Health inspection·August 15, 2024

F 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm Based on a resident group interview, interviews with resident and staff, and review of a facility policy, it was determined that the facility failed to ensure the rights of resident's privacy by opening residents' mail without resident consent for one of three residents reviewed (Resident R1). Residents Affected - Few Findings include: Interview with Resident R1 on August 15, 2024, at 10:30 a.m. stated Resident R1 stated he was not receiving the statements for a long time, he used to receive it every month. He stated activity staff who was responsible to give the mail to him were taking the mail and hiding or destroying the mails. Resident stated he received an open mail of his personal bank statement on July 31, 2024, when he realized staff stole money from his account. Interview with the Nursing Home Administrator on August 15, 2024, at 12:00 p.m. stated activity staff were responsible for delivering the mail and packages for the residents, they hide or remove residents mail or packages. Nursing Home Administrator stated business office manager received residents mail and kept it in her possession without delivering it to the resident. The business office manager then went on leave and did not made arrangements or notify other facility staff to deliver Resident R1's mail. Nursing Home Administrator stated Business office manager opened resident's personal bank statement and went over the statement. Nursing Home Administrator stated this was confirmed by her own admission when she reported holding residents mail and asked facility administrator to after facility started investigation into Resident R1's misappropriation of funds. Nursing Home Administrator confirmed that Business office manager should not have been open resident's mail. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(2) Management 28 Pa. Code 201.29 (j) Resident rights. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 2 of 20 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 08/15/2024 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 - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the review of clinical records, facility policies and procedures, resident's financial information, facility investigation and resident and staff interviews, it was determined that the facility failed to ensure that the residents where free from misappropriation and exploitation of property related to the unauthorized access of Resident R1's financial information, theft of money from resident's bank account, unauthorized purchase on resident's account, and receiving monetary assistance by the facility staff. Facility staff failed to report the alleged violation in a timely manner. This failure resulted in an Immediate Jeopardy situation to Resident R1 who experienced financial loss, mental health decline, and psychosocial harm for one of three residents reviewed. This was identified as past non-compliance. (Resident R1) Residents Affected - Some Findings Include: Review of facility policy Program for Prevention of Abuse, Neglect, Exploitation and Misappropriation dated January 2024, revealed that Residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This includes but is not limited to freedom from corporal punishment, involuntary seclusion, verbal, mental, sexual or physical abuse, and physical or chemical restraint not required to treat the resident's symptoms. The resident abuse, neglect and exploitation prevention program consists of a facility-wide commitment and resource allocation to support the following objectives: Protect residents from abuse, neglect, exploitation or misappropriation of property by anyone including, but not necessarily limited to: a. facility staff; b. other residents; consultants; volunteers; staff from other agencies; family members; legal representatives; friends; visitors; and/or any other individual. Develop and implement policies and protocols to prevent and identify: abuse or mistreatment of residents; a. neglect of residents; and/or b c. theft, exploitation or misappropriation of resident property. 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 Protect residents from any further harm during investigations. Review of facility policy, Resident Rights dated January 2023 revealed, Employees shall treat all residents with kindness, respect, and dignity. Federal and state laws guarantee certain basic rights to all residents of this facility, These rights include the resident's right to: a. dignified existence; b. be treated with respect, kindness, and dignity; c. be free from abuse, neglect, misappropriation of property, and exploitation. e. self-determination. g. exercise his or her rights as a resident of the facility and as a resident or citizen of the United States: h. be supported by the facility in exercising his or her rights: i. exercise his or her rights without interference, coercion, discrimination or reprisal from the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 3 of 20 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 08/15/2024 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 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some facility. r. manage his or her personal funds, or have the facility manage his or her funds (if he or she wishes). Review of current Employee Hand book revealed that Employee Conduct and Ethics: All employees are expected to have the highest level of integrity. Employees may not solicit or accept gratuities, gifts, or loans from patients or residents, their families or visitors. In the case where a gratuity is forced upon you, it must immediately be given to your department head or supervisor who will return. SOLICITATION AND DISTRIBUTION Soliciting or accepting gifts, cash, cash equivalents, payments, services, vacations, pleasure trips, or any favors from referral sources, suppliers, vendors, or any other person, firm or corporation that does or seeks to do business with the Company is strictly prohibited. In addition, employees should not borrow, hold money, or agree to cash checks on behalf of a patient, resident, family member, visitor, or employee. Solicitation by employees in resident care areas for any reason is strictly prohibited. Solicitation by employees in non-resident care areas while on working time is strictly prohibited. Collections for charitable purposes shall be considered solicitations for the purposes of this policy, unless approved by management. Employees participating or assisting in solicitation that violates this policy are subject to disciplinary action, up to and including termination. Review of MDS (Minimum Data