Health inspection·July 10, 2025

F 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to ensure that the resident and/or their representative received written notice of transfer and written notice of the facility bed-hold policy at the time of transfer for three of five residents reviewed for hospitalization (Residents 28, 59, and 65).Findings Include:Nursing documentation for Resident 65 dated May 15, 2025, at 11:58 PM revealed that the resident had a change in condition and 911 was called. A Medication Administration Note dated May 16, 2025, at 5:36 AM revealed that Resident 65 was admitted to the hospital for a urinary tract infection.A review of the census for Resident 65 revealed that the resident returned to the facility on May 21, 2025. Clinical record review revealed no documentation to indicate that Resident 65 and/or their representative received a written notice of transfer and a written notice of the facility bed-hold policy at the time of transfer. Documentation was also requested by the surveyor during meetings with the Nursing Home Administrator and Director of Nursing on July 8, 2025, at 2:10 PM and July 9, 2025, at 2:00 PM. An interview with the Director of Nursing on July 10, 2025, at 12:59 PM confirmed there was no documentation to indicate that Resident 65 and/or their representative received written notice of transfer and written notice of the facility bed-hold policy at the time of transfer.Clinical record review for Resident 59 revealed that he was transferred to the emergency room to be evaluated for mental status changes, weakness, and frequent falls on March 12, 2025. He was admitted to the hospital from the emergency room for weakness and pneumonia. Clinical record review revealed no documentation to indicate that Resident 59 and/or their representative received a written notice of transfer and a written notice of the facility bed-hold policy at the time of transfer. Documentation was also requested by the surveyor during meetings with the Nursing Home Administrator and Director of Nursing on July 9, 2025, at 2:17 PM. The facility failed to provide a written notice of transfer and a written notice of bed-hold that included all the written components to the resident and/or the resident's responsible party at the time of transfer for Resident 59. Clinical record review revealed Resident 28 was transferred to the hospital from [DATE] to May 2, 2025, for a change in his condition. Further review revealed no documentation to indicate that Resident 28's representative received a written notice of transfer and a written notice of the facility bed-hold policy at the time of transfer. Interview with Employee 4 (social worker) and Employee 5 (admissions) on July 10, 2025, at 9:57 AM confirmed these findings for Resident 28.28 Pa. Code 201.14(a) Responsibility of license28 Pa. Code 201.29(a) Resident rights Event ID: Facility ID: 395533 If continuation sheet Page 2 of 19 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 395533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Ridge Senior Living at Windy Hill 100 Dogwood Drive Philipsburg, PA 16866 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 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. 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 and staff interview, it was determined that the facility failed to provide care and services to maintain or improve the ability to perform activities of daily living for one of two residents reviewed for eating concerns (Resident 12).Findings include:Clinical record review for Resident 12 revealed an MDS (Minimum Data Set, assessment completed at specific intervals to determine care needs) assessment dated [DATE], that staff assessed Resident 12 as requiring the supervision with set up help only for eating. Resident 12's next MDS assessment dated [DATE], revealed staff assessed Resident 12 as now requiring extensive assistance of one staff for eating.There was no documented evidence in Resident 12's clinical record to indicate that the facility identified or assessed Resident 12's decline in her ability to perform this activity of daily living.Interview with Employee 2 (registered nurse assessment coordinator) on July 10, 2025, at 11:45 AM confirmed these findings and stated that she would submit a screen for speech therapy to assess Resident 12's decline in his ability to feed himself.The surveyor reviewed the above findings for Residents 12 with the Director of Nursing and the Nursing Home Administrator on July 9, 2025, at 12:05 PM. The facility was unable to provide any further documentation that the facility assessed Resident 12's decline in eating ability or implemented any measures to mitigate the decline.28 Pa. Code 211.12(d)(1)(3)(5) Nursing services Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395533 If continuation sheet