Inspection·January 10, 2023

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **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 ensure that the Minimum Data Set (MDS) assessment was completed to accurately reflect the resident's current status for one of 30 sampled residents. (Resident 116) Residents Affected - Few Findings include: Clinical record review revealed that Resident 116 had diagnoses that included chronic kidney disease and diabetes. The MDS assessment dated [DATE], indicated that the resident utilized a physical restraint on a less than daily basis. There was no documented evidence that the resident utilized any kind of restraint. In an interview on January 9, 2023, at 1:30 p.m., the Administrator stated that there were no residents that utilized restraints. 28 Pa. Code 211.5(f) Clinical records. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395710 If continuation sheet Page 2 of 4 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 395710 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oxford Rehabilitation and Healthcare Center 300 East Winchester Ave Langhorne, PA 19047 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observation, and resident interview, it was determined that the facility failed to provide services and treatment to prevent further limitations in range of motion for two of 12 sampled residents with limitations in range of motion. (Residents 81, 135) Findings include: Clinical record review revealed that Resident 81 had diagnoses of a stroke, hemiplegia (paralysis) affecting the left non-dominant side and muscle weakness. The Minimum Data Set (MDS) assessment dated [DATE], indicated that the resident was alert and oriented, was totally dependent on staff for most activities of daily living, required extensive assistance from staff for dressing and had impairment in range of motion on one side of both her upper and lower extremities. On April 12, 2022, a physician ordered for staff to apply a left upper extremity resting hand splint one time a day and to take off the splint after four hours. Review of the occupational therapy Discharge summary dated [DATE], indicated that the resident was able to tolerate the left upper extremity hand splint for at least three hours without pain. The discharge recommendation was for staff to apply the left resting hand orthotic splint for four hours with skin checks each shift. Observation on January 8, 2023, at 10:00 a.m,. and 12:00 p.m., revealed that the resident was dressed and was in her bed without the left hand splint on her left hand. The resident was again observed on January 9, 2023, at 10:00 a.m,. and 12:00 p.m., dressed and in bed without the left splint on her hand. In an interview on January 10, 2023, at 10:45 a.m., the Resident stated that she does have a splint for her left hand but that the staff does not apply the splint consistently. Further observation revealed that the resident had received her morning care and the left hand splint had not been applied by staff and was on the floor beside her bed. Clinical record review revealed that Resident 135 was admitted to the facility on [DATE], with diagnoses that included hemiplegia and hemiparesis, chronic obstructive pulmonary disease, and dysphagia (difficulty swallowing). The MDS assessment dated [DATE] revealed the resident had no cognitive impairments and required extensive assistance from staff for dressing and personal hygeine. On July 18, 2022, a physician ordered that staff apply a left resting hand orthotic (splint) in the morning and remove at bedtime. Review of Resident 135's care plan revealed she had a self care performance deficit with an intervention for staff to apply a left resting hand orthotic in the morning and remove at bedtime. Observations on January 9, 2023, from 11:38 a.m. through 12:40 p.m., revealed Resident 135 in bed, with no left hand orthotic. In an interview on January 8, 2023, at 11:58 a.m., Resident 135 stated staff did not assist her to apply her left hand orthotic. 28 Pa. Code 211.12 (d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395710 If continuation sheet Page 3 of 4 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 395710 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oxford Rehabilitation and Healthcare Center 300 East Winchester Ave Langhorne, PA 19047 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on facility policy review, clinical record review, and staff interview it was determine the facility failed to maintain clinical records that were complete and accurate for two of 30 sampled residents. (Residents 44 and 147) Findings include: Review of the facility policy entitled COVID-19 Testing Requirements - CMS, last reviwed September 24, 2022, revealed that the facility was to document COVID testing results in the resident's clinical record. In an interview on January 10, 2023 at 11:21 a.m., the Director of Nursing and the Infection Preventionist stated that every resident was tested for COVID-19 on January 6, 2023. Clinical record review revealed that there was no documention related to the COVID testing or results for Resident 44 or 147 on January 6, 2023, in the clinical record. In an interview on January 10, 2023, at 11:56 a.m., the Infection Preventionist confirmed that test results were only kept on a piece of paper and that there was no documentation to reflect the COVID testing results from January 6, 2023, in the clinical record in accordance with facility policy. 28 Pa. Code 211.5(f) Clinical records. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395710 If continuation sheet Page 4 of 4