Inspection visit

InspectionMay 2, 2025

MOUNTAIN VIEW REHABILITATION AND SENIOR LIVING CTRCMS #39504527 citations on this visit

27 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 27 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

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 and resident interview, it was determined that the facility failed to provide a clean, comfortable, homelike environment on two of four open nursing units (F Nursing Unit: Resident 114 and G Nursing Unit: Residents 148 and 131). Findings include: Observation of Resident 114's room on April 29, 2025, at 1:02 PM revealed brown spots and stains on the resident's privacy curtain. Concurrent observation of the resident's bathroom revealed the ceiling light cover contained several dead insects. The wall beside the toiled contained a dried brown substance, and the cold-water handle of the sink was covered in rust and a black substance from the base to the top. The hot water handle was covered in white buildup. The above information regarding Resident 114's room and bathroom was reviewed with the Nursing Home Administrator and Director of Nursing on April 30, 2025, at 2:20 PM. Observation of Resident 148's room on April 29, 2025, at 10:23 AM revealed his overbed table and bed was covered by unorganized newspapers. His bedside stand was covered with unorganized papers, two uncovered and unbagged respiratory masks, boxed food items, a boxed puzzle, plastic soda bottles, and other unidentified items that were stacked a foot high. A bedside commode was positioned between the window and Resident 148's bed. Interview with Resident 148 on the date and time of the observation revealed that he requested the facility remove the bedside commode since he was not using it and it was, in (his) road, it should have been moved last week. A roll of toilet paper was on the floor behind the head of Resident 148's bed. A mostly empty and unlabeled plastic bottle on his chest of drawers contained one-quarter inch of turquoise liquid. During the interview with Resident 148, a housekeeper entered the room and removed the bedside commode. The amount and organization of Resident 148's personal items rendered those areas inaccessible to effective housekeeping services. Observation of Resident 148's room on April 30, 2025, at 9:25 AM revealed that the toilet paper roll remained on the floor behind the head of his bed. Two oxygen humidification bottles were on the floor under his bed. A bag of incontinence briefs was stored under his bed. A banana with more than half the peel covered in spotted blackened areas was on the overbed table, which unorganized papers covered. The unorganized stack of papers, oxygen masks, puzzle box, soda bottles, and unidentified items remained on his bedside table. The amount and organization of Resident 148's personal items rendered those areas inaccessible to effective housekeeping services. Observation of Resident 148's room with Employee 19 (licensed practical nurse) on May 1, 2025, at 1:35 PM revealed that the toilet paper roll, incontinence briefs, and oxygen humidification bottles (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 53 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 05/02/2025 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)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some remained on the floor under Resident 148's bed. The unorganized stack of papers, oxygen masks, puzzle box, soda bottles, and unidentified items remained on his bedside stand. The blackened banana remained on his overbed table, which continued to be covered by unorganized papers. Interview with Employee 19 on the date and time of the observation confirmed that staff would be responsible for the oxygen masks and humidification bottles. Employee 19 was unable to identify the substance in the mostly empty plastic bottle on Resident 148's chest of drawers. Employee 19 confirmed that the amount and organization of Resident 148's personal items rendered those areas inaccessible to effective housekeeping services. Observation of Resident 131's room on April 29, 2025, at 11:27 AM revealed that his bedside stand and overbed table surfaces were covered with papers, empty beverage cups, several cereal boxes, and a used medical face mask. The unorganized items covering his bedside stand and a plastic storage container on the floor next to his bedside stand rose over one foot from the surface of the bedside stand. The amount and organization of Resident 131's personal items rendered those areas inaccessible to effective housekeeping services. Observation of Resident 131's room on May 1, 2025, at 1:39 PM with Employee 19 revealed that the areas of his overbed table and bedside stand remained unchanged with stacked papers, food items, and two bags of incontinence briefs. Resident 131 opened the lockable drawer of his bedside stand to show the surveyor and Employee 19 an item that he identified as a piece of fish that he kept in his room for months to show staff, residents, and visitors for, show and tell, while complaining about the facility's food quality. The surveyor reviewed the above concerns regarding Resident 148's and 131's room environment during an interview with the Nursing Home Administrator and the Director of Nursing on May 1, 2025, at 2:30 PM. 483.10(i)(1)-(7) Safe/clean/comfortable/homelike Environment Previously cited deficiency 6/7/2024 and 2/20/25 28 Pa. Code 201.18(b)(3)(e)(2.1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 2 of 53 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 05/02/2025 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)

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge. Based on clinical record review and resident, and staff interview, it was determined that the facility failed to develop and implement a discharge planning process to align with the resident's goals for one of two residents reviewed (Resident 60). Findings include: Review of Resident 60's clinical record revealed that the facility admitted her on May 28, 2024. A minimum data set assessment (MDS, a form completed at specific intervals to determine care needs) dated June 4, 2024, indicated that Resident 60's goal was to discharge to another facility. The facility answered no to the question on the MDS regarding if active discharge planning is occurring for the resident to return to the community. There was no documented evidence that the facility developed a plan of care to align with Resident 60's goals to be transferred to another facility. Interview with Resident 60 on April 30, 2025, at 10:05 AM revealed that she wants to move closer to her family. Resident 60 indicated that she has wanted to transfer out to another facility since she was admitted . Resident 60 indicated that she has talked to staff about it but that nobody is doing anything. Social service documentation dated October 28, 2024, indicated that the facility told the resident they would put out her referrals again. There was no documented evidence in Resident 60's clinical record to indicate what referrals were completed, where the referrals were sent, or if any follow up was attempted or received. A social service noted dated March 17, 2025, indicated that by the request of the family and the resident, a referral was made to another facility for a transfer. There was no documented evidence in Resident 60's clinical record to indicate if any follow up was completed on its status. There was no evidence in Resident 60's clinical record that the facility followed up with the resident or the resident's family since March 18, 2025. Interview with Employee 4, social service director, on May 2, 2025, at 11:30 AM confirmed the above findings for Resident 60. 28 Pa. Code 201.18 (3)(e)(1) Management 28 Pa. Code 211.10(a) Resident care plan FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 3 of 53 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 05/02/2025 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)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and resident and staff interview, it was determined that the facility failed to implement a comprehensive person-centered care plan regarding a pacemaker (Resident 112) and percutaneous endoscopic gastrostomy tube (Resident 81) out of 35 residents reviewed. Findings Include: Clinical record review for Resident 81 revealed a current physician's order for bolus tube feedings and water through a percutaneous endoscopic gastrostomy tube (PEG tube, a type of medical tubing passed through the abdominal wall and into the stomach to facilitate feeding and hydration). Observation of Resident 81 on May 1, 2025, at 12:42 PM revealed that he had a capped PEG tube present in his abdomen. Further review of Resident 81's clinical record revealed no evidence of a comprehensive care plan (a care plan addressing care such as the tube feedings, assessment, complications, and emergency procedures) related to the PEG tube. An interview with the Director of Nursing on May 2, 2025, at 12:40 PM confirmed the resident did not have a care plan related to the PEG tube and staff will develop one. Clinical record review for Resident 112 revealed they have a cardiac pacemaker (an electronic device to help regulate the beating of the heart). Hospital documentation dated March 23, 2025, at 8:34 AM revealed a past medical history that included a pacemaker placement in April 2024, due to tachy-[NAME] syndrome (a type of abnormal cardiac rhythm that alternates between slow and fast beating). An interview with Resident 112 on April 30, 2025, at 12:18 PM revealed the resident has an implanted pacemaker in the left chest. A medical device was noted on the resident's bedside stand that the resident reported talks with the pacemaker and transmits the data to the hospital. The resident further reported that the hospital will call if any problems are detected. Review of the current care plan for Resident 112 revealed the resident has an altered cardiovascular status related to the medical history. The care plan did not address the resident's pacemaker. There was no comprehensive care plan related to the pacemaker and transmittal device. The above information for Resident 112 was reviewed in a meeting with the Nursing Home Administrator and Director of Nursing on April 30, 2025, at 2:30 PM. The facility failed to implement comprehensive person-centered care plans for Residents 81 and 112. 28 Pa. Code 211.10 (a)(c)(d) Resident care policies 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 4 of 53 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 05/02/2025 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)

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observation, and staff interview, it was determined that the facility failed to revise a resident's comprehensive care plan for one of 35 residents reviewed (Resident 104). Findings include: Clinical record review for Resident 104 revealed that the facility completed a comprehensive significant change MDS (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) assessment dated [DATE]. Care areas that triggered for care plans included falls, pressure ulcers, and nutritional status (including feeding tube, a flexible tube inserted through the abdomen into the stomach for the purpose of administering fluids, nutrition, and medications). An active physician's order dated June 24, 2022, instructed staff to implement a low bed (bed positioned lower to the ground than a standard height). Review of Resident 104's plan of care to address her potential for falls revealed interventions that included a low bed (initiated June 24, 2022). Observation of Resident 104 on April 29, 2025, at 12:26 PM revealed she was in a bed that was not in a low position. The bed height was higher than a standard bed. Observation of Resident 104 on May 1, 2025, at 1:08 PM with Employee 19 (licensed practical nurse) revealed she was in a bed that was not in a low position. The bed remained at a height higher than a standard bed. Interview with Employee 19 on May 1, 2025, at 1:55 PM revealed that when the facility implemented a new bed for Resident 104 due to a change in facility ownership (estimated as several months ago, the beginning of 2025) and resulting change in durable medical equipment (DME) suppliers, the new bed was incapable of lowering to the floor as required for a low bed. Employee 19 confirmed that Resident 104's active physician orders and plan of care included the implementation of a low bed although this was not possible for Resident 104 due to the new DME suppliers. The surveyor reviewed the above discrepancy regarding Resident 104's bed height during an interview with the Nursing Home Administrator and the Director of Nursing on May 1, 2025, at 2:30 PM. Observation of Resident 104's bedside on April 29, 2025, at 12:21 PM revealed the feeding tube equipment at her bedside included a bag labeled Isosource 1.5 cal (a calorically dense complete liquid nutrition formula with fiber for increased calorie needs and/or limited fluid tolerance). Clinical record review of a nutritional progress note dated March 4, 2025, at 10:14 AM revealed that the dietitian indicated that due to supplier changes within the facility, Resident 104's enteral (administration of food or medication via the gastrointestinal tract) formula would change to match availability. The enteral formula physician order would be Isosource 1.5 at an increased rate due to trending weight loss, New order to read: Isosource 1.5 at 70 milliliters per hour times four hours. An active physician's order dated March 5, 2025, instructed staff to administer an enteral feeding (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 5 of 53 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 05/02/2025 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)

F 0657 two times a day of Isosource 1.5 at 70 milliliters per hour for four hours. Level of Harm - Minimal harm or potential for actual harm Review of Resident 104's active plan of care to address her tube feeding related to dysphagia (abnormal swallowing ability), history of significant weight loss and gain, and mechanically altered diet, revealed instructions for staff to administer a tube feeding of Jevity 1.5 60 milliliters for four hours daily (noted as revised on February 7, 2025). Residents Affected - Few The facility did not revise Resident 104's care plan to reflect the accurate type or amount of enteral feeding. The surveyor reviewed the above concern regarding Resident 104's nutritional plan of care during an interview with the Nursing Home Administrator and the Director of Nursing on May 2, 2025, at 12:15 PM. Observation of Resident 104 on April 29, 2025, at 12:24 PM revealed she was in a bariatric bed with a specialty mattress with a mechanical pump. The mechanical pump for the mattress included settings for a patient weight of 100 pounds, bariatric mode (350 to 1000 pounds) and maximum inflation off. Review of Resident 104's weight assessments dated March 4, 2025, to April 29, 2025, revealed that staff assessed her as ranging from 139.6 pounds to 133.1 pounds. Active physician orders for Resident 104 revealed a physician's order dated June 24, 2022, for staff to implement an alternating pressure air mattress to her bed. The order included instructions for staff to monitor settings every shift by, sliding forearm between two horizontal cells of mattress making sure resident is immersed 30 to 50 percent into mattress. Interview with Employee 19 (licensed practical nurse) on May 1, 2025, at 1:22 PM revealed that she attended wound care round assessments with the facility's contracted wound care specialists weekly. Employee 19 stated that she was not familiar with Resident 104's mattress pump settings; however, confirmed that the mattress did not appear to have an alternating pressure feature. Employee 19 also confirmed that Resident 104 would not be considered bariatric; nor did the setting of 100 pounds reflect Resident 104's current weight. Review of Resident 104's available plans of care failed to include specific mattress pump settings. A plan of care last revised March 26, 2025, to address Resident 104's pressure ulcers and potential for pressure ulcer development related to immobility listed interventions that included, PRM (pressure redistribution mattress) to bed/alternating pressure air mattress. Interview with Employee 19 on May 1, 2025, at 1:55 PM revealed that when the facility implemented a new bed for Resident 104 due to a change in facility ownership and resulting change in DME suppliers, the new bed likely no longer included an alternating pressure capability. Employee 19 confirmed that Resident 104's active physician orders and plan of care included the implementation of an alternating pressure mattress. The surveyor reviewed the concern regarding Resident 104's plan of care related to mattress type and settings during an interview with the Director of Nursing and Employee 2 (assistant director of nursing) on May 2, 2025, at 9:45 AM. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 6 of 53 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 05/02/2025 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)