Set-Assessment of Resident care needs) for Resident R1 dated May 9, 2024, revealed that the resident was admitted to the facility on [DATE]. Further review of the MDS revealed that the resident had a BIMS (Brief Inter for Mental Status) score of 12, which indicated that the resident's cognitive status was moderately impaired. Review of facility investigation dated July 31, 2024 revealed that resident had requested charge nurse to open his phone and look at (online retailer) charge, first nurse not able to open, called second nurse to open (online retailer) account. Nurse told resident there was a maternity dress, (an electronic phone pen) and a glasses case ordered. Resident stated he did not order them, further investigation found there were multiple other charges. Charge nurse reported to administrator. Further review of facility investigation revealed that after discussion with resident it was discovered that activity aide had made purchases on account, after meeting with activity aide, she admitted to the charge, she was suspended, during the investigation a second activity aide went to resident and believed to have cleared his phone of charges, followed by a dietary aide who then took resident phone and erased further information, both the activity aide and dietary aide were suspended. On August 1, 2024, facility staff met with resident again in the morning and had a new bank statement, found charges to multiple sites the resident did not make and then admitted to 3 employees who would order him food and then proceeded to use cash app, online food delivery service, online taxi booking service and online retailer store account for themselves. The investigation of misappropriation of property was substantiated and the facility terminated the activity aides. The dietary aide was terminated for accepting a monetary gift, and the facility concluded that the allegations was unsubstantiated for misappropriation. One nurse aide was terminated for accepting monetary gifts and was unsubstantiated for misappropriation. The police came in spoke with resident and took copies of all information. The information was sent to detectives to investigate. Review of statement from Employee E4, Nurse Aide, on August 6, 2024, revealed that she received $500.00 from Resident R1 when she told him she was going on vacation and she would be off. Another day the resident sent the nurse aide $700.00 dollar to do something nice for her and asked her to go get her hair done. It was revealed that the employee gave him her cash app id for resident to transfer (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 4 of 20 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 08/15/2024 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 the money. Employee admitted that she understood accepting money from resident was wrong. Level of Harm - Immediate jeopardy to resident health or safety Review of facility investigation revealed that Nurse aide Employee E4, received a total gift of $1,200.00 dollars from residents account to employee's cash app account. Further review revealed that the employee was terminated for accepting monetary gifts from a resident which is against facility policy. Residents Affected - Some Review of statement from Activity aide, Employee E5, , on August 6, 2024, stated Resident R1 gifted a maternity dress last Wednesday or Thursday. She never asked him to buy her the dress, he surprised her with it last week, it was still in the amazon packaging. Review of facility investigation revealed that nurse aide, Employee E7 reported that the staff in question (Employee E5) used his card. Employee E7 stated she felt that he did not want Employee E5 get in trouble because she was pregnant. She looked into April 2024 bank statement and found $954.00 in charges. Review of facility investigation revealed that on May 29, 2024, Resident R1 account was used to transfer a $100.00 and $200.00 on June 27, 2024, to Employee E5, Activity Aide. Further review of the investigation revealed that After reviewing resident bank statements, cash apps, (online grocery store), online taxi service rides, after review with resident and reviewing each charge, it was determined that [Employee E5, Activity Aide] was using resident bank card on multiple occasions, purchasing clothing, shoes, many food deliveries, online taxi service rides-lift, and trips to inhouse soda and vending machines. Discussion with employee she admitted to using the apps and his card paying for all of the purchases. At this time, it is still undetermined if employee had resident bank information on her phone or if all transactions were done through resident phone. Employee E5 did admit to purchasing items on resident account. Review of statement from Employee E6, Dietary Aide, on August 6, 2024, stated the employee used cash app to herself, for $20.00, she stated she went to resident and asked for $20.00 to get an uber ride home after work. She states she gave resident the $20.00 in exchange. Employee E6 stated she heard Resident R1 stated a nurse or aide might have taken money from him. Review of facility investigation revealed that on June 17, 2024, Resident R1 account was used to transfer a $700.00 and $20.00 at two different times to Employee E6, Dietary Aide. Further review of facility investigation revealed that on July 1, 2024, Resident R1's account was used to transfer $100.00 dollars to Employee E8, Activity Aide's son's account. Further review revealed that after full review of bank statements, witness statements and accused statements, the accusation of misappropriation of resident funds have been substantiated. Employee E8 was terminated. Review of facility investigation related to Employee E9, Business Office Manager, dated July 31, 2024, revealed that the employee was suspended for suspicion of involvement in the case of misappropriation and later terminated for opening resident's mail. Further review of the investigation revealed that the Resident R1 was in administrator office reviewing charges on his phone account and Employee E9, Business Office Manager brought in an opened bank statement and handed it to the resident stating that he should pay attention to the second page of the bank statement. Employee E9, Business Office Manager was interviewed by the administrator, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 5 of 20 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 08/15/2024 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 Level of Harm - Immediate jeopardy to resident health or safety she stated she accidentally opened the statement and saw suspicious charges. Employee E9, Business Office Manager was suspended due to suspicion