Inspection·March 28, 2024

F 0600 Level of Harm - Minimal harm or potential for actual harm with no attempts to get out of chair noted. No aggressive actions toward others noted and the resident's level of supervision was changed from 1:1 to every fifteen-minute checks. Progress notes indicated that March 21, 2024, at 9:26 a.m., Resident C2 displayed behaviors of yelling and agitation in response to another resident yelling out and required staff redirection. Residents Affected - Some A facility incident investigation completed by Employee 3, a registered nurse (RN), dated March 22, 2024, at 7:50 p.m., revealed that Resident CR2 hit Resident C1 in the chest. The residents were in the hallway and Resident C2 rolled over to Resident C1 and struck him in the chest. Resident C1 did not swing back. Resident C2 denied that he struck another resident, stating I did not hit anyone. The residents were immediately separated, and residents were assessed with no injuries or redness, or bruising noted. Predisposing physiological factors included impaired memory and confusion. Immediate interventions included re-instating 1:1 supervision of Resident C2 for safety. Employee 4's, RN, witness statement dated March 22, 2024, at 8:00 p.m., revealed that while giving meds down the hallway, I heard arguing between {Resident C1} and another resident {C2}. When approaching {Resident C2}, he hit another resident {Resident C1} in the chest with his closed fists. Both residents were separated and Resident C2 went down the hallway to his room and the other resident {C1} was assessed without injuries. A review of Resident C3's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses that included neurocognitive disorder with Lewy bodies [is a type of progressive dementia that leads to a decline in thinking, reasoning, and independent function. Its features may include spontaneous changes in attention and alertness, recurrent visual hallucinations, REM sleep behavior disorder, and slow movement, tremors, or rigidity], dysphagia (difficulty swallowing), and cognitive communication deficit. A quarterly Minimum Data Set (MDS) assessment dated [DATE], indicated that the resident had severe cognitive impaired with a BIMS of 3. A review of Resident C3's behavior plan of care that was initiated on December 26, 2023, revealed that the resident had behavior problems at times related to increased confusion, combative with care, wandering behaviors, and physically aggressive with peers with a goal for the resident to have fewer episodes of behaviors. Planned interventions were to meet and anticipate the needs of the resident and praise any indication of the resident's progress/improvement in behavior. A facility incident investigation report completed by Employee 5, a RN, dated March 24, 2024, at 6:30 p.m., revealed that she was called to the unit due to Resident C3 striking another resident {Resident C1} on the right upper arm with his closed hand twice. Both residents were sitting in the hallway in front of North's nursing station. Resident C3 stated, that other resident {Resident C1} would not stop saying things to him, so I hit him. Both residents were immediately separated by staff members and Resident C3 returned to his unit and safety measures were initiated. Resident C1 was assessed with no injuries observed and no complaints of pain. A review of a witness statement completed by Employee 6, a Licensed Practical Nurse (LPN), dated March 24, 2024, at 6:30 p.m., revealed that while at the nurse's desk in the North hallway, she observed resident Resident C3 slap Resident C1 and separated them for safety. The facility failed to protect Resident C1's from physical abuse perpetrated by other residents with histories of physical aggression. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395421 If continuation sheet Page 2 of 16 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 395421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glen Brook Rehabilitation and Healthcare Center 801 East 16th Street Berwick, PA 18603 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 0600 During an interview with the Nursing Home Administrator (NHA) on March 28, 2024, at 1:15 p.m., the NHA confirmed that Resident C1 was not protected from physical abuse. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 201.29(a)(c)(d) Resident rights Residents Affected - Some 28 Pa. Code 201.18(e)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395421 If continuation sheet Page 3 of 16 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 395421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glen Brook Rehabilitation and Healthcare Center 801 East 16th Street Berwick, PA 18603 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on review of select facility policy and staff interview, it was determined that the facility failed to fully develop and implement an abuse prohibition policy with corresponding written procedures to assure staff carry out the tasks necessary to fulfill required components for abuse prevention. Residents Affected - Some Findings include, A review of a facility policy for, Abuse, Neglect and Exploitation reviewed February 7, 2024 revealed guidelines to include: 1. The facility will develop and implement written policies and procedures that; a. Prohibit and prevent abuse, neglect and exploitation of residents and misappropriation of resident property. b. Establish policies and procedures to investigate any such allegations The abuse policy did not include Involuntary seclusion as a form of abuse or any definitions of the types of abuse included in the policy. Screening procedures included: A. Potential employees will be screened for a history of abuse, neglect, exploitation or misappropriation of resident property. 1. Background, reference, and credential's checks shall be conducted on potential employees, contracted temporary staff Prevention of abuse, neglect and exploitation to include: The facility will implement policies and procedures to prevent and prohibit all types of abuse, neglect, misappropriation of resident property and exploitation that achieves: --Providing residents, representatives and staff information on how and to whom they may report concerns, incidents and grievances without fear of retribution and providing feedback regarding the concerns that have been expressed. Reporting/Response: The facility will have written procedures that include: 1. Reporting all alleged violations to the administrator, state agency, adult protective services and to all other required agencies(e.g. law enforcement when applicable) within specified timelines. a. Immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegations involve abuse or result in serous bodily injury, or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395421 If continuation sheet Page 4 of 16 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 395421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glen Brook Rehabilitation and Healthcare Center 801 East 16th Street Berwick, PA 18603 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some b. Not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serous bodily injury B. The administrator will follow up with government agencies, during business hours, to confirm the initial report was received, and to report the results of the investigation when final within 5 working days of the incident, as required by state agencies. The policy does not include the criteria for notifying the local Area on Aging or the State Department of Aging. The policy did not include procedures making the state nurse aide registry and licensing agency's aware of any actions taken by the courts regarding an employee unfit for duty, and notification of law enforcement for the following criteria abuse or neglect resulting in physical bodily injury, sexual abuse, misappropriation of resident funds/property and unexplained/unexpected death. The facility abuse prohibition policy provided to the survey team at the time of the survey ending March 28, 2024, did not contain components to include identifying all types of abuse. The facility failed to identify state specific screening requirements if potential employees had resided in Pennsylvania the previous 2 years, and if not, conduct an FBI (Federal Bureau of Investigation) criminal background check. The policy for investigation into Alleged abuse, neglect and exploitation include: A. An immediate investigation is warranted when suspicion of abuse, neglect or exploitation, or reports of abuse, neglect or exploitation occur. B. Written procedures for investigation include: 1. Identifying staff responsible for the investigation 2. Investigating different types of alleged violations 3. Identifying and interviewing all involved persons, including the alleged victim, alleged perpetrator, witnesses and others who might have knowledge of the allegations. The facility failed to include corresponding procedures for screening, abuse prevention, investigation and reporting. The policy provided included a Abuse/Neglect allegation checklist. There was no documented evidence at the time of the survey that this policy statement and check list of requirements included written procedures for implementation by staff to investigate allegations of abuse, timeframes for investigation and reporting to the State Licensing Agency, AAA, PDA and local law enforcement and staff training requirements. There was no evidence that the facility's abuse policy included written procedures to meet all required components including screening, training, prevention, identification, investigation, protection or reporting procedures. During an interview March 28, 2024 at approximately 2 PM, the interim NHA verified that the abuse prevention policy provided at the time of the survey did not contain all the required components and there were no written procedures for staff to follow to carry out the steps noted on the checklist (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395421 If continuation sheet Page 5 of 16 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 395421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glen Brook Rehabilitation and Healthcare Center 801 East 16th Street Berwick, PA 18603 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607 to assure timely and consistent implementation by staff. Level of Harm - Minimal harm or potential for actual harm Refer F600 28 Pa. Code 201.18 (e)(1) Management Residents Affected - Some 28 Pa. Code 201.29(a)(b) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395421 If continuation sheet Page 6 of 16 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 395421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glen Brook Rehabilitation and Healthcare Center 801 East 16th Street Berwick, PA 18603 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, clinical record review and staff interview, it was determined that the facility failed to timely develop and implement a person-centered care plan to meet one resident's current needs for the use of an implantable cardiac devices for one of nine sampled residents (Resident B1). Findings including: Clinical record review revealed that Resident B1 was admitted to the facility on [DATE], with diagnoses to include A-V block (atrioventricular block (AV block) is a disease of the electrical conduction system of the heart in which electrical impulses conduct from the cardiac atria to the ventricles through the atrioventricular node (AV node) more slowly than [NAME] and heart disease), implantable cardiac pacemaker and hypertensive chronic kidney disease with heart failure. Review of quarterly Minimum Data Set Assessment (Minimum Data Set - a federally mandated standardized assessment conducted at specific intervals to plan resident care) dated February 7, 2024, revealed that Resident B1 was moderately cognitively impaired with a BIMS score BIMS (Brief Interview for Mental Status) is a mandatory tool used to screen and identify the cognitive condition of residents upon admission into a long-term care facility) of 10 required assistance from staff for activities of daily living. A review of the resident's current plan of care initially dated April 24, 2023, did not include any reference to the presence of, or the care, for the resident's implantable pace maker. During an interview on March 28, 2022, at 1 PM, the acting Director of nursing confirmed that the implantable cardiac pacemaker was not addressed on the resident's plan of care. 28 Pa Code 211.12 (d)(3)(5) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395421 If continuation sheet Page 7 of 16 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 395421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glen Brook Rehabilitation and Healthcare Center 801 East 16th Street Berwick, PA 18603 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 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation and staff interview, it was determined that the facility failed to correctly post daily nursing time. Residents Affected - Many Findings include: During an observation on March 28, 2024, at approximately 9:30 a.m. the facility's posted nursing time was observed in the lobby of the facility. The schedule was posted for the entire day at 9:30 a.m. for the next two shifts of nursing duty. The nursing time was also posted in full time staff equivalents and not the total number of nursing staff members on duty and the actual hours worked by these nursing staff members An interview with the interim NHA (nursing home administrator) on March 28, 2024, at the time of this observation confirmed that the nursing time is to be posted before each shift not for the entire day and should include total number and actual hours worked by licensed and unlicensed nursing staff directly responsible for resident care per shift 28 Pa. Code 211.12 (c) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395421 If continuation sheet Page 8 of 16 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 395421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glen Brook Rehabilitation and Healthcare Center 801 East 16th Street Berwick, PA 18603 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records and select facility policy and resident and staff interview it was determined that the facility failed to provide pharmacy services to assure consistent availability of routine prescribed pharmaceuticals and medications for four of nine residents reviewed (Residents B3, B4, B5, and C4). Findings include: A review of the facility's policy titled Ordering and Receiving Non-Controlled Medications provided by facility during the survey of March 28, 2024, and dated as last reviewed by the facility August 2020, indicated that repeat medications (refills) are written on a medication reorder form or by peeling the reorder tab from the prescription label and placing it in the appropriate area on the medication reorder form provided by the pharmacy, or requested via the facility's EHR (Electronic Health Record) system. A review of the clinical record revealed that Resident B3, was admitted to the facility on [DATE], with diagnosis to include diabetes. Current physician orders for Resident B3 dated September 16, 2023, revealed, Alpha-Lipoic Acid Oral Capsule 600 mg, Give 600 mg by mouth two times a day for diabetic neuropathy A review of the resident's March 2024 Medication Administration Record (MAR) revealed that on March 17, 2024, at 5 PM and March 18, 2024, at 8 AM the Alpha-Lipoic Acid was not available in the facility for administration to the resident. A review of the clinical record of Resident B4, revealed admission to the facility on August 26, 2023, with diagnoses of flaccid hemiplegia and peripheral vascular disease The resident had a current physician order dated March 21, 2024, revealed to Cleanse a sacral wound with Normal Saline Solution. Apply Santyl (a topical debridement agent), nickel thick, to wound bed. Cover with a foam dressing. Change