Page 3 of 19 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 395533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Ridge Senior Living at Windy Hill 100 Dogwood Drive Philipsburg, PA 16866 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 clinical record review and staff interview, it was determined that the facility failed to provide the highest practicable care regarding physician ordered medication parameters for one of one resident reviewed for concerns (Resident 43) and failed to provide the highest practicable care regarding pacemaker care for one of one resident reviewed (Resident 384). Clinical record review for Resident 43 revealed a diagnosis list that included hypertension (high blood pressure), essential hypertension, and paroxysmal atrial fibrillation (an irregular heartbeat that comes and goes). Residents Affected - Few Review of Resident 43's current care plan revealed the resident has an altered cardiovascular status related to the medical history. An intervention included to administer medications as ordered. A review of the current physician orders for Resident 43 dated May 6, 2025, indicated for staff to administer Metoprolol Succinate ER Extended Release (a medication that is used to treat high blood pressure and/or heart rate) 25 milligrams (mg) give one tablet orally at bedtime related to essential hypertension. Hold if systolic blood pressure (SBP, the top number of a blood pressure reading where the heart contracts) less than or equal to 110 or a heartrate less than or equal to 70. A review of the Medication Administration Record (MAR) for Resident 43 revealed that the Metoprolol was marked as administered outside of the physician specified parameters for the following: May 9, 2025: the pulse was documented as 62.May 10, 2025: the pulse was documented as 65. May 11, 2025: the pulse was documented as 70.May 13, 2025: the pulse was documented as 62. June 9, 2025: the pulse was documented as 67.June 10, 2025: the pulse was documented as 69.June 11, 2025: the pulse was documented as 70. July 4, 2025: the pulse was documented as 68. July 8, 2025: the pulse was documented as 63. There was no documentation for Resident 43 as to why the medication was administered outside of the specific physician ordered parameters. The above information for Resident 43 was reviewed in a meeting with the Director of Nursing (DON) on July 10, 2025, at 12:24 PM. The DON confirmed on July 10, 2025, at 12:59 PM that there was no documented evidence as to why the medication was administered outside of the physician ordered parameters. Clinical record review for Resident 384 revealed an order dated July 3, 2025, for him to have a chest x-ray because he had tachycardia (fast heart rate) and a fever. The results of the chest x-ray indicated that Resident 384 had some infiltrates (areas that are whiter, such as fluid, inflammatory cells, or other material). The x-ray also noted that Resident 384 had a cardiac pacemaker (a device that is used to regulate the hearts rhythm. Review of Resident 384’s pacemaker care plan initiated on June 9, 2025, revealed an intervention to monitor pacemaker checks. Review of Resident 384’s current physician order revealed no evidence of orders for pacemaker checks. An interview with the DON on July 9, 2025, at 12:20 PM revealed that she was unaware and unsure if Resident 384 had a pacemaker but would investigate and get back to the surveyor. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395533 If continuation sheet Page 4 of 19 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 395533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Ridge Senior Living at Windy Hill 100 Dogwood Drive Philipsburg, PA 16866 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 Level of Harm - Minimal harm or potential for actual harm A follow-up interview with the DON on July 10, 2025, at 9:45 AM confirmed the above noted findings that there were no orders related to Resident 384’s pacemaker or pacemaker checks. The facility failed to provide the highest practicable care regarding physician ordered medication parameters for Resident 43 and failed to provide the highest practicable care regarding pacemaker care for Resident 384. Residents Affected - Few 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395533 If continuation sheet Page 5 of 19 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 395533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Ridge Senior Living at Windy Hill 100 Dogwood Drive Philipsburg, PA 16866 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and resident and staff interviews, it was determined that the facility failed to provide services to maintain a resident's range of motion ([NAME]) for one of two residents reviewed for ROM concerns (Resident 19).Findings include:Interview with Resident 19 on