Health inspection·December 15, 2023

F 0572 Give residents a notice of rights, rules, services and charges. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility residents record, review of facility documentation, and interviews with staff, it was determined that the facility failed to inform residents of their rights, rules, regulations, and responsibilities prior to and/or upon the resident's admission for nine out of 34 residents reviewed. (R1, R2, R6, R7, R10, R18, R35, R36, R37) Residents Affected - Some Findings Include: Review of facility documentation given to residents titled, Your Rights and Protections as a Nursing Home Resident undated revealed What are my rights in a nursing home? As a nursing home resident, you have certain rights and protections under Federal and state law that help ensure you get the care and services you need. You have the right to be informed, make your own decisions, and have your personal information kept private. The nursing home must tell you about these rights and explain them in writing in a language you understand. They must explain in writing how you should act and what you're responsible for while you're in a the nursing home. This must be done before or at the time you're admitted , as well as during your stay. You must acknowledge in writing that you got this information. Review of Residents R1, R2, R6, R7, R10, R18, R35, R36, R37's clinical records revealed no documented evidence that the resident rights and resident conduct and responsibilities were reviewed during the residents' stay as follows: Review of thirty-four resident records revealed one out of thirty-four did not have resident rights reviewed upon admission. (R1) Review of Resident R1's clinical record revealed that the resident was admitted on [DATE]. There was no documented evidence that the resident rights not reviewed until December 14, 2023 with Resident R1's wife. Review of Resident R36's clinical record revealed an admission date of June 24, 2018. There was no documented evidence that the resident rights were reviewed again with the resident until December 14, 2023. Review of Resident R10's clinical record revealed an admission date of November 18, 2021. There was no document evidence that the resident rights were reviewed again with the resident until December 14, 2023. Review of Reisdent R37's clinical record revealed an admission date of October 14, 2020. There was Page 1 of 8 396107 396107 12/15/2023 Ann's Choice 16000 Ann's Choice Way Warminster, PA 18974

F 0572 Level of Harm - Minimal harm or potential for actual harm no document evidence that the resident rights were reviewed again with the resident until December 14, 2023. Review of Resident R2's clinicial record revealed an admission date of December 14, 2021. There was no document evidence that the resident rights were reviewed again with the resident until December 14, 2023. Residents Affected - Some Review of Resident R7's clinicial record revealed an admission date of June 9, 2021. There was no document evidence that the resident rights were reviewed again with the resident until December 14, 2023. Review of Resident R18's clinicial record revealed an admission date of February 28, 2020. There was no document evidence that the resident rights were reviewed again with the resident until December 14, 2023. Review of Resident R35's clinicial record revealed an admission date of May 10, 2019. There was no document evidence that the resident rights were reviewed again with the resident until December 14, 2023. Review of Resident R6's clinicial record revealed an admission date of February 28, 2020. There was no document evidence that the resident rights were reviewed again with the resident until December 14, 2023. Review of resident council minutes from the last six months (June, July, August, September, October, November) show no resident rights reviewed during resident council. On December 15, 2023 at 10:10 a.m. an interview was held with Nursing Home Administrator, Employee E1 confirmed that the resident rights have not been being reviewed periodically with residents during their stay. 28 Pa. Code 201.29 (e) Resident rights 396107 Page 2 of 8 396107 12/15/2023 Ann's Choice 16000 Ann's Choice Way Warminster, PA 18974

F 0584 Level of Harm - Minimal harm or potential for actual harm 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. Based on observation, and interviews with staff, it was determined that the facility failed to ensure that enterl feeding equipment was maintin clean for one of one resident observed. (Resident R57) Residents Affected - Few Findings include: Observation conducted on December 12, 2023, at 9:40 a.m. of Resident R57's room revealed that there was a feeding tube stand close to the resident's bed. The base of the feeding tube stand and the floor surrounding the base of the feeding tube-stand, were covered with hardened thick brownish liquid spill. Interview conducted on December 12, 2023, at 9:44 a.m., with Licensed Nurse, Employee E14, confirmed the above findings. 28 Pa.Code 201.14 Responsibility of licensee 396107 Page 3 of 8 396107 12/15/2023 Ann's Choice 16000 Ann's Choice Way Warminster, PA 18974

