Inspection visit

InspectionMarch 5, 2024

BEAVER HEALTHCARE AND REHABILITATION CENTERCMS #39510926 citations on this visit

26 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 26 deficiencies, 3 of them serious (actual harm or immediate jeopardy). The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0565 Honor the resident's right to organize and participate in resident/family groups in the facility. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy, resident council documents, resident council group interview, resident interview, and staff interview it was determined that the facility failed to respond to concerns from resident council and failed to respond to concerns in a timely manner for three out of nine months (December 2023, January 2024, and February 2024). Residents Affected - Some Findings include: The facility Resident council policy dated 9/28/23, indicated that the facility supports resident rights' to organize and participate in a resident council. The purpose of the resident council is for residents to have input in the operation of the facility, discussion of concerns for improvement, and communication between residents and facility staff. Review of Resident council minutes dated December 2023 and February 2024 identified a request from council to obtain a new beautician. The documentation did not indicate follow-up actions or communication from nursing home administration to obtain a new professional beautician. During an interview on 2/27/24, at 11:27 a.m. Resident R46 stated: I need a haircut! During a resident council group interview on 2/28/24, at 1:31 p.m. 11 of 11 residents voiced a concern with the facility administration not resolving their request for a new hair dresser. During an interview on 2/29/24, at 10:53 a.m. the Assistant Nursing Home Administrator/Director of Social Services Employee E1 confirmed that the facility failed to respond to concerns from resident council and failed to respond to concerns/requests in a timely manner for three months. 28 Pa. Code 201.18(b)(1) Management Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 49 Event ID: 395109 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. Based on review of facility policy, tour of the facility, and staff interview it was determined that the facility failed to make certain that a posted grievance policy and procedure was met federal guidelines for two out of two nursing units (Front hall nursing unit and back hall nursing unit). Findings include: The facility Grievance procedure policy dated 9/28/23, indicated that the facility encourages residents and their family members to make known to the facility any concerns. The facility has developed grievance procedure that will address all such concerns. The grievance official will be responsible for overseeing the grievance process. During a tour on 2/27/24, at 9:25 a.m. observations of the facility did not find a posted grievance policy, grievance official e-mail and business address. During a tour on 2/28/24, at 9:13 a.m. observations of the facility did not find a posted grievance policy, grievance official e-mail and business address. During a tour on 2/28/24, at 11:45 a.m. observations with Assistant Nursing Home Administrator/Director of Social Services Employee E1 did not find a posted grievance policy, grievance official e-mail and business address. During an interview on 2/28/24, at 11:47 a.m. the Assistant Nursing Home Administrator/Director of Social Services Employee E1 confirmed that the facility failed to make certain that a posted grievance policy and procedure was met federal guidelines as required. 28 Pa. Code 201.29(1) Resident rights 28 Pa. Code 201.18(e)(4) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 2 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 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 review of facility policy, resident clinical record, resident interview and staff interview it was determined that the facility failed to provide goods and services resulting in neglect for one of two residents (Resident R104). Findings include: The facility Identifying types of abuse policy last reviewed 9/28/23, indicated neglect is defined as the failure of the facility, its employees or service providers to provide goods and services that a resident requires, but the facility fails to provide them. And this results in physical harm, pain, mental anguish or emotional distress. Review of Resident R104's admission record indicated she was admitted on [DATE], with diagnoses that included Polycythemia vera (an increase in blood cells creating the potential of blood clotting and blood that is thicker than normal), hypothyroidism (decrease in production of thyroid hormone), and major depressive disorder (a constant feeling of sadness and loss of interest). Review of Resident R104's MDS assessment (Minimum Data Set: MDS - a periodic assessment of resident care needs) dated 2/29/24, indicated that the diagnoses were current upon review. Review of Resident R104's care plan dated 2/22/24, indicated to provide assistance with toileting or provide incontinent care as needed. During an interview on 2/27/24, at 11:34 a.m. Resident R104 stated: I had to go bathroom and I waited one and a half hours. I ended up pissing in my diaper. Resident R104 stated that she had her call bell on the whole time but was uncertain which day that this occurred. During an interview on 2/27/24, at 11:47 a.m. Resident R104's allegation of neglect was reported to the Nursing Home Administrator (NHA) During an interview on 3/2/24, at 11:20 a.m. the Assistant Nursing Home/Administrator/Director of Social Services Employee E1 confirmed that the facility failed to the facility failed to provide goods and services resulting in neglect . 28 Pa Code 201.14(a) Responsibility of licensee. 28 Pa Code 201.18(b)(1)(e)(1) Management. 28 Pa Code 201.29(a)(j) Resident rights. 28 Pa Code 211.12(d)(1)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 3 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, resident clinical record, reports submitted to the State, resident interview and staff interview it was determined that the facility failed to report an allegation of neglect within 24 hours to the local state field office for one of two residents (Resident R104). Findings include: The facility Identifying types of abuse policy last reviewed 9/28/23, indicated neglect is defined as the failure of the facility, its employees or service providers to provide goods and services that a resident requires, but the facility fails to provide them. And this results in physical harm, pain, mental anguish or emotional distress. The facility Abuse, neglect, exploitation, or misappropriation--reporting and investigating policy last reviewed 9/28/23, indicated that all reports of resident abuse, neglect, exploitation, or misappropriation of resident property are reported to local, state and federal agencies. The administrator immediately reports his or her suspicion to the state licensing agency, local state ombudsman, resident representative, and adult protective services. Immediately means within 24 hours of an allegation that does not involve abuse or result in serious bodily injury. Review of Resident R104's admission record indicated she was admitted on [DATE], with diagnoses that included Polycythemia vera (an increase in blood cells creating the potential of blood clotting and blood that is thicker than normal), hypothyroidism (decrease in production of thyroid hormone), and major depressive disorder (a constant feeling of sadness and loss of interest). Review of Resident R104's MDS assessment (Minimum Data Set: MDS - a periodic assessment of resident care needs) dated 2/29/24, indicated that the diagnoses were current upon review. Review of Resident R104's care plan dated 2/22/24, indicated to provide assistance with toileting or provide incontinent care as needed. During an interview on 2/27/24, at 11:34 a.m. Resident R104 stated: I had to go bathroom and I waited one and a half hours. I ended up pissing in my diaper. Resident R104 stated that she had her call bell on the whole time but was uncertain which day that this occurred. During an interview on 2/27/24, at 11:47 a.m. Resident R104's allegation of neglect was reported to the Nursing Home Administrator (NHA). Review of reports submitted to the local state field office from 2/28/24 to 3/2/24 did not include Resident R104 allegation of neglect. During an interview on 3/2/24, at 11:20 a.m. the Assistant Nursing Home/Administrator/Director of Social Services Employee E1 confirmed that the facility failed to report Resident R104's allegation of neglect within 24 hours to the local state field office as required. 28 Pa Code: 201.14(a )(c )(e ) Responsibility of licensee (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 4 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0609 28 Pa Code: 201.18 (b)(1)(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: 395109 If continuation sheet Page 5 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records, and staff interviews, it was determined that the facility failed to ensure that a comprehensive resident care plan was implemented to meet resident care needs for one of six residents reviewed (Resident R37) to address care needs related to a Life Vest (a wearable defibrillator designed to protect residents from sudden cardiac death). Findings include: Review of the clinical record revealed that Resident R37 was admitted to the facility on [DATE]. Review of Resident 37's MDS (Minimum Data Set, periodic assessment of resident care needs) dated 1/31/24, indicated diagnoses of dilated cardiomyopathy (a condition in which the heart's main pumping chamber is enlarged. And becomes weaker as it grows larger), Multiple Sclerosis (a disease that affects the central nervous system), and acute respiratory failure (occurs suddenly and interferes with the ability of the lungs to deliver oxygen). Review of Resident R37's Nursing admission evaluation dated 1/24/24, stated Life Vest noted. Review of Resident R37's physician orders revealed an order written on 1/29/24, that indicated, Life Vest. Change and charge battery QD (daily) one time a day related to other cardiomyopathies (heart muscle disease). Review of Resident R37's physician orders revealed an order written on 1/29/24 that indicated Life Vest Check placement, function, skin integrity every shift related to other cardiomyopathies. Review of Resident R37's care plan conducted on 3/1/24, revealed no instructions for the care and operation of Resident R37's Life Vest. During an interview on 3/1/23, at 11:49 a.m. the Nursing Home Administrator confirmed that the facility failed to implement a comprehensive care plan for Resident R80 to address care needs for her Life Vest. 28 Pa. Code: 211.11(a) Resident care plan. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 6 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policies and clinical records, and staff interviews, it was determined that the facility failed to adhere to acceptable standards of practice related to participation in interdisciplinary meetings and monitoring of Food Service operations Residents Affected - Few Findings include: The Pennsylvania Code, Title 49, Chapter 21, Professional and Vocational Standards: Responsibilities of the Licensed Dietitian/ Nutritionist Section 21.711 Professional Conduct indicated that the Licensed Dietitian/ Nutritionist shall provide information which will enable patients to make their own informed decisions regarding nutrition and dietetic therapy, including the reasonable expectations of the professional relationship. Review of Facility assessment dated [DATE] states that the facility will have a full time Dietitian on staff. During an interview on 2/27/24 at 12:33 p.m. Dietary Manager Employee E5 stated he does not talk to resident's regarding their food preferences. During an interview on 3/2/24 at 11:30 a.m. Registered Dietitian Employee E17 stated she has not come into the building since October 2023 and that she comes into the facility per resident needs. She also confirmed she does not do resident food preferences or interview residents as part of their admission nutrtion assessement. 28 Pa. Code: 201.14(a) Responsibility of Licensee. 28 Pa. Code: 211.12(d)(1) Nursing Services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 7 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy and clinical record review and resident, family, and staff interviews, it was determined that the facility failed to make certain that showers and assistance for activities of daily living were consistently provided for one of five residents (Resident R46). Residents Affected - Few Findings include: Review of the facility policy Activities of Daily Living, Supporting last reviewed 9/28/23, indicated that residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. Supervision is defined as oversight, encouragement or cueing provided three or more times during the last seven days. Review of the clinical record revealed that Resident R46 was admitted to the facility on [DATE]. Review of Resident R46's MDS (Minimum Data Set, periodic assessment of resident care needs) dated 11/29/23, indicated diagnoses of stroke, hemiplegia (paralysis of one side of the body), and unsteadiness on feet. Section GG0130 indicated that Resident R46 requires supervision with bathing and showering. During an observation on 2/27/24, at 11:27 a.m. Resident R46 was noted to have hair past his shoulders. During an interview on 2/27/24, at 11:27 a.m. Resident R46 stated I need a haircut. I'm not young anymore. When asked if he had been offered a haircut. Resident R46 stated I haven't gotten a haircut since I have been here. During an interview on 2/29/24, at 11:05 a.m. Resident R46 stated I was just thinking that it's been a while since I got a shower. When Resident R46 was asked how he normally knows when he is supposed to get a shower he replied They come in and say 'Get your stuff. Let's go.', and they take me to the shower and stand there while I shower. Review of clinical record reveals that Resident R46 is to receive showers every Tuesday and Friday evening. Review of clinical record revealed that Resident R46 did not receive showers on 2/9/24, 2/13/24, 2/20/24, and 2/23/24 as scheduled. During an interview on 2/29/24, at 12:31 p.m., the Director of Nursing (DON) confirmed that beautician quit in October and have not had anyone in this role since then. During an interview on 3/4/24, at 11:00 a.m. the DON confirmed that the facility failed to provide assistant for showers for Resident R46 as ordered. 