Health inspection·May 8, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few May 7, 2025, at 10:16 a.m. a follow up interview was conducted with the Social Worker, Employee E10 who reported that Resident R68 exhibits hoarding behaviors and had previously been instructed to sort through and dispose of some of her belongings. However, these notices were not documented in the resident's clinical record. In the specific incident on this date, the resident's belongings were removed from her room without prior notice. Resident R68 was informed only as she entered her room and observed her items being loaded onto a truck dolly for transport to the facility's storage area. On May 8, 2025, at 11:30 a.m., an interview was conducted with the Administrator, who confirmed that the facility was investigating the incident involving the removal of Resident R68's belongings. The Administrator acknowledged that the situation was not handled appropriately and stated, It should not have happened the way it did. 28 Pa. Code 211.12 (d)(1) (5)Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 2 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 0568 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home. Based on review of facility documentation, interview with staff and residents, it was determined that the facility failed to make financial record available to the resident through quarterly statements and upon request for one out one resident reviewed. (Resident R63). Findings include: On May 6, 2025, at approximately 12:00 p.m., an interview was conducted with Resident R63. The resident stated that they do not have access to their $3,000.00 and expressed a desire to gain access to these funds. On May 7, 2025, at 1:22 p.m., an interview was held with the Business Office Manager (Employee E22) and the Regional Business Office Manager, Employee E23. They reported that the previous Business Office Manager-who is no longer employed at the facility-did not maintain records indicating when or how residents and their representatives received quarterly financial statements. Employee E23 further confirmed that efforts are currently underway to develop and implement policies and procedures to ensure that residents and their representatives receive financial statements on a quarterly basis moving forward. At 1:41 p.m. on the same day, a follow-up interview with Resident R63 confirmed that they had not received quarterly financial statements in the past and, therefore, were unaware of their account balance. Pa. Code 201.18(b)(2) Management Pa. Code 201.29(a) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 3 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of facility policies, and interviews with residents and staff, it was determined that the facility failed to provide a safe, clean, comfortable and homelike environment for three of three nursing units observed (2 South Nursing Unit, 2 North Nursing Unit and 1 North Nursing Unit). Findings include: Review of facility policy, Quality of Life - Homelike Environment revised May 2017, revealed, Staff shall provide person-centered care that emphasizes the residents' comfort, independence and personal needs and preferences. Continued review revealed, Comfortable and adequate lighting is provided in all areas of the facility to promote a safe, comfortable and homelike environment. On May 5, 2025, at 12:27 p.m., an observation was conducted on the 2 North Nursing Unit in room [ROOM NUMBER]-D, where it was noted that Resident R68 had approximately six different boxes on the floor next to her bed and window. Underneath the bed, the entire floor was covered with various boxes containing open dry food items. Resident R68 explained that these boxes were her emergency food. Later that day, at 2:05 p.m., a follow-up observation was conducted with the Unit Manager, Employee E17, who confirmed the observations. On May 6, 2025, at 12:59 p.m., an interview was conducted with the Unit Manager, Employee E17, who reported participating in the removal of Resident R68's belongings. During the process, approximately 10 to 12 boxes were removed from the resident's room. Employee E17 further stated that two large black trash bags containing empty boxes, mouse droppings, and soiled washcloths were also discarded and were originally stored underneath the bed. On May 6, 2025, at 10:02 a.m., observations in Rooms 212-A and 212-B revealed numerous personal cardboard boxes on the floor, along with random items such as clothing, personal hygiene products, and food placed on top of the boxes. The room exhibited characteristics of a hoarding environment, with a narrow path for staff to access both Resident R127, who was in bed 212-B, and Resident R54. On May 6, 2025, at 10:15 a.m., the Maintenance Director, Employee E25 confirmed the hoarding observations in the room [ROOM NUMBER]. Observation on May 6, 2025, at 10:06 a.m. of the 2 South Nursing Unit, revealed Employee E5, licensed nurse, provide respiratory care to Resident R119. Continued observation revealed that the resident's overbed light was off and that Employee E5, licensed nurse, provided the respiratory treatment in a dark environment. Interview, at the time of the observation, Employee E5, licensed nurse, stated that the pull cord on the resident's overbed light was too short and unable to be reached, so she was unable to turn the light on. Continued observations on the 2 South Nursing Unit on May 6, 2025, at 10:19 a.m. revealed that the pull cords on residents' overbed lights were too short and unable to reached to turn the lights on and off for the following rooms: 259-A, 259-B, 264-B, 264-C and 266-B. Observation on May 6, 2025, at 10:01 a.m. of the 2 South Nurses Station revealed that all three desk chairs were broken; one chair was missing an arm rest, one chair's padding was deteriorated with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 4 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few exposed plastic, and one chair had no seat cushioning as well as the height adjustment would not work which resulted in the chair being stuck in a low position. Interview, at the time of the observation, Employee E8, unit clerk, confirmed the above findings and stated that the staff had to borrow chairs from the resident's dining room to sit on since the desk chairs were broken. Observations on May 5, 2025, at 12:22 p.m. on the 1 North Nursing Unit in room [ROOM NUMBER] revealed the wallpaper behind the foot board of C-bed (Resident R143) was ripped and scratched up. Observations on May 6, 2025, at 9:45 a.m. in room [ROOM NUMBER] revealed the wallpaper behind B-bed (Resident R128) was ripped and scratched up. Observations on May 6, 2025, at 1:23 p.m. revealed a hole in hallway baseboard, located outside room [ROOM NUMBER]. 28 Pa Code 201.14(a) Responsibility of licensee 28 Pa Code 204.15(a) Windows 28 Pa Code 205.67(b)(c) Electric requirements for existing construction FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 5 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 - Few 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 interviews with residents and staff, review grievance, and review of facility policy, it was determined that the facility did not ensure prompt efforts were made to resolve residents' grievances and/or concerns for 7 of 7 residents interviewed (Residents R79, R52, R63, R61, R46, R68, R98) and related to missing items for one of 30 resident records reviewed (Resident R54). Findings include: Review of facility policy titled, Resident and Family Concerns and Grievances Policy and Procedure not dated, states, To provide for the prompt resolution of medical and non-medical grievances while maintaining confidentiality, in accordance with applicable federal and state statutes and regulations. On May 6, 2025, at 9:52 a.m. an interview was held with Resident R54 who reported that this is the second time when facility has lost her clothing when she gave the housekeeping staff to wash her items. Reported her missing items to the Social Worker a month ago and she has not heard back. On May 6, 2025, at 10:46 a.m. an resident council meeting was held with seven alert and oriented residents (Residents R79, R52, R63, R61, R46, R68, R98) who reported that they do not get a resolution of their grievances when they file grievances. A grievance form for Resident R54 was provided with the following information. It disclosed that a grievance was filed by Resident R54 on April 8, 2025, that she was missing her clothing for three weeks. Resident R54 send her laundry down in a silver bag with her name on it. Resident R54 has been asking housing keeping over and over for her items. Resident R54 received another resident's laundry instead of hers. Resident R54 is missing a twin set with white flowers, all her underwear and few pairs of jeans. The grievance form further revealed the following timeline. April 16, 2025 laundry search, items not found April 25, 2028 Talk to resident, items still not returned May 5, 2025 Asked resident to give a coast of items to look at reimbursing or preplacing May 6, 2025 Received On May 7, 2025, at 9:58 a.m. an interview was conducted with the Administrator, Employee E1 about the timeline of the grievance and when is the facility will be able to be resolved it. Employee E1 reported that resident's items will be ordered today to close her grievance. It was further confirmed the facility did not ensure prompt efforts were made to resolve grievance. 