Inspection·February 1, 2024

F 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview it was determined the facility failed to complete a discharge summary for one of three residents reviewed. (Resident 50) Findings Include: Review of resident's records revealed a progress note dated [DATE], at 2:36 am, noting the resident discharged to [NAME] Hospital at approximately 1:30 am. Resident noted to have shortness of breath, pulse ox was 56% on room air. Resident was put on O2 @ 5liters via nasal cannula. Pulse ox was up 82%. Resident was lethargic, sweaty and could not respond much when name was called. Blood sugar was 256, vital signs were unstable. Nursing supervisor called on-call doctor and resident was sent out via EMS. POA was made aware before resident was sent out to hospital. Further review of resident's record revealed a progress note dated [DATE], at 7:03 am, noting resident was being admitted to [NAME] Hospital with a diagnosis of pneumonia. It was further noted that Resident 50 never returned to the facility. Resident 50 expired in the hospital on [DATE]. Review of Resident 50's entire clinical record revealed there was no discharge summary completed for Resident 50. Interview with the Director of Nursing on February 1, 2024, at 2:28 p.m. confirmed there was no documentation of medication disposition or documentation that personal belongings were returned to the family upon the discharge of Resident 50. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(2)(3) Management 28 Pa. Code 211.12(c)(d)(3) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396123 If continuation sheet Page 2 of 8 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 396123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Care at Maris Grove 500 Maris Grove Way Glen Mills, PA 19342 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)

F 0678 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of established guidelines for cardiopulmonary resuscitation (CPR), the facility's policies, residents' clinical records, and staff interviews, it was determined that the facility failed to ensure that CPR was provided in accordance with established facility policy and procedure for Resident 207, creating a situation for one of six residents were placed in an Immediate Jeopardy situation related to failure to perform cardiopulmonary resuscitation. Findings include: Review of guidelines from the American Heart Association (AHA), dated 2020, revealed, the AHA urged all potential rescuers to initiate CPR unless a valid Do Not Resuscitate (DNR) order was in place; if there were obvious clinical signs of irreversible death present, including rigor mortis (stiffness of the limbs and body that develops 2 to 4 hours after death and may take up to 12 hours to fully develop), dependent lividity (reddish-blue discoloration of the skin resulting from the gravitational pooling of blood in the lower lying parts of the body in the position of death), decapitation (separation of the head from the body), transection (division by cutting across the body), or decomposition (decay); or if initiating CPR could cause injury or peril to the rescuer. Review of the facility's policy titled Cardiopulmonary Resuscitation (CPR), dated [DATE], stated that in the case of an unwitnessed arrest of a resident who is a FULL CODE, determination of the appropriateness of CPR initiation should be undertaken by the nurse after a resident assessment, validation of Code Status and interventions appropriate to the findings initiated. Further review of the facility policy revealed, the licensed nurse will assess the resident upon discovery of the unresponsiveness. Assessment of death in which CPR would be a futile and inappropriate intervention requires that ALL SEVEN of the following signs be present and that the arrest be unwitnessed: i. Resident is unresponsive. ii. Resident has no respiration. iii. Resident has no pulse. iv. Resident's pupils are fixed and dilated. v. Resident's skin is cold relative to the resident's baseline skin temperature. vi. Resident has generalized cyanosis. vii. There is presence of venous pooling of blood in dependent body parts causing purple discoloration of the skin which does blanch with pressure (liver mortis). Review of Resident 207's clinical record revealed Resident 207 was admitted to the facility on [DATE], with diagnoses including but not limited to Hemiplegia (one-sided paralysis or weakness), Spinal Stenosis (spinal column narrows and compresses the spinal cord) and Parkinson's disease (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396123 If continuation sheet Page 3 of 8 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 396123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Care at Maris Grove 500 Maris Grove Way Glen Mills, PA 19342 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)

