Health inspection·December 1, 2023

F 0554 swab to use when I go out. My sister and girlfriend know how to do it too if something happens and I can't do it. Level of Harm - Minimal harm or potential for actual harm Review of Resident R7's physician orders failed to include an order for self-administration of medications. Residents Affected - Few Review of Resident R7's care plan failed to reveal self-administration of medication management. Review of Resident R7's clinical record indicated the absence of a Self-Administration of Medication assessment. During an interview on 11/29/23, at 1:38 p.m. the Assistant Director Employee E1 stated, That resident is not allowed to administer her own insulin, her sister does it. This surveyor informed Assistant Director Employee E1 that Resident R7 stated she administers her own insulin and that the facility cannot guarantee that Resident R7 is not self-administering insulin while out of the facility. Assistant Director Employee E1 stated, Eh, I know her, she's not doing it. During an interview on 11/29/23, at 1:22 p.m. the Nursing Home Administrator (NHA) provided a Nursing Clinical Note dated 9/17/17, which stated, Resident taken on LOA by family to go out to eat. Residents family educated on medication administration of insulin if resident has adequate PO intake. Family verbalizes understanding and performs return demonstration with proper technique. Residents family sent with insulin and supplies for 1200 standing dose of Humalog. Review of Resident R7's physician orders failed to include an order stating that her sister has been properly educated and may administer Resident R7's insulin while she is out of the facility. Review of Resident R7's care plan failed to reveal goals and interventions pertaining to safe insulin administration while out of the facility. Review of Resident R7's clinical record failed to include ongoing assessment and education of safe medication administration provided to Resident R7's sister regarding insulin administration while out of the facility. During an interview on 11/29/23, at 1:22 p.m. the NHA confirmed there is no physician order for Resident R7 to have her insulin administered by her sister while out of the facility, Resident R7's care plan has not been updated to include goals and interventions pertaining to safe insulin administration while out of the facility, and that per facility documentation, Resident R7's sister was last educated regarding safe insulin administration on 9/17/17. During this interview, the NHA confirmed that the facility failed to determine the ability to self-administer medications for one of four residents. 8 Pa. Code 201.14(a) Responsibility of Licensee. 28 Pa. Code: 211.10(c)(d) Resident care policies. 28 Pa. Code: 211.12(d)(1)(5) Nursing services. 28 Pa. Code: 211.9(a)(1) Pharmacy services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 2 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 0583 Keep residents' personal and medical records private and confidential. 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, observations, and staff interview, it was determined that the facility failed to maintain privacy of confidential information during medication administration for one of three medication carts ([NAME] Medication Cart). Residents Affected - Few Findings include: Review of facility policy Confidentiality last reviewed 8/30/23, indicated employees must be vigilant to make sure that confidential information, including resident financial and health records, are not inadvertently disclosed to individuals who do not have authorization or a need-to-know. Computer systems storing confidential information must be secure and destroyed when legal or regulatory methods for its retention no longer apply. During an observation on 11/30/23, at 9:28 a.m. the [NAME] Medication Cart was observed outside of resident room [ROOM NUMBER] with the computer screen open with resident information visible to anyone passing by in the hallway. A report sheet with resident information was also present on the medication cart and visible for anyone passing by in the hallway. During an interview on 11/30/23, at 9:30 a.m. Licensed Practical Nurse (LPN) Employee E4 confirmed the above observations. During this interview, LPN Employee E4 acknowledged the lack of privacy with resident information on the computer screen and report sheet. During an interview on 11/30/23, at 2:45 p.m. the Nursing Home Administrator confirmed that the facility failed to maintain privacy of confidential information during medication administration for one of three medication carts. 28 Pa. Code: 201.29(i) Resident Rights 28 Pa. Code: 211.12(d)(3) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 3 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 a review of clinical records, facility documents, and resident and staff interviews, it was determined that the facility failed to provide appropriate assistance to prevent falls as ordered, for two of three residents reviewed (Resident R5 and R56). Findings include: Review of the facility Abuse Prevention of Resident Abuse, Neglect, Mental Abuse, Reports of Theft, Exploitation and Misappropriation of Property policy dated 9/23, indicated it is the facility policy to provide a safe and secure environment for all residents and will protect a resident's right to be from any form of abuse and neglect. Review of the facility's Use of Mechanical Lift policy dated 8/30/23, indicated the facility must provide the safest lifting/transferring technique as determined by nursing or therapy to maintain the resident highest level of functioning. It was indicated transfer orders are to be confirmed by reviewing the Activities of Daily Living book or physician orders in the medical chart prior to use of mechanical lift. Review of the clinical record indicated Resident R5 was