Health inspection·November 3, 2023

F 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. 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 record, facility documentation, and interview with staff it was determined that the facility failed to issue the resident/responsible party a Notice of Medicare Non-Coverage (NOMNC) prior to termination of Medicare A services, as required for one of three resident records reviewed (Resident CL118). Residents Affected - Few Findings include: Interview with the Nursing Home Administrator, Employee E1, conducted on November 3, 2023, at approximately 12:00 p.m. revealed the facility did not have a policy regarding notice of Medicare non-coverage. Review of Resident CL118 revealed that the resident was admitted to the facility on [DATE], with Medicare Insurance Coverage for skilled nursing care. Further review of clinical record revealed that the resident was discharged from the facility on July 8, 2023. There was no documented evidence that a Notice of Medicare Non -Coverage (NOMNC-written notice to the resident, beneficiary, or resident representative, of the right to an expedited review of a Medicare service termination of Medicare A Services prior to the discharge from the facility) was provided to the Resident CL118 or the resident's responsible party. Interview on November 3, 2023, at 12:30 p.m. with Nursing Home Administrator, confirmed that the facility had no documented evidence that a Notice of Medicare Non-Coverage (NOMNC) had been issued to Resident CL118 prior to the termination of the Medicare A service. 28 Pa. Code 201.29 (f) Resident Rights Page 1 of 9 395864 395864 11/03/2023 Juniper Village at Bucks County Rehab and Skd Care 3200 Bensalem Boulevard Bensalem, PA 19020

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on interview with staff and review of facility provided documentation, it was determined that the facility did not ensure that an allegation regarding nursing aide practicing administering medication was thoroughly investigated (Employee E12) Residents Affected - Few Findings include: Review of nurse aide, Employee E12's personnel file, revealed that Employee E12 was hired on July 20, 2023, for a full time nurse aide position. Review of witness statement provided by Nursing Home Administrator, dated August 23, 2023, stated the following: while sitting at the nurses station I observed that [Employee E12] was passing medications, to my knowledge she was only a CAN (nurse aide). This happened on multiple occasions but when asking it was stated she took her test and she was just waiting for her license. Notified director of nursing and then informed of the nepotism. (Employee E12 was director of nursing's daughter in-law). Director of nursing did not want to reprimand her daughter in law and both resigned that day. Review of Employee E12's 'exit interview form' dated August 24, 2023, reason for termination was 'involuntary' due to other: falsely documenting. Review of facility reported incident dated August 24, 2023, noted medication administration records were reviewed and it is noted 08/15/2023 - 08/24/2023, [Employee E12] signed as the person administering the medications on the unit. Review of facility provided investigation report failed to include witness statements from residents and facility staff. Further the investigation report did not included list of medications which were administered by Employee E12 as well as list of residents which were assessed after incident. 28 Pa Code 211.12(c )(d)(1)(5) Nursing Services 28 Pa Code 201.14(a)Responsibility of licensee 395864 Page 2 of 9 395864 11/03/2023 Juniper Village at Bucks County Rehab and Skd Care 3200 Bensalem Boulevard Bensalem, PA 19020

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the review of clinical records and interview with staff, it was determined that the facility failed to notify the resident and the resident's representative(s) of the transfer to the hospital and the reasons for the transfer in a timely manner, after a selected resident was transferred to the hospital for one of nine residents reviewed. (Resident R2) Findings Include: Review of MDS (Minimum Data Set-Assessment of resident care needs) for Resident R2 dated August 29, 2023, revealed that the resident was admitted to the facility on [DATE]. Further clinical record review revealed Resident R2's responsible party was her daughter. Review of nursing note for Resident R1 dated July 29, 2023, revealed that the resident was discharged to the hospital related to a fall. Review of clinical record revealed no evidence that Resident R2's representative was notified of the transfer to the hospital and the reasons for the transfer in writing, and in a language and manner they understood. Interview with the Nursing Home Administrator, Employee E1, and Director of Nursing, Employee E2, on November 3, 2023, at 9:42 a.m. confirmed that the Residents R2's representative was not notified in writing of the reasons for the transfer, and in a language and manner they understood. 28 Pa. Code 201.14(a) Responsibility of license 28 Pa. Code 201.29(a) Resident rights 395864 Page 3 of 9 395864 11/03/2023 Juniper Village at Bucks County Rehab and Skd Care 3200 Bensalem Boulevard Bensalem, PA 19020