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. Based on review of facility policy, interviews with residents and staff, and observation, it was determined that the facility did not allow the ability to form anonymous grievances for all residents on two of two nursing units. (1st and 2nd floor) Findings Include: Review of facility policy titled Grievance/Concern Investigations and Resolutions- CC with a version date of July 2023 stated, Continuing Care (CC) resident have the right to voice grievances to either the facility or other entities/agencies that hears grievances without fear of discrimination or reprisal. Grievances may be filed orally or in writing and can be filed anonymously. The facility will acknowledge the grievance and actively work towards prompt resolution with an investigation completed within 30 days or sooner in accordance with state regulations. During a group interview conducted on December 13, 2023 at 10:00 a.m. with five alert and oriented residents (Residents R27, R5, R13, R57, R217) the residents stated that they were unaware of how to file a grievance with the facility anonymously. Interview held with Director of Social Services, Employee E8 on December 12, 2023 at 10:42 a.m. revealed that the facility did not have grievance forms readily accessible to resident without having to ask. When asked where the residents are able to access forms Social Services Director Employee E8 stated that residents have the ability to ask for the grievance forms from the front desk, the social worker, or nurse manager. Interview held with front desk receptionist, Employee E18 and she was unaware of where the grievance forms were located. After looking through her desk drawer she stated she did not have any. Observation of two units (first and second floor) and the main lobby area revealed no area with grievance forms or a grievance box visible and available to residents to access. 28 Pa. Code 201.29 (b) Resident rights 396107 Page 4 of 8 396107 12/15/2023 Ann's Choice 16000 Ann's Choice Way Warminster, PA 18974

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observations, and interviews with residents and staff, it was determined that the facility failed to ensure that adequate personal hygiene and grooming was maintain related to nail care for one out of 24 residents reviewed (Resident R4). Residents Affected - Few Findings include: A review of Resident R4's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses to include Displaced Spiral Fracture Shaft of Right Femur (The femur is the thigh bone), Multiple Fracture of Ribs, and Parkinson's Disease (A disorder of the central nervous system that affects movement, often including tremors). Review of Resident R4's admission Minimal Data Set (MDS- assessment of resident care needs) dated December 5, 2023 revealed that the resident was assessed as cognitively intact and required substantial/ maximum assist with personal hygiene. Observation of Resident R4 on December 12, 2023, at 10:09 a.m., revealed the Resident R4 had long, jagged fingernails with dark substance under the fingernails. Resident R4 communicated during interviewe at the time of the observation that no staff had offered to trim her nails. Interview with Licensed nurse, Employee E14, on December 12, 2023 at 10:15 a.m. confirmed that the resident's nails needed to be trim. 28 Pa Code:201.29(j) Resident rights. 28 Pa Code: 211.11(d)(1)(5) Nursing services. 396107 Page 5 of 8 396107 12/15/2023 Ann's Choice 16000 Ann's Choice Way Warminster, PA 18974

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, reviews of resident clinical records, review of mediication documentation and interviews with staff, it was determined that the facility failed to follow physician orders for one out of three residents' medication administration reviewed. (Resident R9) Residents Affected - Few Findings include: Review of literature, published in the National Library of Medicine(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3236147) revealed; chewable tablets are quickly broken down in the mouth before swallowing, the chewable aspirin formulation achieved the most rapid rate of absorption. Delayed Release (DR) medications are medications that are designed to release the active ingredient(s) later after taking it, which can help control where it is released in the body (e.g., small intestines). Many people at risk for heart disease take daily low-dose aspirin to help prevent blood clots. Since Delayed Release Aspirin has to wait until it gets to the small intestines to be absorbed into the bloodstream, its effects can take longer than regular aspirin, which is quickly absorbed in the stomach. Review of Resident R9's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnosis including Type 2 Diabetes Mellitus (A chronic condition that affects the way the body processes blood sugar (glucose; with Type 2 Diabetes, the body either doesn't produce enough insulin, or it resists insulin), and Long-Term Use of Aspirin (Aspirin also lowers the risk of heart attack, stroke or blood clot). Review of physician order dated May 12, 2023, for Resident R9, revealed an order for Aspirin 81 milligrams, delayed release, by mouth, daily. Observation conducted on December 13, 2023, at 9:11a.m., during medication administration to Resident R9, it was observed that a Licensed Nurse, Employee E19, administered Aspirin chewable tablet 81 milligrams to Resident R9 and not delayed release as ordered by the physician. Interview with Licensed nurse, Employee E19, at the time of the findings confirmed these observation. 28 Pa. Code 211.10(c) Resident care policies 28 Pa. Code 211.12(d)(1) Nursing services 396107 Page 6 of 8 396107 12/15/2023 Ann's Choice 16000 Ann's Choice Way Warminster, PA 18974

