Willow Grove Post Acute

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

review of facility provided documentation, it was determined that the facility failed to address residents' concerns related to late call bell response time three of six residents reviewed. (Resident Resident R3, Resident R4, Resident R5) Findings include:During interview with Resident Resident R3, on Monday, December 1, 2025 at 11:10 am, room [ROOM NUMBER]-A, he reported waiting excessively long time for response from nursing staff during overnight shifts, 11 pm to 7 am.Review of facility provided grievance reports for month of November 2025 revealed care concern was submitted on November 2, 2025 regarding Resident Resident R4, and untimely hygiene care; unidentified shift.Further review of grievance reports revealed care concern was submitted on November 2, 2025, regarding Resident Resident R5 and call bell response time; unidentified shift.Further review of facility report submitted to the State Survey Agency, dated November 18, 2025, revealed Resident Resident R5's concern related to waiting long periods for care, and not cleaned properly after being soiled; unidentified shift.Review of facility provided call bell audits for month of November 2025 revealed that audits were mainly completed during day and evening shifts, unidentified times, and excluding room #'s from which concerns were reported.Further review of call bell audits, dated November 22, 2025, revealed unidentified shift and time, noting one hour wait time for call bell response from 2:30 pm to 3:30 pm. 28 PA Code 201.18(b)(3) Management

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

Event ID:

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/01/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Willow Grove Post Acute

3485 Davisville Road Hatboro, PA 19040

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 0919

Make sure that a working call system is available in each resident's bathroom and bathing area.

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 provided documentation, interview with residents and observations, it was determined that facility did not ensure that call bells were properly functioning for one of six residents reviewed. (Resident Resident R2) Findings include: Review of facility current policy ‘Answering the Call Light,' indicates that purpose of

this procedure is to ensure timely responses to the resident's requests and needs.Further review of policy indicates that staff are to ensure that the call light is plugged in and functioning at all times, and report all defective call lights promptly.During interview with Resident Resident R2 on Monday, December 1, 2025 at 11:30 am, room [ROOM NUMBER]-B, the resident reported that his call bell had not function for a while and did not bother reporting it since (his/her) other concerns were unaddressed as well.Further observation of Resident Resident R2's environment revealed non-functioning call bell system. 28 Pa Code 211.12(d)(1)(5) Nursing services

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet