Health inspection·February 27, 2024

F 0557 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. Based on observations and resident interviews, it was determined that the facility failed to ensure that personal belongings were accounted for three of 21 residents reviewed (Resident R83, R58 and R60). Residents Affected - Few Findings include: Review of the facility policy, Admissions, Transfers and Discharge, with a revision date of September 2013 indicated that when taking inventory of a resident's personal effects, staff should inventory all clothing, equipment, valuables, etc. and record the quantity of each item, a discreption of each item and other identifying factors as necessary or appropriate. The policy also indicated that when all items have been inventoried and recorded on the Inventory of Personal Effects form, staff is to sign their name, and instruct the resident and/or his/her family member who witnessed the inventory to also sign the form. Continued review of the policy also indicated that staff is to provide the reident and/or family member with a copy of the completed and signed inventory form. Review of the resident's February 2024 physician orders indicated that the resident was admitted into the facility in December 2023 with diagnoses of substance abuse; bipolar (a mental health condition that causes extreme mood swings that include emotional highs and lows); respiratory failure (a serious condition that affects your breathing and oxygen levels in the blood), and muscle weakness. During an interview with the resident on February 22, 2024 at 11:40 a.m. the resident reported that he has clothing that has been missing for 18 days. He reported that he sent them to be washed by laundry and never received them back. Review of the resident's electronic clinical record and the resident's paper record did not produce evidence of the resident's inventory sheet upon his admission to the facility where resident's clothing and personal properly was recorded and accounted for upon admission (e.g. clothing, dentures, cell phone, shoes) During an interview with the housekeeping director (Employee E12) and the Regional Housekeeping Director (Employee E25) on February 26, 2024, at 10:00 a.m. it was confirmed that there was no inventory sheet completed on the resident when he was admitted into the facility. It was also confirmed that there was no record of what clothes were taken from the resident's room for washing and drying. Review of the February 2024 physician orders for Resident R58 included the diagnoses of cerebral infarction (a stroke); lymphedema (a condition that results in swelling of the leg or arm); hypertension (high blood pressure); morbid obesity; lack of coordination and need for assistance with personal care. During an interview with the resident on February 22, 2024 at 11:12 a.m. the resident was observed lying in bed. The resident reported that he does not get dressed because he had no clothes and no shoes. Resident provided consent and upon opening up his closet and drawers, there was no evidence of any clothing or shoes. During an interview with Resident R60 at 11:16 a.m. the resident was observed wearing a tan short jacket that was dirty and with approximately 4 white strips of tape on the right side of the jacket. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 2 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0557 Level of Harm - Minimal harm or potential for actual harm Resident reported that he burned his jacket prior to his admission into the facility, so he taped that burned sections of the jacket. During the interview the resident reported that he only had 2 pairs of paints to wear and 2 tops to wear. Resident was dressed in checkered black and red flannel pair of paints that he had on during the interview, and a red shirt with print shirt on the front of it. The resident showed a black pair of jeans, and a tan colored sweat shirt. Residents Affected - Few Resident provided consent and upon opening up his closet and drawers, there was no evidence of any clothing other clothing for the resident to wear. During an observation in the room that Resident R58 and Resident R60 shared with the Regional Administrator (Employee E3) on February 26, 2024 at 12:45 p.m. a discussion was held regarding both residents not having clothes to wear, in addition to Resident R58 reporting not having any clothes and not having any shoes to wear. 28 Pa. Code 201.18 (b)(1) Management 28 Pa. Code 211.10(d) Resident care policies 28 Pa. Code 211.12(d)(3) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 3 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on staff interviews and review of the clinical record, it was determined that the facility failed to ensure that the physician was notified of a fall incident sustained by a resident for one out of 21 residents reviewed (Resident R89). Findings include: Review the February 2024 physician orders for Resident R89 indicated that the resident was admitted into the facility from the hospital on January 5, 2024 with the diagnoses of seizures (a sudden, uncontrolled burst of electrical activity in the brain that can cause changes in behavior, movements, feelings and levels of consciousness); cerebral infarction (a stroke); chronic obstructive pulmonary disorder (COPD- a condition involving constriction of the airways and difficulty or discomfort in breathing); alcohol abuse; substance abuse; anxiety (a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome); depression (a mood disorder that causes a persistent feeling of sadness and loss of interest), in addition to a right below the knee amputation. Review of a nursing noted date January 10, 2024 at 6:29 a.m. indicated that the resident was found on his floor in his bedroom by nursing staff. The note also documented that the resident fell on the bathroom floor from out of his wheelchair and crawled from the bathroom to his bed to try and get up on his own. Continued review of the nursing note documented that nursing made an attempt to notify the physician's office of the fall, and that they were unable reached the physician. Per the nursing note, MD [name of Dr.] office unable to be reached. Review of the resident's clinical record regarding referenced incident did not show evidence that the facility made any additional attempts to contact the resident's physician after not being able to reach the resident's physican during the initial contact in order to ensure appropiate care and services. During an interview with the Director of Nursing (DON) on February 27, 2024 at 10:10 a.m. it was discussed that there was no documentation in the clinical record that the physician was notified after the resident's fall on January 10, 2024. 