July 9, 2025, at 10:30 AM revealed that he receives no follow through after therapy discharges him. He said the therapist will tell him that staff are going to do exercise to his legs, but it either does not happen or does not happen consistently.Clinical record review of a physical therapy Discharge summary dated [DATE], revealed that resident was to receive a restorative active range of motion program (resident can move extremity on his own) and passive range of motion (staff move the extremity through range of motion) program to his lower extremities. Review of the facility's task documentation revealed that Resident 19 was receiving a restorative active assist range of motion program to his bilateral lower extremities that was documented as being done through May 15, 2025. May 16 to 31, 2025, there was no documentation to indicate Resident 19 received the therapy recommended range of motion programs to his bilateral lower extremities.Interview with the Director of Nursing on July 10, 2025, at 10:00 AM revealed that there was a communication issue between therapy and nursing so Resident 19's recommended range of motion program never got initiated until June1, 2025.Review of Resident 19's task documentation for June 2025, revealed that he was to receive active range of motion to his bilateral lower extremities on dayshift daily. Review of the documentation revealed that Resident 19 did not receive active range of motion to his bilateral lower extremities on the following days: June 2, 3, 4, 6, 9, 10, 14, 15, 16, 18, 19, 20, 22, 23, 25, 27, 28, 30, 2025. The Director of nursing was made aware of the concerns related to Resident 19's range of motion program to his lower extremities on July 10, 2025, at 11:05 AM.28 Pa. Code 211.12(d)(1)(5) Nursing services Event ID: Facility ID: 395533 If continuation sheet Page 6 of 19 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 395533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Ridge Senior Living at Windy Hill 100 Dogwood Drive Philipsburg, PA 16866 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 0692 Provide enough food/fluids to maintain a resident's health. 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, review of select facility policies and procedures, and staff interview, it was determined that the facility failed to implement interventions promote acceptable parameters of nutritional status for one of five residents reviewed for nutritional concerns (Residents 28).Findings include: The facility policy entitled Weight assessment and Intervention, last reviewed without changes February 26, 2025, revealed residents are weighed upon admission and at intervals established by the interdisciplinary team. Weights are recorded in each unit's weight record chart and in the individual's medical record. Any weight change of five pounds or more since the last weight assessment is retaken the next day for confirmation. Undesirable weight change is evaluated by the treatment team whether the criteria for significant weight change has been met. The physician and the multidisciplinary team identify conditions and medications that may be causing weight loss or increasing the risk of weight loss.Clinical record review revealed the facility admitted Resident 28 on February 20, 2025, with diagnoses including severe protein-calorie malnutrition.Review of Resident 28's documentation survey report for meal intakes revealed the following:June 2025, staff documented Resident 28 consumed zero to 25 percent on 52 of 90 meals.July 2025, staff documented Resident 28 consumed zero to 25 percent on 23 of 27 meals.Further review of Resident 28's clinical record revealed the following weight assessments:May 2, 2025, 119.0 poundsMay 3, 2025, 119.0 poundsMay 5, 2025, 114.5 poundsMay 6, 2025, 115.0 poundsJune 1, 2025, 95.0 pounds (a 20- pound, 17.39 percent severe weight loss, weight was crossed out by Employee 1, registered dietician, and she noted re-weighed)June 2, 2025, 103.0 pounds (weight crossed out by registered dietitian, noting re-weighed) July 2, 2025, 91.0 pounds (no evidence of a re-weight obtained the next day as per facility policy)July 7, 2025, 87.0 pounds (a 28- pound, 24.35 percent severe weight loss in two months)Review of Resident 28's clinical record revealed a Nutritional Risk assessment dated [DATE], noted Resident 28 is underweight with increased nutrient needs and impaired nutrient utilization related to low body weight, elevated nutrition requirements, and altered biochemical function. Employee 1 indicated they would monitor Resident 28's nutrition status and update his nutrition plan of care as needed. A Nutritional Risk Assessment date May 13, 2025, was completed with no changes. There was no further assessment of Resident 28's severe weight loss until July 7, 2025.Further review of Resident 28's clinical