Inspection·April 13, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records, facility policies, and interviews with staff, it was determined that the facility failed to provide treatment and care for two of 6 residents reviewed (Resident R71 and Resident R88). Residents Affected - Few Findings include: 04/12/23 02:10 PM RD [NAME] confirmed facility did not determine the cause of the residents weight gain and did not put in place new interventions. RD did confirm resident gained 24 lbs in 7 days. Review of Resident R71's clinical medical record revealed the following diagnosis: Muscle Weakness Reduction in the power exerted by muscles resulting in an inability to perform a given task on first attempt), Weakness (lack of energy or strength), Adult failure to thrive (less active than normal, requiring assistance in activities of daily living), Morbid (severe) obesity due to excess calories (serious health condition that can interfere with basic physical functions such as breathing or walking due to excessive caloric intake). Review of Resident R71's clinical medical record revealed the following weight: 8/21/2022-208.8 Lbs, 8/24/2022-207.9 Lbs, 8/26/2022-207.6 Lbs, 9/4/2022-205.0 Lbs, 10/3/2022-206.3 Lbs, 10/6/2022- 206.0 Lbs, 10/14/2022- 206.6 Lbs, 10/21/2022- 230.6 Lbs, 10/26/2022- 231.5 Lbs, 11/3/2022- 232.6- Lbs. Further review of Resident R71's clinical medical record revealed on October 14, 2022, the resident weighed 206.6 lbs. On October 30, 2022, the resident weighed 230.6 pounds which is a 11.62 % Gain. Review of facility's policy titled Weight Assessment and Interventions dated March 2022. The policy states The Physician and the IDT team will identify conditions and medications that may be causing weight changers or increasing the risk of weight changes. Further review of Resident's 71's clinical medical record failed to find any, progress notes, IDT notes, Dietitian notes, Dietary review, or assessments addressing Resident R71's 24-pound weight in 7 days. Interview conducted with the Registered Dietitian (RD) on April 12, 2023, at approximately 2:10 P.M. confirmed Resident R71 gained 24 pounds in 7 days. RD also confirmed the facility failed to identify why Resident R71 gained 24 pounds in 7 days and confirmed that facility did not develop or implement new interventions to reduce ore prevent the resident from gaining further weight. Review of Resident 88's weight revealed a weight on January 18, 2023 of 101.3 and a weight on February 2, 2023 of 122.0 an increase of 20.7 pounds. Review of Resident 88's progress notes revealed a weight note on February 9, 2023 at 9:30 a.m. stating weight change noted, weight reflects 14% increase over 30 days resident noted with edema per skin assessment- may contribute to weight fluctuations will make IDT (interdisciplinary team) aware of weight changes and continue with current POC (plan of care). Further review of Resident 88's progress notes revealed a note dated February 14, 2023 at 9:49 p.m. stating Resident has edema (swelling) to B/L (bilateral- both) legs, right leg more swollen. New order for u/s (ultrasound) of RLE (right lower extremity) to r/o (rule out) DVT (deep vein thrombosis(continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395319 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 395319 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465 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 0684 occurs when a blood clot forms in one or more of the deep veins in the body, usually in the legs.) Level of Harm - Minimal harm or potential for actual harm Further review of Resident 88's progress notes revealed a Nursing note on March 1, 2023 at 4:37 p.m. stating B/l legs have increase edema and weeping (fluid leaking from the legs due to swelling) CRNP made aware. New order for Lasix (anti-diuretic used to decrease amount of fluid in the body) 20mg (milligrams) daily x3 days. Residents Affected - Few Further review of Resident 88's weight revealed a weight on March 7, 2023 of 121.5 and a weight on March 8, 2023 of 127.7 an increase of 6.2 pound in a day. Further review of Resident 88's progress notes revealed a weight note on March 9, 2023 at 8:45 a.m. stating weight change noted. Nursing reports resident is snacking constantly, meal intake 100% and continues with b/l lower edema. Will make IDT aware of weight gain and continue to monitor as needed. Further review of Resident 88's progress notes revealed a note on March 14, 2023 at 2:59 p.m. stating Edema noted to b/l legs. Increased edema to b/l legs. CRNP make aware. New orders, Lasix 20mg PO (orally) daily. The next weight in the resident's record is on March 21, 2023 with a weight of 127.1 Interview with the Director of Nursing and the Nursing Home Administrator on MArch 11, 2023 at 12:30 p.m. confirmed there was a delay in treatment of Resident 88's significant weight gain from January 18, 2023 to February 2, 2023 of 20.7 pounds and a delay for the weight gain of March 7, 2023 to March 8, 2023 of 6.2 pounds. Pa Code 211.12.