Inspection·November 17, 2023

F 0656 Plan for staff education Level of Harm - Minimal harm or potential for actual harm Center specific VAD treatment plan Draft VAD standing orders with Nurse Practitioner and according to Genesis Policy and Procedure. Residents Affected - Some Review of clinical record for Resident R138 revealed that the resident was admitted to the facility with diagnosis including congestive heart failure and presence of heart assist device. Review of care plan for Resident R138 dated October 20, 2023, revealed no evidence that the facility developed a care plan for the care of LVAD with intervention and precautions specific to the care of LVAD including care of the machine, dressing changes, monitor for placement and monitoring for signs and symptoms of infection. Review of clinical record for Resident R357 revealed that the resident was admitted to the facility with diagnosis including ischemic cardiomyopathy and presence of heart assist device. Review of care plan for Resident R357 dated November 2, 2023, revealed no evidence that the facility developed a care plan for the care of LVAD with intervention and precautions specific to the care of LVAD. Review of clinical record for Resident R358 revealed that the resident was admitted to the facility with diagnosis including congestive heart failure and presence of heart assist device. Review of care plan for Resident R138 dated November 8, 2023, revealed no evidence that the facility developed a care plan for the care of LVAD with intervention and precautions specific to the care of LVAD including care of the machine, dressing changes, monitor for placement and monitoring for signs and symptoms of infection. 28 Pa. Code 211.10(c)(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: 395459 If continuation sheet Page 2 of 15 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 395459 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Center 262 Toll Gate Road Langhorne, PA 19047 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 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm Based on review of professional literature, clinical records, facility documentation, resident and staff interviews, it was determined that the facility failed to provide care and services to meet the accepted standards of practice for three of three residents reviewed for care and management of Left Ventricular Assist Device (LVAD-mechanical pumps that are attached directly to the heart. One end of the pump is attached to the left chamber (left ventricle) which helps pump blood out of the ventricle to the aorta and then to the rest of the body) (Resident R357, R138 and R358). Residents Affected - Some Findings Include: Review of journal from American Nurses Today (Facility provided document) volume 12, Number 5, Caring for Patients with a left ventricular assist device dated May 2017, revealed the following information: Proper Assessment Caring for the hospitalized patient with an LVAS begins with through assessment of both LVAD and patient. Monitor blood pressure and mean arterial pressure (MAP), the goal is 60 mm Hg to 90 mm Hg. Elevated MAP decreases flow and perfusion. If MAP is too high, the patient may require antihypertensive drugs, such as metoprolol, hydralazine, and isosorbide dinitrate. These drugs may need to be adjusted until the goal MAP is reached. Always check with the provider before holding any medications due to a low MAP. Check the LVAD each time you assess the patient's vital signs. You will hear the continuous humming sound of the pump when auscultating the heart. Make sure the battery- charging station is plugged into the wall and at least two spare batteries are in the charge station; a green light indicates a full charge. Additional safety checks include assessing the driveline to ensure it's securely in place and confirming there's a back-up system controller in the room. Technical Care of the LVAD The LVAD requires regular care and system checks, including power-source changes, daily self-tests, and driveline dressing changes. Performing these tasks in the hospital provides teaching opportunities for patients and caregivers. Performing a daily self-test Teach the patient to perform a daily self-test to ensure the LVAD is working properly. When the patient presses and holds the battery button on the system controller, the screen displays Self Test, If the panel is working properly, the audio alarm will sound, and control panel alarms will light up. These alarms include power and battery alarms, a red heart (hazard) alarm, and a wrench (advisory) alarm. Changing the driveline dressing Assess the driveline site during each patient assessment, or more frequently if you're concerned about dislodgment. Except under special circumstances, the driveline dressings must be changed daily or every other day, depending on the provider's order and how long the patient has had the LVAD. Ultimately, you're responsible for ensuring the dressing change is completed; however, if you or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395459 If continuation sheet Page 3 of 15 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 395459 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Center 262 Toll Gate Road Langhorne, PA 19047 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 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the VAD coordinator have trained and observed the patient and caregiver changing the dressing, you can let them do it. Managing Complications Common LVAD complications include infection, pump thrombus, hemorrhage, arrhythmias, and suction events. Infection Several factors put patients with LVADs at high risk for infection- for example, malnutrition. Potential sources of infection include