28 Pa. Code: 211.12(1) Nursing services. 28 Pa. Code: 211.10(d) Resident care policies. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 8 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 28 Pa. Code: 211.12 (2)(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: 395109 If continuation sheet Page 9 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 review of clinical records and staff interview, it was determined that the facility failed to make certain that residents were provided appropriate treatment and services for one of three residents (Resident R37) to address care needs related to Life Vest (wearable defibrillator designed to protect residents from sudden cardiac death). Residents Affected - Few Findings include: Review of the clinical record revealed that Resident R37 was admitted to the facility on [DATE]. Review of Resident 37's MDS (Minimum Data Set, periodic assessment of resident care needs) dated 1/31/24, indicated diagnoses of dilated cardiomyopathy (condition in which the heart's main pumping chamber is enlarged. And becomes weaker as it grows larger), Multiple Sclerosis (a disease that affects the central nervous system), and acute respiratory failure (occurs suddenly and interferes with the ability of the lungs to deliver oxygen). Review of Resident R37's Nursing admission Evaluation dated 1/24/24, stated Life Vest noted. Review of Resident R37's physician orders revealed an order written on 1/29/24, that indicated, Life Vest. Change and charge battery QD (daily) one time a day related to other cardiomyopathies (heart muscle disease). Review of Resident R37's physician orders revealed an order written on 1/29/24 that indicated Life Vest Check placement, function, skin integrity every shift related to other cardiomyopathies. During an interview on 3/1/23, at 11:49 a.m. the Nursing Home Administrator confirmed that the facility failed to have appropriate orders for Resident R37's Life Vest upon admission to ensure appropriate treatment and services. 28 Pa. Code 201.14(a) Responsibility of Licensee. 28 Pa. Code 201.29(a) Resident rights. 28 Pa. Code 211.10(c)(d) Resident care policies 28 Pa Code 211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 10 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical records, and staff interviews, it was determined that the facility failed to make certain that residents were monitored, assessed, and received the necessary services to prevent pressure ulcers from developing or worsening for one of three residents (Resident R10). Residents Affected - Few Findings include: Review of facility policy Pressure Ulcers/Skin Breakdown - Clinical Protocol dated 9/28/23, indicated the staff and practitioner will examine the skin of newly admitted residents for evidence of existing pressure ulcers or other skin conditions. Review of the clinical record indicated Resident R10 was admitted to the facility on [DATE]. Review of resident R10's Minimum Data Set (MDS - a periodic assessment of care needs) dated 2/27/24, indicated diagnoses of high blood pressure, peripheral vascular disease (circulatory condition in which narrowed blood vessels reduce blood flow to the limbs), and malnutrition (lack of sufficient nutrients in the body). Review of a physician's order dated 10/16/23, indicated to complete weekly body audits every day shift on Fridays. This order was discontinued on 11/28/23. Review of Resident R10's Weekly Body Audit documentation revealed the following: - 10/17/23: right heel re-opened area unstageable, resident states he scraped it on the wood of the bottom of the bed - 10/18/23: no new skin alteration identified - 10/20/23: no new skin alteration identified - 11/29/23: no new skin alteration identified - 12/9/23: right buttock stage II discovered, approximately 5 centimeters (cm) x 3 cm, scant bleeding, wound bed red/dark pink - 12/9/23: left buttock superficial shearing, scattered - 12/15/23: no new skin alteration identified Review of the clinical record failed to reveal a Weekly Body Audit completed on 10/27/23, 11/3/23, 11/10/23, 11/17/23, and 11/24/23. During an interview on 3/4/24, at 10:53 a.m. the Director of Nursing (DON) confirmed that the Weekly Body Audits were not completed by the facility on the dates listed above as ordered. Review of Resident R10's admission Wound Assessment Report dated 10/23/23, indicated Resident R10 admitted to the facility with an unstageable pressure ulcer (obscured full-thickness skin and tissue (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 11 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 loss) to the right posterior (back) heel. Level of Harm - Minimal harm or potential for actual harm Review of Resident R10's Wound Assessment Report revealed the following: Residents Affected - Few - 12/11/23: Stage 2 pressure ulcer (partial-thickness skin loss with exposed tissue) to the right buttock measuring length (L) 3 cm x Width (W) 1.5 cm x Depth (D) 0.10 cm, with a wound status of new - 12/27/23: Stage 2 pressure ulcer to the right buttock measuring L 2.5 cm x W 3.5 cm x D 0.10 cm, with a wound status of improving with delayed wound closure - 1/3/24: Unstageable pressure ulcer to the right buttock measuring L 8 cm x W 2 cm x D 0.10 cm, with a wound status of worsening - 1/3/24: Unstageable pressure ulcer to the right lateral (outer edge) foot measuring L 2 cm x W 2 cm x D 0.2 cm, with a wound status of new Review of Resident R10's Wound Assessment Report dated 1/15/24, indicated that the pressure ulcer to Resident R10's right posterior heel was resolved on this date. Review of the most current Wound Assessment Report dated 3/4/24, revealed the following: - Stage 3 (full thickness tissue loss) pressure ulcer to the right buttock measuring L 5 cm x W 2 cm x D 0.10 cm with a wound status of worsening - Stage 3 pressure ulcer to the right lateral foot measuring L 1.7 cm x W 1.4 cm x D 0.10 cm, with a wound status of improving with delayed wound closure Review of a Nursing Note dated 3/3/24, completed by MDS Coordinator Employee E13 stated, Per hospital referral report, uploaded 10/17/2023, did admit with stage 3 pressure ulcer right buttocks, and a nonhealing surgical wound on his right lateral foot. During an interview on 3/4/23 at 10:53 a.m. the DON stated, That's not true, he got those wounds while he was here. His buttocks wound got better for a while and then it got worse. We're going to attempt to reposition him with a wedge starting today and I told the staff that they must start documenting if he refuses the wedge or to be repositioned. That note sounds like someone trying to cover something up that was possibly missed. During an interview on 3/4/24, at 10:53 a.m. the DON confirmed that the facility failed to make certain that residents were monitored, assessed, and received the necessary services to prevent pressure ulcers from developing or worsening for one of three residents (Resident R10). 28 Pa. Code:211.10(a)(c)(d) Resident care policies. 28 Pa. Code: 211.12(d)(1)(2)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 12 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical records, facility documents, resident interview, and staff interview, it was determined that the facility failed to provide adequate supervision resulting in an elopement (resident exits to an unsupervised or unauthorized area without the facility's knowledge). This failure created an immediate jeopardy situation for one of 50 residents (Resident R48). Findings include: The facility Wandering and elopements policy last reviewed 9/28/23, indicated that the facility will identify residents who are at risk of unsafe wandering and strive to prevent harm while maintaining the least restrictive environment. If an employee observes a resident leaving the premises, staff should attempt to prevent the resident from leaving, get help from other staff, and instruct another staff to inform the charge nurse. When the resident returns to the facility, the charge nurse shall examine the resident for injuries, contact the physician and report findings, notify the resident's legal representative, and complete and file an incident report. A review of the Resident Assessment Instrument 3.0 User's Manual effective October 2019, indicated that a Brief Interview for Mental Status (BIMS, a screening test that aides in detecting cognitive impairment). The BIMS total score suggests the following distributions: 13-15: cognitively intact 8-12: moderately impaired 0-7: severe impairment Review of Resident R48's admission record indicated she was admitted on [DATE], with diagnoses that included dementia (a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning), Post-concussion syndrome (lingering symptoms such as headache or confusion after a concussion), depression, hypertension (a condition impacting blood circulation through the heart related to poor pressure), altered mental status (symptoms indicative of brain malfunction with symptoms such as forgetfulness, confusion and behavioral changes), and a history of falling. Review of Resident R48's MDS assessment (Minimum Data Set assessment: MDS -a periodic assessment of resident care needs) dated 1/18/24, indicated that the diagnoses were the most recent upon review. Review of Resident R48's MDS assessment dated [DATE], Section C0500-BIMS screening indicated a score of 5 revealing that Resident 48 was not alert and oriented, and had a severe cognitive impairment. Review of Resident R48's care plan dated 1/12/24, indicated resident was an elopement risk related to concussion symptoms and wandering behaviors, alarming bracelet in place, and nursing staff provide supervision. Review of Resident R48's elopement risk assessment dated [DATE], indicated that resident was cognitively impaired with poor decision making skills, was at risk for elopement, and exhibited wandering (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 13 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 behaviors. Level of Harm - Immediate jeopardy to resident health or safety Review of Resident R48's physician orders dated 1/16/24, indicated to provide alarming security bracelet. Residents Affected - Few Review of facility submitted documentation dated 2/29/24, indicated on Tuesday, 2/27/24, at approximately 3:15 p.m. Resident R48 was observed by staff outside of the building walking in the parking lot of the facility. Staff members immediately went outside and walked her back into the building. There were no injuries and when asked Resident R48 stated, I'm just walking the dogs. It's such a beautiful day. Resident was last seen walking in hallway approximately 15-minutes prior to being seen in the parking lot. Resident R48 was unable to tell staff which door Resident R48 exited but it was assumed to be the main entrance as multiple staff were present at the back entrance and claim they would have seen her if she exited that door. Resident R48 had a wanderguard security device placed on admission, no alarm sounded when she exited the building, no staff observed her by an exit or actively exiting the building. Maintenance Supervisor Employee E7 was conducting a check of the fire alarm system at that time, which does unlock the doors, but stated the doors were only unlocked for three to five seconds. Review of Activity Aide Employee E10's incident/witness statement dated 2/27/24, indicated that Resident R48 was leaving behind the back nurses station when she witnessed Resident R48 outside. Activity Aide Employee E10 and other staff immediately went outside and redirected Resident R48 back inside. Review of Nurse Aide Employee E8 incident/witness statement dated 2/27/24, indicated that Activity Aide Employee E10 alerted staff that Resident R48 was outside. Staff ran outside and escorted her back into the building. Prior to seeing her, the fire alarm was being tested. Review of Nurse Aide Employee E9's incident/witness statement dated 2/28/24, indicated that she was gathering her things to leave when Activity Aide Employee E10 alerted staff that Resident R48 was outside. Review of Resident R48's clinical record after the elopement on 2/27/24 did not include a complete full body assessment immediately after the incident, an incident report regarding the elopement, or the implementation of 15-minute checks to ensure supervision of Resident R48. Review of Resident R48's clinical record after the elopement on 2/27/24, the Medication Administration Record (MAR) February for 2024 did not include 15-minute checks until 2/29/24. No other documentation of interventions was identified on Resident R48's record. During an interview on 2/29/24, at 10:20 a.m. the Director of Nursing (DON) stated: The wander guard did not go off and we do not know why. No one heard the alarm when she left the building. The wander guard was replaced and worked fine. I don't think an assessment was done immediately after the elopement. Activity Aide Employee E10 went and told Assistant Nursing Home Administrator/Director of Social Services Employee E1. Assistant Nursing Home Administrator/Director of Social Services Employee E1 was not certain Resident R48 was outside. During an interview on 2/29/24, at 12:38 p.m. Speech Therapists Employee E11 stated: I did not see Resident R48 leave the door. I left at 2:53 p.m. on 2/27/24 and I did not see her when I was leaving. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 14 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few During an interview on 2/29/24, at 1:06 p.m. Activity Aide Employee E10 stated the following: I was on break behind the nurse station. I looked up and saw Resident R48 go past the window. We went outside and redirected her back in. It was me, Nurse Aide Employee E8, Nurse Aide Employee E9, and Maintenance Supervisor Employee E7. They were by the back door. It was Tuesday, the weather was not bad. Resident R48 was not hurt/injured. You think the wander guard would of went off. Staff walked her to the front door. Resident R48 was talking normal. I'm not sure which door she exited. Incident occurred around 3:20 p.m. or 3:25 p.m. on 2/27/24. During an interview on 2/29/24, at 1:10 p.m. Nurse Aide Employee E8 stated the following: I was charting at the nurse station. I was about to leave. Activity Aide Employee E10 looked up and said Resident R48 was outside. Resident R48 was outside by herself with a coffee cup in her hand. She said resident was walking her dogs and it was a beautiful day. I walked with her and brought her into the building. It was nice outside. not cold. maybe 60 degrees. The incident occurred around 3:15 p.m. or 3:20 p.m. Nurse Aide Employee E8 was asked how does nursing staff account for residents, and she stated: they have the wander guard on, they cannot get in or out without the wander guard on. we check on the residents per hour. The nurse tells us which residents are wandering residents and residents are accounted for every hour. Maintenance Supervisor Employee E7 tested the fire alarm and from what I understood and the wander guard was not working. Resident R48 was not harmed or injured. There is no wander guard on the back door, only one at the front door. During an interview on 2/29/24, at 1:16 p.m. Nurse Aide Employee E9 stated the following: I came back and sat down at the back hall nurse station. I was close to leaving. Activity Aide Employee E10 stated that Resident R48 was outside. We ran to the backdoor, found Resident R48 in the parking lot and found her safe. Resident R48 kept saying she wanted to go for a walk. She was not harmed or injured. Resident R48 was wearing long sleeves and pants. The time was close to 3:23 p.m. that is when I punch out to leave. Residents are accounted by staff and we do rounds. That is done per shift at the start of the shift. Nurses tell us who are the wandering residents. I did not hear an alarm. There is no alarm at the back door. They changed her bracelet. During an interview on 2/29/24, at 1:22 p.m. Maintenance Supervisor Employee E7 stated the following: I was standing by room [ROOM NUMBER] and heard someone say that Resident R48 was outside. I looked out the window and saw Resident R48 walking in the parking lot. I saw an aide escort her back in. I have no idea how she got out. The back door does not have a wander guard alarm. Someone will come in on Monday to give us a quote for an alarm. During an interview on 2/29/24, at 2:05 p.m. the Director of Nursing (DON), Regional Clinical consultant Employee E12, and Assistant Nursing Home Administrator/Director of Social Services Employee E1 were notified that Immediate Jeopardy (IJ) was called due to the elopement on 2/27/24, and facility staff were provided an Immediate Jeopardy (IJ) template at that time, and a corrective action plan was requested. On 2/29/24, at 5:14 p.m. an immediate action plan was received and accepted which included the following interventions: 1. Elopement reassessment of all residents. 2. Resident R48 placed on q-15 minute checks. 3. Resident R48 care plan updated. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 15 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 4. Resident R48 wander guard replaced and tested. Level of Harm - Immediate jeopardy to resident health or safety 5. Resident R48 body assessment to rule out injury. Residents Affected - Few 7. Complete whole house education with all staff on elopement policy/procedure, elopement binder, and appropriate 6. Update to Elopement policy to add q-15 minute checks after an elopement incident. supervision by 12:15 p.m. on 3/1/24. 8. Elopement book will be maintained, updated regularly, and staff educated on location of elopement book. 9. Reassess all current residents with wander guards to ensure function, completed by Maintenance Supervisor Employee E7. On 3/1/24, at 9:12 a.m. all residents assessments for elopement risk were observed and found to be completed. The elopement policy was updated, and documentation verifying all current residents with wander guards function correctly, and careplans were review and updated if needed. During interviews of staff working on 3/1/24, between 12:15 p.m. and 1:40 p.m. staff (22 out of 80 staff persons) confirmed they were trained on the updated elopement policy, what to do during an elopement, the elopement book at the nurse's station and appropriate resident supervision. Verification of the facility's Corrective Action Plan revealed all elements of plan were substantially completed and the Immediate Jeopardy was lifted on at 1:55 p.m. on 3/1/24. During an interview on 3/1/24, at 2:38 p.m. the Nursing Home Administrator (NHA) confirmed that the facility failed to provide adequate supervision resulting in Resident R48's elopement. This failure created an immediate jeopardy situation for Resident R48 and potentially put her at risk of harm or injury. 28 Pa. Code 201.18 (e)(1)(3) Management. 28 Pa. Code 207.2(a)Administrators Responsibility 28 Pa. Code 211.12(a)(c)(d)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 16 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident observations, resident interviews, staff interviews, clinical record review, and grievance review, it was determined that the facility failed to have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of three of ten residents (Resident R35, R46, and R104). Findings Include: Review of a resident grievance dated 10/25/23, Resident R 35 stated concern over response time to call bells being answered. During an interview on 2/28/24, at 12:01 p.m. MDS (minimum data set- periodic assessment of resident care needs) Coordinator Employee E13 stated Lately we've had no agency (nursing staff). I think it ' s because they weren't being paid. We were pretty good there for a while until we didn ' t get paid the second time. During a group interview on 2/28/24 at 1:31 p.m. the following was stated: 11 out of 11 residents stated that there is not enough staff 2 out of 11 residents clarified that evening shift is short staffed. Review of the clinical record revealed that Resident R46 was admitted to the facility on [DATE]. Review of Resident 46's MDS (Minimum Data Set, periodic assessment of resident care needs) dated 11/29/23, indicated diagnoses of stroke, hemiplegia (paralysis of one side of the body), and unsteadiness on feet. Section GG0130 indicated that Resident R46 requires supervision with bathing and showering. During an interview on 2/29/24, at 11:05 a.m. Resident R46 stated I was just thinking that it's been a while since I got a shower. When Resident R46 was asked how he normally knows when he is supposed to get a shower he replied They come in and say 'Get your stuff. Let's go.', and they take me to the shower and stand there while I shower. Review of clinical record reveals that Resident R46 is to receive showers every Tuesday and Friday evening. Review of clinical record revealed that Resident R46 did not receive showers on 2/9/24, 2/13/24, 2/20/24, and 2/23/24 as scheduled. Review of Resident R104's admission record indicated she was admitted on [DATE], with diagnoses that included Polycythemia vera (an increase in blood cells creating the potential of blood clotting and blood that is thicker than normal), hypothyroidism (decrease in production of thyroid hormone), and major depressive disorder (a constant feeling of sadness and loss of interest). Review of Resident R104's MDS assessment (Minimum Data Set: MDS - a periodic assessment of resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 17 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0725 care needs) dated 2/29/24, indicated that the diagnoses were current upon review. Level of Harm - Minimal harm or potential for actual harm Review of Resident R104's care plan dated 2/22/24, indicated to provide assistance with toileting or provide incontinent care as needed. Residents Affected - Many During an interview on 2/27/24, at 11:34 a.m. Resident R104 stated: I had to go bathroom and I waited one and a half hours. I ended up pissing in my diaper. Resident R104 stated that she had her call bell on the whole time but was uncertain which day that this occurred. During an interview on 3/4/24 , at 11:00 a.m. the DON confirmed that the facility failed to provide timely assistance to answer call bells for Resident R35, and R104, and failed to assist with showers for Resident R46 and failed to have sufficient nursing staff and to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of three of seven residents. During an interview on 3/5/24, at 12:40 p.m. Nurse Aide Employee E26 stated We work short a lot, and have to try to help each other to get stuff done, but sometimes you just can't get finished. 28 Pa. Code: 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(e)(6) Management. 28 Pa. Code: 201.20(a) Staff development. 28 Pa. Code: 211.12(a)(c)(d)(1)(2)(3)(4) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 18 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on manufacturer's instructions, clinical record review, and staff interview it was determined that the facility failed to ensure that nursing staff have the specific competencies and skill sets necessary to provide care for a resident with a Life Vest (a wearable defibrillator designed to protect residents from sudden cardiac death), and placed one resident (Resident R37) in immediate jeopardy in which health and safety were impacted. Findings include: Review of the [NAME] Life Vest Patient Manual updated 2023, indicated the following: · Wear all day and all night · Life Vest slides on and off like a backpack. · If the garment fits loosely, call [NAME] (manufacturer). The garment should be snug against the skin. · Remove Life Vest to bathe, shower, or change the garment, · Turn on Life Vest by inserting the battery. Always have the garment on before inserting the battery. · Every 24 hours, change and recharge the batteries. · There are two batteries. Always charge one while using the other. · Place the charger in a safe place where it can be plugged in. · (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 19 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0726 Battery should slide in easily. Do not force the battery into the monitor. Level of Harm - Immediate jeopardy to resident health or safety · Residents Affected - Few · Practice changing the battery. Act quickly for siren alerts. Press the response buttons. · This alert signals that Life Vest has detected a life threatening rapid heart rhythm. · Only the patient should press the response button. · If a treatment is received by the Life Vest, leave the Life Vest on and call the doctor. Call [NAME] for a new electrode belt, and check display for any messages and take action. · Read the display for gong alerts and follow the instructions on the screen. · When connecting and disconnecting the electrode belt be careful not to bend the pins. · Remove the battery from the monitor before you remove the garment. · Remove the electrode belt from the garment and insert it into a clean garment. · Make sure the silver sides of the therapy pads (with the green label) face the mesh of the pocket. Snap the pockets closed. · Position and secure the vibration box to the garment. · (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 20 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0726 Attach the round electrodes to the garment. Match the colors on the backs of the electrodes to the colors on the garment. Level of Harm - Immediate jeopardy to resident health or safety · Residents Affected - Few Electrodes and therapy pads should press against bare skin. The mesh fabric pockets and silver side of the therapy pads (with green labels) MUST TOUCH BODY for the device to work properly. · Do not put the monitor, electrode belt, battery or charger in water; do not get components wet. · Call [NAME] immediately if a Call for Service- Message Code 102 appears on the Life Vest screen. A replacement device will be provided within 24 hours from your notification to [NAME]. · Wash the garment every 1-2 days. Do not use bleach or fabric softener. · If prompted to download data, follow the instructions to do so. Review of the clinical record revealed that Resident R37 was admitted to the facility on [DATE]. Review of Resident 37's MDS (Minimum Data Set, periodic assessment of resident care needs) dated 1/31/24, indicated diagnoses of dilated cardiomyopathy (a condition in which the heart's main pumping chamber is enlarged. And becomes weaker as it grows larger), Multiple Sclerosis (a disease that affects the central nervous system), and acute respiratory failure (occurs suddenly and interferes with the ability of the lungs to deliver oxygen). Review of Resident R37's