of involvement in this case. Continued review of the investigation revealed that the facility did not establish how long Employee E9, Business Office Manager kept the bank statement to herself, or she accessed any other bank statement which could have helped resident to identify unauthorized charges early. Residents Affected - Some Review of facility investigation related to Nurse aide, Employee E10, revealed that resident had disclosed that Employee E10 had taken $5,000.00 from his social security account. Facility was unable to verify at the time. Review of facility investigation related to Activities Director, Employee E11, revealed that from multiple interviews with all staff involved it was determined Employee E11, was aware of the theft and misappropriation activity within the department and did not report to administrator, and he contacted suspended staff during investigation. Review of a statement by social service department July 31, 2024, revealed that she interviewed the Charge nurse, Employee E12 looked into Resident R1's account and showed online retailer store purchase of maternity dress which resident did not recognize but stated the dress could be for Employee E5 who was pregnant. Review of Resident R1's bank statement from May 2024 to July 2024 revealed that there were online taxi booking service transaction on the following days: July 10, 2024- $9.02 July 11, 2024- $13.18 July 16, 2024- $15.31, $6.05 July 17, 2024- $15.92, $14.12 July 18, 2024- $9.00 July 19,- $8.91, $9.98, $14.36 July 22, 2024- $36.60 July 27, 2024- $14.76 July 29, 2024- $17.57 Review of Resident R1's bank statement from May 2024 to July 2024 revealed that there were multiple transactions to two different online food delivery services on the following days: July 1,2024- $54.84, $97.98, $60.30, $9.16 July 5, 2024- $26.61, $48.64, $5.03, $4.34, $36.20, $26.61, $48.64 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 6 of 20 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 08/15/2024 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 July 6, 2024- $120.13, $41.41 Level of Harm - Immediate jeopardy to resident health or safety July 8, 2024- $120.13, $41.41 Residents Affected - Some July 12, 2024- $11.58, $12.24, $26.72 July 10, 2024- $40.61, $4.17, $35.86, $29.18 July 15, 2024 -$28.68, $18.98, $54.56, $42.74, $31.03 July 17, 2024- $24.45, $15.92, $14.01, $33.77 July 19, 2024- $23.39, $27.36, $27.05, $27.23 July 20, 2024- $35.45, $17.01 July 22, 2024- $51.03, $57.54 July 24, 2024- $14.75, $15.54 July 25, 2024- $21.95, $40.14, $34.10 July 26, 2024- $23.70, $40.14, $43.03, $55.25, $21.89 July 29, 2024- $16.21 July 31, 2024- $15.75, $35.21 Review of Resident R1's bank statement from May 2024 to July 2024 revealed that there were purchase to an online grocery delivery service on the following days: July 1, 2024 - $31.05, $60.03, $97.99, $95.87, $70.58, $31.67 July 2, 2024 - $33.94, $25.96 July 3, 2024- $32.65 July 4, 2024- $72.99 July 5, 2024- $52.60, $72.99 July 8, 2024- $52.60 July 9, 2024- $42.34, $70.86 July 10, 2024- $39.44, $32.79, $105.6, $31.67 July 11, 2024, 2024- $30.18, $61.43 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 7 of 20 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 08/15/2024 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 July 12, 2024- $139.67, $32.39, $9.00, $5.94, $24.45 Level of Harm - Immediate jeopardy to resident health or safety July 13, 2024- $28.12, $24.45 Residents Affected - Some July 15, 2024- $164.11 July 14, 2024- $28.12, July 16, 2024- $75.75, $144.10, $104.00, $144 July 17, 2024- $46.92 July 18, 2024- $67.07 July 19,- $51.92, $67.07 July 21, 2024- $137.72, July 22, 2024- $31.07, $101.53, $136.50, $100, $25.00, $2.18 July 23, 2024- $106.57, $31.31, $40.50 July 24, 2024- $34.00, $60.90, $1.25, July 25, 2024- $37.27 July 27, 2024- $57.74 July 29, 2024- $45.20, $80.00, $8.64, $28.29, $62.98 July 30, 2024- $134.95, $49.90 July 31, 2024- $27.22, $27.99 Telephone bill pay for the following days, July 2, 2024- $251.13 July 26, 2024- $200.00 July 25, 2024- $57.03 Review of Resident R1's bank statement from May 2024 to July 2024 revealed that there were lingerie, clothing, and beauty retailer purchases on: July 5, 2024 - $6.70 July 10, 2024- $7.82 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 8 of 20 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 08/15/2024 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 July 17, 2024- $56.46 Level of Harm - Immediate jeopardy to resident health or safety July 28, 2024- $36.20 Residents Affected - Some Review of bank statement for June 2024 revealed there were 32 transactions for a food delivery service ranging between $72.00- $240.00. There were several food delivery transactions, cell phone bill payments, and electronic online purchases. Review of available bank statement for May 22 to May 31, 2024 revealed there were 12 transactions on for a food service delivery including transactions in the amount ranging from $64.00- $247.00, and $89.00. The bank statement also reflected several transactions for food delivery. Review of available bank statement for April 11, 2024 to April 19, 2024, revealed there were 10 transactions for food delivery service between the amounts of $50.00- $101.00. Review of available bank statement for March 2024, revealed there were purchases for a lingerie retail store on March 5, 2024- $38.17, March 14, 2024- $42.53; March 16, 2024-$27.30, March 17, 2024- $47.61, March 19, 2024- $38.70, March 21, 2024-$53.99, March 23, 2024-$75.59, March 24, 2024- $56.99, and March 26, 2024-$32.33. There were seven food delivery transactions. Grocery delivery for purchases of $55.74, $38.89, $21.69, $33.80, and $16.98. Three taxi trips purchased of $23.12, $38.00, $21.97 and a purchase of $16.98 for a department store. Review of bank statement for February 2024, revealed that there was a cash app transfer on February 3, 2024 of $15.00 in addition to online grocery purchase of $21.59 and $32.06, cash app transfer of $20.00, cell phone bill payment of $56.00, for a lingerie store of $31.84, and $32.33. Several food delivery transactions which were on the same day and online taxi services of $10.69, $9.98, $8.33, $8.34, $7.97, $10.57, $8.97, $35.89, $23.07, $14.66, and cash app transfers of $20.00. Interview with Resident R1 on August 15, 2024, at 10:30 a.m. stated staff emptied my 2 bank accounts and tricked me and broke my trust. There is $23,0000, left in my account but it was over $40,000 back in March 2024 and April, 2024. He stated he gave $500.00 and $700.00 to an aide when she told him she was struggling and her situation. Resident stated he was paralyzed on one side so he could not hold