Inspection·March 27, 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 facility policy review, clinical record review, review of facility documentation, and resident interview, it was determined that the facility failed to ensure that residents were free from mental and/or physical abuse for two residents (Residents 1 and 2), which resulted in psychosocial harm for one of seven residents reviewed. (Resident 1) Findings include: Review of the facility policy entitled, Abuse Prohibition, last reviewed February 21, 2025, revealed that instances of abuse of all residents, irrespective of any mental or physical condition, cause physical harm, pain, or mental anguish. It included a resident's right to be free from verbal abuse, sexual abuse, physical abuse, and mental abuse. Clinical record review revealed that Resident 1 (R1) was admitted to the facility on [DATE], and had diagnoses that included hemiplegia and hemiparesis (paralysis on one side), anxiety, depression, and heart disease. Review of the Minimum Data Set (MDS) assessment (a periodic assessment of resident care needs) dated February 12, 2025, indicated that the resident was not cognitively impaired. Clinical record review revealed that Resident 2 (R2) was admitted to the facility on [DATE], and had diagnoses that included congestive heart failure, diabetes, borderline personality disorder (a mental disorder characterized by instability in mood, behavior, and functioning), major depressive disorder, and schizoaffective disorder (a mental health condition characterized by symptoms of schizophrenia, such as hallucinations and delusions, and mood disorder, such as mania and depression). Review of the MDS assessment dated [DATE], indicated that the resident was not cognitively impaired. Activities documentation dated March 13, 2025, revealed that an incident occurred on March 6, 2025, during a men's night pizza party involving R1 and R2. R1 was sitting with a peer and R2 entered the event and was not able to sit with R1. After a few minutes of R1 not paying attention to R2, R2 screamed at R1 and exited the activity. Additional facility documentation revealed that on March 14, 2025, R1 hit R2 with a walker following an argument. Review of a grievance form dated March 17, 2025, revealed that in the morning during the day shift (7:00 a.m. to 3:00 p.m.), R1 reported to staff that R2 had been harassing him if he didn't provide food and money and that R2 would enter his room during meals and take his food off his tray. R1 reported that R2 would harass and call him from his cellular phone and say, Bring me a drink, get me a blanket. He also reported that he would give R2 money to be left alone. R1 reported that R2 had threatened him with sexual acts, such as penetration, and he would always say no. R2 would then hit him on (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 3 Event ID: 395541 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 395541 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sinking Spring Skilled Nursing and Rehabilitation 3000 Windmill Road Sinking Spring, PA 19608 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)