Nursing admission evaluation dated 1/24/24, stated Life Vest noted. Review of Resident R37's physician orders revealed an order written on 1/29/24, that indicated, Life Vest. Change and charge battery QD (daily) one time a day related to other cardiomyopathies (heart muscle disease). Review of Resident R37's physician orders revealed an order written on 1/29/24 that indicated Life Vest Check placement, function, skin integrity every shift related to other cardiomyopathies. During an interview on 2/28/24, at 1:45 p.m. MDS Coordinator Employee E13 stated that education was not provided to staff on the care and operation of the Life Vest, but it probably should have. During an interview on 3/1/24, at 9:34 a.m. LPN Employee E6 stated that she had not received any training on the Life Vest for Resident R37. LPN Employee E6 stated that she had a resident in the past (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 21 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0726 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few that had a Life Vest, and that the facility brought in someone from the manufacturer to educate the staff prior to the resident's arrival, but not for Resident R37. During an interview on 3/1/24, at 10:05 a.m. LPN Employee E14 also verified that she had not received training for Resident R37. During an interview on 3/1/24, at 1:10 p.m. Nurse Aide Employee E15 was asked what she knew about Life Vests and she replied I don't know anything about it or how to operate it. They don't involve the aides. Review of Resident R37's care plan conducted on 3/1/24, revealed no instructions for care and operation of Resident R37's Life Vest. On 3/1/24, at 3:54 p.m., the Nursing Home Administrator (NHA) was made aware that Immediate Jeopardy (IJ) existed, NHA was provided the IJ Template, that placed one resident (Resident R37) in immediate jeopardy in which health and safety were impacted, and a corrective action plan was requested. On 3/1/24, at 6:36 p.m., an acceptable Corrective Action Plan was received which included the following interventions: Immediate Action: · NHA spoke with [NAME] representative who will be sending educational information overnight to the facility that will pertain all [NAME] Life Vests that may remain in the facility for current and future use. · Resident R37's son had package from [NAME] that included instructions, and extra supplies, and was asked to return them to the facility. Residents: · Resident R37's physician's orders and care plan were updated System Correction: · All present licensed nursing and aide staff will be educated on the [NAME] Life Vest on 3/1/2024 via [NAME] online education by Registered Nurse Supervisor. · All licensed nursing and aide staff will be re-educated on the [NAME] Life Vest prior to their (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 22 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0726 shift on their next shift by Director of Nursing/Designee via [NAME] online education. All education will be completed by 3/4/2024. Level of Harm - Immediate jeopardy to resident health or safety · Residents Affected - Few Policy and Procedure for new admissions requiring the use of wearable cardioverter defibrillators now includes in servicing of all licensed nurses and aides upon admission and prior to care. Monitoring: · Director of Nursing/Designee will audit all new admissions to ensure current staff has appropriate education for wearable cardioverter defibrillators and/or any other non-standard medical equipment. Tracking and trending will be taken through Quality Assurance Committee for tracking and trending purposes. During an interview on 3/2/24, at 9:35 a.m. Assistant Nursing Home Administrator (ANHA) informed that 11 employees out of 37 had been educated on the Life Vest by watching a video that was on [NAME]'s website and that they were still waiting for the overnight package from [NAME] that would contain education materials. During an interview on 3/3/24, at 11:35 a.m. NHA was asked if the overnight package from [NAME] had arrived, to which she replied No. Overnight does not mean overnight. A link was also requested to the video that staff was watching for education. During an interview on 3/4/24, at 1:30 p.m. ANHA, and NHA informed that 23 out of 37 employees had received Life Vest education via the link on [NAME]'s website. ANHA, and NHA were asked again for a link to this education, to which ANHA replied she cannot figure out how to send the link. State Agency requested a step by step instruction on how to find the particular education that the facility staff was using. State Agency reviewed the educational video on line on 3/4/24, at 1:35 p.m. and found that the education was geared towards 'First Responders, and did not include most of the above education, but provided details on how to use a defibrillator in conjunction with the Life Vest. During an interview on 3/4/24, at 1:45 p.m. NHA was informed that the video that staff was instructed to view as part of Life Vest education did not include appropriate information for daily care. During an interview on 3/4/24, at 1:50 p.m. NHA was asked if the overnight package containing education materials from [NAME] had arrived. NHA then got up and walked down the hall to look and see if it had arrived. During an observation on 3/4/24, at 1:52 p.m. NHA walked into conference room with the package from [NAME] that contained the education materials. Review of these educational materials revealed them to be appropriate. During an interview on 3/5/24, at 12:18 a.m. NA Employee E15 confirmed that she received education (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 23 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0726 Level of Harm - Immediate jeopardy to resident health or safety on the Life Vest which included information about the different alarms. NA Employee E15 added First of all, I didn't know that it could be washed. I learned a lot. The first education didn't include anything useful for an aide. During an interview on 3/5/24, at 12:40 p.m. NA Employee E26 confirmed that she received education on the Life Vest, and replied This is the first time I ever worked with one. I didn't know anything about them. Residents Affected - Few During an interview on 3/5/24, at 12:55 p.m. NA Employee E32 confirmed that she had received education on the Life Vest and recapped that she learned about the different alarms and that the vest could be removed for showers. NA Employee E32 added At least I know now. During an interview on 35/24, at 1:26 p.m. NA Employee E33 confirmed that she had received education on the Life Vest and stated I was glad I got the education because I have taken care of people before (with a Life Vest) and I never had a good understanding of it. During an interview on 3/5/24, at 2:00 p.m. RN Employee E25 also confirmed that he had received education on the Life Vest, and added he learned new things regarding the risk of shock. The Immediate Jeopardy was lifted on 3/5/24, at 2:43 p.m. when the action plan was verified. During an interview on 3/5/24, at 4:15 p.m. the ANHA confirmed that the facility failed to ensure that nursing staff have the specific competencies and skill sets necessary to provide care for a resident with a Life Vest which created a situation that placed one resident (Resident R37) in immediate jeopardy in which health and safety were impacted. 28 Pa. Code 211.11(d) Resident care plan FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 24 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0730 Observe each nurse aide's job performance and give regular training. Level of Harm - Minimal harm or potential for actual harm Based on review of personnel records, and staff interview it was determined that the facility failed to complete annual performance evaluations for four out of five nurse aides (NA Employee E4, E19, E20, and E21). Residents Affected - Some Findings include: Review of personnel files revealed that Nurse Aide Employee E4 start date was 9/4/18, last performance evaluation was completed 8/14/19. Review of personnel files revealed that Nurse Aide Employee E19 start date was 8/8/13, last performance evaluation was completed 10/30/19. Review of personnel files revealed that Nurse Aide Employee E20 start date was 6/2/11, last performance evaluation was completed 5/15/20. Review of personnel files reviewed that Nurse Aide Employee E21 start date was 10/21/20, last performance evaluation was completed 10/21/21. During an interview on 2/28/24, at 12:30 p.m. the Human Resource Employee E18 confirmed that the facility does not have up to date performance reviews completed on NA Employee E4, E19, E10 and E21. 28 Pa Code: 201.20 (a)(b)(c)(d) Staff development. 28 Pa Code: 201.14 (a) Responsibility of licensee. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 25 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident must receive and the facility must provide necessary behavioral health care and services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical record review, and staff interview it was determined that the facility failed to provide a resident with necessary behavioral non-pharmacological interventions to maintain the highest practicable mental and psychosocial well-being for one out of four sampled resident records (Resident R3). Findings include: Review of facility policy Psychotropic Medication Use dated 9/28/23, indicated that a psychotropic medication is any medication that affects brain activity associated with mental processes and behavior. Psychotropic medication management includes indications for use, dose, duration, adequate monitoring for efficacy and adverse consequences and preventing, identifying, and responding to adverse consequences. Review of Resident R3's admission record indicated Resident R3 was admitted on [DATE]. Review of Resident R3's MDS assessment (Minimum Data Set Assessment: A periodic assessment of resident care needs) dated 1/3/24, indicated she was admitted with the following diagnoses that included Depression, Dementia (a group of symptoms that affects memory, thinking and interferes with daily life), and coronary artery disease (damage or disease in the heart's major blood vessels). Resident R3's MDS assessment section C0200 Brief Interview for Mental Status (BIMS, a screening test that aides in detecting cognitive impairment). The BIMS total score suggests the following distributions: 13-15: cognitively intact, 8-12: moderately impaired, 0-7: severe impairment. Resident R3's BIMS score was a 13 indicating Resident R3 was cognitively intact. Review of Resident R3's MDS assessment, dated 1/3/24, section D0150 Resident Mood Interview indicated that R3 answered no to the assessment questions. The questions include, Do you have little interest or pleasure in doing things? and Are you feeling down, depressed, or hopeless? Review of Resident R3's care plan dated 6/13/23, indicated to evaluate effectiveness and side effects of medication for possible decrease/elimination of psychotropic drugs. Review of Resident R3's care plan dated 7/12/23, indicated to consult psychiatrist (a medical practitioner specializing in the diagnosis and treatment of mental illnesses) and follow up as needed. Review of Residents R3's physician orders indicated she was prescribed the following medications: -Ordered on 9/25/23, Trazodone 50 mg at bedtime for insomnia (unable to sleep) -Ordered on 10/3/23, Olanzapine 20 mg at bedtime for bipolar -Ordered on 10/3/23, Olanzapine 10 mg in the evening for bipolar -Ordered on 10/4/23, Olanzapine 5 mg in the morning for bipolar (a disorder associated with episodes of mood swings ranging from depressive lows to manic highs) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 26 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0740 Level of Harm - Minimal harm or potential for actual harm -Ordered on 12/3/23, Alprazolam (Xanax) 0.5 mg every eight hours as needed for anxiety (a feeling of worry) Review of Resident R3's clinical record indicate that she was given Xanax, as needed, on 6/27/23, 6/28/23, 9/6/23, 10/3/23, 11/14/23, 12/3/23, 12/8/23, and 12/9/23. Residents Affected - Few Review of Resident R3's clinical record indicated no tracking or documentation of her behaviors prior to administrating any psychotropic medications. Review of Resident R3's clinical record failed to reveal documentation that the facility had attempted to reduce, taper, or discontinue the antipsychotic medications prescribed for Resident R3. During an interview on 3/2/24, at 2:58 p.m. the Director of Nursing confirmed that the facility failed to provide residents with necessary behavioral healthcare, to maintain the highest practicable mental and psychosocial well-being for Resident R3 as required. 28 Pa. Code: 201.14 (a) Responsibility of licensee. 28 Pa. Code: 211.10 (a)(d) Resident care policies. 