Health inspection·April 3, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon interviews with residents and staff, review of clinical records, facility documentation and policy, it was determined that the facility failed to ensure residents were free from abuse and neglect for one of 21 resident records reviewed (Resident R94). Findings include: Review of the facility's policy titled, Abuse, Neglect, and Exploitation revised July 2024, states, The facility will not tolerate abuse, neglect, mistreatment, of residents. The same policy states that Mental abuse includes humiliation, punishment and deprivation. Review of Resident R94's clinical record revealed that the resident was admitted to the facility on [DATE] with the diagnoses of bipolar disorder (moods of extreme highs and of extreme lows), depression, muscle weakness and scoliosis (unnatural curvature of the spine). Review of Resident R94's nursing note dated March 20, 2025, stated, Resident reported to staff that she had put her call light on and requested to go to the bathroom, she stated that staff informed her she should go in the brief she was wearing, and she would come back to change her once she was finished. She stated that when she was finish, she rang her call light to be changed, and staff changed her while she was in bed. During an interview with Resident R94's roommate, Resident R57 on April 1, 2025 at 12:30 p.m. stated, I overheard an aide say to Resident R94 that she was tired of changing the resident and told the resident to go in her pants. On April 2, 2025, at 10:57 a.m. during an interview with Resident R94 stated, The aide was getting me ready for bed and I told her I had to use the bathroom. She said to go in my pants, and she would come back to change me. I couldn't hold it, and I went in my pants. It felt degrading and I am embarrassed to even say it happened. Interview with the Unit Manager Employee E3 on April 2, 2025 at 12:39 p.m. stated Resident R94 is continent of urine. She is able to feel when she has to urinate. When she has to use the bathroom, she tells us and we assist her to the toilet. Review of the facility's reported event submitted on March 20, 2025, and the facility's investigation concluded he allegation was found substantiated and the nursing assistant was terminated for mental abuse. Page 1 of 9 395912 395912 04/03/2025 Suburban Woods Health & Reha 2751 Dekalb Pike Norristown, PA 19401

F 0600 28 Pa Code 201.18(b)(1) Management Level of Harm - Minimal harm or potential for actual harm 28 Pa Code 201.29(a)(c) Resident rights 28 Pa Code 211.10(c) Resident care policies Residents Affected - Few 28 Pa Code 211.12(c) Nursing services 28 Pa Code 211.12(d)(1)(5) Nursing services 395912 Page 2 of 9 395912 04/03/2025 Suburban Woods Health & Reha 2751 Dekalb Pike Norristown, PA 19401

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Potential for minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records and staff interview, it was determined that the facility failed to ensure that the Minimum Data Set Assessments (MDS - a federally mandated standardized assessment conducted at specific intervals to plan resident care) accurately reflected the status of two residents out of 21 sampled (Residents R48 & R93). Residents Affected - Many Findings included: A review of Resident R48's clinical record revealed that the resident was admitted to the facility on [DATE]. Review of Resident R48's physician orders revealed a February 4, 2025, order to admitted to hospice care with the diagnosis of Parkinson's Disease (progressive disease of the central nervous system). Further review of a Significant Change Minimun Data Set (MDS) assessment dated [DATE], section J revealed that the resident had a life expectancy of less than six months, and that section O did not indicate that the resident was on hospice. Interview with the MDS Coordinator, Employee E4 on April 2, 2025, at 11:25 a.m. confirmed that Resident R48 was put on hospice care on February 4 and that Section J of the February 4, 2025, MDS indicated a life expectancy of less than six months and that Section O of the MDS should have been triggered for hospice services. Review of Resident R93's clinical record revealed a Quarterly MDS dated [DATE]. Review of Section C: Cognitive Pattern within the MDS dated [DATE], revealed this section was not completed and marked as not assessed. Interview on April 3, 2025, at 10:15 a.m. with MDS Coordinator, Employee E4, revealed interviews for mental status could not be completed timely by the social services department and subsequently needed to be coded as no information. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 211.5(f) Clinical Records 395912 Page 3 of 9 395912 04/03/2025 Suburban Woods Health & Reha 2751 Dekalb Pike Norristown, PA 19401