admitted to the facility on [DATE], and readmitted to the facility on [DATE]. Review of Resident R5's Minimum Data Set (MDS - periodic assessment of resident's care needs) dated 5/17/23, revealed diagnoses of dementia (a group of symptoms that affects memory, thinking and interferes with daily life), high blood pressure, and hemiplegia (paralysis of one side of the body) affecting the dominant right side. Section G: Functional Status indicated Resident R5 required an assist of two persons with bed mobility. Review of the facility's incident statement dated 6/18/23, for Resident R5 indicated Nurse Aide (NA) Employee E14 rolled Resident R5 on her right side and Resident R5 was holding onto the night stand. NA Employee E14 turned around to grab a washcloth and the resident slid out of bed. Review of Resident R5's progress note dated 6/18/23, entered by Registered Nurse (RN) Employee E15 indicated the resident fell out of bed while being changed during morning care. The resident stated her head hurt. Review of Resident R5's Incident Report Documentation dated 6/20/23, indicated Resident R5 was lying on the floor beside the bed. It was stated she rolled out of bed while morning care was provided. Review of the clinical record indicated Resident R56 was admitted to the facility on [DATE]. Review of Resident R56 MDS dated [DATE], revealed diagnoses of morbid obesity, dementia, and high blood pressure. Section G: Functional Status indicated Resident R56 required an assist of two persons with toilet use. Review of Resident R56's physician order dated 7/21/23, indicated the resident required a [NAME]/Partial lift assist x2 for transfers. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 4 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 Review of Resident R56's progress noted dated 7/25/23, indicated the resident was lowered to the floor in bathroom by nursing assistant after standing next to toilet to be cleaned. The resident stated I'm just embarrassed. Review of Resident R56's Incident Statement dated 7/25/23, indicated NA Employee E16 had Resident R56 pull herself up with assistance by the toilet to get changed. After a few minutes, the resident began to drop down. It was indicated the resident expressed she was tired from walking with therapy. During an interview on 11/29/23, at 2:10 pm., NA Employee E14 stated Resident R5 required an assist of two persons with bed mobility. It was indicated NA Employee E14 only used an assist of one person. NA Employee E14 stated staff must check a resident's care plan to see the level of assistance they require. During an interview on 11/29/23, at 1:56 p.m. RN Employee E17 stated all nurse aides should know what level of assistance a resident needs prior to moving. It was stated if for whatever reason the nurse aide is unaware they can ask a nurse. If a resident requires an assist of two persons with bed mobility, it was indicated the nurse aide must get another nurse aide or nurse to assist prior to moving in bed. During an interview on 10/29/23, at 2:21 p.m. the Nursing Home Administrator confirmed that the facility failed to provide appropriate assistance to prevent falls as ordered for two of three residents (Resident R5 and R56). 28 Pa. Code 201.18(e)(1) Management 28 Pa. Code 201.20(a)(b) Staff development 28 Pa. Code 201.29(a)(c)(d) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 5 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 0610 Respond appropriately to all alleged violations. 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, facility documents, and staff interview, it was determined that the facility failed to fully investigate injuries of unknown origin for one of four residents reviewed (Resident R2). Residents Affected - Few Findings include: A review of the facility's Abuse, Neglect, and Exploitation policy dated 8/30/23, indicated an immediate investigation is warranted when suspicion of abuse, neglect, or exploitation, or reports of abuse, neglect, or exploitation occur. It states physical injury of a resident of unknown source is a possible indicator of abuse. It was indicated the facility must identify and interview all persons, including alleged victim, alleged perpetrator, witnesses and other who might have knowledge of the allegations. It was indicated complete and thorough documentation of the investigation must be provided. Review of the facility's Resident Incident or Accident Report policy dated 8/30/23, indicated all incidents and accidents involving a resident shall be documented on an Incident/Accident Report form. It was indicated the Clinical Coordinator or charge nurse is to make sure the form is completed in full. Review of the clinical record revealed that Resident R2 was admitted to the facility on [DATE], and readmitted on [DATE] with diagnosis that included a hip fracture, anxiety, and muscle weakness. Review of Resident R2's physician order dated 11/2/23, indicated the resident was ordered to transfer using a Hoyer/Full lift with an assist of two persons. Review of Resident R2's physician order dated 11/2/23, indicated for occupational therapy to evaluate and treat as indicated. Review of Resident R2's Report of Consultation dated 11/14/23, indicated the resident was seen for a follow-up appointment following her right hip fracture. It was indicated the resident had a failed right hip screw with migration in to the pelvis. Review of Resident R2's progress note dated 11/14/23, indicated Resident R2 sustained a right intertrochanteric femur fracture she underwent IM nailing. It was indicated her right hip hardware has failed and is pushing into her pelvis. During an interview on 11/29/23, at 1:19 p.m., the Nursing Home Administrator confirmed that the facility failed to investigate injuries of unknown origin for one of four residents reviewed. (Resident R2). 28 Pa. Code: 201.14 (a) Responsibility of licensee. 