Health inspection·March 6, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on review of minutes from the Residents' Council meeting and resident and staff interviews it was determined that the facility failed to provide care in a manner and environment, which promotes each resident's quality of life, by failing to respond timely to residents' request for assistance as evidenced by experiences reported by five residents out of five sampled (Residents 14, 11, 9, 13 and 10 ). Findings include: During interviews conducted throughout the day tour of duty on March 6, 2024, the residents stated that they feel the facility is not adequately staffed because they wait extended periods of time for staff to respond to their requests for assistance, including untimely responses to their requests via the nurse call bell system. A review of minutes from the Residents' Council meeting on February 1, 2024, revealed that Resident 14 was requesting staff assignments be reassessed as he has been left in the bathroom for long periods of time when his assigned aide is off the floor. He reported that staff tell him they do not have him on their assignment and do not provide the necessary assistance, which has caused him to wait extended periods of time in the bathroom. Interview with Resident 11 on March 6, 2024, at 10:43 AM revealed that she feels that short staffing and agency nursing staff are a problem in the facility. She stated that over that last couple of days I would ring the bell to use the bathroom because I can't do it myself. I had to wait over an hour. I couldn't hold it and, unfortunately, I soiled myself. Interview with Resident 9 on March 6, 2024, at 11:15 AM, revealed that she has waited over 2 hours for staff to answer her call bell. The resident stated that these long waits often occur an hour or so around shift changes. Resident 9 reported that on March 4, 2024, she was put in bed at 7:30 PM. At 1:00 AM an aide came in to check if the resident needed to be changed, and the resident replied that she did not at that time. Resident 9 stated she woke at 5:00 AM and activated the call bell as she needed to use the bathroom at that time. No one answered her call bell until 6:20 AM, when an aide peeked in the resident's room and said she would tell the other girls that she needed to be changed. Resident 9 stated that she soiled herself waiting for staff assistance. It was not until 7:30 AM, 2.5 hours after Resident 9 activated her call bell for assistance, that a nurse aide came in the resident's room to provide assistance. Resident 9 stated that she was so saturated with urine by that time that they had to change all the bed linens. She stated, I was so embarrassed, but I couldn't help it, I had to go. (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: 395566 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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)