Inspection·April 2, 2025

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few record in the Pennsylvania Sexual Offender Registry (the Pennsylvania Sex Offender Registry, established under Megan's Law, is a public database managed by the Pennsylvania State Police that lists individuals convicted of certain sexual offenses, with the aim of protecting communities by making this information accessible). The document indicated Resident CR1 has a sexual offense conviction for involuntary deviate sexual intercourse (involuntary deviate sexual intercourse in Pennsylvania law involves engaging in oral, anal, or object penetration with another person without their voluntary consent due to force, threat of force, unconsciousness, unawareness, impairment by drugs or alcohol, mental disability, or the age difference in certain non-marital situations) on May 12, 2006. The care plan for Resident CR1, initiated on August 8, 2023, identified a focus area that the resident was a registered sex offender. The goal was for the resident to display no evidence of sexual advances toward staff or visitors. Interventions implemented to support this goal included providing non-judgmental support, offering psychological or psychiatric services as needed, and ensuring that no staff or visitors under the age of 18 entered Resident CR1's room unless accompanied by an adult. Additionally, the care plan dated August 8, 2023, identified that Resident CR1 exhibited inappropriate sexual behaviors toward staff and residents, including exposing his genitals in public areas and masturbating in hallways. The goal was for the resident to display no evidence of behavior problems through the next review period. Interventions in place to assist the resident in meeting this goal included 1:1 supervision while awake, 15-minute safety checks while asleep, staff using calm approaches, redirecting and distracting the resident during behavioral episodes, providing non-judgmental support, and documenting all episodes of inappropriate behavior. A review of a quarterly MDS assessment dated [DATE], revealed that Resident CR1 is cognitively intact with a BIMS score of 13 (a score of 13-15 indicates cognition is intact). A progress note dated January 27, 2025, at 5:43 AM, revealed Resident CR1 to remain on 1:1 watch while awake and out of bed and 15-minute checks when the resident is in bed sleeping secondary to allegations of inappropriate touching of another resident on January 17, 2025. A progress note dated February 22, 2025, at 9:27 PM revealed Resident CR1 was noted by staff earlier today to be masturbating while out of bed in the room doorway within direct view of staff and other residents. The resident was redirected and informed that the behavior was unacceptable. The note indicated that these behaviors continued for a few minutes as staff walked across the hall to dispose of trash or get soiled laundry in proper receptacles. Documentation showed that on February 22, 2025, at 9:27 PM Resident CR1 was observed earlier masturbating in the doorway of his room, while out of bed, which is across the hall from Resident 2's room, visible to staff and other residents. This behavior persisted for a few minutes, despite redirection as staff walked across the hall to dispose of trash or get soiled laundry in proper receptacles. A progress note dated February 23, 2025, at 1:06 PM revealed Employee 2, social services director, was made aware Resident CR1 was seen masturbating in the hall. The note indicated Employee 2, the social services director, explained to Resident CR1 the behavior is not acceptable in the hall. Employee 2 explained that Resident CR1 would need to masturbate in the privacy of his room. Resident CR1's care plan was updated to include offering resident redirection to room for self-sexual gratification with privacy sign in place initiated on February 27, 2025. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395298 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 395298 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakewood Rehabilitation & Healthcare Center 147 Old Newport Street Nanticoke, PA 18634 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A progress note dated March 17, 2025, at 5:59 PM indicated Resident CR1 was discharged into the custody of his parole officer. During an interview on April 2, 2025, at 10:05 AM, Employee 2, the social services director, indicated she met with Resident CR1 on February 23, 2025, to provide education regarding his inappropriate behaviors, such as exposing himself and masturbating. Employee 2, the social services director, indicated she was unaware of any other residents who were involved in the incident that occurred on February 22, 2025. During an interview on April 2, 2025, at approximately 2:24 PM, Employee 1, Licensed Practical Nurse (LPN), indicated Resident CR1was standing in his bedroom doorway masturbating on February 22, 2025. Employee 1, LPN, recalled another staff member yelling, Pick your pants up. However, Employee 1 was not able to remember the other staff member's name. She explained Resident CR1 masturbated while looking at Resident 2 in her bedroom. Employee 1, LPN, indicated she redirected Resident CR1 from his doorway into his room and told him that behavior is not acceptable. Employee 1, LPN, indicated Resident 2 was unable to describe the event due to her cognitive status. During the interview on April 2, 2025, Employee 1, LPN, indicated she reported that Resident CR1 was masturbating in view of other residents in report and documented the information in Resident CR1's clinical record. Employee 1, LPN, explained the facility never asked her for more information regarding the incident. Employee 1, LPN, indicated that she believed the Nursing Home Administrator (NHA) was informed about the incident but did not indicate that she personally informed the NHA. A review of the facility floor plan revealed Resident CR1's room was across the hall from Resident 2's room at the time of the alleged incident. During an interview on April 2, 2025, at approximately 1:30 PM, the Nursing Home Administrator (NHA) confirmed there was no documented evidence the facility investigated the allegations that Resident CR1 masturbated in view of other residents, including Resident 2. Although Resident 2 was unable to describe the event due to her cognitive impairment and the facility could not determine whether she perceived or was emotionally affected by the incident the nature of the behavior warranted a thorough investigation. The NHA confirmed it is the facility's responsibility to conduct a thorough investigation into allegations of abuse to ensure all residents are protected from abuse. 28 Pa. Code 201.14 (a) Responsibility of licensee 28 Pa. Code 201.18(e)(1) Management 28 Pa. Code 201.29(a) Resident Rights 28 Pa. Code 211.12(c) Nursing Services cmazz FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395298 If continuation sheet Page 3 of 3