28 Pa. Code: 201.14 (c)(e) Responsibility of licensee. 28 Pa. Code: 201.18 (e)(1) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 6 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policies, closed resident records and staff interview, it was determined that the facility failed to acquire physician's discharge order for two out of three closed resident records (Closed Record CR73 and CR89). Finding include: The facility Discharge Summary Guidelines policy dated 8/30/23, indicated that the facility will provide discharge information on a resident to receiving organizations and subsequent health care providers. Review of Closed Record CR73's admission record indicated he was admitted [DATE], with diagnosis that included dementia (a group of symptoms that affects memory, thinking and interferes with daily life), high blood pressure, and depression. Review of Closed Record CR73's Minimum Data Set (MDS - a periodic assessment of care needs) dated 11/1/23, indicated that the diagnoses remain current upon review. Review of Closed Record CR73's clinical note dated 11/8/23, indicated that he will be discharged to his new apartment on 11/15/23. Review of an additional clinical note for CR73 dated 11/15/23, indicate that he was discharged at 9:30 a.m. Review of Closed Record CR73's admission record indicated that he was discharged on 11/15/23. Review of Closed Record CR73's clinical record did not include a physician's order to discharge home from the facility. Review of Closed Record R89's admission record indicated she was admitted [DATE], with diagnosis that included fracture of spine, atrial fibrillation (a disease of the heart characterized by irregular often faster heartbeat), and heart disease. Review of Closed Record R89's Minimum Data Set (MDS - a periodic assessment of care needs) dated 9/30/23, indicated that the diagnoses remain current upon review. Review of Closed Record R89's clinical note from her provider dated 11/10/23, indicated she was seen for discharge, and will be going home this weekend with daughter. Review of Closed Record R89's clinical note dated 11/11/23, indicated the she was discharged home with daughter. Review of Closed Record R89's admission record indicated that she was discharged on 11/11/23. Review of Closed Record R89's clinical record did not include a physician's order to discharge home from the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 7 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 0622 Level of Harm - Minimal harm or potential for actual harm During an interview on 11/30/23, at 1:05 p.m., Registered Nurse Assessment Coordinator (RNAC) Employee E10 confirmed that the facility failed to acquire and document a physician's discharge order for Closed Record CR73 and CR89. 28 Pa Code: 201.29 (a) Resident rights. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 8 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, observations, and staff interviews, it was determined that the facility failed to maintain sanitary conditions of respiratory equipment for one of three residents reviewed (Resident R352). Residents Affected - Few Findings include: Review of the facility policy Oxygen: Via Concentrator dated 6/2017, last reviewed on 8/30/23, indicated that oxygen concentrators are used to supply oxygen with liter flows on 1 to 10 liters per minute (LPM). It was indicated the oxygen tubing must be dated and attached to the green adapter or humidifier. Review of the facility policy Oral Inhalation and Nebulizer Administration dated 1/9/17, last reviewed on 8/30/23, indicated that it is the facility policy to allow for safe, accurate, and effective administration of medications using an oral inhaler or nebulizer (changes a medication into a mist so it can be inhaled into the lungs). Once a respiratory treatment is completed, the nebulizer must be turned off and disconnected. Review of admission record indicated Resident R352 was admitted on [DATE]. Review of Resident's R352's clinical record indicated the diagnosis of respiratory failure (not enough oxygen in the body), hypercapnia (too much carbon dioxide in the blood), and asthma (inflammatory disease that affects the airways in the lungs and makes it harder for air to flow out). Review of Resident R352's Minimum Data Set (MDS - periodic assessment of resident's care needs) dated 11/28/23, indicated the diagnoses were current. Review of Resident R352's physician order dated 11/22/23, indicated to administer oxygen at 2-4 liters and to titrate to maintain oxygen saturation (the amount of oxygen you have circulating in your blood) greater than 90% each shift. Review of Resident R352's physician order dated 11/22/23, indicated to administer 2.5-0.5 mg/3ml DuoNeb (used to treat and prevent wheezing and shortness of breath) four times daily. During an observation on 11/27/23, at 11:41a.m., R352's oxygen tubing was observed not dated, lying on floor with the oxygen concentrator (medical device that removes nitrogen from room air and provides oxygen-enriched gas for people who need more oxygen in their blood) on and running while the resident was not in the room. Further observation at this time revealed Resident R352's nebulizer equipment was not dated, or disconnected and observed sitting on the bedside table with the T-piece, mouthpiece, and medication cup assembled and sitting on top of the machine. During an interview on 11/27/23, at 11:41 a.m., Registered Nurse Employee E7 confirmed that the facility failed to maintain sanitary conditions of respiratory equipment for one of three residents (Resident R352). 