28 Pa. Code 201.29(a) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 6 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 Based on review of facility policy, review of facility documentation, review of clinical records, and staff interviews, it was determined that the facility failed to complete a thorough investigation and maintain documentation that an allegation of neglect was thoroughly investigated for one of two residents reviewed (Resident R51). Residents Affected - Few Findings Include: Review of undated facility policy Residents Right to Freedom from Abuse, Neglect, and Exploitation Policy and Procedure revealed in response to allegations of abuse, neglect, or mistreatment the facility should have evidence that alleged violations are thoroughly investigated and prevent further abuse, neglect, or mistreatment while the investigation is in progress. Further review of facility policy revealed that the results of investigations should be reported to the administrator and State Survey Agency within 5 working days of the incident. Review of Resident R51's quarterly Minimum Data Set (MDS - federally mandated resident assessment and care screening) dated February 5, 2025, revealed the resident had diagnoses of muscle weakness, lack of coordination, Aphasia (communication disorder), Cerebrovascular Accident (CVA - stoke; loss of blood flow to part of the brain), Hemiplegia (paralysis on one side of the body) and Hemiparesis (weakness on one side of the body). Continued review of Resident R51's MDS assessment revealed the resident's BIMS (Brief Interview of Mental status) score of 14, which indicated that the resident was cognitively intact. Further review of the MDS assessment indicated Resident R51 used a wheelchair for mobility. Review of Resident R51's comprehensive care plan dated January 18, 2018, revealed the resident had a potential for falls related to weakness, difficulty with walking, and CVA with hemiparesis. Review of information submitted to the Pennsylvania Department of Health by the facility on March 7, 2025, revealed Resident R51, who was noted to be alert and oriented x 3 (alert and oriented to person, place, and time) sustained a fall with knee injury during transport to oncology appointment on March 6, 2025. During wheelchair transport, the van came to an abrupt stop and Resident R51 hit the right knee. Review of Resident R51's clinical record revealed a nursing note dated March 6, 2025, indicating after the resident returned from the appointment, the right knee was noticeably swollen. Resident R51 was subsequently transferred to the hospital for evaluation on March 6, 2025, when a fracture of the right knee was confirmed. Review of facility investigation documentation on May 7, 2025, at 10:15 a.m. revealed no statement from Resident R51 was available for review regarding the details of the fall from March 6, 2025. Interview on May 7, 2025, at 10:15 a.m. with Director of Nursing, Employee E2, confirmed no statement was available for Resident R51 within the investigation documentation provided. Review of statement obtained by the facility van driver, Employee E24, dated March 6, 2025, revealed the employee needed to come to an abrupt stop and Resident R51 fell on (his/her) right knee. When the van driver, Employee E24, turned around Resident R51 was noted to be on (his/her) right knee (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 7 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 (he/she) did have seatbelt on and wheelchair lockdown. Level of Harm - Minimal harm or potential for actual harm Interview on May 7, 2025, at 12:21 p.m. with Nursing Home Administrator (NHA), Employee E1, revealed that the NHA conducted the investigation into the incident. Administrator reviewed the written statement obtained from the van driver, Employee E24 revealed as I began to drive through the arm rail it began to came down then I had to stop abruptly on brake and [Resident] fell on (his/her) right knee. When I turn around the resident was on (his/her) knee (he/she) did have seatbelt on and wheel chair lock down. Residents Affected - Few Further interview with Nursing Home Administrator, Employee E1, revealed Resident R51 was only strapped in with the lap seat belt. NHA was asked if the shoulder harnesses were in use to which the NHA indicated the shoulder harnesses were not in use at the time of the fall. Review of van driver, Employee E24's personnel file, revealed the employee received training on May 31, 2024, on Driver Safety Responsibilities which included driver and passengers are required to wear seat belts and shoulder harnesses. Further review of van driver, Employee E24's personnel file revealed the employee also received training on May 31, 2024, for driver basic skills evaluation which included the proper use of facility's Securement Checklist. Review of the Securement Checklist revealed before driving off, the van driver should put on the resident's seat belt with the lap belt buckle. Ensure belt fits tight across lap and under wheelchair armrest. Continued Interview on May 7, 2025, at 12:21 p.m. with Nursing Home Administrator (NHA), Employee E1, confirmed no other details were collected from the van driver, Employee E24, regarding how the resident was strapped in/if the harnesses or seat belt was used properly (under wheelchair arm rest versus over). Interview on May 7, 2025, at 2:15 p.m. with the Director of Nursing, Employee E2, revealed the employee is unaware of the process and procedure to secure residents in wheelchairs into the facility transport van. Review of facility documentation revealed no documented evidence that the facility conducted hands on return demonstration with the van driver, Employee E24, to determine how Resident R51 was strapped in. Review of facility documentation and staff interview revealed the facility failed to collect sufficient information regarding the incident to identify and rule out neglect. 28 Pa. Code 201.14 (a) Responsibility of licensee. 28 Pa. Code 201.18 (b)(1) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 8 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record reviews, review of facility policies and staff interviews, it was determined that the PASRR (Preadmission Screening and Resident Review) was not appropriately completed according to the resident assessment for three of three residents reviewed related to PASRR assessments (Residents R24, R63 and R125). Residents Affected - Few Findings include: The PASRR (Preadmission Screening Resident Review) was created in 1987 through language in the Omnibus Budget Reconciliation Act (OBRA) and it has three goals: to identify individuals with mental illness and/or intellectual disability, to ensure they are placed appropriately, whether in the community or in a nursing facility, and to ensure they receive the services they require for their mental illness or intellectual disability. The PASRR Level 1 must be completed on all persons who are considering admission to a Medicaid certified nursing facility. A Level II PASRR evaluation must be completed if the Level 1 PASRR determined that the person is a targeted person with mental illness or an intellectual disability. The Level II PASRR would determine if placement or continued stay in the requested or current nursing facility is appropriate. Review of facility policy, Resident Assessment Policy and Procedure dated 2025, revealed, The Facility shall coordinate assessments with the preadmission screening and resident review (PASARR) program under Medicaid in subpart C of this part to the maximum extent practicable to avoid duplicative testing and effort. Review of Resident R125's Quarterly MDS (Minimum Data Set - a mandatory periodic resident assessment tool), dated March 9, 2025, revealed that the resident was admitted to the facility on [DATE], and had diagnoses including anxiety disorder (intense, excessive, persistent worry or fear), depression (mood disorder characterized by low mood, a feeling of sadness, and a general loss of interest in things) and bipolar disorder (also known as manic depression, is a mental illness that brings severe high and low moods and changes in sleep, energy, thinking, and behavior). Review of Resident R125's PASRR Level I assessment, dated November 8, 2023, revealed that the resident did not have any serious mental illnesses listed on the assessment. Review of Resident R63's was admitted to the facility on [DATE], and had diagnoses including unspecified dementia, unspecified severity without behavioral disturbance, psychotic disturbance, mood disturbance, bipolar disorder, and anxiety. Review of Resident R63's PASRR Level I assessment, dated May 31, 2023, revealed that the resident did not have any serious mental illnesses listed and neurocognitive disorder (dementia) on the assessment. On May 7, 2025 at 10:28 a.m. Employee E10, social worker, confirmed that Resident R63's mental health diagnoses were not listed on the PASRR assessment and that they should have been included on the assessment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 9 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 0645 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on May 7, 2025, at 12:21 p.m. Employee E10, social worker, confirmed that Resident R125's mental health diagnoses were not listed on the PASRR assessment and that they should have been included on the assessment. Review of Resident R24's clinical record revealed the resident was initially admitted to the facility on [DATE]. Review of Resident R24's quarterly MDS dated [DATE], revealed that the resident had diagnoses of bipolar disorder, psychotic disorder, schizophrenia (mental health condition characterized by symptoms such as hallucinations, delusions, and disorganized thinking) , anxiety, and depression. Review of Resident R24's PASRR Level I assessment, dated August 25, 2020, revealed the resident had diagnoses of bipolar disorder and schizophrenia. Continued review of Resident R24's PASRR Level I assessment, dated August 25, 2020, revealed thee resident had a positive screen for a further PASRR Level II evaluation. Review of Resident R24's entire clinical record revealed no documented evidence a PASRR Level II evaluation was completed as required per the PASRR Level 1 assessment. Interview on May 8, 2025, at 10:22 a.m. with Social Services, Employee E10, confirmed Resident R24 did not have a PASRR Level II evaluation as required. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 201.18(e)(1) Management 28 Pa. Code 211.5(f)(v) Medical records 28 Pa. Code 211.10(a) Resident care policies FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 10 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 0646 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the appropriate authorities when residents with MD or ID services has a significant change in condition. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, review of clinical record, and staff interviews, it was determined that the facility failed to notify the state mental health authority of a significant change in a mental health condition for one of three residents reviewed for Preadmission Screening and Resident Review (PASARR) screening (Resident R24). Findings Include: The PASRR (Preadmission Screening Resident Review) was created in 1987 through language in the Omnibus Budget Reconciliation Act (OBRA) and it has three goals: to identify individuals with mental illness and/or intellectual disability, to ensure they are placed appropriately, whether in the community or in a nursing facility, and to ensure they receive the services they require for their mental illness or intellectual disability. Review of Resident Assessment Policy and Procedure dated 2025 revealed The Facility shall notify the state mental health authority or state intellectual disability authority, as applicable, promptly after a significant change in the mental or physical condition of a resident who has a mental disorder or intellectual disability for resident review. Review of Resident R24's clinical record revealed the resident was initially admitted to the facility on [DATE]. Review of Resident R24's quarterly MDS dated [DATE], revealed that the resident had diagnoses of anxiety disorder (intense, excessive, persistent worry or fear), depression (mood disorder characterized by low mood, a feeling of sadness, and a general loss of interest in things), bipolar disorder (also known as manic depression, is a mental illness that brings severe high and low moods and changes in sleep, energy, thinking, and behavior), and schizophrenia (mental health condition characterized by symptoms such as hallucinations, delusions, and disorganized thinking). Review of Resident R24's PASRR Level I assessment, dated August 25, 2020, revealed the resident had diagnoses of bipolar disorder and schizophrenia. Continued review of Resident R24's PASRR Level 1 assessment, dated August 25, 2020, revealed Section III-B - Recent Treatments/History which included a series of yes or no questions on whether the resident received treatment in an acute psychiatric hospital or partial psychiatric program at least once in the past two years or any admission to a state hospital which were all marked as no. Review of Resident R24's clinical record revealed a nurses note dated August 16, 2024, that the resident presented with extreme paranoia, disorganized thinking, and paranoid delusions with verbalized threats of harm to self and others. Physician ordered to send Resident R24 to the hospital for evaluation and treatment of mental health crisis. Continued review of Resident R24's clinical record revealed a nurses note dated August 17, 2024, that the resident was admitted to geriatric psychiatric unit for evaluation and treatment. Review of Resident R24's clinical record revealed a psychiatric progress note dated September 17, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 11 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 0646 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2024, that indicated the resident was seen for follow-up to recent psychiatric hospitalization for paranoia and escalating mood symptoms, readmitted on [DATE]. Review of Resident R24's entire clinical record revealed no documented evidence that the facility notified that State mental health authority and/or the State intellectual disability authority regarding the resident's change in mental status and her admission into a psychiatric treatment facility. Review of facility documentation revealed the facility failed to update the Level I PASRR to reflect that the resident had an inpatient stay at a psychiatric hospital in September 2024. 28 Pa Code 201.14(a) Responsibility of licensee. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 12 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy and review of clinical records, it was determined that the facility failed to develop and implement a baseline careplan for one of two new admissions reviewed (Resident R449). Findings Include: Review of facility policy, Comprehensive Person-Centered Care Planning Policy and Procedure dated 2025, revealed, the facility will develop and implement a baseline care plan, within 48 hours of a resident's admission, that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care. Review of Resident 449's clinical record revealed the resident was admitted to the facility on [DATE], and had a diagnosis of opioid dependence with other opioid-induced disorder, and cannabis abuse with other cannabis-induced disorder. Continued review of Resident R449's clinical record revealed a History and Physical dated May 3, 2025, by Physician, Employee E28, that indicated Resident R449 was a new admit to the facility status post a hospitalization on April 13, 2025, for cardiac arrest. Per the family, Resident R449 had been using drugs and eating little over last few weeks. Resident R449's urine drug screen from hospitalization April 13, 2025, was positive for cocaine and cannabis. Review of Resident R449's clinical record revealed no documented evidence a baseline care plan was developed and implemented related to the resident's pertinent and recent history of drug abuse. 28 Pa Code 211.10(c) Resident care policies 28 Pa Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 13 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 review of facility policies, clinical record reviews and interviews with staff, it was determined that the facility failed to develop comprehensive person-centered care plans related to behavioral health needs for one of 34 residents reviewed (Resident R85). Findings include: Review of facility policy, Comprehensive Person-Centered Care Planning Policy and Procedure dated 2025, revealed, The Facility will develop and implement a comprehensive person-centered care plan for each resident . that includes measurable objectives and timeframes to meet each resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. Review of Resident R85's Quarterly MDS (Minimum Data Set - a mandatory periodic resident assessment tool), dated April 1, 2025, revealed that the resident was admitted to the facility on [DATE], and had diagnoses including Alzheimer's Disease (a progressive disease that destroys memory and other important mental functions), Parkinson's Disease (a progressive disorder of the nervous system that affects movement) and depression (mood disorder characterized by low mood, a feeling of sadness, and a general loss of interest in things). Continued review revealed that the resident received antipsychotic and antidepressant medications. Review of Resident R85's Medication Administration Records for May 2025 revealed that the resident received Clozaril (an antipsychotic medication), sertraline (an antidepressant medication) and clozapine (an antipsychotic medication). Review of Resident R85's care plan, dated last reviewed April 29, 2025, revealed that no care plan had been developed related to the resident's mental health diagnoses or psychotropic medications. Interview on May 7, 2025, at 12:48 p.m. Employee E9, unit manager, confirmed that no care plan had been developed related to Resident R85's mental health diagnoses or psychotropic medications. 28 Pa Code 211.10(c) Resident care policies 28 Pa Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 14 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 Based on review of facility documentation, review of clinical records, and staff interview, it was determined that the facility failed to promptly assess a resident status post a fall for one of two residents reviewed for falls (Resident R51). Residents Affected - Few Findings Include: Review of Resident R51's quarterly Minimum Data Set (MDS - federally mandated resident assessment and care screening) dated February 5, 2025, revealed the resident had diagnoses of muscle weakness, lack of coordination, Aphasia (communication disorder), Cerebrovascular Accident (CVA - stoke; loss of blood flow to part of the brain), Hemiplegia (paralysis on one side of the body) and Hemiparesis (weakness on one side of the body). Continued review of Resident R51's MDS assessment revealed the resident's BIMS (Brief Interview of Mental status) score of 14, which indicated that the resident was cognitively intact. Further review of the MDS assessment indicated Resident R51 used a wheelchair for mobility. Review of Resident R51's comprehensive care plan dated January 18, 2018, revealed the resident had a potential for falls related to weakness, difficulty with walking, and CVA with hemiparesis. Review of information submitted to the Pennsylvania Department of Health by the facility on March 7, 2025, revealed Resident R51, who was noted to be alert and oriented x 3 (alert and oriented to person, place, and time) sustained a