Health inspection·March 15, 2024

F 0623 Level of Harm - Potential for minimal harm Residents Affected - Many Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 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 seven of seven sampled residents who were transferred to the hospital. (Residents 18, 50, 76, 83, 95, 102, and 109) Findings include: Clinical record review revealed that Resident 18 was transferred to the hospital on December 22, 2023, after a change in condition. There was no documentation to support that the resident and/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 50 was transferred and admitted to the hospital on [DATE], after a change in condition. There was no documentation to support that the resident and/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 76 was transferred to the hospital on December 12, 2023, after a change in condition. There was no documentation to support that the resident and/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 83 was transferred to the hospital on December 14, 2023, after a change in condition. There was no documentation to support that the resident and/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 95 was transferred to the hospital on February 18, 2024, after a change in condition. There was no documentation to support that the resident and/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 102 was transferred to the hospital on October 12 and 24, 2023, after changes in condition. There was no documentation to support that the resident and/or the resident's responsible party or legal representative was provided written information regarding the transfer to the hospital. Page 1 of 3 395680 395680 03/15/2024 Willow Brook Rehabilitation and Healthcare Center 120 Trexler Avenue Kutztown, PA 19530

F 0623 Level of Harm - Potential for minimal harm Residents Affected - Many Clinical record review revealed that Resident 109 was transferred to the hospital on March 3, 2024, after a change in condition. There was no documentation to support that the resident and/or the resident's responsible party or legal representative was provided written information regarding the transfer to the hospital. In an interview on March 15, 2024, at 9:00 a.m., the Administrator confirmed that residents and/or resident representatives were not given written notice regarding transfers from the facility. 395680 Page 2 of 3 395680 03/15/2024 Willow Brook Rehabilitation and Healthcare Center 120 Trexler Avenue Kutztown, PA 19530

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and staff interview, it was determined that the facility failed to maintain sanitary conditions in the kitchen. Residents Affected - Many Findings include: Observation during a tour of the kitchen on March 12, 2024, at 9:47 a.m., revealed the following: The inside of the microwave was dirty and splattered with dried food. In the food preparation area, there were two uncovered garbage cans that contained garbage. There was a dirty plastic bag that covered tubing for the juice machine. There was an accumulation of dirt and grease on the side of the grill, underneath the flat top, and surrounding the stove top controls. There was a puddle of water under the steamer. There was debris under the shelves in dry storage. In dry storage, there was a box of chocolate chips with a use by date of February 1, 2024. Observation of multiple cycles of the dish machine while the machine was in use following the breakfast meal service revealed that the final rinse cycle did not maintain a temperature of 180 degrees Fahrenheit for heat sanitization. Following observations of four cycles, the dish machine began to shut off before reaching the final rinse cycle. Dietary Aide 1 (DA 1) attempted to restart the machine three times; the machine shut off before the final rinse cycle on each attempt. DA 1 stated that the dish machine has occasionally shut off before the wash and rinse cycle were complete and the machine occasionally does not achieve the proper temperatures. In an interview on March 12, 2024, at 1:00 p.m., the Registered Dietitian confirmed that the dish machine was not in working order and did not maintain an adequate temperature for heat sanitization. 28 Pa. Code 201.18(b)(3) Management. 28 Pa. Code 207.2(a) Administrator's responsibility. 395680 Page 3 of 3