Health inspection·June 18, 2025

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. Based on review of facility policy, review of clinical records, interview with staff, it was determined that the facility failed to ensure comprehensive care plans were developed to address resident care needs related to a significant weight loss for one of three residents reviewed. (Resident R169) Findings include: Review of facility policy titled Unintended Weight Loss ensures residents will maintain acceptable body weight unless a clinical condition demonstrates that this is not possible residents with unintended weight loss will be assessed by the interdisciplinary team and interventions will be implemented to prevent further weight loss and promote weight gain. The director of wellness and director dietary manager are responsible for managing the processes for prediction or prevention, treatment, monitoring and calculation of unintended weight loss. Compliance includes developing a care plan that includes measurable objectives and time frames to meet the residents needs as identified in the residence assessment, the disciplinary team assesses residents with identified weight loss, develops care plan, implements, evaluates and reevaluates to treat and prevent weight loss and maintain adequate nutritional status of the resident, and communicate of weight changes to attending provider and residents' family. The licensed nurse documents the note of vacations in the medical record. Review of facility document titled Care Plan revealed the purpose of care plan is to write activity goals and approaches for each resident based on MDS (minimum data set , a federal mandated assessment tool), triggers and current needs of the resident. The process of care planning involves identifying the problem common need and strength of each resident then determine goals that are measurable specific and have a target date lastly determine approaches or interventions which are specifically what will be done to assist the resident in meeting the goal considering physical cognitive emotional abilities monitoring approaches will be numbered and will be recorded in care plan progress notes. Review of Resident R169's clinical record revealed that this resident entered the facility on May 29, 2025, after hospital discharge. Resident R169 was discharged back to the hospital for gastrointestinal bleeding, on June 3, 2025. There resident remained NPO (no food). Resident was received back at the facility June 10, 2025. Further review of resident R169's clinical record revealed a significant weight loss of 18.8 pounds in a period of eleven days. Review of Resident R169's clinical record weight history revealed that Resident R169 was documented as being weighed June 1, 2025, at 143.8 pounds, June 10, recorded weight was 144.0 pounds upon returned to the facility, June 11, 2025, recorded weight was 125.0 pounds. Interview with dietician employee E3 on June 16, 2025, revealed that she was made aware of the Page 1 of 6 395864 395864 06/18/2025 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 weight loss on this day, she offered the resident supplemental shakes, but resident refused. Registered Dietician, Employee E3 confirmed not updating the resident's care plan to address most recent weight loss. Employee E3 stated the protocol would be conversation with nursing staff which then would be relayed to physician, then the care plan would be updated. Residents Affected - Few 28 Pa. Code 211.12 (d)(3) Nursing services 28 Pa Code 211.10(b) Resident Care Plan 395864 Page 2 of 6 395864 06/18/2025 Juniper Village at Bucks County Rehab and Skd Care 3200 Bensalem Boulevard Bensalem, PA 19020

F 0847 Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of facility documents and resident clinical records and interviews with staff and resident and family member, it was determined that the facility failed to ensure that residents had the capacity to understand the terms of a binding arbitration agreement for one of one resident reviewed (Resident R69). Residents Affected - Some Findings include: Review of admission record indicated Resident R69 was admitted to the facility on [DATE]. Review of Resident R69's admission Minimum Data Set (MDS - a periodic assessment of care needs) dated June 12, 2025, a BIMS score of 15, which indicated that the resident was cognitively intact. Review of Resident R69's Binding Arbitration Agreement (a binding agreement by the parties to submit to arbitration all or certain disputes which have arisen or may arise between them in respect of a defined legal relationship, whether contractual or not. The decision is final, can be enforced by a court, and can only be appealed on very narrow grounds) indicated that she signed the document on admission on [DATE]. The agreement was missing a name and signature who reviewed the agreement with Resident R69. An interview was conducted with the Social Worker, Employee E5, on June 17, 2025, at 10:03 a.m. Employee E5 reported that they reviewed the arbitration agreement with Resident R69 on June 9, 2025. However, it was further revealed that Employee E5 did not inform Resident R69 of their right to rescind the agreement within 30 days of signing, nor did they explain that the binding arbitration agreement does not prevent the resident from communicating with federal, state, or local officials, including federal and state surveyors, other health department employees, or representatives of the Office of the State Long-Term Care Ombudsman. Employee E5 revealed that when she reviews the biding arbitration agreement she only discusses that dispute shall be kept confidential and you can't discuss with anyone. An interview was conducted with the Nursing Home Administrator, Employee E1, on June 17, 2025, at 10:25 a.m. Employee E1 reported that when Employee E5 is on leave, she sometimes steps in to review the arbitration agreement with residents. It was further revealed that Employee E1 does not inform residents of their right to rescind the agreement within 30 days of signing, nor does she explain that the binding arbitration agreement does not prevent residents from communicating with federal, state, or local officials, including federal and state surveyors, other health department employees, or representatives of the Office of the State Long-Term Care Ombudsman. An interview was conducted with the Resident R69 and spouse, on June 17, 2025, at 12:43 p.m. which revealed that Resident R69 was not aware of that she/he able to rescind the agreement within 30 days of signing, nor that the binding arbitration agreement does not prevent residents from communicating with federal, state, or local officials, including federal and state surveyors, other health department employees, or representatives of the Office of the State Long-Term Care Ombudsman. An interview with the Administrator on June 17, 2025, at 2:45 p.m. confirmed that the facility failed to inform Resident R69-and other residents-when explaining the arbitration agreement in a 395864 Page 3 of 6 395864 06/18/2025 Juniper Village at Bucks County Rehab and Skd Care 3200 Bensalem Boulevard Bensalem, PA 19020

