Inspection·January 16, 2025

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on facility policy review, employee file review, and staff interview, it was determined that the facility failed to initiate an employee criminal background check, verify professional license/registration, and/or ensure employees completed required abuse training in a timely manner for six of six newly hired employees. (Employees RN 1, RN 2, RN 3, NA 1, NA 2, DA 1) Residents Affected - Some Findings include: Review of the facility policy entitled, Abuse, Neglect, Exploitation, Mistreatment and Misappropriation of Resident Property, last reviewed October 10, 2024, revealed that the facility was to screen potential employees for a history of abuse, neglect, or mistreating residents prior to employment. This included attempts to obtain information from previous employers and checking with the appropriate licensing boards and registries. The facility was also to educate staff upon hire and annually thereafter regarding the facility's policy to prevent Abuse, Neglect, and Exploitation of residents, and Misappropriation of Resident Property. Review of employee files revealed the following: NA 1 had been working at the facility as a nurse aide since October 21, 2024. The facility failed to conduct a criminal background check. There was a lack of evidence to support that required training to prevent abuse, neglect, and exploitation of residents, and misappropriation of resident property had been completed upon hire. NA 2 had been working at the facility as a nurse aide since December 6, 2024. The facility failed to conduct an inquiry to the State nurse aide registry. There was a lack of evidence to support that required training to prevent abuse, neglect, and exploitation of residents, and misappropriation of resident property had been completed upon hire. RN 1 had been working at the facility as a registered nurse since August 14, 2024. The facility failed to collect employment references. There was a lack of evidence to support that required training to prevent abuse, neglect, and exploitation of residents, and misappropriation of resident property had been completed upon hire. RN 2 had been working at the facility as a registered nurse since January 6, 2025. The facility failed to conduct an inquiry to the State licensing authority or gather employment references. There was a lack of evidence to support that required training to prevent abuse, neglect, and exploitation of residents, and misappropriation of resident property had been completed upon hire. RN 3 had been working at the facility as a registered nurse since August 12, 2024. The facility failed to conduct a criminal background check, an inquiry to the State licensing authority, or gather employment references. There was a lack of evidence to support that required training to prevent abuse, neglect, and exploitation of residents, and misappropriation of resident property had been completed upon hire. DA 1 had been working at the facility as a dietary aide since December 9, 2024. There was a lack of evidence to support that required training to prevent abuse, neglect, and exploitation of residents, and misappropriation of resident property had been completed upon hire. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395574 If continuation sheet Page 2 of 10 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 395574 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belle Terrace 1320 Mill Road Quakertown, PA 18951 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 0607 Level of Harm - Minimal harm or potential for actual harm In an interview on January 16, 2025, at 1:20 p.m., the Administrator confirmed that pre-employment screening and required training had not been completed in a timely manner as per facility policy for the newly hired employees listed above. 28 Pa. Code 201.14(a) Responsibility of Licensee. Residents Affected - Some 28 Pa. Code 201.18(b)(1) Management. 28 Pa. Code 201.19(3)(7)(8) Personnel policies and procedures. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395574 If continuation sheet Page 3 of 10 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 395574 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belle Terrace 1320 Mill Road Quakertown, PA 18951 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on facility policy review, clinical record review, review of facility documentation, and staff interview, it was determined that the facility failed to report an allegation of abuse to the Administrator and the State Survey Agency for one of 16 sampled residents. (Resident 16) Findings include: Review of the facility policy entitled, Abuse, Neglect, Exploitation, and Misappropriation of Resident Property, last reviewed October 10, 2024, revealed that all incident and allegations of abuse were to be reported immediately to the administrator or designee. Clinical record review revealed that Resident 41 had diagnoses that included anxiety, cognitive decline, and Alzheimer's disease. On October 12, 2024, staff noted that in the morning during the day (7:00 p.m. to 3:00 p.m.) shift, that Resident 41 put a brief over Resident 16's head. Resident 41 started punching Resident 16 and stated she was going to smash her in the face with a heavy object. Resident 41 also stated that she wanted to kill Resident 16 multiple times throughout the shift. There was no evidence that staff notified the Administrator until the evening (3:00 p.m. to 11:00 p.m.) shift. There was no evidence that the facility reported the incident to the State Survey Agency. In an interview on January 16, 2025, at 12:37 p.m., the Director of Nursing (DON) confirmed that staff did not immediately notify the Administrator of the incident per the facility policy. In an interview on January 16, 2025, at 2:40 p.m., the DON confirmed that the facility did not report the incident to the State Survey Agency. 