F 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and resident and staff interview, it was determined that the facility failed to implement interventions to maintain mobility for one of one resident reviewed for rehabilitation concerns (Resident 61). Residents Affected - Few Findings include: Interview with Resident 61 on [DATE], at 10:28 AM revealed that she no longer received skilled therapy services (e.g., physical therapy), and she believed that her ability to walk was getting worse because she was not walking. Resident 61 stated that she needed staff to follow behind her with a wheelchair in the event she grew tired when walking. Resident 61 stated, I was on a PT (physical therapy) and OT (occupational therapy) plan, but it expired on Friday. This other plan is supposed to take over according to the girl in the office, but not doing any this week. Clinical record review for Resident 61 revealed a PT Discharge summary dated (Thursday) [DATE]. The discharge recommendations included one staff to assist with a roller walker for transfers and ambulation and a restorative nursing program for ambulation and seated lower extremity. Ambulation program established/trained: restorative ambulation program, ambulate with roller walker up to 50 feet as able with the assistance of one staff and wheelchair to follow. Review of a plan of care developed by the facility to address Resident 61's activities of daily living self-care performance deficit related to impaired balance revealed interventions that included: Transfer/ambulate assistance of two with roller walker, revised on [DATE] Restorative nursing program for ambulation as ordered, initiated on [DATE] Review of restorative nursing documentation dated [DATE], revealed the intervention for staff to complete a restorative nursing ambulation program consisting of the assistance of one staff with a roller walker and wheelchair to follow in the room and corridor for up to 50 feet as able. Staff did not initial completion of the intervention on the following dates and shifts: Day and evening shifts [DATE], 28, and 29, 2025 Day shift [DATE] Evening shift [DATE] The surveyor reviewed the above concern regarding the incompletion of Resident 61's restorative nursing program during an interview with the Director of Nursing on [DATE], at 11:30 AM. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 7 of 53 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 05/02/2025 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)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, clinical record review, and resident and staff interview, it was determined that the facility failed to ensure a dependent resident received assistance with shaving for one of four residents reviewed for activities of daily living concerns (Resident 129). Residents Affected - Few Findings include: Interview with Resident 129 on April 30, 2025, at 9:33 AM revealed that he preferred not to have facial hair. Resident 129 stated that he preferred shaving, down to the skin. Resident 129 stated that he had not received staff assistance with shaving in three weeks. Observation of Resident 129 on the date and time of the interview revealed he had a full beard and mustache with hair along his neck below his chin and jaw line. Review of the identification picture in Resident 129's electronic medical record revealed he had a mustache, but no beard. Clinical record review of social services documentation dated April 18, 2025, at 2:36 AM revealed that the writer met with Resident 129 on April 8, 2025, for an MDS (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) assessment, and Resident 129 was cognitively intact. Review of a quarterly MDS dated [DATE], revealed that the facility assessed Resident 129 as requiring substantial/maximum assistance with personal hygiene (the ability to maintain personal hygiene, including combing hair, shaving, applying makeup, washing/drying face and hands). The surveyor reviewed the above concern regarding Resident 129's facial hair and his report that staff have not assisted him to shave in weeks during an interview with the Nursing Home Administrator and the Director of Nursing on April 30, 2025, at 1:30 PM. Nursing documentation dated April 30, 2025, at 5:30 PM (following the surveyor's questioning) revealed that staff spoke with Resident 129 at this time, and Resident 129 did not recall the last time that he was offered shaving assistance. Resident 129 requested to be clean shaved that evening. The writer indicated that the nurse aide and licensed practical nurse on the unit were made aware of Resident 129's request and were to perform the task that night. Observation of Resident 129 on May 2, 2025, at 9:14 AM revealed that he continued to have a full beard and mustache. Interview with the Director of Nursing on May 2, 2025, at 9:45 AM and 12:15 PM revealed that the facility could not provide additional information regarding Resident 129's continued facial hair and omission of shaving assistance as requested. The Director of Nursing stated that staff assured her that the task would be completed and did not report any issue with completing the task. 28 Pa Code 211.12(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 8 of 53 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 05/02/2025 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)

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 observation, clinical record review, and staff interview, it was determined that the facility failed to implement a physician ordered positioning device for one of four residents reviewed for range of motion concerns (Resident 104). Residents Affected - Few Findings include: Clinical record review for Resident 104 revealed an active physician's order dated September 4, 2024, for staff to implement a left palm guard (device applied to the hand that is used to provide a barrier between fingers and the palm to prevent injury to the palm from severe finger flexion/contracture) at all times; remove for care and skin checks every shift. An active physician's order dated August 6, 2024, repeated the instruction for staff to apply a left palm guard at all times except for care and skin checks every shift. Observation of Resident 104 on the following dates and times revealed no device on her left hand: April 30, 2025, at 11:15 AM April 30, 2025, at 12:40 PM May 1, 2025, at 1:55 PM Interview with Employee 19 (licensed practical nurse) on May 1, 2025, at 1:55 PM confirmed that Resident 104 did not have any device on her left hand as ordered by the physician. The surveyor reviewed the above findings related to Resident 104's palm guard during an interview with the Nursing Home Administrator and the Director of Nursing on May 1, 2025, at 2:30 PM. 28 Pa. Code 211.12(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 9 of 53 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 05/02/2025 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)

F 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and resident and staff interview, it was determined that the facility failed to arrange vision practitioner services for one of three residents reviewed for vision and hearing concerns (Resident 129). Residents Affected - Few Findings include: During an interview with Resident 129 on April 30, 2025, at 9:48 AM he stated, I should have a pair (of glasses), but I don't. Resident 129 claimed that he had not received services from a professional practitioner for eye exams or glasses in at least a year. Clinical record review of social services documentation dated April 18, 2025, at 2:36 AM revealed that the writer met with Resident 129 on April 8, 2025, for an MDS (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) assessment, and Resident 129 was cognitively intact. Social services documentation dated July 19, 2024, at 4:30 PM revealed that Resident 129 consented to the facility's consultant eye care provider for vision services. The writer indicated that a referral was sent to the facility's contracted eye care provider. The surveyor requested evidence of any professional eye care services provided to Resident 129 in the past year during an interview with the Nursing Home Administrator and the Director of Nursing on April 30, 2025, at 1:30 PM. Review of a handwritten note from the facility on May 1, 2025, revealed that the facility's contracted vision services provider did not come to the facility between July 19, 2024, and November 15, 2014. Resident 129 was not on the list for services for the November 15, 2024, visit. Per the facility's handwritten note, the facility's contracted vision services provider was at the facility March 7, 2025, and April 14, 2025; and Resident 129 refused services on April 14, 2025. Resident 129's clinical record did not contain documentation that Resident 129 refused vision services on March 7, 2025, or April 14, 2025. The facility failed to provide evidence of the provision of professional vision services for Resident 129. The surveyor reviewed the above concerns regarding Resident 129's professional vision services during an interview with the Director of Nursing on May 1, 2025, at 11:30 AM. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 10 of 53 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 05/02/2025 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)

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on observation, clinical record review, and staff interview, it was determined that the facility failed to implement necessary treatment and services to promote healing for one of five residents reviewed for pressure ulcer concerns (Resident 104). Residents Affected - Few Findings include: Clinical record review for Resident 104 revealed skin/wound note documentation dated February 25, 2025, at 10:17 AM that staff noted an open area measuring 0.25 centimeters (cm) round to Resident 104's left elbow with redness noted to the area. Nursing staff notified the physician's assistant and initiated a treatment. Review of Resident 104's treatment administration record (TAR, electronic documentation of the completion of treatments) dated February and March 2025, revealed that staff implemented a topical treatment to Resident 104's left elbow of Bacitracin (antibacterial ointment) and a foam dressing (dry dressing used to absorb drainage and provide cushion) every three days. Staff initialed completion the treatment on the evening shift on February 25 and 28, 2025, and March 3, 2025. An incident investigation dated February 25, 2025, at 12:00 AM revealed interdisciplinary team notes dated February 26, 2025, that the wound nurse would follow Resident 104, and a referral was forwarded to the facility's contracted wound care specialists. Documentation by the contracted wound care specialists dated March 4, 2025, included an assessment of a Stage II (sore on a bony prominence that has broken through the top layer of the skin and part of the layer below, resulting in a shallow, open wound) wound on the left elbow, that measured 0.3 cm by 0.5 cm with an unmeasurable depth. The practitioner's plan for treatment included for staff to apply bacitracin and a sterile gauze sponge once daily for 30 days. Review of Resident 104's TAR dated March 2025, revealed that staff failed to implement the treatment change recommended by the facility's contracted wound care specialists. Staff continued to document the application of bacitracin and a foam dressing every three days on March 6, 9, 12, and 15, 2025. Documentation by the wound care specialists dated March 18, 2025, revealed that Resident 104's elbow pressure ulcer worsened to now include necrosis (death of a localized area of tissue due to disease or injury), a larger size of 1.6 cm by 1.5 cm by an unmeasurable depth. The wound presented as 30 percent black necrotic tissue and 70 percent thick necrotic tissue. The surveyor reviewed the above findings regarding the implementation of Resident 104's wound treatments during an interview with Employee 2 (assistant director of nursing) on May 1, 2025, at 10:35 AM and with the Nursing Home Administrator and the Director of Nursing on May 1, 2025, at 2:30 PM. Observation of Resident 104 on April 29, 2025, at 12:24 PM revealed she was in a bariatric bed with a specialty mattress with a mechanical pump. The mechanical pump for the mattress included settings for a patient weight of 100 pounds, bariatric mode (350 to 1000 pounds) and maximum inflation off. Review of Resident 104's weight assessments dated March 4, 2025, to April 29, 2025, revealed that staff assessed her as ranging from 139.6 pounds to 133.1 pounds. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 11 of 53 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 05/02/2025 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)

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Active physician orders for Resident 104 revealed a physician's order dated June 24, 2022, for staff to implement an alternating pressure air mattress to her bed. The order included instructions for staff to monitor settings every shift by sliding forearm between two horizontal cells of mattress making sure resident is immersed 30 to 50 percent into mattress. Interview with Employee 19 (licensed practical nurse) on May 1, 2025, at 1:22 PM revealed that she attended wound care round assessments with the facility's contracted wound care specialists weekly. Employee 19 stated that she was not familiar with Resident 104's mattress pump settings; however, confirmed that the mattress did not appear to have an alternating pressure feature. Employee 19 also confirmed that Resident 104 would not be considered bariatric; nor did the setting of 100 pounds reflect Resident 104's current weight. Review of Resident 104's available plans of care failed to include specific mattress pump settings. A plan of care last revised March 26, 2025, to address Resident 104's pressure ulcers and potential for pressure ulcer development related to immobility, listed interventions that included, PRM (pressure redistribution mattress) to bed/alternating pressure air mattress. Interview with Employee 19 on May 1, 2025, at 1:55 PM revealed that when the facility implemented a new bed for Resident 104 due to a change in facility ownership and resulting change in durable medical equipment suppliers, the new bed likely no longer included an alternating pressure capability. Employee 19 confirmed that Resident 104's active physician orders and plan of care included the implementation of an alternating pressure mattress. The surveyor reviewed the concern regarding Resident 104's plan of care related to mattress type and settings during an interview with the Director of Nursing and Employee 2 on May 2, 2025, at 9:45 AM. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 12 of 53 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 05/02/2025 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)

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, clinical record review, and staff interview, it was determined that the facility failed to complete restorative nursing programs related to range of motion for three of four residents reviewed (Residents 23, 47, and 151). Findings include: Review of Resident 23's clinical record revealed a minimum data set assessment (MDS, a form completed at specific intervals to determine care needs) dated January 13, 2025, indicated that the facility assessed her as having limited range of motion to one side of her upper extremities. A physician's order dated February 25, 2025, directed nursing staff to complete passive range of motion to Resident 23's upper extremities. There was no documented evidence in Resident 23's clinical record to indicate that nursing staff were completing the range of motion to Resident 23's upper extremities since February 2025. Interview with Employee 2, assistant director of nursing, on May 2, 2025, at 9:18 AM confirmed the above findings for Resident 23. Clinical record review for Resident 47 revealed a quarterly MDS dated [DATE], noting staff assessed Resident 47 as independent with bed mobility, transfers, and toilet use. Review of Resident 47s next quarterly assessment dated [DATE], noted staff assessed Resident 47 as now requiring the limited assistance of one staff member for bed mobility and transfers, and limited assistance of two staff members for toilet use. Review of Resident 47's physical therapy documentation revealed physical therapy treated Resident 47 from January 27 to February23, 2025. Further review of Resident 47's physical therapy documentation revealed her discharge summary recommended a restorative nursing program for staff to ambulate Resident 47 150 feet twice a day with handheld assistance of one staff member and seated active range of motion exercises 10 reps twice a day. A restorative referral form was sent to nursing on February 17, 2025. Further review of Resident 47's physical therapy discharge summary revealed her prognosis to maintain her current level of function would be excellent with consistent staff support and participation in the established restorative nursing program. Discharge summary noted treatment results were communicated to the interdisciplinary team and correspondence given to primary caregivers to facilitate development and follow through of Resident 47's plan of treatment. Review of Resident 47's occupational therapy documentation revealed occupational therapy treated Resident 47 from January 27 to March 27, 2025. Further review of Resident 47's physical therapy documentation revealed her discharge summary recommended staff continue Resident 47's restorative nursing program for her upper extremities range of motion and activities of daily living. Further review of Resident 47's occupational therapy discharge summary revealed her prognosis to maintain her current level of function would be good with consistent staff follow through. There was no documented evidence in Resident 47's clinical record to indicate nursing staff completed Resident 47's recommended restorative nursing program since February 2025. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 13 of 53 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 05/02/2025 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)

