Inspection·June 26, 2025

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Potential for minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of Minimum Data Set (MDS - federally mandated standardized assessment conducted at specific intervals to plan resident care), clinical records and staff interview, it was determined that the facility failed to ensure that the MDS assessment accurately reflected the status for two of 35 residents reviewed (Residents R13 and R43). Residents Affected - Some Findings include: Resident R13's clinical record revealed an admission date of 1/9/25, with diagnoses that included bipolar disorder (condition of mood swings characterized by manic highs and depressive lows), anxiety, and chronic pain. Review of MDS instructions for section K0300 indicated that if weight loss of five percent or more in the last month or loss of 10 percent or more in the last six months to code yes. During an interview on 6/26/25, at 8:55 a.m. the Registered Dietitian confirmed that R13 did not have significant weight loss and the MDS dated [DATE], for section Swallowing/Nutritional Status Section K0300 Weight Loss: Loss of 5% or more in the last month or loss of 10% or more in the last 6 months was coded incorrectly. Resident R43's clinical record revealed an initial admission date of 6/07/24, with diagnoses that included Type 2 diabetes (chronic condition where the body either doesn't produce enough insulin or can't properly use the insulin it produces, leading to high blood sugar levels), bipolar disorder (mental health condition causes extreme mood swings that include emotional highs, called mania, and lows, known as depression), long-term kidney disease, and adult failuer to thrive (syndrome of decline in older adults characterized by weight loss, decreased appetite, poor nutrition, and inactivity). Resident R43's clinical record revealed a physician's order originally dated 6/08/24, and reordered 5/28/25, to administer ticagrelor oral tablet (anti-platelet-prevents platelets in your blood from sticking together to prevent blood clots) three times a day. Review of MDS instructions for Section N0415 indicated to check if the resident is taking any of the listed medications by pharmacologial classification. Resident R43's Quarterly MDS dated [DATE], Quarterly MDS dated [DATE], Quarterly MDS dated [DATE], Annual MDS dated [DATE], and Quarterly MDS dated [DATE], Sections N0415 indicated that Resident R43 was receiving an anticoagulant. During an interview on 6/25/25, at 2:56 p.m. Registered Nurse Assessment Coordinator Employee E4 confirmed that Resident R43's Quarterly MDS dated [DATE], Quarterly MDS dated [DATE], Quarterly MDS dated [DATE], Annual MDS dated [DATE], and Quarterly MDS dated [DATE], Sections N0415 were coded incorrectly for receiving an anticoagulant. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 211.5(f)(ix) Medical Records (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395361 If continuation sheet Page 2 of 8 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395361 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Manor East/West 8300 West Ridge Road Girard, PA 16417 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 0641 28 Pa. Code 211.12(d)(3) Nursing services Level of Harm - Potential for minimal harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395361 If continuation sheet Page 3 of 8 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395361 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Manor East/West 8300 West Ridge Road Girard, PA 16417 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 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on review of clinical records, observations, and staff interview, it was determined that the facility failed to ensure that physician's orders were followed for one of 35 residents reviewed (Resident R197). Residents Affected - Few Findings include: Review of Resident R197's clinical record revealed an admission date of 12/11/24, with diagnoses that included hemiplegia (a condition where a person is paralyzed and unable to move one side of their body), hyperlipidemia (high cholesterol), and hypertension (high blood pressure). Review of Resident R197's clinical record revealed a physician's order dated 1/30/25, to apply edema glove (a compression glove to reduce swelling) to left hand. Review of tasks (area in the clinical record where nursing assistants document) revealed a task to apply Geri sleeve (special sleeve worn to protect the skin from injury) to left upper extremity on in the a.m. and off at hour of sleep (HS). Observations on 6/23/25, at 3:22 p.m. revealed Resident R197 sitting in his/her wheelchair in their room with no glove/sleeve on their left hand/arm. Observation on 6/24/25, at 9:18 a.m. revealed Resident R197 was lying in their bed with no glove/sleeve on their left hand/arm. Observation again on 6/24/25, at 12:40 p.m. revealed the resident was sitting in their wheelchair with no glove/sleeve on their left hand/arm. Observations on 6/25/25 at 9:00 a.m., 1:30 p.m., and again at 1:40 p.m. revealed the resident sitting in their wheelchair with no glove/sleeve on their left hand/arm. During an interview on 6/25/25, at 1:40 p.m. Licensed Practical Nurse (LPN) Employee E5 confirmed that Resident R197 did not have a glove/sleeve on his/her left hand/arm. LPN Employee E5 also confirmed that Resident R197 should have a glove/sleeve to their hand/arm according to physician's orders. 