fall with knee injury during transport to oncology appointment on March 6, 2025. During wheelchair transport, the van came to an abrupt stop and Resident R51 hit the right knee. Review of Resident R51's clinical record revealed a nursing note dated March 6, 2025, by Registered Nurse, Employee E17, that Resident R51 was on a transport to an oncology appointment when the resident slid out of the wheelchair striking (his/her) right knee. Resident R51 was noted to be able to bear wear following the incident. Upon return from appointment, Resident R51's knee was noticeably swollen, and a stat x-ray was subsequently ordered. Review of statement obtained by the facility van driver, Employee E24, dated March 6, 2025, revealed the employee needed to come to an abrupt stop and Resident R51 fell on (his/her) right knee. When the van driver, Employee E24, turned around Resident R51 was noted to be on (his/her) right knee (he/she) did have seatbelt on and wheelchair lockdown. Review of facility documentation incident report dated March 6, 2025, revealed under investigative statements by Licensed Nurse, Employee E27, this writer was told from van driver that [Resident R51] fell on (his/her) right knee in van, during an abrupt stop and that his knee was swelling Further review of facility documentation revealed no documented evidence that the van driver, Employee E24, notified the physician or nursing staff at the time of Resident R51's fall. Review of facility documentation revealed no evidence that the van driver, Employee E24, obtained instructions from nursing or the physician for how to further proceed after Resident R51's fall in the van. 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: 395203 If continuation sheet Page 15 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 28 Pa. Code 211.10 (d) Resident Care Policies Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12 (d)(5) Nursing Services. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 16 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of facility policy, review of clinical records, and staff interviews, it was determined that the facility failed to ensure that residents with limited range of motion received treatment and services to maintain or improve range of motion/mobility for two of 34 residents reviewed for limited range of motion (Resident R1 and Resident R36). Findings include: Review of facility policy on Restorative Nursing Services with a most recent revision date of October 31, 2024 revealed that under section POLICY STATEMENT: Residents will receive restorative nursing care and services as needed to help promote optimal safety and independence. PROCEDURE #1. Residents may be started on a restorative nursing program upon admission, during their course of stay or upon discharge from rehabilitative care. #2. A registered nurse will complete an assessment before establishing a restorative nursing program for program additions on admission or during the course of stay. Therapy will provide program recommendations for residents being discharged from rehabilitative care as indicated. An initial restorative assessment is not needed by the registered nurse for residents who are recommended for a restorative program upon discharge from rehabilitative care. Observation conducted on May 5, 2025, at 9:06 a.m. revealed that Resident R1 was in bed. Interview with Resident R1 conducted at the time of the observation revealed that Resident R1 did not have any complaints. Review of Resident R1's clinical record revealed that Resident R1 was admitted to the facility on [DATE]. Further review of Resident R1's clinical record revealed the diagnoses of Polyneuropathy (a condition that damage serve nerves in the body), Traumatic Subarachnoid Hemorrhage (bleeding into the space between the surface of the brain and the arachnoid), Unsteadiness on Feet, Unspecified fracture of Left Wrist and Hand. Review of Physical Therapy discharge note dated March 14, 2025 revealed that Resident R1 was discharged from Physical; Therapy on March 14, 2025, with the following recommendations: RNP (restorative nursing program) to facilitate maintaining current level of performance and in order to prevent decline, development of and instruction in the following RNP's has been completed with the IDT: ROM (range of motion) Active and transfers Review of Resident R1's clinical record revealed no documented evidence that RNP for ROM (range of motion) Active and transfers was provided to Resident R1 Interview with Registered Occupational Therapist Employee and Physical Therapy Assistant Employee E19 conducted on May 8, 2025, at 9:57a.m. confirmed that Resident R1 was on Rehab but was discontinued with recommendations for restorative nursing program for range of motion. Further interview with Employee E18 reveled that the staff were educated on the how to provide proper Range of Motion to Resident R1 Interview with licensed nurse Employee E11 conducted on May 8, 2025, at 11:36 a.m. confirmed that there was no documented evidence that Range of Motion was provided to Resident R1 according to rehab (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 17 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 0688 recommendations. Level of Harm - Minimal harm or potential for actual harm Observation of Resident R36 conducted on May 7, 2025, at 9:21 a.m. revealed that resident was sitting on his bed. Residents Affected - Few Interview with resident revealed that resident did not have any complaints and did not engage with surveyor during interview. Review of Resident R36's clinical record revealed that Resident R36 was admitted to the facility on August17, 2020 with diagnoses of Hemiplegia/Hemiparesis ( weakness on one side of the body) following Cerebral infarction affecting left non- dominant side, Anterior spiral artery compression syndrome, Spondylopathy (disorder of the vertiebrates), and Aphasia (language disorder affecting the speech). Review of Resident R36's Physical Therapy discharge note dated March 20, 2025 revealed that Resident R36 was discharged from Physical Therapy on March 20, 2025, with the following recommendations: RNP to facilitate maintaining current level of performance and in order to prevent decline, development of and instruction in the following RNP's has been completed with the IDT: ROM Active and transfers Review of Resident R36's clinical record revealed non documented evidence that RNP for ROM Active and transfers was provided to Resident R36 Interview with Registered Occupational Therapist Employee and Physical Therapy Assistant Employee E19 conducted on May 8, 2025, at 9:57a.m. revealed that Resident R36 was on Rehab but was discontinued with recommendations for restorative nursing program for range of motion. Interview with licensed nurse Employee E11 conducted on May 8, 2025 at 11:36 a.m. confirmed that there was no documented evidence that ROM was provided to Resident R36 according to rehab recommendations 28 Pa Code 211.10(d) Resident care policies 28 Pa. Code 211.12 (d)(1)(3) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 18 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few Based on observations, review of facility documentation and clinical records, and staff and resident interviews, it was determined the facility failed to ensure that one of four residents reviewed (Resident R51) was adequately secured during transportation in the facility's van. This failure resulted in actual harm to Resident R51 who sustained a fracture of the right knee after sliding out of the wheelchair on the way to an appointment. (Resident R51) Findings Include: Review of Resident R51's quarterly Minimum Data Set (MDS - federally mandated resident assessment and care screening) dated February 5, 2025, revealed the resident had diagnoses of muscle weakness, lack of coordination, Aphasia (communication disorder), Cerebrovascular Accident (CVA - stoke; loss of blood flow to part of the brain), Hemiplegia (paralysis on one side of the body) and Hemiparesis (weakness on one side of the body). Continued review of Resident R51's MDS assessment revealed the resident's BIMS (Brief Interview of Mental status) score of 14, which indicated that the resident was cognitively intact. Further review of the MDS assessment indicated Resident R51 used a wheelchair for mobility. Review of Resident R51's comprehensive care plan dated January 18, 2018, revealed the resident had a potential for falls related to weakness, difficulty with walking, and CVA with hemiparesis. Review of information submitted to the Pennsylvania Department of Health by the facility on March 7, 2025, revealed Resident R51, who was noted to be alert and oriented x 3 (alert and oriented to person, place, and time) sustained a fall with knee injury during transport to oncology appointment on March 6, 2025. During wheelchair transport, the van came to an abrupt stop and Resident R51 hit the right knee. Review of Resident R51's clinical record revealed a nursing note dated March 6, 2025, indicating after the resident returned from the appointment, the right knee was noticeably swollen. The physician subsequently ordered an x-ray for evaluation of the right knee which showed an acute fracture of the kneecap. Further review of Resident R51's clinical record revealed the resident was subsequently transferred to the hospital for evaluation on March 6, 2025, when a fracture of the right knee was confirmed. Review of personnel file for the facility's van driver, Employee E24, revealed the employee was hired by the facility in June 2022 as the driver for resident transportation. Continued review of van driver, Employee E24's personnel file, revealed the employee received training on May 31, 2024, on Driver Safety Responsibilities which