F 0688 Level of Harm - Minimal harm or potential for actual harm The findings for Resident 47 were reviewed with the Nursing Home Administrator and Director of Nursing during a meeting on May 2, 2025, at 12:06 PM. Clinical record review for Resident 151 revealed a diagnosis list that noted the resident needs assistance with personal care and has a lack of coordination. Residents Affected - Some Review of the current physician orders for Resident 151 revealed that the resident requires assistance of one with a rolling walker for transfers and ambulation. Further review of the current physician orders for Resident 151 revealed an order dated April 8, 2025, for an occupational therapy evaluation and treatment. Review of the tasks list (located in the electronic health record where staff document specific care related events for a resident) for Resident 151 revealed a restorative nursing range of motion (ROM) program dated February 25, 2025, for bilateral lower extremities that included two sets of 10 reps of hip flexion, knee extension, and ankle pumps. Further review of the tasks list for Resident 151 revealed a restorative nursing active range of motion for bilateral upper extremities for two sets of 10 reps of flexion and extension of the resident's shoulders, elbows, wrists, and fingers. Review of the task documentation for Resident 151 for the lower and upper extremity program for February 2025, revealed no tasks documented as completed for the day shift and the task was documented as not applicable NA for the evening shift on February 25-28, 2025. Review of the task documentation for Resident 151 for the lower extremity program and upper extremity program for March 2025, revealed the task was documented as completed on March 1-4, 2025. The remaining days had no documentation that the task was completed, attempted, or the resident refused. The above information for Resident 151 was reviewed in a meeting on May 1, 2025, at 2:30 PM. There was no further documented evidence provided by the facility that staff were completing Resident 151's ROM program for the February and March dates. 28 Pa. Code 211.12 (d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 14 of 53 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 05/02/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on clinical record review, observation, and staff interview, it was determined that the facility failed to implement an intervention to prevent potential resident injury for one of eight residents reviewed for falls (Resident 104). Findings include: Clinical record review for Resident 104 revealed a physician's order dated June 24, 2022, for staff to implement a low bed (approximate average bed height is 24 to 25 inches from the floor to the top of the mattress (about knee level); low-profile beds are 11 inches or less). A plan of care developed by the facility for Resident 104 because of her potential risk for falls listed interventions that included a low bed (last revised February 7, 2025). Observation of Resident 104 on April 29, 2025, at 12:26 PM revealed that she was in a bed that was not in a low position. The bed height was higher than a standard bed, approximately hip level. Observation of Resident 104 on May 1, 2025, at 1:08 PM with Employee 19 (licensed practical nurse) revealed that she was in a bed that was not in a low position. The bed remained at a height higher than a standard bed. Interview with Employee 19 on May 1, 2025, at 1:55 PM revealed that when the facility implemented a new bed for Resident 104 due to a change in facility ownership (estimated as several months ago, the beginning of 2025) and resulting change in durable medical equipment (DME) suppliers, the new bed was incapable of lowering to the floor as required for a low bed. Employee 19 confirmed that Resident 104's active physician orders and plan of care included the implementation of a low bed although this was not possible for Resident 104 due to the new DME suppliers. The surveyor reviewed the above discrepancy regarding Resident 104's bed height during an interview with the Nursing Home Administrator and the Director of Nursing on May 1, 2025, at 2:30 PM. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 15 of 53 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 05/02/2025 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)

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, review of select facility policies and procedures, and staff interview, it was determined that the facility failed to implement interventions to promote acceptable parameters of nutrition for two of eight residents reviewed (Residents 181 and 104). Residents Affected - Few Findings include: The policy entitled Impaired Nutrition/Unplanned Weight Loss- Clinical Protocol, last reviewed without changes on January 17, 2025, revealed the staff and physician will define residents current nutritional status, significant weight loss or gain, and high risk residents with acute symptoms that may be causing weight gain or increasing risk of weight loss. The staff will report to the physician significant weight gains or losses or any abrupt or persistent change from baseline appetite or food intake. The physician and staff will monitor nutritional status, the resident's response to interventions, and possible complications of such interventions. Clinical record review revealed the facility admitted Resident 181 on April 9, 2025. Further review of Resident 181's clinical record revealed the following weight assessments: April 9, 2025, 131.8 pounds April 10, 2025, 129.0 pounds April 15, 2025, 129.4 pounds April 22, 2025, 123.5 pounds April 23, 2025, 122.1 pounds April 29, 2025, 122.8 pounds (a nine pound, 6.82 percent severe weight loss in less than 30 days) Review of Resident 181's clinical record revealed an admission nutrition evaluation dated April 13, 2025, noting Resident 181 lost two pounds since admission. Assessments revealed Resident 181's medications were reviewed with no diuretics or edema noted on admission for potential weight changes. Assessments revealed Resident 181 will maintain her weight without significant changes through next review period. Further review of Resident 181's clinical record revealed an admission MDS (Minimum Data Set, an assessment completed at specific intervals to determine resident care needs) assessment dated [DATE], that revealed the facility determined that a care plan for nutrition would be developed. Review of Resident 181's care plan revealed there was no care plan addressing her nutritional status. Further review of Resident 181's clinical record revealed no assessment of Resident 181's severe weight loss, or any interventions addressing the severe weight loss. Interview with the Director of Nursing and Nursing Home Administrator on May 2, 2025, at 12:37 PM confirmed these findings. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 16 of 53 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 05/02/2025 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)

F 0692 Clinical record review for Resident 104 revealed diagnoses that included: Level of Harm - Minimal harm or potential for actual harm Gastrostomy (PEG, feeding tube, flexible tube inserted through the abdomen into the stomach to administer nutrition, fluids, and medications) Residents Affected - Few Pressure ulcer of the left elbow Chronic kidney disease (insufficient ability of the kidneys to filter waste and fluids from the blood) Hyperlipidemia (increased lipids/fats in the blood) Gastro-esophageal reflux disease (abnormal stomach acid flow back into the esophagus) History of tracheostomy (surgically created opening in the windpipe to allow air to pass directly into the lungs) History of oropharyngeal dysphagia (difficulty in swallowing due to issues in the throat behind the mouth) History of muscle wasting and atrophy (wasting and thinning of muscle mass) A plan of care developed by the facility to address Resident 104's tube feeding listed interventions that included a PEG tube feed as ordered with water flushes: Jevity 1.5 60 milliliters per hour for four hours daily (last revised February 7, 2025); and supplements as ordered: Magic Cup (nutritional supplement) twice daily with lunch and dinner and liquid protein supplement twice daily (last revised February 7, 2025). Staff documented the following weight assessments for Resident 104: October 1, 2024, 152.5 pounds October 8, 2024, 151 pounds October 15, 2024, 150.9 pounds October 22, 2024, 145.6 pounds October 23, 2024, 148.7 pounds October 29, 2024, 147 pounds November 5, 2024, 147.2 pounds November 12, 2024, 149.8 pounds November 19, 2024, 147 pounds November 26, 2024, 146.4 pounds (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 17 of 53 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 05/02/2025 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)

F 0692 December 3, 2024, 143.6 pounds Level of Harm - Minimal harm or potential for actual harm December 10, 2024, 142.2 pounds December 17, 2024, 143.3 pounds Residents Affected - Few Documentation by the facility dietitian dated December 18, 2024, at 11:35 AM revealed that Resident 104 had a current significant weight loss of 7.6 pounds, 5.1 percent in one month. The documentation indicated that Resident 104's typical consumption of meals ranged between 25 and 75 percent. At the time of this documentation, Resident 104 had no pressure injuries (ulcers) noted. Goals included that Resident 104's weight would remain stable. Staff documented the following weight assessments for Resident 104: December 24, 2024, 145.6 pounds December 31, 2024, 146 pounds January 7, 2025, 144.3 pounds January 14, 2025, 146.2 pounds January 21, 2025, 140.6 pounds January 22, 2025, 141.8 pounds January 28, 2025, 141.4 pounds February 4, 2025, 143.8 pounds February 25, 2025, was 139.4 pounds (no weight assessments recorded between February 4 and 25, 2025) March 4, 2025, 138.4 pounds Documentation by the facility dietitian dated March 4, 2025, at 10:42 AM noted that Resident 104 was consuming 25 to 75 percent of her meals, she had a poor appetite, and that her needs were met with enteral nutrition; however, she had a weight loss noted over time. The dietitian noted a current weight of 139.4 pounds. The documentation indicated that due to supplier changes within the facility, Resident 104's enteral formula would change to match availability. The enteral formula order would now be Isosource 1.5. at an increased rate due to trending weight loss (at 70 milliliters per hour for four hours, 8:00 PM to midnight). The dietitian noted Resident 104's weight history as follows: One month (January 28, 2025), 141.8 pounds Three months (November 26, 2024), 146.4 pounds (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 18 of 53 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 05/02/2025 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)

F 0692 Six months (August 27, 2024), 154.7 pounds Level of Harm - Minimal harm or potential for actual harm The dietitian noted that the weight assessments showed a loss over six months that was 9.9 percent, not significant per MDS parameters; however, borderline. The dietitian noted that weight loss was undesirable and that the goal was to maintain weight stability. The documentation indicated that Resident 104 had no pressure related breakdown; however, also noted that she had a new open area to her left elbow (pressure ulcer over a bony prominence). The writer indicated that she would continue to follow Resident 104. Residents Affected - Few The facility did not revise Resident 104's tube feeding plan of care to reflect the change in her enteral feeding type and amount. Resident 104's weight assessments continued to show a decline: March 11, 2025, 139.6 pounds March 18, 2025, 138.9 pounds March 25, 2025, 135.1 (a 3.3-pound, 2.38 percent, loss since the change in her enteral feeding) Documentation by the facility dietitian dated March 28, 2025, at 12:53 PM revealed that she acknowledged Resident 104's weight was currently 135.1 pounds, down 17.5 pounds, 11.4 percent, in six months, which she noted as significant and undesirable. The dietitian noted that Resident 104's meal consumption varied from zero to 100 percent. The dietitian noted that Resident 104's needs were met with enteral nutrition; however, she had weight loss noted over time. The dietitian acknowledged that Resident 104 had an unstageable wound to her left elbow. The dietitian referenced the increase in Resident 104's enteral feeding (that occurred on March 4, 2025, more than three weeks earlier), that she would add weekly weights to check for accuracy (although recorded assessments indicated weekly weights in place since before January 2024) since she questioned the accuracy of the current weight. The dietitian did not request staff to re-weigh Resident 104 at the time of her assessment and documentation. The dietitian did not implement any new interventions despite Resident 104's continued weight loss since the change in her enteral feeding type and amount. Documentation by the facility dietitian dated April 6, 2025, at 10:31 PM indicated that Resident 104 was consuming 50 to 75 percent of most meals, that she had a poor appetite at times, that her needs were met with enteral nutrition; however, she had a weight loss noted over time. The dietitian noted that Resident 104 was at risk for malnutrition, had an unstageable wound to her left elbow, but that she had no recommendations or changes this review period. Staff assessed Resident 104's weight as 135.6 pounds on April 8, 2025. Interdisciplinary documentation (that noted the inclusion of Dietary) dated April 14, 2025, at 3:42 PM continued to note that Resident 104 was consuming 50 to 75 percent of most meals, that she had a poor appetite at times, that her needs were met with enteral nutrition; however, she had a weight loss noted over time. The documentation noted that Resident 104 was at risk for malnutrition, had an unstageable wound to her left elbow, but that there were no recommendations or changes for the review period. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 19 of 53 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 05/02/2025 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)

