Health inspection·December 10, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete and along the walls, dresser, there's dirt and debris and my windowsill and blinds do not get cleaned.Observation on 12/9/25, at 11:43 a.m. Resident R3's room had a dirty privacy curtain with a white/brown stain on the bottom fold, debris and crumblike substances along the perimeter of the wall, under the bed, along the dressers, the windowsill was dusty along with the blinds covering the windows.Observation on 12/9/25, at 11:50 a.m. the large shower room on the second floor was noted to have the hose/shower head detached from the pipe in the wall and lying on the floor of the shower stall. There was a brown spot on the floor of the shower room stall.Interview on 12/9/25, at 11:51 a.m. Housekeeping Employee E4 confirmed the hose/shower head was detached from the pipe in the wall and the brown debris on the floor of the shower stall.Interview on 12/10/25, at 12:51 p.m. the Nursing Home Administrator confirmed that the facility failed to maintain a clean, safe, and homelike environment for three of six residents (Resident R1, R2, and R3) and one of two shower rooms on the second floor (Large Shower Room).28 Pa. code: 201.14 (b) Responsibility of licensee.28 Pa Code: 201.18 (e)(1)(2) Management. 28 Pa Code: 201.29 (a)(c) Resident Rights. Event ID: Facility ID: 395300 If continuation sheet Page 2 of 8 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 395300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Perry Health & Rehab Center 9850 Old Perry Highway Wexford, PA 15090 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility documents, facility policy, clinical records, and staff interviews, it was determined that the facility failed to implement written policies and procedures to ensure a complete and thorough investigation of an allegation of abuse for one of three residents (Resident R4). This failure was determined to be past noncompliance as of 12/5/25.Findings include:Review of facility policy Pennsylvania Resident Abuse Policy dated 3/14/25, indicated the facility's policy is to investigate all allegations, suspicions and incidents of abuse, neglect, involuntary seclusion, intimidation, exploitation of residents, misappropriation of resident property and injuries of unknown source. Review of the admission record indicated Resident R4 was admitted to the facility on [DATE].Review of Resident R4's Minimum Data Set (MDS- a periodic assessment of care needs) dated 11/7/25, indicated the diagnoses of cachexia (a complex metabolic syndrome causing severe, unintentional weight loss), dysphagia (difficulty swallowing), and hypothyroidism (thyroid gland doesn't produce enough thyroid hormone). Section C0500 the Brief Interview for Mental Status (BIMS - is a screening test that aids in detecting cognitive impairment) indicated a score of 15, cognitively intact.Review of Resident R4's progress notes indicated the following:-11/15/25, at 1:34 a.m. found resident at approximately 11:30 p.m. on 11/14/25, crying with complaints of lower back pain, which resident verbalized the pain started when resident was turned when getting a brief changed by Nurse Aide (NA) at approximately 10:00 p.m.-11/17/25, at 11:20 a.m. family at nurses' station inquiring about phone call that she received from their mom regarding care from NA on Friday night. This nurse reported information to management for further review. Patient also has increase pain in lower back. -11/17/25, Provider note at 12:19 p.m. resident seen today at the request of the facility for acute onset lower back pain. Resident seen lying in bed. Resident states that pain originated during care. Resident feels that their leg was elevated too much, causing immediate pain that has persisted. X rays obtained without acute injury.-11/20/25, at 10:35 a.m. Physician note resident seen lying in bed in distress after having been changed and repositioned by staff complaining of severe lower back pain.Review of facility provided documentation dated 12/2/25, at 3:30 p.m. indicated the Director of Nursing was speaking with Resident R4's family. During the conversation family verbalized an occurrence involving an aide elevating resident's legs during incontinence care causing pain on the evening of 11/14/25.Interview on 12/10/25, at 12:51 p.m. the Director of Nursing confirmed the allegation of abuse was not reported to administration and the facility failed to implement written policies and procedures to ensure a complete and thorough investigation of an allegation of abuse for Resident R4 and requested past noncompliance status be reviewed for the event and handed over information on immediate interventions and education that had been completed regarding abuse policy and procedures once facility administration became aware.Review of facility's corrective action plan indicated on 12/2/25, the Director of Nursing became aware that facility was out of compliance with F607 Develop/Implement Abuse/Neglect Policies. In lieu of discovery facility immediately initiated the following:-On 12/2/25, the Director of Nursing called residents family to discuss status of patient who is currently admitted to hospital. During conversation, family verbalized an occurrence involving an aide elevating resident's legs during incontinence care causing pain on the evening of 11/14/2025.