F 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to ensure that the resident and resident representative receive written notice of the facility bed-hold policy at the time of a facility-initiated transfer to a hospital for one of nine residents reviewed. (Resident R2) Findings include: Review of MDS (Minimum Data Set-Assessment of resident care needs) for Resident R2 dated August 29, 2023, revealed that the resident was admitted to the facility on [DATE]. Further clinical record review revealed Resident R2's responsible party was her daughter. Review of nursing note for Resident R1 dated July 29, 2023, revealed that the resident was discharged to the hospital related to a fall. Further review of Resident R2's clinical record revealed that there was no documented evidence that Resident R1's representative was provided with a written notice of the facility bed-hold policy at the time of Resident R1's facility-initiated transfer to the hospital. Interview with the Nursing Home Administrator, Employee E1, and Director of Nursing, Employee E2, on November 3, 2023, at 9:42 a.m. confirmed that the Residents R2's representative was not provided with the bed hold policy upon transfer. 28 Pa Code 201.14(a) Responsibility of licensee 395864 Page 4 of 9 395864 11/03/2023 Juniper Village at Bucks County Rehab and Skd Care 3200 Bensalem Boulevard Bensalem, PA 19020

F 0641 Ensure each resident receives an accurate assessment. 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 accurately complete a resident assessment related to discharge status for one of 27 residents reviewed (Resident R9). Residents Affected - Few Findings include: Review of undated facility policy titled, Electronic Transmission of the MDS, indicated that all MDS (Minimum Data Set - a mandatory periodic resident assessment tool) assessments, including significant change, will be transmitted in accordance with OBRA regulations (schedule of assessments that will be performed for a nursing facility resident at admission, quarterly, and annually, whenever the resident experiences a significant change in status, and whenever the facility identifies a significant error in a prior assessment). Review of Resident R9's clinical records revealed a physician order dated, April 12, 2023, which stated Resident R9 was admitted on Hospice on April 11, 2023. Further review revealed Resident R9 was discharged from hospice on October 12, 2023. Review of Resident R9's MDS titled, Significant Change in Status, dated April 18, 2023, was coded No for Hospice. Further review of Resident R9's MDS dated [DATE], revealed that Hospice Care was still coded, No. Interview with the Registered Nurse Assessment Coordinator, Employee E5, conducted on November 3, 2023, at 11:07 a.m. confirmed that the Significant Change in Status MDS, dated [DATE] and July 17, 2023, for Resident R9 was coded inaccurately. 28 Pa Code 201.14(a) Responsibility of licensee 2 Pa Code 211.5(f) Medical records 395864 Page 5 of 9 395864 11/03/2023 Juniper Village at Bucks County Rehab and Skd Care 3200 Bensalem Boulevard Bensalem, PA 19020

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 review of facility policies, clinical records, and staff interviews, it was determined that the facility failed to develop comprehensive care plans to meet care needs for one of nine residents reviewed. (Resident R116) Findings include: Review of an undated facility policy titled, Care Planning indicated that residents Care Plan ae based on Quarterly Minimum Data Set (MDS - federally mandated assessment of a resident's abilities and care needs) triggers and current needs of the resident. Review of Resident R116's admission MDS dated , October 23, 2023, revealed Resident R116 was admitted to the facility on [DATE], and had a BIMS (Brief Interview for Mental Status) score of two, indicating that the resident had severely impaired cognition. Review of Resident R116's admission elopement risk evaluation dated, October 20, 2023, revealed that Resident R116 was a potential elopement risk. Further review of Resident R116's clinical record revealed no documented evidence a comprehensive care plan was developed regarding elopement risk. Interview with the Director of Nursing, Employee E2, was conducted on November 2, 2023, at approximately 3:34 p.m. where the above-mentioned findings were brought to her attention. Employee E2 confirmed that a care plan regarding Resident R116's elopement risk should have been developed upon assessment. 28 Pa. Code 211.10(c)(d) Resident care policies 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 395864 Page 6 of 9 395864 11/03/2023 Juniper Village at Bucks County Rehab and Skd Care 3200 Bensalem Boulevard Bensalem, PA 19020

