Inspection·January 24, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of facility's abuse policy, clinical records, and select investigative reports and staff interview it was determined the facility failed to assure that one resident (Resident 289) was free from sexual abuse perpetrated by another resident (Resident 102) and one resident (Resident 25) was free from neglect out of 27 residents sampled. Findings included: A review of the current facility policy titled Abuse Prohibition, last reviewed by the facility on September 6, 2024, revealed it is the policy of the facility to provide a safe environment where residents are not subject to mental, physical, sexual, and verbal abuse or neglect by staff, residents, volunteers, consultants, contractors, and other caregivers, visitors or family members. The current policy titled Identifying Types of Abuse last reviewed by the facility on September 6, 2024, defined sexual abuse as non-consensual sexual conduct of any type with a resident. Sexual abuse includes, but is not limited to: a. Unwanted intimate touching of any kind especially of breasts or perineal area. b. All types of sexual assault or battery, such as rape, sodomy, and coerced nudity. c. Forced observation of masturbation and/or pornography; and d. Taking sexually explicit photographs and/or audio/video recordings of a resident(s) and maintaining and/or distributing them. This would include, but is not limited to, nudity, fondling, and/or intercourse involving a resident. A review of Resident 102's clinical record revealed admission to the facility on September 21, 2024, with diagnoses to include chronic obstructive pulmonary disease (lung disease that blocks airflow and makes it difficult to breathe), hypertension (high blood pressure), and depression. An admission Minimum Data Set assessment (MDS-a federally mandated standardized assessment completed periodically to plan resident care) dated September 27, 2024, indicated the resident was moderately cognitively impaired with a BIMS (brief interview of mental status to a tool to assess the resident's attention, orientation and ability to register and recall new information) a score of 9 (8-12 represents moderate cognitive impairment). Facility documentation indicated a pattern of sexually inappropriate behaviors by Resident 102 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 2 of 19 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 395103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elan Skilled Nursing and Rehab, A Jewish Senior LI 1101 Vine Street Scranton, PA 18510 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 0600 prior to the reported incident involving Resident 289: Level of Harm - Minimal harm or potential for actual harm A review of nursing documentation dated September 24, 2024, at 12:27 PM revealed Resident 102 was noted to be sitting close to Resident 91 and making inappropriate comments and gestures of a sexual nature while speaking to her. The nurse approached Resident 102 and explained that his behaviors are inappropriate. Redirection provided with positive effect. Residents Affected - Few A review of nursing documentation On September 26, 2024, at 1:19 AM, Resident 102 was observed naked in the hallway and attempting to enter another resident's room. Resident 102 placed his soiled brief next to a resident's door. Nurse aides provided incontinence care to the resident, and he returned to bed. A review of Resident 102's plan of care, initiated October 3, 2024, revealed the resident had the potential to be verbally aggressive due to dementia, ineffective coping skills, poor impulse control as evidenced by his use of socially inappropriate statements and language, negative statements toward others, and overhead making sexually explicit comments to a female resident. Care plan interventions were as follows: Providing privacy and emotional support as needed. Redirecting him with conversations about his job. Reinforcing that staff are present to assist with care and are honest in their communication. Identifying and minimizing triggers for verbal aggression, such as noise levels. Offering a tour of his surroundings to help de-escalate behaviors. Encouraging him to call his daughter. Supporting participation in activities. Assessing his understanding of situations and behaviors. Encouraging him to express his thoughts and feelings. Providing choices regarding care and activities. Reinforcing positive behaviors with appropriate encouragement A review of Resident 289's clinical record revealed admission to the facility on October 4, 2024, with diagnoses to include Alzheimer's disease (a progressive brain disease that destroys memory and other important mental functions). An admission MDS dated [DATE], revealed the resident was severely cognitively impaired with a BIMS score of 3 (a score of 0-7 indicates severe cognitive impairment). Resident 289 did not possess the mental capacity to consent to sexual contact and activity. A review of the Employee 4 (licensed practical nurse) witness statement dated October 7, 2024, at 9:30 AM revealed that Resident 102 was observed in the lunchroom with Resident 289. Resident 289's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 3 of 19 