ventilators, central venous catheters, peripheral I.V. lines, and indwelling urinary catheters. Keep in mind that all hospital patients are at risk for methicillin-resistant Staphylococcus aureus infection and Clostridium difficile infection, as well as pressure injuries, which can become infected. After surgery, driveline infections are common. To help prevent these infections, provide thorough patient and caregiver education on performing driveline dressing changes. Review of an undated facility education document Post acute care of patient with VAD-Principles and Practices revealed that Prior to admission: Prepare a VAD treatment plan specific to your patient and center. Include patient history. Plan for staff education Center specific VAD treatment plan Draft VAD standing orders with Nurse Practitioner and according to Genesis Policy and Procedure. Contact discharging hospital's VAD coordinator to schedule onsite training for core staff if needed -Unit Managers -Cart Nurses (weekend and night shift especially important) -NPE -NPE to present training materials provided by VAD manufacturer and VAD coordinator -Broader education of clinical staff -Clinical competencies Special Considerations. Patient must be managed by an RN (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395459 If continuation sheet Page 4 of 15 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 395459 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Center 262 Toll Gate Road Langhorne, PA 19047 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 0658 An undated document provided by the facility titled LVAD-Left Ventricular Assist Device revealed that Blood pressure is taken with a Doppler. Level of Harm - Minimal harm or potential for actual harm -A peripheral pulse may not be palpable Residents Affected - Some -If parameters are out of range call LVAD coordinator -Driveline dressing changed weekly and as needed-Must be sterile dressing change. -If there is yellow or red alarm notify LVAD coordinator ASAP! -A q shift test needed to be completed to ensure the LVAD is working properly-Press and hold the battery button on the system controller, then screen displays self-test- the audio alarm will sound an control panel alarm will light up-these alarms include power, hazard and advisory alarms. The MAP-mean arterial pressure goal is usually between 65-85 the BP obtained via a Doppler. Complications. Infections-LVAD patients are at high risk for infection-drive line dressing care is most importance. Interview with the Director of Nursing, Employee E2, confirmed that on November 15, 2023, at 1:59 p.m. stated facility did not have an LVAD policy and staff competency protocol to ensure staff education and skills. Review of LVAD instruction for Resident R138 revealed that staff should complete daily weights, check vital signs and VAD parameters every shift, document all vital signs obtained into flow sheets. Further review of the instructions revealed that staff should call VAD coordinator with any alarms, MAP below 60 or above 90, 1 hour after administering scheduled blood pressure medication. Complete driveline dressing change weekly with supervision. Review of LVAD instruction for Resident R138 revealed that staff should immediately call LVAD coordinator if at any time the residents pump reading were out of parameter limits. Further review of the instruction revealed that there was no out of range parameters were established. Review of physician order for Resident R138 dated October 20, 2023, revealed orders to record shift check of LVAD controller and the power base unit (PBU) every day shift and night shift, vital signs every day and night shift, weight daily, check previous shifts alarms - document if alarm is present, and Record Pump Rate (PR), Pulse Index (PI), Pump Power (PP) and Pump Speed (PS) every shift, Review of Medication and Treatment Administration Record (MAR/TAR) and LVAD flowsheet for Resident R138 for the month of October 2023 revealed that no PI, PP, PS or PR for October 29 and 31-day shift. There was no weight documented for October 21, 23, 25 and 31. Further review of LVAD flow sheet revealed that no self-test was documented as completed on October 21, 22, 23, 25, 27 and 30 day and night shifts. October 26 and 29 day shift, October 28 and 31 night shift. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395459 If continuation sheet Page 5 of 15 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 395459 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Center 262 Toll Gate Road Langhorne, PA 19047 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 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Further review of LVAD flow sheet for Resident R357 revealed that there was MAP documented above 90, 16 times from October 20 to November 14 with any documented evidence of a follow up or notification to the physician or LVAD coordinator. Review of physician order for Resident R358 dated November 8, 2023, revealed orders to record shift check of LVAD controller and the power base unit (PBU) every day shift and night shift, vital signs every day and night shift, weight daily. Review of Medication and Treatment Administration Record (MAR/TAR) and LVAD flowsheet for Resident R358 for the month of November 2023 revealed that there was no weight documented for November 9, 10 and 13. Review of physician progress note for Resident R358 dated November 8, 2023, revealed that the resident was admitted with LVAD drive line infection and resident was on wound vac (Vacuum-assisted closure of a wound is a type of therapy to help wounds heal). A recommendation was made to change wound vac according to the orders. Review of physician progress note for Resident R358 dated November 10, 2023, revealed