daily, every day shift A review of a March 2024 MAR revealed that on March 23, 2024, day shift the Santyl debridement agent was not available in the facility for administration of the resident's wound treatment. A review of a nurses note dated March 23, 2024 at 10:26 AM revealed that This nurse went to do treatment and unable to locate Santyl. Supervisor aware. Cleansed wound and dressed with Dry Sterile Dressing until further notice. A review of Resident B5's clinical record revealed admission on [DATE], with diagnoses to include HEPATIC ENCEPHALOPATHY (A loss of brain function as a result of failure in the removal of toxins from the blood due to liver damage) and PORTAL HYPERTENSION (Portal hypertension is a serious condition that affects the blood flow from the digestive organs to the liver ). Current physician orders for Resident B5 dated November 6, 2023, Lactulose Oral Solution 10 GM/15 ML, Give 45 ml by mouth four times a day related to HEPATIC ENCEPHALOPATHY and r/t increased Ammonia Level. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395421 If continuation sheet Page 9 of 16 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 395421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glen Brook Rehabilitation and Healthcare Center 801 East 16th Street Berwick, PA 18603 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A nurses note dated March 23, 2024 at 4:03 PM revealed, Lactulose Oral Solution 10 GM/15 ML Give 45 ml by mouth four times a day related to HEPATIC ENCEPHALOPATHY was on order. The medication was not available in the facility for administration to this resident. A nursing note dated March 25, 2024 at 07:02 AM revealed that the medication was on order. The resident, who is his own responsible party, was made aware, along with the physician with no new orders at this time. The resident's March 2024 MAR revealed that on March 23, 2024, at 5 PM dose of Lactulose was not available in the facility for administration to the resident. However, nursing staff signed the resident's MAR as administered to the resident as ordered from March 23, 24 and 25, 2024. During an interview with the acting Director of Nursing (DON) March 28, 2024, at approximately 1 PM the DON stated that the routine medication Lactulose was not available in the facility for administration from March 23, 2024, through March 25, 2024, as noted in the nursing documentation in the resident's clinical record. She also verified that despite the medication not being unavailable, licensed nursing staff signed the resident's MAR indicating that the medication was administered to the resident as scheduled. During an interview with the acting Director of Nursing (DON) on March 28, 2024, at 1 PM she confirmed that when there are three doses of the medications remaining, staff should reorder medications through PCC (Point Click Care - electronic healthcare software provider). She confirmed that facility staff failed to follow this policy for reordering medications, failing to ensure consistent availability of a prescribed medications. A review of Resident C4's clinical record revealed admission to the facility on April 20, 2023, with diagnoses that included urinary tract infections (UTI) and personal history of traumatic brain injury. Physician orders dated March 25, 2024, were noted for Macrobid Oral Capsule 100 MG [(Nitrofurantoin Monohyd Macro) an antibiotic used to treat urinary infections], give 1 capsule by mouth two times a day and Cipro Oral Tablet 500 MG (Ciprofloxacin HCl), give 1 tablet by mouth two times a day related to related to urinary tract infection. Resident C4's Medication Administration Record (MAR) dated March 2024, revealed that on March 25, 2024, Macrobid and Cipro antibiotic administration was noted as 8 or other. The nurse's administration note indicated that the medications were not available from pharmacy for administration on the date. A review of the facility's Omnicell [an automatic medication administration system that stores medications for availability to prevent delays in administration of medications] inventory list dated March 28, 2024, revealed that both Macrobid Oral Capsule 100 MG and Cipro Oral Tablet 500 MG were available in the system, for administration to Resident C4 but were not accessed and administered to the resident on that date. An interview with the acting Director of Nursing (DON) on March 28, 2024, at 1:10 p.m., confirmed that the facility's Omnicell contained both antibiotics, but staff failed to administer them to Resident C4 when the drugs were not available in the resident' supply on March 25, 2024. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395421 If continuation sheet Page 10 of 16 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 395421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glen Brook Rehabilitation and Healthcare Center 801 East 16th Street Berwick, PA 18603 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 28 Pa. Code 211.12 (d)(3)(5) Nursing services. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.9 (a)(1)(k) Pharmacy services Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395421 If continuation sheet Page 11 of 16 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 395421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glen Brook Rehabilitation and Healthcare Center 801 East 16th Street Berwick, PA 18603 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records and select investigative reports and staff interview, it was determined that the facility failed to maintain accurate and complete clinical records, according to professional standards of practice for one of nine sampled residents (Resident A1). Findings include: According to the American Nurses Association Principles for Nursing Documentation, nurses document their work and outcomes and provide an integrated, real-time method of informing the health care team about the patient status. Timely documentation of the following types of information should be made and maintained in a patient record to support the ability of the health care team to ensure informed decisions and high quality care in the continuity of patient care: Assessments, Clinical problems, Communications with other health care professionals regarding the patient, Communication with and education of the patient, family, and the patient's designated support person and other third parties. According to the Title 49, Professional and Vocational Standards, Department of State, Chapter 21 State Board of Nursing Subsection 21.11 (a) The register nurse assesses human responses and plans, implements and evaluates nursing care for individuals or families for whom the nurse is responsible. In carrying out this responsibility, the nurse performs all of following functions: (4) Carries out nursing care actions which promote, maintain, and restore the well-being of individuals (6)(b) The registered nurse is fully responsible for all actions as a licensed nurse and is accountable to clients for the quality of care delivered and Subsection 21.18. (a)(5) document and maintain accurate records. According to the Title 49, Professional and Vocational Standards, Department of State, Chapter 21 State Board of Nursing Subsection 21.145. (a) The licensed practical nurse (LPN) is prepared to function as a member of a health-care team by exercising sound nursing judgement based on preparation, knowledge, skills, understanding and past experiences in nursing situations. The LPN participates in the planning, implementation, and evaluation of nursing care in settings where nursing takes place. A review of Resident A1's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses which included morbid obesity. A review of a facility incident report dated March 24, 2024, revealed that the resident had accused a staff member of calling her a whore. Resident A1 notified facility nursing staff on March 26, 2024, that 2 nights prior, a nurse aide had called her a whore as she was walking out of the room. A review of the resident's clinical record revealed no documentation in the resident's clinical record regarding the resident's allegation of verbal abuse. An interview with the Nursing Home Administrator on March 28, 2024, at approximately 2:45 PM confirmed that there was no documented evidence that the resident's allegation of verbal abuse was documented in the resident's clinical record. 28 Pa. Code 211.5 (f)(iii) Medical records. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395421 If continuation sheet Page 12 of 16 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 395421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glen Brook Rehabilitation and Healthcare Center 801 East 16th Street Berwick, PA 18603 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 28 Pa. Code 211.12 (c)(d)(1)(5) Nursing services. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395421 If continuation sheet Page 13 of 16 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 395421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glen Brook Rehabilitation and Healthcare Center 801 East 16th Street Berwick, PA 18603 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on observations, review of the statement of deficiencies from the surveys ending February 6, 2024, and February 28, 2024, and the activities of facility's quality assurance committee and staff interviews it was determined that the facility failed to implement effective plans to correct quality deficiencies in pharmacy services, timely obtaining resident medications, and accurate clinical records to ensure that corrective action plans designed to improve the delivery of care and services were consistently implemented to correct and deter future quality deficiencies. Findings included: During the survey ending February 28, 2024, quality deficiencies were cited under the requirements for pharmacy services due to the facility's failure to timely obtain resident medications and clinical records for failing to maintain accurate and complete medical records reflecting the resident's experience in the facility. In response to these deficiencies, the facility developed a plan of correction to correct these deficient practices that included quality assurance monitoring plans to assure solutions were sustained. These corrective plans were to be completed and functioning by March 15, 2024. However, during this revisit survey completed on March 28, 2024, continued deficiencies were identified under these same requirements. In response to the deficiency cited under pharmacy services the facility has determined that residents have the potential to be affected. Staff Educator / designee educated