28 Pa. Code: 211.12 (d)(3)(5) Nursing Services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 27 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 - Many 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 facility documentation, and staff interviews, it was determined the facility failed to implement a complete drug regimen review process for five months for five out of five sampled residents (Resident R3, R8, R11, R17, and R49). Findings include: The facility Medication utilization and prescribing-clinical protocol policy dated 9/28/23, indicated that the consultant pharmacist should us the monthly and interim drug regimen review to help identify potentially problematic medications, including medication regimens that are not supported based on clinical signs or symptoms. The staff and practitioners in collaboration with the consultant pharmacist will take into account medication related issues and drug interactions. Review of the clinical record indicated Resident R3 was admitted to the facility on [DATE]. Review of Resident R3's Minimum Data Set (MDS - a periodic assessment of care needs) dated 1/3/24, indicated diagnoses of coronary artery disease (damage or disease in the heart's major blood vessels), depression (a constant feeling of sadness and loss of interest), and dementia (a group of symptoms that affects memory, thinking and interferes with daily life). Review of Resident R3's care plan dated 6/13/23, indicated to evaluate effectiveness and side effects of medication for possible decrease/elimination of psychotropic drugs. Review of Residents R3's physician orders indicated she was prescribed the following medications: - Ordered on 12/3/23, Alprazolam 0.5 milligrams (mg) every eight hours as needed for anxiety (a feeling of worry) - Ordered on 10/4/23, Olanzapine 5 mg in the morning for bipolar (a disorder associated with episodes of mood swings ranging from depressive lows to manic highs) - Ordered on 10/3/23, Olanzapine 10 mg in the evening for bipolar - Ordered on 10/3/23, Olanzapine 20 mg at bedtime for bipolar - Ordered on 9/25/23, Trazodone 50 mg at bedtime for insomnia (unable to sleep) Review of Resident R3's clinical record did not include a medication regimen review from a certified pharmacist or pharmacist consultant for October 2023, November 2023, December 2023, January 2024, and February 2024. Review of the clinical record indicated Resident R8 was admitted to the facility on [DATE]. Review of Resident R8's MDS dated [DATE], indicated diagnoses of high blood pressure, anxiety (a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 28 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 feeling of worry, nervousness, or unease), and depression. Level of Harm - Minimal harm or potential for actual harm Review of Resident R8's care plan dated 1/12/24, indicated to evaluate effectiveness and side effects of medications for possible decrease/elimination of psychotropic drugs and dose reduction attempts as appropriate. Residents Affected - Many Review of Resident R8's physician orders dated 1/12/24, indicated she was prescribed the following medications: - Abilify 15 mg at bed time for depression - Bupropion 300 mg once a day for depression - Venlafaxine 300 mg once a day for depression - Klonopin 1 mg two times a day for anxiety Review of Resident R8's clinical record did not include a medication regimen review from a certified pharmacist or pharmacist consultant for January 2024, and February 2024. Review of the clinical record indicated R11 was admitted to the facility on [DATE]. Review of R11's MDS dated [DATE], indicated diagnoses of schizophrenia (a mental disorder characterized by delusions, hallucinations, disorganized speech and behavior), diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time), and depression. Review of R11's care plan dated 1/24/24, indicated to evaluate effectiveness and side effects of medication for possible decrease/elimination of psychotropic drug. Dose reduction attempts as appropriate. Review of Residents R11's physician orders, indicated he was prescribed the following medications: - Ordered on 10/9/23, Buspirone 20 mg three times a day for depression - Ordered on 10/10/23, Lexapro 10 mg daily for depression - Ordered on 10/9/23, Doxepin 150 mg at bedtime for depression - Ordered on 1/11/24, Risperdal 4 mg at bedtime for schizophrenia Review of Resident R11's clinical record did not include a medication regimen review from a certified pharmacist or pharmacist consultant for October 2023, November 2023, December 2023, January 2024, and February 2024. Review of Resident R17's admission record indicated she was originally admitted on [DATE]. Review of Resident R17's MDS assessment dated [DATE], indicated she had diagnoses that included dementia (a condition characterized by memory loss and progressive or persistent loss of intellectual functioning), peripheral vascular disease (PVD, circulatory condition in which narrowed blood vessels (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 29 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 - Many reduce blood flow to the limbs) , anxiety disorder (a medical condition creating a sense of acute fear, restlessness, and worry) and hypertension (a condition impacting blood circulation through the heart related to poor pressure). Review of Resident R17's care plan dated 8/31/18, indicated to evaluate effectiveness and side effects of medications for possible decrease/elimination of psychotropic drugs and Monitor Pharmacist's drug regimen for identification of potential drug interactions and side effects. Review of Resident R17's physician orders dated 12/5/23, indicated she was on the following medications: Abilify 20mg for psychosis Trintellix 5mg for depression Nortriptyline 50mg for depression Review of Resident R17's did not include a medication regimen review from a certified Pharmacist or Pharmacist consultant for October 2023, November 2023, December 2023, January 2024 and February 2024. Review of Resident R49's admission record indicated he was originally admitted [DATE]. Review of Resident R49's MDS assessment dated [DATE], indicated that his medical diagnoses included vascular dementia, Benign Prostatic Hyperplasia (flow of urine is blocked from enlarged prostate), and hyperlipidemia (elevated lipid levels within the blood). Review of Resident R49's care plan dated 2/6/24, indicated that Resident R49 was at risk for adverse effects related to use of anti-depression medication and use of antipsychotic medication. Review of Resident R49's physician orders dated 2/8/24, indicated he was on the following psychiatric medication: Depakote 500 mg for vascular dementia. Review of Resident R49's clinical record did not include a medication regimen review from a certified Pharmacist or Pharmacist consultant for October 2023, November 2023, December 2023, January 2024 and February 2024. During an interview on 2/29/24, at 9:35 a.m. the DON confirmed that the facility was unable to locate medication regimen reviews for Residents R3, R8, R11, R17, and R49. During an interview on 2/29/24, at 9:41 a.m. the DON stated, We do not have any pharmacy review records or medication regimen reviews from October 2023 to now. The pharmacy consultant quit in October 2023 and we didn't realize that we have to hire another one, the pharmacy does not supply one automatically. We now have one starting in March. 28 Pa. Code 211.2(a) Physician services (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 30 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 28 Pa. Code 211.5(f) Clinical records Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.10(c) Resident care policies Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 31 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policies, clinical record review, and staff interview, it was determined that the facility failed to make certain resident medication regimens were free from potentially unnecessary medications for two of four residents (Resident R3 and R8). Findings include: Review of facility policy Antipsychotic Medication Use dated 9/28/23, indicated antipsychotic medications will be prescribed at the lowest possible dosage for the shortest period of time and are subject to gradual dose reduction and re-review. Residents who are admitted from the community or transferred from a hospital who are already receiving antipsychotic medications will be evaluated for the appropriateness and indications for use. The interdisciplinary team will re-evaluate the use of the antipsychotic medication at the time of admissions and/or within two weeks (at the initial MDS assessment) to consider whether or not the medication can be reduced, tapered, or discontinued. PRN (as needed) orders for antipsychotic medications will not be renewed beyond 14 days unless the healthcare practitioner has evaluated the resident for the appropriateness of that medication and documented the rationale for continued use. The duration of the PRN order will be indicated in the order. Review of facility policy Medication Utilization and Prescribing - Clinical Protocol dated 9/28/23, indicated that the consultant pharmacist should use the monthly and interim drug regimen review to help identify potentially problematic medications, including medication regimens that are not supported based on clinical signs or symptoms. The staff and practitioners in collaboration with the consultant pharmacist will take into account medication related issues and drug interactions. Review of the clinical record indicated Resident R3 was admitted to the facility on [DATE]. Review of Resident R3's Minimum Data Set (MDS - a periodic assessment of care needs) dated 1/3/24, indicated diagnoses of coronary artery disease (damage or disease in the heart's major blood vessels), depression (a constant feeling of sadness and loss of interest), and dementia (a group of symptoms that affects memory, thinking and interferes with daily life). Review of Resident R3's care plan dated 6/13/23, indicated to evaluate effectiveness and side effects of medication for possible decrease/elimination of psychotropic drugs. Review of Residents R3's physician orders indicated she was prescribed the following medications: - Ordered on 12/3/23, Alprazolam 0.5 milligrams (mg) every eight hours as needed for anxiety (a feeling of worry) - Ordered on 10/4/23, Olanzapine 5 mg in the morning for bipolar (a disorder associated with episodes of mood swings ranging from depressive lows to manic highs) - Ordered on 10/3/23, Olanzapine 10 mg in the evening for bipolar - Ordered on 10/3/23, Olanzapine 20 mg at bedtime for bipolar (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 32 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0758 - Ordered on 9/25/23, Trazodone 50 mg at bedtime for insomnia (unable to sleep) Level of Harm - Minimal harm or potential for actual harm Review of Resident R3's clinical record did not include a medication regimen review from a certified pharmacist or pharmacist consultant for October 2023, November 2023, December 2023, January 2024, and February 2024. Residents Affected - Few Review of Resident R3's clinical record failed to reveal documentation that the facility had attempted to reduce, taper, or discontinue the antipsychotic medications prescribed for Resident R3. Review of the clinical record indicated Resident R8 was admitted to the facility on [DATE]. Review of Resident R8's MDS dated [DATE], indicated diagnoses of high blood pressure, anxiety (a feeling of worry, nervousness, or unease), and depression. Review of Resident R8's care plan dated 1/12/24, indicated to evaluate effectiveness and side effects of medications for possible decrease/elimination of psychotropic drugs and dose reduction attempts as appropriate. Review of Resident R8's physician orders dated 1/12/24, indicated she was prescribed the following medications: - Abilify 15 mg at bed time for depression - Bupropion 300 mg once a day for depression - Venlafaxine 300 mg once a day for depression - Klonopin 1 mg two times a day for anxiety Review of Resident R8's clinical record did not include a medication regimen review from a certified pharmacist or pharmacist consultant for January 2024, and February 2024. Review of Resident R8's clinical record failed to reveal documentation that the facility had attempted to reduce, taper, or discontinue the antipsychotic medications prescribed for Resident R8. During an interview on 2/28/24, at 10:32 a.m. the Director of Nursing (DON) stated, We do not get a pharmacy review document from the pharmacist. I get emails from the pharmacy saying if there is a specialty medication change. During an interview on 2/29/24, at 9:35 a.m. the DON confirmed that the facility was unable to locate medication regimen reviews for Residents R3, R8, R11, R17, and R49. During an interview on 2/29/24, at 9:41 a.m. the DON stated, We do not have any pharmacy review records or medication regimen reviews from October 2023 to now. The pharmacy consultant quit in October 2023 and we didn't realize that we have to hire another one, the pharmacy does not supply one automatically. We now have one starting in March. During an interview on 2/29/24, at 9:41 a.m. the DON confirmed that the facility failed to make certain resident medication regimens were free from potentially unnecessary medications for two of four (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 33 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0758 residents (Resident R3 and R8). Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code: 201.14(a) responsibility of licensee. 28 Pa. Code 211.9(a)(1) Pharmacy services. Residents Affected - Few 28 Pa. Code 211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 34 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on review of facility policies, observations, and staff interviews, it was determined that the facility failed to properly and safely store medications under appropriate temperatures in one of two medication rooms (Front medication room). Finding include: The facility Medication: labeling and storage policy last reviewed on 9/28/23, indicated that the facility stores all medications and biologicals under proper temperature, humidity, and light controls. During observations on 2/27/24, at 10:24 a.m. observations of medication room/ front medication room with MDS coordinator RN Employee E13 found the following: medication room refrigerator observed with a temperature reading 50°F The Refrigerator temperature log indicated that refrigerator temperatures must fall between 36°F and 46°F. During an interview, on 2/27/24, at 10:27 a.m. MDS coordinator RN Employee E13 confirmed that the facility failed to properly and safely store medications under appropriate temperatures 28 Pa. Code: 211.9(a)(1)(h)(k)(l)(1) Pharmacy services. 