record revealed there were no weights obtained on Resident 28 from May 6, 2025, to July 2, 2025 (after Employee 1 crossed off other staff members weights assessments obtained on June 1 and June 2, 2025). There was no documentation of Resident 28 refused any weights during this time.Review of Resident 28's physician orders revealed that staff administered Resident 28 Med Pass (fortified nutritional shake) 2.0, 150 ML (milliliter), three times a day from February 21 to May 6, 2025, when Med Pass was discontinued and the facility ordered staff to administer Resident 28 Boost (nutritional supplement) twice a day. Review of Resident 28's Medication Administration Record (MAR, a form utilized to document the administration of medications and supplements) dated May 2025 revealed staff documented Resident 28 consumed less than 25 percent of Boost supplement on 32 of 51 administrations.Review of June 2025 MAR revealed that staff documented Resident 28 consumed less that 25 percent of Boost supplement on 42 of 60 administrations.There was no documentation that Resident 28's physician assessed Resident 28's severe weight loss until July 2, 2025.Interview with Employee 1 on July 9, 2025, at 2:22 PM confirmed these findings for Resident 28. Employee 1 stated that she did not believe the June 1 and June 2 weights were accurate; therefore, she crossed them out. Employee 1 confirmed she did not obtain a reweight or implement any interventions in June 2025, because she felt the weights were inaccurate. Employee 1 confirmed there was no documentation of any attempts to Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395533 If continuation sheet Page 7 of 19 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 395533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Ridge Senior Living at Windy Hill 100 Dogwood Drive Philipsburg, PA 16866 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 0692 reweigh Resident 28 until July 2, 2025. 28 Pa. Code 211.10(d) Resident care policies 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395533 If continuation sheet Page 8 of 19 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 395533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Ridge Senior Living at Windy Hill 100 Dogwood Drive Philipsburg, PA 16866 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, clinical record review, and staff interview, it was determined that the facility failed to provide appropriate respiratory care and services for one of one resident reviewed (Residents 23).Findings include:Clinical record review revealed the facility admitted Resident 23 on December 26, 2019, with a diagnose of chronic obstructive pulmonary disease with (acute) exacerbation added on October 12, 2023. Observation of Resident 23 on July 8, 2025, at 10:50 AM and 1:25 PM revealed he was in his wheelchair with a nasal cannula (NC, tubing to deliver oxygen to the nose) on and running at 2.5 liters per minute (LPM).Observation of Resident 23 on July 9, 2025, at 10:53 AM revealed Resident 22 was in his wheelchair with oxygen on and running at 2.5 LPM.Review of Resident 23's physician orders revealed a current order for staff to administer Resident 23 oxygen continuous every shift at 1.5 liters via nasal canula.The findings were reviewed with the Nursing Home Administrator and Director of Nursing on July 9, 2025, at 12:00 PM.28 Pa. Code 211.12(d)(1)(5) Nursing services Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395533 If continuation sheet Page 9 of 19 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 395533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Ridge Senior Living at Windy Hill 100 Dogwood Drive Philipsburg, PA 16866 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 0699 Provide care or services that was trauma informed and/or culturally competent. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and resident and staff interview, it was determined that the facility failed to identify triggers related to a resident's diagnosis of Post-Traumatic Stress Disorder (PTSD), to provide culturally, competent, trauma-informed care, and to eliminate or mitigate re-traumatization for one of five residents reviewed for mood/behavior (Resident 59).Findings include:Clinical record review for Resident 59 revealed that the facility admitted him with a diagnosis of PTSD (PTSD, a mental and behavioral disorder that develops related to a terrifying event), on April 30, 2024.Interview with Resident 59 on July 9, 2025, at 8:45 AM revealed that he has PTSD that is triggered by loud noises, and other people screaming in the middle of the night. He said the screaming startles him and he wakes up panicked wondering what had happened. Further review of Resident 59's care plan revealed no evidence that the facility identified triggers (everyday situations that cause a person