Health inspection·January 30, 2025

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, review of facility policies, review of facility documentation, clinical record review and interviews with staff, it was determined that the facility failed to maintain an effective infection control program related to Respiratory Precautions for one resident on respiratory precaution of seven residents reviewed (Resident R122). Residents Affected - Few Findings include: Review of facility policy on Enhance Respiratory Precaution reveled that under section PURPOSE: To prevent transmission of emerging or highly pathogenic infections spread by means of respiratory route. Under section POLICY: Any patient known or suspected to have an infection with an emerging or highly pathogenic organism that may be transmitted by means of the respiratory route shall be placed on Enhanced Respiratory Precaution. Section GENERAL SCOPE OF PRACTICE: #D. Personal Protective Equipment (PPE); Prior to entering the room, staff shall perform hand hygiene and then don appropriate respiratory protection (N95- a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles or PAPR-Powered Air Purifying Respirator), isolation gown, gloves and eye protection. prior to exiting the room, staff shall remove gown and gloves and perform hand hygiene. Review of Resident R122's clinical record revealed that Resident R122 was admitted to the facility on [DATE], with diagnoses of but not limited to: COVID+, Hemiplegia/Hemiparesis, Diabetes Mellitus. Medication observation conducted on January 29, 2025 at 8:55 a.m. with licensed nurse, Employee E3 for Resident R122 revealed that Resident R122 had a diagnoses of covid19 and was in and enhanced respiratory precaution. Further observation revealed that the door to Resident R122's room had a signage for Red Zone and Signage for Enhanced Respiratory Precaution with instructions on the signage as follow: hand Hygiene, N-95 or PAPR, Eye/Face protection, Gown and gloves, dedicated disposable equipment, disinfect reusable equipment. Further observation revealed that while outside Resident R122's room (Room # 305), Employee E3 donned, gown, gloves and N-95 mask, and proceeded to go inside Resident R22's room and spoke with Resident R122. Further observation revealed that Employee E3 came out of Resident R122's room wearing the N-95, gown and gloves. She proceeded to remove the gloves and discard it in the garbage bin attached to the medication cart which was parked outside of Resident R122's room. Further, Employee E3 did not remove the gown. Employee E3 then proceeded to prepare Resident R122's medication, while standing outside of Resident R122's room still wearing the PPE's that she wore inside Resident R122's room. Further observation revealed that after preparing the medications for Resident R122, Employee E3 then walked towards Room # 304 which was next to Resident R122's room, still wearing the same gown she wore inside resident R122's room and proceeded to take gloves which were in a bin on the wall located outside the door or Room # 304. Employee E3 then donned the gloves, walked back towards the medication cart, proceeded to take the medications that she prepared and went inside Resident R122's room and administered her medications. Interview with the Licensed nurse, Employee E3 conducted after she came out of the room confirmed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395515 If continuation sheet Page 2 of 3 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 395515 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Willowcrest Albert Einstein Med Ctr Philadelphia, PA 19141 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few that she did not remove and discard the gown when she entered Resident R122's room and that she continued to wear the same gown while prepping the medications and walking in the hallway to get a clean pair of gloves. Interview with Infection control manager, Employee E4 and Infection Control Nurse, Employee E5 conducted on January 29, 2025 at 10:26 am during infection control interview revealed that staff must don N-95 mask, eye protection, surgical gown and gloves prior to entering a room occupied by a patient on Enhanced Respiratory Precaution, and that staff must remove and discard the gown and gloves, before exiting the room. 28 Pa Code 201.14(a) Responsibility of licensee 28 Pa Code 201.18(d) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395515 If continuation sheet Page 3 of 3