28 Pa. Code 211.12(c) Nursing services 28 Pa. Code 211.12(d)(3) Nursing services (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 9 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 0695 28 Pa. Code 211.12(d)(1)(5) Nursing services Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 10 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of facility policy, clinical record review, and staff interview, it was determined that the facility failed to obtain physician's orders, update resident care plans, and conduct ongoing accurate assessments to ensure that bedrails were used to meet residents' needs and the risks associated with bedrail usage for four of six residents (Residents R7, R15, R19, and R79). Findings include: Review of facility policy Side Rail Use last reviewed 8/30/23, indicated if side rails are determined to be appropriate, the nurse must obtain a physician's order for the use of quarter side rails. The use of enabler/assist bar or quarter side rails to enable independence with bed mobility must be care planned. The continued use of the enabler/assist bar or quarter side rails must be assessed on a quarterly basis by the nurse or with any change in resident's status that would affect the independent use of the enabler/assist bar or quarter side rail. Review of the clinical record indicated that Resident R7 was admitted to the facility on [DATE]. Review of Resident R7's Minimum Data Set (MDS - a periodic assessment of care needs) dated 11/14/23, indicated diagnoses of diabetes mellitus (high blood sugar), bipolar disorder (a mental condition marked by alternating periods of elation and depression), and hypertension (high blood pressure). Review of Resident R7's MDS dated [DATE], Section GG: Functional Abilities and Goals, Question GG170 indicated that Resident R7 required partial/moderate assistance with the helper doing less than half of the effort to perform bed mobility. Review of Resident R7's clinical record failed to reveal a physician's order for enabler bar usage. Review of R7's clinical record failed to reveal a current assessment for the continuation of enabler bar usage. Review of Resident R7's current care plan failed to include interventions and goals related to the use of enabler bars. During an interview on 11/28/23, at 11:06 a.m. Licensed Practical Nurse (LPN) Employee E2 confirmed that bilateral (both sides) enabler bars were applied to Resident R7's bed. Review of the clinical record indicated that Resident R15 was admitted to the facility on [DATE]. Review of Resident R15's MDS dated [DATE], diagnoses of hypertension, Alzheimer ' s Disease (a progressive disease that destroys memory and other important mental functions), and depression (a constant feeling of sadness and loss of interest). Review of Resident R15's MDS dated [DATE], Section GG: Functional Abilities and Goals, Question GG0170 indicated that Resident R15 required extensive assistance with one person physical assist to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 11 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 0700 perform bed mobility. Level of Harm - Minimal harm or potential for actual harm Review of Resident R15's clinical record failed to reveal a physician's order for enabler bar usage. Residents Affected - Some Review of R15's clinical record failed to reveal a current assessment for the continuation of enabler bar usage. Review of Resident R15's current care plan failed to include interventions and goals related to the use of enabler bars. During an interview on 11/28/23, at 11:06 a.m. Licensed Practical Nurse (LPN) Employee E2 confirmed that bilateral enabler bars were applied to Resident R15's bed. Review of the clinical record indicated that Resident R19 was admitted to the facility on [DATE]. Review of Resident R19's MDS dated [DATE], indicated diagnoses of hypertension, depression, and peripheral vascular disease (a condition where narrowed blood vessels reduce blood flow to the limbs). Review of Resident R19's MDS dated [DATE], Section GG: Functional Abilities and Goals, Question GG0170 indicated that Resident R19 required supervision or touching assistance to perform bed mobility. Review of Resident R19's clinical record failed to reveal a physician's order for enabler bar usage. Review of R19's clinical record failed to reveal a current assessment for the continuation of enabler bar usage. During an interview on 11/28/23, at 11:06 a.m. Licensed Practical Nurse (LPN) Employee E2 confirmed that bilateral enabler bars were applied to Resident R19's bed. Review of the clinical record indicated that Resident R79 was admitted to the facility on [DATE]. Review of Resident R79's MDS dated [DATE], indicated diagnoses of hyponatremia (low blood sodium), depression, and epilepsy (disorder of the brain characterized by repeated seizures). Review of Resident R79's MDS dated [DATE], Section GG: Functional Abilities and Goals, Question GG0170 indicated that Resident R79 required supervision or touching assistance to perform bed mobility. Review of Resident R79's clinical record failed to reveal a physician's order for enabler bar usage. Review of R79's clinical record failed to reveal a current assessment for the continuation of enabler bar usage. During an interview on 11/28/23, at 11:06 a.m. Licensed Practical Nurse (LPN) Employee E2 confirmed that bilateral enabler bars were applied to Resident R79's bed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 12 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 11/28/23, at 2:47 p.m. the Director of Nursing (DON) confirmed that Residents R7 and R15 did not have a physician's order, care plan, or assessment for enabler bar usage and Residents R19 and R79 did not have a physician's order or assessment for enabler bar usage. During an interview on 11/28/23, at 2:47 p.m. the DON confirmed that he facility failed to obtain physician's orders, update resident care plans, and conduct ongoing accurate assessments to ensure that bedrails were used to meet residents' needs and the risks associated with bedrail usage for four of six residents. 