Inspection·September 26, 2023

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on review of policies, Pennsylvania laws and personnel records, as well as staff interviews, it was determined that the facility failed to ensure that Pennsylvania State Police background checks were completed for one of five employees reviewed (Nurse Aide 2). Residents Affected - Few Findings include: The facility's policy regarding criminal background checks, dated April 21, 2023, revealed that the personnel/human resources director, or other designee, will conduct background checks, reference checks, and criminal conviction checks (including finger printing as may be required by state law) on all potential employees and contract personnel who meet the criteria for direct-access employee, as stated above. Such investigation will be initiated within two days of an offer of employment or contract agreement. Chapter 5, Section 502(a)(1) of Pennsylvania Act 169, dated December 18, 1996, indicated that a criminal history report was to be obtained from the State Police for all applicants. Section 501 defined State Police as The Pennsylvania State Police. Section 506 indicated that the facility could employ applicants on a provisional basis for a single period not to exceed 30 days if the applicant has applied for the Pennsylvania State Police criminal history record and the applicant provides a copy of the request form. The personnel file for Nurse Aide 2 revealed that she was hired by the facility on August 22, 2023, and as of September 25, 2023, there was no documented evidence that a Pennsylvania State Police background check was obtained. Interview with the Nursing Home Administrator on September 25, 2023, at 1:38 p.m. confirmed that there was no documented evidence that a Pennsylvania State Police background check was obtained and/or completed for Nurse Aide 2. 28 Pa. Code 201.18(b)(1)(e)(1) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 2 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the Resident Assessment Instrument User's Manual and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that comprehensive admission and annual Minimum Data Set assessments were completed in the required timeframe for 12 of 89 residents reviewed (Residents 50, 54, 62, 72, 89, 90, 91, 107, 112, 127, 144, 145). Findings include: The Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual, which provides instructions and guidelines for completing required Minimum Data Set (MDS) assessments (mandated assessments of a resident's abilities and care needs), dated October 2019, indicated that an admission MDS assessment was to be completed no later than 14 days following admission. An admission MDS assessment for Resident 107 revealed that the resident was admitted to the facility on [DATE], and the resident's admission MDS assessment was dated as completed on May 24, 2018, which was 16 days after admission. An admission MDS assessment for Resident 144 revealed that the resident was admitted to the facility on [DATE], and the resident's admission MDS assessment was dated as completed on September 7, 2023, which was 30 days after admission. An admission MDS assessment for Resident 145 revealed that the resident was admitted to the facility on [DATE], and the resident's admission MDS assessment was dated as completed on September 7, 2023, which was 24 days after admission. The RAI User's Manual, dated October 2019, indicated that an annual comprehensive MDS assessment was to be completed no later than the assessment reference date (ARD - the last day of the assessment's look-back period) plus 14 calendar days. An annual comprehensive MDS assessment for Resident 50, with an ARD of August 8, 2023, was due to be completed by August 22, 2023, but was not signed as completed until September 1, 2023, which was 24 days from the ARD until completion. An annual comprehensive MDS assessment for Resident 54, with an ARD of April 14, 2023, was due to be completed by April 28, 2023, but was not signed as completed until May 1, 2023, which was 15 days from the ARD until completion. An annual comprehensive MDS assessment for Resident 62, with an ARD of August 15, 2023, was due to be completed by August 29, 2023, but was not signed as completed until September 13, 2023, which was 29 days from the ARD until completion. An annual comprehensive MDS assessment for Resident 72, with an ARD of August 11, 2023, was due to be completed by August 25, 2023, but was not signed as completed until September 8, 2023, which was 28 days from the ARD until completion. An annual comprehensive MDS assessment for Resident 89, with an ARD of August 8, 2023, was due to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 3 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some be completed by August 22, 2023, but was not signed as completed until September 7, 2023, which was 30 days from the ARD until completion. An annual comprehensive MDS assessment for Resident 91, with an ARD of August 10, 2023, was due to be completed by August 24, 2023, but was not signed as completed until September 4, 2023, which was 25 days from the ARD until completion. An annual comprehensive MDS assessment for Resident 112, with an ARD of August 8, 2023, was due to be completed by August 22, 2023, but was not signed as completed until August 27, 2023, which was 19 days from the ARD until completion. An annual comprehensive MDS assessment for Resident 127, with an ARD of August 9, 2023, was due to be completed by August 23, 2023, but was not signed as completed until September 7, 2023, which was 29 days from the ARD until completion. The RAI User's Manual, dated October 2019, indicated that the ARD must be set within 92 days after the ARD of the previous assessment. An annual MDS assessment for Resident 90 revealed that the ARD was July 2, 2023, a prior MDS assessment within 92 days could not be found. An interview with the Regional Registered Nurse Assessment Coordinator (RNAC - a registered nurse who is responsible for the completion of MDS assessments) on September 26, 2023, at 9:19 a.m. confirmed that the above admission and annual MDS assessments were completed late. 28 Pa. Code 211.5(f) Clinical records. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 4 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 0638 Assure that each resident’s assessment is updated at least once every 3 months. Level of Harm - Minimal harm or potential for actual harm Based on review of the Resident Assessment Instrument User's Manual and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that Quarterly Minimum Data Set assessments were completed within the required timeframe for 56 of 89 residents reviewed (Residents 2, 9 16, 17, 18, 22, 23, 25, 31, 32, 33, 38, 39, 42, 49, 54, 55, 57, 59, 63, 67, 68, 69, 71, 74, 78, 82, 83, 85, 86, 90, 94, 97, 98, 101, 102, 104, 106, 109, 114, 115, 117, 119, 120, 122, 123, 124, 126, 127, 128, 129, 130, 134, 136, 137, 138). Residents Affected - Some Findings include: The Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual, which provides instructions and guidelines for completing required Minimum Data Set (MDS) assessments (mandated assessments of residents' abilities and care needs), dated October 2019, indicated that the completion date for a quarterly assessment is the Assessment Reference Date (ARD - the last day of an assessment's look-back period) plus 14 days. A quarterly assessment is due every 92 days (ARD of most recent assessment + 92 days). A quarterly MDS assessment for Resident 2, with an ARD of August 9, 2023, was completed on August 27, 2023, which was four days late. A quarterly MDS assessment for Resident 9, with an ARD of August 23, 2023, was completed on September 12, 2023, which was seven days late. A quarterly MDS assessment for Resident 16, with an ARD of August 11, 2023, was completed on August 27, 2023, which was three days late. A quarterly MDS assessment for Resident 17, with an ARD of August 9, 2023, was completed on August 24, 2023, which was two days late. A quarterly MDS assessment for Resident 18, with an ARD of August 12, 2023, was completed on September 8, 2023, which was 14 days late. A quarterly MDS assessment for Resident 22, with an ARD of August 25, 2023, was completed on September 13, 2023, which was six days late. A quarterly MDS assessment for Resident 23, with an ARD of August 22, 2023, was completed on September 13, 2023, which was nine days late. A quarterly MDS assessment for Resident 25, with an ARD of August 22, 2023, was completed on September 13, 2023, which was nine days late. A quarterly MDS assessment for Resident 31, with an ARD of August 13, 