included driver and passengers are required to wear seat belts and shoulder harnesses. Further review of van driver, Employee E24's personnel file revealed the employee also received training on May 31, 2024, for driver basic skills evaluation which included the proper use of facility's Securement Checklist. Review of the Securement Checklist revealed before driving off, the van driver should put on the resident's seat belt with the lap belt buckle. Ensure belt fits tight across (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 19 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 lap and under wheelchair armrest. Level of Harm - Actual harm Review of statement obtained by the facility van driver, Employee E24, dated March 6, 2025, revealed the employee needed to come to an abrupt stop and Resident R51 fell on (his/her) right knee. When the van driver, Employee E24, turned around Resident R51 was noted to be on (his/her) right knee (he/she) did have seatbelt on and wheelchair lockdown. Residents Affected - Few Interview on May 7, 2025, at 10:00 a.m. with Resident R51, surveyor asked resident if the seat belt was on at the time of the fall on March 6, 2026, resident responded no. Attempts to interview Employee E24 were unsuccessful as Employee E24 is no longer employed by the facility and did not return phone calls. Review of facility documentation revealed the facility transportation van was assessed on March 7, 2025, by Maintenance staff, Employee E25, and E26, verified the seatbelt attachments functioned without issue. Observation of a hands on demonstration and description of securing a resident and wheelchair into the facility van was provided on May 7, 2025, at 2:18 p.m. with Maintenance staff, Employees E25 and E26. Surveyor physically got into a wheelchair in the van. When seatbelt was tightly secured, surveyor was unable to easily slide out of wheelchair without getting trapped under the seat belt and subsequently readjust self back into wheelchair. Maintenance Employee, E26 also reported shoulder harnesses should be used to secure resident in the wheelchair. 4 different floor straps to secure wheelchair, a lap seatbelt and 2 shoulder harnesses. Interview on May 7, 2025, at 12:21 p.m. with Nursing Home Administrator, Employee E1, revealed that she conducted the investigation into the incident. Administrator reviewed the written statement obtained form the van driver, Employee E24 revealed as I began to drive through the arm rail it began to came down then I had to stop abruptly on brake and [Resident] fell on (his/her) right knee. When I turn around the resident was on (his/her) knee (he/she) did have seatbelt on and wheel chair lock down. Further interview with Nursing Home Administrator, Employee E1, revealed the Resident R51 was only strapped in with the lap seat belt. NHA was asked if the shoulder harnesses were in use to which the NHA indicated the shoulder harnesses were not in use at the time of the fall. The facility failed to ensure Resident R51's seatbelt was adequately secured during transportation in facility's van. This failure resulted in actual harm to Resident R51 who sustained a fracture of the right knee after sliding out of the wheelchair on the way to an appointment in the facility's transport van. (Resident R51) 28 Pa. Code 201.14 (a) Responsibility of licensee 28 Pa. Code 211.10 (d) Resident Care Policies 28 Pa. Code 211.12 (d)(5) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 20 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 Based on a review of clinical records and facility policies and procedures, observations of care and services, and interviews with staff, it was determined that the facility failed to consistently provide respiratory care and supplemental oxygen as ordered by the physician for one of 30 residents reviewed. (Resident R95). Residents Affected - Few Findings included: A review of the facility policy titled Oxygen Administration dated April 1, 2022, stated The purpose of this procedure is to provide guidelines for safe oxygen administration. Bulletin # 1 under Preparation paragraph further stated verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration. A review of the clinical record for Resident R95 revealed an admission date of September 15, 2021, with diagnoses including chronic pulmonary edema, heart failure, and both acute and chronic respiratory failure with hypoxia (low levels of oxygen). Review of Resident R95's physician orders dated January 12, 2024, for supplemental oxygen via nasal cannula every shift for shortness of breath (SOB), with instructions to titrate as needed. On May 5, 2025, at 11:59 a.m., an observation and interview were conducted with Resident R95, who was seated in her wheelchair with her oxygen turned off. A follow-up observation on May 5, 2025, at 2:05 p.m., with the Unit Manager (Employee E17) confirmed that Resident R95 was still in her wheelchair. While portable oxygen was attached to the wheelchair, the tank was empty. The resident was connected to a bedside oxygen concentrator delivering oxygen at a 2-liter flow rate. Resident R95 expressed a desire to move around in her wheelchair, but the bedside concentrator limited her mobility. Employee E17 was unaware of the reason why the original physician order did not specify an exact oxygen flow rate. On May 6, 2025, at 1:54 p.m., the physician order was revised to indicate: Oxygen 2 liters via nasal cannula every shift for SOB. Titrate oxygen to maintain oxygen saturation 92%. 28 Pa. Code 211.10(c) 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: 395203 If continuation sheet Page 21 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 - Minimal harm or potential for actual harm 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. Based on observations, review of facility documentation, review of personnel files and interviews with staff, it was determined that the facility failed to ensure that agency nursing staff demonstrated competencies and skill sets necessary to care for residents' needs for three of three agency personnel files reviewed (Employees E3, E15 and E16). Findings include: Review of facility staffing schedules revealed that Employee E3, licensed nurse; Employee E15, licensed nurse; and Employee E16, nurse aide; worked at the facility on May 5, 2025, as agency nursing staff. Observation of morning medication pass on May 5, 2025, at 9:45 a.m. revealed that Employee E3, agency licensed nurse, made a medication error as well as failed to maintain appropriate infection control practices during medication administration. Continued observation of morning medication pass on May 5, 2025, revealed that Employee E15, agency licensed nurse, left the medication cart unlocked and unattended, next to the resident dining area, from 10:36 a.m. through 10:42 a.m. Review of personnel files for Employee E3, agency licensed nurse; Employee E15, agency licensed nurse; and Employee E16, agency nurse aide; revealed that there were no skills evaluations or trainings available for review at the time of the survey. Interview on May 7, 2025, at 2:13 p.m. the Director of Nursing confirmed that the facility did not conduct any in-service training or skills competency evaluations for Employee E3, agency licensed nurse; Employee E15, agency licensed nurse; and Employee E16, agency nurse aide. Interview on May 8, 2025, at 12:33 p.m. Employee E13, human resources, confirmed that the facility did not have an orientation or training program in place for agency staff. Refer to F759, F761 and F880. 28 Pa. Code 201.20(a)(b) Staff development 28 Pa. Code 211.12(d)(1) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 22 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observations, review of facility policies and interviews with staff, it was determined that the facility failed to ensure that drug records were in order and that an account of all controlled drugs was maintained and periodically reconciled for four of four medication carts reviewed (2 North upper medication, 2 North low medication cart, 2 South back medication cart ) and maintain a system that allows for timely identification of narcotic diversion. Findings include: Review of facility policy, Pharmacy Services Policy and Procedure dated 2025, revealed, The Facility shall have a system to account for controlled medications' receipt and disposition in sufficient detail to enable an accurate reconciliation. Observation on May 5, 2025, at 10:03 a.m. of the 2 North upper medication cart, with Employee E3, agency licensed nurse, revealed that the number of blister pack medication cards was not documented during the shift-to-shift narcotic medication reconciliation process. Interview, at the time of the observation, Employee E3, agency licensed nurse, confirmed the above finding. Observation on May 5, 2025, at 10:11 a.m. of the 2 North low medication cart, with Employee E4, licensed nurse, revealed that the number of blister pack medication cards was not documented during the shift-to-shift narcotic medication reconciliation process. Interview, at the time of the observation, Employee E4, licensed nurse, confirmed the above finding. Observation on May 5, 2025, at 10:24 a.m. of the 2 South back medication cart, with Employee E5, licensed nurse, revealed that the number of blister pack medication cards was not documented during the shift-to-shift narcotic medication reconciliation process. Interview, at the time of the observation, Employee E5, licensed nurse, confirmed the above finding. Review of Narcotic book conducted on May 6, 2025, at 9:26 a.m. with Licensed nurse, Employee E20 during mediction observation on the first floor unit, revealed that individual narcotic accountability sheets were in a loose binder. Further observation