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 395103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elan Skilled Nursing and Rehab, A Jewish Senior LI 1101 Vine Street Scranton, PA 18510 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few hand was on Resident 102's lap, while Resident 102 was holding Resident 289's hand on his genital region. Staff immediately intervened, separating the two residents. Resident 289 expressed discomfort and confusion about the incident, stating that it was gross and that they did not understand why it had occurred. Social Services was contacted right away to address the situation. A review of facility documentation dated October 9, 2024, at 4:12 PM showed that the Director of Nursing (DON) was informed of a staff-written statement regarding an incident that occurred on October 8, 2024. The statement described a reportable event, prompting an ongoing investigation. The physician was notified, and the incident was reported to the Department of Health and local law enforcement. The facility also reported the event to Adult Protective Services (AAA). Resident 289's representative was contacted and informed of the situation. Emotional support was provided to Resident 289, who did not recall the incident. As a precautionary measure, Resident 289 was placed on fifteen-minute safety checks, and staff were instructed to ensure that Resident 289 and Resident 102 remained separated. Despite the incident occurring on October 7th 2024 documentation regarding the event and the decision to implement safety measures was not completed until October 9th 2024 resulting in a 2 day delay in reporting and intervention. Interview with the Clinical Operations Executive on January 24, 2025, at approximately 11:15 AM confirmed that Resident 102 displayed sexually inappropriate behaviors, and that the facility failed to ensure that Resident 289 was free from sexual harassment perpetrated by Resident 102 by not implementing sufficient interventions to address Resident 102's identified pattern of inappropriate behaviors. Review of clinical record revealed Resident 25 was admitted to the facility on [DATE], with diagnoses which included depression, arthritis, and dementia (loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life). Review of the plan of care for Resident 25 revealed that the resident required the assist of 2 staff members and the use of a sit-to-stand lift for toileting and transfers. Review of facility investigation dated December 26, 2024, at 10:30 AM, revealed that Resident 25 was assisted to the bathroom by Employee 6, nurse aide. Review of witness statement completed by Employee 6, she assisted Resident 25 out of his wheelchair by putting my whole right arm under his right arm. Employee 6 then proceeded to walk the resident to the bathroom with the assistance of a walker, he got unsteady on his feet and began to slowly go backwards. I tried to catch him to ease the fall. He landed on his bottom. Review of witness statement completed by Employee 1, LPN, dated December 23, 2024, indicated that when resident was assigned to new aide, aide was advised he was an Apex [sit-to-stand lift]. Review of personnel file for Employee 6 revealed a hire date of November 5, 2024. According to the employee's file, education was provided regarding the facility's abuse policy and procedures upon hire. Interview with the Director of Nursing on January 24, 2025, at 11 AM confirmed that Employee 6 failed to follow Resident 25's plan of care which resulted in a fall without injury. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 4 of 19 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 395103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elan Skilled Nursing and Rehab, A Jewish Senior LI 1101 Vine Street Scranton, PA 18510 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 0600 28 Pa. Code 201.29 (a)(c) Resident rights Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 201.18 (e)(1) Management 28 Pa. Code 211.12 (c)(d)(3)(5) Nursing services Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 5 of 19 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 395103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elan Skilled Nursing and Rehab, A Jewish Senior LI 1101 Vine Street Scranton, PA 18510 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm review, and staff interview it was revealed the facility failed to implement its abuse prohibition procedures to identify potential sexual abuse, timely notify administration and the State Survey Agency, report to the resident representatives and physician, and promptly investigate alleged sexual abuse of one resident out of 27 sampled (Resident 289). Residents Affected - Few Findings include: Review of the facility policy titled Abuse Prohibition last reviewed September 6, 2024, revealed all allegations of abuse shall be reported immediately to the Charge Nurse, Director of Nursing, Administrator, and resident's physician for investigation into the circumstances of the incident. The staff member who discovers the incident, suspected abuse situation or has the initial knowledge of such incidents will be responsible for immediately notifying his or her supervisor. The supervisor who becomes aware of such incidents must