Inspection·July 31, 2024

F 0623 Level of Harm - Minimal harm or potential for actual harm During an interview on 7/31/24, at 2:10 p.m. the Director of Nursing (DON) stated, We do not send anything to the Ombudsman's Office and confirmed that the facility failed to provide a transfer notice to a representative of the Office of the Long-Term Care Ombudsman Division for two of three residents. 28 Pa. Code 201.29 (a) (c.3) (2) Resident rights. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395266 If continuation sheet Page 2 of 4 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 395266 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Valley Rehabilitation and Healthcare Center 257 Georgetown Road Beaver Falls, PA 15010 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 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record reviews and staff interviews, it was determined that the facility failed to permit the readmission of a hospitalized resident without providing evidence that the facility was not able to meet the resident's needs for one of three residents reviewed (Resident R1). A review of the facility policy Transfer and discharge- 30 day last reviewed 7/9/24, indicated a resident and/or his or her representative (sponsor), will be given a thirty-day advanced notice of an impending transfer or discharge from facility. Under the following circumstances, the notice will be given as soon as it is practicable but before the transfer or discharge. The transfer is necessary for the resident ' s welfare and the resident ' s needs cannot be met in the facility. A review of Resident R1's clinical record indicates admission date of 7/12/24, with the diagnoses of Vascular Dementia with agitation (decline in thinking skills caused by reduced blood flow), Urinary tract infection (infection in the urinary system), and Hypertension (high blood pressure). A review of progress note 7/12/24, 12:23 p.m indicates resident arrived around 3:00 p.m., accompanied with family. Wander guard put on left leg. Family signed DNR. No complaints of pain at this time. Alert and Oriented x1 with confusion. Has been exit seeking throughout shift. Aide attempted to redirect resident, and resident yelled and tried to hit aide. Staff closed double doors, and resident did not attempt again this shift. Also, put resident on q 15 min checks. Has had increase behaviors, and attempted to do initial assessment, but resident refused. Stated please don't touch me. Attempted three times throughout shift. Resident refused each time. Resident has been finding empty rooms and lays down for about 30 minutes at a time throughout shift. Orders verified and transcribed . Oriented to room, call light, and staff. A review of progress note 7/13/24, 4:21 p.m. Resident has had increased behaviors this shift. Attempting to exit seek, redirecting resident back to hall. Resident keeps stating that she needs to have surgery. Reassuring resident no surgery will be performed. Resident requested to speak to family. Resident spoke with [NAME] and has had seem to relax a little more. Resident standing at nursing station at this time. Will continue q15 min checks and noted in physician binder about increased behaviors. A review of progress note 7/15/24 5:28 p.m. Resident complained of shortness of breath, nausea, chest pain during activities. Escorted resident back to her room and obtained Vital Signs. Blood pressure 152/82, Heart rate-80, Temperature -98.1, Respirations-20, Oxygen saturation 97% on Room Air. Call made to sister to have permission to send to ER for eval. Physician notified. Medic Rescue on their way. A review of progress note 7/15/24, 6:08 p.m. resident left with Medic Rescue via stretcher at this time. A review of progress notes did not indicate that family/resident was not notified of Resident R1 requiring a secure unit or transfer to another facility or that that Resident R1 would not be returning to facility upon hospital transfer. During an interview 7/31/24, 10:15 a.m. with admission coordinator Employee E4 stated from my (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395266 If continuation sheet Page 3 of 4 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 395266 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beaver Valley Rehabilitation and Healthcare Center 257 Georgetown Road Beaver Falls, PA 15010 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 0626 Level of Harm - Minimal harm or potential for actual harm understanding Resident R1 was not a fit for our building she was exit seeking and wandering, was not safe for her to be here, she needed a locked down unit. During an interview 7/31/24, at 10:54 a.m. Social service director stated, my normal process for a transfer would be to contact the family and work on a transfer to a memory care facility . Residents Affected - Few During an interview 7/31/24, at 2:10 pm. The Nursing Home Administrator stated, no formal notice of discharge was given to the family, the hospital was told the facility was not taking Resident R1 back at the time of transfer and confirmed the facility failed to permit the readmission of a hospitalized resident without providing evidence that the facility was not able to meet the resident's needs for one of three residents reviewed. 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: 395266 If continuation sheet Page 4 of 4