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. (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 2 Event ID: 396083 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 396083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063 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)