Health inspection·August 28, 2025

F 0559 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made. Based on staff and resident interviews and review of clinical records, it was determined that the facility failed to ensure that documented room change notifications to the resident and/or emergency contact were provided for one out of 33 residents reviewed (Resident R133).Findings include:During an interview with Resident R133 on August 27, 2025, at 2:07 p.m. stated facility moved his room without providing prior notice. The resident stated the staff came into his room and asked him to move. The resident stated he was not prepared and did not pack his belongings, and staff did not give him the opportunity to do it himself because it was important for him to pack his belongings himself.Review of room change notification for Resident R133 dated February 19, 2025, revealed that resident had room change on February 19, 2025, and the date of notification was on February 19, 2025. The question for written copy provided to was answered N/A (Not Applicable Resident is alert and oriented X3.Further review of clinical records revealed no evidence that the facility provided written notice to the resident prior to the room change.Interview with Administrator on August 28, 2028 at 11:00 a.m. confirmed that the facility did not provide written notice to Resident R133 when his room was changed on February 19, 2025. 28 Pa. Code 201.14(a) Responsibility of licensee28 Pa. Code 201.29(c.3) (1) Resident rights 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 5 Event ID: 395865 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 395865 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Maplewood Nursing and Rehab Center 125 W Schoolhouse Lane Philadelphia, PA 19144 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)