(a) Nursing services Pa Code 211.6.(b) Dietary services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395319 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 395319 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Actual harm Based on clinical record review, facility policy and procedure review and staff interview it was determined the facility failed to implement interventions to prevent pressure ulcers for three of 10 residents reviewed (Residents 12, 16, and 99) causing actual harm of a Stage 3 and two unstageable Pressure ulcers for Resident 12. Residents Affected - Few Findings Include: Review of facility policy and procedure titled Pressure Ulcers/ Skin Breakdown- Clinical Protocol, Revised March 2014, revealed the nursing staff and Attending Physician will assess and document an individual's significant risk factors for developing pressure sores, for example, immobility. Review of Resident R12's significant change MDS (periodic assessment of resident needs) dated February 6, 2023 revealed the resident was recently placed on hospice service (end of life care) and determined to be at risk of developing pressure ulcers. Review of Resident 12's Progress Notes revealed a nursing note on January 8, 2023 at 10:37 a.m. stating x-ray results received and show suspected right femur fracture, RP (Responsible Party) notified and requested to be sent to the ER (Emergency Room). Review of documentation from the hospital stay revealed Resident 12 was seen by an Orthopedic physician on January 9, 2023 due to fracture of the right distal femur (knee). They were going to continue with conservative measures with bracing. Review of Resident 12's Progress Notes revealed a nursing note dated January 11, 2023 at 9:41 p.m. stating patient re-admitted at 5: 15 p.m. from the hospital with Fx (fracture) Femur .brace to right knee to be worn at all times. Review of Resident 12's physician orders revealed an order dated January 12, 2023 for RT (right) leg immobilizer on at all times, observe for redness or skin integrity. Review of Resident 12's Skin Integrity care plan failed to reveal goal/interventions to address newly ordered leg immobilizer or monitoring of right leg for redness and skin integrity under the immobilizer. Review of Resident 12's Medication and Treatment Administration Records for January, February, and March 2023 failed to reveal any skin integrity or redness observation documentation. Review of Resident 12's Progress Notes revealed a nursing note dated April 6, 2023 at 5:39 p.m. revealed open R (right) knee areas and posterior (back) ankle areas observed under residents leg brace Review of Resident 12's Weekly Wound Observation Tool dated April 6, 2023 at 3:48 p.m. revealed an unstageable pressure wound (injuries to skin and underlying tissue resulting from prolonged pressure on the skin) on the top of the right knee cap that was 40% slough (dead white or yellow tissue) with a small amount of bloody drainage that was 5 centimeters wide and 4 centimeter long. Another wound on the right side of the kneecap was an unstageable pressure wound that was 40% slough and was 4 centimeters wide and 4 centimeters long with no drainage. Another wound on the posterior right ankle was a stage 3 (full-thickness skin loss potentially extending into the subcutaneous (fat) tissue (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395319 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 395319 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465 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 0686 layer), there was no description of the wound base on the assessment, with no drainage and 3 centimeters long and 2 centimeters wide. Level of Harm - Actual harm Residents Affected - Few Interview with Licensed Nursing Employee E5 on April 12, 2023 at 11:32 a.m. revealed the wounds that were found on Resident 12's knee and ankle were significant wounds that were caused by pressure of the brace. Employee E5 further stated staff would be expected to remove the brace twice a day to check for skin integrity but there was no documented evidence this was occurring as expected. Interview with Licensed Physical Therapy Employee E6 on April 13, 2023 at 9:30 a.m. revealed they were not consulted until after the wounds were discovered. Employee E6 further stated that the type of immobilizer Resident 12 was wearing had straps that could be undone to allow staff to check Resident 12 skin integrity under the immobilizer as needed. Interview with Licensed Practical Nurse Employee E7 on April 13, 