Hopkins Center

F-F689

28 Pa. Code 201.18(e)(1) Management

28 Pa Code 211.10(d) Resident care policies

28 Pa. Code 211.12 (c)(d)(1) Nursing Services

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 4 of 13 395342 Department of Health & Human Services Printed: 09/04/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 395342 B. Wing 03/13/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hopkins Center 8100 Washington Lane 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)

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 48347 Residents Affected - Few Based on the review of facility documentation, clinical records, hospital records, and interviews with resident and staff, it was determined the facility failed to provide appropriate staff supervision and failed to complete a thorough assessment of the resident environment for Resident Resident R75 with a diagnosis of alcohol dependency.

This failure resulted in actual harm to Resident Resident R75 who was found with symptoms of intoxication, transferred to the hospital, diagnosed with alcohol intoxication with a blood alcohol level of 276 mg/dL and required intravenous therapy for one of 38 residents reviewed. (Resident Resident R75)

Findings include:

Review of Resident Resident R75's clinical record revealed the resident was admitted to the facility on [DATE REDACTED], with diagnoses of alcohol dependence, Bipolar Disorder (condition in which a person has periods of depression, and periods of being extremely happy), history of transient ischemic attack (stroke), alcohol cirrhosis of liver (severe scaring of the liver), generalized anxiety disorder, and difficulty walking.

Review of Resident Resident R75's Minimum Data Set assessment (MDS- assessment of resident care needs) dated August 5, 2024, revealed the resident had a BIMS (Brief Interview of Mental Status) score of 15, indicating

the resident was cognitively intact. Continued review of the MDS revealed that the resident had no upper or lower extremities impairment and was independent with ambulation.

Review of Resident Resident R75's nursing notes dated September 17, 2024, (late entry 5:46 p.m.) revealed the resident was found to have a small water bottle with clear liquid in the bottom that smelled of alcohol. The resident did say (she/he) was drinking. (She/he) refused to say how (resident) obtained the alcohol. (Resident) stated everyone here was buying it. [Resident Resident R75] was hitting elevator, slurring (his/her) speech order to send to ED (emergency room ) or evaluation was obtained however [Resident Resident R75] refused to go with ambulance. (Resident) refused to allow NHA (Nursing Home Administrator) and DON (Director of Nursing) ro (sic) search (resident) room. MD (physician) was made aware and nursing. Plan of care ongoing.

Review of Resident's Resident R75's clinical record revealed that there was not evidence that a care plan was developed related to the resident's diagnosis of alcohol dependency and/or following the incident on September 17, 2024 in which the resident admitted obtaining and drinking alcohol.

Review of nursing note dated October 2, 2024, at 9:00 a.m. revealed the resident met with the administrator team to address a drinking incident that occurred over the weekend. During the meeting, the team discussed

the situation in detail, reviewed the impact of the incident and provided the resident with a formal 30-day notice of discharge.

Review of Social Service documentation dated October 2, 2024, revealed that Resident Resident R75 had a drinking incident that occurred over the weekend (9/29-9/30, 2024). A 30-day discharge notice was issued to the resident due to endangerment of resident safety related to multiple occasions where resident was found to be visibly intoxicated with verbal aggression towards others.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 5 of 13 395342 Department of Health & Human Services Printed: 09/04/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 395342 B. Wing 03/13/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hopkins Center 8100 Washington Lane 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)

F 0689 Review of Resident Resident R75's nursing notes from September 2024 through October 2024 revealed no documented evidence of verbal aggression toward other residents related to the use of alcohol. Level of Harm - Actual harm

Review of Resident Resident R75's nursing notes dated October 3, 2024, at 3:19 p.m. revealed Resident had Residents Affected - Few screamed out in (her/his) room that (resident) stung by a bee .Patient was slurring (her/his) words and tipsy sitting up in bed. Resident went to bathroom and was tipsy walking to the bathroom. Nursing seen a water bottle hidden under a pillow in (resident) room. When UM (Unit Manager) opened the bottle to smell, you could smell liquor in bottle resident grabbed it from my hand and stated that is non of your business leave it alone. Patient than began to state (she/he) needs benadryl bc (because) (she/he) is allergic . [Physician] called an notified of above and gave verbal order to sent resident out to hospital . Prior to resident leaving (she/he) agreed to a room search and 3 more empty water bottles were found smelling of vodka, and empty mouth wash were also found.

Review of facility documentation submitted to the State survey agency dated October 3, 2024, revealed that Resident Resident R75 was observed by staff on 10/3/24, slurring (her/his) speech, arguing aggressively with staff and other residents. [Her/his] behavior appeared impaired. [Resident] refused to allow search of [her/his] room and belongings. [Resident] did state that someone from the kitchen brings in the alcohol. [She/he] refused to mention the name of the staff member. A facility investigation was conducted which included interview with Resident Resident R75, other residents and all dietary staff and in-house staff. The resident refused room searches. Resident Resident R75 does not receive any visitors but frequently orders from an online store and online meal service. The investigation was inconclusive of how resident received alcohol.

