Inspection·November 3, 2023

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident 28, and Resident 41 were their respective beds and unable to reach or access their call bells. The call bells for all three residents were observed on the floor. Observation on November 1, 2023, at 9:15 AM in resident room [ROOM NUMBER] revealed Resident 22 and Resident 61 in their respective beds and unable to reach or access their call bells. The call bells for both residents were observed on the floor. During an observation of resident rooms [ROOM NUMBERS] on November 1, 2023 at 9:30 AM, Employee 1 (licensed practicing nurse) confirmed that Residents 22, 25, 28, 41, and 61 were unable to access their call bells and unable to notify staff if they needed assistance. Employee 1 was observed removing the call bells from the floor and placing the device within reach of each resident following surveyor inquiry. An interview with the Nursing Home Administrator on November 3, 2023, at approximately 10:30 AM verified that call bells are to be placed within reach of each resident at all times. 28 Pa. Code 211.12 (d)(5) Nursing Services 28 Pa. Code 201.29 (a) Resident Rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395288 If continuation sheet Page 2 of 17 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 395288 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sapphire Care and Rehab Center 221 East Brown Street East Stroudsburg, PA 18301 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. Based on clinical record review and staff interview, it was determined that the facility failed to include the resident's discharge planning in the comprehensive care plan of one resident out of five reviewed (Resident 71). Findings include: A review of the clinical record revealed Resident 71 was admitted to the facility May 12, 2023, with a diagnosis to include hemiplegia (paralysis of one side of the body) and hemiparesis (weakness on one side of the body) following a cerebral infarction (stroke). Review of the quarterly Minimum Data Set assessment (MDS-a federally mandated standardized assessment process conducted at specific intervals to plan resident care) dated October 23, 2023, revealed that the resident was moderately cognitively impaired with a BIMS score of 10 (Brief Interview for Mental Status - a tool to assess cognitive function. A score of 8-12 indicates moderate cognitive impairment). According to the MDS assessment, Section Q: Resident's Overall Goal: the resident expects to remain in this facility as per information provided by her family. A review of Resident 71's comprehensive care plan conducted on October 31, 2023, revealed that the resident's current care plan did not address a discharge plan for the resident to remain in the facility for long term placement. Interview with the Nursing Home Administrator on November 2, 2023, at approximately 1:30 PM, confirmed the absence of discharge planning on Resident 71's care plan. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395288 If continuation sheet Page 3 of 17 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 395288 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sapphire Care and Rehab Center 221 East Brown Street East Stroudsburg, PA 18301 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 - Some 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 clinical record review and resident and staff interviews, it was determined that the facility failed to consistently provide services planned to maintain mobility/range of motion for one of three sampled residents for mobility/range of motion (Resident 8). Findings include: A review of Resident 8's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses to include fracture of the right acetabulum (hipbone socket), right pubis (pelvis) and sacrum (triangular bone in lower back between the two hipbones), muscle weakness, history of falls and abnormality of gait and mobility. Resident 8 was discharged from Physical Therapy on August 24, 2023. Discharge recommendations indicated that Resident 8 was to receive a Restorative Nursing Program (RNP) to walk daily, up to 100 feet using a two-wheeled walker and contact guard assistance (staff provide touch assistance), for 15 minutes. A physician order dated August 24, 2023, was noted for an RNP: Ambulate up to 100 feet with RW (rolling walker), contact guard assist, for 15 minutes daily. Review of facility document titled Documentation Survey Report v2 (general care nursing tasks completed for the resident) dated September 2023, revealed that the RNP for ambulation was not provided on 13 days out of the ordered 30 days in the month with staff documenting NA (not applicable) as the response reason. Continued review of facility document titled Documentation Survey Report v2 dated October 2023, revealed that the RNP for ambulation was not provided on 20 days out of the ordered 31 days in the month with staff documenting NA as a response reason. During an interview with Resident 8 on October 31, 2023, at 12:30 PM the resident stated that nursing staff do not provide her restorative nursing services for ambulation. The resident stated, They don't walk me! Interview with the Nursing Home Administrator (NHA) on November 2, 2023, at approximately 1:25 PM, verified that NA is not an appropriate response to document in the Documentation Survey Report v2. The NHA confirmed that the facility failed to consistently implement the ordered restorative nursing program for Resident 8 to maintain functional ability and deter decline. 