2023 at 9:45 a.m. revealed he/she was currently assigned to Resident 12 and had been assigned to Resident 12 prior to the development of the pressure ulcers. Employee E7 reported he/she did not check under Resident 12's immobilizer for skin integrity because there was no order in the system to do so. Interview with Licensed Nursing Employee E4 on April 13, 2023 at 12:30 p.m. revealed staff completed a weekly skin assessment on April 2, 2023 at 3:50 p.m. and this was the last documented evidence Resident 12's skin integrity had been checked under the immobilizer until the discovery of the wounds on April 6, 2023. The facility failed to assess Resident 12's skin integrity under an immobilizer on the right leg resulting in actual harm to Resident 12 when two unstageable and one stage 3 pressure ulcer were discovered on April 6, 2023. Review of Resident 16's clinical record revealed a diagnosis of hemiplegia (paralysis on one side of the body) and hemiparesis (weakness or inability to move on one side of the body) following cerebral infarction (stroke) affecting the resident's dominant right side. Review of Resident 16's progress notes revealed a nurse's note dated March 17, 2022, which stated: This nurse alerted by therapy of a 1cm x 1cm area to R outer foot. [Suspected Deep Tissue Injury (persistent non-blanchable deep red, purple or maroon area of intact skin, non-intact skin or blood-filled blisters caused by damage to the underlying soft tissues)] is purple in color with red peri-wound. Therapy suspects it is from an ill-fitting brace, and a call was placed by PT to have brace fitted/replaced. Resident [complains of] pain when area is touched. Resident is unsure of how injury was acquired but states it's been hurting for like 4 days. NP and supervisor notified, new order entered to apply skin prep to area until seen and evaluated by podiatry. Review of Resident 16's physician orders, care plan, and Medication/Treatment Administration Records failed to reveal evidence that the resident was ordered a brace, how often the brace should be worn, or that skin checks were being done while the resident was wearing the brace. Interview with the Nursing Home Administrator and Director of Nursing on April 13, 2023, at approximately 10:40 a.m. confirmed there was no documented evidence related to any orders for Resident 16's right foot brace or skin checks for the brace. Review of Resident 99's clinical record revealed diagnoses including dementia (irreversible, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395319 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 395319 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465 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 0686 progressive degenerative disease of the brain, resulting in loss of reality contact and functioning ability), generalized muscle weakness, and reduced mobility. Level of Harm - Actual harm Residents Affected - Few Further review of Resident 99's clinical record revealed the resident had a pressure ulcer that healed on March 13, 2023. Review of Resident 99's progress notes revealed a nurse's note dated December 16, 2022, which stated: Reviewed with IDT [(Interdisciplinary Team)] has a [stage 2 pressure ulcer (superficial with a pale pink wound bed and serous, or clear, drainage and presents itself as an abrasion or blister or shallow crater)] on sacrum. [Resident 99] is incontinent of [bowel and bladder], prefers to lay on her back will order a air mattress. A Skin/Wound note on the same date stated: Wound rounds with IDT ST2 sacrum 5x2x0.1cm. Wound bed pink and with small amt (amount)of yellow material. No drainage noted and no [signs or symptoms] of infection. [Nurse Practitioner] aware of area and husband notified. New order for Xeroform dressing daily. Further review of Resident 99's progress notes revealed a nurse's note dated December 29, 2022, which stated: Wound rounds with IDT and [Wound Physician] [unstageable] 2x1x0.1cm. [Deterioration] with peri wound breakdown. Continue with therahoney daily cover with bordered gauze. Further review of the nurse's notes from December 29, 2022, revealed: air mattress requested for worsening wound. Further review of the resident's clinical record failed to reveal a date when the air mattress was provided to Resident 99. Interview with the Nursing Home Administrator and Director of Nursing on April 13, 2023, at approximately 10:40 a.m. failed to reveal an explanation for the delay in obtaining an air mattress for Resident 99, or what was done in the meantime while awaiting an air mattress for Resident 99. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1)(3)(e)(1) Management 28 Pa. Code 211.5(f) Clinical records 28. Pa. Code 211.12(c)(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395319 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 395319 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465 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 0689 Level of Harm - Minimal harm or potential for actual harm Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on clinical record review, facility documentation review and staff interview it was determined the facility failed to prevent accident for two of 32 residents reviewed (Residents 12 and 85) Residents Affected - Few Findings Include: Review of Resident 12's progress notes revealed a nursing note on February 1, 2023 at 11:34 p.m. stating Resident was found on the floor near the window on a fall mat. The bed bolsters were not attached correctly and were sideways on the bed when the resident was found Review of facility fall investigation report, dated February 1, 2023 revealed the bed bolsters were not attached correctly and were sideways on the bed when the resident was found. Interview with the Nursing Home Administrator on April 13, 2023 at 12:30 p.m. confirmed the bed bolsters were not attached to the bed correctly when Resident 12 fell out of bed. Review of Resident 85's diagnosis list revealed Cerebral Infarction (Stroke), and Hemiplegia (Paralysis of one side of the body). Review of the nursing progress notes dated August 29, 2022, at 11:03 a.m., revealed that on August 27, 2022, during the 7-3 shift, the resident sustained a skin tear measuring 10.0 x 5.0 cm during care while being transferred from bed to chair, the dressing was applied, physician and family was notified. Review of the facility documentation, and incident report dated August 27, 2022, revealed that at 1:37 p.m. while being transferred from bed to chair, the resident bumped her/his right lower leg onto the side of the wheelchair and sustained a skin tear. The same report indicated that the resident ' s wheelchair was the predisposing situational factor. review of the nursing progress notes dated August 29, 2022, at 9:34 a.m., revealed a right lower extremity skin tear reviewed by the interdisciplinary team, which will assess the wheelchair for sharp edges. The clinical records review failed to reveal that the resident's wheelchair was examined. Review of the nursing progress notes dated September 26, 2022, at 12:29 p.m., revealed nurse was called to the resident's room, and observed a moderate amount of blood coming from the right lower extremity, upon assessment of a new skin tear measuring 3.0 x 4.0 cm was noted below the current area on the right lower extremity. The nurse assistant reported that while helping the resident in the bathroom, the resident bumped her/his leg in the wheelchair while being transferred from the toilet to the wheelchair. Review of the facility's documentation, the incident report dated September 26, 2022, at 12:07 p.m., revealed resident bumped her/his right to the wheelchair while being transferred from the toilet to the wheelchair, and sustained a new skin tear to the right lower leg. The report indicated that the predisposing factor was the wheelchair. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395319 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 395319 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465 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 0689 Level of Harm - Minimal harm or potential for actual harm Iterview with the Director of Nursing was conducted on April 13, 2023, at 11:30 a.m. The Director of Nursing (DON) reported that after the August 27, 2022, incident, an intervention to check the wheelchair was documented but the DON was unable to say if the intervention was done. The DON confirmed that there was no documentation indicating that the resident ' s wheelchair was checked, and no other interventions were put in place. Residents Affected - Few The facility failed to ensure intervention was implemented to prevent Resident 85 from another accident. 28 Pa. Code §201.18(b)(1)(3) Management 28 Pa. Code §211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395319 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 395319 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465 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 Based on a review of the facility's policy, clinical records review, and staff interviews, it was determined that the facility failed to obtain the resident's admission weight, notify the physician and address a significant weight change timely for one of 22 residents reviewed (Resident 9). Residents Affected - Few Findings include: Review of the facility's policy titled Weight Assessment and Intervention, dated March 2022, revealed the nursing staff will measure resident weights on admission, and weekly for two weeks thereafter. Any weight change of 5% or more since