Health inspection·July 13, 2023

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based upon clinical record review and interview, it was determined the facility failed to communicate with a dialysis center regarding an incident and fall that occurred at the dialysis facility resulting in dialysis not being completed and failed to investigate the fall at the dialysis center for one of one resident reviewed (Resident 5). Residents Affected - Few Findings include: Review of Resident 5's clinical progress note dated June 5, 2023, revealed Pt [patient] evaluated post fall while at dialysis (he tipped backwards in wheelchair going up a hill into the facility). Pt. denies injury or hitting head. [resident] does state [resident's] shoulders are sore. [resident's] pain is managed with Oxycodone. Pt. has been more compliant with dialysis and pleasant for the most part. However, [resident] did not receive tx [treatment] today bc [because] he was too late. Unit clerk aware. Will follow. Further review of Resident 5's clinical record failed to reveal evidence of investigation into Resident 5's fall at the dialysis center on June 5, 2023. Interview with the Director of Nursing on July 13, 2023, at 11:50 a.m. confirmed that no investigation into Resident 5's fall, which resulted in Resident 5 not receiving dialysis on June 5, 2023, was conducted. No investigation or information was available to determine Resident 5's arrival time at the dialysis center, where resident was dropped off or what time resident arrived at the facility. The facility failed to communicate with the dialysis center and failed to timely investigate a fall that occurred at the dialysis center. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.12(d)(1) Nursing Services 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 4 Event ID: 395917 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 395917 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brinton Manor Nursing and Rehabilitation Center 549 Baltimore Pike Glen Mills, PA 19342 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)