28 Pa. Code: 201.14 (a) Responsibility of licensee. 28 Pa. Code: 211.12 (d) (1)(3)(5) Nursing services. 28 Pa. Code 211.10(c)(d) Resident care policies. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 13 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policies, observations, and staff interviews, it was determined that the facility failed to properly store medications in one out of three medication carts ([NAME] Medication Cart), failed to monitor refrigerator temperatures utilized for medication storage in one of two nursing units (Wellstep Path), and failed to properly secure a medication cart while not in use for one of three medications carts ([NAME] Medication Cart). Findings include: A review of facility policy Medication Storage last reviewed 8/30/23, indicated that all medications dispensed by the pharmacy are stored in the container when the pharmacy label. Certain medications or package types such as IV solutions, multiple dose injectable vials, ophthalmics, nitroglycerin tablets, blood guar testing solutions and strips, once opened, require an expiration date shorter than the manufacturer's expiation date to insure medication purity and potency. Only licensed nurses, pharmacy personnel, and those lawfully authorized to administer medications (such as medication aides) are permitted to access medications. Medication rooms, carts, and medication supplies are locked when not in use or direct view of persons with authorized access. Medications requiring refrigeration are kept in a refrigerator at temperatures between 2°C (36°F) and 8°C (46°F) with a thermometer to allow temperature monitoring. The Facility should maintain a temperature log in the storage area to record temperatures at least once a day. During an observation on 11/29/23, at 9:42 a.m. of the [NAME] Medication Cart indicated the following medications stored in one compartment without individual packaging or separation from other residents medications: - Resident R380's glargine pen (prefilled pen to inject long acting insulin under the skin) and NovoLog (rapid acting insulin) not in a box or individual bag. - Resident R380's Novolog pen (prefilled pen to inject rapid acting insulin under the skin). Continued observations of the [NAME] Medication Cart revealed the following medication not dated upon opening: - Resident R349's Ventolin (an inhaled medication used to make breathing easier) inhaler, no date opened. - A bottle of Systane (an eyedrop used to alleviate dry eyes) eye drops open with no date opened or patient label present on the bottle. During an interview on 11/29/23, at 9:50 a.m. Licensed Practical Nurse (LPN) Employee E5 confirmed the above findings. During an observation on 11/30/23, at 9:28 a.m. the [NAME] Medication Cart was observed outside of resident room [ROOM NUMBER] with the main drawer unlocked. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 14 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 During an interview on 11/30/23, at 9:30 a.m. Licensed Practical Nurse (LPN) Employee E4 confirmed the above observation. During this interview, LPN Employee E4 acknowledged that the medication cart is to be locked when left unattended. During an interview on 11/30/23, at 2:45 p.m. the Nursing Home Administrator confirmed that the facility failed to properly store medications in one out of three medication carts and failed to properly secure a medication cart while not in use for one of three medications carts. During an observation on the Wellstep Path Nursing Unit 12/1/23, at 10:30 a.m., a Refrigerator Temperature Log for the month of October 2023 revealed missing recorded refrigerator temperatures for the following dates: 10/1/23, through 10/15/23, and 10/17/23, through 10/31/23; a total of 30 missing temperatures. During an interview on 12/1/23, at 10:58 a.m. Assistant Director of Nursing (ADON) Employee E7 confirmed that the facility failed to properly monitor refrigerator temperatures utilized for medication storage for one of two nursing units (Wellstep Path). 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: 395164 If continuation sheet Page 15 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 a review of facility policies, observations and staff interviews it was determined that the facility failed to properly label and date food products in the Main Kitchen (Main Kitchen) and failed to properly monitor refrigerator temperatures on one of two nursing unit pantries (Wellstep Path) which created the potential for food borne illness. Findings Include: Review of the facility policy Sanitation in Food Purchasing, Storage and Distribution last reviewed 8/30/23, indicated that all opened food items will be stored in properly covered and dated containers. Review of facility policy Food Brought into Residents' Room from Outside Sources last reviewed 8/30/23, indicated that nursing staff will monitor refrigeration units. All units must be maintained at internal temperatures that are deemed safe for food storage according to State and Federal regulations. During an observation in the Main Kitchen walk-in refrigerator, on 11/27/23, at 9:50 a.m., a metal bin that contained an open package of hot dogs did not have a label or date, and was not sealed, and a pie that was loosely covered in plastic wrap did not have a label or date. During an observation in the Main Kitchen dry storage area, on 11/27/23, at 9:54 a.m., an open package of egg noodles and an open package of bow tie pasta, were not sealed and did not have a label or date. During an observation in the Main Kitchen walk-in freezer on 11/27/23, at 9:58 a.m., an open box of blue berries was not sealed and not dated, a large plastic container marked beef vegetable soup dated 11/2/23, was not sealed and product was exposed, and a metal tray of cupcakes was not labeled or dated. During an interview on 11/27/23, at 10:01 a.m., Food Service