Inspection visit

InspectionSeptember 21, 2023

COMPLETE CARE AT HARSTON HALL LLCCMS #39579135 citations on this visit

35 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 35 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0552 Ensure that residents are fully informed and understand their health status, care and treatments. Level of Harm - Minimal harm or potential for actual harm Based on clinical record reviews and interviews with staff, it was determined that the facility failed to ensure that residents and their representatives were informed of and allowed to participate in decisions regarding medication changes for two of 32 residents reviewed (Residents R71 and R94). Residents Affected - Few Findings include: Clinical record review for Resident R71 revealed a psychiatry (mental health) note, dated May 16, 2023, which indicated that the resident had a history of anxiety disorder (intense, excessive, persistent worry or fear) and depression (mood disorder characterized by low mood, a feeling of sadness, and a general loss of interest in things). Resident R71 was noted by the psychiatrist to be aphasic (loss of ability to understand or express speech, caused by brain damage) and that during the visit the resident opened her eyes, tracked briefly, but did not answer any questions. The psychiatrist noted that the resident was currently taking Lexapro (antidepressant medication) 10 mg. (milligrams) daily. The psychiatrist recommended to increase Resident R71's dose of Lexapro to 15 mg. daily. Review of progress notes for Resident R71 revealed a note, dated May 22, 2023, at 4:58 p.m. which indicated that the psychiatry consult and recommendations were reviewed by the attending nurse practitioner and transcribed. Further review of progress notes revealed no indication that Resident R71 or her representative were informed or agreeable to the increase in the resident's antidepressant medication. Clinical record review for Resident R94 revealed a psychiatry note, dated August 8, 2023, which indicated that the resident had a history of progressive dementia (decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities) with disturbances including psychosis (a mental disorder characterized by a disconnection from reality), bipolar disorder (also known as manic depression, is a mental illness that brings severe high and low moods and changes in sleep, energy, thinking, and behavior) and anxiety. The note also indicated that the resident's primary language was Spanish. The psychiatrist noted that the resident was currently taking Seroquel (an antipsychotic medication) 12.5 mg. daily. The psychiatrist noted that Resident R94's behaviors have been stable for several months and recommended a gradual dose reduction and to decrease the resident's Seroquel to 12.5 mg. every other day. Continued review for Resident R94 revealed another psychiatry note, dated August 22, 2023, which again recommended the gradual dose reduction and to decrease the resident's Seroquel to 12.5 mg. every other day. The psychiatrist requested documentation if the recommendations were declined. Review of progress notes for Resident R94 revealed no indication that the psychiatry (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 56 Event ID: 395791 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0552 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few recommendations from August 8, 2023, were ever reviewed. Continued review revealed a general progress note, dated August 25, 2023. At 5:53 p.m. which indicated that the gradual dose reduction for Resident R94's Seroquel was noted, verified and transcribed. Further review of progress notes revealed no indication that Resident R94 or her representative were informed or agreeable to the decrease in the resident's antipsychotic medication. Interview on September 20, 2023, at 9:34 a.m. the Director of Nursing was unable to explain and had no comment as to why Residents R71 and R94 or their representatives were not informed of or provided the opportunity to make decisions regarding the residents' medication changes. 28 Pa Code 201.29(a) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 2 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Allow resident to participate in the development and implementation of his or her person-centered plan of care. Based on clinical record reviews and interviews with residents and staff, it was determined that the facility failed to ensure that residents and their representatives were involved in their care planning process for three of 32 residents reviewed (Residents R43, R71 and R94). Findings include: Interview on September 18, 2023, at 10:40 a.m. Resident R43 stated that she was unhappy because no one at the facility ever discussed her care with her or provided her with the opportunity to make decisions regarding her care planning process. Clinical record review for Resident R43 revealed that the most recent care plan meeting note was dated October 27, 2022, almost one year ago. Clinical record review for Resident R71 revealed that the most recent care plan meeting note was dated August 17, 2022, over one year ago. Review of facility documentation submitted to the Pennsylvania Department of Health on June 2, 2023, at 10:19 p.m. by the Director of Nursing revealed that on June 2, 2023, at approximately 10:00 a.m., it was brought to the facility's attention that [Resident R71's] family is alleging neglect by the facility. The family alleged that the resident's hair was not well groomed and that she had wet clothing on during their visit. Continued review of progress notes for Resident R71 revealed a note, dated June 6, 2023, at 3:39 p.m. which indicated that a care conference was scheduled for June 7, 2023, and that the conference was cancelled by the resident's family. Further review of progress notes for Resident R71 revealed no indication of any attempts to reschedule the care conference meeting or that any care planning meetings occurred. Clinical record review for Resident R94 revealed that the most recent care plan meeting note was dated March 7, 2023, over six months ago. Interview on September 20, 2023, at 9:34 a.m. the Director of Nursing stated that all care conference meetings should be documented in residents' progress notes and was unable to explain why Residents R43, R71 and R94 have not had any recent care planning meetings. 28 Pa. Code 201.29(a) Resident rights 28 Pa. Code 211.12(d0(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 3 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and interviews with staff and facility policies, it was determined that the facility failed to accommodate a resident's preference for showering for one of 23 resident records reviewed (Resident R62). Findings include: Review of the facility Resident Rights policy and procedure states the purpose is to ensure the preservation of every resident's right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility The right to reside and receive reasonable accommodations of residents' needs. Review of Resident R62's clinical record revealed that the resident was admitted [DATE] with the diagnoses of Parkinson's disease (a brain disease that causes uncontrollable movements), dysphagia,(difficulty swallowing) difficulty walking with a history of falling and presence of neurostimulator (uses electric pulses to reduce symptoms of tremors). Review of Resident R62 June 14, 2023, quarterly MDS (Minimum Data Set an assessment of residents' needs) , revealed the resident was awake, alert, and oriented and required total dependance with bathing of one person assist. Review of Resident R62's care plan meeting on June 29, 2023 indicated Resident R62 would prefer showers three days a week. Further review of Resident R62's clinical record revealed on July 13, 2023 nursing progress note stated, Resident continues to insist on receiving shower. Resident educated that because of the room change, new shower days are Wednesday and Saturday. All charge nurses and care nurses are aware and are on the same page upon decision. Interview with the Nursing Home Administrator and the Director of Nursing confirmed on September 20, 2023 at 10:30 a.m. that the faciltiy failed to accommodate Resident R62's preferences. 28 Pa. Code 211.12(d)(1)(2) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 4 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0565 Honor the resident's right to organize and participate in resident/family groups in the facility. Level of Harm - Minimal harm or potential for actual harm Based on observation and interviews with resident and review of resident council minutes and facility policies determined with facility failed to provide a private space during the resident council meeting, failed to respond to concerns/requests from group meetings, failed to respond to concerns/requests in a timely manner, and failed to demonstrate their response and rationale for such concerns/requests for six of six residents attending resident council interviews and group meeting (Residents R8, R41, R43, R62, R75, and R90). Residents Affected - Few Findings include: Review of the facility Resident Rights policy and procedure states the purpose is to ensure the preservation of every resident's right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility The right to reside and receive reasonable accommodations of residents' needs. Each resident has the right to organize and participate in a resident or family groups in the facility. The facility shall provide a resident a private space and take reasonable steps to make residents and family members aware. The facility shall provide a designated staff person who is approved by the residents who is responsible for providing assistance and responding to written requests that result from group meetings. The facility must be able to demonstrate a response and rationale for such response. Each resident has the right to a safe clean comfortable and homelike environment. Clean bed and bath linens that are in good condition and comfortable sound levels. A group meeting was held on September 19, 2023 at 1:00 p.m. with Residents R8, R41, R43, R62, R75, and R90 who regularly attend the monthly group council meetings. Review of past resident council minutes revealed on June 28, 2023 minutes had a question directed towards the residents that asked What are you grateful for about living her? What would make living here even better? The documented response was concerns and issues are being addressed quicker. Resident R8, R41, R43, R62, R75, and R90 disagreed with that response. Resident R43 and R90 indicated coming to resident council is a waste of time and pointless because they facility does not do anything about the concerns to group meetings. Further review of June 28, 2023, resident council minutes revealed a nursing concerns that nursing staff were not changing the bed sheets. This concern was later documented on the minutes that the Director of Nursing addressed this concern with the nursing staff (undated). Residents R8, R41, R43, R62, R75, and R90 disagreed that this was addressed with the nursing staff. All residents agreed they still do not receive clean sheets on a weekly basis and all make their beds because the aides (nursing assistants) do not. Further review of previous resident council minutes revealed on July 24, 2023 the group continued to complaint about the sheet. The facility response, not dated, Nursing staff was educated. Residents R8, R41, R43, R62, R75, and R90 all agreed they complained to the Director of Nursing a couple weeks ago about the noise the night shift nursing staff makes. The surveyor asked what kind of noise and they agreed it sounds like a war going on. The staff on night shift fight with each other, and the supervisors. Resident R62 said she had to change her room to get away from the nurses' station because that's where they all hang at night. At approximately 2:00 p.m. the Activity Director (who assists/coordinate monthly meetings, documents group minutes and responds to requests resulting from the meetings) interrupted the meeting by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 5 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0565 Level of Harm - Minimal harm or potential for actual harm bringing outside residents in the room. Before the group meeting had to abruptly end the State surveyor asked the activities director how he knows the residents' concerns are being corrected. The activity director responded by saying he goes to the department heads and they tell him. For clarification the surveyor asked the Activity Director if he also asks the residents if their concerns are rectified. The activity director responded by stating , If the department heads say it's taken care of , it is. Residents Affected - Few Interview with the Director of Nursing (DON) on September 19, 2023 at 3:00 p.m stated the meeting was meant to be private and spoke to the staff related to linens and the noise on night shift. During that interview the DON could not show documented evidence theses concerns were addressed with the nursing staff, nor evidence the DON ensured these concerns were rectified nor any correspondence with the residents at the conclusion. 28 Pa. Code 201.18(b)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 6 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0567 Honor the resident's right to manage his or her financial affairs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview with resident and staff, review of facility documents and review of facility policy, it was determined that the failed to allow residents to effectively manage their personal funds for one of 32 residents reviewed (Resident R81). Residents Affected - Few Findings include: Review of facility policy on Resident's Funds revealed that under section Purpose it was indicted to ensure that residents at the facility have access to and are able to manage their personal funds. Section Policy stated that each one of the facility's residents has the right to manage his or her financial affairs including the right to know in advance what charges the facility may impose against a resident's personal funds. The facility does not require residents to deposit their personal funds with the facility. If the resident chooses to deposit their personal funds with the facility, upon written authorization of the resident, the facility shall act as the fiduciary of the resident's fund and hold, safeguard, manage and account for the personal funds the resident deposited with the facility as specified in this policy. Under section Procedure III (Access to Funds) B. Resident requests access to their funds will be honored by facility staff as soon as possible but no later than: #a. the same day for amounts less than $100.00 amounts less then $50 for Medicaid residents, #b. three (3) banking days for mounts of $100 or $50 for Medicaid residents or more if the request was made for a check. Review of Resident R81's clinical rerecord revealed that Resident R81 was admitted to the facility on [DATE]. Continued review of Resident R81's clinical record revealed the diagnoses of Alzheimer's Disease (is a brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks), Polyneuropathy (multiple nerve disorder), pain on the right knee, Hypertrophic Osteoarthropathy (is a rare condition that affects bones, joints, and skin). Review of Resident R81's Quarterly MDS (Minimum Data Set-a federally required resident assessment completed at a specific interval) Section C0500 Brief Interview for Mental Status dated August 1, 2023 revealed a score of 8 suggesting that Resident R55 had moderately impaired cognition Interview with Resident R81 conducted on September 19, 2023, at 11:29 a.m. revealed that Resident R81 gets $45 from the facility every month but has not received her $45 monthly stipend for two months now. Further, Resident R81 revealed that she called had the facility finance department to find out why she hasn't gotten her money and to request for her $45, but nobody got back to her. Follow-up interview with Resident R81 conducted on September 19, 2023, at 1:34 p.m. revealed that she got her money but that she only received $35.00. Further Resident R81 revealed that would like to all $45 of her money. Resident R81 also revealed that the finance person informed her that they don't have enough cash to give her that is why she only received $35. Review of Resident R81's Resident Fund Statement from July 2023 to September 19, 2023, revealed that $45 was taken out of Resident R81's account on July 20, 2023. and $35 on September 19, 2023. As of September 19, 2023, Resident R81's account balance was $3,205.00. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 7 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0567 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident R81's Resident Fund Statement from April 1, 2023, to June 30, 2023, revealed that $45.00 was taken out of her account on April 12, 2023, and $45 on May 2, 2023. No money was taken out of Resident R81's account from July 21, 2023, to September 18, 2023. Interview with Business Office Manager, Employee E13, conducted on September 19, 2023, at 3:36 p.m., revealed that quarterly statements are mailed out to residents who have an account with the facility. Further interview with Employee E13 confirmed that Resident R81 received $35 earlier in the morning and she also confirmed that Resident R81 did not receive her $45 for two months. Further, Employee E13 revealed residents who are unable to go down to her office would call her to request for money and she goes to them to hand deliver the money and they sign a receipt. Further interview with Employee E13 also confirmed that she gave Resident R81 $35. Further, Employee E13 revealed that she only gave Resident R13 because Resident R81 did not specify how much she wants. Further, Employee E13 also revealed that based on Resident R81's spending history she figured that that $35 was enough to cover Resident R81's needs for the month without confirming with Resident R81 how much her money she needs. Employee 13 stated that she will make sure to give Resident R81's remaining $5. 