Inspection·June 18, 2025

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records, resident grievances, observations, and resident and staff interviews, it was determined the facility failed to provide care in a manner that promotes and enhances each resident's dignity and quality of life by failing to respond in a timely manner to residents' requests for assistance for 5 residents out of 10 sampled. (Residents CR1, 2, 3, 4, and 5). Findings include: A review of a grievance filed with the facility by the daughter of Resident CR1, dated April 9, 2025, revealed that Resident CR1 had a bowel movement in her brief and required staff assistance for hygiene care. She activated her call bell at 9:41 AM requesting assistance. Facility records indicated that by 11:41 AM no staff had responded to the call bell, and as of 12:00 PM she remained unchanged. Resident CR1 was ultimately provided incontinence care at 12:30 PM, approximately three hours after her initial request for assistance. The grievance documentation indicated the daughter informed the nurse on duty, who stated that someone would respond; however, timely care was not provided. Facility records show that the facility acknowledged to the daughter that the excessive delay in responding to the request for assistance was not acceptable and that she should notify the supervisor immediately if delays occur. An interview with Resident CR1 and her daughter could not be completed during the survey During an interview with Resident 2 on June 18, 2025, at 10:45 AM she reported she frequently has waited over an hour for staff to answer her call bell. She stated, I've soiled myself so many times waiting for them to come, I've lost count, and added Supper time is the worst. They don't come, so I had to stop asking. During an observation on June 18, 2025, at 10:55 AM in room [ROOM NUMBER], there was a strong odor of BM (bowel movement) permeating throughout the room. Resident 5 was observed lying in bed uncovered, with a visibly soiled brief. Bowel movement matter was observed to be leaking out of the sides of the brief, soiling the bedsheet underneath. Resident 5's call bell was activated at 10:55 AM. The call bell alert light was visible above the resident's doorway. At 11:10 AM Employee 1 (Occupational Therapist) entered Resident 5's room. The call bell light was turned off and Employee 1 exited the room without providing care. At 11:14 AM the call light was activated again with the resident yelling help me. At 11:25 AM the Activities Director entered the room, turned off the call bell, and told the resident Someone will be right in. Employee 2 exited the room and did not provide the required care. At 11:30 AM, 35 minutes after the resident first activated the call bell, a nurse aide entered the room to provide assistance for incontinence. (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 2 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 06/18/2025 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)