a recommendation to change wound vac Monday, Wednesday and Friday. Further review of the physician orders for Resident R358 and Treatment Administration Record` revealed no evidence that a physician order was obtained for driveline dressing changes or a dressing change date was scheduled and completed until November 15, 2023. Review of LVAD flow sheet for Resident R358 revealed that there was missing documentation on November 10, 13, 15, 16 for both shifts. Review of physician order for Resident R357 dated November 9, 2023, revealed orders to change LVAD dressing change utilizing sterile technique every Thursday day shift. Review of TAR for Resident R357 revealed that the nurse signed out the order as completed on November 9, 2023. Review of LVAD parameters for Resident R357 revealed that there was values entered for pump speed, flow, pulse index and power. However, the notification range was not entered or established for staff guidance to notify the physician or LVAD coordinator. Review of LVAD flow sheet for Resident R357 revealed that there was missing documentation on November 6,10, 13 for both shifts. Interview with Licensed Practical Nurse, Employee E13, on November 17, 2023, at 12:54 p.m. stated she did not complete the dressing changes for Resident R138 and R357 because there was no dressing supply available. She stated the previous shift nurse placed clean dressings instead of a sterile dressing. Interview with Director of Nursing, Employee E2, on November 17, 2023, at 2:00 p.m. confirmed that the facility did not provide care and services to residents with LVAD according to professional standards. Employee E2 stated facility did not have a policy and staff competency related to LVAD care. Facility did not complete LVAD education since March 2020. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395459 If continuation sheet Page 6 of 15 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 395459 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Center 262 Toll Gate Road Langhorne, PA 19047 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 0658 28 Pa. Code: 201.14(a) Responsibility of licensee. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12(d)(1)(2)(5) Nursing services Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395459 If continuation sheet Page 7 of 15 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 395459 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Center 262 Toll Gate Road Langhorne, PA 19047 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 0659 Provide care by qualified persons according to each resident's written plan of care. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, facility procedures and interview with staff, it was determined that the facility failed to ensure that Left Ventricular Assist Device (LVAD-mechanical pumps that are attached directly to the heart. One end of the pump is attached to the left chamber (left ventricle) which helps pump blood out of the ventricle to the aorta and then to the rest of the body) care and services were provided by a qualified person (Registered Nurses), in accordance with facility protocol and acceptable standards for three of three residents reviewed. (Resident R138, R357 and R358). Residents Affected - Some Findings Include: Review of an undated facility education document Post acute care of patient with VAD-Principles and Practices revealed that Prior to admission: Prepare a VAD treatment plan specific to your patient and center. Include patient history. Plan for staff education Center specific VAD treatment plan Draft VAD standing orders with Nurse Practitioner and according to Genesis Policy and Procedure. Contact discharging hospital's VAD coordinator to schedule onsite training for core staff if needed. -Unit Managers -Cart Nurses (weekend and night shift especially important) -NPE -NPE to present training materials provided by VAD manufacturer and VAD coordinator -Broader education of clinical staff -Clinical competencies Special Considerations. Patient must be managed by an RN Review of clinical record for Resident R138 revealed that resident was provided care and assessments, including LVAD assessments were completed by Licensed Practical Nurse (LPN), Employee E14, on November 6, 2023, day shift. Review of clinical record for Resident R138 revealed that resident was provided care and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395459 If continuation sheet Page 8 of 15 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 395459 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Center 262 Toll Gate Road Langhorne, PA 19047 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 0659 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some assessments, including LVAD assessments were completed by Licensed Practical Nurse (LPN), Employee E13, on November 4, 9, 11. Employee E11 also signed the LVAD dressing change order on November 9, 2023, Review of staffing sheet and Resident R138's clinical record revealed that Licensed Practical Nurse, Employee E15, provided care and assessments, including LVAD assessments on November 8, 2023, day shift. Review of clinical record for Resident R138 revealed that resident was provided care and assessments, including LVAD assessments were completed by Licensed Practical Nurse (LPN), Employee E16, on November 8, 2023, night shift. Review of clinical record for Resident R357 revealed that resident was provided care and assessments, including LVAD assessments were completed by Licensed Practical Nurse (LPN), Employee E14, on November 6, 2023, day shift. Review of clinical record for Resident R357 revealed that resident was provided care and assessments, including LVAD assessments were completed by Licensed Practical