-Immediate investigation was initiated including the following:-Identified the aide that was assigned to the resident on date of noted incident with notification and statement attained.-Aide was suspended pending investigation and removed from schedule.-All other residents on unit that are able to be interviewed were interviewed with no care concerns noted.-Per investigation look back at the initial x-ray was negative of any acute findings. A CT scan (advanced Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395300 If continuation sheet Page 3 of 8 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 395300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Perry Health & Rehab Center 9850 Old Perry Highway Wexford, PA 15090 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete imaging test that uses X rays and a computer to create detailed, cross-sectional pictures of the inside of the body) was completed on 11/20/25, during a hospital transfer with an indeterminate L4 (fourth vertebrae of the lower spine) compression fracture (break or collapse) that was reviewed by the in house Nurse Practitioner and could not be verified as acute.-Education was completed on abuse and the timeliness of reporting concerns/customer service timely.-Skin sweeps are being completed on all residents in the facility Adult Protective Services is aware at this time.-Audits will be completed twice weekly for one month with random residents for any care/concern issues.-Facility is not substantiating abuse or neglect related to statements attained and results of investigation.-PB22 was completed.-Facility came back into compliance on 12/5/25, when education was completed.On 12/10/25, at 12:51 p.m. it was verified that the facility had implemented its corrective action plan, and education was verified for 121 facility employees on abuse and the timeliness of reporting concerns timely. Exit interview on 12/10/25, at 12:51 p.m. information was provided to the Nursing Home Administrator and the Director of Nursing that the facility failed to implement written policies and procedures to ensure a complete and thorough investigation of an allegation of abuse and that the facility had successfully met the task of Past Non-Compliance effective 12/5/25, when the corrective actions were achieved by the facility. 28. Pa Code 201.14(a) Responsibility of licensee.28. Pa Code 201.18(b)(1)(e)(1) Management.28. Pa. Code 211.12(d)(1)(5) Nursing services. Event ID: Facility ID: 395300 If continuation sheet Page 4 of 8 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 395300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Perry Health & Rehab Center 9850 Old Perry Highway Wexford, PA 15090 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, resident clinical records, facility provided documents, reports submitted to the State, and staff interview it was determined that the facility failed to report an allegation of abuse for one of three residents (Resident R4).Findings include:Review of facility policy Pennsylvania Resident Abuse Policy dated 3/14/25, indicated the facility's policy is to investigate all allegations, suspicions and incidents of abuse, neglect, involuntary seclusion, intimidation, exploitation of residents, misappropriation of resident property and injuries of unknown source. Facility must immediately report all such allegations to the Administrator who will immediately begin an investigation and notify applicable local and state agencies in accordance with the procedures in this policy.Review of the admission record indicated Resident R4 was admitted to the facility on [DATE].Review of Resident R4's Minimum Data Set (MDS- a periodic assessment of care needs) dated 11/7/25, indicated the diagnoses of cachexia (a complex metabolic syndrome causing severe, unintentional weight loss), dysphagia (difficulty swallowing), and hypothyroidism (thyroid gland doesn't produce enough thyroid hormone). Section C0500 the Brief Interview for Mental Status (BIMS - is a screening test that aids in detecting cognitive impairment) indicated a score of 15, cognitively intact.Review of Resident R4's progress notes indicated the following:-11/15/25, at 1:34 a.m. found resident at approximately 11:30 p.m. on 11/14/25, crying with complaints of lower back pain, which resident verbalized the pain started when resident was turned when getting a brief changed by Nurse Aide (NA) at approximately 10:00 p.m.-11/17/25, at 11:20 a.m. family at nurse's station inquiring about phone call that they received from their mom regarding care from NA on Friday night. This nurse reported information to management for further review. Patient also has increase pain in lower back. -11/17/25, Provider note at 12:19 p.m. resident seen today at the request of the facility for acute onset lower back pain. Resident seen lying in bed. Resident states that pain originated during care. Resident feels that their leg was elevated too much, causing immediate pain that has persisted. X rays obtained without acute injury.