28 Pa. Code 201.18 (e)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 8 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on review of facility policies, clinical record review and interviews with staff, it was determined that the facility failed to ensure that a resident's representative was notified in a timely manner of a resident's falls and transfer to the hospital for one of 32 residents reviewed (Resident R98). Findings include: Review of an untitled facility policy related to notification when accidents occur, dated reviewed February 2023, revealed that the facility must consult with the resident and notify the resident's physician and designated representative immediately when there is a decision to transfer or discharge the resident from the facility. In addition, the nurse manager ensures physician and designated representative is promptly notified of all falls regardless of severity. The facility policy defines immediately as as soon as possible and defines promptly as as soon as possible, but no longer than 24 hours. Clinical record review for Resident R98 revealed a progress note, dated August 22, 2023, at 8:50 a.m. which stated, Resident had witnessed fall. Continued review for Resident R98 revealed a change in condition note, dated August 25, 2023, at 9:11 a.m. which indicated that the resident had altered mental status and was sent to the hospital for evaluation. There was no indication that the resident's representative was notified at the time of the decision to transfer Resident R98 to the hospital. Further review of progress notes for Resident R98 revealed a general note, dated August 28, 2023, at 2:42 p.m. which indicated that the facility spoke with the resident's representative about the resident's hospitalization, fall and bruising that was sustained as a result of the falls. Interview on September 21, 2023, at 9:53 a.m. the Director of Nursing had no comment and was unable to explain why Resident R98's representative was not notified of his fall and transfer to the hospital in a timely manner. 28 Pa. Code 201.29(a) Resident rights 28 Pa. Code 211.12(d)(1) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 9 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of facility policy and interview with staff, it was determined that the facility did not ensure that confidentiality of resident's medical electronic records related to wound care was maintained for one of 32 residents observed (Resident R100). Residents Affected - Few Findings include: Review of Facility Protected Health Information Policy revealed that under section Policy revealed that: Protected health information (PHI) is individually identifiable health information that is transmitted or maintained by electronic media or any other form or medium. PHI will be used and disclosed in accordance with the Health Insurance Portability and Accountability Act (HIPAA) privacy standards and other applicable laws. Under section: Procedure #I, PHI includes oral, written, or otherwise recorded information that is created or received by Complete Care at [NAME] Hall. #II, PHI may relate to a resident's physical or mental health, payment or health care services provided to a resident. #III, PHI may pertain to a health condition or payment in the past, present, or future, and the resident who is the subject of the information may be alive or deceased . #IV, PHI will be protected in any form, including but not limited to, telephone conversation and voice mail, paper records, computers, transmissions over the internet, dial-up lines, private networks, fax machines, electronic memory chips, magnetic take, magnetic tape, magnetic disk, external hard drive Observation of the third floor conducted on [DATE], at 11:39 a.m. revealed that an unattended medication cart was in the hallway across the nurse's station against the wall with the lap top open and the screen facing the hallway. Further, Resident R100's medical information was open and visible. Further observation revealed that licensed nurse, Employee E6 was further down and across the hall. Interview with licensed nurse, Employee E6 conducted at the time of the observation revealed that she was the one who was using the laptop. Further Employee E6 confirmed that the laptop was open and Resident R100's medical information was open. Employee E6 also revealed that she left the cart to prepare the dressing supplies for Resident R100. 28 Pa. Code 211.29(a) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 10 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview with resident and staff, and review of facility policy, it was determined that the facility failed to initiate a grievance process and did conduct a proper investigation related to the resident's lost of personal property for one of 32 residents reviewed (Resident R55). Findings include: Review of the facility policy on Personal Property with review date of March 2023 revealed that under section Policy Statement, Residents are permitted to retain and use personal possessions and personal clothing as space permits. Under section Policy Interpretation and Implementation: #1. Each resident's room is equipped with private closet that permits easy access to resident's clothing. #2. Residents are encouraged to maintain his/her room in a home-like environment by bringing personal items. #4. A representative in the admitting office will advise the resident prior to or upon admission as to the types and amount of personal possession that the resident may keep in his or her room. #5. The resident's personal belongings and clothing shall be inventoried upon, admission or as such items are replenished. #6. The facility will promptly investigate any complaints of misappropriation or mistreatment of resident property. Review of Resident R55's clinical rerecord revealed that Resident R55 was admitted to the facility on [DATE]. Resident R55's diagnoses include were but not limited to contractures of the right hand, neuralgia and neuritis, Acute embolism and thrombosis, contracture of left and right knee. Review of Resident R55's quarterly MDS (Minimum Data Set-a federally required resident assessment completed at a specific interval) Section C0500 Brief Interview for Mental Status dated June 20, 2023, revealed a score of 14 suggesting that Resident R55's cognition was intact. Interview with Resident R55 conducted on September 18., 2023 at 12:28 p.m. revealed that she had a box of clothing worth $5,000.00 in boxes which was stored in her closet. Further, Resident R55 revealed that she reported the lost items to the facility and that she also reported her lost of property to the previous Nursing Home Administrator, but nothing came of it. Further Resident R55 also revealed that she had given the facility a list of the items stolen from her. Further Resident R55 revealed that she called the police and that the police told her that the facility has to do an investigation on the missing box of clothing. Interview with Director of Nursing (DON), Employee E2 conducted on September 21, 2023, at 10:32 a.m. revealed that she was aware that Resident R55 claimed that she lost personal property. Further, Employee E2 stated that no able to remember when the resident made the complaint and that the previous Nursing Home Administrator was handling the investigation, but the previous administrator did not tell her what items were missing nor the monetary value of Resident R55's missing personal property. Further Employee E2 revealed that the previous Nursing Home Administrator told her to call Resident R55's nephew to inquire about Resident R55's missing personal properties, but when she called the nephew, he didn't want to get involved. Further interview with Employee E2 revealed that she wasn't aware of what the previous Nursing Home Administrator did to investigate the claim of missing property and that it was the responsibility of the administrator to initiate investigation and to resolve issues regarding lost items. Employee (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 11 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few E2 confirmed that there was no documented evidence of investigation, findings, or corrective action for Resident R55's missing personal belongings. Further, Employee E2 also revealed that the case was not endorsed to her when the previous administrator left. Interview with current Facility Administrator Employee E1 revealed that he was not aware of the complaint of lost property until surveyor inquired of it on September 18, 2023. Interview with Social Worker, Employee E4 conducted on September 21, 2023, at 1:00 p.m., revealed that she was not aware of Resident R55's complaints of lost personal property. Further Employee E4 revealed that she started investigation Resident R55's complaint as of yesterday. 28 Pa. Code 201.14(a) Administrator's responsibility 28 Pa. Code 201.18(b)(3) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 12 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policies and documentation, clinical record reviews and interviews with staff, it was determined that the facility failed to ensure that residents were free from neglect for four of 32 residents reviewed (Residents R71, R73, R87 and R16). Findings include: Review of facility policy, Abuse, Neglect, Exploitation and Misappropriation Prevention Program dated last reviewed May 2023, revealed, Residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. Continued review revealed, Implement measures to address factors that may lead to abusive situations, for example: adequately prepare staff for caregiving responsibilities; provide staff with opportunities to express challenges related to their job and work environment without reprimand or retaliation; instruct staff regarding appropriate ways to address interpersonal conflicts. Further review revealed, Identify and investigate all possible incidents of abuse, neglect, mistreatment, or misappropriation of resident property. Investigate and report any allegations within timeframes required by federal requirements. Review of Resident R71's Annual MDS (Minimum Data Set - a mandatory periodic resident assessment tool), dated February 1, 2023, revealed that the resident was admitted to the facility on [DATE], and had diagnoses including cancer, cerebrovascular accident (damage to the brain from interruption of its blood supply), hemiplegia (paralysis) and aphasia (loss of ability to understand or express speech, caused by brain damage). Continued review revealed that the resident had a BIMS (Brief Interview for Mental Status) of zero, indicating that the resident was severely cognitively impaired. Further review revealed that the resident required extensive assistance from two or more staff persons for bed mobility and extensive assistance with assistance from one staff person for transfers, dressing, toileting and hygiene. Review of Resident R71's care plan, dated initiated March 19, 2023, revealed that the resident was at risk for falls related to deconditioning, cerebrovascular accident and immobility. Continued review of Resident R71's care plan revealed that no care plan was developed related to the resident's need for assistance with activities of daily living, such as bed mobility, transfers, dressing, toileting and hygiene. Review of facility documentation submitted to the Pennsylvania Department of Health on April 5, 2023, at 11:37 a.m. by the Director of Nursing revealed that Resident R71 sustained a witnessed fall. Review of progress notes for Resident R71 revealed a note, dated April 4, 2023, at 1:20 p.m. which stated, Resident was being repositioned by care nurse and slid to the floor .Unable to assess ROM [range of motion] and neurochecks due to aphasia. Resident sent to [hospital emergency department] via stretcher. Continued review of facility documentation related to Resident R71's fall on April 4, 2023, revealed a written statement from Employee E17, nurse aide, dated April 4, 2023, which stated, Washing patient had her turned to the side she was holding on black railing and shifted her weight over the bed. Once she fell over the nurse helped me put patient back in the bed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 13 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on September 20, 2023, at 11:20 a.m. the Director of Nursing stated that Employee E17, nurse aide, was an agency staff and that she was no longer allowed to work at the facility after the incident. The Director of Nursing stated that Resident R71 required assistance from two staff persons for bed mobility and transfers and that when the fall occurred Employee E17, nurse aide, was providing care to the resident by herself, without assistance from other staff. The Director of Nursing stated that Employee E17, nurse aide, turned the resident away from her during care, resulting in the fall. The Director of Nursing insisted that Employee E17, nurse aide, would have been aware that the resident required two person assistance because that information is reviewed during report at the beginning of the shift. Continued review of progress notes for Resident R71 revealed a note, dated August 3, 2023, at 6:17 a.m. written by Employee E19, licensed nurse, which stated, Resident unable to receive total care during shift. RN [registered nurse] supervisor and DON [Director of Nursing] made aware with no effective resolution in place. CNA [nurse aide] assigned refused to complete assignment. Interview on September 19, 2023, at 11:19 a.m. the Director of Nursing stated that she was completely unaware of the above note. Clinical record review for Resident R16 revealed a note, dated August 3, 2023, at 6:21 a.m. written by Employee E19, licensed nurse, which stated, Resident unable to receive total care during shift. RN [registered nurse] supervisor and DON [Director of Nursing] made aware with no effective resolution in place. CNA [nurse aide] assigned refused to complete assignment. Review of Resident R16's care plan, dated initiated February 21, 2013, revealed that the resident was dependent for activities of daily living care in bathing, grooming, dressing, bed mobility, transfers, locomotion and toileting due to cognitive loss and chronic disease compromising functional ability. Clinical record review for Resident R73 revealed a note, dated August 3, 2023, at 6:23 a.m. written by Employee E19, licensed nurse, which stated, Resident unable to receive total care during shift. RN [registered nurse] supervisor and DON [Director of Nursing] made aware with no effective resolution in place. CNA [nurse aide] assigned refused to complete assignment. Review of Resident R73's care plan, dated initiated November 3, 2022, revealed that no care plan was developed related to the resident's need for assistance with care and activities of daily living, such as bed mobility, transfers, dressing, toileting and hygiene. Review of Resident R73's Quarterly MDS, dated [DATE], revealed that the resident required extensive assistance with bed mobility, transfers, eating, toileting, hygiene and bathing. Clinical record review for Resident R87 revealed a note, dated August 3, 2023, at 6:24 a.m. written by Employee E19, licensed nurse, which stated, Resident unable to receive total care during shift. RN [registered nurse] supervisor and DON [Director of Nursing] made aware with no effective resolution in place. CNA [nurse aide] assigned refused to complete assignment. Review of Resident R87's care plan, dated initiated May 31, 2022, revealed that the resident has an activities of daily living self-care performance deficit. Review of Resident R87's Quarterly MDS, dated [DATE], revealed that the resident required extensive (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 14 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0600 Level of Harm - Minimal harm or potential for actual harm assistance with bed mobility, transfers, dressing, eating, toileting, hygiene and that the resident was totally dependent for bathing. During a follow-up interview on September 19, 2023, at 4:59 a.m. the Director of Nursing stated that she was completely unaware of the above notes for Residents R16, R73 and R87. Residents Affected - Few Staff assignment sheets for the overnight shift of August 2 into August 3, 2023, were reviewed with Employee E14, licensed nurse, on September 20, 2023, at 12:20 p.m. The staff assignment sheet revealed that Employee E19 was the assigned licensed nurse on that shift for Residents R71, R16, R73 and R87. Continued review revealed that Employee E15 was the assigned nurse aide on that shift for Residents R71, R16, R73 and R87. Continued review revealed that Employee E15, nurse aide, was also assigned to provide one-to-one care to another resident on the farthest opposite side of the unit until 4:00 a.m. Further review revealed that two additional licensed nurses and two additional nurse aides were on duty on that unit on that shift. Review of staffing schedules for the overnight shift of August 2 into August 3, 2023, revealed a total of five licensed nurses and seven nurse aides were on duty. Review of nurse aide documentation for the overnight shift of August 2 into August 3, 2023, revealed that no care was documented for that shift for Residents R71, R16, R73 and R87. Interview on September 20, 2023, at 4:37 p.m. Employee E16, Regional Director, confirmed that no care was documented by nurse aide staff for the overnight shift of August 2 into August 3, 2023, for Residents R71, R16, R73 and R87. During another follow-up interview on September 20, 2023, at 4:48 p.m. the Director of Nursing revealed that she had not initiated any investigations at that time for Residents R71, R16, R73 and R87 in regards to the above notes indicating that the residents did not receive any care during the shift due to a nurse aide refusing to complete her assignment. Further interview revealed that the Director of Nursing was unaware that an investigation related to neglect needed to be done. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 201.18(b)(2) Management 28 Pa. Code 201.18(e)(1) Management 28 Pa. Code 201.29(c) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 15 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policies, clinical record review, facility documentation and staff interviews, determined the facility failed to prevent the misappropriation of medication for one of 32 residents reviewed. (Residents 109) Residents Affected - Few Findings include: Review of the facility Abuse policy updated on 1/2023 indicated residents have the right to be free from misappropriation of resident property and exploitation. It protects the resident by anyone including facility staff, and staff from other agencies and/or any other individual. Review of Resident R109's physician orders dated June 24, 2023, revealed an order for Oxycodone HCI 5 milligram (mg) tablets (a controlled opioid pain medication) to be given every six hours as needed for moderate to severe pain. Review of information submitted by the facility to the State Survey Agency, dated July 25, 2023, revealed a narcotic diversion of Resident R109's pain medication, Oxycodone. Statement obtained from staff who was interviewed revealed that a licensed nurse stated that she came into work on July 24, 2023 and counted the narcotic by reading out loud the numbers on the narcotic book and looking for the correct number of narcotic on the narcotic book. On July 25, 2023 after doing the narcotic count around 7:20 am patient was up in chair at door and asked for PRN (as needed) pain meds. Went into cart and realized that there was no PRN pain meds (Oxy) Another nurse was standing out my cart waiting for me to count .with her, who then started to check. The facility concluded that narcotic count discrepancy did occur and the missing medications could not be located. The facility was able to identified a licensed nurse, Employee E82 as the primary nurse responsible for the narcotics on the shift. Subsequently the facility terminated the employee. Refer to F755 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.12(c) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 16 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0606 Not hire anyone with a finding of abuse, neglect, exploitation, or theft. Level of Harm - Minimal harm or potential for actual harm Based on review facility policies, review of personnel files and interviews with staff, it was determined that the facility failed to obtain a federal criminal background check as required for one of five personnel files reviewed related to background checks (Employee E20). Residents Affected - Few Findings include: Review of facility policy, Background screening Investigations dated reviewed March 2023, revealed, the Personnel/Human Resources Director, or other designee, will conduct background checks, reference checks and criminal conviction checks (including fingerprinting as may be required by state law) on all potential employees and contract personnel . Such investigation will be initiated within two days of an offer of employment or contract agreement. Review of Employee E20's personnel file revealed that she was hired by the facility as a nurse aide on May 30, 2023. Continued review revealed Background Check - Applicant Information; The information below is needed to perform a background check as required for employment by our facility. The employee listed dates of residency at a Pennsylvania address from July 16, 2022, to May 16, 2023 (date of the application). Continued review revealed that Employee E20, nurse aide, provided an out-of-state photo identification card that was issued on May 13, 2022. Further review of Employee E20's personnel file revealed no evidence that the employee was an established resident within the state of Pennsylvania for at least two years. Interview on September 20, 2023, at 2:40 p.m. the Nursing Home Administrator confirmed that a federal criminal background check had not been obtained for Employee E20, nurse aide. The Nursing Home Administrator did not provide any additional evidence to verify that Employee E20 was an established resident within the state of Pennsylvania for at least two years. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(e)(1) Management 28 Pa. Code 201.19(8) Personnel policies and procedures FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 17 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on review of facility policies and documentation, clinical record reviews and interviews with staff, it was determined that the facility failed to report allegations of neglect within required time frames for four of 32 residents reviewed (Residents R71, R73, R87 and R16). Findings include: Review of facility policy, Abuse, Neglect, Exploitation or Misappropriation Reporting and Investigating dated reviewed May 2023, revealed, If resident abuse, neglect, exploitation, misappropriation of resident property or injury of unknown source is suspected, the suspicion must be reported immediately to the administrator and to other officials according to state law. Continued review revealed, The administrator or the individual making the allegation immediately reports his or her suspicion to the following persons or agencies: The state licensing/certification agency responsible for surveying/licensing the facility. Further review revealed, 'Immediately' is defined as within two hours of an allegation involving abuse or result in serious bodily injury; or within 24 hours of an allegation that does not involve abuse or result in serious bodily injury. Review of progress notes for Resident R71 revealed a note, dated August 3, 2023, at 6:17 a.m. written by Employee E19, licensed nurse, which stated, Resident unable to receive total care during shift. RN [registered nurse] supervisor and DON [Director of Nursing] made aware with no effective resolution in place. CNA [nurse aide] assigned refused to complete assignment. Interview on September 19, 2023, at 11:19 a.m. the Director of Nursing stated that she was completely unaware of the above note. Clinical record review for Resident R16 revealed a note, dated August 3, 2023, at 6:21 a.m. written by Employee E19, licensed nurse, which stated, Resident unable to receive total care during shift. RN [registered nurse] supervisor and DON [Director of Nursing] made aware with no effective resolution in place. CNA [nurse aide] assigned refused to complete assignment. Clinical record review for Resident R73 revealed a note, dated August 3, 2023, at 6:23 a.m. written by Employee E19, licensed nurse, which stated, Resident unable to receive total care during shift. RN [registered nurse] supervisor and DON [Director of Nursing] made aware with no effective resolution in place. CNA [nurse aide] assigned refused to complete assignment. Clinical record review for Resident R87 revealed a note, dated August 3, 2023, at 6:24 a.m. written by Employee E19, licensed nurse, which stated, Resident unable to receive total care during shift. RN [registered nurse] supervisor and DON [Director of Nursing] made aware with no effective resolution in place. CNA [nurse aide] assigned refused to complete assignment. During a follow-up interview on September 19, 2023, at 4:59 a.m. the Director of Nursing stated that she was completely unaware of the above notes for Residents R16, R73 and R87. Staff assignment sheets for the overnight shift of August 2 into August 3, 2023, were reviewed with Employee E14, licensed nurse, on September 20, 2023, at 12:20 p.m. The staff assignment sheet revealed that Employee E19 was the assigned licensed nurse on that shift for Residents R71, R16, R73 and R87. Continued review revealed that Employee E15 was the assigned nurse aide on that shift for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 18 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0609 Residents R71, R16, R73 and R87. Level of Harm - Minimal harm or potential for actual harm Review of nurse aide documentation for the overnight shift of August 2 into August 3, 2023, revealed that no care was documented for that shift for Residents R71, R16, R73 and R87. Residents Affected - Some Interview on September 20, 2023, at 4:37 p.m. Employee E16, Regional Director, confirmed that no care was documented by nurse aide staff for the overnight shift of August 2 into August 3, 2023, for Residents R71, R16, R73 and R87. During another follow-up interview on September 20, 2023, at 4:48 p.m. the Director of Nursing revealed that she had not reported or initiated any investigations at that time for Residents R71, R16, R73 and R87 in regards to the above notes indicating that the residents did not receive any care during the shift due to a nurse aide refusing to complete her assignment. Continued interview revealed that the Director of Nursing was unaware that an investigation related to neglect needed to be done. Upon further interview, the Director of Nursing demonstrated that she reviewed the above notes written by Employee E19, licensed nurse, from August 3, 2023, and stated that it was not her fault that she did not know about the notes because Employee E19 wrote the notes incorrectly. 28 Pa Code 201.14(a) Responsibility of licensee 28 Pa Code 201.18(b)(1) Management 28 Pa Code 201.18(e)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 19 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0610 Respond appropriately to all alleged violations. 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 policies and documentation, clinical record review and interviews with staff, it was determined that the facility failed to thoroughly investigate all allegations of neglect for six of 32 residents reviewed (Residents R98, R62, R71, R73, R87 and R16). Residents Affected - Some Findings include: Review of facility policy, Abuse, Neglect, Exploitation or Misappropriation Reporting and Investigating dated reviewed May 2023, revealed, The individual conducting the investigation as a minimum: reviews the documentation and evidence; reviews the resident's medical record to determine the resident's physical and cognitive status at the time of the incident and since the incident; observes the alleged victim, including his or her interactions with staff and other residents; interviews the person(s) reporting the incident; interviews any witnesses to the incident; interviews the resident; interviews the resident's attending physician to determine the resident's condition; interviews staff members (on all shifts) who have had contact with the resident during the period of the alleged incident; interviews the resident's roommate, family members and visitors; interviews other residents to whom the accused employee provides care or services; reviews all events leading up to the alleged incident; and documents the investigation completely and thoroughly. Resident R62 was admitted [DATE] diagnosed with Parkinson's disease (a brain disease that causes uncontrollable movements), dysphagia,(difficulty swallowing) difficulty walking, a history of falling and presence of neurostimulator (uses electric pulses to reduce symptoms of tremors). Review of Resident R62's quarterly MDS (Minimum Data Set an assessment of residents' needs) dated June 14, 2023, revealed the resident was awake, alert, and oriented. The resident required extensive assistance for bed mobility, transfers, toileting, limited assistance with dressing and required supervision with meals. Review of Resident R62's progress notes revealed a late entry note created on August 30, 2023, linked to an incident that occurred on August 27, 2023, with the note's effective date of August 28, 2023 from the Director of Nursing that indicated Speech Therapy was consulted to evaluate Resident R62 for swallowing problems that occurred during mealtime. Review of the facility's incident report titled Choking (not part of Resident R62's medical records) dated August 27, 2023 prepared by Licensed Practical Nurse (LPN) Employee E75 discribes the incident Was in lounge and seen choking on a piece of meat. Meat was dislodged by striking on upper back between shoulder and further documented that a nursing assistant was present, disloged the meat. Further review of the choking incident failed to include Nurse aide, Employee E77's witness statement. On September 20, 2023, at 11:30 a.m. the Director of Nursing stated a witness statement was not obtained from Nursing assistant, Employee E77 confirming the facility did not complete a thourough investigation by failing to obtain the witness statements from NA Employee E77 who was present when Resident R62 choked during mealtime. Review of facility documentation submitted to the State Survey Agency on June 2, 2023, at 10:19 p.m. by the Director of Nursing revealed that on June 2, 2023, at approximately 10:00 a.m., it was brought to the facility's attention that [Resident R71's] family is alleging neglect by the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 20 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some The family alleged that the resident's hair was not well groomed and that she had wet clothing on during their visit. Continued review of the submitted documentation revealed, The allegations were promptly addressed. The top clothing was immediately changed. Her hair brushed and hairdresser appointment was made. There was no indication of whether the allegation was determined to be substantiated or not by the facility or if a perpetrator was identified. Review of facility documentation related to the above allegation revealed written witness statements provided by Employee E14, licensed nurse, Employee E32, nurse aide, and Employee E63, nurse aide. Interview on September 20, 2023, at 12:20 p.m. Employee E14, licensed nurse, confirmed that she provided that written statement for Resident R71 which stated, I am the charge nurse on the front hall. Resident is always well groomed and receives total care. Upon further interview, Employee E14, licensed nurse, was not aware of the specific incident or allegations of neglect. Employee E14, licensed nurse, stated that she frequently works with Resident R71 and in general the nurse aides provide her with good care. Staffing assignment sheets for June 2, 2023, for the day shift, were reviewed with Employee E14, licensed nurse. Employee E14, licensed nurse, confirmed that Employee E18 was the nurse aide assigned to care for Resident R71. Review of Medication Administration Records for June 2, 2023, revealed that Employee E12 was the licensed nurse who provided medications to Resident R71 during the day shift on June 2, 2023. Review of progress notes for Resident R71 revealed that there were no notes written by any staff during the day or evening shifts on June 2, 2023. Further review of facility documentation related to the reported neglect allegations revealed that no witness statements were obtained from Employee E18, nurse aide, or Employee E12, licensed nurse. No observations or assessments of Resident R71's condition were recorded. There were no documented communications with the attending physician regarding the neglect allegations. There were no interviews with other residents who received care from Employee E18, nurse aide, or Employee E12, licensed nurse. Interview on September 20, 2023, at 12:05 p.m. the Director of Nursing stated that she did not know who the assigned staff were for Resident R71 on June 2, 2023, during the day shift. The Director of Nursing stated that the date and time of the alleged neglect were not identified and that a perpetrator was not identified. The documentation that was submitted by her to the State Survey Agency was reviewed with her; the documentation stated that on June 2, 2023, at approximately 10:00 a.m. that the facility was made aware of the neglect allegations and that immediate actions, including changing the resident's wet clothing and brushing her hair, were taken at that time. The Director of Nursing was unable to explain her own discrepancies and had no further comments. Review of progress notes for Resident R98 revealed a note written by Employee E26, licensed nurse, on August 22, 2023, created at 3:50 a.m. which stated, Noted resident had witnessed fall. Resident assessed prior to returning back to bed via mechanical device. No complaints of pain or discomfort. Resident states that he feels fine. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 21 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some The incident report and facility investigation related to Resident R98's witnessed fall on August 22, 2023, was requested from the Director of Nursing and Nursing Home Administrator on September 20, 2023, at 9:34 a.m. The documents were requested again September 20, 2023, at 3:46 p.m. and 4:48 p.m. and September 21, 2023, at 9:45 a.m. Interview on September 21, 2023, at 9:53 a.m. the Director of Nursing stated that no incident report or investigation was completed for Resident R98 at the time of his fall. Interview on September 21, 2023, at 10:39 a.m. Employee E26, licensed nurse, stated that she was notified by two nurse aides that Resident R98 had a fall. Employee E26, licensed nurse, stated that she did not witness the fall, that she does not know how the resident fell and did not ask the nurse aides how the resident fell. Employee E26, licensed nurse, stated that she went into the resident's room and saw the resident sitting on the floor next to his bed. Employee E26, licensed nurse, stated that the nurse supervisor on duty at the time, Employee E31, licensed nurse, responded to the fall. Interview on September 21, 2023, at 11:39 a.m. Employee E31, licensed nurse, stated that she was just asked yesterday to write a statement about Resident R98's fall from August 22, 2023. Employee E31, licensed nurse, stated that Resident R98 was already back in bed when she went to assess him, that she did not ask what happened or who put the resident back into bed and that she did not complete an incident report or collect any witness statements. Interview on September 21, 2023, at 3:18 p.m. Employee E27, nurse aide, stated that her and another aide heard a sound, went to check on Resident R98 and found him on the floor. Employee E27, nurse aide, stated that she does not know what happened and that she did not witness the fall. Employee E27, nurse aide, stated that she does not want to get into trouble over this incident because she needs her job and had no further comments. Review of progress notes for Resident R71 revealed a note, dated August 3, 2023, at 6:17 a.m. written by Employee E19, licensed nurse, which stated, Resident unable to receive total care during shift. RN [registered nurse] supervisor and DON [Director of Nursing] made aware with no effective resolution in place. CNA [nurse aide] assigned refused to complete assignment. Interview on September 19, 2023, at 11:19 a.m. the Director of Nursing stated that she was completely unaware of the above note. Clinical record review for Resident R16 revealed a note, dated August 3, 2023, at 6:21 a.m. written by Employee E19, licensed nurse, which stated, Resident unable to receive total care during shift. RN [registered nurse] supervisor and DON [Director of Nursing] made aware with no effective resolution in place. CNA [nurse aide] assigned refused to complete assignment. Clinical record review for Resident R73 revealed a note, dated August 3, 2023, at 6:23 a.m. written by Employee E19, licensed nurse, which stated, Resident unable to receive total care during shift. RN [registered nurse] supervisor and DON [Director of Nursing] made aware with no effective resolution in place. CNA [nurse aide] assigned refused to complete assignment. Clinical record review for Resident R87 revealed a note, dated August 3, 2023, at 6:24 a.m. written by Employee E19, licensed nurse, which stated, Resident unable to receive total care during shift. RN [registered nurse] supervisor and DON [Director of Nursing] made aware with no effective resolution in place. CNA [nurse aide] assigned refused to complete assignment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 22 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a follow-up interview on September 19, 2023, at 4:59 a.m. the Director of Nursing stated that she was completely unaware of the above notes for Residents R16, R73 and R87. Staff assignment sheets for the overnight shift of August 2 into August 3, 2023, were reviewed with Employee E14, licensed nurse, on September 20, 2023, at 12:20 p.m. The staff assignment sheet revealed that Employee E19 was the assigned licensed nurse on that shift for Residents R71, R16, R73 and R87. Continued review revealed that Employee E15 was the assigned nurse aide on that shift for Residents R71, R16, R73 and R87. Review of nurse aide documentation for the overnight shift of August 2 into August 3, 2023, revealed that no care was documented for that shift for Residents R71, R16, R73 and R87. Interview on September 20, 2023, at 4:37 p.m. Employee E16, Regional Director, confirmed that no care was documented by nurse aide staff for the overnight shift of August 2 into August 3, 2023, for Residents R71, R16, R73 and R87. During another follow-up interview on September 20, 2023, at 4:48 p.m. the Director of Nursing revealed that she had not reported or initiated any investigations at that time for Residents R71, R16, R73 and R87 in regards to the above notes indicating that the residents did not receive any care during the shift due to a nurse aide refusing to complete her assignment. Continued interview revealed that the Director of Nursing was unaware that an investigation related to neglect needed to be done. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 201.18(e)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 23 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policies, clinical record reviews and interviews with staff, it was determined that the facility failed to maintain sufficient documentation regarding the basis for the discharges, for one of 3 closed records reviewed (Residents R88). Findings include: Review of the facility's policy for Transfers/Discharges revised on 2/2023 revealed except in a medical emergency, the facility must consult with the resident immediately if the resident is competent and notify the resident's physician and designated representative when there is a decision to transfer the resident. Resident R88 was admitted to the facility on [DATE], diagnosed with, congestive heart failure with pulmonary edema (heart does not pump sufficiently and blood and fluid then collect in the lungs causing pulmonary edema) and acute respiratory failure with hypoxia (lacks oxygen). Review of Resident R88's change in condition assessment dated [DATE], at 11:14 a.m. from Licensed nurse, Employee E10 revealed Noticed resident with congestion while giving morning medication. Licensed nurse, Empployee E10 documented Head of bed elevated, arousal to tactile and verbal simulation noting Resident R88's vital signs at 9:56 a.m. stable, SpO2 (oxygen saturation is the amount of oxygen in your blood) was 97% via nasal canula. The Nurse Practioner was notified, and a new order was obtained for Guaifenesin 600 milligrams, to help with the resident's congestion. Continue review of Resident R88's clinical record did not reveal additional assessments nor progress notes noting any abnormal vital signs or symptoms. Progress notes from Licensed nurse, Employee E10 , three hours later at 2:33 p.m. documents the resident as being transferred to the emergency room. Interview with Licensed nurse, Employee E10, on September 20, 2023, at 11:00 a.m. stated on the morning of September 17, 2023, Resident R88 was Using his accessory muscles (muscles other than the diaphragm and intercostal muscles) to breathe and his SpO2 was dropping steadily (low levels of oxygen in the blood). Further review of Resident R88's hospital transfer form, documented that the resident vital signs obtained were stable earlier in the day at 9:56 a.m, did not use the current date, but used the date of resident's previous hospital transfer, did not include additional transfer documentation, nor was documented evidence of Resident R88's drop in SpO2. Interview with the Director of Nursing on September 20, 2023 at 2:06 pm confirmed the change in condition failed to have the appropriate information communicated to the receiving healthcare institution, It did not paint an accurate picture of the resident's status. 28 Pa. Code 211.10. (c) Resident care policies 28 Pa. Code 211.12(c)(d)(1) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 24 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record reviews and interviews with staff, it was determined that the facility failed to develop a baseline care plan within 48 hours of a resident's admission related to pressure ulcers for one of five residents with pressure ulcers reviewed (Resident R213). Findings include: Clinical record review for Resident R213 revealed an admission Nursing Assessment, which indicated that the resident was admitted to the facility on [DATE], from the hospital. Continued review revealed that the resident was noted to have a scar on her sacrum. Review of progress notes for Resident R213 revealed a general note, dated September 2, 2023, at 1:08 a.m. which indicated that the resident had a stage one pressure ulcer to her sacrum (a stage one pressure ulcer is an area of intact skin with non-blanchable redness of a localized area). Review of treatment records for Resident R213 revealed a physician's order, dated September 2, 2023, for Pressure ulcer over sacrum: cleanse wound with wound cleanser and apply sureprep to periwound skin and adhesive contact area. Apply hydrogel impregnated gauze and cover with bordered gauze every day shift. The treatment was documented as administered on September 2, 3, and 4, 2023. Review of a wound consultant note for Resident R213, dated September 6, 2023, revealed that the resident had a stage three pressure ulcer (a stage three pressure ulcer is full thickness tissue loss) to her sacrum that measured 2.2 c.m. (centimeters) length by 2 c.m. width by 0.2 c.m. depth. The wound was noted to have 90% granulation tissue (new connective tissue that forms on a wound during the healing process) and 10% slough tissue (dead skin cells). Review of Resident R213's care plan revealed that a care plan was not developed until September 4, 2023, related to the resident's risk for impairment to skin integrity. Further review revealed that a care plan specific to Resident R213's sacral wound was not developed until September 5, 223. Interview on September 20, 2023, at 9:34 a.m. the Director of Nursing was unable to explain why Resident R213's baseline care plan was not developed within 48 hours as required. 28 Pa Code 201.14(a) Responsibility of licensee 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: 395791 If continuation sheet Page 25 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews with staff and review of clinical records, it was determined the facility failed to develop and implement a comprehensive person-centered care plan, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs for 6 of 23 resident records reviewed (Resident R10, R39, R62, R64, R71, and R94). Findings include: Review of Resident R39 clinical record revealed an admission date of January 13.2023 diagnosed with encephalopathy (disease of the brain), Parkinson's disease (brain disease causing uncontrollable movements), Alzheimer's disease (brain disease causing decreased function) dysphagia, (difficulties swallowing), used a gastrostomy to provide daily nutrients. Review of Resident R39's quarterly MDS (Minimum Data Set, an assessment of residents; needs) dated June 14, 2023 revealed the resident needed extensive assistants for bed mobility, transfers, dressing eating toileting, personal hygiene, and was completely dependent on staff for bathing. On September 18, 2023, at 12:00 p.m. during lunch, Resident R39 was observed in bed with his hands at his side staring at his untouched lunch tray. The resident stated he couldn't eat and needed someone to help him. Surveyor asked Licensed Nurse, Employee E80 if the resident receives assistance with meals and Employee E80 replied she did not believe he did. During that time, Speech Therapist, Employee E 74 stated he did need assistants he cannot eat by himself. Review of Resident R39's speech therapy evaluation and plan of care starting on July 12, 2023, indicated Resident R39 needed assistance with meals. Further review of Resident R39's clinical records revealed the resident's care plan did not specify the type of assistants he needed with everyday activities of daily living including meals. The above findings were confirmed with the Director of Nursing on September 18, 2023, at 2:00 pm. Resident R62 was admitted [DATE] diagnosed with Parkinson's disease (a brain disease that causes uncontrollable movements), dysphagia, (difficulty swallowing), and used a neurostimulators (a deep brain stimulator (DBS) that uses electrical pulses to reduce symptoms of tremors, stiffness and walking caused by Parkinson's disease. Review of Resident R62 June 14, 2023, quarterly MDS dated [DATE], revealed the resident required extensive assistance for bed mobility, transfers, toileting, limited assistance with dressing and supervision with meals. Review of Resident R62's physician orders dated December 12, 2022, instructed to charge neuro-stimulator in left chest wall at least 20 minutes a day, every day, one time a day for keeping stimulator charged, place on resident's neurostimulator charge DBS (Deep Brain Stimulator) at least 20 minutes every shift. Physician orders dated July 28, 2023, instructed to remind and assist resident in setting up her device (Deep Brain Stimulator) to charge on 3 days of the week, every day shift, every Wednesday, Friday and Sunday. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 26 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident R62's care plan revealed the resident was not care planned for the neurostimulators nor the necessary charging needed for proper function. This was confirmed with the Director of Nursing on September 20, 2023, at 3:30 p.m. Review of Resident R71's Annual MDS, dated [DATE], revealed that the resident was admitted to the facility on [DATE], and had diagnoses including cancer, cerebrovascular accident (damage to the brain from interruption of its blood supply), hemiplegia (paralysis) and aphasia (loss of ability to understand or express speech, caused by brain damage). Continued review revealed that the resident had a BIMS (Brief Interview for Mental Status) of zero, indicating that the resident was severely cognitively impaired. Further review revealed that the resident required extensive assistance from two or more staff persons for bed mobility and extensive assistance with assistance from one staff person for transfers, dressing, toileting and hygiene. Review of Resident R71's care plan, dated initiated March 19, 2023, revealed that the resident was at risk for falls related to deconditioning, cerebrovascular accident and immobility. Continued review of Resident R71's care plan revealed that no care plan was developed related to the resident's need for assistance with activities of daily living, such as bed mobility, transfers, dressing, toileting and hygiene. Review of facility documentation submitted to the State survey Agency on April 5, 2023, at 11:37 a.m. by the Director of Nursing revealed that Resident R71 sustained a witnessed fall. Review of progress notes for Resident R71 revealed a note, dated April 4, 2023, at 1:20 p.m. which stated, Resident was being repositioned by care nurse and slid to the floor .Unable to assess ROM [range of motion] and neurochecks due to aphasia. Resident sent to [hospital emergency department] via stretcher. Continued review of facility documentation related to Resident R71's fall on April 4, 2023, revealed a written statement from Employee E17, nurse aide, dated April 4, 2023, which stated, Washing patient had her turned to the side she was holding on black railing and shifted her weight over the bed. Once she fell over the nurse helped me put patient back in the bed. Interview on September 20, 2023, at 11:20 a.m. the Director of Nursing stated that Employee E17, nurse aide, was an agency staff and that she was no longer allowed to work at the facility after the incident. The Director of Nursing stated that Resident R71 required assistance from two staff persons for bed mobility and transfers and that when the fall occurred Employee E17, nurse aide, was providing care to the resident by herself, without assistance from other staff. The Director of Nursing stated that Employee E17, nurse aide, turned the resident away from her during care, resulting in the fall. The Director of Nursing insisted that Employee E17, nurse aide, would have been aware that the resident required two person assistance because that information is reviewed during report at the beginning of the shift. Further interview with the Director of Nursing confirmed that no care plan was developed for Resident R71 related to the resident's need for assistance with activities of daily living, such as bed mobility, transfers, dressing, toileting and hygiene. Review of Resident R94's Annual MDS, dated [DATE], revealed that the resident required a language (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 27 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0656 interpreter to communicate with health care staff and that the resident's preferred language was Spanish. Level of Harm - Minimal harm or potential for actual harm Review of Resident R94's care plan, dated initiated June 29, 2022, revealed that the resident has a communication problem related to language barrier (Spanish speaking) with interventions including language line posted in room and Spanish speaking staff to be assigned when available. Residents Affected - Few Observation on September 19, 2023, at 11:36 a.m. revealed Resident R94 in her room watching television in Spanish. Interview was attempted with the resident, however, Resident R94 only spoke in Spanish. No communication devices for language translation were observed or available in Resident R94's room to facilitate communication. Interview on September 19, 2023, at 11:42 a.m. Employee E14, licensed nurse, confirmed that no language line information or communication board was available in Resident R94's room. Employee E14, licensed nurse, stated that she did not know where to find the language line information and that she uses a translation app on her personal cell phone to communicate with the resident. Interview on September 20, 2023, at 9:34 a.m. the Nursing Home Administrator and Director of Nursing were both unaware if the facility had a language line and were unable to provide any information regarding language translation services. Observation of Resident R64 conducted on September 18, 2023, at 10:29 during tour of the Third-floor unit revealed that Resident R64's was sleeping with both hands in a fisted position. Further Resident R64 was not wearing hand splints. Review of Resident R64's clinical record revealed that Resident R64 was admitted to the facility on [DATE]. Resident R64's diagnoses include were but not limited to Contracture Unspecified Joint, Paraplegia, Muscle Spasm, Age related Osteoporosis, Polyneuropathy. Review of Resident R64's quarterly MDS dated [DATE], Section C0500 BIMS (Brief Interview for Mental Status) revealed that Resident R64's BIMS score was 15, suggesting that Resident R64 was cognitively intact, section 0400 (Functional Limitation of range of Motion revealed that) A (Upper extremity-shoulder, elbow, wrist, hand) was coded was coded 2 (impairment on both sides). and 0400 B (Lower extremity (hip, knee, ankle, foot) was coded 2 (impairment on both sides). Review of Resident R64's September 2023 physician's orders revealed that resident had an order for Patient to wear finger splints (3 & 4) 2 times/day for 2 HRs (after breakfast and after lunch). nursing to perform skin checks throughout day. Review of Resident R64's clinical record revealed that there was no care plan addressing resident's limitation in his hands and the use of finger splints. Interview with the Director of Nusing, Employee E2 September 20, 2023 at 10:53 p.m. revealed that she has never seen resident with a splint and also confirmed that there was no care plan addressing resident's use of splint. 