Nurse (LPN), Employee E13, on November 4, 9, 11. Employee E11 also signed the LVAD dressing change order on November 9, 2023. Review of staffing sheet and Resident R357's clinical record revealed that Licensed Practical Nurse, Employee E15, provided care and assessments, including LVAD assessments on November 8, 2023, day shift. Review of clinical record for Resident R357 revealed that resident was provided care and assessments, including LVAD assessments were completed by Licensed Practical Nurse (LPN), Employee E16, on November 8, 2023, night shift. Review of clinical record for Resident R358 revealed that resident was provided care and assessments, including LVAD assessments were completed by Licensed Practical Nurse (LPN), Employee E14, on November 6, 2023, day shift. Review of clinical record for Resident R358 revealed that resident was provided care and assessments, including LVAD assessments were completed by Licensed Practical Nurse (LPN), Employee E13, on November 4, 9, 11. Employee E11 also signed the LVAD dressing change order on November 9, 2023. Review of staffing sheet and Resident R358's clinical record revealed that Licensed Practical Nurse, Employee E15, provided care and assessments, including LVAD assessments on November 8, 2023, day shift. Review of clinical record for Resident R358 revealed that resident was provided care and assessments, including LVAD assessments by Licensed Practical Nurse (LPN), Employee E16, on November 8, 2023, night shift. Interview with Director of Nursing, Employee E2, on November 17, 2023, at 2:00 p.m. confirmed that the facility protocol stated RN should be assigned to care for residents with LVAD and Resident R138, R357 and R358 were provided care and assessment by LPN's including LVAD assessments and dressing changes. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395459 If continuation sheet Page 9 of 15 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 395459 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Center 262 Toll Gate Road Langhorne, PA 19047 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 0659 28 Pa. Code: 201.14(a) Responsibility of licensee. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12(d)(1)(5) Nursing services Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395459 If continuation sheet Page 10 of 15 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 395459 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Center 262 Toll Gate Road Langhorne, PA 19047 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 observations, interview with staff and residents it was determined that the facility did not ensure that residents receive treatment and care in accordance with professional standards of practice related to skin assessments and not following physician orders for two out of 33 residents reviewed (Resident R5 and R138) Residents Affected - Some Findings include: Review of facility's policy 'Skin Integrity and Wound Management', revised on February 1, 2023, The nursing assistant will observe skin daily and report any changes or concerns to the nurse. The licensed nurse will evaluate any reported or suspected skin changes or wounds. Review of Resident R5's care plan, revised on August 1, 2023, revealed that Resident R5 was at risk for skin breakdown related to advanced age, contractures, decreased activity, frail fragile skin, history of pressure ulcer, impaired cognition, impaired sensation, incontinence, hypotension, hypoxia and had actual skin breakdown. The intervention included for the resident to wear heel boots to bilateral feet at all times. Remove for skin checks. Observation of Resident R5's skin on November 16, 2023 at 1:23 p.m., with nurse aide, Employee E5 revealed that Employee E5 removed Resident R5's heel boot on left lower extremity. Upon removal of the heel boot there was an unsanitary discoloration on the inside of boot as well as reddened, callous and painful to touch left heel. Finding confirmed by Licensed nurse, Employee E4 and Unit manager, Employee E3. Review of Resident R5's last skin assessment, which was completed on November 10, 2023 at 7:41 p.m., revealed no evidence of Resident R5's assessment of left lower extremity. Additional review of progress notes between November 10, 2023 and November 16, 2023, revealed no evidence of assessment or evaluation of Resident R5's lower left extremity. Further review of Resident R5's orders revealed an order placed on November 16, 2023 at 6:18 p.m., for Aquaphor advanced therapy external ointment to be applied to left heel everyday at bedtime. Review of physician order for Resident R138 dated October 20, 2023, revealed an order for Hydralazine(Medication to treat blood pressure) 25 milligrams (mg), one tablet three times a day for Hypertension (high blood presure), hold the medication for MAP (mean arterial pressure) less than 85. Review of Medication Administration Record for Resident R138 for October 2023 revealed that the medication was administered on October 22 at 8:00 a.m. with a MAP of 82, October 26 at 8:00 a.m. with a MAP of 74, October 31 at 8:00 a.m. with a MAP of 84, October 25 at 2:00 p.m. with a MAP of 77, October 26 at 2:00 p.m. with a MAP of 72, October 28 at 2:00 p.m. with a MAP of 72, October 30 at 2:00 p.m. with a MAP of 84, October 31 at 2:00 p.m. with a MAP of 84, October 30, at 10:00 p.m. with a MAP of 84. Review of Medication Administration Record for Resident R138 for November 2023 revealed that the medication was administered on November 1 at 8:00 a.m. with MAP of 84, November 6 at 2:00 p.m. with a MAP of 78, November 13 at 2:00 p.m. with a MAP of 84. Interview with Director of Nursing, Employee E2, on November 17, 2023, at 2:00 p.m. confirmed that the staff did not follow physician orders related to the medication administration of Resident R138. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395459 If continuation sheet Page 11 of 15 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 395459 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Center 262 Toll Gate Road Langhorne, PA 19047 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 28 Pa. Code 211.10(c) Resident care policies Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12(d)(1)Nursing services Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395459 If continuation sheet Page 12 of 15 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 395459 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Center 262 Toll Gate Road Langhorne, PA 19047 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 Based on observations, reviews of clinical records and review of facility policies and procedures, it was determined that the facility failed to provide adequate treatment for midline catheter (a long, thin, flexible tube that is inserted into a large vein in the upper arm. It is used to safely administer medication into the bloodstream) line in accordance with professional standards of practice for one of 30 residents reviewed (Resident R356). Residents Affected - Few Findings include: Review of the facility policy Midline Catheter Dressing Change, dated February 2022 revealed that Sterile dressing change using transparent dressings is performed. Upon admission: If transparent dressing is dated, clean, dry and intact, the admission dressing change may be omitted and scheduled 7 days from the date on the dressing label. Review Resident R356's physician order dated November 7, 2023 revealed an order to change midline catheter transparent dressing every seven days. Observation of Resident R356 on November 14, 2023, at 10:18 a.m. revealed that the resident had a left upper extremity midline line insertion. The documentation on the dressing indicating the date and time the dressing last changed was on November 6, 2023. An interview with Employee E29, Registered Nurse on November 14, 2023, at 2:43 p.m confirmed that the dressing was last changed on November 6, 2023, and it should have been changed on November 13, 2023. An interview with Director of Nursing, Employee E2, on November 15, 2023, at 1:59 p.m. confirmed that the midline dressing for Resident R356 was last changed on November 6, 2023, and the dressing change was not completed as ordered by the physician. 28 Pa. Code: 211.10 (c) Resident care policies 28 Pa. Code: 211.10 (d) Resident care policies 28 Pa. Code: 211.12 (d)(3) Nursing services 28 Pa. Code: 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395459 If continuation sheet Page 13 of 15 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 395459 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Center 262 Toll Gate Road Langhorne, PA 19047 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 the review of facility documentation and staff interview, it was determined that the facility failed to ensure that nursing staff possessed the appropriate competencies and skill sets related to the care and assessment of Left Ventricular Assist Device (LVAD-mechanical pumps that are attached directly to the heart. One end of the pump is attached to the left chamber (left ventricle) which helps pump blood out of the ventricle to the aorta and then to the rest of the body) for 16 of 16 staff reviewed (Employee 13, 14, 15. 16. 17, 18, 19, 20. 21, 22, 23, 24, 25, 26, 27 and 28) Findings include: Review of an undated facility education document Post acute care of patient with VAD-Principles and Practices revealed that Prior to admission: Prepare a VAD treatment plan specific to your patient and center. Include patient history. Plan for staff education Center specific VAD treatment plan Draft VAD standing orders with Nurse Practitioner and according to Genesis Policy and Procedure. Contact discharging hospital's VAD coordinator to schedule onsite training for core staff if needed. -Unit Managers -Cart Nurses (weekend and night shift especially important) -NPE -NPE to present training materials provided by VAD manufacturer and VAD coordinator -Broader education of clinical staff -Clinical competencies Special Considerations. Patient must be managed by an RN A review of the facility documentation revealed that the facility had three residents, Resident R138, Resident R357 and Resident R358, with LVAD. Review of clinical record for Resident R357 and Resident R358 revealed that Employee 13, 14, 15. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395459 If continuation sheet Page 14 of 15 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 395459 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Center 262 Toll Gate Road Langhorne, PA 19047 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 16. 17, 18, 19, 20. 21, 22, 23, 24, 25, 26, 27 and 28 were assigned to care for LVAD including assessments and dressing changes. A request for the evidence of LVAD care and assessment competencies or annual evaluations were made to Director of Nursing on November 15, 2023, at 1:59 p.m. Residents Affected - Some Review of facility training records revealed no documented evidence that the nursing staff competencies or annual evaluations related to LVAD care and assessment were completed for Employee 13, 14, 15. 16. 17, 18, 19, 20. 21, 22, 23, 24, 25, 26, 27 and 28. Interview with Director of Nursing, Employee E2, on November 17, 2023, at 2:00 p.m. confirmed that the facility did not have a policy and staff competency related to LVAD care. Facility did not complete LVAD education since March 2020. 28 Pa. Code 211.12 (c)(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395459 If continuation sheet Page 15 of 15