Review of hospital discharged records dated October 4, 2024, revealed the resident primary diagnosis of alcohol intoxication. The resident's blood alcohol (BAC) level 276 (BAC as mg/dL: for every 100 milliliters (or 1 deciliter) of blood, there are 200 milligrams of alcohol) at admission. Patient received IV (intravenous fluids).

Review of www.consumershield.com/articles/blood-alcohol-level-chart A revealed, a blood alcohol consumption level of 0.40%+ is typically lethal, while 0.25%-0.39% can cause coma or death. Severe alcohol poisoning at these levels may shut down vital functions.

Review of Resident Resident R75's care plan revealed, a care plan for substance abuse/ alcohol dependence was not developed until October 6, 2024.

Interview with Nursing Home Administrator (NHA), Employee E1 and Director of Nursing, Employee E2 on March 12, 2025, at 1:35 p.m. confirmed there were no reported incidents or investigation relating to September 17, 2024, and during the weekend of October 2, 2024, that pertained to Resident Resident R75 being observed intoxicated.

Interview with Resident Resident R75 on March 11, 2025, at 10:15 a.m. revealed the resident was aware of the thirty-day discharge notice and that she/he has been working with social work and care provider to aid in this transition. [She/he] looking forward to moving on with [her/his] life and eager to leave the facility.

Interview with Resident Resident R75 on March 13, 2025, at 9:05 a.m. revealed that she/he has had no problems with

the administration and or any rules/ regulations of the facility. Resident Resident R75 confirmed placing orders online for food and products.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 6 of 13 395342 Department of Health & Human Services Printed: 09/04/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 395342 B. Wing 03/13/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hopkins Center 8100 Washington Lane 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)

F 0689 Review of the resident's clinical record revealed no documented evidence the faciltiy implemented interventions to monitor and supervise Resident Resident R75's environment for the presence and consumption of Level of Harm - Actual harm alcohol.

Residents Affected - Few The facility failed to provide appropriate staff supervision and failed to complete a thorough assessment of

the resident environment which resulted in actual harm to Resident Resident R75 who was found with symptoms of intoxication, transferred to the hospital, diagnosed with alcohol intoxication with a blood alcohol level of 0. 27% and required intravenous therapy.

28 Pa. Code 201.18(e)(1) Management

28 Pa Code 211.10(d) Resident care policies

28 Pa. Code 211.12 (c)(d)(1) Nursing Services

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 7 of 13 395342 Department of Health & Human Services Printed: 09/04/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 395342 B. Wing 03/13/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hopkins Center 8100 Washington Lane 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)

F 0730 Observe each nurse aide's job performance and give regular training.

Level of Harm - Minimal harm or 39344 potential for actual harm Based on review of personnel records and interviews with staff, it was determined that the facility failed to Residents Affected - Some complete annual performance reviews for nurse aide staff as required for five of five nurse aide personnel files reviewed (Employees E5, E6, E21, E22 and E23).

Findings include:

Review of Employee E5's personnel filed revealed that the employee was hired by the facility on June 13, 2023, as a nurse aide. Continued review revealed than an annual performance review had not been completed for the employee.

Review of Employee E6's personnel filed revealed that the employee was hired by the facility on July 16, 2004, as a nurse aide. Continued review revealed than an annual performance review had not been completed for the employee.

Review of Employee E21's personnel filed revealed that the employee was hired by the facility on October 2, 2006, as a nurse aide. Continued review revealed than an annual performance review had not been completed for the employee.

Review of Employee E22's personnel filed revealed that the employee was hired by the facility on April 1, 2020, as a nurse aide. Continued review revealed than an annual performance review had not been completed for the employee.

Review of Employee E23's personnel filed revealed that the employee was hired by the facility on June 23, 2021, as a nurse aide. Continued review revealed than an annual performance review had not been completed for the employee.

Interview on March 13, 2025, at 1:03 p.m. with the Director of Nursing, revealed that annual performance reviews for Employees E5, E6, E21, E22 and E23 had not been completed at any time during 2024 or 2025.