to re-experience the traumatic event as if it was reoccurring) for him related to his diagnosis of PTSD. Resident 59's clinical record contained no evidence the facility collaborated with the resident, and as appropriate, the resident's family, friends, and any other healthcare professionals (such as psychologists, and mental health professionals) to develop and implement individualized interventions.These findings were reviewed with the Nursing Home Administrator and Director of Nursing on July 9, 2025, at 12:20 PM. 28 Pa Code 211.12 (d)(3)(5) Nursing services Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395533 If continuation sheet Page 10 of 19 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 395533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Ridge Senior Living at Windy Hill 100 Dogwood Drive Philipsburg, PA 16866 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 0730 Observe each nurse aide's job performance and give regular training. Level of Harm - Minimal harm or potential for actual harm Based on employee personnel record review and staff interview, it was determined that the facility failed to complete a performance evaluation of each nurse aide at least once every 12 months for three of three nurse aides reviewed (Employees 7, 8, and 9).Findings include:The facility noted the following hire dates for three employees reviewed for performance evaluations (EPR, employee performance review): Employee 7's hire date of November 5, 1991, last EPR was November 14, 2023Employee 8's hire date of June 24, 1996, last EPR was May 26, 2024.Employee 9's hire date of October 31, 2017, last EPR was October 18, 2023.A request to review the annual performance evaluations revealed no documented evidence that the facility completed performance evaluations for Employee 7, 8, and 9 (nurse aides) at least once every 12 months. Interview with the Nursing Home Administrator on July 10, 2025, at 9:40 AM confirmed that performance evaluations were not completed annually on the three employees requested. 28 Pa. Code 201.19 (2) Personnel policies and procedures Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395533 If continuation sheet Page 11 of 19 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 395533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Ridge Senior Living at Windy Hill 100 Dogwood Drive Philipsburg, PA 16866 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 0744 Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. 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 and staff interview, it was determined that the facility failed to develop and implement an individualized person-centered care plan to address dementia and cognitive loss displayed by three of five residents reviewed (Residents 33, 52, and 61). Findings include: Residents Affected - Some Clinical record review for Resident 33 revealed the facility admitted her on March 26, 2025, with diagnosis including Dementia (loss of memory, language, problem-solving, and other thinking abilities that interfere with daily life). A review of Resident 33's admission Minimum Data Set Assessment (MDS, a form completed at specific intervals to determine care needs) dated March 31, 2025, indicated that the facility assessed Resident 33 as having a diagnosis of dementia. The facility determined that a care plan for dementia and cognitive loss would be developed. A review of Resident 33's care plan revealed that there was no indication that the facility had developed and implemented a person-centered care plan to address the resident's dementia and cognitive loss. The findings were reviewed with the Nursing Home Administrator and Director of Nursing during a meeting on July 9, at 2:30 PM. On July 10, 2025, at 10:00 AM the Director of Nursing confirmed the facility had no further documentation that the facility developed and implemented an individualized person-centered care plan to address Resident 33's dementia. Clinical record review for Resident 52 revealed the facility admitted her on June 11, 2025, with diagnoses including dementia. A review of Resident 52’s MDS, dated [DATE], indicated that the facility assessed Resident 52 as having a diagnosis of dementia. The facility determined that a care plan for dementia and cognitive loss would be developed. A review of Resident 52's care plan revealed that there was no indication that the facility had developed and implemented a person-centered care plan to address the resident's dementia and cognitive loss. The findings were reviewed with the Nursing Home Administrator and Director of Nursing during a meeting on July 9, 2025, at 12:05 PM. On July 10, 2025, at 10:23 AM the Nursing Home Administrator confirmed the facility had no further documentation that the facility developed and implemented an individualized person-centered care