Inspection·December 4, 2025

F 0687 Provide appropriate foot care. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observation, and resident and staff interview, it was determined that the facility failed to obtain professional podiatry services for four of two residents reviewed for skin conditions (Resident R1, R2, R3, and R4).Findings include:Review of the facility's Resident Council Minutes dated 8/25/25, revealed Resident R1, R2, and R3 would like to see the podiatrist. Review of the admission record indicated Resident R1 was admitted to the facility on [DATE], and readmitted on [DATE]. Review of Resident R1's Minimum Data Set (MDS - a periodic assessment of care needs) dated 8/5/25, indicated diagnoses of multiple sclerosis (damages the protective cover around nerves called myelin in your central nervous system), mononeuropathy (damage that occurs to single nerve) of bilateral lower limbs, and unsteadiness on feet. Review of Resident R1's clinical record failed to include an order to consult podiatry. During an interview on 10/15/25, at 2:44 p.m. Resident R1 stated they need to see a podiatrist. Resident R1 was observed with socks on. Review of the admission record indicated Resident R2 was admitted to the facility on [DATE]. Review of Resident R2's Minimum Data Set (MDS - a periodic assessment of care needs) dated 8/9/25, indicated diagnoses of anxiety, depression, and chronic pain syndrome. Review of Resident R2's physician order dated 5/2/25, indicated to consult podiatry and follow up as needed. During an interview on 10/14/25, at 2:37 p.m. Resident R2 indicated they have not seen podiatry and their toe nails have gotten longer. Resident R2 toe nails were observed to be thick and elongated. Documentation by the facility's contracted podiatry provider dated 8/19/25, failed to reveal Resident R2 was seen by podiatry as ordered.Review of the admission record indicated Resident R3 was admitted to the facility on [DATE]. Review of Resident R3's Minimum Data Set (MDS - a periodic assessment of care needs) dated 6/18/25, indicated diagnoses of cognitive communication deficit, anxiety, and depression. Review of Resident R3's clinical record failed to include an order to consult podiatry. Review of the admission record indicated Resident R4 was admitted to the facility on [DATE], and readmitted [DATE]. Review of Resident R4's Minimum Data Set (MDS - a periodic assessment of care needs) dated 7/3/25, indicated diagnoses of urinary tract infection, muscle weakness, and cognitive communication deficit. Review of Resident R4's physician order dated 8/11/25, indicated to consult podiatry and follow up as needed. Documentation by the facility's contracted podiatry provider dated 8/19/25, failed to reveal Resident R4 was seen by podiatry as ordered.During an interview on 10/14/25, at 11:51 a.m. Registered Nurse Unit Manager, Employee E1 stated all residents should have an as needed order to consult podiatry. If a resident needs to be seen by podiatry, the social worker is notified, then the residents are added to the list. Interview with the Director of Nursing (DON) on 10/14/25, at 2:53 p.m. confirmed Resident R1 and R3 failed to have an order to consult podiatry. During an interview on 10/14/25, at 3:41 p.m. the Nursing Home Administrator and DON confirmed the facility failed to obtain professional podiatry services for four of six residents reviewed (Resident R1, R2, R3, and R4).28 Pa. Code 211.12(d)(1)(3)(5) Nursing services Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395423 If continuation sheet Page 2 of 4 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 395423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Champion City Nursing and Rehabilitation Center 6655 Frankstown Avenue Pittsburgh, PA 15206 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 0711 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and interviews with staff, it was determined that the facility did not ensure that a physician s timely wrote, signed, and dated progress notes at each visit for one of four residents reviewed (Resident R4).Findings include:Review of the facility Physician Visits policy dated 4/2/25, revealed the attending physician must make visits in accordance with applicable state and federal regulations. The attending physician must perform relevant tasks at the time of each visit, including a review of the resident's total program of care and appropriate documentation. A physician visit is considered timely if it occurs not later than ten