Health inspection·November 30, 2023

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, it was determined that the facility failed to ensure a clean, homelike environment for two of two nursing floors of 32 residents reviewed. (Rooms 105, 120, 128, 131 and 211) Findings include: Observations of room [ROOM NUMBER] on first floor unit, on November 27, 2023 at 10:30 am, revealed stained privacy curtain, stained ceiling above bed A, and stained bed linens on bed B. Resident R3's unclean personal laundry was observed stored behind television. Observations of room [ROOM NUMBER] on second floor unit on November 27, 2023 at 11:00 am revealed stained privacy curtain. Observation of room [ROOM NUMBER] on first floor unit on November 27, 2023 at 11:07 a.m. revealed an air conditioner with chipped painted on top of it and the wall above it had paint peeling off. Observation of room [ROOM NUMBER] on the first floor unit on November 27, 2023 at 1:05 p.m. reaveled two wholes unrepaired on the exterior of the bathroom door. Observation of room [ROOM NUMBER] on the first floor unit on November 27, 2023 at 1:43 p.m. revealed dirty floors. 28 Pa Code 201.14(a)Responsibility of licensee 28 Pa Code 201.18(b)(1)(3) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395258 If continuation sheet Page 2 of 16 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 395258 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bristol Health & Rehab Center 905 Tower Road Bristol, PA 19007 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 review of facility policy, observations, and interviews with residents and staff, it was determined that the facility failed to ensure a formal grievance process was in place for one of 32 residents reviewed (Resident R108). Findings Include: Review of facility policy titled Resident Grievances with a review date of May 5, 2019 states, The facility will make available to all residents posting in a prominent location in the facility information of the right to file grievances orally or in writing; the right to file grievances anonymously; contact information for the Grievance Official; a reasonable timeframe for completing the review of the grievance, the right to obtain a written decision regarding the grievance; and contact information for independent entities with whom grievances may be filed. Further review of facility policy revealed The Grievance Official will meet with the resident and inform the resident of the results of the investigation and how the resident's grievance was resolved or will be resolved, if applicable. Interview held with Resident R108 on November 28, 2023 at 12:22 p.m. revealed the resident had brought up a concern to the facility regarding her wanting to be double-briefed. The resident stated she had brought this up to the facility serval times and the facility has only given her an answer of, we need to run it by someone higher. Review of Resident R108's clinical record revealed a diagnosis of retention or urine, muscle weakness, and reduced mobility. Interview with Nursing Home Administrator, Employee E1 and Director of Nursing, Employee E2 on November 30 at 2:05 p.m. revealed the facility was aware of the concern made regarding double briefing from Resident R108. Employee E1 and E2 revealed they had not yet come up with a decision. Review of the facility grievance logs from the last twelve months revealed no grievance on file for Resident R108. Review of Resident R108's clinical record revealed no progress notes or documentation regarding the resident's request. A tour was taken with Director of Social Services, Employee E12 on November 30, 2023 at 10:32 a.m. the tour revealed the short term unit and unit one both had Grievance information posted that was out of date. The correct grievance official and contact information was not listed. A tour of unit two revealed there was no posted grievance official information, no grievance forms accessible, and no box to place grievance forms. Interview with the Maintenance Director, Employee E14 at 10:39 a.m. revealed a resident had ripped down the grievance information on multiple occasions on unit two. 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: 395258 If continuation sheet Page 3 of 16 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 395258 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bristol Health & Rehab Center 905 Tower Road Bristol, PA 19007 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 28 Pa. Code 201.18 (b)(3) Management Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 201.18 (e) (1) Management 28 Pa. Code 201.29(a) Resident rights Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395258 If continuation sheet Page 4 of 16 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 395258 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bristol Health & Rehab Center 905 Tower Road Bristol, PA 19007 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 policy, review of clinical records, observations, and staff interviews, it was determined that the facility failed to update care plans to meet care needs for three of 32 residents reviewed (R90, R127, R135) Findings Include: Review of the care plan policy titled Plan of Care Review undated reads, It is the policy of this facility to provide resident centered care that meets