2023, was completed on September 8, 2023, which was 13 days late. A quarterly MDS assessment for Resident 32, with an ARD of August 21, 2023, was completed on September 13, 2023, which was ten days late. A quarterly MDS assessment for Resident 33, with an ARD of August 10, 2023, was completed on August (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 5 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 0638 27, 2023, which was four days late. Level of Harm - Minimal harm or potential for actual harm A quarterly MDS assessment for Resident 38, with an ARD of August 14, 2023, was completed on September 13, 2023, which was 17 days late. Residents Affected - Some A quarterly MDS assessment for Resident 39, with an ARD of August 15, 2023, was completed on September 6, 2023, which was nine days late. A quarterly MDS assessment for Resident 42, with an ARD of August 13, 2023, was completed on September 8, 2023, which was 13 days late. A quarterly MDS assessment for Resident 49, with an ARD of August 15, 2023, was completed on September 8, 2023, which was 11 days late. A quarterly MDS assessment for Resident 54, with an ARD of June 17, 2023, was completed on July 3, 2023, which was three days late. A quarterly MDS assessment for Resident 55, with an ARD of August 12, 2023, was completed on September 8, 2023, which was 14 days late. A quarterly MDS assessment for Resident 57, with an ARD of August 10, 2023, was completed on August 27, 2023, which was four days late. A quarterly MDS assessment for Resident 59, with an ARD of August 16, 2023, was completed on September 8, 2023, which was 10 days late. A quarterly MDS assessment for Resident 63, with an ARD of August 10, 2023, was completed on August 27, 2023, which was four days late. A quarterly MDS assessment for Resident 67, with an ARD of August 21, 2023, was completed on September 10, 2023, which was seven days late. A quarterly MDS assessment for Resident 68, with an ARD of August 11, 2023, was completed on September 8, 2023, which was 15 days late. A quarterly MDS assessment for Resident 69, with an ARD of August 23, 2023, was completed on September 12, 2023, which was seven days late. A quarterly MDS assessment for Resident 71, with an ARD of August 24, 2023, was completed on September 13, 2023, which was seven days late. A quarterly MDS assessment for Resident 74, with an ARD of August 18, 2023, was completed on September 6, 2023, which was six days late. A quarterly MDS assessment for Resident 78, with an ARD of August 15, 2023, was completed on September 13, 2023, which was 16 days late. A quarterly MDS assessment for Resident 82, with an ARD of August 19, 2023, was completed on September 9, 2023, which was eight days late. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 6 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 0638 Level of Harm - Minimal harm or potential for actual harm A quarterly MDS assessment for Resident 83, with an ARD of August 19, 2023, was completed on September 9, 2023, which was eight days late. A quarterly MDS assessment for Resident 85, with an ARD of August 8, 2023, was completed on September 4, 2023, which was 14 days late. Residents Affected - Some A quarterly MDS assessment for Resident 86, with an ARD of August 21, 2023, was completed on September 13, 2023, which was 10 days late. A quarterly MDS assessment for Resident 90, with an ARD of August 17, 2023, was completed on September 8, 2023, which was nine days late. A quarterly MDS assessment for Resident 94, with an ARD of August 10, 2023, was completed on September 5, 2023, which was 13 days late. A quarterly MDS assessment for Resident 97, with an ARD of August 26, 2023, was completed on September 13, 2023, which was five days late. A quarterly MDS assessment for Resident 98, with an ARD of July 5, 2023, was completed on July 24, 2023, which was six days late. A quarterly MDS assessment for Resident 98, with an ARD of August 11, 2023, was completed on September 6, 2023, which was 13 days late. A quarterly MDS assessment for Resident 101, with an ARD of August 15, 2023, was completed on September 13, 2023, which was 16 days late. A quarterly MDS assessment for Resident 102, with an ARD of August 15, 2023, was completed on September 8, 2023, which was nine days late. A quarterly MDS assessment for Resident 104, with an ARD of August 10, 2023, was completed on August 27, 2023, which was four days late. A quarterly MDS assessment for Resident 106, with an ARD of August 10, 2023, was completed on August 27, 2023, which was four days late. A quarterly MDS assessment for Resident 109, with an ARD of August 12, 2023, was completed on September 8, 2023, which was 14 days late. A quarterly MDS assessment for Resident 114, with an ARD of August 14, 2023, was completed on September 8, 2023, which was 12 days late. A quarterly MDS assessment for Resident 115, with an ARD of August 24, 2023, was completed on September 13, 2023, which was seven days late. A quarterly MDS assessment for Resident 117, with an ARD of August 11, 2023, was completed on August 27, 2023, which was three days late. A quarterly MDS assessment for Resident 119, with an ARD of August 15, 2023, was completed on September 13, 2023, which was 16 days late. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 7 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 0638 Level of Harm - Minimal harm or potential for actual harm A quarterly MDS assessment for Resident 120, with an ARD of August 11, 2023, was completed on September 8, 2023, which was 15 days late. A quarterly MDS assessment for Resident 122, with an ARD of August 23, 2023, was completed on September 13, 2023, which was eight days late. Residents Affected - Some A quarterly MDS assessment for Resident 123, with an ARD of August 18, 2023, was completed on September 8, 2023, which was eight days late. A quarterly MDS assessment for Resident 124, with an ARD of August 26, 2023, was completed on September 13, 2023, which was five days late. A quarterly MDS assessment for Resident 126, with an ARD of August 3, 2023, was completed on August 18, 2023, which was two days late. A quarterly MDS assessment for Resident 127, with an ARD of July 3, 2023, was completed on July 19, 2023, which was three days late. A quarterly MDS assessment for Resident 128, with an ARD of August 16, 2023, was completed on September 8, 2023, which was 10 days late. A quarterly MDS assessment for Resident 129, with an ARD of August 9, 2023, was completed on August 27, 2023, which was four days late. A quarterly MDS assessment for Resident 130, with an ARD of August 11, 2023, was completed on September 8, 2023, which was 15 days late. A quarterly MDS assessment for Resident 134, with an ARD of August 19, 2023, was completed on September 10, 2023, which was nine days late. A quarterly MDS assessment for Resident 136, with an ARD of August 24, 2023, was completed on September 13, 2023, which was seven days late. A quarterly MDS assessment for Resident 137, with an ARD of August 17, 2023, was completed on September 8, 2023, which was nine days late. A quarterly MDS assessment for Resident 138, with an ARD of August 11, 2023, was completed on September 8, 2023, which was 15 days late. Interview with the Regional Registered Nurse Assessment Coordinator (RNAC - a registered nurse who is responsible for the completion of MDS assessments) on September 26, 2023, at 9:19 a.m. confirmed that the MDS's were not completed within the required timeframe. 28 Pa. Code 211.5(f) Clinical records. 