Health inspection·June 27, 2025

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. Based on review of clinical records, interview with staff and review of facility provided documentation, it was determined facility failed to ensure that one of 23 residents reviewed exercised right to go to bed and the time of her/his choosing. (Resident R67) Findings include: Review of facility policy 'Resident Rights,' revised October 13, 2012, indicates that the resident has the right to exercise his/her rights as a resident of this facility and as a citizen of the United States. Exercising rights means that residents have autonomy and choice, to live their everyday lives and receive care. Review of Resident R67's clinical record, on Friday, June 27, at 10:00am, revealed the diagnoses of adjustment disorder with depressed mood, anxiety disorder, abnormalities of gait and mobility, muscle weakness, abnormal posture, and subsequent encounter of falls. Review of Resident R67's Minimum Data Set (MDS resident assessment and care needs), completed April 7, 2025, indicated that Resident R67 required extensive assistance of two of more physical assist for transfers. Review of facility provided investigation report, completed on May 14, 2025, indicated that resident stated that staff members forced her to go to bed on May 3, 2025 when (she/he) was not ready. (She/He) stated that two women tried to put (her/him) to bed, (she/he) told them no, and then the nurse came in and told them to do what they needed to do. The resident stated the women then grabbed (her/his) by (her/his) arms and put (her/him) into bed. Resident was noted with bruising to bilateral arms the following day when (she/he) reported the incident to (her/his) family and nursing staff. Review of nursing notes, dated May 14, 2025, at 2:38 p.m., indicated family brought attention to several bruises on resident's bilateral upper extremities. Resident reports the right upper extremity feels sore. Statements collected from staff. Further review of investigation report revealed that resident right's committee met with employee. While unable to determine if bruising occurred from the alleged incident, it was determined that the resident's rights to participate in (her/his) care was violated when Licensed nurse, Employee E7 and Nurse aide, Employee E8, transferred resident to (her/his) bed without (her/his) permission. 28 Pa Code 201.29(j) Resident rights (continued on next page) 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 6 Event ID: 395961 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 395961 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Philadelphia Protestant Home 6500 Tabor Road Philadelphia, PA 19111 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)