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 facility provided documentation, and interview with staff, it was determined that facility did not ensure to complete annual performance evaluation for two out of five nurse aides reviewed (Employee E8 and E11) Residents Affected - Few Findings include: According to facility provided documentation - nurse aides, Employees E7, E8, E9, E10, and E11 have been employed at facility for one year or longer. Requested performance evaluations for nurse aides on November 1, 2023, at 3:05 pm; facility was able to provide performance appraisal for Employees E7, E9, and E10. Upon further request for additional performance appraisals, facility was unable to locate performance evaluations for nurse aides, Employees E7 and E8. Findings confirmed by facility's director of nursing and administrator. 28 Pa Code 201.20(a)(b)(c)(d) Staff development 28 Pa Code 201.14(a)Responsibility of licensee 395864 Page 7 of 9 395864 11/03/2023 Juniper Village at Bucks County Rehab and Skd Care 3200 Bensalem Boulevard Bensalem, PA 19020

F 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. Based on resident council interview, staff interviews, review of facility policy and reviews of the established mealtime schedule, it was determined that the facility failed to ensure a nourishing snack was provided when 14 hours are between a substantial evening meal and breakfast on the main nursing unit. Findings include: A review of facility updated policy titled; Snacks indicated that residents will be offered snacks/nourishment to meet their needs. Residents are offered regular snacks throughout the day. Further review indicated that each resident is offered a mid- morning, mid-afternoon, and mid-evening snack as park of the daily structured program. A review of the established meal schedule for the residents revealed that the supper meal was scheduled for 5:00 p.m., and that he breakfasts meal the following morning was offered at 8:00 a.m. This was a 15-hour meal span of time until breakfast the following day. An interview was conducted on November 1, 2023, at 11:00 a.m. during the resident council with alert and oriented Residents, R67, R114, R4, R5, R115, R2, R117, revealed that snacks were not offered at bedtime. Residents reported that they eat dinner at 5:00 p.m. and get hungry at nighttime. A walkthrough the facility with the Nursing Home Administrator, Employee E1, was conducted on November 2, 2023, at 11:37 p.m. Interviews were conducted with alert and oriented Residents: R66, R115, R64, R65, who reported they were not aware of snacks being available in the kitchen and that they were not offered a midmorning, mid-afternoon, and midevening snack since their admission. An interview with the Dietary aide who was responsible for distributing snacks, Employee E4, conducted on November 2, 2023, at 12:19 p.m. confirmed that she had not passed out snacks to the residents yesterday and on this day. 28 Pa. Code: 201.14(a) Responsibility of license 395864 Page 8 of 9 395864 11/03/2023 Juniper Village at Bucks County Rehab and Skd Care 3200 Bensalem Boulevard Bensalem, PA 19020

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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, observations, and interviews with staff, it was determined that the facility did not ensure that food was stored, prepared, distributed, and served in accordance with professional standards for food service safety. Findings include: Review of facility policy titled, Labeling and Dating of Food undated indicated that all food removed from original package must have product name, receive date and use by date. Review of policy titled, Storage- Refrigerator and Freezer undated indicate that all food items in refrigerators must be properly dated and labeled. An initial tour of the Food Service Department conducted on November 1, 2023, at 7:00 a.m., with Employee E3, Food Service Manager, revealed the following: Observations in the walk-in refrigerator revealed the following items did not have a received and or use by date: Meatloaf, steak, squash, scones, salmon, roast beef, ham, turkey, and salami. Further observation revealed four pulled raw beef briskets without a received date, pulled date, and use by date; and two pans of raw chicken thighs with an expiration date of October 29, 2023. Observations were confirmed by Employee E3, Food Service Manager, along the duration of the tour of the dietary department. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.6 (f) Dietary Services 395864 Page 9 of 9