Inspection·October 13, 2023

F 0550 28 Pa Code: 201.29 (i) Resident rights. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395013 If continuation sheet Page 2 of 16 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 395013 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eldercrest Rehabilitation & Healthcare Center 2600 West Run Road Munhall, PA 15120 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 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of facility admission documents and staff interview, it was determined that the facility failed to ensure resident rights to make informed decisions and choices about important aspects of residents' health, safety and welfare by making certain residents understand the Notice of Medicare Non-Coverage (NOMNC) form and failed to ensure the agreement is explained to the resident and his or her representative in a form and manner that he or she understands for one of four residents (Resident R110). Residents Affected - Few Findings include: Review of the Resident Assessment Instrument 3.0 User's Manual effective October 2019 indicated that a Brief Interview for Mental Status (BIMS), is a screening test that aides in detecting cognitive impairment. The BIMS total score suggests the following distributions: 13-15: cognitively intact 8-12: moderately impaired 0-7: severe impairment Review of Resident R110's admission record indicated the resident was admitted to the facility on [DATE]. Review Resident R110's admission assessment dated [DATE], indicated that Resident R110 was alert and oriented to person and place only. Review of Resident R110's demographic information available in the electronic medical record indicated that Resident R110's son was designated as the responsible party. Review of the Minimum Data Set (MDS - periodic assessment of care needs) dated 4/3/23, included diagnoses of diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time) and heart failure (a progressive heart disease that affects pumping action of the heart muscles). Review of Section C: Cognitive Patterns, Questions C0500 BIMS Summary Score revealed Resident R1's score to be 3, severe impairment. Review of the NOMNC form dated 4/4/23, revealed that it was signed by Resident R110. During an interview on 10/13/23, at 1:30 p.m. the Nursing Home Administrator and the Director of Nursing confirmed Resident R110 lacked the ability to have the arbitration agreement clearly explained to her, and confirmed the facility failed to ensure the NOMNC is explained to the resident and his or her representative in a form and manner that he or she understands for one of four residents. 28 Pa. Code 201.24 (b) admission Policy. 28 Pa. Code 201.14(a) Responsibility of Licensee. 28 Pa. Code 201.18(b)(2) Management. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395013 If continuation sheet Page 3 of 16 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 395013 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eldercrest Rehabilitation & Healthcare Center 2600 West Run Road Munhall, PA 15120 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 0582 28 Pa. Code 201.29(a)(j) Resident Rights. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395013 If continuation sheet Page 4 of 16 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 395013 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eldercrest Rehabilitation & Healthcare Center 2600 West Run Road Munhall, PA 15120 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical records and staff interview, it was determined that the facility failed to make certain that residents were provided appropriate treatment and care to possibly prevent hospitalization for one of four residents (Resident R4). Residents Affected - Some Findings include: Review of the facility policy, Heart Failure - Clinical Protocol (heart failure is a progressive heart disease that affects pumping action of the heart muscles), dated 3/15/23, indicated the physician will review and make recommendations for relevant aspects of the nursing care plan; for example, wheat symptoms to expect, how often and what (weights, renal function, digoxin level) to monitor, and when to report findings to the physician, etc. A review of the Resident Assessment Instrument 3.0 User's Manual effective October 2019, indicated that a Brief Interview for Mental Status (BIMS) is a screening test that aides in detecting cognitive impairment. The BIMS total score suggests the following distributions: 13-15: cognitively intact 8-12: moderately impaired 0-7: severe impairment Review of the clinical record revealed that Resident R4 was admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS - periodic assessment of resident care needs) dated 8/17/23, included diagnoses of heart failure, aphasia (language disorder that affects communication and difficulty speaking), and history of a stroke. Review of Section C: Cognitive Patterns, Questions C0500 BIMS Summary Score revealed Resident R4's score to be not able to be assessed due to Resident R4 being rarely understood. Review of a physician's order dated 8/25/23, indicated that Resident R4 will have his weight assessed twice per week, on Tuesdays and Fridays. Review of Resident R4's care plan for cardiac disease included the intervention Obtain weights as indicated and report significant changes. Further review of the care plan failed to include parameters of what weight changes to report. Review of Resident R4's weight record from 8/25/23, through 9/20/23, revealed the following: 8/25/23: 224.4 lbs. (pounds) 8/29/23: Not assessed. 