-11/20/25, at 10:35 a.m. Physician note resident seen lying in bed in distress after having been changed and repositioned by staff complaining of severe lower back pain.Review of facility provided documentation (State report) dated 12/2/25, at 3:30 p.m. indicated the Director of Nursing was speaking with Resident R4's family. During the conversation family verbalized an occurrence involving an aide elevating resident's legs during incontinence care causing pain on the evening of 11/14/25.Interview on 12/10/25, at 12:51 p.m. the Director of Nursing confirmed the allegation of abuse was not reported to administration and the facility failed to report an allegation of abuse for one of three residents (Resident R4) and requested past noncompliance status be reviewed for the event and handed over information on immediate interventions and education that had been completed regarding abuse policy and procedures once facility administration became aware.Review of facility's corrective action plan indicated on 12/2/25, the Director of Nursing became aware that facility was out of compliance with F609 Reporting of Alleged Violations. In lieu of discovery facility immediately initiated the following:-On 12/2/25, the Director of Nursing called residents family to discuss status of patient who is currently admitted to hospital. During conversation, family verbalized an occurrence involving an aide elevating resident's legs during incontinence care causing pain on the evening of 11/14/2025.-Immediate investigation was initiated including the following:-Identified the aide that was assigned to the resident on date of noted incident with notification and statement attained.-Aide was suspended pending investigation and removed from schedule.-All other residents on unit that are able to be interviewed were interviewed with no care concerns noted.-Per investigation look (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395300 If continuation sheet Page 5 of 8 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 395300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Perry Health & Rehab Center 9850 Old Perry Highway Wexford, PA 15090 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete back at the initial x-ray was negative of any acute findings. A CT scan (advanced imaging test that uses X rays and a computer to create detailed, cross-sectional pictures of the inside of the body) was completed on 11/20/25, during a hospital transfer with an indeterminate L4 (fourth vertebrae of the lower spine) compression fracture (break or collapse) that was reviewed by the in house Nurse Practitioner and could not be verified as acute.-Education was completed on abuse and the timeliness of reporting concerns/customer service timely.-Skin sweeps are being completed on all residents in the facility Adult Protective Services is aware at this time.-Audits will be completed twice weekly for one month with random residents for any care/concern issues.-Facility is not substantiating abuse or neglect related to statements attained and results of investigation.-PB22 was completed.-Facility came back into compliance on 12/5/25, when education was completed.On 12/10/25, at 12:51 p.m. it was verified that the facility had implemented its corrective action plan, and education was verified for 121 facility employees on abuse and the timeliness of reporting concerns.Exit interview on 12/10/25, at 12:51 p.m. information was provided to the Nursing Home Administrator and the Director of Nursing that the facility failed to report an allegation of abuse for one of three residents (Resident R4) and that the facility had successfully met the task of Past Non-Compliance effective 12/5/25, when the corrective actions were achieved by the facility. 28 Pa Code: 201.14 (a)(c )(e ) Responsibility of management28 Pa Code: 201.18 (b)(1) (e)(1) Management. Event ID: Facility ID: 395300 If continuation sheet Page 6 of 8 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 395300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Perry Health & Rehab Center 9850 Old Perry Highway Wexford, PA 15090 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 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility documents, facility policy, clinical records, and staff interview, it was determined that the facility failed to conduct a thorough investigation of an allegation of abuse for one of three residents (Resident R4).Findings include:Review of facility policy Pennsylvania Resident Abuse Policy dated 3/14/25, indicated the facility's policy is to investigate all allegations, suspicions and incidents of abuse, neglect, involuntary seclusion, intimidation, exploitation of residents, misappropriation of resident property and injuries of unknown source. Review of the admission record indicated Resident R4 was admitted to the facility on [DATE].Review of Resident R4's Minimum Data Set (MDS- a periodic assessment of care needs) dated 11/7/25, indicated the diagnoses of cachexia (a complex metabolic syndrome causing severe, unintentional weight loss), dysphagia (difficulty swallowing), and hypothyroidism (thyroid gland doesn't produce enough thyroid hormone). Section C0500 the Brief Interview for Mental Status (BIMS - is a screening test that aids in detecting cognitive impairment) indicated a score of 15, cognitively intact.Review of Resident R4's progress notes indicated the following:-11/15/25, at 1:34 a.m. found resident at approximately 11:30 p.m. on 11/14/25, crying with complaints of lower back pain, which resident verbalized the pain started when resident was turned when getting a brief changed by Nurse Aide (NA) at approximately 10:00 p.m.