F 0692 Weight assessments recorded for Resident 104 revealed a continued weight loss as follows: Level of Harm - Minimal harm or potential for actual harm April 15, 2025, 134.4 pounds April 22, 2025, 134.5 pounds (14.2-pound, 9.54 percent, weight loss in six months) Residents Affected - Few April 29, 2025, 133.1 pounds The April 29, 2025, weight assessment indicated a 5.3-pound, 3.82 percent, continued weight loss since the change in Resident 104's enteral feeding. There was no documentation to indicate that the dietitian continued to review Resident 104 after April 6, 2025, to evaluate the effectiveness of the interventions implemented to achieve her goal of weight stability. The surveyor reviewed the above findings regarding Resident 104's continued, insidious, weight loss during an interview with Director of Nursing and Employee 2 (assistant director of nursing) on May 2, 2025, at 9:45 AM and the Nursing Home Administrator, the Director of Nursing, and Employee 2 on May 2, 2025, at 12:15 PM. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 20 of 53 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 05/02/2025 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)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, observation, and staff interview, it was determined that the facility failed to provide respiratory, and tracheostomy care consistent with professional standards of practice for one of one resident reviewed with a tracheostomy (Resident 81) and one of four residents reviewed for respiratory concerns (Resident 435). Residents Affected - Few Findings include: Clinical record review for Resident 81 revealed a diagnosis list that included a tracheostomy (trach, an artificial opening through which a medical tube is placed through the front of the neck into the airway to facilitate breathing). Review of the current physician orders for Resident 81 revealed orders for daily tracheostomy care that included changing the inner cannula. Resident 81's current care plan revealed that the resident has a tracheostomy, and one intervention included emergency procedures if the tracheostomy became dislodged. These emergency interventions included: Keep an extra trach tube and obturator (a curved device to help facilitate the placement of a trach) at the bedside If the tube is coughed out, open the stoma (the opening in the trachea or breathing tube of the body) with a hemostat (a type of surgical instrument). If the tube cannot be reinserted, then monitor and document for signs of respiratory distress. If able to breathe spontaneously then elevate the head of the bed 45 degrees and stay with the resident. Obtain medical help immediately. Observation of Resident 81's room with Employee 20, licensed practical nurse, on April 30, 2025, at 10:39 AM revealed that the resident did have a capped trach. There was no emergency kit or extra trach tube with the obturator, as indicated in the care plan, visible in the resident's room or that could be found by staff. The extra tracheostomy supplies were in a locked medication closet behind the main nurse's station on the nursing unit. Clinical record review for Resident 435 revealed a diagnosis list that included chronic obstructive pulmonary disease (COPD, a lung disease caused by obstructed airflow and breathing difficulties) and chronic systolic heart failure (the heart has difficulty pumping blood). Review of the current physician orders for Resident 435 revealed an order dated April 17, 2025, for supplemental oxygen via a nasal cannula (a type of medical tubing to deliver supplemental oxygen to the nose) at two liters per minute (LPM) every shift for shortness of breath and dyspnea on exertion (shortness of breath during physical activities) as needed for shortness of breath and dyspnea on exertion. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 21 of 53 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 05/02/2025 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)

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident 435's current care plan revealed that the resident has an altered cardiovascular and respiratory status related to the medical history. An intervention included, Give oxygen as ordered by the physician. Observation of Resident 435 on April 29, 2025, at 12:46 PM revealed the resident was in bed and receiving supplemental oxygen via a nasal cannula attached to an oxygen compressor device at the bedside. The flow rate was set slightly above three LPM. Observation of Resident 435 on April 30, 2025, at 10:31 AM revealed the resident was sitting at the bedside in a wheelchair and was receiving supplemental oxygen via a nasal cannula attached to the oxygen compressor. The flow rate was set at just above three LPM. An interview with Employee 20 on April 30, 2025, at 10:34 AM revealed that the resident is on supplemental oxygen, but would have to check the orders to confirm the flow rate. The employee then proceeded to the room to adjust the flow rate to two LPM as indicated in the physician's order. The facility failed to provide respiratory, and tracheostomy care consistent with professional standards of practice. The above information for Residents 81 and 435 were reviewed in a meeting with the Nursing Home Administrator and Director of Nursing on April 30, 2025, at 2:30 PM. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 22 of 53 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 05/02/2025 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)

F 0699 Provide care or services that was trauma informed and/or culturally competent. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and staff and resident interview, it was determined that the facility failed to identify triggers related to a resident's diagnosis of Post-Traumatic Stress Disorder, to provide culturally, competent, trauma-informed care, and to eliminate or mitigate re-traumatization for one of four residents reviewed for mood/behavior (Resident 165). Residents Affected - Few Findings include: Clinical record review for Resident 165 revealed a diagnosis of Post Traumatic Stress Disorder (PTSD, a mental and behavioral disorder that develops related to a terrifying event) since her admission to the facility on October 14, 2024. Review of Resident 165's care plan revealed she uses psychotropic medications related to PTSD. There were no identified triggers (everyday situations that cause a person to re-experience the traumatic event as if it was reoccurring). The facility failed to identify and care plan triggers that may retraumatize Resident 165 related to her diagnosis of PTSD. These findings were reviewed with the Nursing Home Administrator and Director of Nursing on May 1, 2025, at 2:05 PM. 28 Pa Code 211.12 (d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 23 of 53 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 05/02/2025 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)

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. Based on a review of facility documentation, clinical record review, employee personnel record information, and staff and resident interview, it was determined that the facility failed to ensure that nursing staff possessed the specific competencies and skill sets related to medication administration, the care and assessment of residents with indwelling urinary catheters, gastrostomy tubes, and transfer techniques for two of three employees reviewed (Employees 3 and 5, G nursing unit: Residents 36, 104, 43, and 101). Findings include: The Centers for Medicare and Medicaid Services (CMS) QSO-24-13-NH memo dated June 18, 2024, noted that requirements specify that the facility assessment must include an evaluation of diseases, conditions, physical or cognitive limitations of the resident population, acuity (the level of severity of residents' illnesses, physical, mental, and cognitive limitations, and conditions) and any other pertinent information about the resident population as a whole that may affect the services the facility must provide. The assessment of the resident population should drive staffing decisions and inform the facility about what skills and competencies staff must possess to deliver the necessary care required by the residents being served. The Facility Assessment Tool reviewed during the onsite survey last updated February 21, 2024, revealed that all staff training and competencies needed by staff included activities of daily living (e.g., transfers and using mechanical lifts), medication administration, and specialized care (e.g., catheterization insertion/care and tube feedings). The assessment tool did not differentiate the training and competencies needed by the discipline title of the staff (e.g., registered nurse, licensed practical nurse, and/or nurse aide). A review of the facility Resident Matrix (CMS-802, form used to identify pertinent care categories for residents who reside in the facility) documentation revealed that the facility had a total of 12 residents with indwelling urinary catheters within the 184 resident facility census (6.52 percent). The facility had a total of six residents with tube feedings within the 184 resident facility census (3.26 percent). Interview with Resident 36 (who resided on the G nursing unit) on April 29, 2025, at 11:40 AM revealed that she had a PEG tube (a flexible tube inserted through the abdomen into the stomach for the purpose of administering nutrition, fluids, and medications) that staff flush with water periodically. Clinical record review for Resident 104 (who resided on the G nursing unit) revealed a diagnoses list that included a gastrostomy (PEG tube). Current physician orders for Resident 104 instructed staff to administer Isosource 1.5 cal (a calorically dense complete liquid nutrition formula with fiber for increased calorie needs and/or limited fluid) 70 milliliters per hour for four hours. Interview with Resident 43 (who resided on the G nursing unit) on April 30, 2025, at 11:20 AM revealed that he had a suprapubic urinary catheter (a flexible tube inserted through the lower abdomen directly into the bladder to drain urine), which is changed monthly. Review of Employee 3's (licensed practical nurse) personnel records revealed that the facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 24 of 53 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 05/02/2025 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)

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some completed new hire orientation training on December 20, 2024. The orientation training list did not include evidence of any competencies completed with Employee 3 related to indwelling urinary catheters, PEG tubes, or medication administration. Observation of a medication administration pass on the G nursing unit on April 30, 2025, from 12:07 PM to 12:56 PM revealed Employee 3 administered medications to seven residents on the G nursing unit. Medications administered to Resident 101 included Potassium Chloride (mineral supplement) 10 milliequivalents. The label on the Potassium Chloride supplement instructed staff to administer one tablet every two days. Clinical record review for Resident 101 revealed current physician orders (revised April 30, 2025) for staff to administer 10 milliequivalents of potassium via an oral tablet one time a day. Employee 3 did not compare the medication label with the physician's order (via the electronic medication administration record, eMAR) to identify the discrepancy in the frequency stipulated for the supplement (one time a day versus every two days). The surveyor requested examples of competencies completed with Employee 3 (to include indwelling urinary catheters, feeding tubes, and medication administration) during interviews with the Nursing Home Administrator and the Director of Nursing on April 30, 2024, at 1:30 PM and May 1, 2024, at 2:30 PM. Interview with the Director of Nursing and Employee 2 (assistant director of nursing) on May 2, 2025, at 9:45 AM confirmed that the facility had no evidence of any competencies completed with Employee 3. The interview indicated that Employee 3 was agency/contracted staff, and the facility has not completed competency evaluations with staff in the facility through staffing agency contracts (neither licensed nor unlicensed/nurse aide staff). Interview with Employee 5 (nurse aide) on April 30, 2025, at 12:02 PM revealed that she was assigned to residents on the G nursing unit. The surveyor requested examples of competencies completed with Employee 5 (to include safe resident transfer techniques) during interviews with the Nursing Home Administrator and the Director of Nursing on April 30, 2024, at 1:30 PM and May 1, 2024, at 2:30 PM. Interview with the Director of Nursing and Employee 2 on May 2, 2025, at 9:45 AM confirmed that the facility had no evidence of any competencies related to safe resident transfer techniques completed with Employee 5. The facility failed to ensure staff exhibited the appropriate competencies and skill sets to provide nursing and related services necessary for each resident, as determined by individual resident care needs and in accordance with the Facility Assessment Tool. 28 Pa Code 201.20(a)(6)(d) Staff development FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 25 of 53 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 05/02/2025 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)

F 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident must receive and the facility must provide necessary behavioral health care and services. Based on clinical record review, observation, and resident and staff interview, it was determined that the facility failed to develop and implement behavior health interventions that were individualized to attain or maintain the highest practical physical, mental, or psychosocial well-being for one of four residents reviewed for behavior concerns (Resident 135). Findings include: Observation of Resident 135 on April 29, 2025, at 11:59 AM revealed she was seated across from the nursing station yelling non-sensical things every few minutes. Observation of Resident 135 on April 30, 2025, at 9:54 AM revealed she was seated across from the nursing station yelling on and off things like Ow, oh my God, and just moaning loudly. Interview with Resident 60 on April 30, 2025, at 10:05 AM revealed that she is constantly hearing Resident 135 yell, and it's disruptive. During this same interview, Resident 76's daughter also voiced concerns over the constant yelling, saying it disrupts the homelike environment. Observation of Resident 135 on May 1, 2025, from 11:42 AM until 12:07 PM revealed that she screamed and yelled 26 times in a 25-minute timeframe. Interview with Employee 3, licensed practical nurse, on May 1, 2025, at 12:15 PM revealed that Resident 135 has been screaming like that since she was admitted , which was September 16, 2024. Resident 135 could be heard screaming from an adjacent nursing unit during this observation. Review of Resident 135's clinical record revealed no documented evidence that the facility developed a plan of care (care plan) or individualize interventions to address her behavior of constant screaming. There was no documented evidence that the facility implemented behavior tracking to determine patterns, causes, or interventions to alleviate the behavior. After the surveyor questioning, the facility initiated a psych consult. Review of the psych consult notes dated May 1, 2025, indicated that Resident 135 could be heard yelling from her Broda chair at the nurse's station on approach. The consult indicated that there was very little documentation to support ongoing behaviors. The consult requested the nursing document behaviors to establish if there is a pattern as well as monitor for pain control. Review of Resident 135's clinical record after the May 1, 2025, psych consult requesting that nursing staff document behaviors, revealed that there was still no documented evidence to indicate that the facility was monitoring her behavior of yelling. Interview with the Administrator and Director of Nursing on May 1, 2025, at 2:00 PM confirmed the above findings for Resident 135. 28 Pa. Code 211.12(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 26 of 53 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 05/02/2025 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)

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on clinical record review and staff interview, it was determined that the facility failed to ensure that the resident's attending physician addressed and responded appropriately to pharmacy recommendations for three of five residents reviewed (Residents 30, 48, and 133). Findings include: Clinical record review for Resident 30 revealed a consultant pharmacy review dated December 30, 2024, noting Resident 30 has been receiving Ferrous Sulfate (iron supplement) 325 milligrams (mg) since October 2023. The consultant pharmacist requested Resident 30's physician evaluate for discontinuation of Resident 30's iron supplement. Clinical record review for Resident 48 revealed a consultant pharmacy review dated December 17, 2024, noting Resident 48 receives Colestipol (medication used to lower high cholesterol levels) for hyperlipidemia (condition with a high level of fats or lipids in the blood). The consultant pharmacist requested Resident 48's physician recheck her lipids and/or evaluate the use of her Colestipol. Clinical record review for Resident 133 revealed a consultant pharmacist review dated December 30, 2024, noting Resident 133 has an order for Depakote Sprinkles 500 mg twice a day for a diagnosis of seizure disorder. The consultant pharmacist indicated that Resident 133 did not have a diagnosis of seizure disorder. Interview with the Director of Nursing on May 2, 2025, at 12:22 PM confirmed that Residents 30, 48, and 133's physicians, did not address the December 2024 recommendations. 28 Pa. Code 211.9 (k) Pharmacy services 28 Pa. Code 211.12(d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 27 of 53 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 05/02/2025 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)