28 Pa. Code 211.12(d)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 8 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Minimal harm or potential for actual harm Based on clinical record reviews and staff interviews, it was determined that the facility failed to transmit Minimum Data Set (MDS) assessments to the required electronic system, the Centers for Medicare and Medicaid Services (CMS) Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) System, within 14 days of completion for eight of 89 residents reviewed (Residents 2, 13, 18, 91, 96, 132, 139, 147). Residents Affected - Few Findings include: The Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual, which provides instructions and guidelines for completing required Minimum Data Set (MDS) assessments (federally-mandated assessments of a resident's abilities and care needs), dated October 2019, indicated that comprehensive MDS assessments must be transmitted electronically within 14 days of the Care Plan Completion Date (V0200C2 + 14 days). All other MDS assessments must be submitted within 14 days of the MDS Completion Date (Z0500B + 14 days). Section Z0500B of an entry tracking MDS assessment for Resident 2 revealed that the MDS assessment was completed on May 25, 2023, and was due to be submitted on or before June 7, 2023. However, the assessment was not submitted until June 9, 2023. Section Z0500B of a discharge tracking MDS assessment for Resident 2 revealed that the MDS assessment was completed on June 29, 2023, and was due to be submitted on or before July 12, 2023. However, the assessment was not submitted until July 25, 2023. Section Z0500B of an entry tracking MDS assessment for Resident 13 revealed that the MDS assessment was completed on July 6, 2023, and was due to be submitted on or before July 19, 2023. However, the assessment was not submitted until July 25, 2023. Section Z0500B of an entry tracking MDS assessment for Resident 18 revealed that the MDS assessment was completed on August 22, 2023, and was due to be submitted on or before September 4, 2023. However, the assessment was not submitted until September 13, 2023. Section Z0500B of an entry tracking MDS assessment for Resident 91 revealed that the MDS assessment was completed on June 27, 2023, and was due to be submitted on or before July 10, 2023. However, the assessment was not submitted until July 25, 2023. Section Z0500B of an entry tracking MDS assessment for Resident 96 revealed that the MDS assessment was completed on June 13, 2023, and was due to be submitted on or before June 26, 2023. However, the assessment was not submitted until July 11, 2023. Section Z0500B of an entry tracking MDS assessment for Resident 132 revealed that the MDS assessment was completed on August 23, 2023, and was due to be submitted on or before September 5, 2023. However, the assessment was not submitted until September 7, 2023. Section Z0500B of a discharge tracking MDS assessment for Resident 139 revealed that the MDS assessment was completed on August 27, 2023, and was due to be submitted on or before September 9, 2023. However, the assessment was not submitted until September 13, 2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 9 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 0640 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Section Z0500B of a discharge tracking MDS assessment for Resident 147 revealed that the MDS assessment was completed on August 18, 2023, and was due to be submitted on or before August 31, 2023. However, the assessment was not submitted until September 13, 2023. An interview with the Regional Registered Nurse Assessment Coordinator (RNAC - a registered nurse who is responsible for the completion of MDS assessments) on September 26, 2023 at 9:19 a.m. confirmed that the above MDS assessments were not electronically transmitted to the QIES ASAP system within the required time frames. Event ID: Facility ID: 395078 If continuation sheet Page 10 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on review of the Resident Assessment Instrument User's Manual and clinical records, as well as staff interviews, it was determined that the facility failed to complete accurate Minimum Data Set assessments for three of 89 residents reviewed (Residents 2, 78, 98). Residents Affected - Few Findings include: The Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual, which provides guidance and instructions for the completion of Minimum Data Set (MDS) assessments (mandated assessments of a resident's abilities and care needs), dated October 2019, indicated that the intent of Section N was to record the number of days, during the seven days of the assessment period, that any type of injection, insulin, and/or select medications were received by the resident. Section N0410F was to be coded with the number of days the resident received an antibiotic. A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 2, dated August 9, 2023, revealed that the resident was cognitively impaired, required extensive assistance with daily care needs, had diagnosis that included Alzheimer's disease. Section N0410F was coded (0), indicating that the resident did not receive any antibiotics during the look-back period. Physician's orders for Resident 2, dated August 5, 2023, included an order for the resident to receive 500 milligrams (mg) of Cefuroxime Axetil (an antibiotic medication) two times a day for pneumonia. Review of the Medication Administration Record (MAR) for Resident 2, dated August 2023, revealed that the resident was administered 500 mg of Cefuroxime Axetil at 9:00 am and 5:00 pm on August 6, 7, 8, and 9, 2023. Interview with the Regional Registered Nurse Assessment Coordinator (RNAC) on September 26, 2023, at 9:19 a.m. confirmed that Section N0410F was inaccurately coded on Resident 2's quarterly MDS assessment. The Resident Assessment Instrument (RAI) User's Manual, which gives instructions for completing Minimum Data Set (MDS) assessments (mandated assessments of a resident's abilities and care needs), dated October 2019, revealed that Section N0410C (Antidepressant Medications) was to be coded with the number of days the resident received an antidepressant medication during the seven-day assessment period. Physician's orders for Resident 78, dated June 17, 2021, included an order for the resident to receive 15 milligrams (mg) Remeron (antidepressant) daily. The resident's Medication Administration Record (MAR) for August 2023 revealed that the resident received Remeron daily from August 9-15, 2023. However, a quarterly MDS assessment for Resident 78, dated August 15, 2023, revealed that Section N0410C was coded (0), indicating that the resident did not receive an antidepressant medication during the seven days of the assessment period. Interview with the Regional Registered Nurse Assessment Coordinator (RNAC - a registered nurse who is responsible for the completion of MDS assessments) on September 26, 2023, at 9:19 a.m. confirmed that Section N0410C of Resident 78's MDS assessment of August 15, 2023, was not accurate and should have been coded to include the use of an antidepressant. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 11 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 0641 Level of Harm - Minimal harm or potential for actual harm The Long-Term Care Facility RAI User's Manual, which provides guidance and instructions for the completion of MDS assessments, dated October, 2019, indicated that the intent of Section N was to record the number of days, during the seven days of the assessment period, that any type of injection, insulin, and/or select medications were received by the resident. Section N0410B was to be coded with the number of days the resident received an antianxiety pill. Residents Affected - Few Physician's orders for Resident 98, dated July 3, 2023, included an order for the resident to receive half of a five mg tablet of Diazepam (a medication to treat anxiety) two times a day for anxiety. The resident's MAR, dated August 2023, revealed that staff administered the half of a five mg tablet of Diazepam two times a day for anxiety on August 1 through 31, 2023. A Quarterly MDS assessment for Resident 98, dated August 11, 2023, revealed that Section N0410 B was coded 0, indicating that the resident did not receive an antianxiety during the seven-day look-back period. Interview with the Regional RNAC on September 26, 2023, at 9:19 a.m. confirmed that Section N0410 B was inaccurately coded for Resident 98. 28 Pa. Code 211.5(f) Clinical records. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 12 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on review of facility policies, clinical records, and staff interviews, it was determined that the facility failed to develop a comprehensive care plan that included specific and individualized interventions to address the care needs for five of 89 residents reviewed (Residents 2, 22, 48, 51, 115). Findings include: A facility policy for Comprehensive Person-Centered Care Plans, dated April 21, 2023, included that care plans would be resident centered to express the needs of the residents. A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 2, dated August 9, 2023, revealed that the resident was cognitively impaired, required extensive assistance with daily care needs, was receiving supplemental oxygen, and had diagnosis that included Alzheimer's disease and congestive heart failure (condition when heart does not pump blood as efficiently as it should). Physician's orders for Resident 2, dated July 6, 2023, included that the resident receive 2 liters per minute (L/min) of oxygen for shortness of breath every shift. Physician's orders, dated August 23, 2023, included that the resident receive oxygen at 2 L/min. Oxygen could be titrated (adjusted to meet oxygen needs) as needed to keep his oxygen saturation (measurement of oxygen carried in the blood) above 92 percent. Observations of Resident 2 on September 23, 2023, at 10:50 a.m. revealed that the resident was resting in bed while receiving supplemental oxygen at 2 L/min. There was no documented evidence that a care plan was developed to address Resident 2's individual care and treatment needs related to his supplemental oxygen use. Interview with the Nursing Home Administrator on September 25, 2023, confirmed that a care plan to address the care needs related to Resident 2's use of supplemental oxygen was not developed and should have been. A quarterly MDS assessment for Resident 22, dated August 25, 2023, indicated that the resident was cognitively intact, received insulin (used to lower blood sugar levels) and an anti-anxiety medication, and had diagnoses that included diabetes (a disease that interferes with blood sugar control). Physician's orders, dated August 16 and September 2, 2023, included an order for the resident to receive 24 units of insulin Determir at bedtime and Novolog insulin (fast-acting insulin used to lower blood sugar levels) according to a sliding scale (the amount of insulin given is based on the result of a fingerstick blood sugar test) one time a day every Monday, Wednesday and Friday. Physician's orders, dated July 12, 2023, included orders for the resident to receive 5 milligrams (mg) of buspirone HCl three times a day for generalized anxiety disorder. Review of Resident 22's Medication Administration Record for September 2023 revealed that the resident received insulin Determir and buspirone HCl from September 1 through 25, 2023. Resident 22's current care plan did not include individualized interventions related to the use of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 13 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 insulin or an anti-anxiety medication. Level of Harm - Minimal harm or potential for actual harm Interview with the Director of Nursing on September 26, 2023, at 1:15 p.m. confirmed that Resident 22's care plan did not include specific and individualized interventions related to receiving insulin or an anti-anxiety medication and should have been included on the care plan. Residents Affected - Some A quarterly MDS assessment for Resident 48, dated August 15, 2023, revealed that the resident was cognitively intact, required minimal assistance of staff for daily care needs, had diagnosis that included heart failure, and received an anti-coagulant (blood thinner) medication. Physician's orders for Resident 48, dated November 13, 2021, included an order for the resident to receive 2.5 milligrams (mg) of Xarelto (blood thinning medication) once a day. Interview with the Director of Nursing on September 25, 2023, at 9:56 a.m. confirmed that Resident 48 did not have a care plan developed regarding her use of the anti-coagulant medication and there should have been. A quarterly MDS assessment for Resident 51, dated August 4, 2023, indicated that the resident was cognitively impaired, had an indwelling urinary catheter (a tube inserted and held in the bladder to drain urine), and received an anticoagulant medication. Physician's orders, dated September 8, 2022, included an order for the resident to have an indwelling urinary catheter; and physician's orders, dated November 14, 2022, included an order for the resident to receive 20 mg of Xarelto one time a day. Review of Resident 51's Treatment Administration Record (TAR) and Medication Administration Record (MAR) for September 2023 revealed that the resident had an indwelling catheter and received Xarelto September 1 through 26, 2023. Resident 51's current care plan did not include individualized interventions related to the indwelling urinary catheter or anticoagulant medication. Interview with the Director of Nursing on September 26, 2023, at 1:15 p.m. confirmed that Resident 51's care plan did not include specific and individualized interventions related to the indwelling urinary catheter or anticoagulant medication and should have been included on the care plan. A quarterly MDS assessment for Resident 115, dated August 24, 2023, revealed that the resident was cognitively intact and received an anti-depressant medication. Physician's orders for Resident 115, dated September 8, 2023, included an order for the resident to receive 10 mg of Lexapro (used to treat depression) daily in the morning for depression. Resident 115's MAR for September 2023 revealed that the resident received Lexapro as ordered. Resident 115's current care plan did not include individualized interventions related to the use of an anti-depressant medication. Interview with the Director of Nursing on September 26, 2023, at 1:15 p.m. confirmed that Resident 115's care plan did not include specific and individualized interventions related to receiving and anti-depressant medication and should have been included on the care plan. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 14 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 28 Pa. Code 211.11(d) Resident care plans. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12(d)(1)(5) Nursing services. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 15 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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. Based on review of policies and clinical records, as well as observations and staff interviews, it was determined that the facility failed to ensure that care plans were updated to reflect changes in residents' care needs for three of 89 residents reviewed (Residents 51, 78, 79). Findings include: The facility's policy regarding care plans, dated April 21, 2023, indicated that the resident's care plan would be update or revised when the resident's care changed. A quarterly MDS assessment for Resident 51, dated August 4, 2023, indicated that the resident was cognitively impaired, had an indwelling urinary catheter (a tube inserted and held in the bladder to drain urine), and received an anticoagulant (blood thinning) medication. Resident 51's current care plan indicated that the resident used a diuretic (water pill) related to hypertension. Review of Resident 51's Medication Administration Record (MAR) for September 2023 revealed that the resident was not receiving a diuretic medication. A quarterly MDS assessment for Resident 79, dated July 20, 2023, indicated that the resident was cognitively impaired, received an anti-depressant and opioid (narcotic medication used to control pain), and had diagnoses that included hypertension (high blood pressure), end-stage kidney disease, and depression. Resident 79's current care plan indicated that the resident used a diuretic medication. Review of Resident 79's Medication Administration Record (MAR) for September 2023 revealed that the resident was not receiving a diuretic medication. Interview with the Director of Nursing on September 25, 2023, at 11:52 a.m. confirmed that Resident 51 and 79's care plan was not updated to reflect the discontinuation of their diuretic medication. A quarterly MDS assessment for Resident 78, dated August 15, 2023, indicated that the resident was cognitively impaired and required assistance from staff for daily care needs, including bed mobility. Resident 78's current care plan revealed that the resident required assistance with her activities of daily living after having a stroke. A side rail assessment for Resident 78, dated August 18, 2023, revealed that the resident required half side rails for bed mobility. Observations of Resident 78's bed on September 23, 2023 at 1:33 p.m. revealed that the bed was equipped with two half side rails and they were positioned in the up position. An interview with the Director of Nursing on September 24, 2023 at 12:44 p.m. confirmed that Resident 78's care plan was not resident-specific regarding her use of half side rails for bed positioning and that it should have been. 28 Pa. Code 211.11(d) Resident care plan. 28 Pa. Code 211.12(d)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 16 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 review of facility polices and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that residents received care and treatment in accordance with professional standards of practice, by failing to ensure that physician's orders were followed for four of 89 residents reviewed (Residents 2, 47, 98, 139). Residents Affected - Some Findings include: The facility's policy regarding medication administration, dated April 21, 2023, revealed that medications are administered