Inspection·February 28, 2025

F 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to make certain that the necessary resident information was communicated to the physician before the resident was discharged against medical advice (AMA) for one of one resident reviewed. (Residents R1). Findings include: Review of Resident R1's clinical record revealed the resident was admitted on [DATE], with the diagnoses of fracture of right lower leg, Parkinson's disease (movement disorder of the nervous system), dysphagia (difficulty swallowing), type 2 diabetes (failure of the body to produce insulin), and lack of coordination,. Review of Resident R1's Minimum Data Set (MDS - a periodic assessment of care needs) dated, November 16, 2024, revealed a Brief Interview for Mental Status (BIMS) of 15 which indicated that the resident was cognitively intact. On January 27, 2025, at 9:02 a.m., an interview was held with the Administrator, Employee E1, and the Director of Nursing, Employee E2, who reported that Resident R1 was discharged with AMA (Against Medical Advice) status as the family did not cooperate in receiving transfer training to safely take the resident to a funeral. The interdisciplinary team (IDT), did not agree with Resident R1 leaving the facility without the family being trained to safely transfer the resident. On January 27, 2025, at 10:42 a.m., a telephone interview was conducted with the physician (Employee E7). Employee E7 revealed that he/she was unaware of the AMA status or the family's non-compliance. Employee E7 received a message on January 16, 2025, requesting a call back before 10:00 a.m. regarding Resident R1. However, by the time the physician, Employee E7 returned the call, Resident R1 had already left the facility. Employee E7 stated during interview that if he/she had been informed, it would have been recommended that the facility document the family's refusal rather than having the resident sign for an Against Medical Advice (AMA) discharge. On January 27, 2025, at 11:14 a.m., an interview was conducted with the Rehabilitation Director (Employee E6). Employee E6 revealed that on January 14, 2025, the family requested that Resident R1 attend a family funeral. Two male family members were designated to assist the resident with transfers, as the resident is unable to ambulate independently. Employee E6 reported that Resident R1 required one-person assistance with minimal support for transfers. The family was offered training the following day to ensure a safe transfer; however, the family declined, as the two family members were out of state and unavailable to attend the training. (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: 396078 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 396078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Horsham Center for Jewish Life 1425 Horsham Road North Wales, PA 19454 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)