Inspection·January 23, 2026

F 0812 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many Note: The nursing home is disputing this citation. health or the environment) insecticides (chemical agents used to kill or control insects and must be approved for use and applied in a manner that prevents contamination of food, equipment, and food-contact surfaces) and rodenticides (chemical agents used to kill or control rodents and must be approved for use and applied in a manner that prevents exposure to residents and contamination of food and food preparation areas) are permitted in the facility, and all such supplies are stored away from food storage areas. Garbage and trash are not permitted to accumulate and are removed from the facility daily. Maintenance services assist, when appropriate and necessary, in providing pest control services. A tour of the kitchen on January 22, 2026, at 12:30 PM revealed the following unsanitary conditions with the potential to contaminate food and increase the risk of foodborne illness. Observation of the dishwashing area revealed the floor contained debris and rodent droppings. The perimeter floors throughout the kitchen had a buildup of dirt, debris, and rodent droppings. The floor area under the dishwasher was soiled and contained used latex gloves, garbage, bottle caps, a fork, and rodent droppings. Observation of the food preparation and tray line service area revealed seven sticky traps (colored cardboard or plastic strips coated with a sticky substance that capture insects by adhering them to the trap) placed on the floor. One sticky trap located under the left side of the food preparation area had five cockroaches present, three of which were alive and moving. Another sticky trap located on the right side of the kitchen had five cockroaches present, with two observed alive and moving. A third sticky trap contained four cockroaches, two of which were alive and moving. An interview with the Director of Dietary Services on January 22, 2026, at 12:30 PM indicated the outside pest control company had been treating the kitchen for rodents since December 2025; however, the area was not currently being treated to prevent cockroaches. An interview with Employee 1 (dietary worker) on January 22, 2026, at 12:45 PM revealed he had not seen live mice in one week. The employee stated he frequently opens the kitchen in the morning and usually doesn't see any cockroaches. The employee stated he had not seen many cockroaches recently but had visualized them in the past. An interview with the Nursing Home Administrator (NHA) on January 22, 2026, at 1:00 PM confirmed the facility had a contract with a pest management company and that on December 5, 2025, in response to a rodent infestation, the facility requested pest control services. The inspection recommended remediation services twice weekly. Review of pest control inspection reports revealed that on January 5, 2026, the pest management provider conducted an inspection of the first floor. The inspection identified cockroaches at the coffee station located in the main lobby, 50 feet away from the kitchen entrance. The report also identified two potential rodent entry points, including one located in the dishwasher room, and recommended plugging the opening with steel wool after dishwasher cycles. Review of ongoing pest control monitoring documented visits on January 6, 8, 12, 13, 15, and 20, 2026. None of the documentation indicated that cockroach-specific treatment was initiated. An interview with the pest control provider on January 22, 2026, at 3:00 PM revealed the company provided routine pest control services consisting of spraying the internal and external perimeter of the building. No targeted cockroach treatment areas had been identified. The provider confirmed observing cockroach activity at the coffee station on January 5, 2026. The provider identified the species as a German cockroach (small 0.3-0.6 inches, light brown insects with two dark stripes behind the head, known for rapid reproduction. As the most common household pest worldwide, they are nocturnal, flightless, and thrive in warm, humid indoor environments like kitchens and bathrooms.) Other than increased visit frequency, there was no documented evidence the facility addressed cockroach presence in the kitchen, increased sanitation, or evaluated food distribution practices between pest control visits. The facility failed to provide documented evidence that staff were monitoring for cockroaches in the kitchen (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 2 of 5 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 01/23/2026 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 0812 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many Note: The nursing home is disputing this citation. FORM CMS-2567 (02/99) Previous Versions Obsolete or that increased sanitation measures or environmental controls (such as sealing gaps, repairing cracks, or ensuring doors were closed) were implemented to ensure food was stored, prepared, distributed, and served under sanitary conditions and free of pest infestation. Immediate Jeopardy was identified and called on January 22, 2026, at 1:50 PM due to the facility's failure to maintain the kitchen in a sanitary condition. The Immediate Jeopardy Template was provided to the NHA at 1:53 PM. The presence of live and dead cockroaches in food preparation and storage areas created a high risk of contamination of food, utensils, and food-contact surfaces with disease-causing organisms, resulting in failure to maintain sanitary food service conditions and placing all residents at risk for foodborne illness Evaluation of the facility's records determined that Immediate Jeopardy was initially identified on January 5, 2026, when the pest control company documented the need for pest control treatment in lobby and kitchen. In response, the facility submitted an immediate corrective action plan at 6:45 PM on January 22, 2026. The plan directed disposal of exposed food items, cessation of food preparation, and transition of dietary services to an outside vendor until pest mitigation was completed. Pest control services were activated for immediate treatment of source areas, including clean-out treatment, aerosol application, and gel treatments. The kitchen was placed under