immediately report to the Administrator and Director of Nursing, in person or by telephone. The facility's abuse policy defines sexual abuse as non-consensual sexual contact of any type with a resident. Further review of the policy revealed that The Administrator and/or Director of Nursing must immediately report (no later than 2 hours after the allegation is made) the incident to the following agencies accordingly: a. Orally by telephone and fax to Area of Agency (AAA) b. Electronically to the Department of Health via the electronic reporting site c. Make an oral report to the statewide Protective Services Hotline d. Incidents involving sexual abuse, sexual assault or serious physical bodily injury must also be reported immediately to the local law enforcement agency and Pennsylvania Department of Aging. Facility documentation dated October 7, 2024, at 9:30 AM, indicated that Resident 102 was observed in the lunchroom holding Resident 289's hand on his genital region. Resident 289 stated, That was gross, I don't understand why he did that. Social Services was contacted immediately. A review of a nurse's note dated October 9, 2024, at 4:12 PM indicated that the DON became aware of an October 8, 2024, written staff statement referencing a reportable event involving Resident 289. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 6 of 19 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 395103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elan Skilled Nursing and Rehab, A Jewish Senior LI 1101 Vine Street Scranton, PA 18510 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 0607 The note documented that: Level of Harm - Minimal harm or potential for actual harm The physician was notified, The incident was reported to the Department of Health and local Police, Residents Affected - Few The resident representative was contacted, and The resident was placed on fifteen-minute safety checks. Despite facility policy requiring immediate reporting within two hours, the facility failed to report the allegation until October 9, 2024-two days after the incident occurred. A review of Employee 5 (Admissions Director) interview with Resident 102 dated October 7, 2024 (no time indicated) revealed the resident was moderately cognitively impaired and denies any touching of anyone/and/or any female resident. A review of the clinical record of Resident 289 revealed the resident was severely cognitively impaired and lacked the ability to consent to sexual activity. A review of Resident 289's clinical record revealed: No documentation that the alleged sexual encounter had occurred. No evidence that the facility's administrator, DON, attending physician, or the resident's responsible party were notified at the time of the incident. A review of Resident 102's clinical record also revealed: No documentation of the alleged sexual encounter. No documentation the administrator, DON, attending physician, or responsible party was notified. Additionally, there was no documented evidence the facility developed and implemented a plan to prevent future occurrences and protect Resident 289 and other female residents from Resident 102's inappropriate sexual behavior. A review of the facility's abuse investigation records revealed the facility did not begin investigating the alleged sexual encounter of Resident 289 by Resident 102 abuse until October 9, 2024-two days after the incident. Per facility policy, investigations should begin immediately following an allegation of abuse. Interview with Clinical Operations Executive on January 24, 2025, at approximately 11:15 AM it was confirmed the facility failed to follow its abuse reporting and investigation policies in response to the alleged sexual abuse of Resident 289 by Resident 102. The facility failed to implement its abuse prevention and reporting policies by not immediately identifying, reporting, and investigating an allegation of sexual abuse 28 Pa. Code 201.18 (e)(1) Management. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 7 of 19 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 395103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elan Skilled Nursing and Rehab, A Jewish Senior LI 1101 Vine Street Scranton, PA 18510 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 0607 28 Pa. Code 201.29 (a)(c) Resident Rights. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 201.14(a)(c) Responsibility of Licensee. 28 Pa. Code: 211.12 (c)(d)(1)(3)(5)Nursing Services Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 8 of 19 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 395103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elan Skilled Nursing and Rehab, A Jewish Senior LI 1101 Vine Street Scranton, PA 18510 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 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. Based on a review of clinical records and staff interview it was determined the facility failed to provide residents or their representatives with written information of the facility's bed hold policy upon transfer to the hospital of three residents out of 27 residents sampled (Residents 27, 124, and 102). Findings include: A review of Resident 27's clinical record revealed the resident was transferred to the hospital on