F 0847 Level of Harm - Minimal harm or potential for actual harm language they could understand, that they have the right to rescind the agreement within 30 days of signing. Additionally, the facility did not clarify that the binding arbitration agreement does not prevent residents from communicating with federal, state, or local officials, including federal and state surveyors, other health department employees, or representatives of the Office of the State Long-Term Care Ombudsman. Residents Affected - Some 28 Pa. Code: 201.14(a)(c)(d)(e) Responsibility of licensee. 395864 Page 4 of 6 395864 06/18/2025 Juniper Village at Bucks County Rehab and Skd Care 3200 Bensalem Boulevard Bensalem, PA 19020

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, policy review, and staff interviews, it was determined the facility failed to develop and implement water management program for the prevention, detection, and control of water borne contaminants, such as Legionella (a bacteria that may cause lesionnaires disease, a serious type of pneumonia). Residents Affected - Few Findings inlcude: Review of Centers for Disease Control and Prevention CDC guideline for Water Management in Healthcare Facilities revealed Legionella water management programs identify hazardous conditions and include taking steps to minimize the growth and spread of Legionella in the building water system. Having a water management program is now an industry standard for large buildings in the United States. memo Requirement to Reduce Legionella Risk in Healthcare Facility Water Systems to Prevent Cases and Outbreaks of Legionnaires Disease dated July 6th, 2018, revealed Facilities must develop and adhere to policies and procedures that inhibit microbial microbial growth in building water systems that reduce the risk of growth and spread of Legionella and other opportunistic pathogens in water. This policy memorandum applies to Hospitals, Critical Access Hospitals (CAHs) and Long-Term Care (LTC). However, this policy memorandum is also intended to provide general awareness for all health care organizations Facilities must have water management plans and documentation that, at minimum, ensure each facility: -Conducts a facility risk assessment conducts a facility risk assessment to identify we are Legionella and other opportunistic waterborne pathogens (e.g.: Pneumonias, Acinetobacter, Burkholderia, Stenotrophomonas, nontuberculous mycobacteria, and fungi could grow and spread in the facility water system -Develops and implements a water management program that considers the ASHRAE industry standards and the CDC toolkit - specifies testing protocols and acceptable ranges for control measures, and documents the results of testing and corrective action taken when control limits are not maintained -Maintains compliance with other acceptable Federal, State and local requirements. -Conducts a facility risk assessment conducts a facility risk assessment to identify we are Legionella and other opportunistic waterborne pathogens (e.g.: Pneumonias, Acinetobacter, Burkholderia, Stenotrophomonas, nontuberculous mycobacteria, and fungi could grow and spread in the facility water system -Develops and implements a water management program that considers the ASHRAE industry standards and the CDC toolkit - specifies testing protocols and acceptable ranges for control measures, and documents the results of testing and corrective action taken when control limits are not maintained -Maintains compliance with other acceptable Federal, State and local requirements. 395864 Page 5 of 6 395864 06/18/2025 Juniper Village at Bucks County Rehab and Skd Care 3200 Bensalem Boulevard Bensalem, PA 19020

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of facilities water management plan which is contracted to outside company revealed the purpose of this water management plan is to establish the minimum legionella's risk management requires by illustrating the procedures for minimalizing the risk of Legionnaires disease within the building water system of this facility and practicing routine control measures Including, facility plumbing, hot water expansion tank inspection, aerator should be replaced or dismantled and cleaned on all units to be done quarterly control water systems plumed units which are to be activated weekly to flush the line and verify operation, the Expansion tank for the hot water system should be done annually check for leaks calcifications corrosions around the attachment findings stagnation is the danger and non-flow through tanks hot water heater is to be checked monthly. The aerator should be replaced or dismantled disinfected cleaned quarterly, temperature monitors and testing for legionella at least quarterly in cooling, towers, spa pools, and any fountains is recommended to demonstrate. Continued review of this water management plan revealed that the last water teste was completed February 18, 2023 Interview with Environmental Director, Employee E 4 and Nursing Home Administrator, Employee E1 on June 18, 2025, at 10:00 a.m. confirmed that the facility failed to ensure water testing and compliance of water management plan. The last testing was completed on February 18, 2023. 28 Pa. Code 201.14(a) Responsibility of licensee 395864 Page 6 of 6