9/01/23: 229.8 lbs. 9/05/23: Not assessed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395013 If continuation sheet Page 5 of 16 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 395013 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eldercrest Rehabilitation & Healthcare Center 2600 West Run Road Munhall, PA 15120 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 9/08/23: 230.4 lbs. Level of Harm - Minimal harm or potential for actual harm 9/12/23: Not assessed. 9/15/23: Not assessed. Residents Affected - Some 9/18/23: 233.2 (unscheduled assessment). 9/19/23: Not assessed. Review of a progress note dated 9/18/23, at 10:32 p.m. indicated Resident's sister, again, concerned about increased edema in his RLE & RUE (right lower extremity and right upper extremity); a month ago there was the same concern & a weight gain, at that time M.D. ordered Lasix (medication to relieve fluid retention) 40mg QD (daily); resident again showing weight gain of 3 lbs. (pounds) in 10 days, was 230.4 on 9/8/23, tonight 233.2 in weight chair; RLE is hard, R-foot with +4 pitting edema. No change in respiratory status. M.D. made aware. Review of a progress note dated 9/19/23, at 2:22 p.m. indicated sent a fax to (physician) regarding residents weight gain of 3.2 lbs. Resident has no shortness of breath but remains with edema of lower extremities. Review of a progress note dated 9/20/23, at 11:30 a.m. indicated Resident sent out to hospital with paramedics. Resident was showing significant neuro changes, eyes rolling to the back of head, resident dropping cigarettes. Informed sister and she felt too that he needed to go because of the fluid he has had building up. Faxed doctor of resident being sent out. Review of hospital paperwork dated 9/20/23, indicated Resident R4 was to be admitted due to congestive heart failure exacerbation and hypoxia (low levels of oxygen in the body tissues). In this document's HPI (history of present illness) indicated that it had been reported to the hospital that Resident R4 had fluid overload in the past few days and patient has reportedly gained three pounds in the past few days. Review of a progress note dated 9/26/23, at 9:34 p.m. indicated Returned from hospital 9/25/23, after being diagnosed with congestive heart failure and hypoxia; weighed tonight before going to bed, down from pre-hospital weight of 233.8, now 213.2 in weight chair. Right lower extremity that was so swollen, now looking much thinner, as well as right upper extremity & face. During an interview on 10/13/23, at 1:30 p.m. the Nursing Home Administrator and the Director of Nursing confirmed that no parameters were put in place to advise nurses when to contact the medical provider, that weight gain went unreported until Resident R4's family member voiced her concerns, that the medical provider failed to assess the resident after notification, and confirmed that the facility failed to make certain that residents were provided appropriate treatment and care to possibly prevent hospitalization for one of four residents. 28 Pa. Code 201.14(a) Responsibility of Licensee. 28 Pa. Code 201.18(b)(1)(3) Management. 28 Pa. Code 201.29(a)(c)(d)(j) Resident Rights. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395013 If continuation sheet Page 6 of 16 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 395013 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eldercrest Rehabilitation & Healthcare Center 2600 West Run Road Munhall, PA 15120 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 28 Pa. Code 211.10(c)(d) Resident Care Policies. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395013 If continuation sheet Page 7 of 16 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 395013 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eldercrest Rehabilitation & Healthcare Center 2600 West Run Road Munhall, PA 15120 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm Based on review of manufacturer's instructions, clinical record review, observations, and staff interview, it was determined that the facility failed to make certain that residents are free of significant medication errors for three of four residents (Resident R102, R19, and R28). Residents Affected - Some Findings include: Review of the facility policy Insulin Administration dated 3/15/23, indicated rapid-acting insulin as an onset time of 10-15 minutes. Review of the manufacturer's guidelines for Novolog Flex Pen (injectable diabetic medication to lower blood sugar) revised 10/21, indicated it is a rapid acting insulin and is to be administered five to ten minutes before a meal. Review of the manufacturer's guidelines for Humalog Kwik Pen (injectable diabetic medication to lower blood sugar) revised 4/20, indicated it is a rapid acting insulin and is to be administered within 15 minutes before a meal, or immediately after a meal. During an interview on 10/11/23, at 8:10 a.m. Licensed Practical Nurse (LPN) Employee E4 confirmed that residents receive their blood sugar checks and insulin by the night shift nurse. Review of the facility mealtimes indicated that breakfast is served on Hall 2 at 7:30 a.m., and on Hall 1 at 8:00 a.m. Dinner is served on Hall 2 at 5:30 p.m., and on Hall 1 at 6:00 p.m. Review