the last weight assessment will be retaken for confirmation. The Dietitian is alerted to weight changes via PCC alerts and is checked a few times a week. Review of Resident 9's weight and vitals revealed an admission weight of 145 pounds on October 26, 2022. The resident was ordered with a weekly weight as per the facility's policy. Review of the weights and vitals dated November 4, 2022, revealed a weight of 112.6 pounds, 32.4 pounds (22.34%), and a significant weight loss from the admission weight. Review of the weights and vitals revealed a re-weight was done on November 8, 2022 (116 pounds), and November 9, 2022 (110 pounds) four days after the identified significant weight change. Review of the nursing progress notes dated November 8, 2022, at 1:15 p.m., revealed the resident triggering for a weight loss, initial weight was from the hospital and will continue to monitor weights weekly to establish a baseline. The clinical records review failed to reveal that the physician was notified of the significant weight change. Review of the nursing progress notes dated November 18, 2022, at 7:56 a.m., revealed Resident eats 50% or less for nine consecutive meals within 3 days, Dietitian was updated. Review of the Dietitian's note dated November 19, 2022, at 3:45 p.m., revealed notified nursing due to variable intakes, and suggest house supplement three times a day until intake improves. Review of the November 2022 Medication Administration Records revealed that the house shakes three times daily were not ordered until November 21, 2022, three days after recommended by the Dietitian. Interview with the Registered Dietitian, Employee E8 was conducted on April 13, 2023, at 11:00 a.m. The Dietitian confirmed that the documented admission weight recorded in the resident's clinical records was a weight from the hospital. The Dietitian reported that the resident's weight should have been taken by the nursing staff upon admission. The Dietitian reported that although the facility's policy does not indicate a specific time for re-weigh if a significant weight change was identified, a re-weight should be done within 24-48 hours. The Dietitian reported being notified of the significant weight change but was unable to tell when. The Dietitian reported addressing the significant weight change by adding a house supplement three times daily. The Dietitian reported that the nursing staff notifies the physician of a significant weight change. Interview with the Director of Nursing was conducted on April 13, 2023, at 11:30 a.m. The Dietitian (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395319 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 395319 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465 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 - Few confirmed that the resident's weight should have been taken upon admission and should have not used the hospital's recorded weight. The DON reported that a re-weigh should have been done within 24 hours when a significant weight change was identified. The DON also reported that the nursing (unit manager) was responsible for notifying the physician of a significant weight change. The facility was unable to provide documented evidence that a physician was notified of a significant weight change identified on November 4, 2022. The facility failed to ensure Resident 9's baseline weight was taken and failed to address and notify the physician of a significant weight change timely. 28 Pa. Code 211.5(f) Clinical Records Previously cited 4/29/22 28 Pa. Code 211.10(c) Resident Care Policies Previously cited 4/29/22 28 Pa. Code 211.12(d)(1)(3)(5) Nursing Services Previously cited 4/29/22 FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395319 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 395319 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465 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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident must receive and the facility must provide necessary behavioral health care and services. Based on interview and clinical record review, it was determined that the facility failed to provide the necessary psychological services to attain or maintain the highest practicable mental and psychosocial well-being one of two residents reviewed for mood and behaviors (Resident 38). Findings include: Review of Resident 38's clinical record revealed a diagnosis of panic disorder (recurrent, unexpected panic attacks). Interview with Resident 38 on April 11, 2023, at 10:10 a.m. revealed that the resident had a history of panic attacks (a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause) and was almost hospitalized while at the facility due to having a panic attack that felt like a heart attack. Review of Resident 