F 0678 (progressive disorder that affects the nervous system and the parts of the body controlled by the nerves). Level of Harm - Immediate jeopardy to resident health or safety Review of Resident 207's clinical record revealed, a Pennsylvania Orders for Life-Sustaining Treatment (POLST) dated [DATE], indicating Resident 207's intention to have FULL treatment which includes attempt resuscitation, CPR. The POLST was signed by the physician on [DATE]. Residents Affected - Few Review of Resident 207's clinical record revealed a nursing note by Registered Nurse, Employee E4, dated [DATE], at 6:35 a.m. indicating that upon entering [resident] room, it was clear the resident was expired, [resident] was sitting up in bed 45 degrees with [resident] head turned to the right, there was some brown colored emesis on [resident] right shoulder, [resident] skin was warm but extremely pale. Employee E4 noted employee observed no respiration and there was no pulse. The resident's pupils were fixed and dilated. The nurse was not able to open [resident] mouth because her jaw was rigid, the rest of her body was flaccid. The resident was pronounced at 6:39 a.m. Further review of the nursing note revealed that Employee E4 did not initiate CPR, because she had it in her mind that [resident] was a Code B (on POLST document - DNR - Do Not Resuscitate). Employee E4 indicates that in hindsight she should have confirmed the code status on the chart, initiated CPR and called emergency services per protocol. Review of facility documentation including written statement from non-licensed Employee E5, dated [DATE], at 6:54 a.m. revealed when Employee E5 got too [resident]'s room, [resident], was quiet. Before turning on the light, Employee E5 asked resident if [resident] needed continence care. Resident did not respond. Employee E5 turned on the light and found resident laying with [his/her] head to the side of [his/her] pillow with dark emesis coming out of [his/her] mouth. Employee E5 called out to resident several times but [he/she] did not reply. Employee E5 then ran to get the nurse, Employee E4. Additional review of facility documentation revealed Nurse Aide, Employee E5 documented the last time Employee E5 saw Resident 207 was at approximately 2:50 a.m., when employee provided continence care. Review of facility documentation including written statement by Registered Nurse (RN), Employee E4, dated [DATE], at 5:10 p.m., indicated that he/she was in the hallway starting his/her final rounds when the non-licensed, Employee E5, came running toward him/her in alarm, proclaiming he/she thinks resident is dead. Employee E4 noted he/she followed Employee E5 into the resident's room. Upon entering [resident]'s room, it was clear the resident was expired, [resident] was sitting up in bed 45 degrees with [his/her] head turned to the right, there was some brown colored emesis on [his/her] right shoulder, skin was warm but extremely pale. Employee E4 stated [he/she] observed no respiration and there was no pulse. The resident's pupils were fixed and dilated. The nurse was not able to open resident's mouth because [his/her] jaw was rigid, the rest of the body was flaccid. Additional review of documentation including statement by licensed, Employee E4 documented that he/she did not initiate CPR because she had it in her mind that Resident was a Code B, (on POLST document DNR - Do Not Resuscitate). Employee E4 further indicated, in hindsight he/she should have confirmed the code status on the chart, initiated CPR and called emergency services per protocol. Employee E4 notes [he/she] notified the physician that resident had expired at 6:35 a.m., and then contacted resident's family. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396123 If continuation sheet Page 4 of 8 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 396123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Care at Maris Grove 500 Maris Grove Way Glen Mills, PA 19342 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)

F 0678 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Further review of licensed, Employee E4 witness statement indicated, it wasn't until the Nurse Supervisor Employee 6, came into the room and asked if he/she did CPR, since the resident was a code A, (Cardiopulmonary Resuscitation CPR: person has no pulse and is not breathing), did he/she realize the error. Interview conducted with the Nursing Home Administrator and the Director of Nursing on [DATE], at 10:00 a.m. revealed the administration was aware staff did not perform Cardiopulmonary Resuscitation to Resident 207 in accordance with resident's identified interventions as indicated on POLST, and CPR should have been provided in accordance with the facility's policy. On [DATE], at 3:05 p.m., Immediate Jeopardy was identified and the Nursing Home Administrator and Director of Nursing were informed that the health and safety of residents were in Immediate Jeopardy due to the RN failing to provide CPR in accordance with a resident's POLST and the facility's policy. The facility submitted an action plan on [DATE], at 5:38 p.m. that included the following actions: a full house audit of all resident's charts was performed to ensure accurate code status were in place and in accordance with resident's wishes. Education provided to nursing staff, with successful return demonstration via questionnaire to ensure staff comprehend training and retain information. All staff upon hire will receive advance directive and code status training with successful return demonstration via questionnaire prior to resident contact. Director of Nursing will conduct mock resuscitation drills every shift x1 week for 4 weeks and monthly x3. Trends will be identified and shared with QAPI committee for further review. The Immediate Jeopardy was lifted on [DATE], at 2:32 p.m. when it was confirmed that the facility provided nursing staff with education regarding providing CPR in accordance with residents' advanced directives, and the facility's policy, and completed a Code Blue drill to ensure that licensed nurses were prepared to respond to situations that required CPR. Any remaining staff were scheduled to receive the education prior to the start of their next shift. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1)(3)(e)(1) Management 28 Pa. Code 201.18(e)(3) Management 28 Pa. Code 211.12(c)(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396123 If continuation sheet Page 5 of 8 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 396123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Care at Maris Grove 500 Maris Grove Way Glen Mills, PA 19342 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)