of the physician order dated 9/28/23, indicated to give Resident R102 insulin aspart (rapid acting insulin) three times per day. During an observation on 10/13/23, at 4:13 p.m. Resident R102 was given four units of insulin aspart by Registered Nurse Employee E5. During an observation of the evening meal on 10/13/23, Resident R102 received his dinner at approximately 5:30 p.m., one hour and 17 minutes after the insulin administration. Review of the physician order dated 9/28/23, indicated to give Resident R19 Humalog insulin before meals and at bedtime. Review of Resident R19 ' s Medication Administration Record (MAR) for October 2023 revealed the following: 10/4/23, insulin given at 5:21 a.m. 10/6/23, insulin given at 5:10 a.m. 10/8/23, insulin given at 6:56 a.m. 10/12/23, insulin given at 5:04 a.m. Review of the physician order dated 9/30/23, indicated to give Resident R28 Novolog insulin before (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395013 If continuation sheet Page 8 of 16 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 395013 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eldercrest Rehabilitation & Healthcare Center 2600 West Run Road Munhall, PA 15120 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 0760 meals and at bedtime. Level of Harm - Minimal harm or potential for actual harm Review of Resident R28 ' s Medication Administration Record (MAR) for October 2023 revealed the following: Residents Affected - Some 10/1/23, insulin given at 6:41 a.m. 10/6/23, insulin given at 6:23 a.m. 10/7/23, insulin given at 5:47 a.m. During an interview on 10/13/23, at 1:30 p.m. the Nursing Home Administrator and the Director of Nursing confirmed that the facility failed to make certain that residents are free of significant medication errors for three of four residents. 28 Pa. Code 207.2(a) Administrator's responsibility. 28 Pa. Code: 211.10(c)(d) Resident care policies. 28 Pa. Code: 211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395013 If continuation sheet Page 9 of 16 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 395013 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eldercrest Rehabilitation & Healthcare Center 2600 West Run Road Munhall, PA 15120 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observations, and staff interviews, it was determined that the facility failed to make certain that out-of-date medical supplies were disposed of in one of one medication rooms. Findings include: During an observation on the facility medication room on 10/12/22, at 4:10 p.m. the following was observed: -Nine transport swabs with an expiration date of 8/31/23. -Five transport swabs with an expiration date of 7/31/23. -Thirty PICC line end caps with an expiration date of 3/2022. -Two dressing change kits with an expiration date of 2/28/23. During an interview on 10/12/23, at 4:25 p.m. the Director of Nursing confirmed the above observation, and confirmed the items were no longer in use. During an interview on 10/12/23, at 1:30 p.m. the Nursing Home Administrator and the Director of Nursing confirmed that the facility failed to make certain that out-of-date medical supplies were disposed of on one of one nursing units. 28 Pa. Code: 201.14 (a) Responsibility of licensee. 28 Pa. Code: 201.18 (b)(1)(e)(1) Management. 28 Pa. Code: 211.9 (a)(1) Pharmacy services. 28 Pa. Code: 211.12 (d)(1)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395013 If continuation sheet Page 10 of 16 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 395013 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eldercrest Rehabilitation & Healthcare Center 2600 West Run Road Munhall, PA 15120 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 0847 Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of facility admission documents and staff interview, it was determined that the facility failed to ensure resident rights to make informed decisions and choices about important aspects of residents' health, safety and welfare by making certain residents understand the conditions of a binding arbitration agreement and failed to ensure the agreement is explained to the resident and his or her representative in a form and manner that he or she understands, one of four residents (Resident R110). Residents Affected - Few Findings include: Review of the Resident Assessment Instrument 3.0 User's Manual effective October 2019 indicated that a Brief Interview for Mental Status (BIMS), is a screening test that aides in detecting cognitive impairment. The BIMS total score suggests the following distributions: 13-15: cognitively intact 8-12: moderately impaired 0-7: severe impairment Review of the facility's admission packet contained the document Voluntary Arbitration Agreement, indicated The parties understand and agree that this voluntary arbitration agreement is a binding contract which may be enforced by the parties and that by entering into this arbitration agreement, the parties are giving up and waiving their constitutional right to have their claim decided in a court of law before a judge and/or jury, as well as any appeal from a decision or award of damages. Review of Resident R110's admission record indicated the resident was admitted to the facility on [DATE], with an original admission date of 9/30/19. Review of a progress note from the original admission dated 9/30/19, at 6:30 p.m. indicated, Attempted to get admission