Inspection·August 15, 2025

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 clinical record, facility documentation, and interviews with staff, it was determined that the facility failed to ensure that residents/resident representatives were provided facility rules in writing related to private companions unable to provide direct care for residents while in the facility, one of two resident reviewed for falls (Resident R6). Findings incldue: Review of facility policy Resident Rights, dated 2023, revealed the facility will promote and protect the rights of each resident and places a strong emphasis on individual dignity and self-determination. A written description of a Resident's Rights will be provided to the resident upon admission to the facility and upon request. The facility will adhere to state and federal regulatory requirements pertaining to Resident Rights. Review of clinical record revealed Resident R6 was admitted to the facility on [DATE], with a diagnosis that included dementia (the loss of cognitive functioning that interferes with daily life), hypertension (high blood pressure), and atrial fibrillation (abnormal heart rhythm). Review of Resident R6's clinical record revealed on April 12, 2025, Resident R6 had a fall in his/her room. Review of Resident R6's incident report revealed on April 12, 2025 Resident had a private 1:1 Aide in room to sit with resident 7a-7p; this aide walked outside the resident's room to ask the nurse to help pull the resident up, (thinking the resident needed pulled up to his bed). The nurse entered the room and found the resident laying on the floor matt to the right side of his bed and his head resting on his wheelchair wheel. The 1:1 Aide stated that she was transferring the resident from bed to wheelchair and then she lowered the resident softly to the floor. Further review of Resident R6's incident report revealed The 1:1 aide stated she transferred the resident earlier in the day without any trouble. The nurse told the 1:1 aide that the resident has dementia and needs a 2 person transfer. Interview on August 14, 2025, at 10:30 a.m. with Employee E2, Director of Nursing, confirmed the facility provides verbal information regarding private aides not being allowed to directly care for resident in the facility to residents/resident representatives, but does not provide the information in written format. 28 Pa. Code 201.29 (e) Resident rights Residents Affected - Few 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: 396107 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 396107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ann's Choice 16000 Ann's Choice Way Warminster, PA 18974 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)