psychological, physical and emotional needs and concerns of residents. Safety is a primary concern for our residents, staff and visitors. The purpose of the policy is to provide guidance to the facility to support the inclusion of the resident or resident representatives in all aspects of person-centered care planning and that this planning includes the provision or services to enable the resident to live with dignity and support the resident's goals, choices, and preferences including, but not limited to, goals related to their daily routines and goals to potentially return to a community setting. Review of Resident R90's clinical record revealed an admission date to the facility of February 24, 2021 with the diagnoses of End Stage Renal Disease (a condition in which the kidneys lose the ability to remove waste and balance fluids), and Dependence on Renal Dialysis. Review of Resident R90's current care plan revealed that the resident was care plan for a catheter/shunt site on the right chest wall Permacath. Interview and observation of Resident R90 with Licensed nurse, Employee E5 on November 29, 2023 at 12:23 p.m. revealed the presence of a catheter in the resident's right arm and not in the right chest wall. Employee E5 confirmed the above findings, that Resident R90's care plan was not updated. Review of Resident R127's clinical record revealed that the resident was admitted to the facility on [DATE]. Diagnoses included Dementia (a general term for the impaired ability to remember, think, or make decisions that interferes with doing everyday activities), Review of the resident's Minimum Data Set (MDS- assessment of resident care needs) dated November 12, 2023, revealed the diagnosis of Dementia. Review of Resident R127's care plan revealed that there were no focus, interventions, and outcomes (goals) care- planned for Dementia care. On November 30 , 2023, at 11:59 a.m., interview with the Director of Nursing, Employee E2 confirmed the above findings. Review of Resident R135's clinical record revealed that the resident was admitted to the facility on [DATE] with the diagnoses of Chronic Obstructive Pulmonary Disease (COPD)(COPD refers to a group of diseases that cause airflow blockage and breathing-related problems), Cirrhosis of Liver (Chronic liver damage from a variety of causes leading to scarring and liver failure), Dependence on Supplemental Oxygen and Anxiety Disorder. Review of Resident R135's November 2023 physician order indicated that Resident 135 was admitted to hospice care due to Cirrhosis of Liver. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395258 If continuation sheet Page 5 of 16 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 395258 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bristol Health & Rehab Center 905 Tower Road Bristol, PA 19007 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 Review of the care plan for Resident R135, revealed that there were no focus, interventions, and outcomes (goals) care- planned for hospice care. On November 29 , 2023, at 10:27 a.m., interview with the Director of Nursing, Employee E2 confirmed the above findings. 28 Pa. Code 211.10 (c)(d) Resident care policies Residents Affected - Few 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395258 If continuation sheet Page 6 of 16 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 395258 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bristol Health & Rehab Center 905 Tower Road Bristol, PA 19007 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of clinical record, review of facilty policy and staff interviews, it was determined that the facility failed to provide appropriate respiratory care and services for two of two residents reviewed (Residents R65 and Resident R28). Residents Affected - Few Findings include: Review of an undated facility policy Oxygen Medical Gas Use, revealed that Oxygen will be ordered by a physician or other authorized provider. Will have a physician/provider's order for the oxygen including route of administration, liters per minutes and the frequency of use. Pure oxygen is irritating to mucus membranes, humidification may be requited for comfort. Review of the clinical record revealed that Resident R65 was admitted to the facility on [DATE], with diagnoses of Chronic Obstructive Pulmonary Disease (COPD), (a group of diseases that cause airflow blockage and breathing-related problems). A review of Resident R65's clinical record revealed a physician order, dated October 29, 2023 for Oxygen at 3 liters / min via Nasal Cannula, Continuously and Albuterol Sulfate HFA Inhalation Aerosol Solution 108 (90 Base) MCG/ACT (Albuterol Sulfate)(medication to treat beathing difficulty. Review of Resident R65's care plan dated November 1, 2023, revealed Resident has Chronic Obstructive Pulmonary Disease (COPD) with shortness of breath while lying flat; dyspnea, chronic bronchitis; on 3L O2(oxygen) continuous Observation of Resident R65 on November 27, 2023 at 12:12 PM revealed that there was no date on the oxygen tubing or nebulizer mask of Resident R65. Nebulizer mask noted to be laying on the nightstand. Interview with Resident R65 on November 27, 2023, at 12:12 p.m. stated staff did not change the oxygen tube routinely and did not provide a bag to keep the mobilizer mask after use. Interview with Employee