28 Pa. Code 211.12(d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395361 If continuation sheet Page 4 of 8 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395361 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Manor East/West 8300 West Ridge Road Girard, PA 16417 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on review of facility policy and clinical record, observations, and staff interview, it was determined that the facility failed to ensure that resident with limited range of motion received physician ordered treatment and services to prevent further decrease in range of motion for one of four residents reviewed (Resident R120). Findings include: Review of policy entitled Restorative Nursing: Splints and Orthotics dated 6/18/25, indicated upon receipt of a physician's order the occupational/physical therapist will issue a splinting device for the resident and nursing staff will follow recommendations/physician's orders and instructions. Review of Resident R120's clinical record revealed an admission date of 3/2/21, with diagnoses that included dementia (a disease that affects short term memory and the ability to think logically), contracture of muscle (a condition that affects a muscle to fully stretch or relax causing the muscle to become stiff and unable to bend), and hypothyroidism (a condition when the thyroid produces low amounts of thyroid hormones). Review of Resident R120's clinical record revealed a physician's order dated 10/22/24, for bilateral resting hand splints per standard wear schedule off at breakfast, on at 1:00 p.m., off at supper, on at hour of sleep, off at 2:00 a.m., on at 4:00 a.m. Review of Resident R120's tasks (an area in the clinical record where the nursing assistants document) revealed that documentation lacked evidence that the bilateral resting hand splints were applied per physician's orders. Observations on 6/24/25, at 1:40 p.m. revealed Resident R120 was sitting in his/her wheelchair with no resting hand splints on their bilateral hands. Observation on 6/25/25, at 1:00 p.m. and again at 1:45 p.m. revealed Resident R120 lying in his/her bed with no resting hand splints on their bilateral hands. During an interview on 6/25/25, at 1:45 p.m. Licensed Practical Nurse (LPN) Employee E5 confirmed that Resident R120 did not have resting hand splints on his/her bilateral hands. LPN Employee E5 also confirmed that Resident R120 should have his/her resting hand splints on their bilateral hands per physician's orders. 28 Pa. Code 201.18 (b)(1) Management 28 Pa. Code 211.10 (d) Resident care policies 28 Pa. Code 211.12 (d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395361 If continuation sheet Page 5 of 8 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395361 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Manor East/West 8300 West Ridge Road Girard, PA 16417 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policies and clinical records, observations, and staff interview, it was determined that the facility failed to provide oxygen and maintain oxygen equipment according to physician's orders for three of five residents reviewed for respiratory services (Residents R32, R153, and R195). Residents Affected - Some Findings include: Review of facility policy entitled Oxygen Administration dated 6/18/25, revealed to verify that there is a physician's order for this procedure. Review the physician's order . for oxygen administration. and turn on oxygen. Unless otherwise ordered, start the flow of oxygen at . and adjust the oxygen delivery device so that it is comfortable for the resident and the proper flow of oxygen is being administered. Review of facility policy entitled Oxygen Saturation Pulse Oximetry (SPO2) Oximetry protocol dated 6/18/25, revealed to verify/obtain a physician's order; unless otherwise determined and prescribed by the physician, utilize 90% SPO2 as acceptable; increase or decrease oxygen liter flow by one liter per minute or more. Review of facility policy entitled Cleaning Nebulizer Cone and Mask or Mouth Piece dated 6/18/25, revealed that the resident will be provided with new nebulizer supplies every seven days; and rinse nebulizer T-set ( T-shaped connection between the mouthpiece or mask to the nebulizer chamber to facilitate delivery of aerosolized medication) nightly with wamr water and leave to dry on a clean paper towel. Review of facility policy entitled Medication Orders dated 6/18/25, revealed that oxygen orders must specify the rate of flow, route, and rationale. Resident R32's clinical record revealed an initial admission date of 7/28/22, with diagnoses that included Alzheimer's disease (progressive brain disorder that gradually destroys memory, thinking skills, and the ability to carry out even simple tasks), functional quadriplegia (complete inability to move due to severe disability or frailty, not caused by a spinal cord injury or brain damage), and adult failure to thrive (syndrome of decline in older adults characterized by weight loss, decreased appetite, poor nutrition, and inactivity). Resident R32's clinical record revealed a physician's order dated 5/20/25, for Ipratropium-Albuterol Solution (bronchodilators that relax muscles in the airways and increase air flow to the lungs) inhaled through a nebulizer mask four times a day. Review of Resident R32's Medication Administration Record (MAR) revealed that he/she routinely received the nebulized medications four times a day. There no evidence in the Treatment Administration Record (TAR) of cleaning/maintaining nebulizer equipment. Observations on 6/23/25, at 2:05 p.m., 6/24/25, at 11:46 a.m., and 6/25/25, at 11:06 a.m., revealed a nebulizer mask laying directly on Resident R32's nightstand and that the inside portion of the mask contained dried secretions, and an unidentifiable solid matter. During an interview on 