Health inspection·August 29, 2025

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical record, facility documentation, and interviews with staff, it was determined that the facility failed to report a resident's fall incident and bruise to the local State agency as required for one of four residents reviewed for falls (Resident R14).Findings include:Review of facility policy Investigating Incident Reports and Adverse Events, not dated, revealed all adverse events occurring to residents will be investigated for root cause and to rule out abuse and neglect. An adverse event includes falls, both witnessed and unwitnessed.Clinical record review revealed Resident R14 was admitted to the facility on [DATE] with a diagnosis that included Cerebrovascular Accident (known as stroke, disruption of blood flow to brain, which can lead to brain damage), hemiplegia and hemiparesis affecting right dominant side (affect movement/sensation on one side of body). Review of Resident R14's Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) dated August 11, 20245 revealed the resident require required two or more persons physical assists for transfers.Review of Resident R14's nursing note, dated August 18, 2025, revealed Resident R14 was in the middle of transfer from wheelchair to bed when she/he lost her/his balance and fell on the floor. Resident observed to have a new bruise on right forearm after the fall occurred. Resident is an assist of 2 staff but was being assisted by 1 nurse aide during time of fall.Review of facility incident report, dated August 19, 2025, revealed on August 18, 2025, at 7:22 p.m. Resident R14 lost her/his balance during transferring from wheelchair to bed and fell down on the floor.Review of facility reported information to the State agency for August 2025 revealed no evidence that the facility reported to the State Agency the fall sustained by the resident while being transferred by one nurse aide and not two nurse aides as required.Interview on August 29, 2025 at 10:50 a.m. with Director of Nursing, Employee E3, confirmed the facility failed to report Resident R14's incident to the State agency. 28 Pa. Code:201.14(a)(c) Responsibility of licensee.28 Pa. Code:201.18(b)(1)(e)(1) Management. 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: 395738 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 395738 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paul's Run 9896 Bustleton Avenue Philadelphia, PA 19115 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)