Inspection·January 22, 2026

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed clinical record review, review of select policies and procedures, and staff interview, it was determined that the facility failed to thoroughly investigate and report allegations of abuse and neglect for two of three residents reviewed (Residents CR1 and CR2). Findings include: The policy entitled, Abuse Investigation and Reporting, last reviewed without changes on November 20, 2025, indicated that all reports of resident abuse, neglect, exploitation, misappropriation of resident property, mistreatment and/or injuries of unknown source (abuse) shall be promptly reported to local, state, and federal agencies (as defined by current regulations) and thoroughly investigated by facility management. Findings of abuse investigations will also be reported. The policy indicated that if an incident or suspected incident of resident abuse, mistreatment, neglect, or injury of unknown source is reported the administrator will assign the investigation to an appropriate individual. All alleged violations involving abuse, neglect, exploitation, or mistreatment, including injuries of unknown source and misappropriation of property will be reported by the facility administrator, or designee, to the following persons or agencies: The state licensing/certification agency responsible for surveying/licensing the facility, the local/state ombudsman, the resident's representative, adult protective services, law enforcement, the resident's attending physician, and the facility's medical director. Review of a facility concern/grievance report dated January 8, 2026, communicated to the facility by Resident CR1, revealed that she had a concern that a girl that came into her room the night before (January 7, 2026) and was grumpy right away and stated, you asked for it, now you got it, after she ask for a wedge for behind her back. The form indicated that she had a pad laying on her spine and that she could not find the call bell to ring and she was scared. Attached to the concern form was a summary from the director of nursing that indicated her and the social service director met with Resident CR1 regarding her concern that someone was being rough with her during the night when they put her to bed. Resident CR1 also indicated that the person did not put a wedge under her back and she laid on her back all night. She said she had her call bell but was afraid to use it in case this person came back. The summary indicated that Resident CR1 could not identify who the person was because she had her eyes closed the whole time. The summary reviewed different staff members that the Director of Nursing spoke to and ruled out as perpetrators, and there were written statements from two-night shift nurse aides, regarding the event but no perpetrator was identified through those statements either. The director of nursing's summary indicated that the two night-shift nurse aides felt the resident was hallucinating. The summary was signed by the director of nursing on January 9, 2026. Further clinical record review for Resident CR1 revealed a progress note dated January 9, 2026, at 1:54 PM that indicated a purplish area was noted on her right flank/hip area that extended to just below her right abdominal fold. The certified nurse practitioner was notified and ordered and ultrasound of the area and also ordered Vitamin K (essential to help with blood clotting) be given (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 395418 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 395418 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/22/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookline Nursing and Rehab 2 Manor Boulevard Mifflintown, PA 17059 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)