Health inspection·January 5, 2026

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on clinical record review, interviews with staff and reviews of policies and procedures, it was determined that the facility failed to ensure that medication administration records were completed for two of seven residents. (Residents Cl1 and Cl2). Findings include:A review of the policy titled medication administration dated November 28, 2016, revealed that it was the responsibility of the licensed nursing staff to administer medications in accordance with professional standards of practice and as ordered by the physician. The policy also indicated that the medication was to be administered as ordered by the physician and in accordance with manufacturers' specifications. The nurse was to observe the resident consume the medication. The medication was to be recorded onto the medication administration record, which was part of the resident's clinical record. A review of the policy titled medical record documentation dated November 2025, revealed that each resident's medical record was to contain an accurate representation of the resident through complete, accurate and timely documentation. The policy indicated that licensed staff and the interdisciplinary team members were to document all assessments, observations and services provided for each resident in the medical record in accordance with state law and the facility policy. The policy said that documentation shall be factual, accurate, relevant and complete containing sufficient details about the resident's care and/or responses to care. Clinical record review for Residents Cl1 and Cl2 revealed that the nursing staff failed to completely and accurately document that medications and treatments were administered as ordered by the physician.Clinical record review for Resident Cl1 revealed that this resident had diagnoses of asthma, hypertension, depression, hypoxia, diabetes mellitus and severe stenosis with myelomalacia. The physician had ordered formoterol fumarate inhalation nebulizer solution 20MCG/2ml inhale orally via nebulizer two times a day for asthma. The licensed nurse documented on November 2, 2025, that the 5:00 p.m., dose of inhalation medication for asthma was not administered to Resident Cl1. A licensed nurse documented on November 4 and November 9, 2025, that the 5:00 p.m., doses of medication for formoterol fumarate inhalation nebulizer solution 20MCG/2ml inhale orally via nebulizer were not administered to Resident Cl1. The physician had ordered pregabalin oral capsule 25 mg be administered twice a day for cerebral vascular accident for Resident Cl1. A licensed nurse documented that on November 4, 9 and 10, 2025 the 5:00 p.m., doses of pregabalin oral capsule 25 mg were not administered to Resident CL1 for the diagnosis of cerebral vascular accident. A licensed nurse documented that on December 10, 2025, and December 11, 2025, the 9:00 a.m., the doses of pregabalin oral capsule 25 mg were omitted for Resident Cl1 for the treatment and diagnosis of cerebral vascular accident. The physician had ordered insulin lispro injection three times a day for a diagnosis of diabetes mellitus with a sliding scale amount of insulin, after a blood glucose reading was taken and recorded by the nurse for Resident Cl1. A licensed nurse documented at 5:00 p.m., on November 4 and 9, 2025 that blood glucose was not taken or recorded for Resident Cl1 and that insulin for diabetes mellitus was not administered as ordered by (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: 395819 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 395819 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Caring Heart Rehabilitation and Nursing Center 6445 Germantown Avenue Philadelphia, PA 19119 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)