November 27, 2024, and returned to the facility on December 3, 2024. A review of Resident 124's clinical record revealed the resident was transferred to the hospital on November 26, 2024, and returned to the facility on November 29, 2024. A review of Resident 102's clinical record revealed the resident was transferred to the hospital on December 10, 2024, and returned to the facility on December 13, 2024. There was no documented evidence the facility provided these residents and/or their representatives written information about the facility's bed-hold policy (an agreement for the facility to hold a bed for an agreed upon rate during a hospitalization) at the time of transfer. Interview with the Clinical Operations Executive on January 23, 2025, at 12:45 PM confirmed the facility was unable to provide documented evidence of the provision of written notice of the facility's bed hold policy upon hospital transfer. 28 Pa Code 201.18 (e)(1) Management 28 Pa Code 201.29 (b) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 9 of 19 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 395103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elan Skilled Nursing and Rehab, A Jewish Senior LI 1101 Vine Street Scranton, PA 18510 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined the facility failed to follow physician orders for medication administration for three resident out of 27 sampled (Resident 121, 124, and 46). Residents Affected - Some Findings include: According to the Pennsylvania Code, Title 49, Professional and Vocational Standards, State Board of Nursing, 21.11 (a)(1)(2)(4) indicates that the registered nurse was to carry out nursing care actions that promote, maintain, and restore the well-being of individuals. The Pennsylvania Code, Title 49, Professional and Vocational Standards, State Board of Nursing, 21.145 Functions of the Licensed Practical Nurse (LPN) (a) The LPN is prepared to function as a member of the health-care team by exercising sound judgement based on preparation, knowledge, skills, understandings and past experiences in nursing situations. The LPN participates in the planning, implementation, and evaluation of nursing care in settings where nursing takes place. 21.148 Standards of nursing conduct (a) A licensed practical nurse shall: (5) Document and maintain accurate records. Review of the facility policy titled Medication Administration last reviewed by the facility on September 6, 2024, revealed that the licensed nurse will administer medications following the Rights of Medication Administration listed below: a. Right Drug b. Right Resident c. Right Time d. Right Dose e. Right Route f. Right Dosage Form. g. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 10 of 19 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 395103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elan Skilled Nursing and Rehab, A Jewish Senior LI 1101 Vine Street Scranton, PA 18510 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 Right Reason Level of Harm - Minimal harm or potential for actual harm A review of Resident 121's clinical record revealed the resident was admitted to the facility on [DATE], with diagnoses to include hypertension (high blood pressure) and end stage renal disease (final, permanent stage of chronic kidney disease, where the kidneys can no longer function on their own). Residents Affected - Some A physician order dated December 23, 2024, and discontinued January 16, 2025, was noted for Carvedilol Tablet (used to treat high blood pressure) 6.25 milligrams (mg) daily. Give one tablet by mouth two times a day related to hypertension. Hold this medication if the resident's systolic blood pressure is less than 100 millimeters of mercury (mm Hg) or heart rate is less than 60 beats per minute. Review of the resident's corresponding Medication Administration Records for the months of December 2024, and January 2025, revealed the medication was being administered without documented evidence the resident's blood pressure and/or heart rate had been obtained prior in accordance with physician's orders from December 23, 2024 to January 16, 2025. A review of Resident 124's clinical record revealed the resident was admitted to the facility on [DATE], with diagnoses to include hypertension (high blood pressure) and chronic atrial fibrillation (an irregular, often rapid heart rate that commonly causes poor blood flow). A physician order dated November 29, 2024, remaining current at the time of the survey, was noted for Atenolol tablet (used to treat high blood pressure) 25 milligrams (mg). Give one tablet by mouth one time a day for hypertension. Hold this medication if the resident's systolic blood pressure is less than 100 millimeters of mercury (mm Hg) or heart rate is less than 60 beats per minute. Review of the resident's corresponding Medication Administration Records for the months of November 2024, December 2024, and January 2025, revealed the medication was being administered without documented evidence the resident's blood pressure and/or heart rate had been consistently obtained prior in accordance with physician's orders from November 29, 2024. Review of Resident 46's clinical record revealed the resident was admitted to the facility on [DATE], with