28 Pa. Code: 211.5(f) Medical records 28 Pa Code 211.12(c)(d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395288 If continuation sheet Page 4 of 17 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 395288 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sapphire Care and Rehab Center 221 East Brown Street East Stroudsburg, PA 18301 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to monitor a resident's nutritional parameter and nutrional intake to timely implement nutritional support intervention to improve intake and prevent weight loss for two residents out of five sampled for weight loss (Resident 2 and 73). Residents Affected - Some Findings include: A review of a facility policy Weight Assessment and Intervention last reviewed by the facility October 2023, indicated that the multidisciplinary team would strive to prevent, monitor, and intervene for undesirable weight loss for the facility's residents. Any weight change of five-pounds or more since the last weight assessment will be retaken for confirmation and if a change of five-pounds or more was confirmed that nursing would notify the Physician and Dietitian. The dietitian and/or Certified Dietary Manager (CDM) would review the individuals weight record to follow trends over time, make recommendations as appropriate, and negative trends would be evaluated for on whether or not the criteria for significant weight change had been met (one month - 5% weight loss significant, three months - 7.5% weight loss significant, and six months - 10% weight loss significant). Interventions for undesirable weight loss may be considered as follows: resident choice or preferences, nutrition/hydration needs of the resident, functional factors that may inhibit independent feeding, environmental factors that may inhibit appetite or desire to participate in meals, chewing and/or swallowing abnormalities, medications that may interfere with appetite, the use of supplementation and/or feeding tubes, and end of life decision and advanced directives. A review of Resident 2's clinical record revealed that he was initially admitted to the facility on [DATE], with diagnoses that included type 2 diabetes, major recurrent depression, anxiety, and malignant neoplasm [(cancer) a disease resulting from uncontrolled growth and division of abnormal cells] of the upper left lobe of the lung. The resident's comprehensive plan of care initiated May 11, 2016, and last revised on July 6, 2022, identified that the resident was at nutrition risk related to history of significant weight loss with a goal to maintain a healthy weight gain through next review. Planned interventions were to monitor the resident's meal intakes and document percent consumed. The care plan noted that the resident refused supplements and extra food, and staff were to educate the resident on the importance of eating/drinking fluids to stabilize weight, staff to encourage resident at meals, and monitor weights. A review of Resident 2's weight record revealed that on May 5, 2023, at 9:05 AM, he weighed 120-pounds, and then on June 1, 2023, at 10:43 AM, he weighed 111-pounds, revealing a significant weight loss of 9-pounds or 7.5% in thirty days. A reweight was not obtained for validation of a significant weight change as indicated in the facility's Weight Assessment and Intervention policy. A dietary note completed by the Registered Dietitian (RD) on June 15, 2023, 10-days after the initial significant weight loss was identified, at 6:51 PM, revealed that the resident had a significant weight loss of greater than 5% and recommended fortified foods to promote calorie intake and to monitor weekly. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395288 If continuation sheet Page 5 of 17 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 395288 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sapphire Care and Rehab Center 221 East Brown Street East Stroudsburg, PA 18301 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident 2's diet order summary from his initial admission and through survey ending November 3, 2023, failed to reveal that the recommended fortified foods were provided as planned to deter further weight loss on June 15, 2023. The next RD progress note was not completed until August 1, 2023, at 9:55 AM, which identified that Resident 2's weight had now decreased to 94-pounds and was another significant weight loss of 19-pounds or 16.8% in 30-days. A re-weight that was completed on August 2, 2023, at 5:06 PM, at 94-pounds and confirmed that Resident 2 had further progressive significant weight loss since his initial significant weight loss on June 1, 2023. The facility failed to timely implement a planned weight loss intervention (fortified foods) and failed to monitor the resident weekly to timely identify and address weight changes. There was no documented evidence that the resident's attending physician was notified of the resident's significant weight losses. An interview with the Nursing Home Administrator (NHA) on November 2, 2023, at 1:25 PM, confirmed that the facility failed to timely implement interventions to to prevent further weight loss and monitoring of the resident weekly. The NHA also confirmed that the resident's attending physician was not notified of the resident's weight loss. A review of Resident 73's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses that included facial weakness following a nontraumatic subarachnoid hemorrhage [is bleeding within the subarachnoid space, which is the area between the brain and the tissue covering the brain