28 Pa. Code 211.12(c)(d) Resident care policies 28 Pa. Code 211.12(d)(1)(2)(5) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 28 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on clinical record review and interviews with staff, it was determined that the facility failed to update a resident's care plan after changes were made to the residents code status for one of 32 residents reviewed (Resident R16). Findings include: Review of Resident R16's care plan, dated revised on August 27, 2023, revealed that the resident's code status was full code (allows for all interventions needed to restore breathing or heart functioning, including chest compressions, a defibrillator and insertion of a breathing tube). Review of progress notes for Resident R16 revealed a nurse practitioner note, dated September 4, 2023, at 3:28 p.m. which indicated, Discussed code status and goals of care. Member expressed his desire to change code status to DNR/DNI [do not resuscitate - do not perform lifesaving interventions in the event the resident has no pulse and had stopped breathing; do not intubate - do not perform the placement of a flexible plastic tube into the trachea to maintain an open airway]. New POLST form signed and placed in chart. Review of Resident R16's POLST form (Pennsylvania Orders for Life-Sustaining Treatment) dated September 4, 2023, revealed that it was signed by the nurse practitioner as well as the resident and indicated that the resident wanted DNR and DNI status. Interview on September 20, 2023, at 2:40 p.m. the Nursing Home Administrator confirmed that Resident R16's care plan was not updated to reflect the resident's change in code status. 28 Pa. Code 201.29(a) Resident rights 28 Pa. Code 211.12(d)(1) Nursing services 28 Pa. Code 211.12(d)(3) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 29 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on observation, review of resident records and interviews with facility staff and review of facility policy determined the facility failed to provide the necessary assistants with meals for one resident dependent on staff for eating of 23 resident records reviewed (Resident R39). Residents Affected - Few Findings include: Review of the facility Resident Rights policy and procedure states the purpose is to ensure the preservation of every resident's right to a dignified existence, and self-determination, and the right to reside and receive reasonable accommodations of residents' needs. Review of Resident R39's clinical record revealed taht the resident was admitted to the facility of January 13, 2023 diagnosed with encephalopathy (disease of the brain), Parkinson's disease (brain disease causing uncontrollable movements), Alzheimer's disease (brain disease causing decreased function), and dysphagia, (difficulties swallowing). The resident used a gastrostomy to provide daily nutrients, and on June 7, 2023, was placed on palliative care. Review of Resident R39's quarterly MDS (minimum data set, an assessment of residents' needs) dated June 14, 2023, revealed the resident needed extensive assistants for bed mobility, transfers, dressing, eating, toileting, personal hygiene, and was completely dependent on staff for bathing. On September 18, 2023, during lunch at noon Resident R39 was observed in bed with his hands at his side staring at his untouched lunch tray. The resident stated he couldn't eat and needed someone to help him. Surveyor asked Licensed Nurse (LPN), Employee E80 if the resident receives assistance with meals and Employee E80 replied she did not believe he did. During that time, Speech Therapist, Employee E74 stated he did need assistants that the resident could not eat by himself. Review of Resident R39's speech therapy evaluation and plan of care starting on July 12, 2023, indicated Resident R39 needed assistance with meals but was not indicated in his clinical records. This was confirmed with the Director of Nursing on September 18, 2023, at 2:00 pm. 28 Pa. Code 211.12(d)(1)(2) Nursing Services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 30 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records and facility policies and interviews with residents and staff, it was determined the facility failed to ensure residents received treatment and care in accordance with professional standards of practice related to follow the parameters for one resident's blood sugar levels, obtain a treatment order for a resident's wound, failing to assess a resident after a fall, and failing to ensure a resident's medical devise was properly functioning for four of 23 resident records reviewed (Resident R8, R10, R62, and R88). Residents Affected - Some Findings include: Interview on September 18, 2023, at 11:24 a.m. Resident R8 stated that he has been having a difficult time managing his blood sugar levels and that sometimes they are too high or too low. Review of Resident R8's blood sugar logs revealed that on July 29, 2023, at 9:37 p.m. his blood sugar level was 486 mg/dL (milligrams per deciliter). Continued review revealed that on June 13, 2023, Resident R8's blood sugar level was 57 mg/dL. Review of physician's orders for Resident R8 revealed an order from February 10, 2023, and discontinued on June 30, 2023, for sliding scale insulin (medication used to lower blood sugar levels) to notify the physician for any blood sugar levels less than 60 mg/dL. Continued review of physician's orders for Resident R8 revealed another order from July 1, 2023 and discontinued on August 8, 2023, for sliding scale insulin and to notify the physician for any blood sugar levels greater than 450 mg/dL. Further review of Resident R8's clinical record revealed no indication that the physician was notified of the resident's high and low blood sugar levels. Review of Resident R10's clinical record revealed that Resident R10 was originally admitted to the facility on [DATE], was discharged to a local hospital on August 1, 2023, and was readmitted on [DATE]. Resident R10's diagnoses include were but not limited to Squamous Cell Carcinoma of face, Pressure Ulcer of Left Buttocks and Pressure Ulcer of Right Buttocks. Review of Resident R10's Quarterly MDS (Minimum Data Set-a federally required resident assessment completed at a specific interval) dated July 1, 2023, Section C0500 Brief Interview for Mental Status revealed a BIMS score of 14 suggesting that Resident R55 was cognitively intact, Section M1200 (Skin Ulcer/Injury Treatment was coded yes, indicating that Resident R10 was receiving treatments for skin lesion. Observation of Resident R10 conducted on September 18, 2023, at 1:09 p.m. during tour of the Third-floor unit revealed that resident had a large bandage on his right face and skin lesion on his left face. Review of Resident 10's wound note dated September 18, 2023, revealed that Resident R10 had a right face full thickness lesion 0.5 x 0.5 x 0.1cm in size with small amount of serous drainage. Further, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 31 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some treatment plans were as follow: Cleanse wound with normal saline apply triple antibiotic ointment, dressing change. Review of Resident R10's September 2023 physician order revealed no order for right face treatment. Review of Resident R10's Treatment Administration Record revealed that there was no treatment for right face lesion. There was no documented evidence that treatments were completed to the right side of the resident's face. Further review of clinical record revealed that resident was sent to the hospital on August 1, 2023, and returned on August 5, 2023. Review of Resident R10's discontinued orders revealed an order to Cleanse Rt (right) side of face with NSS (normal saline solution) apply TAB (Triple Antibiotic Treatment) and leave open to air daily every day shift for wound healing, ordered on July 11, 2023 and discontinued on August 4, 2023. Further review of the physician's orders revealed no orders for treatment to Resident R10' right cheek after the treatment was discontinued on August 4, 2023. Review of Resident R10's clinical record revealed a care plan August 11, 2023, addressing Squamous Cell Carcinoma on the right and left side of the face. Interview with DON Employee E2 conducted on September 20, 2023, at 1:52 p.m. confirmed that Resident R10 has been getting triple antibiotic and dressing on his right face. Further Employee E2 confirmed that there was no physician's order for the right face dressing and that the Treatment Administration Record for Resident R10 did not include any treatment to Resident R10's right face. No explanation as to why Resident R10 was receiving triple antibiotic on his face without a physician's order was provided during the interview. Interview with Resident R10 conducted on September 21, 2023, at 2:24 p.m. confirmed that the nurses applied medicine on his face and covered it with dressing. Interview with Licensed nurse, Employee E6 conducted on September 21, 2023, at 2:33 p.m. confirmed that Resident R10 is getting triple antibiotic on his right face and that the site is covered with dressing, Further Employee E6 also revealed that Resident R10 has always been getting Triple Antibiotic to his right face even before he went to the hospital (August 1, 2023). Review of Resident R10's physician orders with licensed Nurse Employee E6 revealed an order dated July 11, 2023, to Cleanse Rt side of face with NSS apply TAB (Triple Antibiotic) and leave open to air daily every day shift for wound healing. Further review of the order revealed that it was discontinued on August 4, 2023. Further review of Resident R10's physician's orders revealed that there were no physician's orders for treatment to Resident R10' right cheek after the treatment was discontinued on August 4, 2023. Further interview with Employee E6 revealed that the order must have been missed when Resident R10 was readmitted on [DATE]. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 32 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident R62 was admitted [DATE] diagnosed with Parkinson's disease (a brain disease that causes uncontrollable movements), dysphagia, (difficulty swallowing), and used a neurostimulators (a deep brain stimulator (DBS) that uses electrical pulses to reduce symptoms of tremors, stiffness and walking caused by Parkinson's disease. Review of Resident R62 June 14, 2023, quarterly MDS dated [DATE], revealed the resident required extensive assistance for bed mobility, transfers, toileting, limited assistance with dressing and supervision with meals. Review of Resident R62's physician orders dated December 12, 2022, instructed to charge the neuro-stimulator in the resident's left chest wall at least 20 min a day every day, one time a day for keeping the stimulator charged and placing on residents neurostimulators charge DBS at least 20 min q shift. The same orders instructed to remind and assist resident in setting up her device (Deep Brain Stimulator) to charge 3 days of the week. every day shift, every Wednesday, Friday and Sunday dated July 28, 2023. Physician note dated September 18, 2023 stated, to continue charging DBS 3 days a week-assisted to get device charged today. Staff aware that patient needs help with this. Physician note dated September 15, 2023, stated to continue charging DBS 3 days a week. Assisted to get device charged today. Staff aware that patient needs help with this. Physician note dated September 9, 2023, indicated the Chief Complaint was DBS low charge. Patient seen in bed looked tired stated she did not sleep. DBS reads low charge. Assisted patient to charge DBS. Continue charging DBS 3 days a week-assisted to get device charged today. Staff aware that patient needs help with this. The facility failed to follow the physician orders to assist Resident R62 with her neurostimulators. This was confirmed with the Director of Nursing on September 20, 2023, at 3:30 p.m. Review of the facility policy titled Neurological Assessment revised `10/2019 stated to obtain the post fall assessment which includes vital signs and a neurological assessment every 15 minutes for the first hour, every 30 minutes for one hour, every one hour for four hours and every four hour for twenty four hours. Resident R88 was admitted to the facility on [DATE] ,diagnosed with, congestive heart failure with acute pulmonary edema (the heart does not pump sufficiently and blood and fluid collect in the lungs causing the pulmonary edema) and acute respiratory failure with hypoxia ( lacks oxygen). Review of Resident R88's care plan revealed he was a fall risk due to improper gait and balance with interventions to anticipate and meet the resident's needs dated June 4, 2023, Review of Resident R88 change in condition note from nursing dated September 14, 2023, revealed the resident was found on the floor, assessed with a laceration on his left eyebrow and skin tear to the elbow. Nursing note indicated neurological checks were imitated. Post fall assessment note by the physician dated, September 15 2023, instructed to continue with the neurological checks. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 33 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0684 Further review of Resident R88's clinical revealed orders for vital signs and neurological checks were not completed as ordered. Level of Harm - Minimal harm or potential for actual harm This was confirmed with the Director of Nursing on September 20, 2023, at 3:30 p.m. Residents Affected - Some 28 Pa. Code 211.12(c) Resident care policies 28 Pa. Code 211.12(c) Nursing services 28 Pa. Code 211.12(d)(1)(2) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 34 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record reviews and interviews with staff, it was determined that the facility failed to properly assess and monitor a pressure ulcer, for one of five residents with pressure ulcers reviewed (Resident R213). Residents Affected - Few Findings include: Clinical record review for Resident R213 revealed an admission Nursing Assessment, which indicated that the resident was admitted to the facility on [DATE], from the hospital. Continued review revealed that the resident was noted to have a scar on her sacrum. Review of progress notes for Resident R213 revealed a general note, dated September 2, 2023, at 1:08 a.m. which indicated that the resident had a stage one pressure ulcer to her sacrum (a stage one pressure ulcer is an area of intact skin with non-blanchable redness of a localized area). Review of treatment records for Resident R213 revealed a physician's order, dated September 2, 2023, for Pressure ulcer over sacrum: cleanse wound with wound cleanser and apply sureprep to periwound skin and adhesive contact area. Apply hydrogel impregnated gauze and cover with bordered gauze every day shift. The treatment was documented as administered on September 2, 3, and 4, 2023. Review of a wound consultant note for Resident R213, dated September 6, 2023, revealed that the resident had a stage three pressure ulcer (a stage three pressure ulcer is full thickness tissue loss) to her sacrum that measured 2.2 c.m. (centimeters) length by 2 c.m. width by 0.2 c.m. depth. The wound was noted to have 90% granulation tissue (new connective tissue that forms on a wound during the healing process) and 10% slough tissue (dead skin cells). Further record review for Resident R213 revealed no indication that the resident had any open wounds upon her admission or when her sacral pressure ulcer opened and advanced from a stage one to a stage three wound. There were no measurements of Resident R231's wound until the wound consultant's assessment, five days after the resident's admission to the facility. Interview on September 20, 2023, at 9:34 a.m. the Director of Nursing stated that Resident R213 was admitted to the facility with an open wound. The Director of Nursing stated that the resident's wound, including measurements, should have been documented on the admission assessment. Resident R213's admission assessment and notes describing the resident as having a stage one pressure ulcer upon admission were reviewed with the Director of Nursing. The Director of Nursing was unable to explain her discrepancy, unable to explain why the resident's wound was not properly assessed upon admission and had no further comments. 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: 395791 If continuation sheet Page 35 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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, Interview with staff and resident, it was determined that the facility failed to ensure that residents receive care and services to prevent deterioration in mobility for one of 32 residents observed (Resident R64) Findings include: Observation of Resident R64 conducted on September 18, 2023, at 10:29 during tour of the Third-floor unit revealed that Resident R64's was sleeping with both hands in a fisted position. Further Resident R64 was not wearing hand splints. Review of Resident R64's clinical record revealed that Resident R64 was admitted to the facility on [DATE]. Resident R64's diagnoses include were but not limited to Contracture Unspecified Joint, Paraplegia, Muscle Spasm, Age related Osteoporosis, Polyneuropathy Review of Resident R64's quarterly MDS dated [DATE], Section C0500 BIMS (Brief Interview for Mental Status) revealed that Resident R64's BIMS score was 15, suggesting that Resident R64 was cognitively intact, section 0400 (Functional Limitation of range of Motion revealed that) A (Upper extremity-shoulder, elbow, wrist, hand) was coded was coded 2 (impairment on both sides) and 0400 B (Lower extremity (hip, knee, ankle, foot) was coded 2 (impairment on both sides). Review of Resident R64's physician's orders revealed that resident had an order for Patient to wear finger splints (3 & 4) 2x/day for 2 HRs (after breakfast and after lunch). nursing to perform skin checks throughout day. Review of Resident R64's September 2023, Treatment Administration Record revealed that there was no treatment for Patient to wear finger splints (3 & 4) 2x/day for 2 HRs (after breakfast and after lunch) and nursing to perform skin checks throughout day. Further review of clinical record revealed no documented evidence of the donning and doffing of the finger splints and skin checks. Interview with Rehab Director, Employee E 5 conducted on September 20, 2023, at 10:53 a.m. confirmed that finger splints are provided to the resident. Further Employee E 5 revealed that resident was screened quarterly. Interview with Director of Nursing, Employee E2 revealed that she has never seen resident with a splint. Further Employee E2 also confirmed that the donning and doffing of Resident R64's finger splint was not in the Treatment Administration Record. 