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 review of select facility policies and procedures, observation, clinical record review, and staff interview, it was determined that the facility failed to ensure adequate storage of medications and biologicals on one of four nursing units (F nursing unit); and failed to ensure accurate labeling of administered medication for one of nine residents observed during medication administration pass (Resident 101). Findings include: Observation of the F nursing unit on April 30, 2025, at 12:18 PM revealed an unlocked and unattended treatment cart. The treatment cart was sitting in a heavily occupied area across from the nursing station, which was accessible to non-licensed staff, visitors, and residents. The treatment cart contained items such as liquid betadine, Triamcinolone cream (a topical steroid cream), wound cleanser sprays, clotrimazole cream (for fungal infections), mupirocin (topical antibiotic), and zinc oxide (for skin rashes). The treatment cart remained unattended until an interview with Employee 1, licensed practical nurse, on April 30, 2025, at 12:24 PM, and she indicated that the treatment nurse left it unlocked. The findings were reviewed during an interview with the Director of Nursing on May 2, 2025, at 11:15 AM. The facility policy entitled, Administering Medications, last revised on February 5, 2025, revealed that the individual administering the medication must check the label three times to verify the right resident, right medication, right dosage, right time, and right method (route) of administration before giving the medication. Observation of a medication administration pass on April 30, 2025, at 12:35 PM revealed Employee 3 (licensed practical nurse) prepared medications for administration to Resident 101 that included potassium chloride (mineral supplement) 10 milliequivalents (mEq). The label on the potassium chloride supplement instructed staff to administer one tablet every two days. Clinical record review for Resident 101 revealed current physician orders (revised April 30, 2025) for staff to administer 10 mEq of potassium via an oral tablet one time a day. Employee 3 did not compare the medication label with the physician's order (via the electronic medication administration record, eMAR) to identify the discrepancy in the frequency stipulated for the supplement (one time a day versus every two days). Interview with Employee 23 (licensed practical nurse) on May 1, 2025, at 2:00 PM confirmed that the label on Resident 101's potassium supplement instructs staff to administer the supplement every two days (every other day). Employee 23 could not find the physician order in Resident 101's electronic medical record that matched the pharmacy instructions on the label to administer every two days. Review of Resident 101's MAR (Medication Administration Record, electronic documentation of the administration of medications) dated April 2025, revealed that staff did not administer a potassium (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 28 of 53 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 05/02/2025 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)

F 0761 supplement to Resident 101 daily or every other day during that month. Level of Harm - Minimal harm or potential for actual harm Resident 101's MAR indicated that staff implemented a physician's order to administer 20 mEq of potassium twice a day for two administrations on April 22, 2025. Residents Affected - Few Resident 101's MAR indicated that staff implemented a physician's order to administer 20 mEq of potassium one time only on April 25, 2025. Resident 101's MAR revealed that Employee 3 initialed the administration of 10 mEq of the potassium supplement as a one-time dose on April 30, 2025, at 1:15 PM. Interview with the Director of Nursing and Employee 2 (assistant director of nursing) on May 2, 2025, at 9:45 AM revealed that the physician's order to administer 10 mEq of potassium to Resident 101 every other day was in effect from February 16, 2025, to March 5, 2025; therefore, each licensed nurse who administered a potassium supplement from the supply available for Resident 101 failed to verify the label with the eMAR three times before administration. The interview indicated that Employee 19 (licensed practical nurse) provided Employee 23 a Medication Change, sticker (sticker applied to a medication label to indicate that the instructions on the medication label may not match the physician's order) following the surveyor's questioning. 483.45(h) Storage of Drugs and Biologicals Previously cited 6/7/24 28 Pa. Code 211.9 (k) Pharmacy services 28 Pa. Code 211.12 (c)(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 29 of 53 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 05/02/2025 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)

F 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observation, and resident and staff interview, it was determined that the facility failed to obtain professional dental services for four of eight residents reviewed for dental concerns (Residents 43, 30, 47, and 133). Residents Affected - Some Findings include: Interview with Resident 43 on April 30, 2025, at 11:02 AM revealed that he was edentulous (had no natural teeth). Resident 43 stated that he lost his dentures before his admission to his facility; and he would like to obtain dentures again. Clinical record review of social services documentation dated April 30, 2025, at 1:13 PM (following the surveyor's questioning) revealed that social services staff confirmed that Resident 43 stated that he needed new dentures, that the facility obtained Resident 43's consent for their contracted professional provider, and that the plan was for Resident 43 to receive services on May 16, 2025. Review of a significant change MDS (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) assessment dated [DATE], revealed that the facility assessed Resident 43 as edentulous, and the facility would proceed to care plan development regarding the dental care area concern. Review of a plan of care initiated by the facility on May 22, 2024 (revised February 7, 2025), revealed that due to Resident 43's self-care activities of daily living (ADL) performance deficits, he required assistance as needed with oral care daily, and he was edentulous. The surveyor requested any evidence that either Resident 43 received routine professional dental services or declined those services since his admission to the facility on May 24, 2024, during an interview with the Nursing Home Administrator and the Director of Nursing on April 30, 2025, at 1:30 PM. The facility did not provide any evidence that Resident 43 received or refused professional dental services since his admission to the facility. Observation of Resident 30 on April 29, 2025, at 2:37 PM revealed broken natural teeth. Clinical record review for Resident 30 revealed no evidence of professional dental services in the past year. Interview with the Director of Nursing on May 2, 2025, at 12:11 PM confirmed Resident 30 has not seen a dentist, or received routine professional dental cleanings in the last year. Clinical record review for Resident 47 revealed nursing documentation dated August 12, 2024, at 7:15 AM that staff noted a right front tooth loose but intact. The documentation indicated that Resident 47 had a dental appointment pending. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 30 of 53 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 05/02/2025 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)

F 0791 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Nursing documentation dated August 15, 2024, at 1:13 PM revealed that staff made multiple telephone calls to local dentists who were unable to schedule an appointment for Resident 47 due to not accepting Medicare. Review of census information for Resident 47 revealed that the facility began receiving Medicaid payment for services on July 1, 2024. Resident 47's clinical record contained no additional evidence that the facility attempted to obtain professional dental services for Resident 47. The surveyor requested any evidence of professional dental services for Resident 47 during an interview with the Nursing Home Administrator and the Director of Nursing on April 30, 2025, at 1:30 PM. Social services documentation dated April 30, 2025, at 6:32 PM (following the surveyor's questioning) revealed that staff telephoned and left a message with Resident 47's guardian regarding available in-facility contracted professional dental services. Interview with the Director of Nursing on May 2, 2025, at 9:28 AM confirmed that the facility had no documentation that Resident 47 received any professional dental care since admission to the facility on September 18, 2023, or her conversion to Medicaid payment for services in July 2024. Clinical record review for Resident 133 revealed that the facility began receiving Medicaid payment for services as of March 30, 2023. An active physician's order dated August 28, 2023, instructed staff to arrange routine care with the facility's contracted professional dental provider. Nursing documentation dated August 27, 2023, at 12:03 PM revealed that the nurse noted, very foul, odor from Resident 133's mouth when she was speaking. The nurse visualized, multiple black, rotten teeth, mostly the back molars. The documentation indicated that the staff referred Resident 133 for dental services. Nursing documentation dated January 30, 2024, at 3:56 PM revealed that the dental hygienist reported to the facility that Resident 133 was provided with a referral for full dental extractions of her remaining teeth. Nursing documentation dated August 5, 2024, at 4:11 PM revealed that Resident 133 returned from a dentist appointment. The transportation aide stated that Resident 133 would not cooperate, was agitated and aggressive during her time with the dentist and was grabbing at the dentist's equipment. The dentist recommended rescheduling Resident 133. Social services documentation dated August 8, 2024, at 2:55 PM revealed that the facility obtained consent from Resident 133's guardian for services from the facility's contracted professional dental provider. Documentation by the certified registered nurse practitioner dated January 4, 2025, noted that Resident 133 continued to need dental care, and she had a foul odor from her mouth. Interview with the Director of Nursing on May 2, 2025, at 9:28 AM revealed that the facility had no (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 31 of 53 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 05/02/2025 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)

F 0791 Level of Harm - Minimal harm or potential for actual harm documentation that Resident 133 received professional dental care since August 5, 2024. The facility did not contact an oral surgeon or arrange for dental extractions with the facility's contracted professional dental provider as recommended. 28 Pa. Code 211.15 Dental services. Residents Affected - Some 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 32 of 53 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 05/02/2025 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)

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observation and resident and staff interview, it was determined that the facility failed to serve food that is palatable and attractive on three of four open nursing units (Nursing Units B, F, and G; Residents 60, 76, 100, 131, 151, 157, 170, and 172) and in one of two dining areas reviewed (Cranberry Dining Room; Residents 106 and 148). Residents Affected - Some Findings include: Review of facility grievance/concerns forms for February 2025, revealed several food concerns initiated from the resident council meeting on February 27, 2025, including concerns the food was different, the serving sizes were smaller, the temperature of all the foods served was the same, the quality of the food was terrible, the food comes burnt, and the fish was gross. The grievance response by facility staff on March 4, and 5, 2025, indicated the cooks would be educated on serving sizes, cooking times, and plate displays, and due to a change in food vendors the dietary director was working to find the best products. A review of facility grievance/concern forms dated March 21, 2025, revealed several concerns initiated from a resident council meeting held March 20, 2025, which indicated all residents at resident council agree that the food is terrible, but understand it is not the kitchen staff's fault. The facility's response to the grievance, dated March 26, 2025, indicated the action plan as, Thank you, we will continue to try to make things better. In an interview and observation of Resident 172 on April 29, 2025, he was lying in bed with his lunch tray at the side of the bed. The resident stated he had not started to eat yet. Resident 172 stated he doesn't like the vegetables served at the facility because they are always mushy. Two carrots were observed on the resident's lunch tray, and they looked very mushy. An observation of Resident 100 on April 30, 2025, at 12:30 PM revealed she was lying in bed with her lunch in front of her. A mix of vegetables on the tray appeared soft and mushy, with liquid from the vegetables pooled on the resident plate extending over to a pile of pasta with red sauce. The noodles appeared dry, the sauce was dry and clumped, (not smooth/runny), and dark brown burnt pieces surrounded the top of the pasta. The above concerns regarding Residents 100 and 172, and no initiation of follow up to resolve the resident complaints about food were reviewed with the Nursing Home Administrator and Director of Nursing on May 2, 2025, at 12:30 PM. Interview with Resident 151 on April 29, 2925, at 1:00 PM revealed concerns about the taste of the food served and that the food isn't good. Interview with Resident 170 on April 30, 2025, at 9:45 AM revealed the resident voiced concerns about the palatability of the food served and stated [the] Food don't taste good. Observation of the lunch dining service in the Cranberry Dining Room on May 1, 2025, revealed that food trays arrived on the food cart at 11:56 AM and staff began passing the food trays to the residents present in the dining area. A test tray obtained after staff had finished passing resident trays in the Cranberry Dining Room (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 33 of 53 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 05/02/2025 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)