the licensed nursing staff on the facility pharmacy procedures for ordering/reordering routine prescribed medications. Licensed nursing staff will order medications when there are 8 doses available. The nurse will management team will review and address pharmacy order alerts in PCC. Director of nursing / designee will review resident clinical records to assure that prescribed medications are available for administration Audits will be completed daily x 7 days, then weekly for 4 weeks, then monthly for 2 months or until compliance is sustained. However, at the time of the survey ending March 28, 2024, it was found through a review of clinical records and select facility policy and resident and staff interview that the facility failed to provide pharmacy services to assure consistent availability of routine prescribed pharmaceuticals and medications for four of nine residents reviewed (Residents B3, B4, B5, and C4). During an interview with the acting Director of Nursing (DON) on March 28, 2024, at 1 PM she confirmed that when there are three doses of the medications remaining, staff should reorder medications through PCC (Point Click Care - electronic healthcare software provider). She confirmed that facility staff failed to follow this policy for reordering medications, failing to ensure consistent availability of a prescribed medications. The facility's plan of correction, however, indicated that Licensed nursing staff will order medications when there are 8 doses available. The nurse will management team will review and address pharmacy order alerts in PCC. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395421 If continuation sheet Page 14 of 16 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 395421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glen Brook Rehabilitation and Healthcare Center 801 East 16th Street Berwick, PA 18603 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Deficient facility practice was cited during the February 28, 2024, survey for failing to maintain accurate and complete clinical records according to professional standards of practice. The facility's plan of correction indicated that the DON/designee will provide in-service education to Licensed nursing staff on the documentation standards of the American Nurses Association Principles for Nursing Documentation. The DON/designee will complete audits of resident records related to incidents of falls to ensure licensed staff are thoroughly and accurately documenting according to professional standards of practice. Audits will be done weekly for four weeks, then monthly for two months or until compliance is achieved. Results will be presented in QAPI committee meeting. However, at the time of this revisit survey a facility incident report dated March 24, 2024, revealed that the resident had accused a staff member of verbal abuse, which reported to nursing staff on March 26, 2024. A review of the resident's clinical record revealed no documentation in the resident's clinical record regarding the resident's allegation of verbal abuse. An interview with the Nursing Home Administrator on March 28, 2024, at approximately 2:45 PM confirmed that there was no documented evidence that the resident's allegation of verbal abuse was documented in the resident's clinical record. The facility's QAPI committee failed to identify that the facility's corrective action plans were not developed and/or implemented in a manner consistent with the regulatory guidelines for these deficiencies cited, to ensure that solutions to the problems were sustained. Refer F755, F842 28 Pa. Code 211.12 (c) Nursing services 28 Pa. Code 201.18 (e)(1)(3) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395421 If continuation sheet Page 15 of 16 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 395421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glen Brook Rehabilitation and Healthcare Center 801 East 16th Street Berwick, PA 18603 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 0943 Level of Harm - Minimal harm or potential for actual harm Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation. Based on staff interviews and a review of employee personnel records it was determined that the facility failed to provide abuse prevention training to one employee out of five reviewed. (Employee 2). Residents Affected - Few Findings include: During an interview with Employee 2 (agency LPN) on March 28, 2024 at 9:45 a.m she stated that this was the first shift she worked at the facility. Employee 2 stated that she was never trained on the facility's abuse prohibition policy prior to assuming her duties today. There was no documentation that Employee 2 was trained on the facility's abuse prohibition policies and procedures as part of staff orientation and training on the prohibition of all forms of abuse, neglect, and exploitation prohibition. Interview with the Administrator on March 28, 2024 at 11:15 a.m., confirmed that the facility had no written records to show that Employee 2 was trained on the facility's policy and procedures on as part of staff orientation and training before assuming job duties. 28 Pa. Code 201.20 (b) Staff development 28 Pa. Code 201.19 (7) Personnel policies and procedures FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395421 If continuation sheet Page 16 of 16