Inspection·August 26, 2025

F 0689 Level of Harm - Actual harm Residents Affected - Few staff member noted, .I went to get a Hoyer from the shower room. Upon return, Employee 1 found the resident on the floor, face down. Clinical nursing documentation for Resident CR1 dated August 2, 2025, at 10:20 AM from Employee 2, registered nurse, revealed Employee 2 was alerted to the resident's room by the nurse aide who entered the room to discover the resident lying face down on the floor. A three centimeter (cm) by two cm laceration was noted above the resident's right eye and a 1 cm laceration to the bridge of the resident's nose. The resident was unable to give a description of the event due to advanced dementia, per the documentation. The documentation further noted that the nurse aide who reported the fall, .stated he was providing care to the resident and left her room to get the Hoyer to transfer her out of bed after care was finished. Upon arrival to the room, it was noted by nursing staff that the bed was still in a high position, and it had been left in a high position when the aid left to obtain the Hoyer. The resident has a history of attempting to transfer herself from her bed and chair though she is not able to do so safely. The documentation noted, .it would appear likely she attempted to stand up from her bed and fell forward. The documentation noted the resident was sent to the hospital for evaluation and treatment. An interview with Employee 2 on August 26, 2025, at 1:28 PM revealed that Employee 2 was the nursing supervisor at the time. Employee 2 stated the licensed practical nurse (LPN) reported that the bed was in the high position. Employee 2 further reported that Resident CR1 was able to scoot around in bed. Review of the facility Incident/Accident form noted Employee Statement with a date of event as August 2, 2025, at 0650. The resident name was noted as Resident CR1. The written and signed employee statement from Employee 3, licensed practical nurse, indicated in part that, Hoyer lift was at the foot of the bed and bed was raised in high position. A phone interview with Employee 3 on August 26, 2025, at 1:50 PM revealed that the bed was in the high position and described as around three feet off the floor from the floor to the top of the mattress. This was observed post fall for Resident CR1. Hospital documentation for Resident CR1 dated August 2, 2025, at 7:58 AM revealed that the resident presented to the Emergency Department (ED) for evaluation of a fall and laceration to the nose and right forehead. The resident presented, .from nursing home after fall out of bed. The patient is unable to provide history. The physical examination documented a laceration to the forehead and bridge of nose. The documentation further noted, The patient underwent CT scans (computed tomography; a type of medical imaging test that creates a scan of the body using x-ray technology) that found a nasal bone (a bone of the nose) fracture and left intertrochanteric hip fracture (a type of fracture of the hip). Clinical impressions included trauma; closed intertrochanteric fracture of hip, left; open fractur of nasal bone; and laceration of forehead. The resident was admitted to the hospital. Nursing documentation for Resident CR1 dated August 5, 2025, at 4:33 PM revealed the resident returned to the facility via ambulance and litter (stretcher). Information provided to the Department on August 3, 2025, noted the date and time of the event for Resident CR1 occurred on August 2, 2025, at 6:55 AM. The factual description noted the resident had an unwitnessed fall out of bed and was found by the nurse aide lying face down on the floor. The resident was noted as non-compliant with transfer status due to advanced stage Alzheimer's Disease with poor safety awareness. The report noted that upon investigation it was found that the resident's bed was left in high bed state while Employee 1 left the room to get supplies while performing care. The facility failed to implement an intervention of a low bed related to fall injury prevention and failed to provide adequate supervision upon leaving the room. Resident CR1 then had a fall with sustained injury. The facility identified the concern with Resident CR1 on August 2, 2025, and as a result, disciplinary action was taken against Employee 1. A full house audit was conducted to identify if an order was in place for the bed to be in the lowest position for residents at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395045 If continuation sheet Page 2 of 3 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 08/26/2025 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 - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete all times while in bed and rounds completed to check if the beds were in the lowest position while the residents were in bed. The facility conducted staff education on August 2, 4, 5, and 8, 2025, that included Bed position. The facility conducted a whole house audit and checked the beds facility-wide on August 2, 2025. The above information was reviewed during an interview with the Nursing Home Administrator and Director of Nursing on August 26, 2025, at 4:45 PM. 483.25(d)(1)(2) Free of Accident Hazards/supervision/devicesPreviously cited deficiency 5/2/2025 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services Event ID: Facility ID: 395045 If continuation sheet Page 3 of 3