Health inspection·January 10, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm brown substance on the floor between the Resident's bed and the doorway, and there were also food crumbs on the floor. Resident 9's bed-side table contained dried food and a dried grey film. Observation with the NHA on January 8, 2024, at 4:00 PM, in Resident 8's room revealed the floor and bed-side table contained food residue and the floor contained a dried light brown liquid as stated above. Residents Affected - Few During an interview with the NHA on January 8, 2024, at 4:00 PM, it was revealed that the Resident room should be cleaned daily and as needed. It was also revealed that Resident 8's floor and bed-side table should be cleaned. 28 Pa. Code 201.18 (e)(1)(2.1)Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395168 If continuation sheet Page 2 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Yorkview Nursing and Rehabilitation 970 Colonial Avenue York, PA 17403 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 Based on clinical record reviews, facility documentation, and staff interviews, it was determined the facility failed to ensure necessary treatment and services, consistent with professional standards of practice to promote healing and prevent infection for two of four residents reviewed (Residents 1 and 3). Residents Affected - Few Findings include: Review of Resident 1's clinical record documented diagnoses that included history of stroke, diabetes mellitus (the body's ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood and urine), dementia (a condition characterized by progressive loss of intellectual functioning and impairment of memory and abstract thinking), dysphagia (difficulty swallowing), contracture (a condition of shortening and hardening of muscles and tendons, often leading to rigidity of joints) of left and right knees, and pressure ulcer (injury to the skin and underlying tissue resulting from prolonged pressure on the skin) to the right heel. Review of Resident 1's November 2023 physician orders and Medication and Treatment Administration Record (MAR - documentation of medication and treatment administration) documented the following treatments were not completed to the right foot as evidence by no documentation or rationale for treatment not being administered: November 8th, 2023: dayshift right heel cleanse with NSS, apply skin prep, and border gauze was blank; November 22 nd, 2023: evening shift right lateral foot cleanse NSS, skin prep, and border dressing and right medial foot cleanse NSS, Therahoney, cover with dry dressing were blank; and November 27th, 2023: day shift right heel cleanse with Dakin's solution, apply Santyl ointment cover with border gauze, right medial foot cleanse with NSS Therahoney to wound bed and cover with dry dressing, and right lateral food cleanse with NSS, apply skin prep, and secure with bordered dressing was documented 16 (see progress note). Review of the progress notes documented the aforementioned treatments would be addressed on evening shift. However, per orders above, treatments were ordered to be completed twice a day, once on day shift and once on evening shift, therefore, the treatments were not completed twice on November 27th, 2023. The facility failed to provide documentation that four treatments were completed to the right foot on day shift and two treatments on evening shift during the month of November 2023. Wound consult dated November 16, 2023, read, in part, new pressure wound to right heel, and new pressure wound to right lateral foot; recommendation for x-ray of right heel to rule out osteomyelitis (bone infection). Progress note dated November 19, 2023, revealed the physician was notified of the x-ray result, which suggested MRI (magnetic resonance imaging- magnetic field and radio waves to take picture inside the body) follow-up; and a slip was sent to transport. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395168 If continuation sheet Page 3 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Yorkview Nursing and Rehabilitation 970 Colonial Avenue York, PA 17403 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Wound consult dated November 23, 2023, read, in part wound on right heel and left lateral foot were stable, new areas noted to right medial foot and right medial first MTP, and noted the x-ray results from November 17th, 2023, were concerning for osteomyelitis. During an interview with Employee 3 (Assistant Director Of Nursing) on January 8, 2024, at 2:30 PM, it was revealed that Resident 1's physician reviewed the x-ray results on November 19, 2023, and initially provided a verbal order for the MRI, then later rescinded the order, and, therefore, an appointment for the MRI wasn't scheduled. The clinical presentation, including labs and vital signs, did not show signs of infection. Wound consult noted dated November 30, 2023, read, in part, wounds to right heel, right lateral foot, right medial foot, and right media first MTP were stable, and noted the x-ray results from November 17th, 2023 were concerning for osteomyelitis. Wound consult note dated December 7, 2023, read, in part, right heel worse, Resident with increased pain, recommend hospital transfer for would evaluation. Review of x-ray results of right foot on November 17, 2023, revealed No radiographic evidence of acute infection. This is concerning for osteomyelitis. Consider MRI follow up. On November 28, 2023, review wound care, lab work, and constipation; progressive decline noted; continue wound treatment, decrease dose of atorvastatin (medication to lower cholesterol) and increase dose of Sennosides-Docusate Sodium (medication to treat constipation). During an interview with Employee 4 (Wound Consultant/Nurse Practitioner) on January 9, 2024, at 1:00 PM, it was revealed facility staff had informed her that an MRI was scheduled and was under that impression for two weeks. It was revealed that the wound consultant couldn't order an MRI, only recommend for it to be done. Once she became aware that the MRI wasn't scheduled, she recommended the resident be transferred to the hospital. During an interview with the Nursing Home Administrator (NHA) on January 9, 2024, at 3:30 PM, the surveyor noted concern with treatments not being completed on Resident 1's right foot. NHA revealed that treatments should be provided per physician order. Review of Resident 3's clinical record revealed diagnoses that included congestive heart failure (CHF heart doesn't pump blood as well as it should), morbid obesity, and anemia ( blood doesn't have enough healthy red blood cells). Review of Resident 3's December 2023 TAR documented pressure ulcer left posterior thigh clean with NSS, apply lotrisone (medication used to treat fungal skin infections) to peri-wound (area around the wound) and collagen with silver (to aid in wound healing and prevent infection) to wound base, secure with ABD dressing (abdominal gauze pad) every day shift, started December 2, 2023, and discontinued December 15, 2023. There was no documentation December 11 and 22, 2023 dayshift. The TAR was blank, and no progress note observed. Further review of Resident 3's TAR documented left upper posterior thigh every day and evening shift, cleanse with NSS, apply miracle cream to wound base, and cover with ABD dressing, started (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395168 If continuation sheet Page 4 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Yorkview Nursing and Rehabilitation 970 Colonial Avenue York, PA 17403 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 December 15, 2023, and discontinued January 5, 2024. Level of Harm - Minimal harm or potential for actual harm There was no documentation on December 22, 2023, day shift. The TAR was blank and no progress note observed. Residents Affected - Few Further review of Resident 3's TAR documented left upper posterior thigh cleanse with NSS, apply magic mix, medical grade honey to wound base, and secure with ABD every brief change and twice a day on day and evening shift, start December 10, 2023, and discontinue December 15, 2023. There was no documentation on December 11, 2023, day shift. The TAR was blank and no progress note observed. During an interview with the NHA on January 9, 2024, at 3:30 PM, the surveyor noted concern with treatments not being completed and it was revealed that treatments should be provided per physician order. 28 Pa Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395168 If continuation sheet Page 5 of 5