plan to address Resident 52's dementia prior to surveyor's questioning. Review of Resident 61’s clinical record revealed that the facility admitted her on March 20, 2024, with a diagnosis of Dementia. Review of Resident 61’s admission MDS dated [DATE], indicated that the facility assessed Resident 61 as having a diagnosis of Dementia and that the facility would develop a care plan for dementia and cognitive loss. A review of Resident 61’s care plan revealed that there was no indication the facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395533 If continuation sheet Page 12 of 19 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 395533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Ridge Senior Living at Windy Hill 100 Dogwood Drive Philipsburg, PA 16866 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 0744 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some developed an individualized person-centered plan of care to address her dementia and cognitive loss, which should reflect family involvement in development. Interview with Employee 4, social worker, on July 10, 2025, at 10:24 AM confirmed the above findings for Resident 61, and indicated that the individualized dementia care plan for Resident 61 was developed after the concerns were discussed by the surveyor. 28 Pa Code 211.12 (d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395533 If continuation sheet Page 13 of 19 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 395533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Ridge Senior Living at Windy Hill 100 Dogwood Drive Philipsburg, PA 16866 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to ensure a consultant pharmacist reviewed a resident's medication regimen monthly for one of five residents reviewed for potentially unnecessary medications (Resident 65).Findings include:Clinical record review for Resident 65 revealed that the resident was admitted on [DATE]. Clinical record review for Resident 65 revealed a diagnosis list that included Alzheimer's Disease (a brain disorder that affects memory, thinking, and cognitive abilities), cognitive impairment, and anxiety. Review of facility documentation for Resident 65 revealed a monthly medication regimen review dated April 10, 2025, from the consultant pharmacist. Further clinical record review for Resident 65 revealed no documentation that a licensed pharmacist completed required monthly medication regimen reviews for the resident during May and June 2025. Documentation for the completed monthly medication reviews was requested by the surveyor during meetings with the Nursing Home Administrator and Director of Nursing on July 8, 2025, at 2:10 PM and July 9, 2025, at 2:00 PM.An interview with the Director of Nursing on July 10, 2025, at 12:59 PM confirmed there was no further documentation to indicate that Resident 65's monthly medication regimen reviews were completed for May or June 2025. 28 Pa. Code 211.9 (k) Pharmacy services28 Pa. Code 211.12(d)(3)(5) Nursing services Event ID: Facility ID: 395533 If continuation sheet Page 14 of 19 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 395533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Ridge Senior Living at Windy Hill 100 Dogwood Drive Philipsburg, PA 16866 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 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, observation, and staff and resident interview, it was determined that the facility failed to assist a resident to obtain routine dental care for one of one resident reviewed for dental concerns (Resident 23).Findings include:Observation and interview with Resident 23 on July 8, 2025, at 10:55 AM revealed he had several missing and broken bottom teeth. Resident 23 stated that he does not remember the last time he was offered dental services.Clinical record review revealed the facility admitted Resident 23 on December 26, 2019, with payment sources that included the state Medicaid benefit. Review of Resident 23's clinical record revealed a physician's order for a dental consult and follow up as needed on January 1, 2025. Further review of Resident 23's clinical record revealed his last dental visit was August 21, 2024.Interview with the Director of Nursing on July 10, 2025, at 10:19 AM confirmed Resident 23 did not receive dental care according to state plan. The facility failed to provide evidence that Resident 23 received routine prophylactic dental cleanings as covered under the State plan.28 Pa. Code 211.12(d)(1)(3)(5) Nursing services Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395533 If continuation sheet Page 15 of 19 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 395533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Ridge Senior Living at Windy Hill 100 Dogwood Drive Philipsburg, PA 16866 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and