Health inspection·November 18, 2025

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of nursing staffing hours and staff to resident ratios, resident census, clinical records, select facility policy, and resident and staff interviews, it was determined that the facility failed to provide sufficient nursing staff to ensure that each resident received timely, person-centered care, services, and supervision necessary to maintain the physical, mental, and psychosocial well-being of the resident population for five of 18 sampled residents (Residents 1, 2, 3, 7, and 9).Findings include: A review of the clinical record revealed Resident 1 was admitted to the facility on [DATE], with diagnoses including cerebral vascular accident (stroke) with left-sided weakness and dementia (A condition in which a person loses the ability to think, remember, learn, make decisions, and solve problems). A review of a quarterly Minimum Data Set assessment (MDS, a federally mandated standardized assessment used to plan resident care) dated September 14, 2025, revealed the resident required staff assistance for activities of daily living and had a BIMS score of 14 (Brief Interview for Mental Status, a tool used to measure cognitive function; a score of 13-15 indicates cognition is intact). A review of a facility investigation dated October 26, 2025, at 3:30 PM revealed Employee 1, nurse aide, answered Resident 1's call bell and found the resident on the floor lying on her stomach, partially under the bed with blankets underneath her. The resident stated she had attempted to transfer from her bed into her chair and slipped, causing her to fall. Resident 1 resided on the east wing of the second floor. A review of the clinical record revealed Resident 2 was admitted on [DATE], with diagnoses including dementia. A quarterly MDS dated [DATE], revealed the resident required staff assistance for activities of daily living and had a BIMS score of 3 (a score of 0-7 indicates severe cognitive impairment). A review of a facility investigation report dated October 26, 2025, at 4:00 PM revealed Resident 2 was seated in a chair in the east wing resident dining room next to the wheelchair weight scale, which was stored and utilized in that area. Employee 2, nurse aide, was assisting the resident to the bathroom. Resident 2 stood up from the chair as Employee 2 turned to retrieve her walker. Resident 2 tripped over the wheelchair weight scale and fell, striking her head on the glass door. Documentation revealed she sustained a 2 centimeter by 0.4 cm (centimeter) laceration 9wound caused by tearing of the skim) on the top left side of her head and a 1.8 cm by 0.2 cm laceration to her left cheek. She was sent to the hospital and received three staples and steri strips (soft adhesive wound closure strips). A review of the clinical record revealed Resident 3 was admitted on [DATE], with diagnoses including dementia. A quarterly MDS dated [DATE], revealed the resident required staff assistance for activities of daily living and had a BIMS score of 3, indicating severe cognitive impairment. A review of facility investigative documentation dated October 26, 2025, at 4:30 PM revealed Resident 3 was wandering between the east and west nursing units and was on a 15-minute observation schedule related to a previous elopement from the facility on October 11, 2025. Employee 3, nurse aide, observed Resident 3 enter the shower room located between the east and west wing units. The resident sat down on the bathtub and fell backward into the tub. A licensed nurse assessed the resident, and no injury was documented. A review of a written witness statement dated October 26, 2025, at 4:30 PM from Employee 3, nurse aide, revealed documentation indicating that the employee reported seeing Resident 3 walking in the hallway from the west unit toward the east unit and that the employee followed the resident with the intention of bringing her back to the west unit, where the resident resided. The statement documented that Resident 3 turned into the west shower room, located between the east and west nursing units, and that when the employee turned the corner into the shower room, the resident was sitting on the edge of the bathtub. The written (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395286 If continuation sheet Page 2 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395286 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broad Mountain Health and Rehabilitation Center 500 West Laurel Street Frackville, PA 17931 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some statement further documented that, as I approached her, she fell backwards into the tub, striking her head then her back on the inside of the tub. The statement noted that the resident had last been observed by the employee 15 minutes prior as part of the resident's every-15-minute monitoring. A review of the facility document titled Resident Observation/Monitoring Tool (every 15-minute watch record) dated October 26, 2025, revealed documentation that Resident 3 was recorded as ambulating and wandering in the hallway continuously from 2:15 PM through 3:30 PM, at which time the record documented that Employee 3 rendered care. The documentation further revealed that Resident 3 was recorded as continuing to wander in the hallway from 3:30 PM through 5:45 