Inspection·June 26, 2025

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 Based on clinical record review, staff interview, and observations, it was determined that the facility failed to implement physicians' orders for two of 12 sampled residents. (Residents 4 and 159) Residents Affected - Some Findings include: In an interview on June 26, 2025, at 10:00 a.m., the Director of Nursing stated that once a medication is administered, it should be recorded onto the resident's Medication Administration Record (MAR). If a dose of regularly scheduled medication is withheld, refused, or given at an other time other than what is scheduled, the reason should be documented on the MAR. Clinical record review revealed that Resident 4 had diagnosis of hypertension (high blood pressure). On June 11, 2025, the physician ordered staff to administer a blood pressure medication (hydralazine hydrochloride) three times a day. Staff was not to administer the medication if the resident's systolic blood pressure (SBP, the first measurement of blood pressure when the heart beats and the pressure is at its highest) was less than 100 millimeters of mercury (mmHg). Review of Resident 4's MAR for June 2025, revealed that staff administered the medication on June 19, 2025, when the SBP was less than 100 mmHg. On June 17 and 25, 2025, there was no documented evidence that the medication was offered to Resident 4 at 2:00 p.m., as scheduled. On June 12, 2025, the physician ordered staff to administer a blood pressure medication (amlodipine besylate) one time a day. Staff was not to administer the medication if the resident's SBP was less than 110 mmHg. Review of Resident 4's MAR for June 2025, revealed that staff administered the medication on June 21, 2025, when the SBP was less than 110 mmHg. On June 12, 2025, the physician ordered staff to administer a blood pressure medication (lisinopril) one time a day. Staff was not to administer the medication if the resident's SBP was less than 110 mmHg. Review of Resident 4's MAR for June 2025, revealed that staff administered the medication on June 21, 2025, when the SBP was less than 110 mmHg. On June 12, 2025, the physician ordered staff to administer a blood pressure medication (metoprolol) one time a day. Staff was not to administer the medication if the resident's heart rate (the number of times a heart beats in one minute) was less than 60. Review of Resident 4's June 2025 MAR revealed that staff administered the medication on June 15, 2025, when the resident's heart rate was less than 60. In an interview on June 26, 2025, at 10:02 a.m., the Director on Nursing confirmed that the medications were administered outside of established parameters and that staff should have documented on the MAR when the medication was offered to the resident. Clinical record review revealed that Resident 159 had diagnoses that included a history of traumatic brain injury and left elbow contracture. A physician's order dated June 23, 2025, directed staff to keep a left palm guard with finger separators in place on the resident's left hand at all times except for removal for hygiene tasks and skin checks every shift. Review of Resident 159's June 2025 MAR revealed that the palm guard was not in place on June 23 and 24, 2025. Observations of the resident's left hand on June 24, 2025, at 11:30 a.m., 1:30 p.m., and on June 25, 2025, at 11:09 a.m., revealed that the left palm guard was in place, but his fingers on the left hand were contracted and were overlapping one another. The finger separators were not in place. In an interview on June 26, 2025, at 1:51 p.m., the Administrator confirmed that the finger separators should have been in place, per the physician's order. CFR 483.25 Quality of Care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395796 If continuation sheet Page 2 of 5 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 395796 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Montgomeryville Skilled Nursing and Rehabilitati 640 Bethlehem Pike Montgomeryville, PA 18936 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 Previously cited 5/22/24 Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12(d)(1)(5) Nursing services. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395796 If continuation sheet Page 3 of 5 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 395796 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Montgomeryville Skilled Nursing and Rehabilitati 640 Bethlehem Pike Montgomeryville, PA 18936 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 0801 Level of Harm - Minimal harm or potential for actual harm Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Based on staff interview, it was determined that the facility failed to employ a full-time qualified dietary services manager in the absence of a full-time qualified dietitian. Residents Affected - Some Findings include: During an interview on June 24, 2025, at 11:45 a.m., the Food Service Director stated the facility did not employ a qualified dietary manager. There was no evidence that the facility had a qualified dietary services manager or a full-time dietitian. In an interview conducted on June 25, 2025, at 1:00 p.m., the Administrator confirmed that there was not a full-time dietitian employed at the facility and that the facility did not employ a qualified dietary manager in the absence of a full-time dietitian. 28 Pa. Code 201.18(b)(3) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395796 If continuation sheet Page 4 of 5 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 395796 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Montgomeryville Skilled Nursing and Rehabilitati 640 Bethlehem Pike Montgomeryville, PA 18936 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 facility policy review, observation, and staff interview, it was determined that the facility failed to store food in a sanitary manner on one of one nursing unit. (Rehabilitation unit) Residents Affected - Few Review of the facility policy entitled, Food Brought in for Residents, dated June 2, 2025, revealed that foods that required refrigeration were to be labelled with the resident's name and the date and then discarded after three days upon notification to the resident. Observation of the Rehabilitation unit resident pantry on June 25, 2025, at 10:30 a.m., revealed in the freezer, a container of ice cream in a bag, a bottle of water, and a juice drink that were not labelled or dated. In the refrigerator, there was a cup of coffee dated June 4, 2025, but was not labelled. There was an opened container of nectar thick lemon-flavored water with a use-by date of June 2, 2025, and a yogurt with a use-by date of June 23, 2025. There was a large plastic lid labelled fresh fruit directly touching the shelf, and there was no bottom part of the container in the refrigerator. There was a sandwich, a bagel wrapped in foil, and a large white plastic bag that contained four sandwich bags of chips, pretzels, pickles, and grapes that were not labelled or dated. In an interview on June 25, 2025, at 1:07 p.m., the Administrator confirmed the unit pantry is for resident food items only. CFR 483.60(i) Food Safety Requirement Previously cited 5/22/24 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(3)(e)(2.1) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395796 If continuation sheet Page 5 of 5