Health inspection·April 1, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy, review of facility documentation, observations, interviews with resident, it was determined that the facility failed to provide a safe, clean, comfortable, homelike environment for two of 12 resident reviewed. (Resident R1 and Resident R2) Findings include: Review of facility policy titled Homelike Environment revised 2021, revealed it is the policy of the facility that residents are provided with a safe, clean, comfortable and homelike environment. The facility staff and management will maximizes, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting which include: a clean, sanitary and orderly environment. Review of Resident R1's quarterly Minimum Data Set (MDS-a federal mandated assessment for all residents) dated February 17, 2025 revealed that Resident R1 was admitted to the facility January 9, 2025. This resident required assistance for activities of daility living, total assistance for transfers, support of enteral feeding (tube feeding). The resident also used a urinary catheter. Observation of Resident R1's room on April 1, 2025 at 10:30 a.m. revealed a foul oder, two large bags of laundry at the door. The resident's roommate- Resident R2 observed lying on a bed with no sheets, the floor was soiled with food/crumbs, papers, a wallet, upside down radio, a visible soiled cloth and shoes scattered around. Interview with Resident R1 revealed that he is not happy about being old and having to live here. He stated that the staff was good and requested juice. Interview with Nursing aide, Employee E3 at time of the above observation revealed that Resident R2 constantly keeps his room dirty. The staff continually are cleaning up after him. This employee sorted and organized the resident's clothes out his closet today to make the room neater. Resident R2 refused care and often does not allow staff to touch his belongings. This employee and the staff constantly try to clean his room, but as soon as its id clean, he trashes it again. Review of Residents R2's quarterly Minimum Data Set ( MDS- federal mandated assesment for all residents) dated March 6, 2025 revealed that Resident R2 was admitted [DATE] with a diagnosis of diabetes (failure of the body to produce insulin). The resident was assessed with a BIMS (brief interview of mental status) score of 15, indicating the resident cognition was intact. Further review of Residents R2, clinical record revealed that the resident has occupied the room since June 8, 2024. (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 2 Event ID: 395989 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 395989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Rehab and Hlthcare Ctratmercyfitzgerald 600 South Wycombe Ave Yeadon, PA 19050 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)