Health inspection·September 3, 2025

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of facility policies, review of facility documentation, clinical record review and interviews with staff, it was determined that the facility failed to maintain an effective infection control program related to Transmission Based Precautions for two of two residents reviewed (Residents R1and R2) and an Infection Preventionist.Findings include:Review of facility policy, Infection Prevention and Control Program revised in July 2022, revealed that it is the community's policy to maintain an Infection Prevention and Control Program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection in accordance with Centers for Disease Control and Prevention (CDC) and the Association of Professionals in Infection Control and Epidemiology (APIC). Further review of policy revealed that The Skilled Nursing Administrator (SNA)/ Director of Nursing Services (DNS) designates a Registered Nurse as the Infection Preventionist (IP). The IP will: A. Be qualified by education, training, experience or certification B. work at least part-time at the facility; and C. have completed specialized training in infection prevention and control, D. be a member of the community's quality assessment and assurance committee and report to the committee on the IPCP on a regular basis. The infection preventionist (IP) evaluates the infection prevention and control program to validate required components with include. A. Fundamental Principles of Infection Control B. Infection Control Program and Infrastructure C. Team member and Resident Safety D. Surveillance and Disease Reporting E. Standard Precautions F. Transmission Based Precautions G. Resident Suite Assignment H. Environmental Cleaning I Safe Injection Practices and Point of Care Testing J. Medication Storage and Handling K. Antibiotic Stewardship program.Interview with Director of Nursing, Employee E1 on September 3, 2025 at 9:05am revealed No infection preventionist in the building, someone is hired however there is not one currently. Interview with Nursing Home Administrator, Employee E2 on September 3, 2025 at 9:45am revealed Facility uses a Regional Registered Nurse, Employee E4, as their Infection Preventionist and she comes to facility a couple times a month. Review of Facility Assessment revealed Frequency relative to Benchmark is High related to infections including, Multidrug-resistant organism, Pneumonia, Septicemia, Urinary Tract Infection, Viral Hepatitis, and Wound Infection. Review of meeting notes for QAPI (Quality Assurance Performance Improvement Plan), no documented evidence of Employee E4, Infection Preventionist in attendance for meetings dated August 27, 2025. Interview with Director of Nursing, Employee E1, on September 3, 2025 at 1:30pm confirmed the Infection Preventionist was not in attendance for the QAPI meetings dated August 27, 2025. Review of facility's documentation revealed the last time the Infection Preventionist, Employee E4 was present at the facility was August 7, 2025. Review of Resident R1's clinical record revealed that resident was admitted on [DATE], with the diagnosis of Obstructive Uropathy (obstruction of urine flow). Review of Resident R1's care plan, date-initiated August 5, 2025, revealed Enhanced Barrier Precautions needed related to Suprapubic Catheter. Review of Resident R2's clinical record revealed that Residents Affected - Few (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 2 Event ID: 395801 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 395801 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Quadrangle 3300 Darby Road Haverford, PA 19041 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)