the phone properly and order stuff from the phone, so he asked the activity aides to help him out. He stated they teamed up and conspired against him to steal his money. He stated he would ask them to order food for him, but they would take his phone and order groceries, trips, clothes, and food for themselves. He stated he lost over $10,000 but he don't know the actual amount. One staff might have took $5000 once. Resident stated he was more depressed and could not trust any staff or anyone, as they were taking advantage of him. Resident stated there were other staff who were aware of the theft but did not report it to him or others or they did not try to stop it. Resident stated he was not receiving the statements for a long time, he used to receive it every month. He stated activity staff who was responsible to give the mails to him were taking the mail and hiding or destroying the mails. Continued interview with resident stated he orders food from outside once daily but usually around $30$40 at the maximum. He stated he once it a while orders groceries but usually ranges $30 or under. Resident stated he did not recognize the multiple charges to the electronic food delivery service, most of the electronic food purchases especially the ones over $30.00, online taxi services and purchases to a lingerie store. Resident stated the only valuable items in his room were his tablet (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 9 of 20 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 08/15/2024 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 and cell phone, other items such as clothes and other stuff did not cost much money. Level of Harm - Immediate jeopardy to resident health or safety Resident stated when he realized the theft, it messed him up and he was upset. Resident stated they were my friends, he thought they were the last person that would do it. It affected his sleep, activities and social life. He stated he did not go out to activities as much he used to, he stated he was not sleeping well at night. Resident stated now that the whole facility knows this he was embarrassed to face other residents and staff. Resident stated he was a Veteran and he had PTSD (Post Traumatic Stress Disorder). Resident stated he got a sum of money from the Veteran's Administration for PTSD settlement. Resident stated staff stole money from that settlement and now if he sees those staff he was afraid if it would trigger PTSD for him. Resident stated he could not buy food or other stuff from outside from July 31, 2024, because of the hold on the account. Resident stated he needed services from psychologist. Residents Affected - Some Interview with the Nursing Home Administrator on August 15, 2024, at 12:00 p.m. stated 2 activity staff and one dietary staff used resident's money to purchase items for themselves. One activity staff admitted to the purchase. Administrator stated most of the transactions from online grocery store, and online food delivery service online grocery service, were not authorized by the residents. Administrator stated resident orders food everyday once but not more than once usually, resident might use vending machine once or twice but not up to 10 times as shown in the statement. Administrator stated activity staff were responsible for delivering the mail and packages for the residents, so it was easy for them to hide or remove residents mail or packages. Administrator confirmed that the facility failed to protect resident's money. Administrator also confirmed that the resident now experiences emotional distress, embarrassment and distrust because of the theft. Review of psychiatric progress note for Resident R1 dated August 13, 2024 revealed that the resident has been upset about fraudulent activity with his bank. An Immediate Jeopardy situation was identified to the Nursing Home Administrator on August 15, 2024, at 2:55 p.m. The facility failed to ensure that the residents where free from misappropriation and exploitation of property related to the unauthorized access of Resident R1's financial information, theft of money from resident's bank account, unauthorized purchase on resident's account, and receiving monetary assistance by the facility staff for over six months (February 2024, March 2024, April 2024, May 2024, June 2024 and July 2024). Facility staff failed to report the alleged violation in a timely manner. This failure resulted in harm to Resident R1 who experienced financial loss, mental health decline, and psychosocial harm. An Immediate Jeopardy template (a document which included information necessary to establish each of the key components of immediate jeopardy) was provided to the Nursing Home Administrator on August 15, 2024, at 2:55 p.m. The facility's corrective action plan included the following interventions: On 07/31/2024 facility was notified that Resident R1 had unauthorized charges on his online retailer account. The facility immediately began an investigation. Action: The threat to Resident R1 was identified and Employees E5 and E6 were suspended and removed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 10 of 20 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 08/15/2024 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 Level of Harm - Immediate jeopardy to resident health or safety from the building. Resident bank debit card was closed and access to his account was closed on 8/1/24. The facility was able to receive statements. Action: Employees E5, E6, E7 were suspended on 7/31/24, followed by termination for misappropriation. Action. The facility revised the facility policy to include protection of resident's financial information. Residents Affected - Some Action: All staff were educated on the facility policy that include Abuse, Neglect. Exploitation and use and protection of resident's financial information by 8/1/24 Action: Facility conducted audits 'to ensure protection of resident fund and property on 8/1/24. NHA/designee will audit funds/ daily x 3 days, weekly x 4 weeks and monthly x 4 months. Results-reported to QAPI. This deficiency was identified as Immediate Jeopardy past non-compliance. Interviews were conducted with activity staff, nurse aides, licensed nursing staff, Registered Nurses and other staff regarding education related to Abuse, Neglect. Exploitation and use and protection of resident's financial information. Staff stated that they received sufficient education from the facility related to Abuse, Neglect. Exploitation and use and protection of resident's financial information. Nurses verbally demonstrated knowledge of Abuse, Neglect. Exploitation and use and protection of resident's financial information. The facility's action plan was accepted on August 15, 2024 at 5:00 p.m. and identified as past non-compliance. 