28 Pa. Code 211.10(d) Resident care policy 28 Pa. Code 211.10(b) Resident care plans 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 36 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record reviews and interviews with staff, it was determined that the facility failed to ensure that respiratory services, including BiPAP machines, were provided for one of five residents reviewed related to respiratory services (Resident R112). Residents Affected - Few Findings include: Review of Resident R112's care plan revealed that he was admitted to the facility on [DATE]. Continued review revealed that a care plan was developed March 10, 2023, for altered respiratory status and difficulty breathing related to sleep apnea and acute respiratory failure. Interventions included for BiPAP to be provided at bedtime with settings of 12/5 cmH2O (centimeters of water, measurement of pressure). Review of Medication Administration Records (MARs) revealed a physician's order, dated March 10, 2023, for BiPAP 12/5 cmH2O apply at bedtime and remove in AM. Continued review revealed that the BiPAP was not administered on March 10, 11 or 12, 2023 due to Other/See Nurse Notes. Review of progress notes for Resident R112 revealed an eMAR note, dated March 10, 2023, at 10:20 p.m. which indicated that the BiPAP was not administered due to Not on hand. Reordered by supervisor. Awaiting delivery. Continued review of progress notes for Resident R112 revealed another eMAR note, dated March 11, 2023, at 5:18 a.m. which indicated that the BiPAP was not administered due to not on hand. Continued review of progress notes for Resident R112 revealed another eMAR note, dated March 12, 2023, at 5:18 a.m. which indicated that the BiPAP was not administered due to No BiPAP. Continued review of progress notes for Resident R112 revealed another eMAR note, dated March 12, 2023, at 6:34 a.m. which indicated that the BiPAP was not administered due to No BiPAP located. Review of Resident R112's nursing notes from March 10, 11, and 12, 2023 revealed no documented evidence that the resident's physician was notified regarding the BiPAP machine not being available for administration. During a follow-up interview, on September 21, 2023, at 4:57 p.m. Employee E31, licensed nurse, confirmed that Resident R112 did not have a BiPAP machine as prescribed by the physician for the duration of his stay at the facility. 28 Pa. Code 211.12(d)(1) Nursing services 28 Pa. Code 211.12(d)(3) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 37 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. Based on review of personnel files, facility documentation and interviews with staff, it was determined that the facility failed to ensure that nursing staff possessed the required skills to properly care for residents' needs for five of seven personnel files reviewed related to skills competencies evaluations (Employees E22, E23, E28, E29 and E30). Findings include: Review of the Facility Assessment Tool, dated September 4, 2023, revealed, All newly hired licensed nurses complete training in which center communication processes, patient related processes, care delivery processes, infection control, physician related processes, medication/pharmacy processes and nursing care processes are covered. During this nurse orientation competency and skills validation are completed .Nursing assistants attend a one day orientation in which certain competencies are completed. Review of facility documentation on September 18, 2023, related to the census and condition of current residents, revealed that two residents currently resided at the facility who required tracheostomy (a surgically created hole in your trachea that allows for breathing) care. Review of Employee E22's personnel file revealed that the employee was hired by the facility on August 7, 2023, as a licensed nurse. Review of Employee E22's skills competency evaluations revealed that there was no documentation of skills verification related to medication administration or tracheostomy care (such as suctioning, trach tube changes and emergency airway management). Review of Employee E23's personnel file revealed that the employee was hired by the facility on June 26, 2023, as a licensed nurse. Review of Employee E23's skills competency evaluations revealed that there was no documentation of skills verification related to medication administration or tracheostomy care (such as suctioning, trach tube changes and emergency airway management). Review of Employee E28's personnel file revealed that the employee was an agency nurse aide. Continued review revealed no documentation of any skills competencies verifications. Review of Employee E29's personnel file revealed that the employee was an agency nurse aide. Continued review revealed no documentation of any skills competencies verifications. Review of Employee E28's personnel file revealed that the employee was an agency licensed nurse. Continued review revealed no documentation of any skills competencies verifications. Interview on September 20, 2023, at 3:12 p.m. Employee E3, Nurse Educator, confirmed that there was no documented evidence of skills verification for Employees E22 and E23 related to medication administration or tracheostomy care. Employee E3, nurse educator, confirmed that two residents in the building required ongoing tracheostomy care and that all residents would require licensed nurses to administer their medications. Continued interview with Employee E3, Nurse Educator, revealed that she does not do any skills trainings or evaluations of agency staff. Employee E3, Nurse Educator, stated that the agency and human resources staff are responsible for verifying skills and trainings of agency staff. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 38 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0726 28 Pa. Code 201.19(7) Personnel policies and procedures Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 201.20(a) Staff development Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 39 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0730 Observe each nurse aide's job performance and give regular training. Level of Harm - Minimal harm or potential for actual harm Based on review of personnel records and interviews with staff, it was determined that the facility failed to complete annual performance reviews for nurse aide staff as required for 22 of 22 nurse aide personnel files reviewed (Employees E18, E32, E35, E36, E38, E39, E43, E44, E45, E47, E48, E49, E51, E52, E53, E54, E55, E56, E57, E58, E59 and E61). Residents Affected - Some Findings include: Interview on September 18, 2023, at 2:10 p.m. evidence of the facility's annual performance review process was requested from Employee E3, nurse educator. During follow-up interviews on September 20, 2023, at 12:33 p.m. and 1:16 p.m. annual performance reviews for staff were again requested from Employee E3, nurse educator. In addition, a list of all staff who have been employed for greater than one year was requested. On September 21, 2023, at 9:27 a.m. performance reviews for the following staff were requested from the Nursing Home Administrator: Employee E18, nurse aide, hire date 12/15/21; E32, nurse aide, hire date 2/16/22; E35, nurse aide, hire date 1/5/22; E36, nurse aide, hire date 6/15/21; E38, nurse aide, hire date 3/16/22; E39, nurse aide, hire date 1/5/22; E43, nurse aide, hire date 4/18/21; E44, nurse aide, hire date 4/18/21; E45, nurse aide, hire date 2/1/22; E47, nurse aide, hire date 3/23/22; E48, nurse aide, hire date 4/18/21; E49, nurse aide, hire date 4/18/21; E51, nurse aide, hire date 4/18/21; E52, nurse aide, hire date 12/15/21; E53, nurse aide, hire date 12/19/21; E54, nurse aide, hire date 11/22/21; E55, nurse aide, hire date 4/6/22; E56, nurse aide, hire date 4/2/22; E57, nurse aide, hire date 3/1/22; E58, nurse aide, hire date 4/18/21; E59, nurse aide, hire date 3/30/22; E61, nurse aide, hire date 3/1/22. During a follow-up interview on September 21, 2023, at 12:36 p.m. performance reviews were again requested from the Nursing Home Administrator. During exit conference on September 21, 2023, at 11:46 p.m. no evidence of any performance reviews were provided to State Agents as requested. 28 Pa. Code 201.19(2) Personnel policies and procedures FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 40 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0732 Post nurse staffing information every day. Level of Harm - Minimal harm or potential for actual harm Based on observations and interviews with staff, it was determined that the facility failed to post nurse staffing data on a daily basis in a prominent place as required. Residents Affected - Few Findings include: Observation on September 21, 2023, at 8:48 a.m. of the main lobby area revealed no evidence of any required staffing data postings. Interview, at the time of the observation, the Nursing Home Administrator confirmed that no staffing data was posted and stated that he does not know where the information is usually posted. Observation on September 21, 2023, at 8:50 a.m. of the second floor nursing unit revealed no evidence of any required staffing data postings. Interview, at the time of the observation, Employee E25, licensed nurse, confirmed that no staffing data was posted on the unit. Observation on September 21, 2023, at 8:57 a.m. of the third floor nursing unit revealed no evidence of any required staffing data postings. Interview, at the time of the observation, Employee E6, licensed nurse, confirmed that no staffing data was posted on the unit. Employee E6 stated that nothing like that is ever posted on the unit. 28 Pa. Code 201.14(a) Responsibility of licensee FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 41 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based review of facility documents, review of facility policy and procedures, observation, and interviews with staff, it was determined that the facility failed to implement a system of records of receipt of controlled drugs between shifts to enable accurate reconciliation, accountability for three medication carts and one discontinued narcotic accountability book. Fining include: Review of the facility policy on Controlled Substances revealed tat under section Policy Statement: The facility shall comply with all laws and regulations, and other requirements related to handling, storage, disposal, and documentation of schedule II and other controlled substances. Under Policy Interpretation and Implementation: #9. Nursing staff must count controlled medications at the end of each shift. The nurse coming on duty and the nurse going off duty must make the count together. They must document and report any discrepancies to the director of nursing. Review of the facility shift to shift log revealed an instruction stating: Sign below acknowledges that you have counted the controlled drugs on hand and have found that the quantity of each medication counted in agreements with the quantity stated on the controlled drug records. Write total number of narcotic cards, boxes/patches, and liquid bottles received at the beginning of the shift; add in whatever controlled additional meds and subtract empty containers in presence of the accepting nurse. Further, the shift-to-shift log had a section for the date followed by four columns for the counts and signatures of licensed nurse. Column one and column two falls under the 7am to 7 pm shift and column three and column four falls under 7pm to 7am. Review of the Third-floor's Narcotic Book conducted on September 19, 2023, at 9:23 a.m. revealed that the section for the outgoing nurse on the shift-to-shift log for September 19, 2023, was signed. Review of the section for the incoming nurse on the shift to shift log for September 19, 2023, did not have any signature, further the section for the count of the number of blister pack was blank (no number entered) , the section count for the count of the number of bottles was blank (no number entered). Interview with licensed nurse licensed nurse Employee E68 revealed that the outgoing nurse counts the controlled substances in the narcotic box together the incoming nurse and that the outgoing nurse signs the Narcotic Book, and the incoming nurse signs the narcotic book if the count is correct. When licensed nurse Employee E68 was alerted of the missing signature by the incoming nurse for September 19, 2023, Employee E 68 immediately took the book and signed, dated, and entered the number of bottles and number of blister packs. Interview with Licensed nurse, Employee E6 confirmed that she didn't sign the shift-to-shift log and didn't enter the number of cards, number of bottles. Review of the Third floor's back hall (West Hall) Narcotic Book revealed that the shift to shift log for August 2, 2023 did not have any signature. Further, the section for the count of the number of blister pack was blank (no number entered) , the section count for the count of the number of bottles was blank (no number entered) for the outgoing nurse the for the 7am-7pm shift (second column) Further, the shift to shift log for August 6, 2023 did not have any signature, for the outgoing nurse (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 42 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0755 the for the 7pm-7am shift (fourth column) Level of Harm - Minimal harm or potential for actual harm Review of the Second-floor's shift to shift accountability form located in the narcotic book for the third floor west hall revealed the following: Residents Affected - Few September 2, 2023, 7am to 7 pm incoming and outgoing shifts did not have an entry for Packs, September 8, 2023, 7pm to 7 am shift, signature for the outgoing nurse was scribbled over. Further, the section for the incoming nurse did not have any entry for number of cards, packs, and bottles, further, there was no signature by the licensed incoming nurse. Interview with Licensed nurse, Employee E 2 conducted at the time of the review confirmed that there were missing entries and signatures in the shift-to-shift log Review of the discontinued controlled substance accountability book revealed that each page of the book was numbered. Further each set of controlled drugs in the narcotic bin would have a corresponding page in the book where the name of the resident, name of the narcotic, dosage, and the count balance was documented. Further, the signature of the nurses attesting to the accuracy of the count was also on the same page. Further observation of the discounted narcotic accountability book revealed that page 78 and page 79 was torn off from the book. Interview with Director of Nursing (DON), Employee E2 conducted on September 21, 2023, at 3:48 p.m. revealed that the nurses counting the narcotics were supposed to be checking controlled drug blister packs against their corresponding page and that the nurses are supposed to be checking the pages of the book during the count. Further interview with DON, Employee E2 revealed that there was an incident of narcotic diversion back in August. Further, Employee E2 revealed that the missing pages were torn by the nurse who took the narcotics. Further, DON revealed that the Narcotic book has been replaced with the current accountability system. Further interview with DON, Employee E2 confirmed that the reason the missing pages were not discovered in a timely manner was because the nurses were not looking at the page number when accounting for the narcotics, so the nurses never realized that pages 78 and page 79 were missing together with their corresponding sets of controlled drugs. 