28 Pa. Code 201.18(e)(1) Management. 28 Pa. Code 211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395574 If continuation sheet Page 4 of 10 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 395574 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belle Terrace 1320 Mill Road Quakertown, PA 18951 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 0623 Level of Harm - Potential for minimal harm Residents Affected - Some Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Based on clinical record review and staff interview, it was determined that the facility failed to notify the resident and the resident's representative(s) of transfer(s), including the reasons for the moves and Ombudsman information, in writing upon transfer from the facility for three of three sampled residents who were transferred to the hospital. (Resident 11, 13, 56) Findings include: Clinical record review revealed that Resident 11 was transferred to the hospital on October 12, 2024, after a change in condition. There was no documentation to support that the resident or the resident's responsible party or legal representative was provided written information regarding the transfer to the hospital. Clinical record review revealed that Resident 13 was transferred to the hospital on December 11, 2024, after a fall and change in condition. There was no documentation to support that the resident or the resident's responsible party or legal representative was provided written information regarding the transfer to the hospital. Clinical record review revealed that Resident 56 was transferred to the hospital on November 4, 2024, after a change in condition. There was no documentation to support that the resident or the resident's responsible party or legal representative was provided written information regarding the transfer to the hospital. In an interview on January 16, 2025, at 9:35 a.m., the Administrator confirmed that the residents or resident representatives were not given written notices regarding their transfers. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395574 If continuation sheet Page 5 of 10 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 395574 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belle Terrace 1320 Mill Road Quakertown, PA 18951 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, observation, and resident interview, it was determined that the facility failed to ensure that physician's orders were implemented for one of 16 sampled residents. (Resident 40) Residents Affected - Few Findings include: Clinical record review revealed that Resident 40 had diagnoses that included heart failure and reduced mobility. According to the Minimum Data Set assessment, dated November 23, 2024, the resident was at risk for pressure ulcers, had limited mobility of her lower legs, and could communicate her needs. On March 12, 2024, the physician ordered that staff float heels (elevate the lower leg so the heel doesn't touch the bed) while in bed. On January 14, 2025, at 11:32 a.m., Resident 40 was observed with her heels directly on the bed. That same day at 1:55 p.m., the resident stated that staff had not been floating her heels, and she was observed with her heels directly on the bed. The resident was again observed on January 15, 2025, at 9:54 a.m., with her heels directly on the bed. CFR 483.25 Quality of care Previously cited 12/28/23, 8/10/24 28 Pa. Code 211.12 (d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395574 If continuation sheet Page 6 of 10 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 395574 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belle Terrace 1320 Mill Road Quakertown, PA 18951 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 0691 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, and family and staff interview, it was determined that the facility failed to provide ostomy (an opening of the bowel through the abdomen), care in accordance with the resident's care plan for one of one sampled resident who had an ostomy. (Resident 158) Findings include: Review of a facility policy entitled, Colostomy/Ileostomy Care, last reviewed October 10, 2024, revealed that staff were to document the date and time the ostomy care was provided, as well as, the name and title of the person who provided the care in the resident's medical record. Clinical record review revealed that Resident 158 was admitted to the facility on [DATE], and had a diagnoses that included Dementia. Review of the care plan revealed that the resident had an ileostomy. The interventions were for staff to keep the skin around the stoma clean and dry, monitor the skin for irritation, and observe the stoma for unusual changes. In an interview on January 14, 2025, at 12:35 p.m., the resident's family member reported that the resident's ostomy supplies had not been changed since admission. There was a lack of evidence in the clinical record to support that staff provided ostomy care or changed the supplies prior to January 14, 2025. There were no physician orders for ostomy care in place until January 14, 2025, six days after the resident was admitted to the facility. The physician orders dated January 14, 2025, directed staff to change the ileostomy wafer every three days and change the ileostomy bag once daily or as needed. In an interview on January 16, 2025, at 11:10 a.m., and 12:54 p.m., the Director of Nursing confirmed that there was no documented evidence that staff changed the resident's ostomy supplies or provided ostomy care prior to January 14, 2025, and that ostomy care should be documented in the resident's clinical record. 