38's physician's orders revealed an order dated December 21, 2022, for psychologist evaluation and treatment as needed. Review of Resident 38's clinical record revealed a nursing progress note dated December 21, 2022, which stated: Updated [physician] on [Resident 38's] anxiety new order to increase Buspar [(medication to treat anxiety]) to 20mg [three times daily] and may see Psychologist for talk therapy. Further review of Resident 38's progress notes revealed a nursing note dated January 13, 2023, at 6:44 p.m., which stated: Resident with reports that he is not feeling well and thinks he is having a panic attack .Encouraged fluids and checked back with patient after dinner, at this time he reports he is feeling better [Physician] notified and no changes at this time. At time of last evening med pass resident reports he has chest pressure .When I checked back with him he reports he is feeling much better and believes it is anxiety. Further review of Resident 38's progress notes revealed a nursing note dated January 26, 2023, at 6:17 p.m., which stated: Resident with report of panic attack and reports he has been feeling increasingly anxious the past few days .Nursing supervisor notified and received new orders for Trazadone (antidepressant that can be used to treat anxiety disorders) 25 mg [at bedtime], resident was notified of change. first dose given tonight. Further review of Resident 38's progress notes revealed a nursing note dated February 27, 2023, at 9:20 a.m., which stated: Resident [complained of] not feeling well this morning, states I think I am having a heart attack, there's a freight train in my chest. Upon assessment no abnormalities to note, no objective pain. [vital signs stable.] . Resident requested to go to ER to be evaluated. EMS arrived and resident then declined to go to hospital following EMS assessment. Resident states he is feeling better at this time and said it must have been this anxiety taking over. Reassurance offered. In bed with call bell in reach, resident states he will notify staff if he begins to feel discomfort again. Cares continue. The surveyor requested copies of all of Resident 38's psychology consults since December, 2022. Interview with the Nursing Home Administrator and Director of Nursing on April 13, 2023, at 10:40 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395319 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 395319 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465 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 0740 Level of Harm - Minimal harm or potential for actual harm a.m. confirmed that Resident 38 had not had any psychology consults from December 21, 2022 through present. 28 Pa Code 211.12(d)(1)(3)(5) Nursing Services Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395319 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 395319 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465 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 - Some 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 clinical record review, it was determined that the facility failed to ensure that medications were available that were ordered for a resident for three of 22 residents reviewed (Resident 38, 90, and 104) and failed to ensure the disposition of medications was reconciled for one of three closed records reviewed (Resident 64). Findings include: Review of Resident 38's clinical record revealed a diagnosis of Parkinson's disease (chronic and progressive movement disorder). Review of Resident 38's physician's orders revealed an order dated December 19, 2022, for Nuplazid (used to treat the symptoms of a certain mental/mood disorders that might occur with Parkinson's disease) 10 milligrams (mg) one time daily. Review of Resident 38's December 2022, January 2023, and February 2023 Electronic Medication Administration Records (eMAR) and eMAR progress notes revealed the medication was routinely not available from the pharmacy. Review of Resident 90's clinical record revealed a diagnosis of generalized anxiety disorder (an anxiety disorder marked by chronic excessive anxiety and worry that is difficult to control). Review of Resident 90's physician's orders revealed an order for alprazolam (Xanax - antianxiety medication) 1 milligram (mg) give one tablet in the afternoon and give one tablet at bedtime. Review of Resident 90's progress notes revealed a nurse's note dated September 15, 2022, which stated: Resident out of Xanax Rx. [(prescription)]. Nursing Supervisor aware, Specialty Rx pharmacy aware. The medication isn't in stock. Review of Resident 90's September 2022 Medication Administration Record revealed the resident did not receive Xanax 1mg on September 14, 2022, at 1:00 p.m. and 9:00 p.m. or on September 15, 2022, at 1:00 p.m. Further