revealed that each individual sheet did not have page number or any identifying marking that allows for immediate identification of missing page and there was no system in place to identify missing narcotic accountability sheets. Interview with Licensed nurse, Employee E20 at the time of the observation noted above confirmed that if the narcotic accountability page is removed from the binder, the incoming nurse will not know that it was missing, further if the page narcotic accountability sheet is removed together with the corresponding blister pack of narcotics, the incoming nurse will not know that the narcotic has been removed from the bin. 28 Pa Code 211.12(d)(1) Nursing services 28 Pa Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 23 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on clinical record reviews, review of facility policies and documentation and interviews with staff, it was determined that the facility failed to ensure that pharmacist recommendations were reviewed by the physician in a timely manner for four of five residents reviewed related to medication regime reviews (Residents R48, R86, R85 and R125). Findings include: Review of facility policy, Pharmacy Services Policy and Procedure dated 2025, revealed, The drug regimen of each resident shall be reviewed at least once a month by a licensed pharmacist . The pharmacist shall report any irregularities to the attending physician and the Facility's medical director and director of nursing, who shall act upon these reports . The attending physician shall document in the resident's medical record that the identified irregularity has been reviewed and what, if any, action has been taken to address it. If there is to be no change in the medication, the attending physician shall document his or her rationale in the resident's medical record. Review of Resident R85's Medication Regimen Review Report, dated January 20, 2025, revealed that the pharmacist made recommendations regarding the resident's medications and that the recommendations were reviewed by the physician. Continued review revealed that there was no date to indicate when the pharmacist's recommendations were reviewed by the physician. Review of Resident R125's Medication Regimen Review Report, dated November 25, 2024, revealed that the pharmacist made recommendations regarding the resident's medications and that the recommendations were reviewed by the physician. Continued review revealed that there was no date to indicate when the pharmacist's recommendations were reviewed by the physician. Review of Resident R125's Medication Regimen Review Report, dated January 21, 2025, revealed that the pharmacist made recommendations regarding the resident's medications and that the recommendations were reviewed by the physician. Continued review revealed that there was no date to indicate when the pharmacist's recommendations were reviewed by the physician. Review of Resident R48's clinical record revealed a physician's orders for: Risperdal Oral Tablet 0.5 MG (Risperidone) Give 0.5 mg by mouth in the morning for psychosis -Start Date 06/19/2024 and (Risperidone) Give 1 mg by mouth at bedtime for psychosis-Start Date 06/18/2024 Review of November 2024 Pharmacy Review dated November 25, 2024, revealed that under Pharmacy a Recommendation: Risperdal 0.5 mg every morning and at bedtime is due to assessment. Under Physician's Rationale to support continued use revealed a notion of History psychosis from PD (psychotic Disorder). Further, there was no date anywhere in the form, indicating when the pharmacy recommendation was reviewed by the physician Review of Resident R86's Medication Regimen Review Report, dated December 26, 2024, revealed that the pharmacist made recommendations regarding the resident's medications and that the recommendations were reviewed by the physician. Continued review revealed that there was no date to indicate when the pharmacist's recommendations were reviewed by the physician. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 24 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 Interview on May 7, 2025, at 10:18 a.m. the Director of Nursing confirmed that the pharmacy recommendations for Residents R48, R86, R85 and R125 were not dated by the physician. Level of Harm - Minimal harm or potential for actual harm 28 Pa Code 211.5(f)(x) Medical records Residents Affected - Some 28 Pa Code 211.9(k) Pharmacy services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 25 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of facility policies, clinical record review and interviews with staff, it was determined that the facility failed to ensure that the medication error rate was less than five percent for two of four residents observed during medication administration (Residents R83 and R88). Residents Affected - Few Findings include: The facility's medication error rate was 5.88% based on observation of 34 medication administration opportunities with two errors observed. Review of facility policy, Medication Administration Policy dated December 4, 2023, revealed, Medications must be administered in accordance with orders, including any required time frame. Review of Medication Administration Records (MARs) for Resident R83 revealed a physician's order, dated March 14, 2025, for aspart (rapid acting) insulin (medication used to lower blood sugar levels), inject 24 units subcutaneously (under the skin) before meals. Continued review revealed another order, dated April 4, 2025, for aspart insulin sliding scale (variable dosage based on blood sugar level), inject subcutaneously before meals. Both orders for aspart insulin were scheduled to be administered at 8:00 a.m. Observation of morning medication pass on May 5, 2025, at 9:45 a.m. revealed that Employee E3, agency licensed nurse, stated that Resident R83's blood sugar level was 323. Employee E3, agency licensed nurse, verified the physician orders for Resident R83; the sliding scale indicated that eight units of insulin should be administered. Employee E3, agency licensed nurse, drew up a total of 32 units of insulin (standing dose of 24 units plus 8 units of the sliding scale dose) and administered them to Resident R83 at 10:00 a.m. Both Resident R83 and Employee E3, agency licensed nurse, confirmed that the resident had already finished eating breakfast. Employee E3, agency licensed nurse, confirmed that Resident R83's insulin should have been administered before the breakfast meal. Review of Resident R88's clinical record revealed that Resident R88 was admitted to the facility on [DATE], with diagnoses of but not limited to Type 2 Diabetes Mellitus. Review of resident R88'd physician orders revealed an order for Novolog Injection Solution 100 UNIT/ML (Insulin Aspart) Inject 8 unit subcutaneously two times a day for DM (diabetes mellitus) Give before Breakfast and Dinner. Hold for BS <150-Start Date-01/17/2025 Medication administration observation on Resident R88 conducted on May 6, 2025, at 9:06AM with Employee E20 revealed that Licensed nurse, Employee E20 administered 8 units of Insulin Aspart to Resident R88. Interview with Licensed nurse, Employee E20 conducted at the time of the observation revealed that Resident R88 had already eaten her breakfast. Further interview with Licensed nurse, Employee E20 confirmed that the order for the Insulin Aspart was to administer the Insulin Aspart before breakfast. 28 Pa. Code 211.9(a)(1) Pharmacy services (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 26 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 0759 28 Pa. Code 211.12 (d)(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: 395203 If continuation sheet Page 27 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 observations, review of facility policies and interviews with staff, it was determined that the facility failed to ensure that medications were stored and labeled in accordance with professional practice standards and failed to ensure that compartments for storage of controlled medications were permanently affixed within storage areas, for thee of five medication storage areas reviewed (2 North upper medication, 2 North low medication cart, 1 North low medication cart, first floor medication room.). Findings include: Review of facility policy, Medication Administration Policy dated December 4, 2023, revealed, The individual administering the medication must check the label to verify the right medication, right dosage, right time and right method of administration before giving the medication. Check the expiration date on the medication label. When opening a multi-dose container, place the date on the container. Continued review revealed, During administration of medications, the medication cart is kept closed and locked when out of sight of the medication nurse. It may be kept in the doorway of the resident's room, with open drawers facing inward and all other sides closed. No medications are kept on top of the cart. The cart must be clearly visible to the personnel administering the medications, and all outward sides must be inaccessible to residents or others passing by. Observation on May 5, 2025, at 10:03 a.m. of the 2 North upper medication cart, with Employee E3, agency licensed nurse, revealed an opened Humalog lispro kwikpen (a multi-dose device designed to administer insulin [medication that treats diabetes by lowering blood sugar levels] for single resident use) that had no resident name label on it. Continued review revealed a Lantus insulin pen for Resident R83 that was opened and undated. Employee E3, agency licensed nurse, confirmed the above findings. Observation on May 5, 2025, at 10:11 a.m. of the 2 North low medication cart, with Employee E4, licensed nurse, revealed an opened Novolog