211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395574 If continuation sheet Page 7 of 10 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 395574 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belle Terrace 1320 Mill Road Quakertown, PA 18951 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on clinical record review and staff interview, it was determined that the facility failed to ensure that pharmacy recommendations were reviewed by the physician in a timely manner for one of 16 sampled residents. (Resident 41) Findings include: Clinical record review revealed that Resident 41 had diagnoses that included anxiety and Alzheimer's disease. Review of a pharmacist's recommendation dated August 1, 2024, revealed that the pharmacist noted that the resident was prescribed melatonin and trazodone at hour of sleep (HS). The pharmacist recommended that the physician review the need for both medications and determine if the melatonin could be discontinued to reduce the resident's amount of medication. There was no evidence that the physician addressed the pharmacist's recommendations until October 1, 2024, or that the melatonin was discontinued until October 2, 2024. In an interview on January 16, 2025, at 12:37 p.m., the Director of Nursing stated that pharmacy recommendations should be addressed by the physician within five to seven days and there was no evidence that the physician addressed the pharmacy recommendation until October 1, 2024. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395574 If continuation sheet Page 8 of 10 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 395574 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belle Terrace 1320 Mill Road Quakertown, PA 18951 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 0868 Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Level of Harm - Minimal harm or potential for actual harm Based on review of facility documents and staff interview, it was determined that the facility failed to conduct Quality Assessment and Assurance (QAA) meetings at least quarterly with all the required committee members for two of four quarterly meetings, the first and fourth, of 2024. Residents Affected - Few Findings include: Review of the facility ' s Quality Assurance and Performance Improvement (QAPI) sign-in sheets and attendance records for meetings held in the first quarter of 2024 revealed the facility's Medical Director failed to attend. Review of facility ' s monthly Quality Assurance and Performance Improvement (QAPI) sign-in sheets and attendance records for meetings held in the fourth quarter of 2024 revealed the facility's Medical Director failed to attend. In an interview on January 16, 2025, at 11:39 a.m., the Administrator confirmed that the Medical Director did not attend all of the quarterly meetings. 28 Pa Code: 201.18(e)(1)(2)(3) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395574 If continuation sheet Page 9 of 10 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 395574 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belle Terrace 1320 Mill Road Quakertown, PA 18951 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 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on facility policy review, clinical record review, and observation, it was determined that the facility failed to follow policies and procedures to prevent the spread of infection for two of 16 sampled residents. (Residents 27 and 35) Residents Affected - Few Findings include: Review of the facility policy entitled, Enhanced Barrier Precautions, last reviewed October 10, 2024, revealed that enhanced barrier precautions were to be used with any resident with a wound or medical device during encounters when contact is expected, including during wound care and the care of feeding tubes. Precautions included the use of protective gowns during the high risk activities. Clinical record review revealed that Resident 27 had diagnoses that included a Stage 3 pressure sore on his lower back. On January 15, 2025, at 9:06 a.m., a physician (MD 1) was observed entering Resident 27's room to examine his pressure sore. MD 1 did not use a protective gown in accordance with facility policy. Clinical record review revealed that Resident 35 had diagnoses that included a history of stroke with difficulty swallowing. She received all nutrition through a feeding tube. On January 14, 2025, at 10:37 a.m., LPN 1 was observed flushing the feeding tube without wearing a gown as required by facility policy. CFR 483.80 Infection Control Previously cited 12/28/23, 8/1/24 28 Pa. Code 211.10(d) Resident care policies. 28 Pa. Code 211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395574 If continuation sheet Page 10 of 10