28 Pa. Code 201.14(a)(b) Responsibility of licensee 28 Pa. Code 201.18(b)(1)(2)(3) Management 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 11 of 20 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 08/15/2024 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 - Immediate jeopardy to resident health or safety Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on staff interviews, clinical record review, and policy review, it was determined that the facility failed to ensure an allegation of exploitation of resident's property was reported to the facility's Nursing Home Administrator in accordance with requirements. The facility failed to protect one of three sampled residents (Resident R1) from exploitation of resident's property by three perpetrators which resulted in an Immediate Jeopardy situation to Resident R1 who experienced financial loss, mental health decline, and psychosocial harm. This was identified as past non-compliance. (Resident R1) The findings include: Review of facility policy Program for Prevention of Abuse, Neglect, Exploitation and Misappropriation dated January 2024, revealed that Residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This includes but is not limited to freedom from corporal punishment, involuntary seclusion, verbal, mental, sexual or physical abuse, and physical or chemical restraint not required to treat the resident's symptoms. Protect residents from abuse, neglect, exploitation or misappropriation of property by anyone including, but not necessarily limited to: a. facility staff; b. other residents; consultants; volunteers; staff from other agencies; family members; legal representatives; friends; visitors; and/or any other individual. Develop and implement policies and protocols to prevent and identify: abuse or mistreatment of residents; a. neglect of residents; and/or b c. theft, exploitation or misappropriation of resident property. 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 Protect residents from any further harm during investigations. Review of facility investigation dated July 31, 2024 revealed that resident had requested charge nurse to open his phone and look at (online retailer) charge, first nurse not able to open, called second nurse to open (online retailer) account. Nurse told resident there was a maternity dress, (an electronic phone pen) and a glasses case ordered. Resident stated he did not order them, further investigation found there were multiple other charges. Charge nurse reported to administrator. Review of facility investigation related to Activities Director, Employee E11, revealed that from multiple interviews with all staff involved it was determined Activities Director, Employee E11, was aware of the theft and misappropriation activity within the department and did not report to administrator, and he contacted suspended staff during investigation. Review of statement from Employee E5, Activity Aide, dated July 31, 2024, revealed that she received gift from Resident R1 but did not report it to the facility administrator or designee. Review of statement from Employee E6, Dietary Aide dated August 6, 2024, revealed that she received (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 12 of 20 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 08/15/2024 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 - Immediate jeopardy to resident health or safety money from Resident R1 on June 16, 2024 and overheard Resident R1 mentioning a Nurse Aide or a nurse might have took money from him. Further review of the statement revealed But because I didn't know what the situation or proof of anything I didn't pay it any mind. Review of statement from Employee E4, Dietary Aide dated August 6, 2024, revealed that she received a total of $1,200.00 from Resident R1 but did not report it to facility the administrator or designee. Residents Affected - Few Further review facility investigation revealed that several staff was aware of the allegation prior but did not report it to the Nursing Home Administrator. Interview with the Nursing Home Administrator on August 15, 2024, at 12:00 p.m. stated business office manager opened resident's personal bank statements and saw questionable charges but did not report it until questioned few days later. Review of facility investigation revealed that on May 29, 2024, Resident R1 account was used to transfer a $100.00 and $200.00 on June 27, 2024, to Employee E5, Activity Aide. Further review of the investigation revealed that After reviewing resident bank statements, cash apps, (online grocery store), online taxi service rides, after review with resident and reviewing each charge, it was determined that [Employee E5, Activity Aide] was using resident bank card on multiple occasions, purchasing clothing, shoes, many food deliveries, online taxi service rides-lift, and trips to inhouse soda and vending machines. Discussion with employee she admitted to using the apps and his card paying for all of the purchases. At this time, it is still undetermined if employee had resident bank information on her phone or if all transactions were done through resident phone. Employee E5 did admit to purchasing items on resident account. Review of statement from Employee E6, Dietary Aide, on August 6, 2024, stated the employee used cash app to herself, for $20.00, she stated she went to resident and asked for $20.00 to get an taxi ride home after work. She states she gave resident the $20.00 in exchange. Employee E6 stated she heard Resident R1 stated a nurse or aide might have taken money from him. Nursing Home Administrator stated it appeared Employee E11 was aware of misappropriation but did not report it timely. Nursing Home Administrator stated some of the nurse aides and activity staff was aware of the misappropriation but did not report it timely. Interview with Resident R1 on August 15, 2024, at 10:30 a.m. stated staff emptied my 2 bank accounts and tricked me and broke my trust. There is $23,0000, left in my account but it was over $40,000 back in March 2024 and April, 2024. He stated he gave $500.00 and $700.00 to an aide when she told him she was struggling and her situation. Resident stated he was paralyzed on one side so he could not hold the phone properly and order stuff from the phone, so he asked the activity aides to help him out. He stated they teamed up and conspired against him to steal his money. He stated he would ask them to order food for him, but they would take his phone and order groceries, trips, clothes, and food for themselves. He stated he lost over $10,000 but he don't know the actual amount. One staff might have took $5000 once. Resident stated he was more depressed and could not trust any staff or anyone, as they were taking advantage of him. Resident stated there were other staff who were aware of the theft but did not report it to him or others or they did not try to stop it. Resident stated he was not receiving the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 13 of 20 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 08/15/2024 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 - Immediate jeopardy to resident health or safety Residents Affected - Few statements for a long time, he used to receive it every month. He stated activity staff who was responsible to give the mails to him were taking the mail and hiding or destroying the mails. Resident stated when he realized the theft, it messed him up and he was upset. Resident stated they were my friends, he thought they were the last person that would do it. It affected his sleep, activities and social life. Resident stated he was a Veteran and he had PTSD (Post Traumatic Stress Disorder). Resident stated he got a sum of money from the Veteran's Administration for PTSD settlement. Resident stated staff stole money from that settlement and now if he sees those staff he was afraid if it would trigger PTSD for him. Resident stated he could not buy food or other stuff from outside from July 31, 2024, because of the hold on the account. Resident stated he needed services from psychologist. Interview with the Nursing Home Administrator on August 15, 2024, at 12:00 p.m. stated 2 activity staff and one dietary staff used resident's money to purchase items for themselves. One activity staff admitted to the purchase. Administrator stated most of the transactions from online grocery store, and online food delivery service online grocery service, were not authorized by the residents. Administrator stated resident orders food everyday once but not more than once usually, resident might use vending machine once or twice but not up to 10 times as shown in the statement. Administrator confirmed that the facility failed to protect resident's money. Administrator also confirmed that the resident now experiences emotional distress, embarrassment and distrust because of the theft. Review of psychiatric progress note for Resident R1 dated August 13, 2024 revealed that the resident has been upset about fraudulent activity with his bank. An Immediate Jeopardy situation was identified to the Nursing Home Administrator on August 15, 2024, at 2:55 p.m. The facility failed to ensure that an allegation of exploitation of resident's property was reported to the facility's Nursing Home Administrator which resulted in actual harm to Resident R1 who experienced financial loss, mental health decline, and psychosocial harm. An Immediate Jeopardy template (a document which included information necessary to establish each of the key components of immediate jeopardy) was provided to the Nursing Home Administrator on August 15, 2024, at 2:55 p.m. The facility's corrective action plan included the following interventions: On 07/31/2024 facility was notified that Resident R1 had unauthorized charges on his online retailer account. The facility immediately began an investigation. Action: The threat to Resident R1 was identified and Employees E5 and E6 were suspended and removed from the building. Resident bank debit card was closed and access to his account was closed on 8/1/24. The facility was able to receive statements. Action: Employees E5, E6, E7 were suspended on 7/31/24, followed by termination for misappropriation. Action. The facility revised the facility policy to include protection of resident's financial information. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 14 of 20 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 08/15/2024 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 - Immediate jeopardy to resident health or safety Action: All staff were educated on the facility policy that include Abuse, Neglect. Exploitation and use and protection of resident's financial information by 8/1/24 Action: Facility conducted audits 'to ensure protection of resident fund and property on 8/1/24. NHA/designee will audit funds/ daily x 3 days, weekly x 4 weeks and monthly x 4 months. Results-reported to QAPI. Residents Affected - Few This deficiency was identified as Immediate Jeopardy past non-compliance. Interviews were conducted with activity staff, nurse aides, licensed nursing staff, Registered Nurses and other staff regarding education related to Abuse, Neglect. Exploitation and use and protection of resident's financial information. Staff stated that they received sufficient education from the facility related to Abuse, Neglect. Exploitation and use and protection of resident's financial information. Nurses verbally demonstrated knowledge of Abuse, Neglect. Exploitation and use and protection of resident's financial information. The facility's action plan was accepted on August 15, 2024 at 5:00 p.m. and identified as past non-compliance. 28 Pa. Code 201.14(a)(b) Responsibility of licensee 28 Pa. Code 201.18(b)(1)(2)(3) Management 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 15 of 20 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 08/15/2024 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 Based on the review of clinical records, job descriptions, facility documentation and interviews with staff, it was determined that the Nursing Home Administrator (NHA) and the Director of Nursing (DON) did not effectively manage the facility to make certain that proper procedures were followed in the facility related to the right of residents to be free misappropriation and exploitation of property, unauthorized access of Resident R1's financial information, theft of money from resident's bank account, unauthorized purchase on resident's account, and receiving monetary assistance by the facility staff. This failure resulted in an Immediate Jeopardy situation to Resident R1 who experienced financial loss, mental health decline, and psychosocial harm for one of three residents reviewed. (Resident R1) Residents Affected - Few Findings Include: Review of the job description for the Nursing Home Administrator (NHA) revealed that The primary purpose of the job position is to manage the Facility in accordance with current applicable federal, state, and local standards, guidelines, and regulations that govern long-term care facilities. To follow all facility policies and apply them uniformly to all employees. To ensure the highest degree of quality care is provided to our residents at all times. All