paperwork signed with resident. Resident refused and stated that her son would sign it. Resident's son (son's name) is her POA. Call placed to (son), message left for him to call facility to obtain verbal consents from him. Review Resident R110's admission assessment dated [DATE], indicated that Resident R110 was alert and oriented to person and place only. Review of Resident R110's demographic information available in her electronic medical record indicated that Resident R110's son was designated as her responsible party. Review of the Minimum Data Set (MDS, periodic assessment of care needs) dated 4/3/23, included diagnoses of diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time) and heart failure (a progressive heart disease that affects pumping action of the heart muscles). Review of Section C: Cognitive Patterns, Questions C0500 BIMS Summary Score revealed Resident R1's score to be 3, severe impairment. Review of Resident R110's admission paperwork indicated all sections, including the Voluntary (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395013 If continuation sheet Page 11 of 16 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 395013 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eldercrest Rehabilitation & Healthcare Center 2600 West Run Road Munhall, PA 15120 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 0847 Arbitration Agreement, were signed by Resident R110. Level of Harm - Minimal harm or potential for actual harm During an interview on 10/13/23, at 1:00 p.m. the Nursing Home Administrator and the Director of Nursing confirmed the facility failed to ensure resident rights to make informed decisions and choices about important aspects of residents' health, safety and welfare by making certain residents understand the conditions of a binding arbitration agreement and failed to ensure the agreement is explained to the resident and his or her representative in a form and manner that he or she understands, one of four residents. Residents Affected - Few 28 Pa. Code 201.24 (b) admission Policy. 28 Pa. Code 201.14(a) Responsibility of Licensee. 28 Pa. Code 201.18(b)(2) Management. 28 Pa. Code 201.29(a)(j) Resident Rights. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395013 If continuation sheet Page 12 of 16 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 395013 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eldercrest Rehabilitation & Healthcare Center 2600 West Run Road Munhall, PA 15120 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 0882 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. Based on review of facility policy, infection control documentation and staff interview, it was determined that the facility failed to have one or more individuals serving as the Infection Preventionist, responsible for the facility's infection prevention plan, including Covid-19 transmission-based precautions for two of three residents (Resident R94 and R111) Based on observations, review of clinical records, facility policies and documentation, and staff interviews, it was determined that the facility failed to maintain an infection prevention and control program by failing to follow infection control guidelines from the Centers for Disease Control (CDC) and the Pennsylvania Department of Health (PA DOH) to reduce the spread of infections and prevent cross-contamination during the COVID-19 pandemic. This resulted one of seven residents who remained in a room with a COVID-19 positive resident becoming positive and symptomatic of COVID-19 (Resident R5). Findings include: Pennsylvania Health Alert Network (PA-HAN) - 694, UPDATE: Interim Infection Prevention and Control Recommendations for COVID-19 in Healthcare Settings (COVID-19, a contagious viral disease that can cause a variety of symptoms, including breathing problems, fever, and cough) dated 5/11/23, indicated: Residents with mild to moderate illness who are not moderately to severely immunocompromised: -At least ten days have passed since symptoms first appeared; and -At least 24 hours have passed since last fever with the use of fever-reducing medications; and -Symptoms (e.g., cough, shortness of breath) have improved. Review of the facility policy SARS-CoV-2 Management dated 3/15/23, indicated the Duration of transmission-based precautions for residents with SARS-CoV-2 infection: Residents with mild to moderate illness who are not moderately to severely immunocompromised: -At least ten days have passed since symptoms first appeared; and -At least 24 hours have passed since last fever with the use of fever-reducing medications; and -Symptoms (e.g., cough, shortness of breath) have improved. During an interview on 10/10/23, the Director of Nursing (DON) confirmed that she also acts as the Infection Preventionist. During this interview, the DON further confirmed that the facility did not have any residents with active Covid-19. During an observation on 10/10/23, at 12:30 p.m., Resident R94's room had isolation supplies hanging from the door. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395013 If continuation sheet Page 13 of 16 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 395013 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eldercrest Rehabilitation & Healthcare Center 2600 West Run Road Munhall, PA 15120 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 0882 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 10/10/23, at 12:45 p.m. the DON stated the Resident R94 had come out of isolation over the previous weekend, and the supplies were not removed as of yet. Review of Resident R94's clinical record indicated she tested positive for Covid-19 on 10/3/23. During an interview on 10/10/23, at 2:30 p.m. the DON confirmed that Resident R94 was no longer required isolation, as she had been in transmission-based precautions for five days. It was confirmed with the DON at this time that five-day isolation is for community members, and residents in a health care facility required a ten-day isolation period. The DON stated that Resident R94 would continue in isolation. Review of the facility provided Covid-19 line list indicated Resident R111 tested positive for Covid-19 on 7/3/23. Review of facility census information indicated that Resident R111 remained in a private room from 7/3/23, through 7/10/23, at which time he was moved to a two-person room, with another resident in that room. Review of the facility-provided Infection Preventionist certificate indicated Registered Nurse Employee E3 was the facility designated Infection Preventionist. Review of the facility-provided listing of key personnel indicated Registered Nurse (RN) Employee E3 was employed in the capacity of a Human Resources employee. During an interview on 10/13/23, at 10:34 a.m. RN Employee E3 confirmed that she had been completing the portion of the Infection Preventionist position in relation to antibiotic stewardship, and had been working in Human Resources. When asked when the last time she had fully been completing the Infection Preventionist job duties, RN Employee E3 stated that it had been last year. During an interview on 10/13/23, at 11:15 a.m. the DON confirmed that she does not have Infection Preventionist certification. During an interview on 10/13/23, at 1:30 p.m. the Nursing Home Administrator and the Director of Nursing confirmed that the facility failed to have one or more individuals serving as the Infection Preventionist, responsible for the facility's infection prevention plan, including Covid-19 transmission-based precautions for two of three residents. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(1)(3)(e)(1) Management. 28 Pa. Code: 211.12(d)(1)(3)Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395013 If continuation sheet Page 14 of 16 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 395013 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eldercrest Rehabilitation & Healthcare Center 2600 West Run Road Munhall, PA 15120 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 0944 Level of Harm - Potential for minimal harm Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program. Based on review of facility documents and staff interview, it was determined that the facility failed to provide Quality Assurance and Performance Improvement (QAPI) training to facility staff. Residents Affected - Many Finding include: Review of the Facility Assessment dated 3/15/23, indicated that Each department will receive the state/federal required trainings. Review of facility education documents revealed the facility failed to offer QAPI education to its staff members. During an interview on 10/13/23, at 1:30 p.m. the Nursing Home Administrator confirmed that the facility failed to provide QAPI training to facility staff. 28 Pa. Code: 201.14(a) Responsibility of Licensee. 28 Pa. Code: 201.20(c) Staff Development. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395013 If continuation sheet Page 15 of 16 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 395013 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eldercrest Rehabilitation & Healthcare Center 2600 West Run Road Munhall, PA 15120 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 0947 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. Based on review of facility policy and documents, and staff interview, it was determined that the facility failed to conduct at least 12 hours of in-service education, within 12 months of their hire date anniversary, for nurse aides as required for two of five nurse aides (Employees E1 and E2). Finding include: A review of the facility policy Competency of Nursing Staff dated 3/15/23, indicated all nursing staff must meet the specific competency requirements of their respective licensure and certification requirements defined by state law. Review of the Facility Assessment dated 3/15/23, indicated that Each department will receive the state/federal required trainings. Review of Nurse Aide (NA) Employees E1 and E2's education records with hire date greater than 12 months revealed the following: NA Employee E1 had a hire date of 8/17/85, with 7.00 hours in-service education between 8/17/22, and 8/17/23. NA Employee E2 had a hire date of 8/16/88, with 3.00 hours in-service education between 8/16/22, and 8/16/23. During an interview on 10/13/23, at 1:30 p.m. the Director of Nursing confirmed that the required education was completed after the end of the required timeframe, and further confirmed that the facility failed to provide the required 12 hours annual in-service education within 12 months of their hire date anniversary for two of five nurse aides. 28 Pa. Code: 201.14(a) Responsibility of Licensee. 28 Pa. Code: 201.20(c) Staff Development. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395013 If continuation sheet Page 16 of 16