Health inspection·January 2, 2024

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. Based on observations, interviews, and review of facility policy, it was determined that the facility failed to allow the ability to form anonymous grievances for all residents on two of two nursing units. (Second Floor, Third Floor) Findings Include: Review of facility policy titled Grievances/Complaints, Filing with no revision date states, Residents and their representatives have the right to file grievances, either orally or in writing, to the facility staff or to the agency designated to hear grievances (e.g., the State Ombudsman). The policy states, 4. Grievances and/or complaints may be submitted orally or in writing, and may be filed anonymously. Resident council was held on December 27, 2023 at 10:30 a.m. eight awake, alert, and oriented residents shared during resident council that the did not know who the grievance official was or who they could go about filling an annonymous complaint. A tour was taken on December 27, 2023 at 1:23 p.m. with Nursing Home Administrator Employee E1. During the tour it was determined that on all three floors there was no access to forms to file anonymous grievances. The facility had been under construction for the past several months, and the spot for grievance forms was not put back up during the re-construction process. (Floor one, floor two, floor three). Review of the the facility grievance form provided by the facility titled Grievances/Complaints, Filing revealed the facility's grievance form did not have a space where you can include a spot for someone to fill out the form as anonymous. Review of the facility grievance log from the past six months revealed no grievances were filed annonymously. 28 Pa. Code 201.29(b) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395483 If continuation sheet Page 2 of 7 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 395483 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Markley Rehabilitation and Healthcare Center 550 East Fornance Street Norristown, PA 19401 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on observation, review of resident's clinical records, review of facility policies and interviews with staff, it was determined that the facility failed to ensure physician's wound care recommendations to prevent and/or promote the healing of pressure injuries were followed for one of three residents reviewed with pressure ulcers (Resident R51). Residents Affected - Few Findings include: Review of the facility's policy for Prevention of Pressure Injuries revised on April 2020 was to identify pressure injury risk factors and develop specific interventions designed to reduce or eliminate the risk of pressure injury and develop a care plan to address the resident's needs and risk factors. Conduct a comprehensive skin assessment upon admission and daily skin assess to identify signs of developing pressure injuries. The policy states to inspect pressure points (sacrum, heels, coccyx etc.), reposition all residents, with or at risk of pressure injures, and select appropriate support surfaces for pressure redistribution in accordance with current clinical practice. Furthermore the policy states to monitor, evaluate, report and document changes in the skin, review the interventions and strategies for effectiveness on an ongoing basis. Review of Resident R51's admissions Minimum Data Set (MDS- assessment of resident's needs) dated October 25, 2023, indicated the resident was alert and oriented. Continued review of the assessement revealed that the resident was diagnosed with anemia (low red blood cells), heart failure, high blood pressure, peripheral vascular disease (circulation disorder), renal insufficiency (kidney failure), obstructive uropathy (obstructed urinary flow), urinary tract infection, and diabetes mellitus. The resident needed substantial assistance with bed mobility, toileting, and moderate assistance with the wheelchair for ambulating. Further review of the MDS indicated two pressure ulcers were present on admission; a Stage II pressure ulcer (a partial thickness loss to dermis, red/pink wound bed, presenting as a shallow open ulcer ) and a Stage III pressure ulcers (full thickness tissue loss and depth of the tissue is not obscured). Review of Resident R51's nursing progress note, dated October 22, 2023, indicated on admission the resident's skin was observed with multiple scabs . abscess to left axilla, stage 3 pressure ulcer to right inner ankle, stage 2 pressure ulcer on the sacrum, and Boggy Heels (a precursor to pressure ulcer development ). Review of Resident R51's clinical record revealed that the resident was seen weekly by a wound specialist. Review of the initial visit, dated October 23, 2023, assessed, and documented the resident with a Stage II pressure ulcer on the resident's coccyx and a Stage Three pressure ulcer on the right ankle. Further review of the wound assessment did not include the presence of the resident's boggy heels found on admission. Wound specialist recommenced preventative measures to included turning and repositioning the resident and floating the heels (a pressure injury