residents are treated fairly, and with kindness, dignity, and respect. Understands and follows fairly Abuse Prohibition policy & procedure. Ensure that personnel are knowledgeable of the residents' responsibilities and rights. Other related duties that may become necessary/appropriate to assure facility is in compliance with current laws, regulations, and guidelines concerning operation of facility. Review of the job description for the Director of Nursing (DON) revealed that Other related duties that may become necessary/appropriate to assure facility is in compliance with current laws, regulations, and guidelines concerning operation of facility. Organize and direct nursing administration, nursing services and resident care developing, organizing, implementing, evaluating and directing the day-to-day functions of the Nursing Service Department, its programs and activities. Reports all complaints/grievances per policy and procedure. Ensure that all residents are treated with kindness, dignity and respect. Knowledgeable of all residents' rights according to facility policy and regulations, including the right for a resident to refuse treatment. Review of facility policy Program for Prevention of Abuse, Neglect, Exploitation and Misappropriation dated January 2024, revealed that Residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This includes but is not limited to freedom from corporal punishment, involuntary seclusion, verbal, mental, sexual or physical abuse, and physical or chemical restraint not required to treat the resident's symptoms. Review of facility investigation dated July 31, 2024 revealed that resident had requested charge nurse to open his phone and look at (online retailer) charge, first nurse not able to open, called second nurse to open (online retailer) account. Nurse told resident there was a maternity dress, (an electronic phone pen) and a glasses case ordered. Resident stated he did not order them, further investigation found there were multiple other charges. Charge nurse reported to administrator. Further review of facility investigation revealed that after discussion with resident it was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 16 of 20 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 08/15/2024 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 discovered that activity aide had made purchases on account, after meeting with activity aide, she admitted to the charge, she was suspended, during the investigation a second activity aide went to resident and believed to have cleared his phone of charges, followed by a dietary aide who then took resident phone and erased further information, both the activity aide and dietary aide were suspended. On August 1, 2024, facility staff met with resident again in the morning and had a new bank statement, found charges to multiple sites the resident did not make and then admitted to 3 employees who would order him food and then proceeded to use cash app, online food delivery service, online taxi booking service and online retailer store account for themselves. The investigation of misappropriation of property was substantiated and the facility terminated the activity aides. The dietary aide was terminated for accepting a monetary gift, and the facility concluded that the allegations was unsubstantiated for misappropriation. One nurse aide was terminated for accepting monetary gifts and was unsubstantiated for misappropriation. The police came in spoke with resident and took copies of all information. The information was sent to detectives to investigate. Interview with Resident R1 on August 15, 2024, at 10:30 a.m. stated staff emptied my 2 bank accounts and tricked me and broke my trust. There is $23,0000, left in my account but it was over $40,000 back in March 2024 and April, 2024. He stated he gave $500.00 and $700.00 to an aide when she told him she was struggling and her situation. Resident stated he was paralyzed on one side so he could not hold the phone properly and order stuff from the phone, so he asked the activity aides to help him out. He stated they teamed up and conspired against him to steal his money. He stated he would ask them to order food for him, but they would take his phone and order groceries, trips, clothes, and food for themselves. He stated he lost over $10,000 but he don't know the actual amount. One staff might have took $5000 once. Resident stated he was more depressed and could not trust any staff or anyone, as they were taking advantage of him. Resident stated there were other staff who were aware of the theft but did not report it to him or others or they did not try to stop it. Resident stated he was not receiving the statements for a long time, he used to receive it every month. He stated activity staff who was responsible to give the mails to him were taking the mail and hiding or destroying the mails. Continued interview with resident stated he orders food from outside once daily but usually around $30$40 at the maximum. He stated he once it a while orders groceries but usually ranges $30 or under. Resident stated he did not recognize the multiple charges to the electronic food delivery service, most of the electronic food purchases especially the ones over $30.00, online taxi services and purchases to a lingerie store. Resident stated the only valuable items in his room were his tablet and cell phone, other items such as clothes and other stuff did not cost much money. Resident stated when he realized the theft, it messed him up and he was upset. Resident stated they were my friends, he thought they were the last person that would do it. It affected his sleep, activities and social life. He stated he did not go out to activities as much he used to, he stated he was not sleeping well at night. Resident stated now that the whole facility knows this he was embarrassed to face other residents and staff. Resident stated he was a Veteran and he had PTSD (Post Traumatic Stress Disorder). Resident stated he got a sum of money from the Veteran's Administration for PTSD settlement. Resident stated staff stole money from that settlement and now if he sees those staff he was afraid if it would trigger PTSD for him. Resident stated he could not buy food or other stuff from outside from July 31, 2024, because of the hold on the account. Resident stated he needed services from psychologist. Interview with the Nursing Home Administrator on August 15, 2024, at 12:00 p.m. stated 2 activity (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 17 of 20 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 08/15/2024 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 staff and one dietary