Health inspection·July 19, 2023

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few comprehensive care plan revealed no documented evidence new interventions were implemented status post fall. Review of facility incident report dated July 8, 2023, revealed the nurse heard a loud noise coming from Resident R25's room and the resident yelling out. Resident R25 was subsequently found laying on the bathroom floor. Continued review of the incident report and review of Resident R25's comprehensive care plan revealed no documented evidence new interventions were implemented status post fall. Review of Resident R25's clinical record revealed a nursing note dated July 18, 2023, that the resident again had an unwitnessed fall and was observed kneeling on the floor in his bathroom holding onto his walker. Per Resident R25's comprehensive care plan revised July 18, 2023, revealed the resident was attempting to initiate morning care. Resident R25's care plan was subsequently updated on July 18, 2023, with new interventions to offer and encourage early morning get-up per the resident preference and that the resident would be assisted by the 11:00 p.m. to 7:00 a.m. nursing shift. Interview on July 19, 2023, at 12:15 p.m. with Director of Nursing, E1, confirmed Resident R25's care plan was not updated with new interventions status post falls on June 30, 2023, and July 8, 2023. Continued interview on July 19, 2023, at 1:00 p.m. with the Director of Nursing, Employee E1, revealed all three falls happened during the morning hours. 28 Pa. Code 211.10 (c) Resident Care Policies. 28 Pa. Code 211.10 (d) Resident Care Policies. 28 Pa. Code 211.12 (d)(5) Nursing Services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395768 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 395768 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meadowood 3205 Skippack Pike Lansdale, PA 19446 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, review of clinical records, resident and staff interviews, it was determined that the facility failed to monitor meal and nutritional supplement consumption for one of one resident reviewed for nutritional status. (Resident R20) Residents Affected - Few Findings include: Review of facility policy Nutrition Risk Guidelines revealed that an undesired significant weight loss qualifies a resident for nutrition risk monitoring. Review of Resident R20's Quarterly Minimum Data Set (MDS - federally mandated assessment of a resident's abilities and care needs) dated April 11, 2023, revealed that the resident was admitted to the facility on [DATE], and had the diagnoses of Alzheimer's Dementia (a disease that destroys memory and other important mental functions), anxiety disorder, and depression. A review of Resident R20's BIMS (Brief Interview of Mental Status) revealed a score of nine, which indicated that the resident had moderately impaired cognition. Review of R20's clinical records revealed Resident R20 had a documented weight of 153 pounds on April 11, 2023, and a weight of 144.2 on July 18, 2023; indicating a significant weight loss of 5.8% weight loss in three months. Further review revealed a documented weight of 174.8 pounds on January 15, 2023, and a documented weight of 144.2 on July 11, 2023; indicating a significant weight loss of 17.5% in six months. Review of physician orders revealed an order dated February 16, 2023, for a dietary supplement, Ensure Clear, two times a day for significant weight loss. This supplement order would provide 480 calories and 16 grams of protein total per day for resident to prevent further weight loss. Review of Resident R20's Medication Administration Records for February, March, April, May, June, and July of 2023 revealed documented evidence that the nutritional supplement had been provided to resident and that it was occasionally refused, but no documented evidence of supplement daily percent intakes by resident. Further review of progress notes revealed no documented evidence regarding an alternative supplement option choice offered to resident when resident had refused the Ensure Clear nutritional supplement. Interview with the Registered Dietitian, Employee E3, on July 18, 2023, at 1:08 p.m. revealed Resident R20 had a history of refusing meals and prefers to eat in her room. Further interview confirmed there was no documented evidence of supplement daily percent intakes by resident to be able to evaluate the effectiveness of this nutrition intervention. Observation of the resident room on July 19, 2023, at 11:03 a.m. revealed an ensure clear with a straw placed on Resident R20's stand. During an interview with Resident R20 this surveyor asked, do you drink all of the ensure? Resident stated, no. Follow-up interview with Resident R20's nurse, Employee E6, on July 19, 2023, revealed Resident R20 can make her needs known by using the call bell, passing it on to the nurse aids, and answering yes and no questions. During interview on July 19, 2023, at 3:05 p.m. with the Director of Nursing, Employee E1, and Administrator, Employee E2, it was confirmed that there was no daily monitoring evidence for Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395768 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 395768 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meadowood 3205 Skippack Pike Lansdale, PA 19446 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 0692 R20's nutrition supplement daily percent intakes. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.5 (f) Clinical records 28 Pa. Code 211.6 (d) Dietary services Residents Affected - Few 28 Pa. Code 211.12 (c)(5) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395768 If continuation sheet Page 4 of 4