F 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some on May 1, 2025, at 12:11 PM revealed a regular tray with a slice of ham, sweet potatoes, and cabbage. The cabbage had an excessive amount of moisture in it and was noted to be pooling around the cabbage on the plate. The cabbage tasted watery upon sampling. An interview with Resident 148 present in the Cranberry Dining Room on May 1, 2025, at 12:15 PM revealed that the resident felt the cabbage tasted waterlogged and the sweet potatoes were a little dry. An interview with Resident 106 present in the Cranberry Dining Room on May 1, 2025, at 12:17 PM revealed the resident had not eaten her soup, which appeared to be chicken noodle soup and voiced, the noodles are mush. Interview with Resident 60 on April 30, 2025, at 10:06 AM revealed that she thinks the food is lousy, no fresh fruit, the meat is poor quality and tough, the mashed potatoes are runny, and that she sometimes goes to bed hungry because she can't eat any of the food. Observation of Resident 60's lunch tray on April 30, 2025, at 12:30 PM revealed that she was served a pasta dish with cheese that was burnt and hard on the edges. Resident 60 indicated that her mixed vegetables were mushy. During this observation, Resident 76 (Resident 60's roommate) indicated that her pasta dish was tough. Interview with Resident 157 on April 29, 2025, at 12:47 PM revealed that he had a lot of complaints about the food appearance and palatability. Resident 157 indicated that he gets burnt food, mushy vegetables, and runny mashed potatoes. The facility failed to provide food that was both palatable and attractive to ensure residents' satisfaction. The above findings regarding food palatability were reviewed in a meeting with the Nursing Home Administrator and Director of Nursing on May 1, 2025, at 1:45 PM. In an interview with Employee 7, director of dining services, on May 2, 2025, Employee 7 indicated the facility did not have a food committee, and facility staff had not been completing test trays to determine palatability/appearance of the food served at the point of service to the residents, despite ongoing complaints regarding the food quality in February and March 2025, which continued among the residents in the above noted interviews. Interview with Resident 131 (who resided on the G nursing unit) on April 29, 2025, at 10:51 AM revealed his opinion of the food provided by the facility was, .terrible, generic foods, powdered eggs. Resident 131 reported that he received fish that resembled beef jerky, and that it was hard enough that he could not eat it. Resident 131 approached the surveyor on April 29, 2025, at 12:30 PM to observe his lunch tray. Resident 131 stated that he was, not going to touch it, because he believed the food would not be edible. Resident 131 stated that he was going to eat his cereal in his room for his lunch meal. Observation of the G nursing unit on April 30, 2025, revealed the cart with lunch meal trays arrived on the unit at 12:09 PM. Staff began to pass trays immediately from the cart to resident rooms until the last tray remained on the cart at 12:22 PM. The surveyor observed the last tray with Employee (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 34 of 53 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 05/02/2025 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)

F 0804 6 (licensed practical nurse) on April 30, 2025, at 12:27 PM for the following findings: Level of Harm - Minimal harm or potential for actual harm Pasta noodles covered in red sauce were dry, clumped, and contained numerous blackened pieces indicative of burning. There was insufficient sauce to moisten the pasta. The pasta entree maximum temperature was 118 degrees Fahrenheit. Residents Affected - Some Mixed vegetables were mushy and watery. The vegetables maximum temperature was 118 degrees Fahrenheit. Observation of Resident 131's room on May 1, 2025, at 1:39 PM with Employee 19 revealed Resident 131 opened the lockable drawer of his bedside stand to show the surveyor and Employee 19 an item that he identified as a piece of fish that he kept in his room for months to show staff, residents, and visitors for, show and tell, while complaining about the facility's food quality. The surveyor reviewed the above food concerns related to Resident 131 and the G nursing unit during an interview with the Nursing Home Administrator and the Director of Nursing on May 1, 2025, at 2:30 PM. The interview revealed that the facility had no policy or procedure regarding an expectation of food palatability temperatures at the point of service (upon arriving on the unit for resident consumption). 28 Pa. Code 201.14(a) Responsibility of licensee FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 35 of 53 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 05/02/2025 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)

F 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. Based on observation, review of facility scheduled mealtimes, and resident and staff interview, it was determined that the facility failed to ensure the provision of a nourishing (satisfying to the resident) evening snack when greater than 14 hours elapsed from the supper meal to breakfast on two of four open nursing units (F and G; Residents 8 and 43). Findings include: Review of the facility's Meal Cart Delivery Times document last revised May 26, 2023, revealed the supper meal service line is to start at 4:15 PM with service to the facility dining rooms and nursing units, and the breakfast service line is to start at 6:30 AM with service to the same areas, indicating a time span exceeding 14 hours. Further review of the meal cart delivery times revealed the facility does not have dining rooms open for breakfast meal service and dining room (Overlook, Chapel, and Cranberry) carts are to be delivered for supper at 4:15 PM, 5:00 PM, and 5:05 PM, and residents would be served breakfast from the hall cart in which they reside. Breakfast service for hall carts indicated the carts are delivered between 6:45 AM and 8:00 AM, indicating a time span of 14 hours and 30 minutes to 15 hours 45 minutes may occur depending on the hall in which the resident resides. Review of a facility provided snack list indicated that snacks are offered at 10 AM, 3 PM, and HS (evening), and are an assortment of the following: graham crackers, saltines, animal crackers, oatmeal cream pies, fudge rounds, and ice cream. In an interview with Resident 8 on April 30, 2025, at 10:00 AM she indicated she had to ask for any snacks, and if she did not ask, she did not receive a snack. Clinical record review for Resident 8 revealed the resident had diagnosis of diabetes (a condition that leads to high blood sugar levels), receives insulin (an injectable medication used to manage high blood sugar levels), and was tasked to receive a snack each evening. A review of Resident 8's evening snack documentation for April 2025, revealed the resident was marked not available on 19 days of the month, refused on two days, marked as task not completed on one day, and contained no documentation at all for the remaining days of the month. Resident 8 was not out of the facility at night to not be available for April 2025. There was no evidence Resident 8 was offered snacks at 10 AM or 3 PM. In an interview with the Nursing Home Administrator and Director of Nursing on May 1, 2025, at 2:30 PM they indicated prescribed snacks are offered to diabetic residents, further clarifying as diabetic residents who use insulin, in the evening, and there was a list that went to the nursing units, and all other residents could receive from the snacks in the pantry areas anytime they wanted one. An observation of the F wing nursing unit pantry area on April 30, 2025, at 10:18 AM revealed 10 cereal packs in the cabinet, a small plastic bin of assorted snacks such as graham crackers, sandwich crackers, fudge round cookies, and three small boxes of oatmeal round cookies on top of the refrigerator. The refrigerator contained two partially empty half gallon contains of milk, and four two quart open containers of assorted juice. There was no ice cream or items a pureed texture diet could (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 36 of 53 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 05/02/2025 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)

F 0809 tolerate stocked in the pantry. Level of Harm - Minimal harm or potential for actual harm An observation of the G unit pantry on April 20, 2025, at 10:51 AM revealed a box of fudge round cookies and a small bin of assorted cookies and crackers in the cabinet. Three half gallon containers of milk were observed in the refrigerator with two of them partially empty. Four two quart containers of juice (two opened) were also observed in the refrigerator and four individual ice cream cups were in the freezer. Residents Affected - Some In an interview with Employee 7, director of dining services, on May 2, 2025, at 11:20 AM, Employee 7 indicated the bins of crackers and cookies are delivered to the nursing units each day, and there is not a list of prescribed snacks for 10 AM or 3 PM, but there is a list for the HS (evening snack) for the diabetic residents. Any resident who wants a snack would get one from what is available and stocked on the unit. Review of the HS snack list provided by Employee 7 revealed the majority of the snacks listed in indicated snack of the day, and only 63 residents of the facility's current census of 184 were listed to receive a prescribed evening snack. The majority of the prescribed evening snacks were listed as snack of the day. Employee 7 indicated there was a rotating list of the snack of the day for each day of the week, which included a rotation of one of either a sugar free cookie, four ounce bowl of applesauce, half of a peanut butter and jelly sandwich, four ounce fruit bowl, or four ounce vanilla pudding. There was no nourishing beverage or other items listed to be provided with the snack. A review of the resident census revealed 54 residents resided on the F nursing unit and 57 on the G nursing unit. Review of facility diets also revealed 11 residents required a pureed texture resided on the F nursing unit and 10 on the G nursing unit. The above observations of the F and G nursing unit pantry areas revealed the supply of cookies/crackers, ice cream, cereals, milk, and juice, were not adequate in quantity to be offered to all residents residing on the unit, nor was there a supply of items to be offered to residents requiring a puree food texture modification residing on the units. The prescribed snacks listed also did not provide evidence a nourishing/satisfying snack was offered, as the snack was often just a sugar free cookie, or small bowl of fruit. The facility staff were not able to provide any evidence a nourishing/satisfying snack was offered to all residents in the facility each evening as the time span between supper and breakfast exceeds 14 hours. Interview with Resident 43 on April 30, 2025, at 11:05 AM revealed that he reported he has been refusing snacks since the facility converted to new administration (described by Resident 43 as over a month). The surveyor requested any evidence that staff offered or Resident 43 consumed snacks between meals or at bedtime (HS) during an interview with the Nursing Home Administrator and the Director of Nursing on April 30, 2025, at 2:00 PM and May 1, 2025, at 2:30 PM. Review of documentation provided by the facility revealed that from January 1, 2025, through February 17, 2025, staff documented the provision of HS snacks for Resident 43; however, no documentation of the offering of an HS snack existed after that time. Handwritten notations on the documentation indicated that, (Resident 43) HX (history) of HS Snack - 2/2 (February 2, 2025, transfer new task was not populating for CNAs (nurse aides) fixed now. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 37 of 53 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 05/02/2025 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)

F 0809 Level of Harm - Minimal harm or potential for actual harm The above information was reviewed with the Nursing Home Administrator and Director of Nursing on May 2, 2025, at 12:30 PM. 28 Pa. Code 201.14(a) Responsibility of licensee Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 38 of 53 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 05/02/2025 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)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and staff interview, it was determined that the facility failed to store food and maintain food service equipment in accordance with professional standards for food service safety in the facility's main kitchen, and two of four open nursing units (F, G, and B). Findings include: An observation in the facility's main kitchen on April 29, 2025, at 9:30 AM with Employee 7, director of dining services, revealed the following: Shelving units in the dishwashing area, with clean food service equipment stored on them, contained dust and debris on the shelves. The ceiling tiles surrounding the exhaust unit extending from the dish machine to the ceiling were bulging wet and stained. Employee 8, dietary aide, was observed with gloved hands taking racks of clean dishware from the clean end of the dish machine and putting the items away onto to clean carts. Employee 8 then retrieved a meal delivery cart from the other end of the machine in which other employees were removing dirty/used meal trays from and moved the cart to another area in the dish room. Employee 8 then proceeded to go back to removing clean items from the clean end of the dish machine and did not change their gloves or perform hand hygiene before returning to handle clean dishware items. A white cutting board like surface extending along the front of a sandwich bar station was observed with deep cuts on the surface and was blackened and stained. Three meal delivery carts were observed in the main area of the kitchen, Employee 7 indicated they were clean for use on the lunch service line. The carts contained cracked plastic handles, dried food on the outside and inside of the cart doors, and around the base of the cart. Dried spills/stains were observed on the interior of the cart doors. A clear plastic container was observed on a lower shelf in the main kitchen area with a tan colored powdery substance inside the container. The container was labeled as chicken broth. A plastic spoon was observed inside the container lying in the powdery substance. The flooring and wall area under the three-compartment sink contained significant dirt and debris, and black buildup. A chest freezer containing ice cream cups beside the tray service line was observed with multiple cracks and broken pieces on the interior. The interior of the lid was observed with the interior insulation of the lid exposed in multiple spots. A plate base warmer beside the chest freezer was observed with debris, and dust buildup on the wheel bumpers, and dried food splatter on exterior sides. A plastic rack with clean plate bases beside the warmer was also covered in dust. The flooring under the tray line belt area was dirty with a large collection of dirt/debris. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 39 of 53 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 05/02/2025 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)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Two steam tables positioned beside the tray service line were observed on and hot, with water in each of the steam wells. The base of the interior steam wells was observed with a brown film covering each base and food debris, including rice, was observed in the water of one of the wells. Employee 7 stated the steam wells were cleaned, drained and wiped out each day at the end of the night, although Employee 7 confirmed rice was not served at the breakfast meal and would have been from a prior lunch or dinner meal. A three-tier black cart between the two steam tables with clean adaptive plates stored on it was observed soiled with a significant amount of dried food and chunks of dried food sticking on the frame of the cart. A wheeled dolly by the steam tables holding multiple dish racks of clean bowls was extremely dusty and covered in dried food, and debris. A three-tier tan cart by the steam table was significantly worn with multiple cracks, stains, and food buildup. The front walk-in cooler was observed with food debris and dried spills on the lower shelf of the storage racks in the cooler where food products were stored. A black plastic storage shelf outside the back walk-in cooler and freezer units was observed with dust and debris buildup on the shelves. The walk-in freezer floor contained significant debris scattered around the flooring and under shelving units, including pieces of paper, pieces of cardboard, peas, carrots, cauliflower, and corn. A wide open box of fish filets was observed on a shelf in the walk-in freezer with the bag inside the box wide open exposing the product. A box of pizza and a box labeled flatbread were also observed wide open on the shelf with the bag inside the box wide open exposing the products. A bag of shrimp was observed sitting on a shelf with no evidence to indicate when the bag of shrimp was placed there or the use by date. Multiple packages of white bread loaves, wheat bread, hot dog buns, and hamburger buns were observed on shelving racks in the dry storage area. Employee 7 indicated all bread products are delivered to the facility frozen, and they are good for seven days once they are pulled from the freezer. There was no evidence when the products observed were removed from the freezer or when they needed to be used by. The lower shelves in the dry storage area where food products were stored were dust and dirty. A white plastic bin on a shelf in the dry storage area containing bags of pudding mix was observed with a buildup of dust and black debris inside the bin. A three tier black cart in the dry storage room that Employee 7 indicated staff use to transport items back and forth to the main kitchen area was dirty and dusty, with food crumbs and dust on the shelves and collected in the grooves of the handles. A large box labeled rainbow sprinkles was observed on a shelf with a quarter of the container remaining in the box, there was no date to indicate when the product was placed there, when it was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 40 of 53 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 05/02/2025 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)