staff used resident's money to purchase items for themselves. One activity staff admitted to the purchase. Administrator stated most of the transactions from online grocery store, and online food delivery service online grocery service, were not authorized by the residents. Administrator stated resident orders food everyday once but not more than once usually, resident might use vending machine once or twice but not up to 10 times as shown in the statement. Residents Affected - Few Administrator stated activity staff were responsible for delivering the mail and packages for the residents, so it was easy for them to hide or remove residents mail or packages. Administrator confirmed that the facility failed to protect resident's money. Administrator also confirmed that the resident now experiences emotional distress, embarrassment and distrust because of the theft. Based on the deficiencies identified in this report, the Nursing Home Administrator and Director of Nursing failed to fulfill essential duties and responsibilities of their position to ensure that the Federal and State guidelines and Regulations were followed, contributing to the Immediate Jeopardy situation. Refer to F602 28 Pa Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management 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 18 of 20 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 08/15/2024 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 0895 Have a Compliance and Ethics Program. Level of Harm - Minimal harm or potential for actual harm Based on policy review, resident clinical record review, and resident and staff interviews, it was determined that the facility failed to implement and enforce the facility compliance and ethics program, so that it is likely to be effective in preventing and detecting criminal, civil, and administrative violations under the Act and in promoting quality of care related to misappropriation and exploitation of resident property, unauthorized access of resident's financial information, theft of money from resident's bank account, unauthorized purchase on resident's account, and receiving monetary assistance by the facility staff. One of three residents reviewed. (Resident R1) Residents Affected - Some Findings include: Review of current Employee Hand book revealed that Employee Conduct and Ethics: All employees are expected to have the highest level of integrity. Employees may not solicit or accept gratuities, gifts, or loans from patients or residents, their families or visitors. In the case where a gratuity is forced upon you, it must immediately be given to your department head or supervisor who will return. SOLICITATION AND DISTRIBUTION Soliciting or accepting gifts, cash, cash equivalents, payments, services, vacations, pleasure trips, or any favors from referral sources, suppliers, vendors, or any other person, firm or corporation that does or seeks to do business with the Company is strictly prohibited. In addition, employees should not borrow, hold money, or agree to cash checks on behalf of a patient, resident, family member, visitor, or employee. Solicitation by employees in resident care areas for any reason is strictly prohibited. Solicitation by employees in non-resident care areas while on working time is strictly prohibited. Collections for charitable purposes shall be considered solicitations for the purposes of this policy, unless approved by management. Review of statement from Employee E4, Nurse Aide, on August 6, 2024, revealed that she received $500.00 from Resident R1 when she told him she was going on vacation, and she would be off. Another day the resident sent the nurse aide $700.00 dollar to do something nice for her and asked her to go get her hair done. It was revealed that the employee gave him her cash app id for resident to transfer the money. Employee admitted that she understood accepting money from resident was wrong. Review of facility investigation revealed that Nurse aide Employee E4, received a total gift of $1,200.00 dollars from residents account to employee's cash app account. Further review revealed that the employee was terminated for accepting monetary gifts from a resident which is against facility policy. Review of statement from Activity aide, Employee E5, on August 6, 2024, stated Resident R1 gifted a maternity dress last Wednesday or Thursday. She never asked him to buy her the dress, he surprised her with it last week, it was still in the amazon packaging. Review of facility investigation revealed that nurse aide, Employee E7 reported that the staff in question (Employee E5) used his card. Employee E7 stated she felt that he did not want Employee E5 get in trouble because she was pregnant. She looked into April 2024 bank statement and found $954.00 in charges. Review of facility investigation revealed that on May 29, 2024, Resident R1 account was used to transfer a $100.00 and $200.00 on June 27, 2024, to Employee E5, Activity Aide. Review of statement from Employee E6, Dietary Aide, on August 6, 2024, stated the employee used (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395791 If continuation sheet Page 19 of 20 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 08/15/2024 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 0895 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some cash app to herself, for $20.00, she stated she went to resident and asked for $20.00 to get an uber ride home after work. She states she gave resident the $20.00 in exchange. Employee E6 stated she heard Resident R1 stated a nurse or aide might have taken money from him. Review of facility investigation revealed that on June 17, 2024, Resident R1 account was used to transfer a $700.00 and $20.00 at two different times to Employee E6, Dietary Aide. Further review of facility investigation revealed that facility investigation found charges to multiple sites the resident did not make and then admitted to 3 employees who would order him food and then proceeded to use cash app, online food delivery service, online taxi booking service and online retailer store account for themselves. The investigation of misappropriation of property was substantiated and the facility terminated the activity aides. The dietary aide was terminated for accepting a monetary gift, and the facility concluded that the allegations was unsubstantiated for misappropriation. One nurse aide was terminated for accepting monetary gifts and was unsubstantiated for misappropriation. The police came in spoke with resident and took copies of all information. The information was sent to detectives to investigate. 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 20 of 20