days after the visit was required. Review of the admission record indicated Resident R4 was admitted to the facility on [DATE], and readmitted [DATE]. Review of Resident R4's Minimum Data Set (MDS - a periodic assessment of care needs) dated 7/3/25, indicated diagnoses of urinary tract infection, muscle weakness, and cognitive communication deficit. Review of late entry progress note effective 7/7/25, entered on 8/3/25, by Medical Director, Employee E2 revealed the resident was seen in follow up care after readmission. The progress note was entered, signed , and dated a total of 27 days later. Review of late entry progress note effective 7/14/25, entered on 8/14/25, by Medical Director, Employee E2 revealed the resident was seen in follow up care after readmission. The progress note was entered, signed ,and dated a total of 31 days later. Review of late entry progress note effective 8/13/25, entered on 9/14/25, by Medical Director, Employee E2 revealed the resident was seen in follow up care after readmission. The progress note was entered, signed ,and dated a total of 32 days later. Resident R4 was discharged from the facility on 8/28/25. During an interview on 10/14/25, at 3:41 p.m. the Nursing Home Administrator and DON confirmed the facility failed to ensure that a physician timely wrote, signed, and dated progress notes at each visit for one of four residents reviewed (Resident R4).28 Pa. Code: 211.12(d)(5) Nursing services.28 Pa. Code: 211.2(a) Physician services.28 Pa. Code: 211.5(f) Clinical records. Event ID: Facility ID: 395423 If continuation sheet Page 3 of 4 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 395423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Champion City Nursing and Rehabilitation Center 6655 Frankstown Avenue Pittsburgh, PA 15206 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 0790 Provide routine and 24-hour emergency dental care for each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy and clinical records, and staff and resident interviews, it was determined that the facility failed to ensure that a dental appointment was scheduled for two of four residents reviewed (Resident R2 and R5).Findings include:Review of the facility's Resident Council Minutes dated 8/25/25, revealed Resident R2 and R5 would like to see the dentist. Review of the admission record indicated Resident R2 was admitted to the facility on [DATE]. Review of Resident R2's Minimum Data Set (MDS - a periodic assessment of care needs) dated 8/9/25, indicated diagnoses of anxiety, depression, and chronic pain syndrome. Review of Resident R2's physician order dated 5/2/25, indicated to consult dental as needed. During an interview on 10/14/25, at 2:37 p.m. Resident R2 stated they have not seen a dentist. Documentation by the facility's contracted dental provider dated 10/9/25, failed to reveal Resident R2 was seen by the dentist.Review of the admission record indicated Resident R5 was admitted to the facility on [DATE]. Review of Resident R5's Minimum Data Set (MDS - a periodic assessment of care needs) dated 8/15/25, indicated diagnoses of high blood pressure, dementia (the loss of cognitive functioning (thinking, remembering, and reasoning) to such an extent that it interferes with a person's daily life and activities), and constipation. Review of Resident R5's physician orders, failed to include a dental consult. During an interview on 10/14/25, at 2:40 p.m. Resident R5 stated I have not seen a dentist. Resident R5 was observed with upper dentures and indicated they have developed a sore on the bottom of their gums from chewing. Documentation by the facility's contracted dental provider dated 10/9/25, failed to reveal Resident R5 was seen by the dentist.During an interview on 10/14/25, at 11:51 a.m. Registered Nurse Unit Manager, Employee E1 stated all residents should have an as needed order to consult dental. If a resident needs to be seen by a dentist, the social worker is notified, then the residents are added to the list. Interview with the Director of Nursing (DON) on 10/14/25, at 2:53 p.m. confirmed Resident R5 failed to have an order to consult dental. During an interview on 10/14/25, at 3:41 p.m. the Nursing Home Administrator and DON confirmed the facility failed to obtain dental services for two of four residents reviewed (Resident R2 and R5).28 Pa. Code 211.12(d)(1)(3)(5) Nursing services28 Pa. Code 211.15(a) Dental Services. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395423 If continuation sheet Page 4 of 4