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, review of facility documentation, review of clinical record, and staff interview, it was determined that the facility failed to provide adequate supervision to prevent an elopement for one of two residents reviewed for wandering/elopement (Resident R308). Findings Include: Review of facility policy Elopement/Unauthorized Absence dated August 2, 2024, revealed the facility will identify residents with potential and/or actual risk factors for elopement and protect the resident through development and implementation of safety interventions. In the event of a resident elopement the facility will implement its policies and procedures promptly to locate the resident in a timely manner. Review of Resident R308's Minimum Data Set (MDS - federally mandated resident assessment and care screening) dated August 8, 2024, revealed the resident had severe cognitive impairment and had diagnoses of dementia (decline in cognitive function that interferes with daily life) and altered mental status. Further review of the MDS revealed Resident R308 was independent for transfers and ambulation. Continued review of Resident R308's MDS dated [DATE], revealed the resident exhibited the behavior of wandering daily. Review of Resident R308's comprehensive care plan dated June 1, 2024, revealed the resident had cognitive impairment related to dementia diagnosis with wandering/elopement. Review of Resident R308's clinical record revealed a nursing note dated June 3, 2024, that revealed the interdisciplinary team (IDT) met and discussed Resident R308's elopement risk. Per the IDT/Elopement Risk note dated June 3, 2024, Resident R308 was placed on 15-minute checks due to the resident removing his wander guard. Continued review of Resident R308's clinical record revealed a nursing note dated August 1, 2024, that revealed IDT met again to discuss Resident R308's elopement risk. Per the IDT/Elopement Risk note, dated August 1, 2024, Resident R308 remained on 15-minute checks due to his continued refusal to wear the wander guard and continued wandering on the unit at times. Review of Resident R308's clinical record revealed a nursing note dated August 15, 2024, by Registered Nurse, Employee E6, that revealed staff were unable to locate Resident R308. Review of facility documentation revealed an incident report dated August 15, 2024, that indicated Resident R308 was last seen ambulating in the hallway at 7:30 p.m. At 7:45 p.m. when the resident's assigned nurse aide, Employee E7, went to check on Resident R308, the resident could not be located. A code was promptly announced to notify staff in the building that Resident R308 could not be located, and staff immediately began to search inside and outside the building. Further review of the incident report dated August 15, 2024, revealed the Director of Nursing, Employee E2, was able to locate Resident R308 in the parking lot at approximately 9:00 p.m. Resident 395912 Page 4 of 9 395912 04/03/2025 Suburban Woods Health & Reha 2751 Dekalb Pike Norristown, PA 19401

F 0689 R308 was subsequently brought back into the building and no injuries were identified upon assessment. Level of Harm - Minimal harm or potential for actual harm Review of Resident R308's clinical record revealed the resident was subsequently put on 1:1 supervision status-post the elopement for increased supervision. Residents Affected - Few Interview on April 3, 2025, at 12:05 p.m. with the Director of Nursing, Employee E2, confirmed this employee found Resident R308 in the parking lot around 9:00 p.m. Further interview with Director of Nursing, Employee E2, revealed Resident R308 admitted to exiting the facility through the front door. Director of Nursing, Employee E2, reported that it was assumed that Resident R308 must have followed behind a family member (of another resident) who was exiting the building. 28 Pa. Code 211.12 (d)(5) Nursing Services 395912 Page 5 of 9 395912 04/03/2025 Suburban Woods Health & Reha 2751 Dekalb Pike Norristown, PA 19401

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on 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: A tour of the Food Service Department was conducted on March 31, 2025, at 9:15 a.m. with Employee E5, Food Service Director (FSD), revealed the following concerns: Observation in the receiving dock revealed a lot of trash scattered around the loading dock next to the dumpster including empty milk carton, plastic juice cups and paper. Observation in the dry storage area revealed a buildup of dust, dirt and black substance on the floor under she shelves next to the aluminum freezer walls. Observation in the walk-in freezer revealed that the floor was dirty and had debris on the floor under the shelves. Observation in the walk-in cooler revealed that the floor was dark and dirty with [NAME] stains on the floor under the shelves. Observation of the wall in the dish room area behind the high-pressure spray hose and scrap sink revealed the paint on the wall was dirty and the paint was peeling off. Observation of the convection oven revealed a heavy build-up of dark black burned on food splatter and grease drippings on the inside surfaces of both ovens. Interview with the FSD on March 31, 2025, at 9:25 a.m. confirmed the above findings. 28 Pa. Code 201.14(a) Responsibility of licensee 395912 Page 6 of 9 395912 04/03/2025 Suburban Woods Health & Reha 2751 Dekalb Pike Norristown, PA 19401