28 Pa. 211.5(f) Clinical records 28 Pa. Code 211.12(c) Nursing services 28 Pa. Code 211.12(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 4 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. Based on the review of clinical records and interview with staff, it was determined that the facility failed to ensure that a comprehensive assessment was completed every 12 months as required for two of eight residents reviewed. (Resident R1 and R50) Findings Include: Review of clinical record for Resident R50 revealed that the resident had an admission MDS (Assessment of Resident Care Needs) assessment completed on January 27, 2023. Further review of the clinical record the revealed that the annual assessment was scheduled with an assessment reference date (ARD) of January 10, 2024. Continued review of the clinical record revealed that the assessment was not completed until February 19, 2024. Review of clinical record for Resident R1 revealed that the resident had a modification admission MDS assessment completed on January 18, 2023. Further review of the clinical record the revealed that the annual assessment was scheduled with an assessment reference date (ARD) of January 10, 2024. Continued review of the clinical record revealed that the assessment was not completed until oon February 19, 2024. Interview with MDS coordinator on February 23, 2024, at 10:44 a.m., confirmed that the MDS's were completed late. She stated she was busy with case management responsibilities and there were over 17 short term residents that required case management services. She did not have enough time to complete MDS responsibilities as she was the only RNAC in the facility. 28 Pa. Code 211.12(d)(5) Nursing services 28 Pa. Code 211.14(f\a) Responsibility of the licensee. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 5 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0638 Assure that each resident’s assessment is updated at least once every 3 months. Level of Harm - Minimal harm or potential for actual harm Based on the review of clinical records and interview with staff, it was determined that the facility failed to ensure that a quarterly assessment was completed not less frequency than once every 3 months as required for six of eight residents reviewed. (Resident R79, R59, R15, R3, R38, R6) Residents Affected - Few Findings Include: Review of clinical record for Resident R79 revealed that the resident had an admission MDS (Assessment of Resident Care Needs) assessment completed on October 13, 2023. Further review of the clinical record the revealed that the quarterly assessment was scheduled with an assessment reference date (ARD) of January 10, 2024. Continued review of the clinical record revealed that the assessment was not completed until February 19, 2024. Review of clinical record for Resident R59 revealed that the resident had a quarterly MDS assessment completed on October 18, 2023. Further review of the clinical record the revealed that the quarterly assessment was scheduled with an assessment reference date (ARD) of January 17, 2024. Continued review of the clinical record revealed that the assessment was not completed until February 23, 2024. Review of clinical record for Resident R15 revealed that the resident had a annual MDS assessment completed on October 17, 2023. Further review of the clinical record the revealed that the quarterly assessment was scheduled with an assessment reference date (ARD) of January 17, 2024. Continued review of the clinical record revealed that the assessment was onot completed until February 23, 2024. Review of clinical record for Resident R3 revealed that the resident had a quarterly MDS assessment completed on October 6, 2023. Further review of the clinical record the revealed that the quarterly assessment was scheduled with an assessment reference date (ARD) of January 5, 2024. Continued review of the clinical record revealed that the assessment was not completed until February 19, 2024. Review of clinical record for Resident R38 revealed that the resident had a quarterly MDS assessment completed on October 13, 2023. Further review of the clinical record the revealed that the quarterly assessment was scheduled with an assessment reference date (ARD) of January 12, 2024. Continued review of the clinical record revealed that the assessment was not completed until February 22, 2024. Review of clinical record for Resident R6 revealed that the resident had a quarterly MDS assessment completed on October 11, 2023. Further review of the clinical record the revealed that the quarterly assessment was scheduled with an assessment reference date (ARD) of January 10, 2024. Continued review of the clinical record revealed that the assessment was not completed until February 19, 2024. Interview with MDS coordinator on February 23, 2024, at 10:44 a.m., confirmed that the MDS's were completed late. She stated she was busy with case management responsibilities and there were over 17 short term residents that required case management services. She did not have enough time to complete MDS responsibilities as she was the only RNAC in the facility. 28 Pa. Code 211.12(d)(5) Nursing services 28 Pa. Code 211.14(f\a) Responsibility of the licensee. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 6 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0646 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the appropriate authorities when residents with MD or ID services has a significant change in condition. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interviews and the review of clinical records, it was determined that the facility failed to ensure that the State mental health authority and/or the State intellectual disability authority was notified of a significant change in resident's mental health status which required admission into a psychiatric facility for one out of 21 residents reviewed (Resident R48). Findings include: Review of the February 2024 physician orders for Resident R48 included the diagnoses of anxiety (a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome); cognitive communication deficit (a group of disorders that affect a person's ability to communicate); depression (a mood disorder that causes a persistent feeling of sadness and loss of interest); schizophrenia (a mental disorder characterized by fixed false convictions in something that is not real of shared by other people, seeing, hearing, feeling or smelling something that does not exist, disorganized thoughts, speech and behavior; heart failure (a progressive heart disease that affects pumping action of the heart muscles that causes fatigue, shortness of breath; and peripheral vascular disease ( a common condition in which narrowed arteries reduce blood flow to the arms or legs). Review of a nursing note dated [NAME] 8, 2023 at 9:41 a.m. indicated that the resident was sent out to a psychiatric hospital for evaluation. Review of a nursing note dated September 8, 2023 at 3:30 p.m. documented that the resident was readmitted into the facility from the psychiatric hospital. Continued review of the clinical record did not show evidence of documentation that the facility notified that State mental health authority and/or the State intellectual disability authority regarding the resident's change in mental status and her admission into a psychiatric treatment facility. During an interview with the Social Worker (Employee E8) on February 26, 2024 at 1:45 p.m it was confirmed by the Social Worker that there was no information to produce to show evidence that the facility notified that State mental health authority and/or the State intellectual disability authority regarding the resident's change in mental status and her admission into a psychiatric treatment facility. 28 Pa. Code 211.12(c) Nursing services 28 Pa. Code 211.12(d)(3) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 7 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and the review of clinical records, it was determined that the facility failed to ensure that resident received activities of daily living care related to shaving and haircuts for 2 out of 21 residents reviewed (Resident R58 and R60). Residents Affected - Few Findings include: Review of the facility policy, Activities of Daily Living (ADLs), Supporting, with a revised date of October 2021, indicated that resident will be provided with care, treatment, and services as appropriate to maintain or improve their ability to carry out activities of daily living. The policy also stated that appropriate care and services will be provided for resident who are unable to carry out activities of daily living independently with the consent of the resident in accordance with the plan of care, including appropriate support and assistance with hygiene (bathing, dressing, grooming, and oral care); toileting mobility and eating. Review of the February, 2024 physician orders for Resident R58 included the following diagnoses: cerebral infarction (a stroke); lymphedema (a condition that results in swelling of the leg or arm); hypertension (high blood pressure); morbid obesity; lack of coordination and need for assistance with personal care. Review of the Quarterly Minimum Data Set Assessment (MDS- a periodic assessment of a resident's needs) dated December 20, 2023 indicated that the resident was awake, alert and oriented. Review of the resident's person-centered plan of care, included a plan of care dated June 30, 2023 for the resident related to deficits of his activities of daily living related to weakness, cerebral infarction, and monoplegia of the resident's lower limb (paralysis of a limb), and obesity. Care plan interventions to address this care concern included assistance with activities of daily living, as needed. During an interview with the resident on February 22, 2024 at 11:12 a.m. the resident reported that this is too long, referring to his hair. Resident's hair was observed to be unkempt, long, and straggly. The length of the hair extended to the end of his neck. Resident reported that he needs a haircut and had not had one in a while. Review of the resident's clinical record provided no documentation as to the last time resident was offered and/or received a haircut. Review of the February 2024 physician orders for Resident R60 indicated that the resident was admitted into the facility on December 19, 2023 with the following diagnoses: kidney failure (a gradual loss of kidney function); diabetes (a condition that happens when your blood sugar is too high); chronic obstructive pulmonary disease (COPD- a condition involving constriction of the airways and difficulty or discomfort in breathing); cerebral infarction (a stroke); muscle weakness; lack of coordination, and the need for assistance with personal care. Review of the admission Minimum Data Set Assessment (MDS- a periodic assessment of a resident's needs) dated December 26, 2023 indicated that the resident was awake, alert and oriented and required staff supervision with his activities of daily living (e.g. combing hair, shaving, applying makeup, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 8 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few washing/drying face and hands). Continued review of the resident's Quarterly MDS indicated that the resident was awake, alert and oriented. During an interview with the resident on February 22, 2024 at 11:16 a.m. the resident reported that he had not had a haircut or his beard trimmed since he was admitted to the facility in December 2023. The resident was observed sitting in his wheelchair with long hair and a long beard that looked unkempt and straggly. Review of the resident's clinical record provided no documentation as to the last time resident was offered and/or received a haircut and a shave. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.10(d) Resident care policies 28 Pa. Code 211.12(d)(1) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 9 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0687 Provide appropriate foot care. Level of Harm - Minimal harm or potential for actual harm Based on review of policies and clinical records, observations and resident and staff interviews, it was determined that the facility failed to ensure that foot care needs were provided timely for one of 48 residents reviewed (Resident 73). Residents Affected - Few Findings include: Review of a quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 73, dated November 22, 2023, revealed that the resident had a BIMS (Brief Interview for Mental Status) score of 3 which indicated that resident's cognitive status was severely impaired. Review of care plan for Resident R73 dated June 8, 2023, revealed that the resident required assistance for mobility and Activities of Daily Living functions. Observation of Resident R73 on February 23, 2024, at 12:41 p.m. with Director of Nursing, Employee E2, revealed that the resident had long and thick toenails on both feet. The nail was discolored with yellowish and whitish discoloration which appeared like infected nails. Employee E2 confirmed the finding and stated she would be contacting the physician for treatment. Review of podiatry consult June 26, 2023, revealed that the resident had mycotic (fungal infection) toenails on all toes on both feet and it was painful with palpation. Nail debridement was completed and follow up exam was ordered in 9 weeks. Further review of the clinical record revealed no evidence that the resident was seen by podiatry until January 5, 2024. Review of podiatry consult January 5, 2024, revealed that the resident had onychomycosis (A nail fungus causing thickened, brittle, crumbly, or ragged nails) in 10 nails with pain and pigment discoloration. Further review of the clinical record revealed evidence that a treatment was recommended for the condition observed by the podiatry. Review of clinical record dated February 24, 2024, revealed that the resident was noted with fungal infection to bilateral foot. Provider made aware. New orders received for Lotrimin AF (antifungal cream) cream and follow up with podiatry during next rounds. Further review of the clinical records and care plan for Resident R73 revealed documented evidence that the facility staff documented resident's foot concern, notified physician, obtained treatment orders or developed a plan for care for the prevention and management of toenail infection until February 24, 2024. 28 Pa Code 211.10 (c)(d) Resident care policies 28 Pa. Code 211.12(d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 10 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observations, interviews with staff and residents, review of clinical records and facility documentation, it was determined that the facility failed to ensure adequate supervision during medication administration for one out of 21 residents reviewed (Resident R59). Findings include: Review of the facility policy, Administering Medications, with a revised date of December 2012 indicated that medications shall be administered in a safe and timely manner, and as prescribed.The policy also indicated that residents may self-administer their own medications only if the attending physician, in conjunction with the interdisciplinary care planning team, has determined that they have the decision-making capacity to do so safely. Review of the February 2024 physician orders for Resident R59 included the following diagnoses: morbid obesity, post-traumatic stress disorder (a mental health condition that's triggered by a terrifying event either experiencing it or witnessing it); atrial fibrillation (an irregular heart rhythm that can cause fatigue, palpitations, stroke, and other complications); depression (a mental health condition that causes a persistent feeling of sadness and loss of interest) ; muscle weakness, and hypertension (high blood pressure). During an observation in Resident R59's room on February 21, 2024 at 10:40 a.m. the resident was observed in her room lying in bed with a cup of 6 pills in a clear plastic cup on her bedside table. She reported that the nurse left them there for her to take. During an interview with Employee E27 on February 21, 2024 10:55 a.m. it was confirmed that Employee E27 gave the resident the medications to take on her own, left the room after providing the medications to the resident, and did not ensure that the resident was supervised during the consumption of the medications. 28 Pa. Code 211.12 (d) Nursing services 28 Pa. Code 211.12(d)(1) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 11 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of facility policies, clinical record review and interviews with residents and staff, it was determined that the facility failed to administer intravenous (IV) nutrition in accordance with physician orders and professional standards of practice for one of one resident reviewed on IV therapy (Resident R245). Residents Affected - Few Findings include: Review of facility policy Parenteral Nutrition (TPN - a method of providing nutrition where a liquid formula is given into a vein through an intravenous catheter), revised July 2017, revealed a physician order is necessary for this treatment. The TPN order should include the formula or a list of all ingredients/nutrients in the base solution, volume, and rate of administration as well as an order for monitoring lab results on a routine basis. The facility must verify with the State Nurse Practice Act the role of the Nurse. Continued review of section Safety Precautions revealed the event that the TPN is stopped or discontinued suddenly, parenteral nutrition will include an order for dextrose 10% IV to run