that causes sudden, severe headache, nausea, vomiting and loss of consciousness], dysphagia (difficulty swallowing), and cognitive communication deficit [acquired cognitive-communication deficits may occur after a stroke, tumor, brain injury, progressive degenerative brain disorder, or other neurological damage that results in difficulty with thinking and how someone uses language]. Resident 73's weight record revealed that on July 4, 2023, her weight was 164-pounds, and then on August 4, 2023, she weighed 150-pounds (no re-weight). The resident had a significant weight loss of 14-pounds or 8.5% weight loss in 30-days. A review of a progress note initiated by the RD on August 10, 2023, and then signed by the RD on August 14, 2023, 10 days after the resident's weight loss, indicated that the resident had a significant weight loss and requested orders from the physician for a house supplement twice per day. A review of Resident 73's Medication Administration Record (MAR) dated August 2023, revealed that the recommended house supplement was not implemented until August 18, 2023. According to the MAR staff would monitor weekly weights. The facility failed to timely identify and assess Resident 73's significant weight loss and failed to timely implement weight loss prevention interventions. Resident 73's weight record revealed that on August 30, 2023, the resident weighed 138.6-pounds, and then on September 1, 2023, she weighed 150-pounds. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395288 If continuation sheet Page 6 of 17 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 395288 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sapphire Care and Rehab Center 221 East Brown Street East Stroudsburg, PA 18301 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On September 11, 2023, 12:10 PM, the resident weighed 138-pounds, and a reweight on September 12, 2023, at 12:33 PM, her weight was 138-pounds and confirmed a further significant weight loss of 12-pounds in 12 days and 9.1% significant weight loss in 30 days. A weekly weight was not obtained for two weeks, October 2, 2023, as indicated in the RD's planned weight monitoring. There was no documented evidence that the Resident 73's progressive weight loss was timely assessed by the RD and no documented evidence that additional interventions to stabilize her weight were timely implemented. There was no documented evidence that her attending physician was notified of the progressive significant weight loss. Interview with the NHA on November 2, 2023, at 1:35 PM, confirmed that the facility failed to timely address resident's significant weight loss to prevent further decline in nutritional parameters. 28 Pa. Code: 211.12 (c)(d)(1)(3)(5) Nursing services 28 Pa. Code 211.5(f) Clinical records FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395288 If continuation sheet Page 7 of 17 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 395288 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sapphire Care and Rehab Center 221 East Brown Street East Stroudsburg, PA 18301 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 0745 Provide medically-related social services to help each resident achieve the highest possible quality of life. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a clinical record review and resident and staff interviews it was determined that the facility failed to provide medically related therapeutic social services to promote the emotional and psychosocial well-being of one of 18 residents sampled (Resident 16). Residents Affected - Few Findings include: According to regulatory guidance under §483.40(d) Medically-related social services means services provided by the facility's staff to assist residents in attaining or maintaining their mental and psychosocial health, which include providing or arranging for needed mental and psychosocial counseling services and identifying and promoting individualized, non-pharmacological approaches to care that meet the mental and psychosocial needs of each resident. A clinical record review revealed that Resident 16 was admitted to the facility on [DATE], with diagnoses to include major depressive disorder (a mental health disorder that is characterized by a depressed mood, diminished interests, and impaired cognitive function) and generalized anxiety disorder (a mental health disorder that produces fear, worry, and a constant feeling of being overwhelmed). A review of the quarterly Minimum Data Set Assessment (MDS - a federally mandated standardized assessment process conducted periodically to plan resident care) dated [DATE], revealed that Resident 16 is cognitively intact with a BIMS score of 15 (Brief Interview for Mental Status- a tool to assess cognitive function; a score of 13-15 indicates cognition is intact). Resident 16's current plan of care revealed that the resident had problems with feelings of sadness, emptiness, and anxiety. The resident's care plan did not include interventions for staff to implement when the resident was experiencing signs of depression and anxiety. During an interview on [DATE], at 11:50 AM, Resident 16 stated she has been struggling with anxiety, depression, and grief after losing her husband earlier this year. Resident 16 stated that she becomes overwhelmed some days and believes that she would benefit from additional support for her mental health and well-being. A clinical record review revealed that Resident 16 has been receiving external behavioral health services. A behavioral health services provider note dated [DATE], indicated that the resident would benefit from pharmacological and non-pharmacological interventions, including the continual offering of support and redirection as needed. Behavioral health services provider notes dated [DATE], and [DATE] indicated non-pharmacological interventions that would benefit Resident 16, including exercise, practicing healthy breathing, and practicing mindfulness (a coping strategy that aims to reduce emotional distress by intentionally focusing on present experiences). A nursing progress note dated [DATE], at 6:47 AM indicated that Resident 16 had episodes of crying and shouting names at staff throughout the shift. The documentation review failed to reveal evidence that any supportive therapeutic social service interventions were implemented to assist the resident with her emotional distress. A nursing progress note dated [DATE], at 10:26 PM indicated that the resident had been crying (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395288 If continuation sheet Page 8 of 17 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 395288 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sapphire Care and Rehab Center 221 East Brown Street East Stroudsburg, PA 18301 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 0745 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few several times during the shift and was observed asking her deceased husband to get her out of the facility. The entry noted that Resident 16 was crying at her bedside and clapping her hands together. According to the entry the certified registered nurse practitioner spent time talking with the resident, but the resident continued to cry and act out following the CRNP visit. There was no evidence of any further supportive social service interventions implemented to assist the resident with her emotional distress and coping with her grief. A nursing progress note dated [DATE], at 3:01 PM indicated that the resident was crying out while in and out of bed. There was no documented evidence of the provision of supportive psychosocial interventions to assist the resident with her emotional distress. A nursing progress note dated [DATE], at 11:53 PM indicated that the resident seemed frustrated with one of the nursing aides. The entry explained that Resident 16 had several crying episodes. There was no documented evidence of the provision of therapeutic social services to assist the resident in coping with her frustration and tearfulness. A nursing progress behavioral note dated [DATE], at 1:55 PM indicated that Resident 16 punched herself in the head and was crying because she thought her son was going to leave while she was using the restroom. There was no documented evidence of the provision of supportive measures in response to the resident's expressions of distress and self-harm. A nursing progress note dated [DATE], at 3:47 PM indicated that the resident cried, yelled, and screamed because she was unable to transfer without assistance. There was no documented evidence of the support services provided to the resident in response to her episode of frustration with her inability to self-transfer. During an interview on [DATE], at approximately 9:30 AM, the Nursing Home Administrator was unable to provide evidence that the facility provided, or secured the necessary social services to assist this resident in dealing with the expressions and indications of distress, difficulty coping with her loss and need for emotional support. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395288 If continuation sheet Page 9 of 17 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 395288 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sapphire Care and Rehab Center 221 East Brown Street East Stroudsburg, PA 18301 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records, controlled medication records, and select facility policy, and a staff interview, it was determined that the facility failed to implement procedures to ensure the accuracy of controlled medication records for one resident out of three residents (Resident 80). Findings Include: A review of facility policy titled Disposal of Medication and Medication-Related Supplies dated July 1, 2023 indicated that it is the facility's policy that all medications included in the Drug Enforcement Administration's (DEA) classification as controlled substances are subject to special handling, storage, disposal, and recordkeeping in the facility in accordance with federal and state laws and regulations. The policy indicated that licensed healthcare professionals witnessing the destruction ensure that the following information is entered on the individual controlled substance record: date of destruction, resident ' s name, name and strength of medication, prescription number, amount of medication destroyed, and signatures of two witnesses. A clinical record review revealed that Resident 80 was admitted to the facility on [DATE], with diagnoses to include metabolic encephalopathy (a conditioned characterized by disturbances in brain function), chronic obstructive pulmonary disease, and acute kidney failure. Resident 80 had a physician order for morphine sulfate (concentrate) oral solution (20 mg/ml) give 0.25 ml by mouth every 3 hours as needed for shortness of breath or pain initiated on September 21, 2023, at 3:30 PM. This order was discontinued on September 25, 2023, at 10:27 AM and morphine sulfate (concentrate) oral solution (20 mg/ml) give 0.5 ml by mouth every 3 hours as needed for shortness of breath or pain was then initiated on