measure implemented to prevent heel wound) while in bed. Review of Resident R51's care plan dated October 23, 2023, for maintaining skin integrity stated to assist the resident in bed with turning and repositioning, daily skin inspections and to report changes during care. Continue review of the resident's care plans included interventions to administering treatments as ordered, monitor for effectiveness, to report new or worsening symptoms of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395483 If continuation sheet Page 3 of 7 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 395483 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Markley Rehabilitation and Healthcare Center 550 East Fornance Street Norristown, PA 19401 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few complications and infections to the physician. related to the resident's right heel documented in the care plan as unstageable (a full thickness tissue loss, with unknown depth due to the wound bed covered with eschar or slough, (dead tissue). Review of Resident R51's physician's note dated October 30, 2023, first noted the resident's heels since admission and assessed the Right heel as Red purplish area . appears to have been a blister' with no obvious fluid accumulation noted at this time. The same note classified the wound as a unspecified stage pressure ulcer of the right heel and instructed to offload the area. Review of Resident R51's clinical record did not include physician orders to float heels nor was the resident's care plan updated with this intervention. Further review of the Resident R51's clinical record revealed no documented evidence this order was implemented nor nursing progress notes noting the status of the resident's right heel. On November 6, 2023, wound consult progress note, remarks on Resident R51's right lateral heel as an unstageable pressure injury measuring 4.5 cm x 5. cm x 0.1 cm, wound base 100% eschar (black dead tissue) and scant amount of serous fluid, recommending floating the heels while in bed. Review of Resident R51's Rehabilitation progress notes revealed, on November 13, 2023, the resident said she was directed by the wound care nurse not to be on her feet and walk around due to sores secondary to waiting for sore to heal. On November 17, 2023, the resident was encouraged to participate in gait training, noting the resident had no shoes secondary to waiting for the sore to heal. The note continues that the resident ambulated with maximum encouragement, minimum to no right knee flexion, decreased step length and complained of pain in the knee and foot. On December 4, 2023 wound specialist attempted to debride the wound (remove dead skin to promote healing) but documented the resident Could not tolerate manipulation due to pain and continued to recommend floating the resident's heels. Physician note dated December 5, 2023, stated the resident said she was Resting and taking it easy because of her foot pain and noted there was pain when the resident applied pressure when standing. The same note also indicated to float the resident's heels. Wound specialist on December 11, 2023, made a partial debridement, (because the resident was unable to tolerate the remainder of the procedure). 60% of the wound was debrided noting the wound measured 2.11 x 2.84 x 0.2 cm. Wound consult recommended to float heels while in bed. On December 11, 2023, Resident R51's care plan was updated to included pressure reducing chair cushion and mattress due to the resident's impaired mobility, incontinence, and weakness. On December 15, 2023, the care plan was updated to evaluate, and document healing progress, and to report significant changes and declines to the resident's right heel. Further review of the resident's clinical record revealed no documented evidence that the intervention to off-load the heels was implemented or care plans noting this intervention. December 16, 2023, Resident R51 refused the daily nursing wound care. On December 18, 2023, the resident declined further debridement of the wound. Wound specialist stated, 'Per the resident wound had been traumatized during MD (medical doctor) appointment and stated she was not up to that today.' On December 19, 2023, Resident R51's care plan was updated to include an air mattress related to impaired mobility and incontinence. On December 23, 2023, the resident refused for the second time, the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395483 If continuation sheet Page 4 of 7 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 395483 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Markley Rehabilitation and Healthcare Center 550 East Fornance Street Norristown, PA 19401 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 0686 daily nursing wound treatment. Level of Harm - Minimal harm or potential for actual harm Wound specialist on December 28, 2023, noted Resident R51 complained of increased pain in heel, and not feeling well. The resident was educated on the importance of wound care and debridement as infection could result in loss of limb or death. It was noted that the resident agreed to continue with the heel debridement. Wound