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 Based on clinical records review and staff interview, it was determined that the facility failed to ensure the physician's order regarding blood sugar was followed for one of the 17 residents reviewed (Resident 19). Residents Affected - Few Findings include: A review of Resident 19's diagnosis revealed malignant neoplasm of the connective and soft tissue of the pelvis, and Hypoglycemia (low blood sugar level). A review of the physician order dated December 19, 2023, revealed an order to check Resident 19's blood sugar every four hours when awake. Call a physician if blood sugar is less than 60 or greater than 350. A review of the January 2024, Treatment Record revealed that from January 1, 2024, until January 31. 2024, Resident 19 had a blood sugar below 60 on the following days: January 3, 2024, at 12:00 a.m., 38 mg/dl; January 7, 2024, at 12:00 p.m., 44 mg/dl; January 9, 2024, at 8:00 a.m., 38mg/dl; January 10, 2024, at 4:00 p.m., 44 mg/dl; January 14, 2024, at 8:00 a.m., 38 mg/dl; January 15, 2024, at 8:00 a.m., 55 mg/dl; January 15, 2024, at 12 noon, 48 mg/dl; January 16, 2024, at 8:00 a.m., 36 mg/dl; January 20, 2024, at 8:00 a.m., 36 mg/dl; January 21, 2024, at 12:00 a.m., 44 mg/dl; January 24, 2024, at 8:00 a.m., 56 mg/dl; January 24, 2024, at 4:00 p.m., 35 mg/dl; January 26, 2024, at 4:00 p.m., 36 mg/dl; and January 26, 2024, at 8:00 p.m., 39 mg/dl. The clinical records review failed to reveal that the physician was notified of Resident 19's blood sugar result of below 60 mg/dl on the dates/time mentioned above. An interview with the Director of Nursing on February 2, 2024, at 11:30 a.m., confirmed that the physician was not notified of Resident 19's below 60 mg/dl blood sugar on the dates/time mentioned above. The facility failed to ensure the physician's order to be notified when Resident 19's blood sugar level was below 60 mg/dl ( 14 times) was followed. 28 Pa. Code 211.5(f) Clinical records 28 Pa. Code 211.12(c)(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396123 If continuation sheet Page 6 of 8 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 396123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Care at Maris Grove 500 Maris Grove Way Glen Mills, PA 19342 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)

F 0755 Level of Harm - Minimal harm or potential for actual harm Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on clinical record review and staff interview, it was determined that the facility failed to ensure the pharmacy services provided medications timely for one of the 17 residents reviewed. (Resident 19). Residents Affected - Few Findings include: Review of Resident 19's clinical records revealed the resident with a diagnosis of Hypoglycemia (low blood sugar). Review of Resident 19's physician orders dated January 17, 2023, revealed an order for True plus Glucose 4 gram chewable four tablets every four hours for low blood sugar. Review of Resident 19's January 2024, Medication Administration Record (MAR) revealed Resident19's glucose tablet was not administered on the following day/time: January 18, 2024, at 2:00 a.m.; January 20, 2024, at 2:00 p.m.; January 27, 2024, at 6:00 a.m., and January 27, 2024, at 10:00 a.m. REview of Resident 19's clinical records and administration notes revealed that Resident 19's glucose tablet was not administered to the resident on the above-mentioned dates/time due to awaiting pharmacy delivery of the medication. Interview with the Director of Nursing conducted on February 1, 2024, at 11:00 a.m., confirmed that Resident 19's glucose tablet was not administered due to the unavailability of the medication in the facility, awaiting pharmacy delivery. The facility failed to ensure pharmacy services provided the glucose tablet for Resident 19 which was ordered for the resident 'hypoglycemia. 28 Pa. Code 211.5(f) Clinical records 28 Pa. Code 211.12(c)(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396123 If continuation sheet Page 7 of 8 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 396123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Care at Maris Grove 500 Maris Grove Way Glen Mills, PA 19342 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)

F 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. Level of Harm - Minimal harm or potential for actual harm Based on a review of their job descriptions it was determined that the Continuing Care Administrator (CCA), and the Director of Nursing (DON) did not effectively manage the facility to ensure that CardioPulmonary Resuscitation was provided in accordance with the facility policy and procedures to residents that are a full code. Residents Affected - Some Findings include: Review of the job description for the Continuing Care Administrator (CCA) revealed the essential function is responsible for ensuring compliance with all federal, state, local and facility regulations, and policies. Oversees and audits nursing services to ensure high quality nursing delivery systems. Review of the job description for the Director of Nursing (DON) revealed the responsibility of the job position is to coordinate and implement the comprehensive delivery of nursing services to all Continuing Care residents (skilled nursing, long term care, assisted living and memory care) according to Erickson's Person-Centered Approach care model and standards, professionally recognized nursing practices and local, state, and federal regulations. The findings in this report identified that the facility failed to ensure that CPR (CardioPulmonary Resuscitation) was provided in accordance with the facility policy and procedures to residents that are a full code (life sustaining interventions). The CCA and DON failed to fulfill their essential job duties that the federal and state guidelines and regulations were followed. Refer to F678 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 201.18(b)(3) Management 28 Pa. Code 201.18(e)(1) Management 28 Pa. Code 207.2(a) Administrator's Responsibility 28 Pa. Code 211.12(d)(1)(5) Nursing Services 28 Pa. Code 211.12(d)(2)(3) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396123 If continuation sheet Page 8 of 8