Inspection·April 3, 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 interviews with staff, review of clinical records, facility policies and facility documentation, it was determined the facility failed to implement interventions to assure one resident (Resident R3) was free from physical abuse resulting in actual harm to Resident R3 who was struck by Resident R4 in the face with a leg rest, and sustained a chipped tooth for one of 10 resident records reviewed. (Resident R3 and Resident R4) Findings include: Review of facility policy titled, Abuse revised December 13, 2024, revealed, each resident will be free from abuse including verbal, mental, sexual, or physical abuse. Further review indicated, residents will be protected from abuse, neglect, and harm while they are residing at the facility and facility will educate staff in techniques to protect all parties. Review of Resident R3's clinical record revealed the resident was admitted on [DATE], with diagnoses including Cervical Disc Disorder, muscle weakness, difficulty walking, cognitive communication deficit, Atherosclerosis (coronary artery bypass graft), and Arterial Fibrillation (irregular rapid heart rate). Review of Resident R3's admission Minimum Data Set (MDS is an assessment of resident's care needs) dated January 28, 2025, revealed Resident R3 was cognitively intact, required maximal assistance with lower body dressing, and used a manual wheelchair for mobility. Review of Resident R3's care plan, initiated on January 22, 2025, revealed Resident R3 has an ADL (activity of daily living) self-care performance deficit related to muscle weakness, difficulty walking, and muscle wasting and atrophy (reduce muscle mass). Further review of Resident R3's care plan revealed the resident had oral/dental problems and was a smoker. Review of Resident R4's clinical record revealed Resident R4 was admitted to the facility on [DATE], with diagnoses including cognitive communication deficit, muscle weakness, Rhabdomyolysis (breakdown of skeletal muscle), Bipolar Disorder (condition in which a person has periods of depression of being extremely happy), and Depression (major loss of interest in pleasurable activities). Review of Resident R4's quarterly MDS assessment dated [DATE], revealed Resident R4 was cognitively intact and used a manual wheelchair for mobility. Review of Resident R4's care plan initiated on August 16, 2024, revealed Resident R4 had a behavior (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: 395687 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 395687 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE York Nursing and Rehabilitation Center 7101 Old York Road Philadelphia, PA 19126 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)