Director Employee E6 confirmed that the facility failed to properly store, label and date food products which created the potential for food-borne illness. During an observation on the Wellstep Path Nursing Unit Pantry 11/30/23, at 10:30 a.m., a Refrigerator Temperature Log for the month of October 2023 revealed missing recorded refrigerator temperatures for the following dates: 10/2/23, 10/3/23, 10/5/23, 10/6/23, 10/7/23, 10/8/23, 10/10/23, 10/11/23, 10/12/23, 10/13/23, 10/14/23, 10/15/23, 10/17/23, 10/18/23, 10/19/23, 10/20/23, 10/23/23, 10/25/23, and the entire month of November 2023 (11/1/23 through 11/30/23). During an interview on 12/1/23, at 10:58 a.m. Assistant Director of Nursing (ADON) Employee E7 confirmed that the facility failed to properly monitor refrigerator temperatures for one of two nursing unit pantries (Wellstep Path) creating the potential for food-borne illness. 28 Pa. Code 201.14(a)Responsibility of licensee. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 16 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 28 Pa. Code 201.18(b)(1) Management. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.6c Dietary services. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 17 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of facility policy, resident clinical records, facility documents, and staff interview, it was determined the facility failed to obtain a physician order for hospice services for one of five residents (Resident R74) and to ensure the coordination of hospice services with facility services to meet the needs of each resident for end-of-life care for two of five residents (Resident R51 and R74). Findings include: Review of the facility Skilled Nursing - Comprehensive Care plans dated 8/3023, indicated that the effectiveness of the care plan must be evaluated from its initiation and modified as necessary. This should be done with any significant change in condition. Communication about care plan changes should be ongoing among interdisciplinary team. Review of the facility policy Hospice Service, dated 8/30/23, indicated that the attending physician will be asked to determine if the patient has a six-month or less prognosis, which is part of the criteria for eligibility. Review of the clinical record indicated that Resident R51 was admitted to the facility on [DATE]. Review of Resident R51's Minimum Data Set (MDS - a periodic assessment of care needs) dated 11/17/23, indicated diagnoses of Alzheimer's Disease (a progressive disease that destroys memory and other important mental functions), depression (a constant feeling of sadness and loss of interest), and epilepsy (disorder of the brain characterized by repeated seizures). Review of Resident R51's physician orders dated 11/16/23, indicated to consult hospice services. Review of Resident R51's current comprehensive care plan failed to indicate a plan of care by the facility for hospice care goals and interventions, and to include coordination of hospice services. A review of the clinical record indicated that Resident R74 was admitted to the facility on [DATE]. Review of Resident 74's MDS dated [DATE], indicated diagnoses of Parkinson's disease (neuromuscular disorder causing tremors and difficulty walking), malnutrition (lack of sufficient nutrients in the body), and depression. Review of facility documents indicated the Resident R74 was admitted to hospice on 11/7/23. Review of Resident R74's current active physician orders did not reveal a physician's order to admit Resident R74 to hospice services. Review of Resident R74's current comprehensive care plan failed to indicate a plan of care by the facility for hospice care goals and interventions, to include coordination of hospice services. During an interview on 11/30/23, at 1:55 p.m., Nursing Home Administrator (NHA) confirmed that facility failed to obtain a physician's order for hospice services for one resident (Resident R74) and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 18 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 0849 failed to implement a hospice plan of care for two residents (Resident R5 and R74). Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.2(a) Physician services 28 Pa. Code 211.11(d) Resident care plan Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 19 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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, national and state guidance, clinical record review, observations, and staff interviews, it was determined the facility failed to identify a COVID positive resident, and implement the proper precautions before the spread to other persons in the facility for one of three residents (Resident R58); failed to implement measures to prevent the potential for cross contamination during removal of Personal Protective Equipment after a dressing change for one of two residents (Resident R84), and failed to provide a safe and sanity environment to help prevent the potential for cross contamination for one of two medication rooms (Third Floor Medication Room). Residents Affected - Many Findings include: Review of Title 42 Code of Federal Regulations (CFR) §483.80 - Infection Control The facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable disease and infections. It was indicated staff are required to follow hand hygiene practices consistent with accepted standards of practice. Review of the CDC (Centers for Disease Control and Prevention) 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings dated 7/23, indicated appropriate doffing/removal of PPE includes, but is not limited to removal of PPE in the following sequence: -Gloves -Goggles or face shield -Gown -Mask or respirator -Wash hands or use an alcohol-based hand sanitizer immediately after removing all PPE Review of the Pennsylvania Department of Health COVID-19 Infection