Inspection·March 1, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record reviews, interviews with staff, facility documentation, policy and procedure reviews and interviews with family members, it was determined that the facility failed to notify the resident's representative of a need to alter treatment significantly and failed to notify the resident's physician of an accident requiring physician intervention for two of 23 residents reviewed. (Residents R96 and R97) Findings include: A review of the facility policy titled Notification of Changes revealed that it was the responsibility of the facility to immediately inform each resident and/or resident representative of accidents that have the potential for physician intervention or significant changes in condition. The policy also indicated that it was the facility's responsibility to ensure that the physician was immediately notified of an accident that had the potential for requiring physician intervention. The policy said that the physician was to be notified immediately of a significant change in physical, mental and psychosocial status of the resident. Clinical record review for Resident R96 revealed that this resident was admitted to the facility on [DATE]. The nursing progress note indicated that Resident R96 had poor cognitive status. The nurse indicated that the resident's diagnosis upon admisssion was CVA (cerebral vasculer accident) with right sisded weakness and aphasia (a loss or impairment of one's capacity to use or comprehend language, which is most commonly caused by injury to a specific area in the brain). Clinical record review on February 13, 2024 indicated that Resident R96 received testing for the virus that causes COVID-19 and the test results were positive. The nursing progress note on February 13, 2024 indicated that interventions were significantly changed for Resident R96 to include taking transmission based precaustions when providing care or visiting this resident. The nursing progress note dated February 15, 2024 indicated that Resident R96 had a persistent cough. Interview with Resident R96's responsible party/family member at 1:00 p.m., on February 27, 2024, revealed that the family member was not notified of the need to alter Resident R96's treatment and care due to the fact that Resident R96 was diagnosed as being positive for the virus that causes COVID-19 on February 13, 2024. The family member reported visiting the facility on February 14, 2024 and having to ask nursing staff, the medical status of Resident R96. Interview with Employee E2, the Director of Nursing, at 9:00 on February 28, 2024 confirmed that the facility had no documentation to indicate that the responsible party for Resident R96 was notified of a significant change (postive results for COVID-19 testing) or change in medical status on (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 8 Event ID: 396120 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 396120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wyncote Care Center 208 Fernbrook Avenue Wyncote, PA 19095 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)