F 0812 opened, or when it needed used by. Level of Harm - Minimal harm or potential for actual harm A metal rack holding a variety of large cans of food products in the dry storage area was observed with a significantly dented can of tomato paste, corn, and diced potatoes available for use. Residents Affected - Many The interior of two lower convection oven units were observed with thick buildup of black debris on the interior base, door ledge, and interior doors. A tiered service cart holding multiple used cooking pans and utensils was observed sitting directly up against a storage shelving unit of clean kitchen equipment. The flooring under the toaster area extending around the corner under a two compartment sink was observed with think black debris buildup and splatter than extended up the wall tiles. A soap dispenser in the same area by the handwashing sink was covered in dust, and two knife racks containing multiple knives were covered in dust. Conduit extending from the ceiling to outlets, and fire alarm alert boxes along the wall were covered in thick dust buildup throughout the kitchen food preparation area. Laminated signs and large posters hanging on the wall were covered in thick dust on the tops of frames and front surfaces of the wall hangings. A small floor stand mixer located by the two-compartment sink, was observed not in use. The mixing bowl was uncovered, and a dead winged insect was observed lying the base of the bowl. The safety guard was covered in dried food debris and a white powdery substance. Foot pedal trash receptables located under two production tables were observed significantly soiled and blackened with dried food and splatter on the exterior and interior of the bins and lids. Ceiling light covers throughout the kitchen area were observed with dead insects in the light covers. A lower shelf of a production table where plastic wrap and other kitchen supplies were stored contained dust, debris, and dried food. A clear plastic bin by the tray line holding packages of clean plastic lids was observed with dried brown debris and spills on the bin. A service hallway where the ice machine was located and where all used meal carts are pulled through was observed with visible dirt/debris buildup on the flooring and along wall edges, another trash receptacle in the hallway was soiled and blackened on the exterior. A threshold from the service hallway into the main kitchen preparation area was observed with thick black buildup, which extended into the kitchen behind a service table and up along the wall behind the table. Black debris was observed hanging from the end of a drainage pipe from the ice machine to the floor drain. A large square exhaust unit hanging from the kitchen ceiling 2-3 feet above the meal service line (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 41 of 53 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 05/02/2025 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)

F 0812 was observed with thick dust buildup covering all sides four sides of the exhaust unit grid like covers. Level of Harm - Minimal harm or potential for actual harm A portable cooler labeled as R2 was observed with duct tape covering a large portion of the exterior door to the unit surrounding the handle. Residents Affected - Many Glass globe covers of the lights in the steamer area exhaust hood were observed with a brown substance covering the globes and collected in the interior of the globes. Flooring under the steamer area was covered in debris, dust, blackened buildup under the equipment, extending up the wall behind the equipment in the area. Wall tiles beside the equipment extending to the right side of the exit door to the hallway were broken, cracked, and covered in black buildup. A black tiered cart by the stove top with butter, granola, and a box of gloves stored on it, was soiled on all three tiers of the cart with dust, dried food, dried liquids, and debris was collected in the handles of the cart. A follow up observation in the main kitchen on May 1, 2025, revealed the following: Four dietary employees, Employee 9, dietary aide, Employee 10, cook, Employee 11, cook, and Employee 12, kitchen supervisor, working in the main area of the kitchen, preparing or serving food. The four dietary employees had significant facial hair and moustaches, each were wearing beard guards with only the hair on the lower portion of their chins covered, all other long facial hair and moustaches were exposed, their clothing appeared soiled and stained. A large white plastic bucket was observed on the lower shelf of a preparation table. The interior of the bucket was covered in brown splatter and debris with a plastic scoop sitting in the bucket. Employee 7 indicated the bucket was used to collect the drainage from the steam table. Multiple potholders were observed being obtained and utilized as staff worked in the kitchen serving lunch. The white potholder mitts were blackened and stained. A ceiling tile over the hood unit above the steamer area was liquid stained and brown. An ice cart utilized to obtain ice for resident beverages was observed on the F wing nursing unit on April 30, 2025, at 10:15 AM. The middle shelf of the cart was observed covered in dust and blackened. The lower shelf of the cart was dirty with dust, debris, and pieces of hair stuck to it. It also had a pink buildup observed on the shelf. An observation of the F nursing unit pantry on April 30, 2025, at 10:18 AM revealed the following: Dead insects in the ceiling light cover of the room. A bin containing a mix of ketchup, mustard, and dressing packets was observed in a cabinet with no date to indicate when it was placed there or when it needed used by. Bins in the cabinet containing tea bags, salt, pepper, creamers and margarine, were dusty and dirty. [NAME] paper bags were observed in the cabinet containing sweetener and sugar packets and two (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 42 of 53 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 05/02/2025 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)

F 0812 Level of Harm - Minimal harm or potential for actual harm plastic bins with mixed jelly packets were observed on the counter in the room, there was no date to indicate when the items were placed there or when they needed used by. The microwave in the F nursing unit pantry was significantly soiled on the interior with dried food splatter and piles of food debris in the corners of the interior of the unit. Residents Affected - Many A can of chicken and rice soup was observed in the cabinet with a manufacturer's best by date of September 18, 2024. A single serve container of oatmeal was observed in the cabinet with a manufacturer's best by date of October 14, 2023. A paper bag was stored in the cabinet from an outside food restaurant with an unidentified food item wrapped inside the bag. The bag was not labeled as to who it belonged to or when it was placed there. A metal tin half full of cookies was in the cabinet with no label or date when it was opened. A gallon plastic bag was observed on the shelf full of dry white rice. There was no label or date on the bag. The refrigerator in the pantry was observed with a large carboard box labeled with a resident's name as well as several plastic grocery bags. Multiple food items were observed packed in the box and bags. There was no date to indicate when the items were placed there or when they needed used by. Two unidentified items wrapped in foil were observed on a shelf in the refrigerator with no label or date. Two bowls of what appeared to be pudding or applesauce/pureed fruit were on the shelf with no label or date. A small container of prune juice was observed in bin in the refrigerator with no date. An observation of the G nursing unit pantry area on April 30, 2025, at 10:51 AM revealed the following: Multiple brown paper bags of items such as pancake syrup packets, sugar, and sweetener stored on the shelves inside cabinets in the area. There was no date as to when the items were placed there or when the needed used by. A plastic bin holding containers of ketchup, mustard, salt, and pepper was observed on the counter. There was no date as to when the items were placed there or when they needed used by. Two plastic bowls were observed in the refrigerator, which appeared to be pudding and applesauce/pureed fruit, were not labeled or dated as to when they were placed there or needed used by. A chef's salad was observed on a plate on the shelf in the refrigerator with no date. Observation of the ice cooler cart, which is used to obtain ice for resident beverages on the unit, on the B nursing unit on April 30, 2025, revealed significant dust/dirt collected on the lower shelf of the ice cart. The above findings in the main kitchen, and B, F, and G, nursing units were reviewed with the Nursing Home Administrator and Director of Nursing on May 1, 2025, at 2:50 PM. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 43 of 53 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 05/02/2025 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)

F 0812 483.60(i)(2) Store, prepare, food safe and sanitary Level of Harm - Minimal harm or potential for actual harm Previously cited 6/7/24 28 Pa. Code 201.14 (a) Responsibility of Licensee Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 44 of 53 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 05/02/2025 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)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, clinical record review, and resident and staff interview, it was determined that the facility failed to implement transmission-based contact precautions for one of 35 residents reviewed (Resident 14) and failed to provide the highest practicable care regarding Enhanced Barrier Precautions for one of 35 residents reviewed (Resident 81). Residents Affected - Few Findings include: Review of the memo entitled Enhanced Barrier Precautions (EBP, gown and glove use) in Nursing Homes to Prevent the Spread of Multi-drug Resistant Organisms released by the Center for Medicaid and Medicare Services (CMS) on March 20, 2024, with an implementation date of April 1, 2024, revealed that nursing care facilities are to use EBP for residents with chronic wounds or indwelling medical devices during high-contact resident care activities regardless of their multidrug-resistant organism status. High-contact activity would include things like dressing, transferring, changing linens, providing hygiene, changing briefs, wound care, or device care. Clinical record review for Resident 81 revealed a diagnosis list that included a tracheostomy (trach, an artificial opening through which a medical tube is placed through the front of the neck into the airway to facilitate breathing) and a percutaneous endoscopic gastrostomy tube (PEG tube, a type of medical tubing passed through the abdominal wall and into the stomach to facilitate feeding and hydration). Review of the current physician orders for Resident 81 revealed orders for daily tracheostomy care that included changing the inner cannula, bolus tube feeding, and water flushes through the resident's PEG tube. Resident 81's current care plan revealed that the resident has a tracheostomy. Observation of Resident 81 on May 1, 2025, at 12:42 PM revealed that resident had a capped PEG tube present in his abdomen and a capped tracheostomy. Observation of Resident 81's trach care on May 1, 2025, at 12:42 PM revealed a tote on the resident's door with various personal protective equipment (PPE) and a sign that noted the resident was on Enhanced Barrier Precautions. Employee 21, licensed practical nurse, confirmed that the resident was on EBPs and proceeded to don the appropriate PPE. Further review of Resident 81's clinical record revealed no evidence that the resident was on EBPs. The clinical record contained no order, no banner (a section near the top of the resident's electronic health record to indicate important care items) that noted EBPs, no care plan interventions, or tasks (located in the electronic health record where staff document specific care related events for a resident) that instructed staff to utilize EBPs. A new physician's order dated May 1, 2025, was now in the electronic health record that instructed staff to utilize EBPs for Resident 81 after surveyor discussion with the facility. The above information for Resident 81 was reviewed in a meeting with the Nursing Home Administrator and Director of Nursing on May 1, 2025, at 2:30 PM. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 45 of 53 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 05/02/2025 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)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On April 29, 2025, at 10:30 AM the Director of Nursing indicated one resident (Resident 14) in the facility was on transmission-based precautions as they had just returned from the hospital. An observation of Resident 14's room on April 29, 2025, at 12:36 PM revealed she was out of the room and the resident's visitor was waiting for her to return as he indicated she was in the dining room for lunch. A bag was observed over the door to the room with personal protective supplies, including gowns and gloves, with a sign indicating enhanced barrier precautions were in place for the room. Resident 14 resided in the room with two other residents. It was unclear who the enhanced barrier precautions were to be implemented for. There was no sign to indicate any of the residents in the room were on transmission-based precautions (contact, droplet, or airborne). As the above observation of Resident 14's room were being made, two staff were observed wheeling Resident 14 back to the room. Employee 16, registered nurse, began working with the resident and administered intravenous medication (medication administered utilizing a pump device, tubing, and needle directly into blood stream). Employee 16 was wearing gloves but not a gown. Clinical record review for Resident 14 revealed she returned to the facility from the hospital on April 28, 2025, after receiving treatment for a urinary tract infection. Further review of the resident's clinical record revealed she had special instructions flagging at the top of her electronic record indicating the resident was on enhanced barrier precautions for a history of ESBL (extended-spectrum beta-lactamase, a substance that makes bacteria resistant to many antibiotics). A physician's order was also present dated April 29, 2025, at 6:00 AM for the resident to have enhanced barrier precautions for her peripheral line (tubing line inserted into a vein) for 4 days. There was no order for transmission based precautions for the resident. In a follow up interview with the Director of Nursing on April 29, 2025, at 2:13 PM it was confirmed that Resident 14 was receiving active treatment for ESBL and was to be on transmission based precautions. Resident 14's physician orders were updated on April 29, 2025, at 2:42 PM to implement contact precautions every shift for four days due to actively being treated for ESBL. An observation of Resident 14's room on April 30, 2025, at 10:08 AM now revealed a contact precautions sign on the door to the room, which indicated Everyone must, clean hands before entering the room, put gloves on before room entry and discard before exit, and everyone must put on a gown before room entry and discard the gown before room exit. There were no doffing bins observed in the room for used gowns or gloves, or nearby in the hallway outside the resident's room. Observation of Resident 14 on April 30, 2025, at 12:20 PM revealed Resident 14's visitor and Employee 22, registered nurse, were in the room with the resident. Employee 22 was observed sitting on the edge of the resident's bed holding the resident's arm and administering IV medication. Neither Employee 22 or the resident's visitor were wearing a gown, and the visitor was not wearing gloves. Employee 22 was concurrently interviewed as the employee doffed their gloves and placed them in a garbage can in the room and exited the room after the above observation. Employee 22 was questioned if any special precautions were needed to enter Resident 14's room and if any additional protective equipment was to be worn when she administered the IV medication to the resident. Employee 22 indicated only if she was bathing or doing hands on care with the resident as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 46 of 53 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 05/02/2025 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)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the resident was on enhanced barrier precautions. Employee 22 was alerted to the contact precautions sign hanging on Resident 14's door, and then stated, maybe I should have gowned. Employee 22 confirmed there were no bins in Resident 14's room to place used gowns or gloves prior to exiting the room. Facility staff failed to implement contact isolation precautions for a resident with active ESBL, and bins were not available to place used personal protective equipment prior to exiting the room. The above findings were reviewed with the Nursing Home Administrator and Director of Nursing on April 30, 2025, at 2:15 PM. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.10(d) Resident care policies 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 47 of 53 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 05/02/2025 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)