in accordance with prescriber orders, including any required timeframe. The following information is checked/verified for each resident prior to administering medications: Vital signs, if necessary. A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 2, dated August 9, 2023, revealed that the resident was cognitively impaired, required extensive assistance with daily care needs, and had diagnosis that included Alzheimer's disease and congestive heart failure (condition when heart does not pump blood as efficiently as it should). A care plan for Resident 2, dated May 26, 2023, indicated that the resident had congestive heart failure and should receive cardiac medications as ordered. Physician's orders for Resident 2, dated July 7, 2023, included an order for the resident to receive 125 micrograms (mcg) of Digoxin (medication used to manage and treat heart failure) one time a day, to be held if the resident had a heart rate that was less than 60 beats per minute (bpm). Review of Resident 2's Medication Administration Record (MAR) for August and September 2023 revealed that the resident was administered 125 mcg of Digoxin daily at 9:00 a.m.; however, there was no documented evidence that the resident's heart rate was obtained as ordered prior to administering the medication. Interview with the Director of Nursing on September 25, 2023, confirmed that there was no documented evidence that Resident 2's heart rate was being obtained prior to administering his Digoxin as ordered by the physician. A quarterly MDS assessment for Resident 47, dated August 3, 2023, revealed that the resident was cognitively impaired, required extensive assistance from staff for daily care needs, and had diagnoses that included coronary artery disease and hypertension (high blood pressure). Physician's orders for Resident 47, dated May 2, 2023, included an order for the resident to receive 25 mg of metoprolol succinate (used to treat heart failure and high blood pressure) one time a day and staff were to hold the medication for a systolic blood pressure (SBP - the top number of the blood pressure reading) of less than 130 millimeters of mercury (mmHg) or a pulse of less than 60 beats per minute. Review of the MAR's for Resident 47 for May, June, July, August and September 2023 revealed that metoprolol was administered when the resident's systolic blood pressure was less than 130 mmHg on May 25 and 29; June 3; July 5, 20 and 25; August 14 and 22; and September 19, 2023, and when the resident's pulse was less than 60 beats per minute on August 14 and 22, and on September 7 and 10, 2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 17 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview with the Director of Nursing on September 26, 2023, at 1:25 p.m. confirmed that staff did not follow the physician-ordered parameters for Resident 47's metoprolol on the above dates and times and the medication should have been held. Physician's orders for Resident 98, dated July 3, 2023, included an order for the resident to receive one 3.125 mg tablet of Carvedilol (used to treat heart failure and high blood pressure) one time a day and staff were to hold if the systolic blood pressure was less than 130 mmHg. Review of the MARs for Resident 98, dated August and September 2023, revealed that staff documented one 3.125 mg tablet of Carvedilol was administered to the resident on August 2, 2023, with a blood pressure of 120/68 mmHg; on August 3, 2023, for a blood pressure of 118/70 mmHg; on August 5, 2023, for a blood pressure of 122/78 mmHg; on August 7, 2023, for a blood pressure of 123/66 mmHg; on August 8, 2023, for a blood pressure of 126/68 mmHg; on August 10, 2023, for a blood pressure of 116/68 mmHg; on August 11, 2023, for a blood pressure of 117/59 mmHg; on August 15, 2023, for a blood pressure of 92/52 mmHg; on August 17, 2023, for a blood pressure of 116/76 mmHg; on August 20, 2023, for a blood pressure of 117/65 mmHg; on August 22, 2023, for a blood pressure of 104/61 mmHg; on August 23, 2023, for a blood pressure of 128/75 mmHg; on August 24, 2023, for a blood pressure of 120/66 mmHg; on August 25, 2023, for a blood pressure of 125/72 mmHg; on August 27, 2023, for a blood pressure of 113/72 mmHg; on August 29, 2023, for a blood pressure 112/66 mmHg; on August 31, 2023, for a blood pressure of 114/62 mmHg; on September 1, 2023, for a blood pressure of 114/67 mmHg; on September 2, 2023, for a blood pressure of 111/76 mmHg; on September 6, 2023, for a blood pressure of 119/74 mmHg; on September 8, 2023, for a blood pressure of 118/68 mmHg; on September 9, 2023, for a blood pressure of 114/62 mmHg; on September 10, 2023, for a blood pressure of 122/68 mmHg; on September 11, 2023, for a blood pressure of 109/61 mmHg; on September 13, 2023, for a blood pressure of 114/63 mmHg; on September 14, 2023, for a blood pressure of 122/70 mmHg; on September 16, 2023, for a blood pressure of 108/66 mmHg; on September 18, 2023, for a blood pressure of 124/55 mmHg; on September 19, 2023, for a blood pressure of 118/65 mmHg; on September 20, 2023, for a blood pressure of 114/63 mmHg; on September 21, 2023, for a blood pressure of 117/63 mmHg, and on September 23, 2023, for a blood pressure of 115/70 mmHg. Physician's orders for Resident 98, dated July 3, 2023, included an order for the resident to receive one 50 mg tablet of Losartan (used to treat high blood pressure) one time a day and staff were to hold for a SBP less than 110 mm/Hg and or a heart rate less than 60 beats per minute. Review of the MARs for Resident 98, dated August and September 2023, revealed that staff documented that the one 50 mg tablet of Losartan was administered to the resident on August 14, 2023, for a blood pressure of 92/52 mmHg; on August 15, 2023, for a blood pressure of 92/52 mmHg; on August 22, 2023, for a blood pressure of 104/61 mmHg; on August 23, 2023, for a blood pressure of 104/61 mmHg; on September 5, 2023, for a blood pressure of 109/64 mmHg; on September 11, 2023, for a blood pressure of 109/61 mmHg; and on September 16, 2023, for a blood pressure of 108/66 mmHg. Interview with the Director of Nursing on September 25, 2023, at 4:10 p.m. confirmed that the MAR's indicated Resident 98 was administered the 3.125 mg tablet of Carvedilol and the 50 mg tablet of Losartan on the above dates. Physician's orders for Resident 139, dated August 27, 2023, included an order for the resident to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 18 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some receive one 5 mg tablet of Midodrine (used to treat low blood pressure) two times a day and staff were to hold for a SBP greater than 130 mmHg. Review of the MAR's for Resident 139 for September 2023 revealed that staff documented the 5 mg tablet of Midodrine was administered at 9:00 a.m. on September 12, 2023, for a blood pressure of 137/66 mmHg and on September 24, 2023, for a blood pressure of 134/45 mmHg. In addition, there was no documented evidence that staff obtained a blood pressure reading prior to the 5:00 p.m. Midodrine administration on September 1, 2, 3, 5 through 15, 17 through 21, 23, and 24, 2023. Interview with the Director of Nursing on September 25, 2023, at 9:43 a.m. confirmed that the 5 mg of Midodrine was administered to Resident 139 on September 12 and 24, 2023, and should not have been since the SBP was greater than 130 mmHg, and there was no documented evidence that a blood pressure was obtained prior to the 5:00 p.m. administration on September 1, 2, 3, 5 through 15, 17 through 21, 23, and 24, 2023. 28 Pa. Code 211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 19 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on review of clinical records, as well as staff interviews, it was determined that the facility failed to ensure that physician's orders were followed for an indwelling urinary catheter for one of 89 residents reviewed (Resident 39). Findings include: A Quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 39, dated August 21, 2023, revealed that the resident was understood, could understand, required extensive assistance from staff for his daily care tasks, and had an indwelling urinary catheter. Physician's orders for Resident 39, dated November 24, 2022, included an order for staff to monitor the resident's suprapubic foley catheter (a tube inserted through the lower abdominal wall into the bladder to drain urine) every shift. Resident 39's clinical record and Treatment Administration Records (TAR's) for August and September 2023 revealed no documented evidence that the resident's suprapubic foley catheter was monitored during the day shift on August 18, 20, 30, 2023, and September 20, 2023; during the evening shift on September 8 and 17, 2023; and during the night shift on August 27, 2023, and September 11, 12, 15, and 23, 2023. Physician's orders for Resident 39, dated December 17, 2022, included an order for staff to monitor the resident's indwelling urinary catheter output every shift. Resident 39's clinical record and TAR's for August and September 2023 revealed no documented evidence that the resident's indwelling urinary catheter output was obtained during the dayshift on August 18 and 20, 2023, and September 20, 2023; during the evening shift on August 27, 2023, and September 8 and 17, 2023; and during the night shift on September 2, 11, 12, 15, 17, and 18, 2023. Interview with the Director of Nursing on September 26, 2023, at 1:20 p.m. confirmed that there was no documented evidence that Resident 39's suprapubic foley catheter was monitored or that the resident's indwelling urinary catheter output was obtained as ordered on the above dates. 