28 Pa. Code:211.12(d)(1)(2)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 35 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0801 Level of Harm - Minimal harm or potential for actual harm Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Based on staff interviews it was determined that the facility failed to employ a qualified Dietary Manager and Registered Dietitian since October 2023. Residents Affected - Some Findings include: During a kitchen tour on 2/27/24 at 9:30 a.m. Dietary Manager Employee E5 stated that he started his position October 2023 and he is not a CDM (Certified Dietary Manager) and he has catering experience. Review of personnel file revealed Employee E5 hire date 10/23. Personnel file confirmed no certification. Interview on 2/29/24 at 1:30 p.m. Director of Nursing confirmed Dietary Manager was not qualified as required. During an interview 3/2/24, 11:30 a.m. Registered Dietitian Employee E17 confirmed there hasn't been an Registered Dietitian at the facility since October 2023. She has been PRN (per resident needs) and she has since resigned from the company effective 3/11/24. 28 Pa. Code 201.18(e)(1)(6)Management. 28 Pa. Code 211.6(c) Dietary services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 36 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0803 Level of Harm - Minimal harm or potential for actual harm Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on menu, resident council group interview and staff interviews, it was determined that the facility failed to follow the menu for two of two meals (Breakfast and Lunch meal Saturday 2/24/24). Residents Affected - Some Findings include: A review of the menu indicated that the menu for breakfast was as follows: Cereal of Choice Pancakes Banana Coffee Milk of Choice, 8 oz Syrup/Margarine A review of the menu indicated that the menu for lunch was as follows: Chicken Sweet & Sour Fluffy Steamed Rice Broccoli Cuts Pears Beverage of Choice Pepper During a resident council group interview on 2/28/24, at 1:31 p.m. three out of 11 residents stated they were not served the correct breakfast and lunch on 2/24/24. During an interview on 2/28/24, at 2:30 p.m. Dietary Manager Employee E5 confirmed that on 2/24/24 the posted menu was not served because of dietary staff call off's. During an interview on 3/1/24, at 11:40 a.m. the Director of Nursing confirmed that the facility served donuts and oatmeal for breakfast, pizza and salad for lunch on 2/24/24. 28 Pa. Code: 211.6(a)(b) Dietary services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 37 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and staff interview it was determined that the facility failed to maintain sanitary conditions in the main kitchen and dining room creating the potential for unsafe condition and cross contamination. Findings include: During an observation of the main designated kitchen on 2/27/24 at 9:15 a.m., the following was observed: -ice machine in the main kitchen contained a brown like substance. Cleaning chart hanging beside the ice machine noted that last cleaning was November 2023 -chemicals were directly on the floor: grease cutter, pot sheen, kex-plus, booster and eco-rinse -bases and lids for the resident trays were being stores right side up inside of upside down -6 packages of hot dog buns not dated -1 bag of sugar was open and not dated -chemicals in a spray bottle on the prep table in the main kitchen while food was being prepared During an observation of tray line in the designated main dining room on 2/27/24 at 11:59 a.m., it was revealed [NAME] Employee E28's coat was covering the clean plates and serving utensils for lunch service. During an interview on 2/27/24 with Dietary Manager E5 confirmed the facility failed to maintain properly sanitary condition's, dating food properly and storage that could lead to potentially unsafe condition and cross contamination. 28 Pa. Code: 201.18(b)(1) Management. 28 Pa. Code: 211.6(c) Dietary services. 28 Pa. Code: 201.14(a) Responsibility of licensee. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 38 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0836 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many Ensure the facility is licensed under applicable State and local law and operates and provides services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility documents, interviews with residents, and staff, it was determined that the facility failed to pay staff in a timely manner as scheduled. This resulted in kitchen staff and multiple nurse aides not reporting to work, which created a situation that placed 50 out of 50 residents in immediate jeopardy in which health and safety were impacted due to a potential interruption of proper food, supplies and services. Findings include: 28 PA Code Commonwealth of Pennsylvania Long Term Care Licensure Regulations, subsection 201.14(g), dated July 1, 2023, indicated that a facility owner shall pay in a timely manner bills incurred in the operation of a facility that are not in dispute and that are for services without which the residents' health and safety are jeopardized. Review of facility staffing schedules revealed the following: Friday 2/23/24, two out of five Nurse Aides (NA) called off on daylight shift, and three out of five NA called off on evening shift. Saturday 2/24/24, one out of four NA called off on daylight shift, and two out of three NA called off on evening shift. Six out of six dietary employees called off. Sunday 2/25/24, one out of three NA employees called off on evening shift, and one out of four NA called off on night shift. Five out of five dietary employees called off. Monday 2/26/24, four out of five NA called off on daylight shift, three out of four NA called off on evening shift, and one out of three NA called off on night shift. During an interview on 2/28/24, at 9:23 a.m. NA Employee E22 stated that staff did not get paid as scheduled on Friday, (2/24/24), but did get paid on Monday (2/26/24). NA Employee E22 stated that she was scheduled off that weekend but was aware that many employees called off that weekend due to not receiving their paychecks on Friday. We never had an issue with paychecks with the previous owners. During an interview on 2/28/24. at 9:25 a.m. NA Employee E15 confirmed that staff did not receive their paychecks as scheduled and Never, ever had these problems before. During an interview on 2/28/24, at 9:53 a.m. Assistant Nursing Home Administrator (ANHA) confirmed that the staff did not receive their scheduled paychecks on 2/23/24, and that they had a lot of call offs that weekend. During an interview on 2/28/24, at 12:01 p.m. MDS (minimum data set- periodic assessment of resident care needs) Coordinator Employee E13 stated Lately we've had no agency (nursing staff). I think it's because they weren't being paid. We were pretty good there for a while until we didn't get paid the second time. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 39 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0836 During a group interview on 2/28/24 at 1:31 p.m. the following was stated: Level of Harm - Immediate jeopardy to resident health or safety · One out of 11 residents stated On Friday, Saturday, Sunday, and Monday ( 2/23/24, 2/24/24, 2/25/24, and 2/26/24), staff did not get paid and did not show up. Residents Affected - Many · One out of 11 residents stated They asked us to stay in bed the day that they did not get paid. · One out of 11 residents stated There was no kitchen staff. We had two donuts from Dunkin' Donuts and lunch was pizza, That was on Saturday (2/24/24). · 11 out of 11 residents stated that there were no nurse aides on Saturday (2/24/24). · One out of 11 residents stated We did not see any management at the home (on Saturday 2/24/24). During an interview on 2/28/24, at 2:01 p.m. Nurse Aide (NA) Employee E4 stated that she called off on Saturday 2/24/24 Because I was mad. They didn't pay us on Friday. They have had issues with not paying us in the past and we are sick of it. During an interview on 2/28/24 at 2:30 p.m. the Dietary Director Employee E5 confirmed that dietary staff failed to show up for work on 2/24/24, and 2/25/24, due to not receiving their paychecks on 2/23/24 as scheduled. During an interview on 2/29/24, at 10:05 a.m. Licensed Practical Nurse (LPN) Employee E6 confirmed that she also did not get paid on 2/23/24, as scheduled but did show up to work on 2/24/24. LPN Employee E6 stated that no one showed up to work in the kitchen on 2/24/24, so the Director of Nursing (DON) had to work in the kitchen and ordered donuts for the residents for breakfast, and that the ANHA called in from home and had pizza delivered to the residents for lunch. LPN Employee E6 also stated that no other management or administrator was in facility on 2/24/24, during the time she worked which was from 7:00 a.m. to 4:30 p.m. During an interview on 2/29/24, at 12:31 p.m. DON stated that beautician quit in October because she was not getting paid and have not had anyone in this role since then. DON also confirmed that staff had called off on Saturday (2/24/24), when they had not yet received their scheduled paychecks on 2/23/24. DON further explained that she had been woken up at 4:30 a.m. on 2/24/24 via multiple text messages and phone calls about staff calling off. DON stated that she came into the facility on 2/24/24, and ordered donuts for the residents for breakfast, and that pizza was ordered for lunch. DON stated that for dinner on 2/24/24, they had kitchen staff from a sister facility come in to prepare food, as well as for all meals on Sunday, 2/25/24. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 40 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0836 Level of Harm - Immediate jeopardy to resident health or safety On 2/29/24, at 1:30 p.m., the ANHA was made aware that Immediate Jeopardy (IJ) existed, NHA was provided the IJ Template, for 50 out of 50 residents in which health and safety were impacted due to a potential interruption of proper food, supplies and services., and a corrective action plan was requested. On 2/29/24, at 5:14 p.m., an acceptable Corrective Action Plan was received which included the following interventions: Residents Affected - Many Immediate Action: · Facility staff were paid on 2/26/24. · Facility instituted an employee fund for any monetary needs until payroll processed. Funds were made available via Cash App, [NAME], and Quick Pay. · Facility implemented bonus program for shift pick up and sign-on bonuses for new hires. Residents: · Secured contract with Ready Shift Staffing to provide staff for facility if there are any call offs. · Management staff will be on-site to assist with patient care needs as suited to qualifications. System Correction: · Facility has changed scheduling and payroll companies to consolidate into one and are now splitting facility payrolls to improve cash flow week to week. · All facilities will be paid 3/8/24 · Payroll will then be split into a new payroll cycle. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 41 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0836 · Level of Harm - Immediate jeopardy to resident health or safety BHG, [NAME] Hills, Scottdale, and [NAME] with first pay on 3/15/24. Residents Affected - Many Lakeview, Ridgeview, and [NAME] with first pay on 3/22/24. · · Payroll is submitted the Wednesday of payroll week. Once submitted, email is sent to company controller with amount of funds that will need to be transferred. The company controller will email facility NHA when wire funds have been transmitted. Monitoring: · Facility NHA, DON, and Scheduler will review staffing daily for a seven day rolling period to ensure staffing meets PPD and ratios. During an interview on 3/2/24, at 1:40 p.m. NA Employee E23 confirmed that she did not get paid on 2/23/24, as scheduled but got paid on 2/26/24. NA Employee E23 stated that the previous payday on 2/9/24, they received their paychecks late. We are supposed to get them at midnight as soon as it becomes Friday, but they didn't give them to us until 5:00 p.m. They also paid us one time in October, and then took the money out of our accounts a few days later. We are scared for next payday. During an interview on 3/3/24, at 11:35 a.m. Housekeeper Employee E24 stated We work hard and we expect to be paid. Without workers what would you have?. During an interview on 3/3/24, at 11:40 a.m. NA Employee E15 stated I don't think we are going to get paid (regarding the upcoming payday on 3/8/24). It's scary. If they would just be honest with us. If I'm not paid I would probably not come in on Monday and I've never called off. During an interview on 3/3/24, at 11:50 a.m. an anonymous employee confirmed that she also did not receive a paycheck as scheduled on 2/23/24, and added First time ever my car payment was late. When anonymous employee was asked if she would come into work if this happens on the next scheduled payday (3/8/24), she replied, I won't come to work. The writing is on the wall. If I don't get paid on Friday I'm not coming back. I think they did this on purpose- squeeze out every penny and then bankrupt them . During an interview on 3/3/24, at 11:59 a.m. LPN Employee E25 stated After seeing what happened with [NAME] (facility owned by the same company that closed earlier in the week as employees had not gotten paid and many stopped coming to work), if we are not paid on Friday, I will l probably not be here Monday. It's just a matter of when to jump ship. The owners must not be afraid to