F 0558
Reasonably accommodate the needs and preferences of each resident.
Level of Harm - Minimal harm
or potential for actual harm
Based on observations, and interview with staff and residents, it was determined that facility failed to
ensure that resident were assisted out of bed as per resident's preference for nine of 69 residents observed
(Resident R10, R11, R12, R13, R14, R15, R16, R17, R18)
Residents Affected - Some
Findings include:
Review of facility policy 'Quality of Care: Activities of Daily Living - Prevent Deterioration,' indicates that
based on the comprehensive assessment of a resident, the facility must ensure that a resident's abilities in
activities of daily living do not diminish unless circumstances of the individual's clinical condition
demonstrate that diminution was unavoidable.
Interview with licensed nurse, employee E4, on April 9, 2025 at 10:50 am, revealed that residents are to be
assisted out of bed by 11:00 am.
Interview with Resident R11, on April 9, 2025, at 11:15 am, revealed that he is paralyzed on right side of
body and requires assistance with transfer from bed to chair. Interview with Resident R11 revealed that the
resident prefers to be placed in wheelchair during day shift (7-3 shift).
Further observations of residents on unit 2-West, revealed Residents R10, R11, R12, R13, R14, R15, R16,
R17, and R18 in beds at 11:15 am.
28 Pa. Code 211.10(d) 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:
396076
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
396076
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/09/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Monumentalpostacutecare at Woodside Park
4001 Ford Road
Philadelphia, PA 19131
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)
F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
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
observations and interview with residents, it was determined that facility did not provide a clean,
comfortable, homelike environment for four of 20 rooms observed (common shower room, Resident R8's
room, room#225-B, room [ROOM NUMBER]-A)
Findings include:
Review of facility policy related to 'Physical environment: common areas,' states that the facility will be
maintained to protect the health and safety of residents, personnel and the public.
Observations of common shower room on unit 2-West, on April 9, 2025, at 10:30 am, revealed used towels
on floor and used paper towels on floor in toilet stall. Further observations revealed shower gel/shampoo
bottles on floor in shower stall. Further observations revealed used hygiene products on shower bed;
shower bed appeared unclean. Findings confirmed with facility's director of nursing.
Observations in room [ROOM NUMBER] revealed stained ceiling tile near bed B; upon interview with
resident R7 it was revealed that during rainy weather water leaks through the ceiling tile, down the wall and
from the bottom of HVAC. A towel was observed under HVAC (air conditioning system).
Further observations on 2-West unit revealed Resident R8, sitting on bed stained with feces, urine-soaked
linen on top of bed, foul odor noted and trash laying on the floor. Resident R8 was attempting to pick up
soiled brief from floor.
Further observations on unit 2-West, room#228, bed A, revealed used urinal attached to trash bin, briefs on
floor, washbasin on floor, used washcloth on bedside table, toilet paper on bedside table.
Review of facility provided grievance reports revealed a concern reported by resident's family member on
March 4, 2025, which states the following : On Sunday, March 2, 2025, I came into my mom's room at
10:30 am. There were used latex gloves on the dresser, used tissues on the floor, a wet washcloth laying on
the side of the bed. I cleaned the room. Today (March 4, 2025) I come in her room and her dentures are
sitting on the edge of the bedside table and could have easily broken. I would like the aides to clean up
after themselves and not leave discarded supplies lying around the room. Also, when not in her mouth,
please put her dentures in the blue cup provided.
28 Pa Code 201.18(b)(1)(3) Management
28 Pa Code 205.63(b) Plumbing and piping systems required for existing and new construction.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396076
If continuation sheet
Page 2 of 2
