R73 was admitted to the facility on [DATE], with diagnoses panic disorder (episodic paroxysmal anxiety), anxiety disorder, major depressive disorder (loss in pleasurable activities), post-traumatic stress disorder (PTSD), dementia (progressive defenerative disease of the brain), psychotic disturbance, mood disturbance and anxiety. Interviewed with Social Worker, Employee E12 on May 2, 2025, at 11:47 a.m., revealed that the Resident R73's PTSD triggers is unknown by facility. Resident R73's current care plan on February 3, 2025, revealed a care plan for PTSD. Further review of the care plan did not address resident's actual diagnoses/condition of PTSD, identifying the resident's past experiences and possible triggers that may cause re-traumatization. Interview with the Social Worker, Employee E12, on May 2, 2025, at 11:50 a.m. confirmed that Resident R73 care plan for PTSD did not include resident's actual diagnoses/condition of PTSD, identifying the resident's past experiences and possible triggers that may cause re-traumatization. 28 Pa. Code 211.12(c)(d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395481 If continuation sheet Page 5 of 9 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 395481 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillcrest Center 1245 Church Road Wyncote, PA 19095 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 0805 Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Level of Harm - Actual harm Residents Affected - Few Based on review of clinical records, facility policy, dietary guidelines, and interview with staff, it was determined the facility failed to ensure Resident R369 was provided food items congruent with his/her dysphagia diet. This failure resulted in actual harm to Resident R369 who was able to obtain food items incongruent with his/her dietary restrictions, experienced a choking episode, requiring Cardio Pulmonary Resuscitation (CPR), and transfer to the hospital for one of 33 reviewed (Resident R369). Findings include: Review of the facility provided guidelines, Diet and Nutritional Care Manual Dysphagia Advanced (Level 3) or Mechanical (Dental) Soft Diet revealed This diet is used for individuals with mild oral and/or pharyngeal phase dysphagia. Foods that are difficult to chew are chopped, ground, shredded, cooked, or altered to make them easier to chew and swallow. Food should be prepared according to individual tolerance to the food. Any food that are very hard, sticky, chewy, or crunchy should be avoided . Food allowed Grains (Low-fat as appropriate) well moistened biscuits, breads, muffins, pancakes, waffles, etc. (moistened with syrup , jelly, margarine or butter as appropriate for the diet) . Review of facility policy titled Person-Centered Care Plan, revised on October 24, 2025, indicated the purpose is to attain or maintain the patient's highest practicable physical, mental and psychosocial wellbeing, and to promote positive communication between patient, patient representative, and team to obtain the patient's and resident representative input into the plan of care, ensure effective communication, and optimize clinical outcomes. Review of R369's clinical record revealed the resident was admitted to facility on September 28, 2017, with medical history of Vascular Dementia (progressive degenerative disease of the brain), Schizophrenia (mental disease characterized by loss of reality contact), Dysphagia (difficulty swallowing), Anxiety, contracture of left upper extremity, Stroke, and behavioral disturbances. Review of Resident R369's annual Minimum Data Set (MDS- assessment of resident's needs), dated February 6, 2025, indicated the resident was assessed with short and long term cognitive impairment, the resident had poor appetite or overeating and required set up with eating. Review of Resident R369's care plan initiated January 31, 2019 revealed I am at risk for impaired swallowing related to CVA (cardio vascular accident-stroke). Interventions included a dysphagia puree, nectar thick liquids set up supervision all meals. Encourage resident to be seated with other residents who have a similar diet consistency when food is being served. Provide assistance during all meals. Resident will be at 90 degrees upright position/out of bed when swallowing food or drink. Encourage small sips/bites and cue as needed (inititiated April 28, 2022). Monitor for sign/symptoms of aspiration i.e. coughing,watery eyes, choking, moist sounding voice, daily lung checks (inititiated April 28, 2022) and if coughing occurs no food or liquids until coughing resolves. Continued review of Resident R369's care plan revealed a care plan inititiated June 27, 2022 for restorative swallowing. [Resident R369] demonstrates difficulty with swallowing CVA with interventions developed as the resident to consume meals safely without signs and symptoms of aspiration. Continued review of the resident's care plan revealed care plan developed on October 17, 2017, for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395481 If continuation sheet Page 6 of 9 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 395481 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillcrest Center 1245 Church Road Wyncote, PA 19095 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 0805 Level of Harm - Actual harm the resident exhibiting or had the potential to exhibit physical behaviors related to cognitive loss/dementia. Interventions updated on February 18, 2019, included for the resident to maintain a safe distance from other residents during group activities and resident was not to eat meals within arms length of other residents. Residents Affected - Few Review of Resident R369's speech therapy discharge recommendations, completed by speech therapist, Employee E8, on March 6, 2025, at 10:34 a.m., revealed under strategies slow rate of intake, small bites/sips, alternate solids/liquids. Review of Resident R369's April 2025 physician orders revealed an order for advanced dysphagia and nectar thick liquid diet. Review of Resident R369's clinical record revealed that on April 20, 2025, at 3:15 p.m., in dining room on first floor unit, Resident R369 showed signs and symptoms of choking. The Heimlich maneuver (first aide method for choking) was initiated and expelling bolus of undigested and unidentified food. Upon further assessment, resident became pulseless, and CPR (Cardio Pulmonary Resuscitation) was initiated. Review of Resident R369's investigation report dated April 20, 2025, confirmed the resident was in the dining room for an