Control and Outbreak Response Toolkit for Long-Term Care dated 7/23, indicated regardless of vaccination states, testing is recommended for anyone with even mild symptoms of COVID-19 as soon as possible. It was indicated to identify and isolate a resident who is COVID positive with transmission based precautions. During an outbreak, room restrictions and full transmission based precautions (N95 or higher-level respirator, gowns, gloves, and eye protection) must be implemented and contact tracing or a broad-based (unit-based or facility-wide) testing should continue for 3-7 days until there are no new cases for 14 days. Viral testing must be completed for all residents and health care personnel, regardless of vaccination status. If negative, test again 48 hours after the first negative test, and if negative, again 48 hours after the second negative test. This will typically be at Day 1 (exposure is Day 0), Day 3, and Day 5. Review of the CDC COVID-19 Testing: What You Need to Know guidelines dated 9/25/23, indicated if a resident's first positive test was with 30 days or less and the resident has symptoms an antigen (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 20 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 test should be conducted. It was indicated after a positive test result, you may continue to test positive for some time. Some tests, especially PCR tests, may continue to show a positive result for up to 90 days. Reinfections can occur within 90 days, which can make it hard to know if a positive test indicates a new infection. It stated consider consulting a healthcare provider if you have questions or concerns about your circumstances. Residents Affected - Many Review of the facility's COVID policy dated 11/23, indicated it is the facility policy to assist in safeguarding the health and well-being of employees, patients, residents, and visitors from the risks associated with COVID-19. It was indicated the policy complies with a state and local laws and is based upon regulation and guidance issued by the Center for Medicaid and Medicare Service, the Center for Disease Control and Preventions (CDC), and other public health and licensing authorities, as applicable, and to ensure appropriate application of the regulation and guidance. It was indicated if a positive resident has been diagnosed as positive for COVID-19, transmission and droplet precautions will be implemented with residents who are suspected or confirmed with COVID-19. Every effort will be made to minimize the number of staff who enter into the resident's room by assigning designated staff to enter the room, if possible. A further review of the facility's COVID policy failed to include guidance on when to test residents during an outbreak on Day 1, Day 3, and Day 5 as recommended by the CDC. Review of the clinical record revealed that Resident R58 was admitted to the facility on [DATE]. Review of Resident R58 Minimum Data Set (MDS - periodic assessment of resident's care needs) dated 9/27/23, revealed diagnoses of Chronic obstructive pulmonary disease (COPD is a group of diseases that cause airflow blockage and breathing-related problems), high blood pressure, and heart failure (a progressive heart disease that affects pumping action of the heart muscles. This causes fatigue, shortness of breath.) Review of Resident R58's progress note dated 11/9/23, indicated the resident appeared to be short of breath while lying in bed with mildly elevated respirations. It was indicated the resident oxygen saturation (measure of how much oxygen is traveling through your body in your red blood cells. Normal oxygen saturation for healthy adults is usually between 95% and 100%) was 76%-82 %. It was documented the resident was placed on 4 liters of oxygen, and when staff tried weaning her down to 2 liters, her oxygen saturation immediately dropped into the 80's. The resident's belly was mildly distended. Review of Resident R58's physician order dated 11/9/23, indicated the resident was ordered a Influenza A/B and Respiratory Syncytial Virus (RSV-type of respiratory test) polymerase chain reaction (PCR- test detects genetic material from a pathogen or abnormal cell sample) respiratory test for shortness of breath and hypoxia. Review of Resident R58's progress note dated 11/10/23, entered by Registered Nurse (RN) Employee E18 indicated a call was received from the lab with a request to order a COVID test as part of the respiratory panel as it is completed with flu and RSV. It was documented that an order was placed. It was indicated Resident R58 was positive for COVID. Review of Resident R58's physician orders from 11/10/23, through 11/20/23, failed to include an order for droplet precautions to be implemented due to Resident R58's positive COVID test. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 21 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 - Many Review of the undated facility documented, titled COVID Line List failed to include documentation of Resident R58's positive COVID test on 11/10/23. A further review of the facility's COVID Line List documentation, failed to include documentation that the facility completed outbreak testing once Resident R58 was identified as COVID positive. During an interview on 11/30/23, at 11:15 a.m. the Nursing Home Administrator stated the last outbreak prior to the resident who tested positive on 11/27/23, was on 10/9/23. It was indicated when a resident tests positive for COVID, the resident is moved to an isolation room, and an isolation bin as well as PPE is placed outside the door. The NHA stated the facility tests the entire unit once a resident is identified as COVID positive. It was stated the staff test resident's on Day 1, Day 3, then Day 5, and if a new positive is identified then testing is restarted on Day 1. The NHA confirmed the facility failed to