-11/17/25, at 11:20 a.m. family at nurses' station inquiring about phone call that they received from their mom regarding care from NA on Friday night. This nurse reported information to management for further review. Patient also has increase pain in lower back. -11/17/25, Provider note at 12:19 p.m. resident seen today at the request of the facility for acute onset lower back pain. Resident seen lying in bed. Resident states that pain originated during care. Resident feels that their leg was elevated too much, causing immediate pain that has persisted. X rays obtained without acute injury.-11/20/25, at 10:35 a.m. Physician note resident seen lying in bed in distress after having been changed and repositioned by staff complaining of severe lower back pain.Review of facility provided documentation (State report) dated 12/2/25, at 3:30 p.m. indicated the Director of Nursing was speaking with Resident R4's family. During the conversation family verbalized an occurrence involving an aide elevating resident's legs during incontinence care causing pain on the evening of 11/14/25.Interview on 12/10/25, at 12:51 p.m. the Director of Nursing confirmed the allegation of abuse was not reported to administration and the facility failed to conduct a thorough investigation for an allegation of abuse for one of three residents (Resident R4) and requested past noncompliance status be reviewed for the event and handed over information on immediate interventions and education that had been completed regarding abuse policy and procedures once facility administration became aware.Review of facility's corrective action plan indicated on 12/2/25, the Director of Nursing became aware that facility was out of compliance with F610 Investigate/Prevent/Correct Alleged Violation. In lieu of discovery facility immediately initiated the following:-On 12/2/25, the Director of Nursing called residents family to discuss status of patient who is currently admitted to hospital. During conversation, family verbalized an occurrence involving an aide elevating resident's legs during incontinence care causing pain on the evening of 11/14/2025.-Immediate investigation was initiated including the following:-Identified the aide that was assigned to the resident on date of noted incident with notification and statement attained.-Aide was suspended pending investigation and removed from schedule.-All other residents on unit that are able to be interviewed were interviewed with no care concerns noted.-Per investigation look back at the initial x-ray was negative of any acute findings. A CT scan (advanced imaging test that uses X rays and a computer to create detailed, cross-sectional pictures of the inside of the body) was completed on 11/20/25, during a hospital transfer with Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395300 If continuation sheet Page 7 of 8 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 395300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Perry Health & Rehab Center 9850 Old Perry Highway Wexford, PA 15090 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 FORM CMS-2567 (02/99) Previous Versions Obsolete an indeterminate L4 (fourth vertebrae of the lower spine) compression fracture (break or collapse) that was reviewed by the in house Nurse Practitioner and could not be verified as acute.-Education was completed on abuse and the timeliness of reporting concerns/customer service timely.-Skin sweeps are being completed on all residents in the facility Adult Protective Services is aware at this time.-Audits will be completed twice weekly for one month with random residents for any care/concern issues.-Facility is not substantiating abuse or neglect related to statements attained and results of investigation.-PB22 was completed.-Facility came back into compliance on 12/5/25, when education was completed.On 12/10/25, at 12:51 p.m. it was verified that the facility had implemented its corrective action plan, and education was verified for 121 facility employees on abuse and the timeliness of reporting concerns.Exit interview on 12/10/25, at 12:51 p.m. information was provided to the Nursing Home Administrator and the Director of Nursing that the facility failed to make certain to conduct a thorough investigation of an allegation of abuse for one of three residents (Resident R4) and that the facility had successfully met the task of Past Non-Compliance effective 12/5/25, when the corrective actions were achieved by the facility. 28 Pa Code: 201.14 (a)(c )(e ) Responsibility of management28 Pa Code: 201.18 (b)(1) (e)(1) Management. Event ID: Facility ID: 395300 If continuation sheet Page 8 of 8