Inspection·June 10, 2024

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. Based on interviews, review of clinical records and review of resident grievances, it was determined that the facility failed to provide a summary of the pertinent findings or conclusions regarding the resident's concerns(s), a statement as to whether the grievance was confirmed or not confirmed, any corrective action taken or to be taken by the facility as a result of the grievance, the date the written decision was issued; and evidence that the resident was notified of the outcome of their grievance for 1 out of 3 residents reviewed (Resident R1): Findings include: Review of the facility policy, Grievance/Concern, with a revision date of January 8, 2024, indicated that the Nursing Home Administrator (NHA) will serve as the Grievance Officer who is responsible for overseeing the grievance process, receiving and tracking grievances through to their conclusion, leading any necessary investigations by the facility, and maintaining the confidentiality of all information associated with grievances. The policy also indicated that the NHA was responsible for issuing written grievance decisions to the resident and coordinating with state and federal agencies, as necessary regarding specific allegations. Continued review of the policy indicated that upon receipt of the Grievance/Concern Form, the NHA or designee will document the grievance/concern on the Grievance Concern Log, and when the grievance is logged, the NHA and appropriate department manager will be notified. Review of the policy also indicated that the department manager will contact the person filing the grievance to acknowledge receipt, investigate the grievance, and take corrective actions if needed. In addition, the policy stated that the department manager will also notify the person filing the grievance of resolution in a timely manner. The policy also indicated that if the grievance/concern is unable to be resolved satisfactory, the resident/representative will be referred to the facility's Market President for assistance. Review of the resident's May 2024 physician orders indicated that the resident was admitted into the facility from the hospital on May 10, 2024 for rehabilitation services with the following diagnosis: spinal stenosis; right foot drop; rotator cuff tear or rupture of left shoulder, and hypertension (high blood pressure). Review of a nursing note on May 22, 2024, at 2:10 p.m. indicated that the resident was discharged back to her home. Review of a Grievance/ Concern Form submitted by the resident dated May 13, 2024, indicated that Resident R1 reported the following: (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 4 Event ID: 396017 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 396017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Willow Grove Post Acute 3485 Davisville Road Hatboro, PA 19040 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)