F 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, review of select facility policies and procedures, and staff interview, it was determined that the facility failed to provide recommended pneumococcal immunizations for one of five residents reviewed for immunizations (Resident 47). Residents Affected - Few Findings include: The facility policy entitled Pneumococcal Vaccine, last reviewed without changes January 17, 2025, revealed all residents will be offered pneumococcal vaccines to aid in preventing pneumococcal infections. Prior to or upon admission, residents will be assessed for eligibility to receive the pneumococcal vaccine series, and when indicated, they will be offered the vaccine series within 30 days of admission to the facility unless medically contraindicated, or resident has already been vaccinated. Administration of the pneumococcal vaccines or revaccinations will be made in accordance with current Centers for Disease Control and Prevention (CDC) recommendations at the time of the vaccination. Clinical record review revealed the facility admitted Resident 47 on September 18, 2023. Documentation in Resident 47's clinical record revealed she received two pneumococcal vaccines prior to her admission (Pneumovax 23 and Pneumovax Dose 2). Review of Resident 47's pneumococcal consent dated May 3, 2024, revealed Resident 47's guardian wanted the facility to administer Resident 47 the pneumococcal vaccine. According to the CDC guidance entitled Pneumococcal Vaccine Timing for Adults dated October 2024, Resident 47's pneumococcal vaccinations would not be completed until she received a Prevnar 15, Prevnar 20 or Prevnar 21 at least one year after the last dose of Pneumococcal 23 vaccine. There was no documented evidence to indicate that the facility offered Resident 47 an updated pneumococcal vaccination. Interview with Employee 18, infection control preventionist, on May 2, 2025, at 12:14 PM confirmed the above findings for Resident 47. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 48 of 53 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 05/02/2025 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)

F 0887 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. Based on a review of select facility policies and procedures, clinical record review, and staff interview, it was determined that the facility failed to offer and administer a COVID immunization for four of five residents reviewed for immunizations (Resident 47, 151, 31, and 133). Findings include: The policy entitled Coronavirus, Prevention, and Control, last reviewed without changes on January 17, 2025, revealed the facility follows current guidelines and recommendations for the prevention and control of coronavirus. Each resident and staff member will be educated about and offered an FDA (U.S. Food and Drug Administration) approved COVID vaccine unless the immunization is medically contraindicated, or the resident or staff member has already been fully immunized. Clinical record review revealed the facility admitted Resident 47 on September 18, 2023. Review of Resident 47's clinical record revealed she refused the COVID booster on December 21, 2023. Review of Resident 47's COVID 19 vaccine consent form dated May 3, 2024, revealed Resident 47's guardian requested the facility to administer the current CDC (Centers for Disease Control and Prevention) recommended COVID vaccine. There was no additional information in Resident 47's clinical record that the facility offered or administered Resident 47's COVID immunization after May 3, 2024. Clinical record review revealed the facility admitted Resident 151 on January 12, 2024. Review of Resident 151's clinical record revealed that she received her last COVID-19 vaccine on April 21, 2022. Review of Resident 151's COVID 19 vaccine consent form dated April 27, 2024, revealed Resident 151's responsible party requested the facility administer the current CDC recommended COVID vaccine. There was no additional information in Resident 151's clinical record that the facility offered or administered Resident 151's COVID immunization after April 21, 2024. Clinical record review revealed the facility admitted Resident 31 on April 5, 2012. Review of Resident 31's clinical record revealed that she received her last COVID- 19 vaccine on October 12, 2022. Review of Resident 31's COVID 19 vaccine consent form dated July 31, 2024, revealed the resident signed requesting the facility administer the current CDC recommended COVID vaccine. There was no additional information in Resident 31's clinical record that the facility offered or administered Resident 31's COVID immunization after July 31, 2024. Clinical record review revealed the facility admitted Resident 133 on February 7, 2023. Review of Resident 133's clinical record revealed no documentation of any COVID-19 vaccines. Review of Resident 133's COVID 19 vaccine consent form date May 6, 2024, revealed a signed consent requesting the facility administer the current CDC recommended COVID vaccine. There was no additional information in Resident 133's clinical record that the facility offered or administered Resident 133 a COVID immunization since admission February 7, 2023. Interview with Employee 18 (infection preventionist) on May 2, 2025, at 12:52 PM confirmed these findings. 28 Pa. Code 211.5(f) Medical records (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 49 of 53 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 05/02/2025 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)

F 0887 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 50 of 53 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 05/02/2025 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)

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm Based on observation and resident and staff interview, it was determined that the facility failed to ensure an effective pest control program to ensure a pest free environment on three of four nursing units, and in the facility's main kitchen (Nursing Unit B, F and G; Residents 43, 60, 100, 114, 131, 148, 157, and 170). Residents Affected - Some Findings include: During an interview with Resident 60 on April 30, 2025, at 10:19 AM revealed that she sees black winged insects (flies) in her room all the time. Observation of the F nursing unit shower room on April 30, 2025, at 10:45 AM revealed a flying blacked winged insect (fly). The shower room does not have any windows, and the door is kept closed. During an interview with Resident 157 on April 29, 2025, at 12:59 PM revealed that he sees flies all the time in his room and in his bathroom. Observation of the F nursing unit on April 30, 2025, at 10:20 AM revealed multiple flies at the nursing station and flies going in and out of the pantry area on the same nursing unit. An interview with Resident 170 on April 30, 2025, at 9:42 AM revealed that the resident had two flies in the room. Observation of Nursing Unit B on April 29, 2025, at 12:15 PM revealed two black colored, winged insects in the hallway. Observation of Nursing Unit B's main nurse station on April 30, 2025, at 10:43 AM revealed two black colored, winged insect flying around. Observation of the facility's main kitchen on April 29, 2024, at 9:30 AM revealed multiple winged insects (flies) in the food storage area, preparation area, service area, and dish room area. An observation of Resident 114 on April 19, 2025, at 1:02 PM revealed she was in her room with her half-eaten lunch tray sitting beside her. Two winged insects (flies) were observed flying in front of the resident's face and around the food tray. An observation of Resident 100 on April 30, 2025, at 12:30 PM revealed she was lying in bed in her room with her lunch tray sitting in front of her. A winged insect (fly) was observed flying around the food plate and landing on the food. An observation on April 30, 2025, at 12:45 PM on the G nursing unit revealed staff had passed the meal trays out of a food delivery cart sitting in the hallway. As the door to the cart was opened to observe the inside of the cart, two winged insects (flies) were observed flying inside the cart. One flew out of the cart as the door was completely opened. Observation of Resident 148's room on April 29, 2025, at 10:23 AM revealed a black, winged, insect (fly) repeatedly crossing between Resident 148 and the surveyor during an interview. Interview with Resident 148 on the date and time of the observation revealed that he was aware that flies can lay (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 51 of 53 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 05/02/2025 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)

F 0925 eggs on food and in wounds, which produce maggots. Level of Harm - Minimal harm or potential for actual harm Observation of Resident 148's room on April 30, 2025, at 9:25 AM revealed a banana with more than half the peel covered in spotted blackened areas on the overbed table that unorganized papers covered. Residents Affected - Some Observation of Resident 148's room with Employee 19 (licensed practical nurse) on May 1, 2025, at 1:35 PM revealed that the blackened banana remained on his overbed table, which continued to be covered by unorganized papers. Observation of Resident 131's room on April 29, 2025, at 11:27 AM revealed a fly in the room sporadically landing on surfaces during an interview with Resident 131. Resident 131's room was cluttered with personal items that included empty beverage cups and several boxes of cereal. Observation of Resident 131's room on May 1, 2025, at 1:39 PM with Employee 19 revealed that the area remained cluttered with personal items that included several boxes of cereal. Resident 131 opened the lockable drawer of his bedside stand to show the surveyor and Employee 19 an item that he identified as a piece of fish that he kept in his room for months to show staff, residents, and visitors for, show and tell, while complaining about the facility's food quality. Observation of Resident 43's room on May 2, 2025, at 9:13 AM revealed a fly in the room sporadically landing on surfaces while the surveyor interviewed Resident 43. Review of the facility's pest control logs revealed that the facility had no documented evidence that pest control was completed since January 2025. Interview with the Administrator and Director of Nursing on May 1, 2025, at 2:00 PM acknowledged the above findings. 28 Pa Code 201.14(a) Responsibility of licensee 28 Pa Code 201.18(b)(3) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 52 of 53 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 05/02/2025 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)

F 0947 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 a review of employee personnel and education records and staff interview, it was determined that the facility failed to ensure that each nurse aide received 12 hours of in-service training annually for one of one nurse aide reviewed (Employee 5). Findings include: Review of Employee 5's personnel record revealed that the facility hired her on February 20, 2015. The surveyor requested training records for Employee 5 during an interview with the Nursing Home Administrator and the Director of Nursing on April 30, 2025, at 1:30 PM. Review of training records provided by the facility for Employee 5 dated February 20, 2024, to February 19, 2025, revealed that Employee 5 completed only six hours of in-service education. The evidence provided indicated that Employee 5 completed only one hour of in-service education after March 27, 2024, to the date of the onsite survey. Interview with the Director of Nursing and the Nursing Home Administrator on May 2, 2025, at 12:33 PM confirmed the above findings for Employee 5. 28 Pa. Code 201.19(7) Personnel policies and procedures 28 Pa. Code 201.20(a)(6)(d) Staff development FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 53 of 53

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Citations

27 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0584GeneralS&S Epotential for harm
F584 - Safe Environment
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.
0656GeneralS&S Dpotential for harm
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
0657GeneralS&S Dpotential for harm
F657 - Comprehensive Care Plans
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
0676GeneralS&S Dpotential for harm
F676 - Based on the comprehensive assessment of a resident and consistent with
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
0677GeneralS&S Dpotential for harm
F677 - A resident who is unable to carry out activities of daily living receives
Provide care and assistance to perform activities of daily living for any resident who is unable.
0684GeneralS&S Dpotential for harm
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
0685GeneralS&S Dpotential for harm
F685 - Vision and hearing
Assist a resident in gaining access to vision and hearing services.
0686GeneralS&S Dpotential for harm
F686 - Skin Integrity
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
0688GeneralS&S Epotential for harm
F688 - Mobility
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
0689GeneralS&S Dpotential for harm
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
0692GeneralS&S Dpotential for harm
F692 - Assisted nutrition and hydration
Provide enough food/fluids to maintain a resident's health.
0695GeneralS&S Dpotential for harm
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
0699GeneralS&S Dpotential for harm
F699 - Trauma-informed care
Provide care or services that was trauma informed and/or culturally competent.
0726GeneralS&S Epotential for harm
F726 - Nursing Services
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
0740GeneralS&S Dpotential for harm
F740 - Behavioral health services
Ensure each resident must receive and the facility must provide necessary behavioral health care and services.
0756GeneralS&S Epotential for harm
F756 - Drug Regimen Review
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
0761GeneralS&S Dpotential for harm
F761 - Labeling of Drugs and Biologicals
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.
0791GeneralS&S Epotential for harm
F791 - Dental Services
Provide or obtain dental services for each resident.
0804GeneralS&S Epotential for harm
F804 - Food and drink
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
0809GeneralS&S Epotential for harm
F809 - Frequency of Meals
Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.
0812GeneralS&S Fpotential for harm
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
0880GeneralS&S Dpotential for harm
F880 - Infection Control
Provide and implement an infection prevention and control program.
0883GeneralS&S Dpotential for harm
F883 - Influenza and pneumococcal immunizations
Develop and implement policies and procedures for flu and pneumonia vaccinations.
0887GeneralS&S Epotential for harm
F887 - Infection control
Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
0925GeneralS&S Epotential for harm
F925 - Maintain an effective pest control program so that the facility is free of
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
0947GeneralS&S Dpotential for harm
F947 - Training Requirements
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
0627GeneralS&S Dpotential for harm
F627 - Transfer and discharge-
Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.

FAQ · About this visit

Common questions about this visit

What happened during the May 2, 2025 survey of MOUNTAIN VIEW REHABILITATION AND SENIOR LIVING CTR?

This was a inspection survey of MOUNTAIN VIEW REHABILITATION AND SENIOR LIVING CTR on May 2, 2025. The surveyor cited 27 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at MOUNTAIN VIEW REHABILITATION AND SENIOR LIVING CTR on May 2, 2025?

Yes, 27 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receivin..."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

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Data from CMS Care Compare public records. Dataset last refreshed June 15, 2026. If you believe any information is inaccurate, report it here.

Inspection·May 2, 2025