at the same rate as PN. Continued review of section Documentation revealed the following should be documented in the resident's medical record: date and time of administration, signature of nurse(s) checking and hanging PN bag and person monitoring infusion, and additives which are to be documented in the medication administration record. Resident R245's was admitted to the facility on [DATE]. Resident R245's care plan dated February 14, 2024, revealed the resident had diagnoses of protein calorie malnutrition (lack of sufficient protein in the body) as well as a refusal to eat related to dysphasia and dislike of foods. Resident 245 also have a Central Venous Catheter (subclavian access). Review of Resident R245's clinical record revealed a physician order dated February 10, 2024, TPN Electrolytes Intravenous Concentrate (Parenteral Electrolytes): Use 127.3 ml/hr intravenously every shift for malnutrition. Multiple Vitamin 5 ml vial 1&2 is to be added to the TPN prior to infusion. Infuse Cyclic TPN at 127.3ml/hr for total volume of 1400ml over 12 hours via central line access device. Infusion start time is 2100 Review of hospital discharge documentation dated February 8, 2024, revealed TPN order start rate at 63.6ml/hr for one hour. Increase rate to 127.3ml/hr for 10 hours. Decrease to 63.6ml/hr for one hour, then stop. TPN order also listed these additives: amino acids 15% 75g, dextrose 70% solution 250g, lipid 20% 40g, sterile water parenteral solution 240.25ml, sodium acetate 2mEq/ml 106 mEq, sodium chloride 4mEq/ml 70 mEq, sodium phosphate 3 mmol/ml 6 mmol, magnesium sulfate 4 mEq (50%) 8mEq, calcium gluconate 100mg/ml (10%) 8mEq, adult MVI 3300unit-150mcg/10ml 10ml, trace elements 1ml. Observation on February 21, 2024 at 10:28 a.m. revealed TPN running @ 127ml/hr without dextrose 10% at the same rate. Also observed was the bottom section of dressing to central venous catheter (subclavian line) noted to be loose and not adhered to the skin. Follow up observation on February 22, 2024, at 8:28 a.m. noted dressing still loose. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 12 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0694 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident R245's Febraurh 2024 Medication Administration Record (MAR) on February 12, 13, 14, 18 and 19 2024, for 7 a.m. - 3 p.m. shift and 3 p.m. - 11p.m. shift, indicated no documentation of TPN being administered. Interview on February 22, 2024, at 10:14 a.m. with Director of Nursing, confirmed no documentation in MAR for those dates. Interview also confirmed that the TPN order did not contain the additives or the taper order for the rate of 63.6ml/hr for the first and last hour of the infusion. Director of Nursing also confirmed that residents dressing frequently becomes loose. 28 Pa. Code 211.10(c) Resident care policies 28 Pa. Code 211.12(d)(1) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 13 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the review of clinical records, and interviews with staff, it was determined that the facility failed to ensure that pain management was provided consistent with physician orders for two of 21 residents reviewed. (Resident R89 and Resident R81) Residents Affected - Few Findings include: Interview with Resident R89 on February 21, 2024, at 11:46 a.m. stated he did not receive her pain medications and some other medications ordered by the physician consistently. He stated she was admitted to the facility on [DATE], and staff stated, some of his medications were not available as they were waiting for the pharmacy to deliver the medications. He did not receive the medication for three days after the admission and he was in pain, with pain level ranging from 8 to 10 of a scale of 10. Resident also stated two weeks ago that happened again, his pain medication was not available, and staff told him they were waiting for the pharmacy to deliver. Review of physician orders for Resident R89 revealed an order dated January 5, 2024, Suboxone 2-8 mg film sublingually in the morning and evening for chronic pain management. Review of Medication Administration Record for Resident R89 for the month of January 2024 revealed that on the resident did not receive the medication on January 5 evening, January 6 and 7, 2024 morning and evening. The reason for not administering was documented as Other/See Progress notes. Further review of the progress notes dated January 5, 6 and 7, 2024 revealed that the medication was not available and waiting to be delivered from pharmacy. Review of Medication Administration Record for Resident R89 for the month of February 2024 revealed that on the resident did not receive the medication on February 7 and 8, 2024. The reason for not administering was documented as Other/See Progress notes. Further review of the progress notes dated February 7 and 8, 2024 revealed no documented reason for the missed doses. During interview with Resident R81 February 21, 2024, at 10:48 a.m. it was revealed that resident's pain medication of Morphine sulfate 15 milligrams (mg) was discontinued. Resident stated that she was recently diagnosis of lung cancer and that she has periods of pain which reach are 'unbearable'. Resident stated that the medicine was discontinued by the doctor due to accusation of selling the medication to her roommate. Resident went on to say that it was a misunderstanding and that she only stated well you could have my cancer when roommate was talking about her own diagnoses. Resident then said that all she has for pain management is Tylenol which doesn't help at all. Review of clinical record revealed a recent Pulmonary consult which showed a primary right lung lesion and need for a follow up with an oncologist. It was also revealed that resident had an order for Morphine Sulfate 15mg every 6 hours as needed for pain which was discontinued on February 20, 2024. Review of physicians note from February 20, 2023 revealed discontinuation of Morphine Sulfate due to possible selling of pills and recording of resident offering the narcotics to another resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 14 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0697 Level of Harm - Minimal harm or potential for actual harm Interview with Director of Nursing on February 22, 2023 at 10:46 a.m. revealed physician never listened to the recording did not include any instances of resident selling narcotics. It was also revealed that no investigation was performed to substantiate the claims of narcotic sales. 