continuous monitoring by the Director of Dietary Services and the Nursing Home Administrator. Audits were scheduled for each meal, daily for seven days. On January 22, 2026, at 4:20 PM a licensed pest control inspector conducted a comprehensive inspection of the kitchen and identified cockroach activity around walls and behind appliances throughout the kitchen. Recommendations included aerosol treatment for immediate control and gel application for prevention. Dietary staff received education on the facility's Pest Control and Kitchen Sanitation Policies and Protocols. All residents were reviewed for signs and symptoms of foodborne illness. The facility initiated daily audits of pest control logs and environmental monitoring and implemented weekly inspection and monitoring by the pest control provider. The Immediate Jeopardy was lifted on January 23, 2026, at 10:00 AM after verification the facility had implemented a comprehensive corrective action plan that immediately addressed the risk of serious harm to residents. Cross Refer F925 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18 (e)(1)(2.1)(3) Management 28 Pa. Code 211.6 (f) Dietary services 28 Pa Code 211.10 (a)(d) Resident care policies Event ID: Facility ID: 395103 If continuation sheet Page 3 of 5 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 01/23/2026 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, a review of facility policy, facility-provided documentation, and interviews with residents and staff, it was determined the facility failed to maintain an effective pest control program to ensure the facility was free of pests, and rodents on two out of four resident nursing units (Nursing Units 3 and 4) and in the kitchen of the facility.Findings include: According to the Centers for Disease Control (CDC), in Controlling Wild Rodent Infestations, rodents can carry many diseases that can spread directly or indirectly to people, including through contact with rodent droppings, urine, or saliva. Signs of rodents include droppings (feces) and gnaw marks. The CDC indicates that to determine if the activity is current, regular cleaning and disinfecting are required. When droppings are identified following cleaning, it can confirm the presence of rodents. A review of the facility policy titled Preventative Maintenance Program, last reviewed by the facility on December 11, 2025, revealed it is the facility policy to maintain an effective pest control program. The policy indicated the facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents. A review of facility-provided documentation revealed that on December 8, 2025, the facility contracted with a licensed pest control company to perform remediation services twice weekly until pest activity was resolved. The remediation plan initiated December 8, 2025, included mass trapping and baiting of all rooms located on floors 3, 4, and 5, with continued monitoring of floors 1 and 2. The remediation plan recommended that any food in resident rooms be placed in plastic containers to prevent access by mice. A review of pest control service documentation revealed: A visit dated December 15, 2025, documented inspection and treatment along the interior perimeter of the facility, including common areas, bathrooms, and hallways. The documentation indicated no pest concerns were noted. A visit dated December 19, 2025, documented that no new mice had been caught since the prior visit and that new glue boards were provided for resident rooms. A visit dated December 29, 2025, documented the same inspection and treatment activities as the December 15, 2025, visit, including treatment of interior perimeter areas, common areas, bathrooms, and hallways. A visit dated January 2, 2026, documented treatment of the interior perimeter on the first floor, including common areas, bathrooms, and hallways, and inspection of the third floor for flies. A visit dated January 5, 2026, documented inspection of the first floor and treatment for roaches in the coffee station. The documentation also confirmed signs of rodent droppings on the fourth floor. Review of pest control documentation dated January 6, January 8, January 12, January 13, January 15, and January 20, 2026, revealed no documentation addressing concerns or documenting targeted treatment to the kitchen area following the identification of roaches and rodent droppings. Observations conducted on January 22, 2026, at approximately 9:00 AM revealed a dead cockroach located behind a resident's bed in room [ROOM NUMBER]. Observations of the third-floor kitchenette revealed rodent droppings present in drawers, with a significant amount of food debris and crumbs observed throughout the area. During an interview conducted on January 22, 2026, at 3:15 PM the outside pest control provider indicated awareness of roaches since January 5, 2026, and stated that no additional targeted treatment had been provided since that date. The provider indicated that targeted treatment was focused on mice activity on the fourth and fifth floors, with general treatment provided on other floors. During an interview conducted on January 22, 2026, at 4:00 PM, the Director of Maintenance stated that construction on the first floor may have contributed to movement of cockroaches toward the kitchen area. The Director of Maintenance further stated the facility was not implementing preventative measures specific to cockroach control in the kitchen. The above findings were reviewed with the Director of Nursing and the Nursing Home Residents Affected - Many Note: The nursing home is disputing this citation. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 4 of 5 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 01/23/2026 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 0925 Level of Harm - Minimal harm or potential for actual harm Administrator on January 22, 2026, at 3:00 PM. The facility failed to maintain an effective pest control program to ensure the facility was free of pests and rodents on Nursing Units 3 and 4 and in the kitchen of the facility.28 Pa. Code 201.18 (e)(1) (2.1) Management. 28 Pa Code 211.20 (a)(b)(c)(d) Resident care policies. Residents Affected - Many Note: The nursing home is disputing this citation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395103 If continuation sheet Page 5 of 5