28 Pa. Code 211.9(a)(1)(k) Pharmacy services 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 43 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on review of facility policies, clinical record reviews and interviews with staff, it was determined that the facility failed to review and implement pharmacy recommendations in a timely manner for three of five residents reviewed related to medication regimen reviews (Residents R98, R55 and R94). Findings include: Review of facility policy, Consultant Pharmacist Services dated reviewed January 2023, revealed that the consultant pharmacist will provide the facility with written or electronic repots and recommendations related to all aspects of medication and pharmaceutical review. Review of progress notes for Resident R94 revealed a pharmacy consultant note, dated March 3, 2023, at 12:56 p.m. which indicated, Medication Regimen Reviewed. Recommendations Made to Prescriber: See Medication Regimen Review report. Review of Resident R94's Medication Regimen Review report, dated March 3, 2023, revealed that the pharmacist was unable to find the resident's psych (mental health) consult and requested for the physician to consider ordering one. Continued review revealed that there was no indication if the attending physician had reviewed the report or the request from the pharmacist, nor any signature or date from the attending physician. Review of progress notes for Resident R98 revealed a pharmacy consultant note, dated August 1, 2023, at 1:55 p.m. which indicated, Medication Regimen Reviewed. Recommendations made to prescriber: See Medication Regimen Review Report. Review of Resident R98's Medication Regimen Review report, dated August 1, 2023, revealed that the pharmacist recommended increasing the resident's Spiriva inhaler (medication used to treat chronic lung diseases) dose from one puff to two puffs for optimal efficacy per the medications recommended prescribing information. The attending physician signed the recommendations on August 7, 2023, and noted that they agreed with the recommendation. Review of Resident R98's medication orders for Spiriva revealed that the current order still indicated only one puff and that the medication dose had never been adjusted in accordance with the agreed upon pharmacist recommendations. Interview on September 21, 2023, at 1:18 p.m. the Director of Nursing had no comment on why Resident R98's Spiriva dose had not been adjusted. During a follow-up interview on September 21, 2023, at 1:57 p.m. the Director of Nursing confirmed that there was no indication that Resident R94's Medication Regimen Review report was reviewed or addressed by the attending physician. Review of Resident R55's Pharmacy progress note dated March 17, 2023, revealed that Medication Regimen Reviewed. Recommendations Made: See Medication Regimen Review Report. Review of Monthly Medication Review provided by the facility revealed that there was no Monthly (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 44 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0756 Pharmacy review for Resident R55 for March 17, 2023. Level of Harm - Minimal harm or potential for actual harm Interview with Director of Nursing, Employee E2 conducted on September 21, 2023, at 5:30 p.m. confirmed that there was no record of the Pharmacy Monthly Review for March 15, 2023 Residents Affected - Few 28 Pa Code 211.12(d)(1) Nursing services 28 Pa Code 211.12(d)(3) Nursing services 28 Pa Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 45 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, staff interviews, review of facility documentation, and review of facility policy, it was determined that the facility failed to ensure that all drugs and biologicals used in the facility were labelled in accordance with professional standards, for two of three medication carts observed. Findings include: Review of the facility policy on Medication Storage with a reviewed date of May 2023, revealed that under section Policy: The facility stores all drugs and biologicals in a safe, and orderly manner. Under section Policy Interpretation and Implementation: #2. Drugs and biologicals are stored in the packaging, containers, or other dispensing systems in which they are received. #3. The nursing staff is responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary manner. #4. Drug containers that have missing, incomplete, improper, or incorrect labels are returned to the pharmacy for proper labeling before storing. Discontinued, outdated, or deteriorated drugs or biologicals are returned to the dispensing pharmacy or destroyed. Observation of the Third-floor's [NAME] hall medication cart conducted on September 19, 2023, at 8:58 a.m. with Licensed nurse, nurse Employee E9 revealed one opened bottle of Bromidine 0.2% for Resident R7 without open date affixed to it and one opened Artificial tears bottle for Resident R60 without open date affixed to it. Interview with licensed nurse, Employee E9 conducted at the time of the observation confirmed that one opened bottle of Bromidine 0.2% for Resident R7 without open date affixed to it and one opened Artificial tears bottle for Resident R60 without open date affixed to it were in the medication cart. Observation of the Third-floor's middle hall medication cart conducted on September 19, 2023, at 9:12 a.m. with Licensed nurse, Employee E10 revealed thirteen tablets in a small cup. Further, the cup had a handwritten label of Famotidine 10 on the cup. Interview with Licensed nurse, Employee E 10 conducted at the time of the observation confirmed that there were thirteen tablets in a small cup. Further, the cup had a handwritten label of Famotidine 10 on the cup. 28 Pa. Code 211.12(c) Nursing services 28 Pa. Code 211.12(d)(1) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 46 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, review of clinical records, observations, review of diet manual and staff interview, it was determined that the facility failed to ensure therapeutic diets were served per physician orders for 2 of 23 residents observed during mealtime (Resident R39, and R162) Findings include: Review of the facility diet manual titled, National Dysphasia Level 3 Advanced diet by the Academy of Nutrition and Dietetics, undated, revealed easy to cut meats fruits and vegetables. Review of Resident R39's clinical record revealed that the resident was admitted to the facility January 13, 2023, with the diagnoses of encephalopathy (disease of the brain), Parkinson's disease (brain disease causing uncontrollable movements), Alzheimer's disease (brain disease causing decreased function) and dysphagia, (difficulties swallowing). Resident R39's July 2023 physician orders instructed Dysphagia Advanced diet dated July 25, 2023. Review of Resident R39's care plan revealed offering a dysphagia advanced lunch, and dysphagia advanced snack 2 times a day dated July 25, 2023. On September 18, 2023, at approximately 12:00 p.m., of Resident R39 revealed that the resident was observed in bed with his lunch tray. The meal ticket indicated ½ cup of chopped broccoli florets were to be served. Observed were two stalks of hard broccoli, not fork tender. The resident indicated, I can't eat that. Review of Resident R162's clinical record revealed the resident was admitted on [DATE], with the diagnosis of congestive heart failure (heart disease). Review of Resident R162's September 2023 physician orders revealed a diet order for dysphagia mechanical soft textured diet. During lunch on September 18, 2023, at 12:35 p.m. Resident R162's meal ticket indicated ½ cup of chopped broccoli florets were to be served. Observation of Resident R162's tray revealed two stalks of uncut hard broccoli, not fork tender were served. The resident complained she could not eat it because it was too hard to eat. The two above observations were confirmed with the Director of Nursing on September 18, 2023, at 2:30 p.m. 28 Pa. Code 201.18(b)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 47 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on review of facility policy, observation, and interview with staff, it was determined that the facility did not ensure that food was stored, in accordance with professional standards for food service safety. Residents Affected - Many Findings include: Review of facility policy on food storage revealed that under section Policy Statement: All time/Temperature Control for safety (TCS) foods, frozen and refrigerated, will be appropriately stored in accordance with the guidelines of the FDA (Food and Drug Administration) Food Code. Under section Procedures: #2. All perishable food will be maintained at a temperature of 41 degrees Fahrenheit or below, except during necessary periods of preparation and service. #4. An accurate thermometer will be kept in each refrigerator and freezer. A written record of daily temperature will be recorded. Observation of the reach in-refrigerator conducted on September 18, 2023, at 9:32 a.m. during tour of the kitchen with Kitchen Manager, Employee E7 revealed that the built in thermometer located outside of the refrigerator had a reading of 51 degrees Fahrenheit. Observation of the thermometer inside the reach-in refrigerator revealed a reading of 44 degrees Fahrenheit. Observation of the content of reach in refrigerator revealed that the reach-in refrigerator contains juices and jellos and dairy product. Interview with the Kitchen Manager, Employee E7 conducted at the time of the observation. confirmed that the thermometer reading inside the refrigerator was 44 degrees Fahrenheit. Further, Employee E7 also confirmed that the contents of the refrigerator were juices, jellos and dairy products. Follow-up observation of the reach-in refrigerator conducted on September 19, 2023, at 2:31 p.m. with the Kitchen Manager, Employee E7 revealed that the thermometer inside the reach-in refrigerator had a reading of 44 degrees Fahrenheit. Interview with Employee E7 conducted at the time of observation confirmed that the reading of the thermometer inside the refrigerator was 44 degrees Fahrenheit. Follow-up observation of the reach-in refrigerator conducted with the Kitchen Manager, Employee E7 on September 18, 2023, at 2:34 p.m. revealed that the thermometer inside the reach-in refrigerator still had a reading of 44 degrees Fahrenheit. Further the built in thermometer located outside the refrigerator revealed a reading of 52 degrees Fahrenheit. Interview with the Kitchen Manager, Employee E7 conducted at the time of observation confirmed that the reading of the thermometer inside the refrigerator was 44 degrees Fahrenheit and the built in thermometer reading was 52 degrees Fahrenheit. Employee7 stated that she will have the refrigerator serviced. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 48 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records, facility documentation and interviews with residents and staff, it was determined that the facility was not effectively managed as it submitted inaccurate documentation related to neglect investigations, neurological monitoring and training records to the State Survey Agency during a Federally mandated survey. Residents Affected - Few Findings include: Review of facility policy, Abuse, Neglect, Exploitation or Misappropriation Reporting and Investigating dated reviewed May 2023, revealed, All reports of resident abuse, neglect, exploitation, or theft/misappropriation of resident property are reported to local, state and federal agencies (as required by current regulations) and thoroughly investigated by facility management. Findings of all investigations are documented and reported. Continued review revealed, If resident abuse, neglect, exploitation, misappropriation of resident property or injury of unknown source is suspected, the suspicion must be reported immediately to the administrator and to other officials according to state law. Further review revealed, The follow-up investigation report will provide sufficient information to describe the results of the investigation, and indicate any corrective actions taken if the allegation was verified. Review of Resident R71's Annual MDS (Minimum Data Set - a mandatory periodic resident assessment tool), dated February 1, 2023, revealed that the resident was admitted to the facility on [DATE], and had diagnoses including cancer, cerebrovascular accident (damage to the brain from interruption of its blood supply), hemiplegia (paralysis) and aphasia (loss of ability to understand or express speech, caused by brain damage). Continued review revealed that the resident had a BIMS (Brief Interview for Mental Status) of zero, indicating that the resident was severely cognitively impaired. Further review revealed that the resident required extensive assistance from two or more staff persons for bed mobility and extensive assistance with assistance from one staff person for transfers, dressing, toileting and hygiene. Review of Resident R71's care plan, dated initiated March 19, 2023, revealed that the resident was at risk for falls related to deconditioning, cerebrovascular accident and immobility. Continued review of Resident R71's care plan revealed that no care plan was developed related to the resident's need for assistance with activities of daily living, such as bed mobility, transfers, dressing, toileting and hygiene. Review of facility documentation submitted to the Pennsylvania Department of Health on April 5, 2023, at 11:37 a.m. by the Director of Nursing revealed that Resident R71 sustained a witnessed fall. Continued review revealed that the incident was reported as a Transfer/admission to Hospital Because of Injury/Accident. Further review revealed that after the fall, the resident was evaluated at the hospital, negative for injury, and returned to the facility. Review of progress notes for Resident R71 revealed a note, dated April 4, 2023, at 1:20 p.m. which stated, Resident was being repositioned by care nurse and slid to the floor .Unable to assess ROM [range of motion] and neurochecks due to aphasia. Resident sent to [hospital emergency department] via stretcher. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 49 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0835 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Continued review of facility documentation related to Resident R71's fall on April 4, 2023, revealed a written statement from Employee E17, nurse aide, dated April 4, 2023, which stated, Washing patient had her turned to the side she was holding on black railing and shifted her weight over the bed. Once she fell over the nurse helped me put patient back in the bed. Interview on September 20, 2023, at 11:20 a.m. the Director of Nursing stated that Employee E17, nurse aide, was an agency staff and that she was no longer allowed to work at the facility after the incident. The Director of Nursing stated that Resident R71 required assistance from two staff persons for bed mobility and transfers and that when the fall occurred Employee E17, nurse aide, was providing care to the resident by herself, without assistance from other staff. The Director of Nursing stated that Employee E17, nurse aide, turned the resident away from her during care, resulting in the fall. The Director of Nursing insisted that Employee E17, nurse aide, would have been aware that the resident required two person assistance because that information is reviewed during report at the beginning of the shift. Further interview with the Director of Nursing revealed that she had no comments to explain why the incident was not reported or investigated as an allegation of neglect. There was no information provided in the facility's report of the incident to the State Survey Agency to indicate that the fall occurred as the result of improper care provided by a nurse aide. Review of facility policy, Neurological Assessment dated reviewed March 2023, revealed, Neurological assessments are indicated: Upon physician order; following an unwitnessed fall; following a fall or other accident/injury involving head trauma; or when indicated by resident's condition. Clinical record review for Resident R98 revealed a progress note, dated August 23, 2023, at 7:58 a.m. which indicated, Resident observed lying on the floor on his back . noted small skin tear to right elbow . Neuro checks initiated. Continued record review for Resident R98 revealed a change in condition note, dated August 25, 2023, at 9:11 a.m. which indicated that the resident had a change in their mental status and that the resident would be transferred to the hospital for evaluation. Continued review revealed a progress note, dated August 25, 2023, at 12:52 p.m. which indicated, Attempted several times to obtain resident's admitting diagnosis from [local hospital] . will reattempt. Further review revealed another progress note, dated August 25, 2023, at 4:24 p.m. which indicated, Spoke with [local hospital] nurse . Resident was admitted with PNA [pneumonia]. Review of neurological assessments for Resident R98 revealed that the assessments were initiated on August 23, 2023, at 5:59 a.m. and included assessment of the resident's level of consciousness, movement, hand grasps, pupil size, pupil reaction, speech, blood pressure, pulse, respirations, and temperature. Continued review revealed that neurological assessments continued to be documented on August 25, 2023, at 9:30 a.m., 1:30 p.m., 5:30 p.m., 9:30 p.m. and on August 26, 2023, at 1:30 a.m., after the resident had been transferred to the hospital. Interview on September 21, 2023, at 11:35 a.m. the Director of Nursing was unable to explain why neurological assessments were documented on August 25, 2023, at 9:30 a.m., 1:30 p.m., 5:30 p.m., 9:30 p.m. and on August 26, 2023, at 1:30 a.m. for Resident R98 and confirmed that the resident was not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 50 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0835 at the facility at that time due to being transferred to the hospital. Level of Harm - Minimal harm or potential for actual harm Resident R62's clinical record revealed the resident was admitted to the facility in December 2021 with the diagnoses of Parkinson's disease (a brain disease that causes uncontrollable movements), dysphagia (difficulty swallowing), difficulty walking with history of falling and presence of neurostimulator (uses electric pulses to reduce symptoms of tremors). Residents Affected - Few Review of Resident R62's quarterly MDS (a Minimum Data Set- an assessment of residents' needs) dated June 14, 2023, revealed the resident was awake, alert, and oriented required extensive assistance for bed mobility, transfers, toileting, limited assistance with dressing and required supervision with meals. Review of Resident R62's incident note, late entry, dated August 28, 2023, from the Director of Nursing (DON) indicated during mealtime the resident verbalized that her dentures became loose while she was eating. I had a problem swallowing what I was eating. During IDT meeting meals were downgraded at the time following incident. Speech was consulted for evaluation and denture glue was provided. Interview with Speech and language pathologist (SLP) Employee E74 on September 20, 2023, at 9:05 a.m. indicated Resident R62 choked in the lounge during a weekend and was evaluated. E74 further stated, Apparently, she choked, and they failed to notify the state (Department of Health) so they wanted me to change the work Choke to something else, but I said absolutely not! Review of SLP E74's evaluation dated August 29, 2023, stated, The resident was referred by nursing due to reported choking incident. Patient reported choking on a piece of porkchop. Nursing staff striked the resident on the upper back between the shoulders which successfully dislodged the porkchop. The SLP indicated Resident R62's diet was upgraded back to a regular diet after the evaluation. Review of Resident R62's incident report prepared by Licensed Nurse, Employee E75 described, During mealtime the resident verbalized that her dentures became loose and was not able to swallow what she was eating. Resident was assisted and slapped on the back as she coughed, and the dentures came outs. The report also indicated that meat dislodged by C.N.A. (nursing assistant). Interview conducated with Licensed nurse, Employee E75 on September 21, 2023, at 8:16 a.m. revealed Never in my years of nursing did I have to lie. The facility wanted me to take out the word choking