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: 395354 If continuation sheet Page 15 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Based on the review of clinical records and interview with staff, it was determined that the facility failed to ensure that there was sufficient nursing staff to complete residents' comprehensive and quarterly assessments in a timely manner. for eight of eight residents reviewed. (Resident R79, R59, R15, R3, R38, 6, R1 and R50) Findings Include: Refer to citation: 636, 638. Based on the review of clinical records and interview with staff, it was determined that the facility failed to ensure that a comprehensive assessment was completed every 12 months as required. Based on the review of clinical records and interview with staff, it was determined that the facility failed to ensure that a quarterly assessment was completed not less frequency than once every 3 months as required. Interview with MDS coordinator, Employee E7 on February 23, 2024, at 10:44 a.m., confirmed that the MDS's were completed late. She stated she was busy with case management responsibilities and there were over 17 short term residents that required case management services. She did not have enough time to complete MDS responsibilities as she was the only RNAC in the facility. Interview with the facility COO (Chief Operating Officer), Employee E3, on February 26, 2024, at 11:04 a.m., stated facility only had one staff, Employee E7 who was responsible and trained for completing resident comprehensive assessment. Employee E3 also stated Employee E7 was also responsible for case management responsibilities of facility short term residents. 28 Pa Code: 211.12 (d)(4) Nursing services 28 Pa Code: 201.14(a) Responsibility of licensee FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 16 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. Based on review of facility documentation and staff interview, it was determined that the facility failed to ensure that licensed nursing staff had the proper competencies including intravenous (IV) catheter care, trach care and total parenteral nutrition (TPN) administration care for six of six licensed nurse training records reviewed (E11, E13, E14, E15, E21 & E22). Findings include: Review of the provided facility policies did not reveal any policy related to nursing competencies. Review of training records provided did not reveal any competencies requested including IV (Intravenous) catheter care, trach care and TPN (Total Parental Nutrition) administration care for Employees E13, E14 and E21. A review of training records for Employees E11, E15 and E22 revealed incomplete competencies as follows: -Employees E11 & E22 had TPN partially completed (no skill assessment) and no competencies for IV or Trach care. -Employee E15 had no competency for TPN. Interview with the Director of Nursing on February 26, 2024, at 1:45 p.m. confirmed the above findings. 28 Pa. Code: 211.12(d)(1) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 17 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 the review of facility documentation, clinical records, staff and resident interviews, it was determined that the facility failed to provide necessary pharmaceutical services for one of 21 residents reviewed. (Resident R89) Findings include: Review of the facility policy, Providing Pharmacy Services with a revision date of January 1, 2021, indicated that the pharmacy will ensure that facility staff has access to medications, emergency services for medications, and drug information on a 24 hour basis. Interview with Resident R89 on February 21, 2024, at 11:46 a.m. stated he did not receive her pain medications and some other medications ordered by the physician consistently. He stated she was admitted to the facility on [DATE], and staff stated, some of his medications were not available as they were waiting for the pharmacy to deliver the medications. He did not receive the medication for three days after the admission and he was in pain, with pain level ranging from 8 to 10 of a scale of 10. Resident also stated two weeks ago that happened again, his pain medication was not available, and staff told him they were waiting for the pharmacy to deliver. Review of clinical record for Resident R89, revealed that the resident was admitted to the facility on dated January 5, 2024, with diagnosis including fracture of right tibia, chronic pain and traumatic ischemia (reduced blood flow) of muscles. Review of physician orders for Resident R89 revealed an order dated January 5, 2024, for Suboxone 2-8 milligrams (mg) film sublingually in the morning and evening for chronic pain management. Review of physician orders for Resident R89 revealed an order dated January 5, 2024, for Oxycodone 5 mg every 4 hours as needed for pain. Review of Medication Administration Record for Resident R89 for the month of January 2024 revealed that resident did not receive the medication on January 5, 2024 evening, January 6 and 7, morning and evening. The reason for not administering was documented as Other/See Progress notes. Further review of the progress notes dated January 5, 6 and 7, 2024 revealed that the medication was not available and waiting to be delivered from pharmacy. Review of Medication Administration Record for Resident R89 for the month of February 2024 revealed that on the resident did not receive the medication on February 7 and 8, 2024. The reason for not administering was documented as Other/See Progress notes. Further review of the progress notes dated February 7 and 8, 2024 revealed no documented reason for the missed doses. 28 Pa. Code: 201.14(a)Responsibility of licensee. 