conduct outbreak testing when Resident R58 tested positive for COVID on 11/10/23. During an interview on 12/1/23, at 10:22 a.m., Infection Preventionist (IP) Employee E1 stated if a resident tests positive for COVID, the facility initiates unit-wide testing. It was indicated residents are tested on Day 1, Day 3, and Day 5. IP Employee E1 stated only the residents who are positive for COVID are documented on the facility's COVID Line Testing, and confirmed Resident R58's positive COVID result on 11/9/23, was not documented on the COVID Line Testing. IP Employee E1 stated since Resident R58 tested positive for COVID in the last 30 days, she should have not been retested. IP Employee E1 confirmed the facility failed to implement droplet precautions and complete outbreak testing once Resident R58 was identified as COVID positive on 11/9/23. Review of the clinical record indicated that Resident R84 was admitted to the facility on [DATE]. Review of the Resident R84's Minimum Data Set (MDS - periodic assessment of resident's care needs) dated 11/6/23, indicated active diagnoses of cellulitis of left lower limb (a skin infection caused by bacteria), malignant neoplasm of connective and soft tissue of left upper limb including shoulder (cancer in the body's soft tissue), and a non-pressure chronic ulcer on unspecified part of left lower leg (open sore or wound caused by erosion of the tissue). Review of Resident R84's physician order dated 10/27/23, indicated the resident was ordered contact isolation (a technique used to prevent the spread of infections that can be transmitted by direct or indirect contact) Review of Resident R84's physician order dated 11/27/23, indicated the resident was ordered a test for Clostridium Difficile Toxins (C-diff is a bacterium that causes diarrhea and colitis, an inflammation of the colon. It is often life-threatening and can be prevented by hand hygiene). During an observation on 11/28/23, at 12:10 p.m. Licensed Practical Nurse (LPN) Employee E4 failed to remove PPE in the correct sequence after providing care to Resident R84. LPN Employee E4 removed her gloves, washed her hands, then removed her gown without washing her hands and exited the room. During an interview on 11/28/23, at 12:12 p.m. LPN Employee E4, and Registered Nurse (RN) Employee E9, confirmed the facility failed to implement measures to prevent the potential for cross contamination, and failed to follow hand hygiene practices consistent with accepted standards of practice during doffing of PPE for one of two residents (Resident R84). During an observation of the Third Floor Medication Room on 11/30/23, at 9:19 a.m. it was noted (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 22 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 that a hooded sweatshirt, a purse, and a winter coat were present on the counter of the medication room. Level of Harm - Minimal harm or potential for actual harm During an interview on 11/30/23, at 9:19 a.m. Registered Nurse (RN) Employee E3 confirmed that the hooded sweatshirt, jacket, and purse all belonged to staff members currently working on the unit. Residents Affected - Many During an interview on 11/30/23, at 2:45 p.m. the Nursing Home Administrator confirmed that the facility failed to provide a safe and sanitary environment to help prevent the potential for cross contamination for one of two medication rooms. 28 Pa. Code: 201.14(a) Responsibility of licensee. 28 Pa. Code: 211.10(d) Resident care policies. 28 Pa. Code: 201.18 (b) (1) (e) (1) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 23 of 24 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 395164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St John Specialty Care Center 500 Wittenberg Way Mars, PA 16046 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 0885 Report COVID19 data to residents and families. 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 record, and staff interview it was determined that the facility failed to notify families of residents with positive COVID-19 test results in a timely manner for one of three COVID-19 positive residents (Residents R58.) Residents Affected - Few Findings include: Review of the facility's Notification of change in condition policy dated 8/30/23, indicated the resident representatives will be notified of a significant change in the resident's physical, mental, or psychosocial status. Review of the clinical record revealed that Resident R58 was admitted to the facility on [DATE]. Review of Resident R58 Minimum Data Set (MDS - periodic assessment of resident's care needs) dated 9/27/23, revealed diagnoses of Chronic obstructive pulmonary disease (COPD is a group of diseases that cause airflow blockage and breathing-related problems), high blood pressure, and heart failure (a progressive heart disease that affects pumping action of the heart muscles. This causes fatigue, shortness of breath.) Review of Resident R58's progress note dated 11/10/23, entered by Registered Nurse, Employee E18 indicated a call was received from the lab with a request to order a COVID test as part of the respiratory panel as it is completed with flu and RSV. It was documented that an order was placed. It was indicated Resident R58 was positive for COVID. Review of Resident R58's progress notes from 11/10/23, through 11/20/23, failed to include documentation that Resident R58's representative was notified. During an interview on 12/1/23, at 10:22 a.m. Infection Preventionist (IP) Employee E1 confirmed that the facility failed to notify the families for one of three residents (Resident R58) with positive COVID-19 results as required. 28 Pa Code: 201.29 (a) Resident Rights. 28 Pa Code: 201.14 (a ) Responsibility of Licensee 28 Pa Code 201.18 (e)(1)(2)(3) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395164 If continuation sheet Page 24 of 24