Health inspection·July 3, 2025

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on review of facility documents and clinical records, observations, and staff interview, it was determined that the facility failed to ensure cleanliness and help prevent the spread of infection regarding respiratory care equipment for one of 29 residents reviewed (Resident R27). Residents Affected - Few Findings include: A facility document entitled Third Shift Task List indicated that on Tuesdays staff are to clean PAP (positive airway pressure) tubing, humidifier chamber, and nasal pillows (two soft pillows to deliver airflow directly into the nostrils) /mask- wash with mild non-antibacterial soap and rinse with warm water; allow to dry; rinse foam filter with water and allow to dry. Resident R27's clinical record revealed an admission date of 4/01/25, with diagnoses that included obstructive sleep apnea (common sleep disorder where breathing repeatedly stops and starts during sleep due to a blockage in the upper airway), and chronic obstructive pulmonary disease (COPD- lung condition caused by damage to the lungs resulting in restricted airflow and breathing problems). Resident R27's clinical record included a physician's order date 4/10/25, resident may wear home BiPAP (Bi-level positive airway pressure machine that can generate two adjustable pressure levels) as currently set up via nasal pillows daily at bedtime. Resident R27's Medication Administration Records revealed he/she had received the BiPAP every night since admission. The clinical record lacked evidence that the BiPAP machine and equipment had been cleaned by staff. Observations on 6/30/25, at 1:20 p.m. 7/01/25, at 10:01 a.m. revealed a BiPAP machine on Resident R27's nightstand. During an interview on 6/30/25, at 1:20 p.m. Resident R27 confirmed that he/she uses the BiPAP every night at bedtime. During an interview on 7/03/25, at 11:00 a.m. the Director of Nursing (DON) confirmed staff fill out the Third Shift Task List and he/she was not sure where they were kept. The DON confirmed the facility was unable to provide evidence of documentation for cleaning and care of the BiPAP equipment. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 211.5(f)(x) Medical records 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395292 If continuation sheet Page 2 of 3 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 395292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wesbury United Methodist Commu 31 North Park Ave Ext Meadville, PA 16335 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observations, and staff interviews, it was determined that the facility failed to ensure that medications subject to abuse were stored in separately locked, permanently affixed compartment in one of three medication refrigerators observed (Village Center). Findings include: Observation on 7/01/25, at 10:21 a.m. revealed a locked refrigerator in the Village Center medication room that contained a locked clear plastic box intended to safely secure controlled medications that contained a 30 mL multi-dose bottle of lorazepam (anti-anxiety medication subject to abuse). The clear plastic box was affixed to the removable shelving and the shelving was not permanently affixed to the refrigerator. At the time of the observation Licensed Practical Nurse Employees E1 and E2 confirmed that the shelf containing the secured locked box was removable from the refrigerator and therefore not pemanently affixed. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395292 If continuation sheet Page 3 of 3