28 Pa. Code 211.12(d)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 20 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 review of clinical records, as well as staff interviews, it was determined that the facility failed to obtain weekly weights as requested by the dietician for one of 89 residents reviewed (Resident 132). Residents Affected - Some Findings include: A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 132, dated August 30, 2023, revealed that he had clear speech; was usually understood and could understand; required extensive assist of one for bed mobility, transfers, dressing, toileting and personal hygiene; was frequently incontinent of bowel and bladder; and weighed 155 pounds, indicating a loss of 5 percent or more and was not on a prescribed weight-loss regimen. A nutrition care plan for Resident 132, dated August 24, 2023, indicated that the resident had a history of weight loss and that he would maintain an adequate nutritional status. Interventions included observing for signs of malnutrition, determining individual likes and dislikes, and to weigh monthly per facility protocol or unless otherwise indicated. A nutrition note by the Registered Dietician, dated February 17, 2023, at 3:46 p.m. indicated that the resident was admitted on [DATE], and was ordered a regular diet, regular texture with thin liquids. Weekly weights x 4 in place to establish baseline. The resident was noted to have a malnutrition diagnosis. A nutrition note by the Registered Dietician, dated March 7, 2023, at 1:22 p.m. indicated that Resident 132's weight of 172.2 pounds on March 2, 2023, triggered for a significant weight change compared to 196 pounds on December 4, 2022 (180 days). Question the accuracy of the December 4, 2023 weight. Resident 132 was ordered a regular diet with double portions and consumes greater than 75 percent on average. The plan of care remains appropriate, weekly weights in place through March 18, 2023. Will monitor to determine baseline and make changes as needed. A review of Resident 132's weight records revealed that on February 22, 2023, his weight was 170.6 pounds and on March 2, 2023, his weight was 172.2 pounds; however, there was no documented evidence that the two remaining weekly weights for March 9, 2023, or March 16, 2023, were obtained as requested by the Registered Dietician on February 17, 2023. A nutrition note by the Registered Dietician, dated April 11, 2023, at 10:43 a.m. indicated that Resident 132 was readmitted on [DATE]. He was ordered a regular diet, regular texture with thin liquids. His weight on April 6, 2023, was 180 pounds, up 4.2 percent in one month, which is a borderline significant gain. There was no noted edema (swelling) upon admission. Weekly weights x 4 (April 13, April 20, April 27, and May 4, 2023) to reestablish a baseline after hospitalization. The Registered Dietician will monitor and follow up as needed. Review of Resident 132's weight records for April 6, 2023, through May 4, 2023, revealed that the weekly weights requested by the Registered Dietician on April 11, 2023, were not obtained. A weight change note by the Registered Dietician, dated May 9, 2023, at 8:59 a.m. indicated that Resident 132 triggered for a significant weight change; however, when using the most accurate comparison dates and corresponding weights, his weight is stable x 30 days and 90 days. The 180-day (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 21 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some comparison weight was unavailable. The current plan of care was appropriate and will continue to monitor and follow up as needed. A weight change note by the Registered Dietician, dated June 6, 2023, at 4:39 p.m. indicated that Resident 132's weight of 164.4 pounds on June 6, 2023, triggered for a significant weight change compared to 180-day weight of 196 pounds on December 4, 2022. Question accuracy of December 4, 2022, weight due to weights being consistently 170-174 pounds between December 4, 2022, and March 2, 2023. Weight changes are insignificant x 30 days and 90 days but a downward trend is noted. Meal intakes were 50-100 percent on average per nursing documentation. Recommend daily bedtime snack to promote weight stability. The Registered Dietician will monitor and follow up as needed. A weight change note by the Registered Dietician, dated July 3, 2023, at 3:57 p.m. indicated that Resident 132's weight today shows a 11.6 pound decrease in one month. Meal intakes noted as 50-100 percent per nursing documentation. Bedtime snack implemented in June with 50-100 percent acceptance per electronic medication administration record (eMAR). No changes were noted in edema. Question accuracy of weight change, recommend further weights to be obtained to verify accuracy. The Registered Dietician will monitor and follow up as needed. A weight change note by the Registered Dietician, dated July 6, 2023, at 11:57 a.m. indicated that Resident 132's weight of 149.9 pounds today confirms that he has experienced a significant weight loss (down 8.9 percent in 30 days, down 16.8 percent in 90 days, and down 14.2 percent on 180 days). The resident usually consumes 50-100 percent of meals on average but was noted to have occasional refusals lately. Bedtime snack was ordered daily, with 100 percent acceptance per eMAR. Recommend increasing snacks to three times per day to prevent further weight loss and promote gradual weight gain/stability. Interview with the Registered Dietician on September 26, 2023, at 9:35 a.m. confirmed that Resident 132's weekly weights were not obtained as requested in March, April and May 2023 and that as of August, 2023, the resident had a true significant weight loss. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 22 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on review of policies and clinical records, as well as staff interviews, it was determined that the facility failed to ensure the accountability of controlled medications (drugs with the potential to be abused) for one of 89 residents reviewed (Resident 22). Findings include: The facility's medication administration policy, dated April 1, 2023, indicated that the individual administering the medication documented in the electronic MAR (medication administration record). A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 22, dated August 25, 2023, revealed that the resident was cognitively intact, required extensive assistance to total dependence from staff for daily care needs, had pain frequently, received pain medication routinely and as-needed, and received an opioid (a controlled pain medication). Physician's orders, dated March 10, 2023, included orders for the resident to receive 50 milligrams (mg) of Tramadol (a narcotic pain medication) every six hours as needed for a pain rating of 6 to 10 (on a scale of 1 to 10, where 10 is the worst pain). Resident 22's controlled substance records for July, August and September 2023 revealed that staff signed out doses of Tramadol for administration to the resident on July 8 at 9:00 p.m., July 18 at 9:00 p.m., August 2 at 9:00 p.m., August 8 at 9:00 p.m., August 10 at 9:00 p.m., August 24 at 9:00 p.m., August 30 at 9:00 p.m., September 15 at 9:00 p.m., and September 19, 2023 at 8:00 p.m. However, there was no documented evidence in the resident's clinical record, including on the MAR and nursing notes, that the Tramadol was actually administered to the resident on the above listed dates and times. Interview with the Director of Nursing on September 26, 2023, at 1:40 p.m. confirmed that the doses of Tramadol that were signed out on Resident 22's controlled medication log on the mentioned dates and times were not documented on the MAR as being administered to the resident and they should have been. 28 Pa. Code 211.9(h) Pharmacy services. 