because they did not see the incident until it was too late to tell the Department of Health. On September 21, 2023, at 8:26 a.m. with nurse aide,(NA) Employee E77 stated, I was in the dining room to use the bathroom and saw Resident R62 choking. I screamed for help and smacked the residents back. She was holding her neck making the choking sign. If I didn't have to use the bathroom, I don't know what would have happened. The NA stated, I refused to lie about it on the witness statement because they didn't want me to use choking, 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(3) Management 28 Pa. Code 201.18(d) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 51 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on review of facility documentation and interviews with staff, it was determined that the facility failed to implement a system for the identification of and control measures for Legionella (bacteria that causes disease found in contaminated water) as required. Residents Affected - Few Findings include: Interview on September 18, 2023, at 2:10 p.m. evidence of the facility's water management plan was requested from the Nursing Home Administrator. Interview on September 21, 2023, at 4:11 p.m. the facility's water management plan was again requested from the Nursing Home Administrator. Review of the facility's Water Management Plan, dated reviewed September 2023, revealed that control measures to monitor for and prevent the growth of Legionella and other water borne illnesses include the following: Cleaning of ice machines on a quarterly basis; changing air filters in ice machines monthly; changing water filters in ice machines annually; flushing of less frequently used rooms weekly; disinfecting of water coolers daily; cleaning of respiratory therapy equipment weekly; replacing respiratory tubing weekly; replacing HVAC-PTAC unit filters monthly; cleaning condenser coils annually; treating condensation pans every three months; disinfecting of juice machines daily; cleaning of juice machines weekly; flushing eyewash stations weekly; flushing of the hot water heater pressure valve quarterly; inspection of hot water heater monthly; disinfection of faucet aerators and shower heads every six months. Interview on September 21, 2023, at 4:50 p.m. the facility's water management plan was reviewed with the Nursing Home Administrator and evidence, such as maintenance logs, of the above control measures to monitor for and prevent the growth of Legionella and other water borne illnesses was requested. During a follow-up interview on September 21, 2023, at 5:14 p.m. the Nursing Home Administrator stated that the maintenance director was off today and the he was unable to access any maintenance logs. During exit conference on September 21, 2023, at 11:46 p.m. no evidence of any Legionella testing, maintenance logs or evidence of implemented control measures to monitor for water borne illnesses were provided to State Agents as requested. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 52 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm Based on observation and staff interview, it was determined that the facility did not ensure to maintain an effective pest management program in the Dietary department Residents Affected - Few Findings include: Observation of the kitchen conducted with Kitchen Manager, Employee E7, revealed that door leading to the outside of the of the food and nutrition department (Kitchen) was propped open with a piece of brick-shaped, gray colored stone-like material and not sealed to prevent the entry of common household pests (roaches, flies, mice, mosquitos etc.). Further observation revealed that there were small insects flying around inside the kitchen around the area of the open exit door. Interview with the Kitchen Manager, Employee E7, confirmed that the kitchen exit door was propped open with a piece of brick-shaped, gray colored stone-like material. Further Employee E7 proceeded to remove the brick-shaped, gray colored stone-like material and closed the door. Further interview with Kitchen Manager, Employee E7 also confirmed that there were small insects flying around inside the kitchen around the area of the open exit door. Further Employee E7 revealed that the insects that were flying around the opened exit door were gnats. 28 Pa. Code 201.18(b)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 53 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0940 Develop, implement, and/or maintain an effective training program for all new and existing staff members. Level of Harm - Minimal harm or potential for actual harm Based on review of facility documentation and interviews with staff, it was determined that the facility failed to develop, implement, and maintain and effective training program, for four of four personnel files reviewed related to annual training records reviewed (Employees E12, E15, E18 and E19). Residents Affected - Few Findings include: Review of the Facility Assessment Tool, dated September 4, 2023, revealed that the facility utilizes paper training for staff to complete mandatory education. The Nurse Educator offers a variety of methods for staff to complete these topics. Interview on September 18, 2023, at 2:10 p.m. evidence of the facility's annual staff education program was requested from Employee E3, nurse educator. A binder full of paper signature attendance records was provided by the facility. Review of the binder on September 20, 2023, at 1:16 p.m. with Employee E3, nurse educator, revealed that there was no tracking mechanism or ability to determine if staff had completed required trainings. A record of trainings completed by Employee E12, licensed nurse; Employee E15, nurse aide; Employee E18, nurse aide; and Employee E19, licensed nurse; were requested. Employee E3, nurse educator, highlighted completed trainings since April 2023 for the above requested staff and confirmed the following: No trainings had been completed for Employee E19, licensed nurse; One training had been completed by Employee E15, nurse aide, that pertained to resident rights; Four trainings had been completed by Employee E12, licensed nurse, that pertained to behavioral health, abuse prevention, human trafficking and resident rights; Four trainings had been completed by Employee E18, nurse aide, that pertained to fire safety, abuse prevention, human trafficking and resident rights. Continued interview with Employee E3, nurse educator, revealed that she was not able to verify any trainings completed by staff prior to April 2023. Further interview revealed that Employee E3, nurse educator, was not able to create any type of tracking mechanism for staff education because she has been unable to get a list of all staff employed by the facility and stated that she has been asking for a list of staff from the human resources department for months. Employee E3, nurse educator, confirmed that the facility has not provided her with the essential tools and information she needs to effectively complete annual staff education requirements. 28 Pa. Code 201.19(7) Personnel policies and procedures 28 Pa. Code 201.20(a) Staff development FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 54 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0943 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation. Based on review of facility documentation and interviews with staff, it was determined that the facility failed to maintain an annual abuse prevention training program, for two of four personnel files reviewed (Employees E15 and E19). Findings include: Review of the Facility Assessment Tool, dated September 4, 2023, revealed that the facility utilizes paper training for staff to complete mandatory education. The Nurse Educator offers a variety of methods for staff to complete these topics. Interview on September 18, 2023, at 2:10 p.m. evidence of the facility's annual abuse prevention education program was requested from Employee E3, nurse educator. A binder full of paper signature attendance records was provided by the facility. Review of the binder on September 20, 2023, at 1:16 p.m. with Employee E3, nurse educator, revealed that there was no tracking mechanism or ability to determine if staff had completed required trainings. A record of trainings completed Employee E15, nurse aide and Employee E19, licensed nurse; were requested. Employee E3, nurse educator, highlighted completed trainings since April 2023 for the above requested staff and confirmed the following: No trainings had been completed for Employee 19, licensed nurse; One training had been completed by Employee E15, nurse aide, that pertained to resident rights. Continued interview with Employee E3, nurse educator revealed that she was not able to verify any trainings completed by staff prior to April 2023 and confirmed that Employees E15 and E19 did not have any evidence of annual abuse training. Further interview revealed that Employee E3, nurse educator, was not able to create any type of tracking mechanism for staff education because she has been unable to get a list of all staff employed by the facility and stated that she has been asking for a list of staff from the human resources department for months. Employee E3, nurse educator, confirmed that the facility has not provided her with the essential tools and information she needs to effectively complete annual staff education requirements related to abuse prevention. Review of the copy of facility attendance record on the abuse in-service revealed that there were fifteen names on the in-service attendance sheet, further Employee E60 was the last to sign on the attendance sheet. Further review of the attendance sheet revealed that there was no type of in-service indicated on the sheet, no date the in-services was provided and the time the in-service was conducted. Further observation revealed that the top portion of the sheet was a blank space with some illegible writings, and some faded out illegible writings on some parts of the top of the sheet Interview with the Director of Nursing, Employee E2 conducted at the time of the observation confirmed that the attendance sheet did not have the type of in-service, date of in-service and time of in-service provided. Surveyor request to see the original in-service attendance sheet to ascertain the type of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 55 of 56 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 395791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031 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 0943 in-service provided and the date it was provided to the staff. Level of Harm - Minimal harm or potential for actual harm In-service nurse, Employee E3 provided the original copy of the facility in-service attendance record on September 21, 2023, at 9:55 a.m. Review of the original attendance record revealed that the top portion of the sheet was covered in white-out (white corrective fluid). Further Resident's Rights and Abuse Neglect was handwritten over the white-out which was not present in the copy of the said in-service attendance sheet provided by the facility earlier. Further, there was no date and time written on the sheet. Residents Affected - Few Further inspection of the in-service attendance record revealed that under the white-out, very visible when held against the light, revealed the following writing: June/July, HIPAA Heat Emergency, Blood Borne Illness, Weather Emergency and Corporate Compliance . Interview with the in-service nurse, Employee E3 at the time of the observation confirmed that she had initially whited out the writings on top part of the original in-service sheet but did not write anything on it. Further, she revealed that she made a copy and gave the copy to surveyor. Further interview with Employee E3 confirmed that she wrote the words Resident's Rights and Abuse Neglect on top of the whited-out section of original in-service attendance record before showing the original to the surveyor. Further interview with the Nurse educator revealed that she couldn't remember the date and time the in-service but stated that it must have been done on June 9, 2023, because she just checked Employee E60 schedule and he worked on June 9, 2023. Further Nurse Educator did not know when the other staff on the attendance were in-serviced. 28 Pa Code 201.19(7) Personnel policies and procedures 28 Pa Code 201.20(a) Staff development FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 56 of 56

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Citations

35 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0553GeneralS&S Dpotential for harm
F553 - The right to participate in the development and implementation of his or her
Allow resident to participate in the development and implementation of his or her person-centered plan of care.
0561GeneralS&S Dpotential for harm
F561 - Self-determination
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
0565GeneralS&S Dpotential for harm
F565 - The resident has a right to organize and participate in resident groups in the
Honor the resident's right to organize and participate in resident/family groups in the facility.
0580GeneralS&S Dpotential for harm
F580 - Notification of Changes
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
0583GeneralS&S Dpotential for harm
F583 - Privacy and Confidentiality
Keep residents' personal and medical records private and confidential.
0585GeneralS&S Dpotential for harm
F585 - Grievances
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
0600GeneralS&S Dpotential for harm
F600 - Freedom from Abuse, Neglect, and Exploitation
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
0602GeneralS&S Dpotential for harm
F602 - The resident has the right to be free from abuse, neglect, misappropriation of re
Protect each resident from the wrongful use of the resident's belongings or money.
0655GeneralS&S Dpotential for harm
F655 - Comprehensive Person-Centered Care Planning
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
0656GeneralS&S Dpotential for harm
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
0657GeneralS&S Dpotential for harm
F657 - Comprehensive Care Plans
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
0677GeneralS&S Dpotential for harm
F677 - A resident who is unable to carry out activities of daily living receives
Provide care and assistance to perform activities of daily living for any resident who is unable.
0684GeneralS&S Epotential for harm
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
0686GeneralS&S Dpotential for harm
F686 - Skin Integrity
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
0688GeneralS&S Dpotential for harm
F688 - Mobility
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.
0695GeneralS&S Dpotential for harm
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
0726GeneralS&S Epotential for harm
F726 - Nursing Services
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
0730GeneralS&S Epotential for harm
F730 - Regular in-service education
Observe each nurse aide's job performance and give regular training.
0732GeneralS&S Dpotential for harm
F732 - Nurse Staffing Information
Post nurse staffing information every day.
0755GeneralS&S Dpotential for harm
F755 - Pharmacy Services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
0756GeneralS&S Dpotential for harm
F756 - Drug Regimen Review
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
0761GeneralS&S Dpotential for harm
F761 - Labeling of Drugs and Biologicals
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
0808GeneralS&S Dpotential for harm
F808 - Therapeutic Diets
Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.
0812GeneralS&S Fpotential for harm
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
0880GeneralS&S Dpotential for harm
F880 - Infection Control
Provide and implement an infection prevention and control program.
0925GeneralS&S Dpotential for harm
F925 - Maintain an effective pest control program so that the facility is free of
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
0940GeneralS&S Dpotential for harm
F940 - Training Requirements
Develop, implement, and/or maintain an effective training program for all new and existing staff members.
0943GeneralS&S Dpotential for harm
F943 - Abuse, neglect, and exploitation
Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.
0610GeneralS&S Epotential for harm
F610 - In response to allegations of abuse, neglect, exploitation, or mistreatment, the
Respond appropriately to all alleged violations.
0552GeneralS&S Dpotential for harm
F552 - Planning and Implementing Care
Ensure that residents are fully informed and understand their health status, care and treatments.
0567GeneralS&S Dpotential for harm
F567 - The resident has a right to manage his or her financial affairs
Honor the resident's right to manage his or her financial affairs.
0606GeneralS&S Dpotential for harm
F606 - The facility must—
Not hire anyone with a finding of abuse, neglect, exploitation, or theft.
0609GeneralS&S Epotential for harm
F609 - The facility must develop and implement written policies and procedures that:
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
0622GeneralS&S Dpotential for harm
F622 - Transfer and discharge-
Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.
0835GeneralS&S Dpotential for harm
F835 - Administration
Administer the facility in a manner that enables it to use its resources effectively and efficiently.

FAQ · About this visit

Common questions about this visit

What happened during the September 21, 2023 survey of COMPLETE CARE AT HARSTON HALL LLC?

This was a inspection survey of COMPLETE CARE AT HARSTON HALL LLC on September 21, 2023. The surveyor cited 35 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at COMPLETE CARE AT HARSTON HALL LLC on September 21, 2023?

Yes, 35 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Allow resident to participate in the development and implementation of his or her person-centered plan of care."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.

Data from CMS Care Compare public records. Dataset last refreshed June 15, 2026. If you believe any information is inaccurate, report it here.

Inspection·September 21, 2023