Health inspection·August 15, 2024

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of facility policy, and staff interview, it was determined that the facility failed to ensure that the environment remained free of accident hazards for two of 12 residents reviewed. (Resident R1 and Resident R15) Findings Include: Review of facility policy titled, Administering Oral Medications dated October 2010 states, The purpose of this procedure is to provide guidelines for the safe administration of oral medications. Under Step in the Procedure the policy states, .16. Allow the resident to swallow oral tablets or capsules at his or her comfortable pace .21. Remain with the resident until all medications have been taken. Review of Resident R1's clinical record revealed the resident was admitted to the facility on [DATE] with the diagnoses of: Gout, Insomnia, Dementia, progressive generative disease of the brain) and Osteoarthritis (degenerative joint disease). Review of Resident R1's Minimum Data Set (MDS- assessment of resident's needs) completed on June 11, 2024 revealed a Brief Interview with Mental Status (BIMS) score of 5, which indicated that the resident had cognitive impairment. Observation of Resident R1 on August 12, 2024 at 10:14 a.m. revealed the resident was at the bedside in her wheelchair with a tray table in front of her eating her breakfast. Observation of Resident R1's tray table revealed the resident had a clear medicine cup with four pills. Interview held with private duty nurse aide, Employee E10 at 10:15 a.m. reports the resident's medication bedside were vitamins and Tylenol. Employee E10 stated the nurse left them there for the resident to take. Interview with Licensed nurse, Employee E4 on August 12, 2024 at 10:31 a.m. revealed the license nurse did dispense the medication this morning while the resident was in the bathroom. Licensed nurse, Employee E4 reported that she does not typically leave medications bedside, and that the medications in the cup were vitamins. Review of Resident R15's clinical record revealed the resident was admitted to the facility March 28, 2024 with diagnoses of Congestive Heart Failure (excessive fluid caused by a weakened heart muscle), Atrial Fibrillation (irregular heart beat), Gastro-Esophageal Reflux, Insomnia, Hypertension (high blood pressure), and Muscle Weakness. Review of Resident R15's Minimum Data Set (MDS) completed on August 2, 2024 revealed a Brief Interview with Mental Status (BIMS) score of 14, which indicated that the resident was cognitively intact. Observation of Resident R15 on August 12, 2024 at 11:08 a.m. revealed to the resident was in her recliner chair seated with her tray table next to her. Observation of the resident's tray table revealed a large white pill split in half sitting on the tray table. Licensed nurse, Employee E6 was called to the room on August 12, 2024 at 11:12 a.m. and confirmed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395753 If continuation sheet Page 2 of 3 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 395753 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaumont at Bryn Mawr 601 North Ithan Avenue Bryn Mawr, PA 19010 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the medication was left bedside. Licensed nurse, Employee E6 stated to the resident, you know you are not supposed to have these. Interview with licensed nurse, Employee E6 at 11:15 a.m. in the hallway revealed that licensed nurse, Employee E6 stated, I thought she took all of her medications when I watched her, she is difficult and takes her pills one at a time. 28 Pa Code 211.12(d)(1) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395753 If continuation sheet Page 3 of 3