E4, Licensed Nurse, on November 27, 2023, at 12:12 p.m. confirmed that resident's oxygen tube did not include a date when the tube was last changed, and the oxygen tube should have been in a bag to prevent infection. Review of physician order for Resident R28 dated August 22, 2023, revealed an order to administer oxygen at 3 liter per minute. Observation of Resident R28 on November 27, 2023, at 12:30 p.m. revealed that resident was on oxygen via nasal canula. There was no date on the canula or no humification was provided. The oxygen was flowing at a rate of 4 liter per minute. Further observation of Resident R28 on November 30, 2023, at 11:16 a.m. revealed that oxygen tubing was undated, and no humidification was used. The oxygen was flowing at a rate of 4 liter per minute. Interview with Employee E4, Licensed Nurse, on November 30, 2023, at 11:16 p.m. confirmed that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395258 If continuation sheet Page 7 of 16 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 395258 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bristol Health & Rehab Center 905 Tower Road Bristol, PA 19007 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident R28's oxygen tube did not include a date when the tube was last changed. Employee E4 also confirmed that the oxygen was not administered at a rate ordered by the physician. Interview with Director of Nursing, Employee E2, on November 30, 2023, at 11:30 a.m. stated staff was expected to date oxygen tubing and nebulizer tubing after changing the tube. Staff should also provide oxygen via humidification bottle to prevent complication. 28 Pa. Code 211.12(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395258 If continuation sheet Page 8 of 16 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 395258 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bristol Health & Rehab Center 905 Tower Road Bristol, PA 19007 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 the review of facility documentation and staff interview, it was determined that the facility failed to ensure that nursing staff possessed the appropriate competencies and skill sets related to the care of residents with tracheostomy (a surgical airway management procedure which consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea) and PICC and Midline line ( a tube placed in a large vein in the neck, chest, groin, or arm to give fluids, blood, or medications or to do medical tests quickly) dressing changes for 20 of 20 staff reviewed (Employee 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 and 50) Findings include: A review of the facility documentation revealed that the facility had four residents with Midline and PICC line catheters who received care and services from staff including site assessment, medication administration and dressing changes. A review of facility documentation revealed that the facility provided care of a resident with tracheostomy from April 2022 to August 2023. A request for the evidence of staff competencies or annual evaluations related to tracheostomy care, Midline and PICC dressing change and assessments were made to Administrator on November 29, 2023, at 2:00 p.m. Review of facility training records revealed no documented evidence that the nursing staff completed competencies or annual evaluations related to tracheostomy care, Midline and PICC dressing change and assessments for Employee 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 and 50. Interview with Director of Nursing, Employee 2, on November 30, 2023, at 11:30 a.m. confirmed that the facility did not have staff competencies for the employees listed above related to tracheostomy care, Midline and PICC dressing change and assessments. 28 Pa. Code 211.12 (c)(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395258 If continuation sheet Page 9 of 16 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 395258 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bristol Health & Rehab Center 905 Tower Road Bristol, PA 19007 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 0741 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents. Based on observations, review of facility documentation, and interview with staff and resident, it was determined that facility failed to utilize and implement non-pharmacological approaches to care in accordance with the resident's abilities, customary daily routine, interests, preferences, and choices on one of 32 residents reviewed. (Resident R7) Findings include: Review of facility's policy 'Behavior Management General,' indicates that problematic behaviors include yelling/screaming and interdisciplinary team is to complete care plan and involve social services and activities departments as appropriate, review pharmacological and non-pharmacological interventions, and include resident specific interventions. Review of Residents R7's clinical records revealed diagnosis of cognitive communication deficit, aphasia, schizoaffective disorder, anxiety, bipolar and major depressive disorder. Review of Resident R7's care plan revealed that resident had a behavior problem related to refusals with taking medications at times including insulin, taking showers, obtaining blood work and vital signs, treatments, supplements and weights. The resident also refused to lay