Health inspection·December 9, 2024

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 review of clinical record and review of facility provided documentation, and interview with staff, it was determined facility failed to ensure complete documentation related to treatment administration for one of three clinical records reviewed. (Resident R1) Findings include: Review of faciltiy's policy 'Treatments,' revised on 06/01/2021, indicates that a licensed nurse or medical technician will perform treatment as ordered, and document administration on 'Treatment Administration Record' (TAR), patient's response, patient's refusal of treatment, and notification of physician. Review of Resident R1's clinical record revealed a physician order obtained on July 11, 2024 for Hydrocortisone External Cream 2% to be applied to upper chest and back topically two times a day for rash with start date of 07/11/2024 at 11:00 PM and discontinued date of 07/18/2024 at 10:18 AM. Review of Resident R1's TAR revealed no documented evidence of the administration of Hydrocortisone cream on July 12, 2024 morning and evening shift, July 13, 2024 evening shift, July 14, 2024 evening shift, July 16, 2024 evening shift, July 17, 2024 evening shift. Further review of Resident R1's clinical record revealed no evidence of documentation of Resident R1's refusal of treatment or any other reason for why treatment was not completed on dates mentioned above. 28 Pa. Code 211.10(c) Resident care policies 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 2 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 12/09/2024 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)