28 Pa. Code 201.19(2) Personnel policies and procedures

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 8 of 13 395342 Department of Health & Human Services Printed: 09/04/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 395342 B. Wing 03/13/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hopkins Center 8100 Washington Lane 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)

F 0880 Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or 39344 potential for actual harm Based on review of clinical records, observations, review of facility policy and interview with staff, it was Residents Affected - Some determined that the facility failed to implement special contact precautions, enhanced barrier precautions and practice infection control practices related to residents reported to be under precautions for care for four of eight residents reviewed. (Resident Resident R15, Resident Resident R7, Resident 69 amd Resident 75)

Findings include:

Review a facility policy titled Special Contact and Droplet Precautions Revised dated February 24, 2025, revealed special contact and droplet precautions will be used to prevent transmission of infectious organisms that can be spread via pathogens that spread through the air or by direct person to person respiratory transmission. An example of a disease requiring special droplet and contact precaution is SARS / COVID. Further review of this policy revealed anyone entering the room must wear proper personal protective equipment (PPE)including respiratory protection N95 respirator, gowns, and gloves prior to entering the room of those who require special contact and droplet precautions.

Review of facility policy, Transmission Based Precautions dated revised July 11, 2024, revealed, Enhanced barrier precautions (EBP) are designed to reduce the transmission of multidrug-resistant organisms (MDRO)

in facilities. Continued review revealed that, EBP consists of the use of gowns and gloves for high-contact care activities which include . changing briefs and wound care.

Review of facility policy Covid - 19 Patient Placement and Roaming Considerations revised November 2024, revealed patients who test positive for COVID 19 will be placed in special contact and droplet precautions If Never mind Patients who are diagnosed with COVID 19 can be removed from transmission based precautions when the following criteria are met at least 10 days have passed since since symptoms first appeared, 24 hours have passed since last fever, and symptoms have improved, results are negative from at least two consecutive tests.

Review of Center for Disease Control and Prevention (CDC) policy titled Enhanced Barrier Precaution in Skilled Nursing Facilities dated November 15 2025, revealed the focus on the use of gown and gloves during high contact resident care activities that have been demonstrated to result in the transfer of MDROS (Multi drug resistant organisms) to hand to hand and clothing of healthcare personnel, even if blood and bodily fluid exposure is not anticipated. Enhanced barrier precautions are recommended for residents known to be colonized or infected with an MDRO as well as those at increased risk of MDRO acquisition, examples are residents with wounds and indwelling medical devices. Healthcare personnel are to wear specific PPE during high contact resident care activities which includes dressing, bathing and providing hygiene, changing linens, changing briefs device care and wound care.

Review of facility provided document Covid line list ( a list of all residents in the facility who have an active diagnosis of COVID) provided to at survey entrance revealed there were ten residents with diagnosis of Covid. Resident Resident R15 was included on the covid line list. This resident tested positive for COVID on March 7, 2025 and currently on contact and droplet precautions.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 9 of 13 395342 Department of Health & Human Services Printed: 09/04/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 395342 B. Wing 03/13/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hopkins Center 8100 Washington Lane 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)

F 0880 Observation of Licensed nurse, Employee E4 on March 10, 2025 at 10:31 a.m. was observed entering Resident Level of Harm - Minimal harm or potential for actual harm Resident R15's room during med pass. Resident Resident R15's door was viewed with a sign on the door which indicated that

the resident in this room was under special contact and airborne precaution. The sign instructed anyone Residents Affected - Some entering the room must wear PPE including gown, gloves, and mask and keep the door closed. Employee E4 was observed entering Resident Resident R15's room with no PPE on.

Interview with licensed nurse, Employee E4 at time of the above observation confirmed that Resident Resident R15 had a diagnosis of COVID and is on contact precautions. Employee E4 stated that the precaution required was only for washing hands.

Second observation of Licensed nurse, Employee E4 on March 10, 2025 at 10:40 a.m. revealed Employee E4 reentering Resident Resident R15's room with only an N95 mask, no gown , no gloves.

Observation of wound care treatment to Resident Resident R7 being provided by a hospice Licensed nurse, Employee E16 and Nursing aide, Employee E17 on March 11, 2025 at 10:40 a.m. revealed both Employee E16 and E17 only wearing gloves and no gown.

Interview with Employee E16 at time of the above observation confirmed that the resident was on enhanced barrier precaution but only as a facility precaution. PPE is not warranted for this resident

Interview with Unit Manager, Licensed nurse, Employee E10 on March 11, 2025 at 10:53a.m. regarding enhanced barrier precaution, specifically the indication for need to wear PPE , revealed that if there is no infection and residents are not on an antibiotic then PPE is not necessary unless they are actually providing care on an effective wound. Ask if all residents with visual enhanced barrier signs on the doorway have infections and or antibiotics and or folic catheter unit manager replied it is a facility protocol as a precaution for the signs being on the doors.

Review of facility documentation, COVID-19 line listing, revealed that Resident Resident R69 tested positive for COVID-19 on March 6, 2025.

Clinical record review for Resident Resident R69 revealed a care plan, dated initiated March 6, 2025, for COVID-19 positive infection, with interventions including contact and droplet precautions.