6/26/25, at 1:10 p.m. Registered Nurse Employee E2 confirmed that the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395361 If continuation sheet Page 6 of 8 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395361 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Manor East/West 8300 West Ridge Road Girard, PA 16417 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 0695 nebulizer mask was soiled, and there was no evidence of when the mask was changed or cleaned. Level of Harm - Minimal harm or potential for actual harm Review of Resident R153's clinical record revealed an initial admission date of 1/06/23, with diagnoses that included prostate cancer, Type 2 diabetes (chronic condition where the body either doesn't produce enough insulin or can't properly use the insulin it produces, leading to high blood sugar levels), altered mental status, and dementia. The clinical record lacked evidence of a physician's order to provide supplemental oxygen (O2). Residents Affected - Some A departmental progress note dated 6/23/25, at 11:50 a.m. revealed that Resident R153 experienced a potential seizure, and that O2 was initiated at two liters per minute and his/her oxygen saturation was recorded at 99%. Review of Resident R153's MAR/TAR and departmental progress notes dated 6/23/25, to 6/25/25, lacked evidence of documentation of his/her continued use of O2, the liter flow, or route. Observations on 6/23/25, at 3:48 pm., and 6/24/25, at approximately 10:10 a.m. revealed that Resident R153 was observed in bed with O2 in use at two liters per minute. During an interview on 6/25/25, at 1:30 p.m. Registered Nurse Employee E2 and Licensed Practical Nurse Employee E3 confirmed Resident R153's clinical record contained incomplete orders and parameters for the use of O2, and lacked documentation of continued use of O2, route and liter flow. Review of Resident R195's clinical record revealed an admission date of 2/18/25, with diagnoses that included Parkinson's (a chronic and progressive movement disorder that causes shaking, slows a person's ability to move and worsens over time), dementia (a disease that affects short term memory and the ability to think logically), and heart failure (the inability of the heart to maintain an adequate supply of blood to organs and tissues). Review of Resident R195's physician's orders revealed an order for oxygen via nasal cannula (a thin tube with two prongs that fit into the resident's nostrils to deliver oxygen) for comfort only, do not titrate SATS (blood oxygen saturation levels) dated 2/21/25, and another order for oxygen per oximetry (a device that provides an oxygen level by placing it on a person's finger) PRN (as needed) dated 2/18/25. The oxygen orders lacked a flow rate (the amount of oxygen to be delivered). During an interview on 6/26/25, at 10:10 a.m. the Director of Nursing (DON) confirmed that Resident R19's oxygen orders lacked a flow rate. The DON also confirmed that Resident R19's oxygen orders were incomplete, and all oxygen orders should indicate a flow rate. 28 Pa. Code 211.10(c) 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: 395361 If continuation sheet Page 7 of 8 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395361 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Manor East/West 8300 West Ridge Road Girard, PA 16417 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 review of facility policies, observations, and staff interviews, it was determined that the facility failed to ensure that medications subject to abuse were stored in separately locked, permanently affixed compartment in one of three medication refrigerators (H Unit), and failed to ensure that medications were discarded in a timely manner for one of three medication rooms observed (A Unit). Findings include: A facility policy entitled Storage of Medications on Nursing Unit dated 6/18/25, revealed that controlled substances that require refrigeration will be secured in the red box designated for controlled substances and secured with a pull tight seal or lock. A facility policy entitled Return of Medication to the Pharmacy dated 6/18/25, revealed that all of the discontinued medication (except controlled substances) will be sent to the pharmacy for credit and/or disposal. Observation on 6/23/25, at 2:15 p.m. of the H Unit medication storage refrigerator revealed Ativan (anti-anxiety, controlled medication) injection syringes, in the red plastic box designated for controlled medications and the box lacked a lock/device to secure the contents. During an interview at the time of the observation, Licensed Practical Nurse (LPN) Employee E1 confirmed the controlled medication box was not secure. During an interview on 6/23/25, at 2:29 p.m. the Director of Nursing (DON) confirmed the red controlled medication box should have a lock/secure device. Observation on 6/23/25, at 3:05 p.m. of the A Unit medication storage refrigerator revealed 1 ½ - 100 milliliter (mL) multi-dose bottles of Cefpodoxime (antibiotic) and one 100 mL bag of Meropenem (antibiotic) intravenous (IV) solution labeled as filled on 6/16/25, and with instructions to discard after 6/21/25. During an interview at that time, LPN Employee E6 confirmed that the bottles and IV bag of antibiotics were expired and should have been discarded/returned to pharmacy. During an interview on 6/23/25, at 3:56 p.m. the DON confirmed that the expired medications should have been discarded or returned to the pharmacy. 28 Pa. Code 211.9(a)(1) Pharmacy services 28 Pa. Code 211.12(d)(1)(5) Nursing Services 28 Pa. Code 201.18(b)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395361 If continuation sheet Page 8 of 8