PM. A review of the facility census for October 26, 2025, for the 3:00 PM to 11:00 PM shift revealed a total census of 105 residents, with 39 residents on the second-floor west unit and 44 residents on the east unit. A review of nursing documentation revealed that during this shift there were two residents on the west unit who were placed on every-15-minute observation and one resident on the east unit who required one-to-one supervision (continuous direct visual observation by a designated staff member).A review of nursing staffing records dated October 26, 2025, revealed that one RN Supervisor was scheduled for the entire building. Documentation for the east wing showed two licensed practical nurses (LPNs) scheduled for four-hour shifts and one LPN scheduled for an eight-hour shift, along with three nurse aides scheduled for eight-hour shifts and two nurse aides scheduled for four-hour shifts for a census of 44 residents. Documentation indicated that the resident requiring one-to-one supervision required a staff member to remain with the resident continuously, rendering that employee unavailable to provide care to additional residents.A review of staffing documentation for the west unit revealed one LPN and three nurse aides scheduled for a census of 39 residents. Documentation further indicated that two residents on the west unit were on every-15-minute observation, including Resident 3, who was recorded throughout the day wandering on her unit and in other areas of the second floor. The documentation indicated that these monitoring responsibilities required dedicated staff time.A review of facility investigative documentation revealed that three resident falls occurred within one hour, between 3:30 PM and 4:30 PM, on October 26, 2025, during the 3:00 PM to 11:00 PM shift. At that time, residents on the second floor were documented as requiring safety checks, toileting, and other activities of daily living, including preparation for the evening meal. Based on review of the staffing records and monitoring assignments, the documented staffing levels did not demonstrate that sufficient personnel were available to complete these duties during this shift.During an interview on November 18, 2025, at 2:00 PM, the findings regarding staffing levels at the time of the three falls were reviewed with the Director of Nursing. No additional information was provided to indicate that staffing available during the shift exceeded the staffing levels documented in the staffing records. A review of Resident 7's clinical record revealed admission on [DATE], with diagnoses including congestive heart failure (a condition in which the heart cannot pump adequately), Type 2 diabetes (a condition affecting the body's ability to regulate blood sugar), and morbid obesity. An annual MDS dated [DATE], revealed total staff dependence for toileting, bed mobility, and transfers and a BIMS score of 15, indicating intact cognition. During an interview on November 18, 2025, at 12:45 PM, Resident 7 stated she often waited over one hour for call bell response and that she experienced incontinence and soiled bedding while waiting. She stated this occurred most often on second shift and also on third shift. A review of Resident 9's clinical record revealed the resident was admitted to the facility on [DATE], with diagnoses which included heart failure and muscle weakness.A quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed that Resident 9 was totally dependent on staff for toileting, bathing/showers, bed mobility and transfers. The resident was cognitively intact with a BIMS score of 14. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395286 If continuation sheet Page 3 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395286 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broad Mountain Health and Rehabilitation Center 500 West Laurel Street Frackville, PA 17931 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on November 18, 2025, at 3:14 PM, Resident 9 reported that his favorite activity in the facility was playing Bingo. The resident stated, I just love to play Bingo, and they don't have enough people to get me up and out of bed. So, I don't get to go. I know they're short (staffed) and I don't want to bother them. A review of the facility's shower schedule dated November 17, 2025, revealed that Resident 9 was scheduled to receive a shower during the 3:00 PM to 11:00 PM shift. Resident 9 reported during the interview on November 18, 2025, that he did not receive a shower or a bed bath the night before. A review of the shower schedule for November 17, 2025, revealed seven residents were scheduled to receive a shower during the 3:00 PM to 11:00 PM shift. A review of the shower logs revealed documentation that only one of the seven scheduled residents received a shower. The logs further revealed that four residents received bed baths instead of a shower, and two shower logs, including Resident 9's, were not completed. There was no documented evidence that any residents scheduled for showers on November 17, 2025, during the 3:00 PM to 11:00 PM shift declined a shower or preferred a bed bath. During a telephone interview on November 18, 2025, at 6:00 PM, Employee 5, reported that insufficient nurse aide staffing on the east wing resulted in delays in answering call bells, missed