insulin pen that had no resident name label on it. Interview, at the time of the observation, Employee E4, licensed nurse, confirmed the above finding. Continued observation of morning medication pass on May 5, 2025, of the 1 North low medication cart, revealed that Employee E15, agency licensed nurse, left the medication cart unlocked and unattended, next to the resident dining area, from 10:36 a.m. through 10:42 a.m. Interview, at the time of the observation, Employee E15, agency licensed nurse, confirmed the above finding. Observation of the first-floor medication room medication refrigerator conducted on May 6, 2025 at 9:52 AM with Unit Manager Employee E21 revealed a transparent plastic box containing an opened vial of Lorazepam Intensol 2mg/ml with 5.5ml left in the vial labelled with Resident R110's name on it. Further, an unopened vial of Lorazepam oral concentrate 2mg/ml, three vials of unopened lorazepam injection 2mg/ml and 10 tablets of Marinol 2.5 mg labelled with Resident R140's name on it was also observed inside the plastic box. Further observation revealed that the plastic box was not permanently affixed to the refrigerator. Interview with Employee E21 conducted at the time of the observation confirmed that the box (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 28 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 containing an opened vial of Lorazepam Intensol 2mg/ml with 5.5ml left in the vial labelled with Resident R110's name on it. Further, an unopened vial of Lorazepam oral concentrate 2mg/ml, three vials of unopened lorazepam injection 2mg/ml and 10 tablets of Marinol 2.5 mg labelled with Resident R140's name on it was not permanently affixed to the refrigerator. Review of facility policy, Pharmacy Services Policy and Procedure dated 2025, revealed, The Facility shall provide separately locked, permanently affixed compartments for storage of controlled drugs listed in Schedule II of the Comprehensive Drug Abuse Prevention and Control Act of 1976 and other drugs subject to abuse, except when the Facility uses single unit package drug distribution systems in which the quantity stored is minimal and a missing dose can be readily detected. 28 Pa Code 211.12(d)(1) Nursing services 28 Pa Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 29 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 review of facility policy, observations, and interviews with staff and residents, it was determined that the facility did not ensure that food was stored, prepared, and served in accordance with professional standards for food service safety. Findings Include: Review of facility policy Dishwashing Machine Use revised March 2010 revealed dishwashing machine chemical sanitizer for use of chlorine solution, the minimum concentration should be 50-100 ppm (parts-per-million) for a contact time of 10 seconds. A tour of the main kitchen conducted on May 5, 2025, 9:30 a.m. with Food Service Director, Employee E29, revealed the following: Observations of the walk-in refrigerator revealed an open large sleeve of ground beef, poorly resealed, and not labeled with received or open date. The opened sleeve of ground beef was placed on top of a new, unopened box (delivered earlier in morning of 5/5/2025) of ground beef. The opened sleeve of ground beef was observed with raw meat drippings on the new box. Observations and interview revealed the main kitchen utilizes a low water temperature, chemical (chlorine minimum concentration should be 50-100 ppm) sanitizer for the cleaning of dishes. When the Food Service Director, Employee E29, tested the concentration of sanitizing solution, the test strip indicated a PPM of < 10. Review of facility documentation revealed a log in the dish room to monitor the chlorine concentration of the dish machine. Per a review of the log, dietary staff were inaccurately documenting the chlorine concentration. Continued observations during a tour of the main kitchen revealed a black metal rack with multiple shelves that holds the boxes of juice used to dispense juice into the juice machine. The metal racks were sticky to touch. Observations revealed two tubes not in use, however were filled with stagnant old juice laying directly on the floor. Observations throughout the main kitchen revealed the floors had a significant amount of food and debris embedded into the grout and perimeter of the kitchen. Observations were confirmed by the Food Service Director, Employee E29, throughout the duration of the tour. Review of facility documentation revealed the contractor came out to assess the dish machine on May 5, 2025, which confirmed it was not dispensing sufficient sanitizing solution due to a hole in the tubing. 28 Pa. Code 201.14 (a) Responsibility of licensee. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 30 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 0813 Have a policy regarding use and storage of foods brought to residents by family and other visitors. Level of Harm - Minimal harm or potential for actual harm Based on observations, review of facility policies and interviews with staff, it was determined that the facility failed to ensure that personal foods were stored and labeled in accordance with food safety standards for one of two nursing units reviewed (2 North medication room). Residents Affected - Few Findings include: Review of facility policy, Medication Storage Policy dated December 4, 2023, revealed, Employee or resident food should not be stored in the medication refrigerator. Review of facility policy, Outside Food undated, revealed, Resident and or person bringing in the food will be notified that perishable food will only be kept for 72 hours. Continued review revealed, Staff will monitor resident's room, unit pantry, and refrigeration units for food and beverage disposal. Observation on May 5, 2025, at 9:58 a.m. of the 2 North medication room, with Employee E3, agency licensed nurse, revealed that the refrigerator contained both resident medications as well as foods brought into the facility. Continued observation revealed several opened containers of foods; none of the containers had dates to indicate when the foods were brought in or opened. Further observation revealed that some of the containers had writing to indicate a name or room number, however, the writing was illegible. Interview, at the time of the observations, Employee E3, agency licensed nurse, stated that she did not know if the foods belonged to staff or residents and confirmed that the opened containers of food did not have any legible names or dates on them. 28 Pa Code 205.25(b) Kitchen FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 31 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 Based on observations, review of facility policies, clinical record reviews and interviews with staff, it was determined that the facility failed to maintain an effective infection control program related to insulin administration and hand hygiene during medication administration for two of three licensed nurses observed (Employee E3 and E20). Residents Affected - Few Findings include: Review of facility policy, Medication Administration Policy dated December 4, 2023, revealed, The individual administering medications must verify the resident's identity before giving the resident his/her medications . The individual administering the medication must check the label to verify the right medication, right dosage, right time and right method of administration before giving the medication. Check the expiration date on the medication label. When opening a multi-dose container, place the date on the container. Continued review revealed, Staff shall follow established facility infection control procedures (e.g., hand washing, antiseptic technique, gloves, isolation precautions, etc.) when these apply to the administration of medications. Review of Medication Administration Records (MARs) for Resident R83 revealed a physician's order, dated March 14, 2025, for aspart (rapid acting) insulin (medication used to lower blood sugar levels), inject 24 units subcutaneously (under the skin) before meals. Continued review revealed another order, dated April 4, 2025, for aspart insulin sliding scale (variable dosage based on blood sugar level), inject subcutaneously before meals. Observation of morning medication pass on May 5, 2025, at 9:45 a.m. revealed Employee E3, agency licensed nurse, prepare aspart insulin for Resident R83. Employee E3, agency licensed nurse, removed a Novolog (aspart insulin) Flexpen from the medication cart. Inspection of the Novolog Flexpen revealed that the pen was opened, however, there was no resident name label or date that the pen was opened. Employee E3, agency licensed nurse, stated that Resident R83's blood sugar level was 323. Employee E3, agency licensed nurse, verified the physician orders for Resident R83; the sliding scale indicated that eight units of insulin should be administered. Employee E3, agency licensed nurse, drew up a total of 32 units of insulin (standing dose of 24 units plus 8 units of the sliding scale dose). Employee E3, agency licensed nurse, then administered the insulin to Resident R83. Review of Novolog prescribing information, available at https://www.novomedlink.com/diabetes/products/treatments/novolog/dosing-and-administration.html revealed, Never Share a NovoLog FlexPen . between patients, even if the needle is changed . Sharing poses a risk for transmission of blood-borne pathogens. Interview, on May 5, 2025, at 10:03 a.m. Employee E3, agency licensed nurse, confirmed that there was no resident name or date on the Novolog Flexpen and that it had previously been opened. Employee E3, agency licensed nurse, stated that it was the only aspart insulin in the cart, that it was the only physician's order she could find on the cart for aspart insulin and assumed that the pen must have belonged to Resident R83. Medication administration observation conducted on May 6, 2025, at 9:42 a.m., with Employee E20 from revealed that a hand sanitizer was on top of the medication cart. Further, during medication administration for Resident R88, Employee E20 did not wash her hands and did not wash her hands or sanitized her hands using the hand sanitizer on top of the cart prior to preparing the medications. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 32 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 - Few Further observation revealed that during medication preparation, Employee E20 handle the inside of the medication cup containing medications for Resident R88 and Employee E20 did not sanitize the Insulin Aspart before inserting the insulin needle into the vial. Observation conducted during the administration of medications to Resident R88 revealed that Employee E20 did not sanitize or wash her hands before and after administering the oral medications to Resident R88. Further, Employee E20 donned gloves and proceeded to inject the insulin into Resident R88. Employee E20 then proceeded to remove the gloves and disposed of it. Employee E20 did not sanitize or wash her hands before donning and after doffing the gloves. Further observation of the medication administration with Employee E20 revealed that, Employee E20 proceeded to prepare Resident R121's medications. Employee E20 did not sanitize or wash her hands before starting to prepare Resident R121's medications. Further Employee R20 handled the inside of the medication cup containing medications for Resident R88. Further, Employee E20 proceeded to administer Resident R121's medication without washing her hands before and after administering the medications to Resident R121. 28 Pa. Code 211.9(a)(1) Pharmacy services 28 Pa. Code 211.12 (d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 33 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observations and staff interviews, it was determined that the facility failed to ensure equipment was maintained in safe and operating conditions related to the main kitchen and fire doors. Residents Affected - Few Findings Include: An initial tour of the main kitchen was conducted on May 5, 2025, at 9:30 a.m. with Food Service Director, Employee E29. Observations and interview with Food Service Director, Employee E29, revealed the main kitchen is equipped with two steamers, four ovens, and one tilt skillet. Further interview and observation revealed one steamer, three ovens, and the tilt skillet are broken. Further observations during the initial tour of the main kitchen on May 5, 2025, at 9:30 a.m. revealed the stainless steel, industiral preparation table was noted to be on a slant. The table was observed to be holding other kitchen prep equipment such as cutting boards, food processor, and toaster oven. Food Service Director, Employee E29, confirmed the table was broken and needed to be replaced or fixed. Follow-up observations on May 8, 2025, at 12:00 p.m. in the main kitchen with Food Service Director, Employee E29, revealed dietary staff were in the midst of tray line assembling resident lunches. Continued observation and interview with the Food Service Director, Employee E29, confirmed the tilt skillet was still broken and was storing dirty pots and pans that were used to prepare lunch. Observation conducted during the tour of the first-floor unit on May 5, 2025, at 9:47 a.m. revealed that the fire door on the first floor unit was propped open with a wooden wedge. Further observation revealed that the magnets that keeps the doors open when the fire alarm is not activated and releases the doors to close it when the fire alarm is activated did not work and the fire door cannot be kept open without the wooden wedge that kept the fire door from closing. Observation of the second-floor unit revealed that two other fire doors on the second floor unit were also propped open with a wooden wedge. Further the magnets that keeps the two fire doors on the second-floor units open when the fire alarm is not activated and releases the doors to close it when the fire alarm is activated did not work and the two fire doors cannot be kept open without the wooden wedge that kept the fire doors from closing. Interview with Director of Maintenance, Employee E25 conducted on May 5, 2025, at 10:28 a.m. confirmed that three of the magnets of the fire doors did not work. Further, Employee E25 confirmed that the doors were propped open with wooden blocks. Further, Director of Maintenance, Employee E25 revealed that when they were working on their wanderguard (security system) system, the alarm panel broke and needed to be changed, after it was changed the interior doors stopped working. Interview with Licensed nurse, Employee E15 conducted on May 5, 2025, at 11:10 AM revealed that he did not know that's the fire doors were broken and that he did not know what to do with the fire doors when the alarm goes off. Further Employee E15 revealed that it was his first day of work. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 34 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 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 0908 Level of Harm - Minimal harm or potential for actual harm Interview with Unit Clerk, Employee E30 conducted on May 5, 2024, at 11:10 AM revealed that she was not aware that the fire doors did not work. 28 Pa. Code 201.14 (a) Responsibility of licensee. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 35 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, observations, and staff and resident interviews, it was determined that the facility failed to maintain an effective pest control program for two of three nursing units and the main kitchen (2nd floor South nursing unit, 1-North Nursing Unit, and main kitchen ). Residents Affected - Some Findings include: Review of facility policy Pest control dated April 1, 2022, revealed Aventura at Prospect shall maintain an effective pest control program. 1. The facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents.2. Pest control services are provided a contracted vendor. 3. Only approved FDA and EPA insecticides and rodenticides are permitted in the facility and all such supplies are stored in areas away from food storage areas. 4. Garbage and trash are not permitted to accumulate and are removed from the facility daily. 5. Maintenance services assist, when appropriate and necessary, in providing pest control services. Interview during an initial tour of the main kitchen on May 5, 2025, at 9:30 a.m. with Food Service Director, Employee E29, confirmed sightings of pests in the main kitchen. Observations during a tour of the main kitchen on May 5, 2025, at 9:30 a.m. revealed a hole, approximately 2 inches wide and 2 inches in height, in the wall (directly above the baseboard) located behind the door that exits the kitchen. The floors of the kitchen had a significant amount food and debris embedded into the grout and perimeter of the kitchen. The metal rack holding the containers of juice used for the juice machine was sticky to touch. Review of pest control report dated May 1, 2025, revealed the pest control company Inspected and treated 1-North pantry for roach activity. Observed snacks from night before stored in cabinet area that's not put in sealed containers. Observed small, opened container of food substance opened upon floor behind vending machine. The pest control report indicated that the findings were reviewed with Nursing Home Administrator, Employee E1. Observations on May 6, 2025, at 1:24 p.m. in the 1-North pantry revealed an open bag of chips in the cabinet, not in a sealed container. Further observations revealed a leftover breakfast tray on the counter, a trash can with no lid, a small plastic pudding cup, and a plastic lid with food substance on it (similar appearance to pudding) on the floor behind the ice machine. Continued observations on May 6, 2025, at 1:24 p.m. in the 1-North pantry surveyors observed two roaches (1 dead and 1 alive) in the drawers of the cabinet. On May 6, 2025, at 10:02 a.m., an interview was conducted with Resident R127, who stated, Do you hear a mouse making a peep noise? There's a trapped mouse next to my bed by the window that a baby mouse has been caught in that mouse trap. At 10:15 a.m. the same day, the Maintenance Director, Employee E25 confirmed the observation in room [ROOM NUMBER], verifying that a live mouse was caught in a trap next to Resident R127's bedside window. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 36 of 37 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 395203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Prospect 815 Chester Pike Prospect Park, PA 19076 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A review of the pest control log for the second-floor south nursing unit revealed no recorded observations of mice after March 23, 2025, when sightings were noted in rooms [ROOM NUMBERS]. The previous entry was dated February 18, 2025. On May 6, 2025, at 10:23 p.m., an interview with Resident R52 revealed that she/he had seen two mice running inside her room [ROOM NUMBER]-D yesterday. Resident R52 reported to a staff. This was not recorded in the pest control logbook. At 10:24 p.m., an interview was conducted with Licensed Nurse, Employee E27, who reported seeing a mouse in the medication room the previous week. However, she acknowledged that she did not document the sighting in the pest control log. 28 Pa. Code 201.14 (a) Responsibility of licensee. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395203 If continuation sheet Page 37 of 37