Easter event, received a snack per the resident dysphagia advanced diet, with resident then impulsively grabbed a snack from a tray which was being passed to other residents. Resident began to choke, staff present in the dining room responded. The nurse aide called for nurses and nurses started Heimlich, a code was called and the nursing staff continued CPR and Heimlich. Pulse was 68 BPM (beats per minute - normal pulse 60 to 100 beats per minute) to no pulse and 78% SPO2 (saturation oxygen ratenormal 95%-100%). EMS (Emergency Medical services) was called and responded and were able to get a pulse and obtained blood presure. The EMS took the resident to the ER (Emergency Room). Review of written statement of nurse aide, Employee E11 revealed I came into the dining room around 3:15PM. We had special snacks for the resident for the holiday. I had a tray of hot dogs, about 1/2 inch long, that I was passing around for the resident. I knew [Resident R369] was not able to get them so I gave [resident] an Oatmeal Cream Pie. [Resident] ate it. As I passed (his/her) seat, (he/she) grabbed a small hot dog from the tray and shoved it down (his/her) mouth. I did not leave the tray unsupervised and I did not take my eyes off it. He started making a noise like (he/she) was choking. I immediately tried to open (his/her) mouth and take it out but (he/she) fought me and refused to open (his/her) mouth but I got it open and I placed my finger inside (his/her) mouth and removed about 1/2 inch piece of the hot dog. I yelled to the nurse who was also in the DR (dining room) with me. Review of Resident R369's hospital documentation dated April 21, 2025, revealed patient was intubated on the scene by EMS (Emergency Medical Services), and they noted copious amount of food in patient's airway. Patient underwent 10-15 minutes of ACLS (cardiovascular life support), received epinephrine x 2, and return of spontaneous circulation (ROSC) was achieved. Further review of hospital documentation revealed resident presented with status post out of hospital cardiac arrest secondary to aspiration of food, acute respiratory failure on vent secondary to above, bilateral pneumonia (an infection of the airsacs in one or both lungs) secondary to above, rib fractures on the left secondary to CPR . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395481 If continuation sheet Page 7 of 9 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 395481 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillcrest Center 1245 Church Road Wyncote, PA 19095 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 0805 Level of Harm - Actual harm Residents Affected - Few Review of hospital dietitian/nutrition documentation, dated April 21, 2025, indicated Resident R369 presented to hospital after choking, cardiac arrest at nursing home. Pt (patient) was intubated at scene, large food bolus removed during intubation. Interview with Licensed nurse, Employee E10, on May 1, 2025, at 10:40 a.m., revealed that she was one of the nursing employees who responded to the code on April 20, 2025, during Resident R369's choking incident. Per Employee E10's statement - during intubation process, a mushy white creamy and brownish substance was expelled. Employee E10 further stated the food substance did not have consistency of hot dog and that she was not made aware of this resident choking on a hot dog. Further interview with Licensed nurse, Employee E10 revealed Resident R369 has a history of eating too fast and impulsively grabbing food from other residents' meal trays. The facility failed to ensure Resident R369 was provided food items consistent with his/her dysphagia diet. This failure resulted in actual harm to Resident R369 who was able to obtain foods inconsistent with dietary restrictions, and care plan interventions who then experienced a choking episode requiring CPR, and transferred to the hospital for evaluation and treatment (Resident R369). 28 Pa Code 201.14(a) Responsibility of licensee 28 Pa Code 211.10(c) Resident care policies 28 Pa Code 211.12(c)(d)(1)(3) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395481 If continuation sheet Page 8 of 9 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 395481 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillcrest Center 1245 Church Road Wyncote, PA 19095 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview with staff and review of facility provided documentation, it was determined that facility did not ensure to maintain infection control and prevention practices on one of three units observed (1st floor unit) Residents Affected - Some Findings include: Review of facility policy 'Standard Precautions,' revised on May 1, 2024, instructs employees to handle, transport, and process soiled, used linen in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and avoids transfer of microorganisms to other individuals and the environment. Review of facility policy 'Enhanced Barrier Precautions, (EBP's) revised on December 16, 2024, indicates that EBP's are an infection control intervention designed to reduce transmission of novel or multi-drug-resistant organisms. It employs targeted personal protective equipment (PPE) use during highcontact patient/resident activities. Observations on 1st floor unit, on Wednesday, April 30, 2025, at 9:30 a.m., revealed nurse aide, Employee E6, collected soiled personal laundry from residents' in room [ROOM NUMBER], and transferred soiled personal belongings in three mesh bags by dragging the bags on floor of the unit's hallway to soiled utility room. Review of Resident R8's clinical record on Wednesday, April 30, 2025, revealed a [AGE] year old resident with history of colonized methicillin - resistant staphylococcus aureus (MRSA) and is at risk for sepsis. Review of R8's care plan, revised on February 12, 2025, further revealed interventions for EBP's; Use gown and gloves when performing high-contact activities: dressing, bathing and showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use of a device (e.g.central line, urinary catheter, feeding tube, tracheostomy, or ventilator), wound care (any skin opening requiring a dressing) Observations on 1st floor unit, on Wednesday, April 30, 2025 at 9:15 am, revealed EBP sign in place in Resident R8 without PPE available to staff. Findings confirmed with units charge nurse, Employee E4 at thet time of the observation. 28 Pa Code 211.10(d) resident care policies 28 Pa Code 211.12(d)(5) nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395481 If continuation sheet Page 9 of 9