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations and interviews with staff, it was determined that the facility did not ensure that food was stored, prepared, distributed and served in accordance with professional standards for food service safety. Findings include: A tour of the Food Service Department was conducted on December 12, 2023, at 6:30 a.m. with Employee E11, morning cook, revealed the following concerns: Observations in the walk-in cooler revealed trash on the floor and under the shelving units including onion skins, celery, lemon wedges, paper and an accumulation of dust and dirt. Observations in the hot production area revealed a convection oven with dark burned on food spatters on the inside of the glass doors. Observation and interview held with Dietary aide, Employee E7 on December 12, 2023 at 9:54 am. during the interview there was observation made of the nourishment refrigerator which appeared to be dirty in the refrigerator side. The inside of the refrigerator and freezer did not have a thermometer. The refrigerator had Caesar salad labeled with a date of December 16, 2023 todays and a use by date of December 16, 2023. When asked Employee E7 stated that it was brought in today and it was labeled incorrectly. Further observation into the kitchenette on the second floor revealed more concerns regarding food storage. In the kitchenette refrigerator there was a pack of seven hot dogs with a today's date label on November 28, 2023. There was no use by date on the label. When asked Dietary aide, Employee E7 stated that the hot dogs would usually be kept a couple of days. Inside the kitchenette fridge was an opened container of prune juice with a today's date opened August 3, 2023. When asked how long opened prune juice would be kept, Dietary aide, Employee E7 stated that juice would be kept for three days. Observation of the kitchenette freezer revealed a Ziploc bag of frozen hamburgers with no label (no today's date and no use by date). There were two paper cups of ice cream covered in plastic wrap were also found in the freezer unlabeled. Two ceramic dish cups of ice cream were found uncovered and unlabeled exposed to freezer burn in the freezer. Further review of the second-floor kitchenette revealed grape jelly not refrigerated with a date of November 24, 2023. The container did not have a label with today's date and a use by date. Peanut butter was also found with a date of October 17, 2023. The container did not have a label with today's date and a use by date. Tour and observation was made on the first floor kitchenette on December 12, 2023 at 10:28 am with dietary aide Employee E10. Observation of the first floor kitchenette revealed inside the kitchenette refrigerator there was grape jelly with a date of November 24, 2023. The jelly did not have a label with a today's date and use by date. There was cinnamon butter with today's date label November 396107 Page 7 of 8 396107 12/15/2023 Ann's Choice 16000 Ann's Choice Way Warminster, PA 18974

F 0812 25, 2023 and a use by date of November 28, 2023. Level of Harm - Minimal harm or potential for actual harm Horseradish with today's date label November 8, 2023 and a use by date of December 8, 2023. Residents Affected - Some Hot dogs were found in the freezer with today's October 10, 2023 and no use by date. When asked how long they store hot dogs for Employee E10 stated, we would keep them about a week. Observations during a follow-up visit to the kitchen with the Dining Services General Manager (DSGM), Employee E26, on December 14, 2023, at 11:45 a.m. revealed open boxes of omelets and meatballs with the inner plastic bag open to the circulating air in the walk-in freezer. Further observations in the second-floor food pantry and serving area revealed a reach-in cooler with a build of food particles and dirt around the door frame and splashed on the back wall behind the drop in food pans. Interview with the DSGM on December 14, 2023, at 12:10 p.m. confirmed the above findings. 28 Pa. Code 201.14(a) Responsibility of licensee 396107 Page 8 of 8