review of Resident 90's physician's orders revealed an order for clonazepam (antianxiety medication) 0.5 mg three times daily. Review of Resident 90's progress notes revealed a nurse's note dated December 4, 2022, which stated: called MD and pharmacy in regards to clonazepam 0.5mg order. Pharmacy still hasn't received the script from [physician.] Review of Resident 90's December 2022 Medication Administration Record revealed the resident did not receive clonazepam 0.5mg on December 4, 2022 at 8:00 a.m., 12:00 p.m., or 8:00 p.m., or on December 5, 2022, at 8:00 a.m. or 12:00 p.m. Further review of Resident 90's progress notes revealed a nurse's note dated February 7, 2023, which stated: regarding clonazepam [0.5] mg unavailable . RN supervisor made aware . to get an scrip (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395319 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 395319 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465 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 from the Doctor. no behavior observed. Level of Harm - Minimal harm or potential for actual harm Review of Resident 90's February 2023 Medication Administration Record revealed the resident did not receive clonazepam 0.5mg on February 7, 2023 at 12:00 p.m. and 8:00 p.m. or on February 8, 2023, at 8:00 a.m. or 12:00 p.m. Residents Affected - Some The facility's failure to have prescribed medications available to Residents 38 and 90 was discussed with the Nursing Home Administrator and Director of Nursing on April 13, 2023, at 10:40 a.m. Clinical records review revealed Resident 104 was admitted to the facility on [DATE], with an Unstageable (Obscured full-thickness skin and tissue loss) ulcer to the right heel. A review of the physician's order dated March 3, 2023, revealed an order to apply Santyl (A medication that removes dead tissue from wounds so they can start to heal) to right heal after cleansing with normal saline, covered with dressing every night shift. A review of the April 2023 Medication Administration Record revealed that the ordered Santyl treatment to the right heel was not done on April 2, 3, and 4, 2023. A review of the nursing progress notes dated March 26, 2023, at 5:20 a.m., revealed pharmacy was notified about sending Santyl ointment. A review of the nursing progress notes dated April 3, 2023, at 6:17 a.m., revealed unable to find the Santyl and placed moist 4 x 4 gauze on the resident's foot. A review of the nursing progress notes dated April 4, 2023, at 4:39 a.m., revealed Santyl was not in the facility, and did normal saline and dressing treatment to the right heel. A review of the nursing progress notes dated April 5, 2023, at 2:32 a.m., revealed awaiting Santyl from the pharmacy, normal saline wet to dry dressing was applied until then. Clinical records review failed to reveal that the physician was notified of the missed Santyl treatment to the resident's right heel on April 2,3, and 4, 2023. A review of the pharmacy packing slip and delivery revealed that the Santyl ointment was delivered on April 5, 2023, at 4:21 a.m. An interview with the Director of Nursing was conducted on April 13, 2023. The DON confirmed that Santyl's treatment to the resident's right heel wound was not done due to the unavailability of the medication. The DON also confirmed that the physician was not notified of the missed Santyl treatment. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.12(d)(1) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395319 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 395319 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465 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. Based on review of clinical records, Facility policies, and staff interviews, it was determined that the facility failed to ensure an accurate monthly medication regimen review and appropriate physician recommendation response for five of five residents reviewed for potentially unnecessary medications (Resident 28, Resident 30, Resident 38, Resident 69, and Resident 90). Findings include: Review of Resident 28's clinical medical record revealed the following Pharmacy reviews where the Pharmacist made recommendations that required Resident R21's physician to respond: March 24, 2023, March 9, 2023, February 9, 2023, January 6, 2023, November 7, 2022, October 6, 2022, July 14, 2022, and June 9, 2022. The Pharmacy reviews listed above were requested for review on April 12, 2023, during an interview with the Nursing Home Administrator (NHA). On April 13, 2023, at approximately 1:30 P.M. The facility had only provided Pharmacy reviews for the following dates: June 9, 2022, October 6, 2022, January 6, 2023, and February 9, 2023. The facility failed to provide Pharmacy reviews from: July 2022, November 2022, December 2022, and March 2023. Upon review, it was revealed the pharmacy review from October 6, 2022, was not addressed until December 9, 2022, and the Pharmacy review from February 9, 2023, was not addressed until April 12, 2023. At the conclusion of the Full Health Survey on April 13, 2023, the facility only provided 4 out of the 8 pharmacy reviews requested and 2 of the provided Pharmacy reviews were addressed by the physician outside of the 30-day window. Review of Resident 30 ' s progress notes written by the consultant pharmacist revealed recommendations were made to changes of the medication regimen on May 10, 2022, August 9, 2022, August 16, 2022, December 8, 2022 and February 10, 2023. Review of the Note to attending Physician/prescriber revealed there was no response to the recommendations of May 10, 2022, August 9, 2022, August 16, 2022, and December 8, 2022 from the physician and the response to the recommendation of February 10, 2023 recommendation were not completed until April 12, 2023. Interview with the Director of Nursing on April 13, 2023 at 1:30 p.m. revealed there was no documentation showing that the physician responded to the pharmacy recommendation of May 10, 2022, August 9, 2022, August 16, 2022, and December 8, 2022 and that there was a delay in the response to the pharmacy recommendation of April 12, 2023. Review of Resident 38's progress notes written by the consultant pharmacist revealed recommendations were made on January 6, 2023, and March 8, 2023. Review of Resident 38's Note To Attending Physician/Prescriber revealed the March 8, 2023 pharmacy (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395319 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 395319 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465 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 recommendation was not addressed by the physician until April 12, 2023. The surveyor asked for a copy of the January 6, 2023 recommendation, and at the conclusion of the survey was not provided with the recommendation or physician response. Review of Resident 69's Note to Attending Physician/Prescriber revealed the December 7, 2022, pharmacy recommendation was not addressed by the physician. The surveyor asked for a copy of the December 7, 2022, recommendation, and at the conclusion of the survey was not provided with the recommendation or physician response Review of Resident 90's progress notes written by the consultant pharmacist revealed recommendations were made on October 6, 2022, December 7, 2022, and March 8, 2023. Review of Resident 90's Notes to Attending Physician/Prescriber revealed the March 8, 2023 was not addressed until April 12, 2023. Further review revealed the October 6, 2022 and December 7, 2022 recommendations were not addressed by the physician. The above findings were confirmed with the Nursing Home Administrator and Director of Nursing on April 13, 2023, at approximately 10:40 a.m. Pa Code 211.9(a)(1) Pharmacy services Pa Code 211.5.(f) Clinical records FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395319 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 395319 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manatawny Center for Rehabilitation and Nursing 30 Old Schuylkill Road Pottstown, PA 19465 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 0882 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. Based on the review facility's documentation and staff interview, it was determined that the facility failed to ensure that the designated Infection Preventionist(s) completed specialized training in infection prevention and control. Findings include: During an entrance conference conducted on April 11, 2023, at 9:29 a.m., the Nursing Home Administrator (NHA) reported that the facilit's Infection Preventionist (IP)/ Assistant Director of Nursing (ADON) was a licensed nurse Employee E3. Employee E3 was present during the meeting and confirmed being the IP in the facility and had only been in that position for approximately one month. Facility documentation which includes Infection Preventionist completed specialized infection control training and personnel file was requested. The facility was unable to provide specialized infection control completed by the IP. An interview with the NHA on April 13, 2023, at 10:00 a.m., reported that Employee E3 was newly hired (March 27, 2023). The NHA confirmed that Employee E3 has not completed specialized infection control training before assuming the IP position. The facility failed to ensure that the facility's designated Infection Preventionist(s) completed specialized training in infection prevention and control. 28 pa. Code 201.18(b)(1)Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395319 If continuation sheet Page 17 of 17