September 25, 2023, at 10:34 AM. A review of Resident 80's medication administration record (MAR) dated September 2023 revealed that morphine sulfate 0.25 ml was administered only once that month, on September 25, 2023, at 8:03 AM. However, a review of the medication administration record revealed no evidence that the morphine sulfate 0.5 ml was administered to Resident 80 during September 2023, after the order was changed on September 25, 2023, ad 10:34 AM. A review of Resident 80's controlled substance records revealed only one controlled substance record for morphine sulfate. The controlled substance record indicated that 0.5 ml of morphine sulfate was removed on September 25, 2023, at 8:00 AM. The amount removed (0.5 ml) did not match the amount administered, as indicated in Resident 80's medication administration record on that date and time (.25 ml). Resident 80 passed away at the facility on September 26, 2023, at 6:24 AM. Resident 80's controlled substance record for morphine sulfate indicated that 29.50 ml of the original 30.0 ml of the medication was disposed of on September 26, 2023. The disposition record failed to include a method of destruction for the morphine sulfate. The controlled substance record was observed with handwritten changes to the medication order without a signature authorizing the changes to the resident's medication order. Directions for the administration (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395288 If continuation sheet Page 10 of 17 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 395288 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sapphire Care and Rehab Center 221 East Brown Street East Stroudsburg, PA 18301 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 of 0.25 ml of morphine sulfate to be given by mouth every 3 hours as needed for pain or shortness of breath was changed to 0.5 ml of morphine sulfate to be given by mouth every 3 hours as needed for pain or shortness of breath. During an interview on November 2, 2023, at approximately 1:00 PM, the Director of Nursing (DON) confirmed that Resident 80's controlled substance record for morphine sulfate did not indicate the method of destruction for the controlled medication. The DON confirmed that handwritten changes on the morphine sulfate medication label without an authorized signature was not an acceptable standard of practice for an order change. The DON confirmed that Resident 80's medication administration record for September 2023 did not match the controlled substance record for the amount of morphine sulfate documented as administered. The DON was unable to provide evidence that the facility implemented established procedures to promote accurate accounting, administration and accountability of disposition of morphine sulfate medication prescribed for Resident 80. 28 Pa Code 211.5(f) Medical records 28 Pa Code 211.9 (a)(1)(j.1)(3)(5) Pharmacy services 28 Pa Code 211.12 (c)(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395288 If continuation sheet Page 11 of 17 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 395288 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sapphire Care and Rehab Center 221 East Brown Street East Stroudsburg, PA 18301 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records and staff interview, it was determined that the physician failed to act upon pharmacist identified irregularities in the medication regimen of one out of 19 sampled residents (Resident 5). Findings include: A review of Resident 5's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses that included dementia, major depressive disorder, and anxiety. Physician orders dated January 14, 2020, were noted for mirtazapine [(Remeron) used to treat depression, also used as an appetite stimulant] give 7.5 mg by mouth at bedtime related to major depression. A physician order's dated January 14, 2023, was noted for Sertraline HCl [(Zoloft) an antidepressant used to treat depression, panic attacks, obsessive compulsive disorder, post-traumatic stress disorder, social anxiety disorder (social phobia), and a severe form of premenstrual syndrome (premenstrual dysphoric disorder)] 25 mg tablet, give 1 tablet by mouth one time a day related to major recurrent depressive disorder. A review of a Pharmacy Review conducted by the facility's consultant pharmacist revealed that on January 17, 2023, the pharmacist recommended that Resident 5's attending physician attempt a gradual dose reduction (GDR) of Zoloft due to this medication within the psychoactive category (without regard to indication) fall under dose reduction guidelines. This includes agents within the antidepressant category and requested for the physician to address and provide an appropriate response to clinically justify the continuation of the medication at the current dosage. There was no provide documented evidence at the time of the survey ending November 3, 2023, that Resident 5's attending physician acted upon the consultant pharmacist's recommendation for a GDR on Zoloft and documented clinical justification for the continuation of the medication at the dosage ordered. A review of a Pharmacy Review conducted by the facility's consultant pharmacist revealed that on April 18, 2023, the pharmacist recommended that Resident 5's attending physician attempt a GDR on mirtazapine (Remeron) 5.5 mg at HS (bedtime) due to this medication within the psychoactive category (without regard to indication) fall under dose reduction guidelines. This includes agents within the antidepressant category and requested for the physician to address and provide an appropriate response to clinically justify the continuation of the medication at the current dosage. There was no documented evidence at the time of the survey ending November 3, 2023, that the physician acted upon the pharmacist's recommendation for a GDR on Remeron and documented clinical justification for the continuation of the medication at the dosage ordered. In an interview with the Director of Nursing (DON), on November 2, 2023, at approximately 1:45 PM, confirmed that Resident 5's attending physician had not responded to the consultant pharmacist's recommendation for GDRs for antidepressants. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395288 If continuation sheet Page 12 of 17 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 395288 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sapphire Care and Rehab Center 221 East Brown Street East Stroudsburg, PA 18301 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 28 Pa. Code 211.9 (k) Pharmacy services. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12 (c) Nursing services. 28 Pa. Code 211.2 (d)(3) Medical Director Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395288 If continuation sheet Page 13 of 17 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 395288 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sapphire Care and Rehab Center 221 East Brown Street East Stroudsburg, PA 18301 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Based on clinical record review and staff interviews, it was determined that the facility failed to ensure the presence of physician documentation of the clinical rationale for the continued administration of duplicate antidepressant drug therapy for one resident out of 19 sampled residents (Resident 5). Findings include: A review Resident 5's physician's orders dated January 14, 2020, revealed an order for mirtazapine [(Remeron) is an antidepressant] give 7.5 mg by mouth at bedtime related to major depression and for Sertraline HCl [(Zoloft) an antidepressant used to treat depression, panic attacks, obsessive compulsive disorder, post-traumatic stress disorder, social anxiety disorder (social phobia), and a severe form of premenstrual syndrome (premenstrual dysphoric disorder)] 25 mg tablet, give 1 tablet by mouth one time a day related to major recurrent depressive disorder. A review of the resident's Medication Administration Record (MAR) for the months December 2022, January 2023, February 2023, March 2023, April 2023, May 2023, June 2023, and July 2023, revealed that the resident consistently received duplicate drug therapy for depression. A review of a Pharmacy Review conducted by the facility's consultant pharmacist on January 17, 2023, revealed that the consultant pharmacist identified dual antidepressant therapy and recommended a gradual dose (GDR) reduction on Zoloft. Resident 5's attending physician failed to respond to the January 17, 2023, pharmacy review and failed to provide documentation to support the continued use of dual antidepressant therapy. On April 18, 2023, the pharmacist identified irregularities in the physician's orders for Remeron 7.5 mg give one tab by mouth at bedtime for antidepressant and recommended to attempt a GDR and/or indicate an appropriate response to justify the use of the antidepressants. Resident 5's attending physician failed to respond to the April 18, 2023, pharmacy review and failed to provide documentation to support the continued use of dual antidepressant therapy. A review of the resident's Medication Administration Record (MAR) for the months January 2023, February 2023, March 2023, April 2023, May 2023, June 2023, July 2023, August 2023, September 2023, October 2023, and through survey ending November 3, 2023, revealed that the resident continued to receive the same dosages of dual antidepressant therapy. Resident 5's clinical record failed to reveal that the attending physician provided an acceptable clinical justification for the continued use of duplicate antidepressant drug therapy. In an interview with the Director of Nursing (SON), on November 2, 2023, at approximately 1:45 PM, confirmed that the facility failed to ensure that Resident 5's attending physicians provided clinical justification/rationale for the continued administration of duplicate antidepressant drug therapy. 28 Pa. Code 211.9 (k) Pharmacy services. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395288 If continuation sheet Page 14 of 17 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 395288 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sapphire Care and Rehab Center 221 East Brown Street East Stroudsburg, PA 18301 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 0758 28 Pa. Code 211.12 (c) Nursing services. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.2 (d)(3) Medical Director 28 Pa. Code 211.5(f) Medical records Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395288 If continuation sheet Page 15 of 17 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 395288 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sapphire Care and Rehab Center 221 East Brown Street East Stroudsburg, PA 18301 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 the facility's infection control tracking logs and infection control and prevention policy and staff interviews it was determined that the facility failed to maintain a comprehensive program to monitor the development and spread of infections within the facility and plan preventative measures accordingly. Residents Affected - Many Findings include: A review of the current facility policy for Infection Control Program Overview, dated as reviewed by the facility October 24, 2022, revealed that The facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. A review of the facility's infection control data conducted during the survey ending November 3, 2023, revealed that the facility's infection control tracking did not reflect evidence of a functional tracking system to monitor and investigate causes of infection and manner of spread. There was no documented evidence of a system, which enabled the facility to analyze clusters, changes in prevalent organisms, or increases in the rate of infection in a timely manner. A review of infection control data revealed the following infections were tracked as noted: January 2023: 1-:MRSA (methicillin resistant staph aurous, antibiotic resistant infection) there was no site of the infection noted on the data form, 3- urinary tract infection, 2- lung infections February 2023: 6 urinary tract infections, 3- leg: infections, 1- mouth infection, 2 ear infections, 1 throat infection and 2 lung infections March 2023: 6 Urinary tract infections, 3 Respiratory, 2 skin, 1 sepsis, 2 other infections and 1 gastroinfections April 2023: 6-urinary tract infection, 2- respiratory, 1 tooth and 4-skin and 1 sepsis infections May 2023: 3-skin infections, 2-sepsis infections, 3-urinary tract infections and 1-knee/UTI, and 3 resistor infections. June 2023: 5 Urinary tract infections, 2 tooth infections, 1 mouth infection, 4 Respiratory, 2 skin, 1 right elbow, 1 shoulder infection, 1 left lower extremity and 2 pneumonia infections July 2023: 7-urinary tract infection, 1- pneumonia, 1 tooth and 1-wound and 1 GI gastro intestinal infection and 1 skin infection. August 2023: 3-skin infections, 1-GI infections, 6-urinary tract infections and 3 respiratory infections. September 2023: 3-skin infections, 2-pneumonia infections, 3-urinary tract infections, 1 ear infections and 1 left foot infection. October 2023: 1-ear infections, 1-lower respiratory infections and 1 hemoptysis(Hemoptysis or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395288 If continuation sheet Page 16 of 17 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 395288 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sapphire Care and Rehab Center 221 East Brown Street East Stroudsburg, PA 18301 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 haemoptysis is the discharge of blood or blood-stained mucus through the mouth coming from the bronchi, larynx, trachea, or lungs) infection. Clinical record revealed Resident 17 was admitted to the facility August 19, 2013, with diagnosis to include diabetes. Residents Affected - Many A physician order dated February 21, 2023, was noted for Nystatin (an antifungal medication) Powder, to apply to under the resident's left breast topically daily, every shift for redness, discontinue when resolved. A review of medication administration records (MAR) dated February 2023 through September 4, 2023, revealed that the antifungal medicated powder was administered daily as ordered. A physician order dated October 9, 2023, was noted for Nystop (Nystatin) 100000 UNIT/GM Powder, apply to both breasts topically every 8 hours as needed for redness. A review of the resident's October 2023 MAR revealed that the antifungal powder was administered to Resident 17 on October 9, 2023 at 4:50 P.M. There was no documented evidence at the time of the survey that Resident 17's fungal infection was noted on the facility's facility infection control logs from February 2023 through the time of the survey ending November 3, 2023. The facility's infection control log revealed no documented evidence of detailed data collection that could be used by the facility to track these infections and to identify any potential trends contained in the tracking data. The data did not include resident room location, the infectious organism or treatment. There was no documented evidence at the time of the survey that based on the available tracking data that the facility had identified any possible trends in order to implement specific interventions to prevent the spread of any of the infections. There was no documentation by the facility of the any of the infection start dates, resolution date, symptoms, complete culture information for any of the infections noted in the facility's monthly infection control tracking logs and the treatments required, if any. It could not be determined if any of the noted infections required isolation protocols to be implemented. There was no indication that the limited data that was compiled was then evaluated to determine what could be done to prevent the spread or recurrence of infection. During an interview conducted on November 2, 2023, at approximately 1 PM the infection control Preventionist confirmed that the infection control tracking was incomplete and failed to include the necessary details to conduct routine, ongoing, and systematic collection, analysis, interpretation, and dissemination of surveillance data to identify infections (i.e., HAI and community-acquired), infection risks, communicable disease outbreaks, and to maintain or improve resident health status and to track staff for adherence to infection control policies and procedures and the potential need to for corrective action. 28 Pa Code 211.12 (c) Nursing services 28 Pa. Code 211.10 (a)(d) Resident care policies FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395288 If continuation sheet Page 17 of 17