lose a part of their souls. During an interview on 3/3/34, at 12:10 p.m. NA Employee E23 stated that she called off on the weekend and on Monday To apply for other jobs, as she had not received her paycheck, and I will not be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 42 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0836 here if the paychecks are not here. Level of Harm - Immediate jeopardy to resident health or safety During an interview on 3/3/24, at 12:20 p.m. NA Employee E21 stated that If I don't get paid Friday, I will not be here. I got another job. Residents Affected - Many During an interview on 3/3/24, at 12:21 p.m. NA Employee E22 stated If we don't get paid Friday (3/8/24), I'm not coming to work until we do. During an interview on 3/3/24, at 12:25 p.m. LPN Employee E14 expressed concern regarding not receiving last paycheck on time. When asked if she would come in to work if not paid on payday, she replied, The right thing to do is come. But honestly, I may not come. Pay stability is not there. During an group interview on 3/3/24, at 12:35 p.m. with Dietary Employees the following was stated: · Dietary Aide Employee E27 stated I've never been at a place that you don't get paid on payday. I come on time and do the job to the best of my ability and expect a pay. · [NAME] Employee E28 stated that if he does not get paid on Friday (3/8/24), I won't be coming to work on Saturday or Sunday (3/9/24, and 3/10/24). · Dietary Aide Employee E29 stated that he works every weekend and called off the weekend of 2/24/24, and 2/25/24 due to not receiving his paycheck, and if he does not receive his paycheck on 3/8/24, he is Not coming Saturday or Sunday (3/9/24, and 3/10/24). · Dietary Aide Employee E30 stated If they don't pay again this will be the fifth time we haven't gotten paid or pay was messed up. Dietary Aide Employee E30 indicated that he works every weekend and will not report to work again if he does not receive his paycheck, and added that the company is Not trustworthy to even get paid. · [NAME] Employee E31 stated she will not be coming to work if they do not get paid. During an interview on 3/3/24, at 2:00 p.m. Resident R25 stated that kitchen staff had not come in the previous weekend due to not getting paid. It was pretty bad. I'm diabetic and I got donuts for breakfast and I don't like pizza. I've heard the employees are getting out of here. It's sad. I love these people and I feel bad for them if they don't have money. I don't have anywhere else to go. The Immediate Jeopardy was lifted on 3/4/24, at 4:24 p.m. when the action plan was verified. During an interview on 3/5/24, at 4:15 p.m. the ANHA confirmed that the facility failed to pay (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 43 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0836 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete staff in a timely manner as scheduled, which resulted in kitchen staff and multiple nurse aides not reporting to work, which created a situation that placed 50 out of 50 residents in immediate jeopardy in which health and safety were impacted due to a potential interruption of proper food, supplies and services. 28 Pa. Code 201.14(g) Responsibility of licensee. 28 Pa. Code 201.18(e)(1)(2) Management. Event ID: Facility ID: 395109 If continuation sheet Page 44 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0838 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, staff interviews and a review of the facility's assessment it was determined that the facility failed to implement and document a complete facility wide assessment, which identified the specific resources necessary to care for its specific resident population. Findings include: Review of the clinical record revealed that Resident R37 was admitted to the facility on [DATE]. Review of Resident 37's MDS (Minimum Data Set, periodic assessment of resident care needs) dated 1/31/24, indicated diagnoses of dilated cardiomyopathy (a condition in which the heart's main pumping chamber is enlarged. And becomes weaker as it grows larger), Multiple Sclerosis (a disease that affects the central nervous system), and acute respiratory failure (occurs suddenly and interferes with the ability of the lungs to deliver oxygen). Review of Resident R37's Nursing admission evaluation dated 1/24/24, stated Life Vest noted. Review of Resident R37's physician orders revealed an order written on 1/29/24, that indicated, Life Vest. Change and charge battery QD (daily)one time a day related to other cardiomyopathies (heart muscle disease). Review of Resident R37s physician orders revealed an order written on 1/29/24 that indicated Life Vest Check placement, function, skin integrity every shift related to other cardiomyopathies. Review of the Facility assessment dated [DATE], failed to include the use of a Life Vest as a condition that requires complex medical care and management routinely cared for in the facility. Interview on 3/5/24, at 3:30 p.m. the Assistant Nursing Home Administrator confirmed the facility failed to implement and document a complete facility wide assessment, which identified the specific resources necessary to care for its specific resident population. 28 Pa. Code: 207.2(a) Administrator's responsibility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 45 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0868 Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Level of Harm - Minimal harm or potential for actual harm Based on review of facility documents, and staff interview, it was determined that the facility failed to ensure that all required staff persons were in attendance at quarterly Quality Assurance Process Improvement (QAPI) Committee meetings for two of three quarters reviewed (second quarter April-June 2023, and third quarter July-September 2023). Residents Affected - Some Findings include: Review of the CFR (Code of Federal Regulations) §483.75(g) Quality assessment and assurance. §483.75(g)(1) A facility must maintain a quality assessment and assurance committee consisting at a minimum of: (i) The director of nursing services; (ii) The Medical Director or his/her designee; (iii) At least three other members of the facility's staff, at least one of who must be the administrator, owner, a board member or other individual in a leadership role; and (iv) The infection Preventionist. (i) Meet at least quarterly and as needed to coordinate and evaluate activities under the QAPI program, such as identifying issues with respect to which quality assessment and assurance activities, including performance improvement projects required under the QAPI program, are necessary. A review of Quality Assurance/Performance Improvement (QAPI) Committee meeting sign-in sheets for the period of June 2023 through February 2024, failed to reveal any sign in signs from second quarter April -June 2023, and third quarter July-September 2023. During an interview on 2/29/24, at 9:42 a.m. the Nursing Home Administrator (NHA) confirmed that the facility failed to ensure that all required staff persons were in attendance at quarterly Quality Assurance Process Improvement (QAPI) Committee meetings for two of three quarters reviewed (second quarter, April - June 2023, and third quarter July- September 2023). 28 Pa. Code 201.18(e)(1)(2)(3) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 46 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy, clinical record review, observation, and staff interview, it was determined the facility failed to implement measures to prevent the potential for cross contamination during a dressing change for one of three residents (Resident R10) and the facility failed to implement an infection control program that included a system of surveillance to identify possible communicable diseases or infections for three of nine months (October 2023, November 2023, and December 2023). Residents Affected - Some Findings include: Review of facility policy Infection Prevention and Control Program dated 9/28/23, indicated an infection prevention and control program is established to maintain and provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. Surveillance tools are used for recognizing the occurrence of infections, recording their numbers and frequency, detecting outbreaks and epidemics, monitoring employee infection, monitoring adherence to infection prevention and control practices, and detecting unusual pathogens with infection control implications. Review of facility policy Wound Care dated 9/28/23, indicated to remove the old dressing and pull a glove over the dressing and discard into an appropriate receptacle. Wash and dry hands thoroughly. Once the dressing change is completed, use a clean field saturated with alcohol to wipe the overbed table used during the dressing change. Review of facility policy Handwashing/Hand Hygiene dated 9/28/23, indicated hand hygiene is indicated immediately before touching a resident, before performing an aseptic (prevent infection) task, after contact with blood, body fluids, or contaminated surfaces, and after touching a resident. Review of the facility's Infection Control documentation for the previous nine months (June 2023 - February 2024), failed to reveal surveillance for tracking infections for residents for three of nine (October 2023, November 2023, and December 2023). During an interview on 2/29/24, at 10:42 a.m. the Director of Nursing (DON) confirmed that the facility was unable to locate and provide documentation to indicate that surveillance for tracking infections was performed during October 2023, November 2023, and December 2023. Review of the clinical record indicated Resident R10 was admitted to the facility on [DATE]. Review of resident R10's Minimum Data Set (MDS - a periodic assessment of care needs) dated 2/27/24, indicated diagnoses of high blood pressure, peripheral vascular disease (circulatory condition in which narrowed blood vessels reduce blood flow to the limbs), and malnutrition (lack of sufficient nutrients in the body). Review of a physician's order dated 2/27/24, indicated to cleanse right buttock with normal sterile saline, apply medihoney (a wound gel) with calcium alginate (a highly absorbent dressing that maintains a moist wound environment) and border gauze (foam dressing) every day shift. During a dressing change observation on 2/29/24, at 10:48 a.m. Registered Nurse (RN) Employee E2 provided incontinence care for Resident R10, removed her gloves, did not perform hand hygiene, donned (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 47 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some a clean pair of gloves, and cleansed Resident R10's right buttock wound with normal sterile saline soaked gauze. RN Employee E2 then removed her gloves, did not perform hand hygiene, donned a new pair of gloves, and applied Medihoney to a piece of Calcium Alginate and applied it to Resident R10's right buttock wound and covered the wound with a border dressing. RN Employee E2 removed all dressing supplies from Resident R10's overbed table and placed Resident R10's personal belongings back on the overbed table without cleansing the table. During an interview on 2/29/24, at 11:03 a.m. RN Employee E2 confirmed that she did not perform hand hygiene between donning and doffing clean gloves and did not cleanse Resident R10's overbed table after completing the dressing change. During an interview on 2/29/24, at 11:03 a.m. the DON confirmed that the facility failed to implement measures to prevent the potential for cross contamination during a dressing change for one of three residents (Resident R10). 28 Pa. code: 201.14 (a) Responsibility of licensee. 28 Pa. Code: 201.18 (b) (1) (e) (1) Management. 28 Pa. Code: 211.10 (d) Resident care policies. 28 Pa. Code: 211.12 (d) (1) (2) (5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 48 of 49 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 395109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Healthcare and Rehabilitation Center 616 Golf Course Road Aliquippa, PA 15001 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 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm Based on review of the facility's infection control policies and procedures and staff interview, it was determined that the facility failed to implement an antibiotic stewardship program for three of nine months (October 2023, November 2023, and December 2023). Residents Affected - Some Findings include: Review of facility policy Antibiotic Stewardship - Review and Surveillance of Antibiotic Use and Outcomes dated 9/28/23, indicated as part of the facility antibiotic stewardship program, all clinical infections treated with antibiotics will undergo review by the infection preventionist or designee. All resident antibiotic regimens will be documented on the facility-approved antibiotic surveillance tracking form. Review of the facility's Infection Control surveillance for June 2023 through February 2024, failed to include documentation to indicate that antibiotic monitoring was completed for October 2023, November 2023, and December 2023. During an interview on 2/29/24, at 10:42 a.m. the Director of Nursing (DON) confirmed that the facility was unable to locate and provide documentation to indicate that antibiotic monitoring was completed for October 2023, November 2023, and December 2023. During an interview on 2/29/24, at 10:42 a.m. the DON confirmed that the facility failed to implement an antibiotic stewardship program for three of twelve months (October 2023, November 2023, and December 2023). 28 Pa. Code: 211.10(c)(d) Resident care policies. 28 Pa. Code: 211.12(d)(1)(2)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395109 If continuation sheet Page 49 of 49