28 Pa. Code: 211.9(a)(1)(f)(2)(4)(g)(h)(k) Pharmacy services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 18 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 interview with staff, it was determined that the facility failed to store, label, and dispense drugs according to professional standards of practice for one of 28 resident medication observations. (Resident R15) Findings Include: During a medication administration observation on February 22, 2024, at 8:54 a.m. with Employee E24, Licensed Practical Nurse, for Resident R15. It was observed that staff took an unlabeled clear 30 ml medication cup from the cart. Inside the cup there were white colored tablets. Staff administered the medication to the resident. During interview with Licensed staff, Employee E24 at the time of the observation Employee E24 stated that the medication Colace 100mg tablet was not available in the medication cart, and she took few pills from the other cart in a cup and placed it inside the cart to administer to the resident for morning medication administration. Interview with Director of Nursing, Employee E2, on February 23, 2024, at 12:30 p.m. stated that the staff should not keep the medication in unlabeled containers. Employee E2 confirmed that that staff should verify each medication administered by the physician order and label of medication on the medication container or packet. 28 Pa. Code 211.12(c) Nursing Services 28 Pa. Code 211.12(d)(1)(5) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 19 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews with staff, and a review of facility policies and documentation, it was determined that the facility did not ensure that food was stored, prepared, distributed, and served in accordance with professional standards for food service safety. Findings include: The undated Policy: Food Storage Policy, states, he Food Service Director and/or Cook(s) will insure that all food items are stored properly, covered containers must be airtight, labeled and dated using a two date system (prepared date and use by date). An initial tour of the Food Service Department was conducted on February 21, 2024, at 9:15 a.m. with Employee E5, AM Cook, which revealed the following: Observation in the food preparation area revealed a 5-pound tub of peanut butter with no date of when it was opened or a use by date and it had peanut butter smeared on the outside of the container. Observation in the walk-in freezer revealed a brown cardboard box of fish cakes with the inner plastic liner open to the circulating air. Interview with the AM [NAME] at 9:30 a.m. on February 21, 2024, confirmed the above findings. Observation during a follow up visit to the kitchen on February 22, 2024, at 12:05 p.m. with the Food Service Director (FSD) revealed the tray line area steam table containing the hot food above which was a black electric cord coming from the ceiling that was covered with dust, grease, dirt and cobwebs which were hanging above the hot food being served. Interview with FSD at 12:30 a.m. on February 22, 2024, confirmed the above findings. 28 PA Code: 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(3) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 20 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observations and an interview with staff it was determined that the facility did not ensure that garbage and refuse was disposed of properly. Residents Affected - Many Findings include: An initial tour of the Food Service Department was conducted on February 21, 2024, at 9:15 a.m. with Employee E5, AM Cook, which revealed the following: Observation in the receiving area revealed three green dumpsters, the middle dumpster had the one of the lids on the top open. Around the dumpster on the right was a lot of debris including used latex gloves, paper, straws, cups, lids, empty pudding cup, empty yogurt cup and a plastic bag sticking out from underneath the dumpster. Interview with the AM [NAME] at 9:30 a.m. on February 21, 2024, confirmed the above findings. 28 PA Code: 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(3) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 21 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on interviews, review of facility's policy and the review of clinical records, it was determined that the facility failed to ensure that complete and accurate documentation for one out of 21 residents reviewed (Resident R89). Findings include: Review of the facility policy, Charting and Documentation, with a revision date of July 2017 indicated that all services provided to the resident progress toward care plan goals, or any change in the resident's medical, physical, function or psychosocial conditions, shall be documented in the resident's medical record. The policy also indicated that the medical record should facilitation communication between the interdisciplinary team regarding the resident's condition and response to care. Review the February 2024 physician orders for Resident R89 indicated that the resident was admitted into the facility from the hospital on January 5, 2024 with the following diagnosis seizures (a sudden, uncontrolled burst of electrical activity in the brain that can cause changes in behavior, movements, feelings and levels of consciousness); cerebral infarction (a stroke); chronic obstructive pulmonary disorder (COPDa condition involving constriction of the airways and difficulty or discomfort in breathing); alcohol abuse; substance abuse; anxiety (a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome); depression(a mood disorder that causes a persistent feeling of sadness and loss of interest), in addition to a right below the knee amputation. Review of a social services note dated January 17, 2024 at 4:16 p.m. documented that the social worker spoke with the resident regarding suicide ideation. Social services to [sic] resident about suicidal ideations . Continued review of the resident's clinical notes did show evidence of any other information regarding what events led up to the social worker needing to speak with the resident regarding