showers, and missed turning and repositioning schedules. Employee 5 reported that many residents on the east wing required the assistance of two staff members for toileting, bed mobility, and transfers and that two residents required one-to-one direct supervision (defined as continuous direct visual observation). Employee 5 reported that additional staff were not consistently scheduled to provide one-to-one supervision and that existing staff were expected to provide the one-to-one monitoring while also caring for the additional 42 residents on the wing. Interview with the Nursing Home Administrator (NHA) and Director of Nursing (DON) on November 18, 2025, at 10:00 AM confirmed that there were two residents on the East Wing who require 1:1 supervision 24 hours/day. Review of the facility's policy titled Resident Observation Policy last reviewed by the facility on July 2, 2025, stated that if a resident is on 1:1 monitoring, the additional staff member assigned will remain with the resident in view at all times. Should the assigned staff member need to leave the area they are responsible for to ensure the resident is directly observed during their absence by another staff member. Staff members will complete the observation/monitoring tool. Review of the nursing schedule for November 17, 2025, for the 11:00 PM-7:00AM shift revealed only two nurse aides and one LPN (Licensed Practical Nurse) were assigned to the East Wing, which had a census of 44 residents. While an RN Supervisor was on duty, she was not assigned exclusively to the East Wing. The NHA and DON stated that the RN Supervisor's workstation had been moved to the East Wing on November 17, 2025, to assist staff as needed. Review of the Resident Observation/Monitoring Tool for the two residents on 1:1 dated November 18, 2025, revealed that Employee 6 (RN Supervisor) initialed entries for both residents at 2:45 AM, 3:00 AM, 5:00 AM and 5:15 AM despite the residents not being roommates or in adjacent rooms. During an interview on November 18, 2025, at 3:50 PM the NHA and DON confirmed that both residents could not have been continuously observed at the same time by Employee 6. A review of nursing time schedules, resident census data, and staff interview information revealed that the facility did not meet minimum nurse aide staffing ratios on five of fourteen reviewed dates (October 24, October 25, October 26, October 28, and November 17, 2025). A review of census records and staffing schedules revealed the number of nurse aides scheduled on those dates was below the minimum required ratios for the applicable shifts, and there was no documentation that additional higher-level staff were available to compensate. During an interview with the Nursing Home Administrator (NHA) on November 18, 2025, at 3:45 PM, the findings regarding nurse aide staffing ratios were reviewed, and no additional information was provided to demonstrate that required staffing levels were met.A review (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395286 If continuation sheet Page 4 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395286 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broad Mountain Health and Rehabilitation Center 500 West Laurel Street Frackville, PA 17931 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete of nursing schedules, resident census data, and staff interview information revealed that the facility did not meet the minimum licensed practical nurse (LPN) staffing ratios on five of fourteen reviewed dates (October 25, November 12, November 15, November 16, and November 17, 2025). A review of staffing schedules revealed that the number of LPNs scheduled on those dates was below the minimum required ratios for the applicable shifts, and there was no documentation that additional higher-level staff were available to compensate. During an interview with the NHA on November 18, 2025, at 3:45 PM, the findings regarding LPN staffing ratios were reviewed, and no additional information was provided to demonstrate that required staffing levels were met.A review of nursing staffing documentation, resident census data, and staff interview information revealed that the facility did not consistently provide the minimum 3.2 hours of general nursing care per resident per day as required under Pennsylvania state licensure regulations. A review of the facility's weekly staffing records revealed general nursing care hours below the required 3.2 hours on October 25, October 26, October 28, and October 30, 2025. During an interview with the NHA on November 18, 2025, at 3:45 PM, the findings regarding general nursing hours were reviewed, and no additional information was provided to demonstrate that the required hours were met. A review of clinical records, staffing schedules, census data, and interview information revealed the facility did not ensure sufficient nursing staff, based on actual resident census and acuity (the level of care and supervision required), to provide necessary services and supervision, and staffing documentation showed state minimum staffing ratios and required nursing hours per resident per day were not met on multiple reviewed dates. 28 Pa. Code 211.12 (c)(d)(1)(3)(4)(5) Nursing services 28 Pa. Code 201.18(b)(1)(e)(1)(2)(3)(6) Management Event ID: Facility ID: 395286 If continuation sheet Page 5 of 5