F 0840 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Employ or obtain outside professional resources to provide services in the nursing home when the facility does not employ a qualified professional to furnish a required service. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records, and interviews with staff, it was determined that the facility failed to ensure timely provision of professional services furnished by outside providers, for one of 21 resident records reviewed (Resident R93). Findings include Review of Resident R93's clinical record revealed that the resident was admitted to the facility on [DATE], with a diagnosis of Huntington's disease (a rare, inherited neurological disorder that causes nerve cells in the brain to break down, leading to progressive physical and mental decline). Review of nursing note dated January 8, 2025, indicated the resident refused to go to an outside appointment with the hospital related to the diagnosis of Huntington disease. Continue review of the same note stated, Appointment attempted to be rescheduled, message left to contact facility to schedule a new appointment date and time. Further review of Resident R93's clinical record revealed no documented evidence that the facility ensure that the appointment was rescheduled. The Director of Nursing on April 3, 2025, at 10:00 a.m. confirmed no new appointment was made. 28 Pa. Code 211.12 (d)(1) Nursing Services. 395912 Page 7 of 9 395912 04/03/2025 Suburban Woods Health & Reha 2751 Dekalb Pike Norristown, PA 19401

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 and interview with staff, it was determined that the facility did not maintain complete and accurate medical records related to diagnoses for physician ordered medications for two of 21 records reviewed (Residents R18 and R81). Findings include: Review of clinical documentation for Resident R18 revealed a physician order, dated January 1, 2025, for Metoclopramide HCl 10MG tablet, with the instructions 1 tab, oral, three times a day .before meals. On the order sheet, the area marked ICD-10 Diagnosis was filled out as N/A (not applicable). There was no reason for use given for the medication. Further review revealed another physician order, dated January 30, 2025, for Systane Hydration, 0.4-0.3%, with the instructions 1 drop in each eye once a day. On the order sheet, the area marked ICD-10 Diagnosis was filled out as N/A. There was no reason for use given for the medication. Review of clinical documentation for Resident R81 revealed a physician order, dated March 20, 2025, for Lidocaine HCl .cream; 4%, with the instructions administer cream to right shoulder [every] shift. On the order sheet, the area marked Diagnosis was blank. There was no reason for use given for the medication. Interview with the Director of Nursing, Employee E2, on April 3, 2025, at 2:15 p.m. confirmed that all medication orders must list the diagnosis or reason for use to be complete. 28 Pa. Code 211.12(c) Nursing service 28 Pa. Code 211.12(d)(1) Nursing service 28 Pa. Code 211.12(d)(2) Nursing service 28 Pa. Code 211.12 (d)(5) Nursing service 395912 Page 8 of 9 395912 04/03/2025 Suburban Woods Health & Reha 2751 Dekalb Pike Norristown, PA 19401

F 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of resident records and interviews with staff, it was determined the facility did not ensure antibiotics were administered with adequate indication for use for one of 21 resident records reviewed (Resident R94). Residents Affected - Few Findings include: Review of Resident R94's clinical record revealed that the resident was admitted to the facility on [DATE] diagnosed with bipolar disorder (moods of extreme highs and of extreme lows), depression, muscle weakness and scoliosis (unnatural curvature of the spine). Review of Resident R94's physician note dated October 28, 2024 indicated the resident's urinalysis was abnormal, noting the resident's white count was improving, the urinalysis weakly suggestive of infection and was still waiting for the colony count and cultures and sensitivities and noted the resident denied any urinary symptoms. Further review of Resident R94's nursing notes, dated October 28, 2024, revealed the labs were further reviewed by a Nurse Practioner that ordered an antibiotic, Bactrim DS for three days. Interview with the Director of Nursing on April 2, 2025, at 3:00 p.m. stated that during QAPI I remind the physicians about prescribing antibiotics with no indication for use and Resident R94 was used as an example. 28 Pa. Code 211.12 (d)(1) Nursing Services. 395912 Page 9 of 9