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Citations

26 citations recorded^*CMS

What do CMS severity letters mean?

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

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

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

0600GeneralS&S Dpotential for harm
F600 - Freedom from Abuse, Neglect, and Exploitation
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
0656GeneralS&S Dpotential for harm
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
0658GeneralS&S Dpotential for harm
F658 - Comprehensive Care Plans
Ensure services provided by the nursing facility meet professional standards of quality.
0684GeneralS&S Dpotential for harm
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
0686GeneralS&S Dpotential for harm
F686 - Skin Integrity
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
0689SeriousS&S Jimmediate jeopardy
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
0726SeriousS&S Jimmediate jeopardy
F726 - Nursing Services
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
0730GeneralS&S Epotential for harm
F730 - Regular in-service education
Observe each nurse aide's job performance and give regular training.
0740GeneralS&S Dpotential for harm
F740 - Behavioral health services
Ensure each resident must receive and the facility must provide necessary behavioral health care and services.
0756GeneralS&S Fpotential for harm
F756 - Drug Regimen Review
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
0758GeneralS&S Dpotential for harm
F758 - Medication Errors
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
0761GeneralS&S Dpotential for harm
F761 - Labeling of Drugs and Biologicals
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
0801GeneralS&S Epotential for harm
F801 - Staffing
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
0812GeneralS&S Fpotential for harm
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
0838GeneralS&S Dpotential for harm
F838 - Facility assessment
Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.
0868GeneralS&S Epotential for harm
F868 - Quality assessment and assurance
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
0880GeneralS&S Epotential for harm
F880 - Infection Control
Provide and implement an infection prevention and control program.
0881GeneralS&S Epotential for harm
F881 - Infection prevention and control program
Implement a program that monitors antibiotic use.
0565GeneralS&S Epotential for harm
F565 - The resident has a right to organize and participate in resident groups in the
Honor the resident's right to organize and participate in resident/family groups in the facility.
0585GeneralS&S Epotential for harm
F585 - Grievances
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
0609GeneralS&S Dpotential for harm
F609 - The facility must develop and implement written policies and procedures that:
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
0677GeneralS&S Dpotential for harm
F677 - A resident who is unable to carry out activities of daily living receives
Provide care and assistance to perform activities of daily living for any resident who is unable.
0725GeneralS&S Fpotential for harm
F725 - Nursing Services
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
0803GeneralS&S Epotential for harm
F803 - Menus and nutritional adequacy
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
0836SeriousS&S Limmediate jeopardy
F836 - Licensure
Ensure the facility is licensed under applicable State and local law and operates and provides services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards.
0321GeneralS&S Epotential for harm
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

FAQ · About this visit

Common questions about this visit

What happened during the March 5, 2024 survey of BEAVER HEALTHCARE AND REHABILITATION CENTER?

This was a inspection survey of BEAVER HEALTHCARE AND REHABILITATION CENTER on March 5, 2024. The surveyor cited 26 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at BEAVER HEALTHCARE AND REHABILITATION CENTER on March 5, 2024?

Yes, 26 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect b..."

What type of survey was this?

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

SourceView on CMS Care Compare

Next steps

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

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Data from CMS Care Compare public records. Dataset last refreshed June 8, 2026. If you believe any information is inaccurate, report it here.

Inspection·March 5, 2024