in bed and prefered to lay on floor. Continued review of the resident's care plan revealed that the resident took clothes off and stood in doorway, not able to be redirected. Resident yelled when getting care done by staff, with following interventions: approach, speak in calm manner, behavioral health consults as needed, communicate with resident/resident representative regarding behaviors and treatment, consult with pastoral care, psych services, and/or support groups, educate resident on importance of maintaining medication regimen, Educate resident on the importance of good personal hygiene and the benefit of taking showers, educate resident on the importance of her nutritional supplements, Educate resident on the importance of her treatments, Monitor behavioral episodes, and attempt to determine underlying causes, Offer food/snacks to calm resident. IE: Chocolate milk; cupcakes; peanut butter and jelly sandwiches, will honor resident choice. Observations on November 27, 2023, 12:00 p.m. and on November 28, 2023 at 11:45 a.m., revealed Resident R7 yelling and clapping hands, disrupting the unit. Observed three nursing staff at nurses station during Resident R7's behavioral episode on November 28, 2023. Observed housekeeping manager, Employee E12, on November 27, 2023 go into resident R7's room to address her behavioral episode. During interview with Licensed nurse, Employee E6, on November 28, 2023, at 12:15 p.m., Employee E6 was unable to name non-pharmacological interventions for Resdient R7 which were effective. Per Employee E6's report - Resident R7 requested food but did not consume food and ends up throwing it on floor. Facility was unable to provide support with skills related to verbal de-escalation, coping skills, and stress management for Resident R7. 28 Pa Code 211.12(d)(3)(5)Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395258 If continuation sheet Page 10 of 16 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 395258 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bristol Health & Rehab Center 905 Tower Road Bristol, PA 19007 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 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. Based on review of facility policy, interviews with residents and staff, and review of resident documentation, it was determined that the facility failed to routinely offer evening snacks to residents. Findings Include: Review of facility policy titled Snacks with a revision date of September 2017 states, Snacks and beverages will be provided as identified in the individual plans of care. Bedtime (a.k.a HS) snacks will be provided for all residents. Additional snacks and beverages will be available upon request for all residents who want to eat at non-traditional times. Further review of the policy states, 3. Snacks will be assembled, labeled, and dated in accordance with the individual plan of care for each resident and those items will be delivered to patient care areas in a timely manner. Interview with Resident R21 on December 4, 2023 at 10:34 a.m. revealed the resident was diabetic and had not been receiving a snack in the evening. The resident stated that she will save items from breakfast like cereal or yogurt to have for a snack in the evening. Observation of Resident R21 room revealed two individual cups of rice krispie cereal and 2 individual cups of yogurt not refrigerated. Review of Resident R21's bed time snack record revealed the resident was not receiving a snack in the evening. Review of the bed time snack record from the last 30 days revealed the following dates the resident record was listed as not applicable : November 1, 2, 3, 4, 5, 6, 7, 8, 12, 13, 14, 15, 16, 17, 18, 20, 21, 22, 23, , 24, 25, 27. Resident council held on November 29, 2023 at 2:30 p.m. with twenty-four alert, and oriented residents. When asked about snacks several of the residents stated they do not receive bed time snack every night. Ten of the twenty-four residents stated that did not receive a snack (Resident R5, R21, R26, R33, R38, R42, R74, R87, R123, R139) Review of Resident R87's bed time snack record revealed the resident was not receiving s snack in the evening. Review of the bed time snack record from the last 30 days revealed the following dates the resident record was listed as not applicable: November 5, 6, 7, 8, 15, 16, 19, 24, 26, and 28. Review of Resident 33's bed time snack record revealed the resident was not receiving s snack in the evening. Review of the bed time snack record from the last 30 days revealed the following dates the resident record was listed as not applicable: November 3, 4, 5, 8, 9, 11, 14, 16, 18, 20, 22, and 28. Review of Resident R38's bed time snack revealed the resident was not receiving a snack. Review of the bed time snack record from the last 30 days revealed the following dates the resident record was missing dates November 1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 19, 20, 21, 22, 24, 25, and 26. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395258 If continuation sheet Page 11 of 16 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 395258 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bristol Health & Rehab Center 905 Tower Road Bristol, PA 19007 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 0809 Review of Resident R74's bed time snack record revealed no entries for the last thirty days. Level of Harm - Minimal harm or potential for actual harm Review of Resident R123's bed time snack record revealed no entries for the last thirty days. Residents Affected - Few Interview on November 30, 2023 at 10:55 a.m. with Director of Dining, Employee E14 revealed there was a staff assigned to putting together 7 p.m. snacks. Observation at 10:58 a.m. revealed the labeled snacks for today for 10 a.m. had still not been prepared for the day. When asked who generally makes the snacks Employee E14 replied her one cook does but she has currently been out all week. Review of the labels for the labeled snacks revealed several mislabeled snacks including grilled ham and cheese, sausage and biscuits. There were several snack labels that had menu items listed that would not be given during a snack time, this was confirmed by Employee E14. Further discussion with Employee E14 revealed there was no record of how many bulk snacks are being sent up to the units during each snack period. Observation of the pantry and refrigerator area revealed the facility was currently low on snacks and still needing to prepare snacks for 2 p.m. and 7 p.m. The facility had less than 100 individually packed snacks, one bulk can of vanilla pudding, and four bulk cans of applesauce. 28 Pa. Code 211.12 (d)(3)(5) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395258 If continuation sheet Page 12 of 16 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 395258 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bristol Health & Rehab Center 905 Tower Road Bristol, PA 19007 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, it was determined that the facility did not ensure that food was stored, prepared, distributed, and served in accordance with professional standards for food service safety. Findings include: Review of facility policy titled, Food Storage: Cold Foods dated April 2018, indicated that Freezer temperatures will be maintained at a temperature of 0 F or below. An accurate thermometer will be kept in each refrigerator and freezer. A written record of daily temperatures will be recorded. All foods will be stored wrapped or in covered containers, labeled and dated, and arranged in a manner to prevent cross contamination. Observations in the walk-in freezer with Employee E14, Food Service Director, on November 27, 2023, 9:45 a.m. revealed that the freezer thermometer was indicating a temperature of 36-degree Fahrenheit (F). There were multiple boxes and bags of different food items in the freezer including the meat items which were soft to touch. Interview with Employee E14 on November 27, 2023, 9:45 a.m. stated the freezer was down from November 23, 2023. She stated the food should have been moved to a refrigerator or should have been used since the freezer was not holding temperature. Any items that were not used should have been discarded. Interview with the Maintenance Director, Employee E13, November 28, 2023, at 2:00 p.m. stated the freezer was down due to a broken compressor. The part have been ordered and the food should have been discarded. Review of freezer temperature log dated November 22, 2023, revealed that the freezer temperature was at -2-degree Fahrenheit (F) in the morning and -1-degree F in the afternoon. On November 23, 2023, the freezer temperature was at 25-degree F in the morning and -1-degree F in the afternoon. On November 24, 2023, the freezer temperature was at 23-degree F in the morning and 22-degree F in the afternoon. The freezer temperature went up to 32 degrees at 11AM and 12PM. On November 25, 2023, the freezer temperature was at 28-degree F in the morning and 30-degree F in the afternoon. On November 26, 2023, the freezer temperature was at 32-degree F in the morning and 36-degree F in the afternoon. Observations in the walk-in refrigerator with Employee E14, on November 27, 2023, 9:40 a.m. revealed that following items did not have a received, pulled date and or use by date: 21 cups of milk, soup, one box of turkey, one box of pineapple. The following items were expired: chef special entrée with a use by date of November 10, 2023, ham with use by date of November 23, 2023. Observations were confirmed by Employee E14, Food Service Director, along the duration of the tour of the dietary department. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.6 (f) Dietary Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395258 If continuation sheet Page 13 of 16 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 395258 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bristol Health & Rehab Center 905 Tower Road Bristol, PA 19007 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on review of facility policy, interviews with staff, and review of clinical records, it was determined that the facility failed to ensure that neurological checks were documented one of 32 residents reviewed. (Resident R144). Findings include: Review of the facility policy titled, Neurological Checks (Neuro-checks) revised June 21, 2018 states, It is the policy of this facility to provide resident centered care that meets the psychological, physical and emotional needs and concerns of the residents. Safety is a primary concern for residents, staff and visitors. The purpose of this policy is