diagnoses which included hypertension, depression, and dementia (loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life). A physician order dated April 15, 2024, remaining current at the time of the survey ending January 24, 2025, was noted for metoprolol tartrate 25mg orally two times a day for hypertension. Instructions included to hold the medication for a blood pressure less than 100 and heart rate less than 60. Further review of the physician orders revealed an additional order dated April 15, 2024, for Norvasc 5mg orally two times a day for hypertension. Instructions for administration were to hold the medication for a systolic blood pressure less than 110 and a heart rate less than 60. A review of the resident's Medication Administration Records dated December 2024 and January 2025 failed to provide evidence that Resident 46's blood pressure or heart rate was monitored prior to the administration of the antihypertensive medications. Interview with the Clinical Operations Executive on January 23, 2025, at 9:30 AM verified that nursing staff failed to consistently obtain Residents 121, 124 and 46 blood pressure and /or heart rate (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 11 of 19 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 395103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elan Skilled Nursing and Rehab, A Jewish Senior LI 1101 Vine Street Scranton, PA 18510 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 prior to administering the medication to ensure its necessity and adherence to physician prescribed parameters for administration. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12 (c)(d)(1)(3)(5) Nursing services Residents Affected - Some 28 Pa. Code 211.5(f)(i)(x)(xi) Medical records 28 Pa. Code 211.9 (a)(1)(d) Pharmacy services 28 Pa. Code 211.10(c) Resident care policies FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 12 of 19 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 395103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elan Skilled Nursing and Rehab, A Jewish Senior LI 1101 Vine Street Scranton, PA 18510 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 a review of clinical records, select facility policy and staff interview it was determined the facility failed to provide documented evidence that interventions for significant weight loss were consistently implemented as planned to promote weight stabilization for one resident (Resident 67) out of seven sampled residents at nutritional risk. Residents Affected - Few Findings include: A review of facility policy entitled Weighing of Residents, last reviewed by the facility on September 6, 2024, indicated that interventions for undesirable weight loss should focus first on food (e.g., extra food, snacks, calorie-dense food, etc.) based on the resident's current food preferences. Liquid nutritional supplements, per facility formulary, may be considered if resident caloric intake remains inadequate to stabilize or increase weight. Interdisciplinary Team members should consider possible interventions relevant to their discipline. The physician may order tests, appetite stimulants, or medications as appropriate. The suggested parameters for evaluating the significance of unplanned and undesired weight loss are as follows; 1 month5% weight loss is significant, greater than 5% is severe, 3 months- 7.5% weight loss is significant, greater than 7.5% is severe, and 6 months- 10% weight loss is significant, greater than 10% is severe. A review of the clinical record revealed that Resident 67 was admitted to the facility on [DATE], with diagnoses that included diabetes (a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces) and congestive heart failure (a condition that occurs when the heart can't pump enough blood to the body). The resident's weight upon admission was 207.8 pounds. The resident experienced multiple hospitalizations and was readmitted to the facility on [DATE], and October 19, 2024. A weight record review indicated that on October 20, 2024, the resident's weight was 196.4 pounds, reflecting a 5.5% weight loss (11.4 pounds) within one month, meeting the facility's definition of significant weight loss. A review of a nutrition admission/readmission progress notes in the resident's clinical record completed by the facility's Registered Dietitian (RD) dated October 20, 2024, at 7:23 AM, documented the resident's weight loss, attributing it to CHF (congestive heart failure occurs when the heart is unable to pump sufficiently to maintain blood flow to meet the body's needs) , related fluid loss from IV Lasix therapy. The RD adjusted the resident's dietary preferences to include additional high-protein foods but did not update the physician or responsible party at that time. A progress noted completed by the RD on October 31, 2024, at 9:02 AM, noted further weight loss, documenting a weight of 188.6 pounds on October 30, 2024, which represented an 8% weight loss (16.7 pounds from weight of September 16, 2024, of 207.8 pounds) within one month. The RD discussed a daily nutritional supplement (Ensure pudding) with the resident, who agreed to consume it, and indicated that nursing staff would update the physician on the weight loss. A subsequent RD progress note on November 2, 2024, at 7:35 AM, indicated the physician was informed of the resident's weight loss, and a care plan was updated to include Ensure pudding daily. On November 7, 2024, the Certified Registered Nurse Practitioner (CRNP) ordered ProStat 30 mL (a high protein oral nutrition supplement), twice daily. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 13 of 19 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 395103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elan Skilled Nursing and Rehab, A Jewish Senior LI 1101 Vine Street Scranton, PA 18510 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 - Few Further review of Resident 67's clinical record failed to reveal documented evidence the orders for weight loss interventions, supplement of choice (Ensure pudding) daily or ProStat twice daily, were initiated as planned to manage weight loss. The Medication Administration Record (MAR) did not include records of supplement administration or consumption. During an interview on January 24, 2025, at 9:00 AM, the RD stated that licensed nursing staff would be expected to document the consumption of Ensure pudding and ProStat in the MAR. Upon further review, the RD confirmed that neither supplement was documented in the MAR and acknowledged the facility failed to implement the planned nutritional interventions to address the resident's weight loss. Additionally, the RD confirmed the facility failed to consistently implement and document physician-ordered nutritional interventions to maintain nutritional parameters and deter weight loss of a resident. 28 Pa Code 211.10 (a)(c) Resident care policies. 28 Pa Code 211.12 (c)(d)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 14 of 19 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 395103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elan Skilled Nursing and Rehab, A Jewish Senior LI 1101 Vine Street Scranton, PA 18510 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, a review of clinical records, and resident and staff interview, it was determined that the facility failed to ensure the ready availability of necessary emergency supplies for two residents out of three sampled receiving hemodialysis (Residents 121 and 187). Residents Affected - Few Findings include: According to the National Kidney Foundation, patients receiving hemodialysis (a lifesaving treatment for kidney failure that removes waste and extra fluids from the blood and regulates blood pressure) should keep emergency care supplies on hand in case of complications related to their dialysis access site. A review of the facility policy titled Care of Dialysis Resident last reviewed by the facility on September 6, 2024, revealed that if a resident has a temporary catheter for dialysis, they are to always have an emergency protocol kit with them. Nurses are required to document in the electronic treatment administration record every four hours that the full kit is present with the resident. A review of Resident 121's clinical record revealed the resident was admitted to the facility on [DATE], with diagnoses to include end stage renal disease (final, permanent stage of chronic kidney disease, where the kidneys can no longer function on their own), and dependence on renal dialysis (process of removing waste products and excess fluid from the body when the kidneys are not able to adequately filter the blood). Resident 121's clinical record indicated she was receiving hemodialysis through a right chest double lumen catheter (the dialysis catheter contains two lumens: venous and arterial. Although both lumens are in the vein, the arterial lumen, like natural arteries, carries blood away from the heart, while the venous lumen returns blood towards the heart. The arterial lumen (typically red) withdraws blood from the patient and carries it to the dialysis machine, while the venous lumen (typically blue) returns blood to the patient (from the dialysis machine) for dialysis access every Monday, Wednesday, and Friday. Resident 121's clinical record revealed a physician order dated January 17, 2025, directed the resident must always have a fanny pack (the fanny pack contains the emergency kit), containing an emergency kit in both the resident's room and on the resident's wheelchair. The fanny pack is required to contain a blue clamp, ABD pads (pads designed for high absorbency to manage heavy draining wounds), 4x4 gauze (gauze dressings), and tape, with staff checking its placement every shift. Observations conducted on January 21, 2025, at 11:50 AM, and January 23, 2025, at 10:15 AM, revealed that only one fanny pack was present on the resident's wheelchair. The second fanny pack, required to be in the resident's room, was not present in the resident's room. Interview with Resident 121, a cognitively intact resident, at the time of the observation indicated the only fanny pack she was aware of was the one on the back of her wheelchair. Interview with Employee 4 (licensed practical nurse) at the time of the observation confirmed the absence of the second fanny pack in the resident's room and indicated the fanny pack, containing the emergency supplies, should be readily available in the room and on the resident's wheelchair. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 15 of 19 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 395103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elan Skilled Nursing and Rehab, A Jewish Senior LI 1101 Vine Street Scranton, PA 18510 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 0698 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident 187's clinical record revealed admission to the facility on January 10, 2025, with diagnoses which included chronic obstructive pulmonary disease (COPD a type of obstructive lung disease characterized by long-term poor airflow. The main symptoms include shortness of breath and cough with sputum production. COPD typically worsens over time), diabetes, and dependence on renal dialysis. Review of Resident 187's physician orders revealed a physician order dated January 10, 2025, required the resident to have a fanny pack containing an emergency kit in both the resident's room and on the wheelchair, with placement checked every shift. Observations performed on January 21, at approximately 11:00 AM, on January 22, at approximately 10:30 AM, and again on January 23, 2025, at approximately 10:30 AM, revealed the fanny pack was only available on the wheelchair; the second fanny pack was missing from the resident's room. Interview with Employee 1, LPN, on January 23, 2025, at approximately 10:30 AM, confirmed that the second fanny pack containing the emergency supplies was not present in the resident's room as required. Further interview with the Clinical Operations Executive on January 24, 2025, at 1:10 PM, confirmed that residents receiving dialysis should have emergency fanny packs in both their rooms and on their wheelchairs to ensure immediate access to emergency supplies in the event of a dialysis-related complication. The facility failed to ensure that emergency dialysis supplies were readily available as ordered for Residents 121 and 187, as evidenced by missing emergency fanny packs in their rooms. This failure placed the residents at risk for delayed emergency intervention in the event of complications related to their dialysis access sites. The facility did not ensure compliance with physician orders or its own policy, which requires staff to verify the presence of emergency supplies every shift. 28 Pa. Code 211.12 (d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 16 of 19 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 395103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elan Skilled Nursing and Rehab, A Jewish Senior LI 1101 Vine Street Scranton, PA 18510 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records and staff interview, it was determined the consultant pharmacist failed to identify drug irregularities (dual anti-depressant therapy and justification for antipsychotic medication) when completing monthly medication reviews and the facility failed to assure that resident's attending physician timely acted upon pharmacist identified irregularities in the medication regimen for two residents out of five residents sampled for unnecessary medications (Residents 114 and 130). Findings included: Review of Resident 114's clinical record revealed the resident was admitted to the facility on [DATE], with diagnoses to include dementia with behavioral disturbances (is a general term that describes the deterioration of memory, language, and other thinking abilities and can be accompanied by behavioral and psychological symptoms such as agitation, anxiety, and psychosis) and major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest that affects how one feels, thinks, and behaves and can lead to a variety of emotional and physical problems). A review of the resident's physician's order dated June 6, 2024, 8:30 PM, revealed an order for Venlafaxine HCL Extended Release 24 Hour (an antidepressant) 75 mg (milligrams), give one capsule by mouth one time a day related to unspecified depression. Additionally, a review physician's orders dated June 7, 2024, at 9:30 AM, revealed the attending physician increased the resident's dose of Venlafaxine HCl ER Tablet Extended Release 24 Hour 75 MG, to give 2 tablets (150 mg) by mouth one time a day related to unspecified depression. A review of nursing progress notes in Resident 114's clinical record revealed a Change in Condition note completed by Employee 3, Licensed Practical Nurse (LPN), dated July 12, 2024, at 11:09 AM, revealed a change in condition assessment was completed related to the resident's attending physician increasing the Venlafaxine related to increased depression. A review of the resident's physician's order dated July 14, 2024, 8:00 PM, revealed an order for Venlafaxine HCL Extended Release 24 Hour 75 mg, give 2 capsules by mouth twice per day at bedtime related to unspecified depression. A review of a Psychiatric Assessment progress note completed by the facility's consultant Psychiatric Mental Health Nurse Practitioner (PMHNP) dated September 25, 2024, at 11:38 AM, revealed Resident 114's mood has deteriorated since last visit (September 18, 2024) and resident agitated and confrontational to other residents. His mood had been deteriorating since before the death of his wife, and only stands to continue to be exacerbated by the grieving process. Furthermore, his poor cognition limits his ability to go through the normal grieving process. Recommend antidepressant coverage at this time and plan to start Mirtazapine (an antidepressant used to treat depression) 7. 