staff interview, it was determined that the facility failed to store food items in a safe and sanitary manner, maintain equipment in a sanitary condition, and prepare food items in accordance with professional standards in the facility's main kitchen.Findings include:Initial tour of the facility's main kitchen with Employee 6, Director of Dining Services, on July 8, 2025, at 10:00 AM revealed the following:A walk-in freezer contained a cardboard box with several items packaged in slide lock plastic bags. One bag contained baked beans with no label or dates. The other bag contained peeled, whole bananas with no label or dates. A concurrent interview with Employee 6 revealed it was unclear on when the items were packaged or the use by date.The top shelf of a storage unit located under the circulating fans in the walk-in freezer contained several packages of sliced flavored bread. There was a significant accumulation of ice on three of the bread packages. The dry goods storage area contained metal shelving units on wheels. The floor under four of the observed shelves contained a significant accumulation of debris that included dust, unopened eight-ounce soda cans, and various debris (discarded paper products, a condiment packet, a single-use butter packet, and several plastic spoons). A shelf in the kitchen contained two partially used vinegar containers with no open date and a partially used container of syrup with no open date on it. An expandable dough cutter located in a drawer had an extensive build-up of a batter-like substance and multiple areas of rust. The above information was reviewed in a meeting with the Nursing Home Administrator and Director of Nursing on July 8, 2025, at 2:10 PM. A review of tray line food temperature logs on July 9, 2025, at 11:48 AM revealed no documented dinner temperatures for the following dates: May 1, 11, 13, 14, and 18, 2025June 18, 22, 25, and 26, 2025An interview with Employee 6 on July 9, 2025, at 11:50 AM revealed that tray line food temperatures should be documented for each meal service. Employee 6 further noted it was unclear why the dinner food temperatures were not documented for the above dates. This information regarding the food temperatures was reviewed in a meeting with the Nursing Home Administrator and Director of Nursing on July 9, 2025, at 12:00 PM. 483.60(i) Food prepare, distribute, and serve -sanitary/safetyPreviously cited 8/2/2428 Pa. Code 201.14(a) Responsibility of licensee28 Pa. Code 201.14(a) Responsibility of licensee Event ID: Facility ID: 395533 If continuation sheet Page 16 of 19 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 395533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Ridge Senior Living at Windy Hill 100 Dogwood Drive Philipsburg, PA 16866 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 0814 Dispose of garbage and refuse properly. Level of Harm - Potential for minimal harm Based on observation and staff interview, it was determined that the facility failed to properly contain and dispose of garbage in the facility's main dumpster area.Findings include:Observation of the facility's main dumpsters on July 8, 2025, at 10:45 AM, located outside of a rear egress door from the facility's main kitchen revealed the following: There was debris and garbage on the ground surrounding the dumpster that included the following: four feet tall weeds, one to two inches of stagnant water ponding in a metal containment area underneath the container that held the facility's generator fuel supply, seven wooden boards of a fence that surrounded the dumpster area that each contained three rusted nails (for a total of 21) protruding from the boards and posing a risk of injury, an accumulation of dead leaves, discarded cardboard, and various discarded items on the ground (hair nets, gloves, paper products, and pieces of wood). The above information was reviewed in a meeting with the Nursing Home Administrator and Director of Nursing on July 8, 2025, at 2:10 PM. 28 Pa. Code 201.14(a) Responsibility of licensee Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395533 If continuation sheet Page 17 of 19 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 395533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Ridge Senior Living at Windy Hill 100 Dogwood Drive Philipsburg, PA 16866 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 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, review of select facility policies and procedures, and staff interview, it was determined that the facility failed to offer recommended pneumococcal immunizations for five of five residents reviewed for immunizations (Resident 11, 18, 19, 23 and 29).Findings include:The policy entitled Pneumococcal Vaccine, last reviewed February 26, 2025, indicates that prior to or upon admission, residents