to guide the nurse in performing neurological checks, usually performed after a head injury or suspicion of a head injury from falls or blows to the head, but may be performed for other reasons in which there is a concern for vascular events included but not limited to cardiovascular accident (CVA or stroke), seizure activity, and brain infections. Further review of the facility policy revealed under Documentation: Complete the Post Fall Assessment, If the resident hit their head or the fall was unwitnessed, complete Neuro Checks per policy, If the resident suffered an injury or has a change of condition, complete the eInteract Change of Condition Assessment, Complete the Fall Follow Up UDA at least twice each day times 3 days unless the resident's condition is such that it should be continued longer. A report should be initiated in Risk Watch. Update the care plan with the new interventions. Further review of the facility policy revealed, Frequency of Neuro-checks a. for stable and unchanging neuro-checks use the following schedule: Every 15 minutes times 4, Every 60 minutes times 4, every 4 hours times four, daily times 4 days. Review of the clinical record for Resident 144 revealed an admission date to the facility on July 7, 2023. Review of the quarterly Minimum Data Set (MDS-periodic assessment of resident care needs) from October 31, 2023 revealed medical diagnoses of Epilepsy (a disorder in which nerve call activity in the brain in disturbed, causing seizures) and Seizures (a burst of uncontrolled electrical activity between brain calls that cause temporary abnormalities in muscle tone, movements, behavior, sensations or states or awareness. Continued review of the MDS revealed that the resident was assessed with a BIMS (Brief Interview for Mental Status) score of 11 indicating moderate cognitive impairment. Review of Resident R144's clinical record revealed on September 21, 2023 the resident sustained a fall when she returned from the hospital. Review of Resident R144's hospital record revealed that the resident had a seizure earlier in the day on September 21, 2023. After returning from the hospital, Resident R144 was left unsupervised at her bedside. After a few minutes a nurse heard Resident R144 calling out for help. The staff member went in to find Resident R144 with a small one-centimeter laceration to her left eyebrow area. Resident R144 was assessed and sent to the emergency room. No new orders were obtained post hospitalization. Staff were to continue with neurological checks per facility policy. Review of Resident R144's neuro check records revealed no documentation that neuro checks were (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395258 If continuation sheet Page 14 of 16 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 395258 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bristol Health & Rehab Center 905 Tower Road Bristol, PA 19007 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 0842 completed on November 24, 2023 which was the third of four days of daily neuro checks. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18 (b)(1) Management Residents Affected - Few 28 Pa. Code 201.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395258 If continuation sheet Page 15 of 16 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 395258 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bristol Health & Rehab Center 905 Tower Road Bristol, PA 19007 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records, facility policies and procedures, and interviews with staff, it was determined that the facility failed to ensure that the physician ordered hospice care was provided for one of 32 residents reviewed. (R105). Findings include: Review of the Hospice Policy of the Facility, Policy #: NS-1178-01, revealed; End of life care or hospice care is a valuable resource to families and residents and will be provided while the resident is in the facility at the request of the resident, responsible party/family, and physician. The facility is responsible for working with hospice care services to provide the optimum benefits for end-of-life care including pain relief, custodial care, and resident preferences to the extent possible. Communication between the facility staff and the hospice care staff is an integral part of this partnership. Review of the clinical record for Resident R105 revealed that the resident was admitted to the facility on [DATE], with diagnoses of Colostomy Status, (A colostomy is an opening in the large intestine, or the surgical procedure that creates one; a colostomy may be needed if an individual cannot pass stools through anus), Muscle Weakness, and Protein Calorie Malnutrition. Further review of Resident R105's clinical record revealed a physician order dated March 16, 2023, and April 3, 2023, for hospice (end of life care) services. Additional review of Resident R105's clinical records indicated that the physician order for hospice service was not implemented, and that Resident R105 did not receive hospice service as ordered. Interview with Licensed Nurse, Employee E4, on November 28, 2023, at 1:55 p.m., confirmed that the facility did not provide the ordered hospice care to Resident R105. 28 Pa Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395258 If continuation sheet Page 16 of 16