Continued record review for Resident Resident R69 revealed a physician's order, dated March 10, 2025, for droplet and contact isolation precaution for COVID-19 infection.

Clinical record review for Resident Resident R75 revealed a progress note, dated March 8, 2025, at 1:44 p.m. that the resident tested negative for COVID-19.

Observation, on March 10, 2025, at 12:18 p.m. revealed that a sign indicating Special Contact and Droplet Precautions was posted on the door of Resident Resident R69 and Resident Resident R75's room. Continued observation revealed Employee E24, nurse aide, took Resident Resident R69 and Resident Resident R75's lunch trays from the lunch truck, then proceeded to enter the residents' room and set up the lunch trays for the residents. Employee E24, nurse aide, then left the room and walked down the hallway. Employee E24, nurse aide, wore only a surgical mask, and did not don an N95 respirator, a gown, or perform hand hygiene while delivering the lunch trays to Residents Resident R69 and Resident R75.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 10 of 13 395342 Department of Health & Human Services Printed: 09/04/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 395342 B. Wing 03/13/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hopkins Center 8100 Washington Lane 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)

F 0880 28 Pa Code 211.10((d) Resident care policies

Level of Harm - Minimal harm or 28 PA Code 211.12(d)(1)(3) Nursing services potential for actual harm

Residents Affected - Some

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 11 of 13 395342 Department of Health & Human Services Printed: 09/04/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 395342 B. Wing 03/13/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hopkins Center 8100 Washington Lane 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)

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 38735 potential for actual harm Based on observation, review of the facility policy and staff and resident interview, it was determined that the Residents Affected - Few facility failed to ensure that call bells were available and operable for resident use for two of 38 residents observed residents. (Residents Resident R63 and Resident R39)

Findings include:

Review of facility policy, Call Lights, revised June 6, 2021, revealed that all Genesis Healthcare patients will have a call light or alternative communication device within their reach at all times when unattended.

Interview with Resident Resident R63 in room [ROOM NUMBER], on March 10, 2025, at 11:25 a.m. revealed that he does not use the call bell much and he pointed to the call bell which was wound around the bedrails. It was noted that the other end of the cord was cut off and laying on the floor, and the severed cord attached to the plug was in the wall jack. When the button was pushed it did not activate. Further observation of the light on

the ceiling outside her door revealed that it did not light after pressing the button multiple times.

Interview with the Licnesed nurse, Employee E26, on March 10, 2025, at 11:30 a.m revealed that the call bell was not working.

Interview with Resident Resident R39 in room [ROOM NUMBER], on March 10, 2025, at 11:40 a.m. revealed that she had an adaptive call bell that she could blow into to call for help. She said that it had been broken sometime

the night before and had not been working all day.

Follow-up interview with Resident Resident R39, on March 11, 2025, at 10:30 a.m. revealed that her call bell was still not working.

Interview with the Unit Manager on the second floor, Licensed nurse, Employee E10, on March 11, 2025, at 10:35 a.m. revealed that Resident Resident R39's call bell was not working, and the facility had ordered the parts for

this specialty call bell because none of their sister facilities had this type of call bell.

28 Pa. Code 205.67(j) Electric requirements for existing construction

28 Pa. Code 201.18 (b)(1) Management

28 Pa Code 211.12(d)(1)(3)(5) Nursing services

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 12 of 13 395342 Department of Health & Human Services Printed: 09/04/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 395342 B. Wing 03/13/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Hopkins Center 8100 Washington Lane 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)

F 0921 Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 46993

Residents Affected - Few Based on observations and review of facility provided documentation, it was determined facility did not ensure to provide a sanitary, comfortable environment for residents for four out of 11 rooms observed on third floor unit (Room# 300, 302, 304, 305)

Findings include:

Review of facility provided policy 'Accommodation of Needs,' revised on February 1, 2023, indicates that residents have a right to a safe, clean, comfortable, and homelike environment, and housekeeping and maintenance services necessary to maintain a sanitary , orderly and comfortable interior.

Observations on March 10, 2025 at 9:39 a.m., room [ROOM NUMBER], revealed food crumbs on floor, and

a strong urine odor.

Further observations on March 10, 2025 at 11:56 a.m., revealed dry yellow substance under chair on floor, urinal on floor.

Further observations on March 10, 2025 of room [ROOM NUMBER], at 9:45 a.m., revealed mustard packets

on floor under bedside table, empty soda can on floor, sweetener packets, lotion cap on floor, papers and a brief bag on floor.

Further observations on March 10, 2025 at 9:50 a.m., room [ROOM NUMBER], revealed food crumbs under bed, snack wraps on floor, dirty and dusty bedside table.

Findings confirmed at the time of the observations with housekeeping Employee, E18.

28 Pa Code 201.14 (a) Responsibility of licensee

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 13 395342