will be assessed for eligibility to receive the pneumococcal vaccine, and when indicated, will be offered the vaccine within 30 days of admission. Administration of the pneumococcal vaccines or revaccinations will be made in accordance with the current CDC (Center for Disease Control and Prevention) recommendations at the time of the vaccinations.Review of Resident 11's clinical record revealed that the facility admitted her on January 28, 2021. Documentation in Resident 11's clinical record revealed that she received a pneumococcal vaccine (Prevnar 13) prior to her admission in 2016, and the PPSV23 in 2001. According to the CDC guidance entitled Pneumococcal Vaccination Timing dated October 2024, the facility is to decide together with the resident, if the resident would like an updated pneumococcal vaccine.There was no documented evidence to indicate that the facility offered Resident 11 an updated pneumococcal vaccination. Review of Resident 18's clinical record revealed that the facility admitted her on March 6, 2023. Documentation in Resident 18's clinical record revealed that she received a pneumococcal vaccine (Prevnar 13) prior to her admission in 2015, and the PPSV23 in 2008. According to the CDC guidance entitled Pneumococcal Vaccination Timing dated October 2024, the facility is to decide together with the resident, if the resident would like an updated pneumococcal vaccine.There was no documented evidence to indicate that the facility offered Resident 18 an updated pneumococcal vaccination. Review of Resident 19's clinical record revealed that the facility admitted him on July 23, 2022. Documentation in Resident 19's clinical record revealed that he received a pneumococcal vaccine (Prevnar 13) prior to his admission in 2022. According to the CDC guidance entitled Pneumococcal Vaccination Timing dated October 2024, Resident 19's pneumococcal vaccinations would not be complete until he received a PCV20 or PCV21 one year after he received his Prevnar 13. There was no documented evidence to indicate that the facility offered Resident 19 an updated pneumococcal vaccination. Review of Resident 23's clinical record revealed that the facility admitted him on December 26, 2019. Documentation in Resident 23's clinical record revealed that he received a pneumococcal vaccine (Prevnar 13) prior to his admission in 2015, and the PPSV23 in 2011. According to the CDC guidance entitled Pneumococcal Vaccination Timing dated October 2024, the facility is to decide together with the resident, if the resident would like an updated pneumococcal vaccine.There was no documented evidence to indicate that the facility offered Resident 23 an updated pneumococcal vaccination. Review of Resident 29's clinical record revealed that the facility admitted her on October 29, 2019. Documentation in Resident 29's clinical record revealed that she received a pneumococcal vaccine (Prevnar 13) prior to her admission in 2018, and the PPSV23 in 2018. According to the CDC guidance entitled Pneumococcal Vaccination Timing dated October 2024, the facility is to decide together with the resident, if the resident would like an updated pneumococcal vaccine.There was no documented evidence to indicate that the facility offered Resident 29 an updated pneumococcal vaccination. 483.80(d) Influenza and Pneumococcal ImmunizationsPreviously cited 8/2/2428 Pa. Code 201.14(a) Responsibility of licensee28 Pa. Code 201.18(b)(1) Management28 Pa. Code 211.12(d)(1)(5) Nursing services Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395533 If continuation sheet Page 18 of 19 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 395533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Ridge Senior Living at Windy Hill 100 Dogwood Drive Philipsburg, PA 16866 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 0947 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. Based on review of employee education records and staff interview, it was determined that the facility failed to ensure that nurse aides received 12 hours of in-service training annually for three of three nurse aides reviewed (Employees 7, 8, and 9).Findings include:During a meeting with the Nursing Home Administrator and Director of Nursing on July 8, 2025, at 2:00 PM the surveyor asked for training records to indicate that nurse aides had received at least 12 hours of in-service training in the last year for Employees 7, 8, and 9 (nurse aides).Interview with the Nursing Home Administrator and Director of Nursing on July 10, 2025, at 10:05 AM confirmed there was no documented evidence that the above employees received the required 12 hours of annual in-service training. 28 Pa. Code 201.19 (7) Personnel policies and procedures28 Pa. Code 201.20(a)(6)(d) Staff development Event ID: Facility ID: 395533 If continuation sheet Page 19 of 19