Inspection·July 31, 2024

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observation, facility documentation, and clinical record review, as well as staff interviews, it was determined the facility failed to ensure the hot water dispensing machine produced water at a safe temperature resulting in actual harm to Resident R1 who sustained burns on the left thigh and groin, requiring treatment in an emergency room. This resulted in an Immediate Jeopardy, when it was determined that the facility failed to monitor the temperatures of the hot water dispensing machine and facility policy failed to identify hot beverage temperature parameters which had the potential to cause the residents discomfort or pain, to jeopardize the health and safety for 54 residents. Findings Include: Review of Resident R1's clinical record revealed diagnoses including but not limited to the following: Anxiety (intense, excessive and persistent worry and fear regarding everyday situations), Hydrocephalus (accumulation of cerebrospinal fluid (CSF) occurs within the brain typically causing increased pressure inside the skull. Older people may have headaches, double vision, poor balance, urinary incontinence, personality changes, or mental impairment ), and Hypertension (high blood pressure). Review of Resident R1's clinical record including nursing progress note dated July 13, 2024, at 5:20 p.m. revealed the resident spilled hot tea at dinner on her groin and inner thighs. Resident immediately transferred back to her room, placed in bed. Examined. Redness noted to inner thighs, left greater than right. Resident also complained of labial pain after initial exam. RN called on call, transfer to ED for exam. [Daughter] made aware. 911 called for transfer to ED (Emergency Department). [Local Police] Officer arrived and spoke with Resident. EMS arrived and transferred to [local hospital]. Further review of Resident R1's medical record revealed a wound consult from Doctor of Medicine (MD) dated July 16, 2024, indicating 8 Left, Medial Thigh (front) is an acute Partial Thickness Burn and has received a status of Not Healed. Initial wound encounter measurements are 1.8 centimeter (cm) length x 4.5 cm width x 0 cm depth, with an area of 8.1 sq cm. Additional review of Resident R1's clinical record revealed a progress note dated July 13, 2024, at 10:23 p.m. indicating the patient returned from the hospital with a dressing on [resident's] left thigh. Subsequent review of Resident R1's clinical record revealed a progress note dated July 14, 2024, at 11:24 a.m. indicating investigated incident recently of spillage of hot liquid onto resident lap. Resident and eyewitness report that resident was attempting to place 2 sugar packets in cup, while (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 4 Event ID: 395498 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 395498 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wesley Enhanced Living Main Line Rehab and Skd Nsg 100 Halcyon Drive Media, PA 19063 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)