Inspection·August 30, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on review of facility policy, observations and staff interviews it was determined that the facility failed to treat resident with dignity and respect during the lunch meal for three out of 6 residents ( R8, R9, and R13). Finding include: Review of facility policy labeled Feeding Policy, dated January 2023, outlined the procedure for feeding a resident stating, 20. If the resident must be fed, make yourself comfortable. Sit infront of the resident . Maintain eye contact. Observations on August 28, 2023, at 12:10 p.m. revealed registered employee E3, standing at a back table with residents R8, R9, and R10 seated around the end of the table. Registered Nurse, Employee E3 stood in between residents R9 and R13, feeding a small bite to R9 and then to R13, moved the chair out of the way and fed R8, conducted while in a standing position. This continued throughout the meal moving from one resident to the next without sitting down. Observations on August 29, 2023, at 12:10 p.m. revealed Registered Nurse, Employee E3, standing at a back table while feeding the residents in the same manner as observed on August 28, 2023. Interviews with the Nursing Home Administrator and the Director of Nursing on August 30, 2023 at 11:15 a.m. confirmed that the staff should sit to feed the residents. The facility failed to treat the residents with dignity and respect during the lunch meal for residents R8, R9, and R13. 28 Pa Code: 201.29(j) Resident's rights 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: 396090 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 396090 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Preston Residence 200 Sycamore Drive West Grove, PA 19390 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)