suicide ideations. During an interview with the Director of Nursing (DON) on February 27, 2024 at 10:10 a.m. the DON reported that she was told that the previous Nursing Home Administrator (NHA) received a call from the resident's daughter who had a concern that her the resident did not sound like himself. During this interview it was discussed with the DON that there was no documentation from the previous Nursing Home Administrator in the resident's clinical record regarding the details of the conversation that he had with the resident's daughter regarding the concerns that she had about her father. During an interview with the Social Worker (Employee E8) on February 27, 2024 at 10:13 a.m. Employee E8 reported that he was told in morning meeting that day to speak with the resident about his mental health needs, and that he did not know any specific details about what the daughter told the previous Nursing Home Administrator. 28 Pa Code 211.12(c) Nursing services 28 Pa Code 211.12(d)(1) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 22 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm Based on the review of facility policy, review of facility documentation and interview with staff, it was determined that the facility failed to establish an antibiotic stewardship program that included antibiotic use protocols and a system to monitor and track the antibiotic use for seven of nine months of antibiotic data requested for review (June, July, August, September, October, November and December, 2023). Residents Affected - Some Finding Include: Review of facility policy Antibiotic Stewardship- Review and Surveillance of Antibiotic use and outcome dated December 2016, revealed that Antibiotic usage and outcome data will b collected and documented using a facility-approved antibiotic surveillance racking form. The data will be used to guide decisions for improvement of individual resident antibiotic prescribing practices and facility-wide antibiotic stewardship. Policy Interpretation and Implementation 1. As part of the facility Antibiotic Stewardship Program, all clinical infections treated with antibiotics will undergo review by the Infection Preventionist, or designee. 2. The IP, or designee, will review antibiotic utilization as part of the antibiotic stewardship program and identify specific situations that are not consistent with the appropriate use of antibiotics. a. Therapy may require further review and possible changes if: (1) The organism is not susceptible to antibiotic chosen; (2) The organism is susceptible to narrower spectrum antibiotic; (3) Therapy was ordered for prolonged surgical prophylaxis; or (4) Therapy was started awaiting culture, but culture results and clinical findings do not indicate continued need for antibiotics. 3. At the conclusion of the review, the provider will be notified of the review findings: 4. All resident antibiotic regimens will be documented on the facility-approved antibiotic surveillance tracking form. The information gathered will include: a. Resident name and medical record number. b. Unit and room number. c. Date symptoms appeared. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 23 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0881 d. Name of antibiotic (see approved surveillance list); Level of Harm - Minimal harm or potential for actual harm e. Start date of antibiotic. f. Pathogen identified (see approved surveillance list); Residents Affected - Some g. Site of infection. h. Date of culture. i. Stop date. j. Total days of therapy. k. outcome; and l. Adverse events. A request for documentation related to facility antibiotic stewardship data was requested to facility administration at the entrance conference on February 21, 2024, at 11:00 a.m. Review of facility antibiotic stewardship data revealed that there was no documented evidence that the facility established and implemented antibiotic stewardship program from June 2023 to December 2024. A request was made to Director of Nursing, Employee E2, on February 23, 2024, at 2:00 p.m. for evidence of facility antibiotic stewardship data. Facility did not submit any data related to facility antibiotic stewardship, tracking the use of antibiotics, tracking of symptoms and review of appropriateness of antibiotics prescribed in the facility from June 2023 to December 2023. Interview with Director of Nursing, Employee E2, on February 26, 2024, at 12:30 p.m. stated antibiotic stewardship and infection surveillance data was not available from June 2023 to December 2023. 28 Pa. Code 211.10(d) Resident care policies. 28 Pa. Code 211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 24 of 25 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 395354 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Stream Nursing and Rehabilitation Center 905 Penllyn Pike Spring House, PA 19477 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 0947 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. Based on a review of facility documentation and staff interview, it was determined that the facility failed to ensure its nurse aide staff was receiving in-service training to be proficient and competent and that the training be no less that 12 hours annually for two of six nurse aides reviewed (Employees E19 and E16). Findings Include: Review of the nurse aide annual training information provided for nurse aide Employee E19 during the survey revealed that there were only six hours of annual training documentation to review and did not meet the twelve hours of annual training requirement. Review of the nurse aide annual training information provided during the survey revealed that nurse aide Employee E16 had only eight hours of training documentation to review and did not meet the twelve hours of annual training requirement. An interview with the Director of Nursing on February 26, 2024, at 1:45 p.m. confirmed that these nurse aides did not meet the minimum required hours of training. 28 Pa. Code 201.14(a) Responsibility of licensee. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395354 If continuation sheet Page 25 of 25