specialist documented copious amounts of seropurulent drainage (mixture of serum and pus) and documented that the wound measured 4.15 x 3.26 x 0.8 with purulent drainage (pus). The wound specialist ordered the resident to take one 100 milligrams tablet two times a day for fourteen days of doxycycline monohydrate (an antibiotic) for possible wound infection, x-ray of the right foot to rule out osteomyelitis (bone infection) and continued to request the resident's heels were off-loaded. Residents Affected - Few Observartion on December 29, 2023, at 10:55 a.m. the surveyor observed Resident R51's sleeping in bed without the heels being off-loaded as recommended by the wound specialist. Interview with the resident's care nurse since admission, Licensed Practical Nurse, Employee E3 confirmed and stated, We don't off-load her heels, never had and she doesn't have an order for it either. During the survey the Nursing Home Administrator could not reveal documented evidence Resident R51's heels were being off-loaded to prevent and/or promote the pressure ulcer from healing. 28 Pa. Code 211.12(d)(1) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395483 If continuation sheet Page 5 of 7 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 395483 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Markley Rehabilitation and Healthcare Center 550 East Fornance Street Norristown, PA 19401 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 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. Based on observations, interviews with residents and staff, and review of facility policy, it was determined that the facility failed to routinely offer evening snacks to each resident for eight of eight residents reviewed. (Residents R12, R18, R20, R28, R47, R49, R57, R64) Findings Include: Review of facility policy titled, Frequency of Meals and Snacks revised July 2017 states, 5. Nourishing snacks will be available for residents who need or desire additional food between meals. 6. Evening snacks will be offered routinely to all residents. Timing of the snack will consider relevant factors (e.g., individuals with gastroesophageal reflux disease may be advised not to eat close to bedtime). 7. Residents will be offered nourishing snacks if the time span between the evening meal and the next day's breakfast exceeds fourteen (14) hours. Nourishing snacks are items from the basic food groups, offered either separately or with each other. Observation of the third-floor snack/nourishment closet on December 27, 2023 at 12:19 p.m. revealed three half used drinks in freezer frozen and unlabeled. The refrigerator was dirty with crumbs and juice spilled on the bottom surface. In the refrigerator there was one sandwich in the back unlabeled and undated. In the pantry area there was a half-used bag of cookies and chips unlabeled and undated, and four vanilla puddings. Interview during resident council held on December 28, 2023 at 10:30 a.m. with eight residents stated that did not receive snacks at bedtime. (Residents R12, R18, R20, R28, R47, R49, R57, R64) When asked what staff does when they ask for a snack Resident R47 stated that staff would say they would go look and be right back, and then they never come back. Interview with Director of Dining Employee E4 on December 28, 2023 at 11:02 a.m. revealed the facility refills the snack/nourishment closet in the evening each day for the following day. A par list was not printed in the kitchen and Employee E4 had difficulty finding it on her computer. A par list was provided at 11:35 a.m. which listed many items that were not in the snack/nourishment closet when it was observed on December 27, 2023. Review of the HS (bedtime) snack record for the last thirty days for Resident R57 revealed no snack were offered on November 29 or November 30. No snack was offered on December 3, 6, 9, 10, 14, 15, 16, 18, 19, 22, 23, 24, 25, and 27. Review of the HS (bedtime) snack record for the last thirty days for Resident R52 revealed no snacks were offered on November 29 or November 30. No snack was offered on December 1, 6, 8, 11, 13, 14, 16, 18, 19, 20, 21, 23, and 26. Review of the HS (bedtime) snack record for the last thirty days Resident R20 revealed no snacks were offered on December 4, 5, 8, 10, 11, 12, 19, 20, and 24. Review of the HS (bedtime) snack record for the last thirty days Resident R28 revealed no snacks were offered on December 1, 5, 8, 11, 12, 17, 19, 20, and 24. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395483 If continuation sheet Page 6 of 7 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 395483 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Markley Rehabilitation and Healthcare Center 550 East Fornance Street Norristown, PA 19401 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 0809 Level of Harm - Minimal harm or potential for actual harm Review of the HS (bedtime) snack record for the last thirty days for Resident R47 revealed no snacks were offered on December 2, 3, 6, 9, 10, 13, 15, 16, 19, 20, 22, 23, 24, 25, and 27. 28 Pa. Code 211.12 (d)(3)(5) Nursing Services Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395483 If continuation sheet Page 7 of 7