Health inspection·January 23, 2024

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 observation and staff interview, it was determined that the facility failed to provide a clean, comfortable, homelike environment, and maintain resident care equipment, on three of four units of the facility. Findings include: Observations conducted during an environmental tour of the facility on January 23, 2024, at 11:30 a.m., included the following: Room G4 - the toilet, sink, floor, and mirror appeared cloudy and unknown residue. Further observation revelaed a soiled plastic glove on the floor behind the trash can. Obseration of area also revealed the absence of a trashcan liner to contain waste materials. The sink fixture indicated signs of corrosion and there was a broken tile on floor. Room G5 - the toilet, sink, floor, and mirror appeared dirty with residue and the sink fixture showed signs of corrosion. Room G4 - Observation of the floor and walls revealed areas of residue of unknown substances. Room G12 - Observation of the room revealed a prevalent smell of urine throughout the room. The bathroom toilet was observed with stains and resident as well as a broken floor tile noted in the area. The sink fixture indicated signs of corrosion. room [ROOM NUMBER] - Observations conducted of the room's toilet, sink, floor, and mirror revealed an unknown residue. room [ROOM NUMBER] - Observations revealed the toilet, sink, floor, and mirror noted to have unknown residue. Further observation revealed a mousetrap placed under the sink. room [ROOM NUMBER] - Observations of the room failed to reveal a trashcan liner. The toilet, sink, floor, and mirror appeared to have an unknown residue. The sink indicated signs of corrosion. room [ROOM NUMBER] - observation of the room revealed a light bulb was malfunctioning. The toilet was stained and soiled. Additiona observation revealed the room's trashcan did not have a liner. Further observation revealed a mouse trap in the room. Interview conducted with the resident occupant revealed the resident cleans the bathroom most times without assistance from staff. Page 1 of 2 396083 396083 01/23/2024 Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some room [ROOM NUMBER] - Observations revelaed the toilet and floor had unknown substance/residue. The sink fixture indicated signs of corrosion. There was a large brown stain on the ceiling tile above resident's bed. room [ROOM NUMBER] - Observations of the room revealed; the floor and toilet had an unknown substance and residue. The bathroom ceiling tiles were noted to have brown stains. Further observation failed to reveal a trashcan liner in the trashcan. The sink indicated signs of corrosion. room [ROOM NUMBER] -Observations of the room revealed a brown stain on a ceiling tile. The bathroom floor, toilet, sink, and mirror were noted to have residue of unknown substance and the trashcan did not have a liner to contain waste materials. room [ROOM NUMBER] - Observations revealed multiple stained areas on ceiling tile in room above resident's head. room [ROOM NUMBER] -Observations revealed the bathroom floor, toilet, sink, and mirror had unknown substances noted on them Observations conducted of the Ground floor shower room revealed a mattress in room. The sink and shower chair were noted to have unknown substances. The toilet was not easily accessible for staff or residents as it was blocked by a shower bed. Additional observation revealed used/soiled towels on the floor Observations of the First floor shower room revealed used/soiled towels on the floor. Additional observations noted a black substance on shower curtain. The toilet, sink, and shower chair appeared soiled with unknown substance. Further observations of the First floor shower room revealed a cup, box of gloves, wheelchair legs, adult incontinence product, shirt, and a wash basin lying on the shower bed. Observations of the Third floor shower room revealed the shower wall, shower seat, toilet and sink were not soiled with an unknown substance. The trashcan did not have a liner to contain waste materials. Additional observation conducted in the Third Floor shower room revealed unknown brown stains on shower curtains. Interview conducted on January 23, 2024, at 2:45 p.m., with the Nursing Home Administrator and the Director of Nursing, when the above information was presented nd all of the environmental observations were discussed. 28 Pa Code 207.2(a) Administrator's Responsibility 396083 Page 2 of 2