5mg orally at bedtime for depression and continue Venlafaxine 75 mg by mouth in the morning for depression and Venlafaxine 150mg by mouth at bedtime for depression. Further review of physician's orders dated September 27, 2024, at 8:30 PM, revealed an order for Mirtazapine oral tablet (an antidepressant used to treat depression) 7.5 mg, give 1 tablet by mouth in the evening for as ordered related to diagnosis of unspecified depression. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 17 of 19 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 395103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elan Skilled Nursing and Rehab, A Jewish Senior LI 1101 Vine Street Scranton, PA 18510 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Despite the presence of duplicate antidepressant therapy (Venlafaxine and Mirtazapine), a review of the consultant pharmacist's medication regimen reviews failed to identify this irregularity. The resident's clinical record lacked documentation of pharmacist recommendations to assess the appropriateness of duplicate therapy or a documented clinical rationale justifying the prescribing of two antidepressants. A review of Resident 130's clinical record revealed the resident was admitted to the facility on [DATE], with diagnoses to include dementia with severe agitation (a person is restless and worried, and unable able to settle down with behaviors that may include pacing, not be able to sleep, or act aggressively toward others) and depression. A review of physician's orders dated August 30, 2024, at 8:30 PM, revealed an order for Olanzapine Oral Tablet 2.5 mg (atypical antipsychotic), for dementia with agitation. CMS regulations require that a clinical rationale or diagnosis must support the use of antipsychotic medications, yet the consultant pharmacist's new admission medication review on September 4, 2024, failed to identify a lack of documented justification for the continued use of Olanzapine. A review of physician's orders in Resident 130's clinical record dated August 30, 2024, at 8:30 AM, revealed orders for Aricept (used to manage dementia and can help improve attention, memory, behavior, and ability to do daily activities) 10 mg, give 1 tablet daily at bedtime related to dementia. Further review of physician's orders revealed an order dated August 31, 2024, at 8:00 AM, for Aricept 5 mg, give 1 tablet by mouth one time a day for dementia. A review of the facility's consultant pharmacist's new admission medication regime review (MMR) dated September 4, 2024, identified the resident had a current order for Aricept and that there were two active orders for 10 mg and 5 mg without specification stating the total dose of 15 mg. Optimal timing for Aricept was to be given at bedtime and indicated the physician's order had 10 mg at bedtime and 5 mg in the morning and requested for the physician to review. The consultant pharmacist identified this discrepancy but failed to ensure timely physician action, as the resident continued receiving the medication as prescribed without clarification or modification through January 8, 2025. Further review of the clinical record failed to reveal that the resident's attending physician timely addressed the consultant pharmacist new admission medication regime review (MMR) that was completed on September 4, 2024, related to prescribing practices for Aricept. An interview with the Director of Nursing (DON) on January 24, 2025, at 10:15 AM, confirmed the consultant pharmacist failed to identify and address medication regimen irregularities for Residents 114 and 130. The DON also confirmed Resident 130's attending physician failed to timely act upon the pharmacist's recommendations and did not provide a documented clinical rationale for the continued use of antipsychotic medication 28 Pa. Code 211.9 (k) Pharmacy services. 28 Pa. Code 211.12 (c) Nursing services. 28 Pa. Code 211.2 (d)(3) Medical Director. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 18 of 19 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 395103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elan Skilled Nursing and Rehab, A Jewish Senior LI 1101 Vine Street Scranton, PA 18510 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm Based on review of clinical records and staff interview, it was determined the facility failed to offer routine annual dental services for one Medicaid payor source (Resident 88) out of four residents sampled for dental services. Residents Affected - Few Findings include: Review of Resident 88's clinical record revealed admission to the facility on March 24, 2021, and the resident's payor source was Medicaid. There was no documented evidence at the time of the survey ending January 24, 2025, the resident had been offered dental services in the past year. Interview with the Clinical Operations Executive on January 23, 2025, at 1:57 PM confirmed the facility had not offered Resident 88 routine dental services in the past year. 28 Pa. Code 211.12 (c)(d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 19 of 19