Health inspection·February 20, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation and staff interview, it was determined that the facility failed to provide a clean, comfortable, homelike environment on three of four nursing units ( A, B, and F Wing Nursing Units) and Chapel, (Residents 1, 7, 8, 9, and 10). Findings include: Observation on the F Wing Nursing Unit on February 20, 2025, at 12:15 PM revealed the following: The floor in the main hallway in front of the nurse's station was scuffed with a build-up of dirt. An indentation in the floor that spanned across the hallway contained various debris. A lidded garbage can in the hallway had an extensive build-up of dried liquid stains on the front. A dining/sitting area located across from the nurse's station was open and utilized by residents per an interview with Employee 1, licensed practical nurse, on February 20, 2025, at 12:26 PM. Observation of this area revealed the following: A vent on the wall under the window contained a significant amount of various debris. The windowsill contained a thermos and three clear, large-sized plastic cups from a fast-food restaurant each partially filled with liquids. A canned energy drink with a clear, plastic cup over the opening was observed on a piece of furniture on the perimeter of the room. There were multiple backpacks placed on the furniture around the room. A concurrent interview with Employee 1 revealed it was unclear who the cups or backpacks belonged to. Continued observation revealed several unidentified staff members in the area proceeded to remove the backpacks and drinks from the room. Three tables placed together in the center of the room had dried stains on the legs. The center table had damage to the edge, and on a corner, with the particle board showing. The floor under the tables had extensive scuffing, debris, and dried liquid spills spanning the length under the three tables. Observation on February 20, 2025, at 12:35 PM of the room for Residents 7, 8, 9, and 10, revealed an eight-inch section of the cove base peeling from the wall located under the sink just inside the (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 395045 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 395045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mountain View Rehabilitation and Senior Living Ctr 2050 Trevorton Road Coal Township, PA 17866 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)