28 Pa. Code 211.12(d)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 23 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on review of manufacturer's instructions and clinical records, as well as observations and staff interviews, it was determined that the facility failed to maintain a medication administration error rate of less than five percent. Residents Affected - Few Findings include: Observations during medication administration on September 24, 2023, revealed that four medication administration errors were made during 25 opportunities for error, resulting in a medication administration error rate of 16 percent. Physician's orders for Resident 139, dated August 27, 2023, included an order for the resident to receive one 5 mg tablet of Midodrine (used to treat low blood pressure) two times a day and staff was to hold for a systolic blood pressure (SBP-top number of a blood pressure reading) greater than 130 millimeters of mercury (mmHg). Observations during medication administration on September 24, 2023, at 8:55 a.m. revealed that Licensed Practical Nurse 3 placed Resident 139's Midodrine into a medication souffle cup with her other medications. She took the medication souffle cup containing the medications, placed them into a plastic sleeve, and crushed the medications. Licensed Practical Nurse 3 then returned the crushed medications to the medication souffle cup and administered them to the resident at 9:00 a.m. At 9:02 a.m. she obtained Resident 139's blood pressure, which was 134/45 mm/Hg. Manufacturer's instructions for Fluticasone nasal spray (a medication to treat allergies), undated, indicated that before using the spray, the user was to blow his/her nose to clear the nostrils, then insert the applicator into a nostril and while keeping the bottle upright, close off the other nostril, and breathe in through the nose. While inhaling, press the pump to release the spray. Physician's orders for Resident 133, dated September 14, 2023, included an order for the resident to receive one spray of Fluticasone 50 micrograms (mcg) in each nostril two times per day. Observations during medication administration on September 24, 2023, at 9:23 a.m. revealed that Licensed Practical Nurse 3 gave Resident 133 the Fluticasone nasal spray bottle and instructed the resident to spray three sprays into each nostril. The resident then sprayed three sprays of the Fluticasone into each nostril. Licensed Practical Nurse 3 did not instruct the resident to blow his nose prior to the administration of the Fluticasone and close off the other nostril during the administration of the Fluticasone. Interview with Licensed Practical Nurse 3 on September 24, 2023, at 9:25 a.m. confirmed that Resident 133 did not blow his nose prior to administration, did not close off the other nostril during the administration, and that the resident was administered three sprays of Fluticasone. Interview with the Director of Nursing on September 26, 2023, at 10:45 a.m. confirmed that Licensed Practical Nurse 3 should have taken Resident 139's blood pressure prior to administering the midodrine and that the medication should not have been given. The Director of Nursing also confirmed that Licensed Practical Nurse 3 should have had Resident 133 blow his nose prior to the administration of Fluticasone, close off the opposite nostril during the administration, and should not have instructed or allowed the resident to administer three sprays of the Fluticasone. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 24 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 0759 28 Pa. Code 211.12(d)(1)(5) Nursing services. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 25 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 review of policies and observations, as well as resident and staff interviews, it was determined that the facility failed to serve palatable food that was at appropriate temperatures. Residents Affected - Some Findings include: The facility's policy regarding food temperatures, dated April 21, 2023, revealed that the service temperature of hot foods to residents would be within the range of 120-140 degrees Fahrenheit (F) based on the resident's preference and cold foods were to be served to the residents at 45 degrees F. Interview with Resident 14 on September 23, 2023, at 2:05 p.m. revealed that the food was terrible and that she rarely gets any food that is edible. Interview with Resident 49 on September 23, 2023, at 2:34 p.m. revealed that the food is terrible and that she has been served moldy bread for her peanut butter sandwiches. She stated that the food often tastes old and stale. Interview with Resident 63 on September 23, 2023, at 1:40 p.m. revealed that the food is terrible and that she often skips the meals and eats a peanut butter sandwich. Interview with Resident 72 on September 23, 2023, at 1:51 p.m. revealed that the food is mushy, has no taste, and is terrible. Interview with Resident 92 on September 23, 2023, at 10:40 a.m. revealed that the food could be better and was not served at the proper temperature. Interview with Resident 115 on September 23, 2023, at 10:42 a.m. revealed that the food was garbage. The posted menu for September 25, 2023, revealed that the lunch meal was a tangy sweet and sour pork, fried rice, oriental vegetables, Mandarin oranges, and beverage of choice. A test tray for the lunch meal on the 2 [NAME] unit on September 25, 2023, revealed that the cart left the kitchen at 12:56 p.m., arrived on the nursing unit at 12:57 p.m., and the last resident was served at 1:02 p.m. The test tray was tasted at 1:02 p.m. and the Mandarin oranges were 61.6 degrees F, and the juice was 55.3 degrees F and had a diluted taste. Interview with the Dietary Manager on September 25, 2023, at 1:02 p.m. confirmed that the juice and Mandarin oranges were not served at the proper temperature and should have been colder. 28 Pa. Code 211.6(b) Dietary services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 26 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on review of policies and manufacturer's instructions, as well as observations and staff interviews, it was determined that the facility failed to store food in accordance with professional standards of food service safety by failing to properly label and date refrigerated foods, to secure a door leading to the outside, and to ensure that ice was made and stored in sanitary ice machines for one of two ice machines reviewed (2 [NAME] unit). Findings include: The facility's policy regarding food storage, dated April 21, 2023, revealed that leftover food was to be stored in covered containers or wrapped carefully and securely. Each item was to be clearly labeled and dated before being refrigerated. Observations in the reach-in refrigerator on September 23, 2023, at 9:07 a.m. revealed that there was a package of chicken breast and a package of multiple hot dogs that were wrapped in cellophane and were not labeled or dated. Observations on September 23, 2023, at 9:14 a.m. revealed there was a door to the outside that was propped open with a plastic milk crate and no staff were present in the area. Interview with [NAME] 4 on September 23, 2022, at 9:07 a.m. and 9:14 a.m. confirmed that all food in the refrigerators were to be labeled and dated, and that the door leading to the outside should not have been propped open. Interview with the Nursing Home Administrator on September 25, 2023, at 10:48 a.m. confirmed that the kitchen door leading to the outside should not have been propped open with the milk crate. The manufacturer's instructions for the use of the Indigo ice machine, dated February 2020, revealed that an air gap (the unobstructed vertical space between the water outlet and the flood level rim of a fixture) was to be left between the drain line and floor drain to prevent drain water from flowing back into the ice machine and storage bin. Observations of the ice machine in the kitchenette on the 2 [NAME] unit on September 26, 2023, at 8:13 a.m. revealed that the drain pipe coming from the ice machine extended down into and past the rim of a plastic floor drain pipe. There was no air gap between the end of the ice machine's drain pipe and the plastic floor drain. Interview with the Maintenance Director on September 26, 2023, at 12:30 p.m. confirmed that the drain pipe coming from the ice machine extended down into and past the rim of the floor drain pipe and that there was no air gap. 28 Pa. Code 211.6(f) Dietary services. 28 Pa. Code 207.4 Ice containers and storage. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 27 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on review of the facility's plans of correction for previous surveys, and the results of the current survey, it was determined that the facility's Quality Assurance Performance Improvement (QAPI) committee failed to correct quality deficiencies and ensure that plans to improve the delivery of care and services effectively addressed recurring deficiencies. Findings include: The facility's deficiencies and plans of correction for a State Survey and Certification (Department of Health) surveys ending September 2, 2022, and December 20, 2022, revealed that the facility developed plans of correction that included quality assurance systems to ensure that the facility maintained compliance with cited nursing home regulations. The results of the current survey, ending September 26, 2023, identified repeated deficiencies related to revising care plans, quality of care, nutrition/hydration status, and infection control. The facility's plan of correction for a deficiency regarding revising care plans, cited during the survey ending September 2, 2022, revealed that the facility developed a plan of correction that included completing audits and reporting the results of the audits to the QAPI committee for review. The results of the current survey, cited under F657, revealed that the facility's QAPI committee failed to successfully implement their plan to ensure ongoing compliance with regulations regarding revising care plans. The facility's plan of correction for a deficiency regarding quality of care, cited during the survey ending September 2, 2022, revealed that the facility developed a plan of correction that included completing audits and reporting the results of the audits to the QAPI committee for review. The results of the current survey, cited under F684, revealed that the facility's QAPI committee failed to successfully implement their plan to ensure ongoing compliance with regulations regarding quality of care. The facility's plan of correction for a deficiency regarding nutrition/hydration status, cited during the survey ending September 2, 2022 revealed that the facility developed a plan of correction that included completing audits and reporting the results of the audits to the QAPI committee for review. The results of the current survey, cited under F692, revealed that the facility's QAPI committee failed to successfully implement their plan to ensure ongoing compliance with regulations regarding nutrition/hydration status. The facility's plan of correction for a deficiency regarding infection control, cited during the survey ending December 20, 2022, revealed that the facility developed a plan of correction that included completing audits and reporting the results of the audits to the QAPI committee for review. The results of the current survey, cited under F880, revealed that the facility's QAPI committee failed to successfully implement their plan to ensure ongoing compliance with regulations regarding infection control. Refer to F657, F684, F692, F880. 28 Pa. Code 201.14(a) Responsibility of licensee. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 28 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 0867 28 Pa. Code 201.18(e)(1) Management. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 29 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 review of facility policies and clinical records, as well as observations and staff interviews, it was determined that the facility failed to ensure that proper infection control practices were followed while administering medications for one of 89 residents reviewed (Resident 139). Residents Affected - Few Findings include: The facility's medication administration policy, dated April 21, 2023, indicated that staff was to follow established facility infection control procedures (e.g., handwashing, antiseptic technique, gloves, isolation precautions, etc.) for the administration of medications as applicable. Physician's orders for Resident 139, dated September 19, 2023, included an order for the resident to receive one one milligram (mg) tablet of Clonazepam (used to treat panic disorder) every 12 hours for anxiety. Observations during medication administration on September 24, 2023, at 8:55 a.m. revealed that while preparing medications for Resident 139, Licensed Practical Nurse 3 removed the Clonazepam from the medication blister package into her bare hand and then placed the medication into a medication souffle cup. She continued to prepare Resident 139's medications. She then crushed the medications in the souffle cup. Upon completion of crushing the medications she then administered the medications to Resident 139 at 9:00 a.m. Interview with Licensed Practical Nurse 3 on September 24, 2023, at 9:25 a.m. confirmed that she should not have touched Resident 139's medications with her bare hand. Interview with the Director of Nursing on September 26, 2023, at 10:45 a.m. confirmed that Licensed Practical Nurse 3 should not have touch Resident 139's medications with her bare hands. 28 Pa. Code 211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 30 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 review of facility policies and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that each resident was offered and/or received the pneumococcal immunizations for four of 89 residents reviewed (Residents 19, 117, 125, 137). Residents Affected - Few Findings include: The facility's policy regarding pneumococcal vaccines, dated April 21, 2023, indicated that prior to admission, all residents will be assessed for eligibility to receive the pneumococcal vaccine series, and when indicated, will be offered the vaccine within thirty days of admission to the facility unless medically contraindicated or the resident has already been vaccinated. A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 19, dated August 3, 2023, revealed that the resident was usually understood and could usually understand others, required limited assistance with personal hygiene needs, was not up to date on his pneumococcal vaccine, and was not offered a pneumococcal vaccine. Review of the immunization records for Resident 19 revealed no documented evidence that the resident was offered, received, or refused a pneumococcal vaccine since admission. A quarterly MDS assessment for Resident 117, dated August 11, 2023, revealed that the resident was cognitively impaired, required limited assistance with personal hygiene needs, was not up to date on his pneumococcal vaccine, and was not offered a pneumococcal vaccine. Review of the immunization records for Resident 117 revealed no documented evidence that the resident was offered, received, or refused a pneumococcal vaccine since admission. A quarterly MDS assessment for Resident 125, dated July 11, 2023, revealed that the resident was understood and could understand others, required supervision with personal care needs, was not up to date on his pneumococcal vaccine, and was not offered a pneumococcal vaccine. Review of the immunization records for Resident 125 revealed no documented evidence that the resident was offered, received, or refused a pneumococcal vaccine since admission. A quarterly MDS assessment for Resident 137, dated August 17, 2023, revealed that the resident was understood and could understand others, required limited assistance with personal hygiene needs, was not up to date on the pneumococcal vaccine, and was not offered a pneumococcal vaccine Review of the immunization records for Resident 137 revealed no documented evidence that the resident was offered, received, or refused a pneumococcal vaccine since admission. Interview with the Director of Nursing on September 26, 2023, at 1:27 p.m. confirmed that the facility had no documented evidence that Residents 19, 117, 125, and 137 were offered, received, or refused a pneumococcal vaccine since their admission or that the vaccine was medically contraindicated. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(1) Management. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 31 of 32 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 395078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pine View Healthcare and Rehabilitation Center 50 North Malin Road Broomall, PA 19008 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 28 Pa. Code 211.12(d)(1)(5) Nursing services. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395078 If continuation sheet Page 32 of 32