Inspection·October 31, 2025

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few R96's clinical record failed to include evidence the resident was provided Q15 minute checks as ordered on 8/13/25. During an interview on 10/27/25, at 11:05 a.m. the Director of Nursing (DON) and Nursing Home Administrator (NHA) confirmed the facility failed to provide evidence documentation the physician ordered Q15 minute checks were completed as ordered. Review of Resident R96's late entry progress note dated 10/18/25, entered by Registered Nurse Supervisor, Employee E2, on 10/22/25, revealed Nurse Aide (NA), Employee E1 entered Resident R96's room to complete care, and the resident wrapped the telephone cord around [his/her] neck and expressed suicidal ideation. Resident R96 expressed wanting to die, was upset and crying. Review of Resident R96's clinical record failed to include a physical assessment that was completed or Q15 minute checks or a 1:1 was implemented after Resident R96 was found with a telephone cord wrapped around their neck and expressed suicidal ideation on 10/18/25.Review of Resident R96's hospital record dated 10/19/25, instructed the residents to follow up with psychiatry within one week.Review of Resident R96 physician order dated 10/20/25, stated to see psychiatry as soon as possible.Review of Resident R96 clinical record on 10/27/25, failed to include evidence the resident was seen by psychiatry as ordered.Review of information submitted by the facility on 10/22/25, revealed a nurse aide reported when they entered Resident R96's room to complete care on 10/22/25, the resident had their telephone cord wrapped around their neck and expressed suicidal ideation. All call bells and bed controls have been secured, and the facility will purchase a cordless phone for residents to use at bedside. Residents have a continued safety care plan in place. Resident has an order for Q shift behavioral checks.During an observation on 10/27/25, at 10:09 a.m. Resident R96 was observed resting in bed with a bed controller wrapped around the positioner bar, not secured. Resident R96's bed was plugged into the wall and the cord was unsecured. The television cord was observed hanging from the television to the wall outlet, the cord was not secured. During an observation on 10/27/25, at 10:12 a.m. Resident R96's roommate was resting in bed and was wearing oxygen tubing that was connected from [his/her] nostrils to the oxygen concentrator located in-between Resident R96's bed. Resident R96's roommate bed controller and call bell cord were not secured. Resident R96's roommate had a television cord that was unsecured. During interview on 10/27/25, at 10:48 a.m. Registered Nurse Supervisor, Employee E2 confirmed Resident R96 was not assessed by a nurse after their suicide ideation on 10/18/25. During an interview on 10/27/25, at 11:05 a.m. the Director of Nursing indicated staff must stay with resident if suicidal, then an order for every 15 minutes or 1:1 is obtained. During an interview on 10/27/25, at 11:07 a.m. the Nursing Home Administrator confirmed the facility failed to provide evidence Q15 minutes checks and/or 1:1 supervision was completed for Resident R96's suicidal ideation on 10/18/25. During an observation and interview on 10/27/25, at 11:21 a.m. Licensed Practical Nurse (LPN), Employee E3 confirmed Resident R96's cords were not secured. LPN, Employee E3 stated if a resident has suicide ideation, they must be placed on Q15 minute checks for 24 to 48 hours until evaluated by psychiatric services. An incident report must be completed, and an assessment is completed by nurse or supervisor, and physician is notified. LPN, Employee E96 confirmed the facility failed to keep a resident free from hazards and provided the necessary monitoring and supervision for a resident with known suicidal ideation and history of suicide attempt (Resident R96). During a phone interview on 10/27/25, at 1:16 p.m. Nurse Aide, Employee E1 stated on 10/18/25, they went in to do care and Resident R96 was observed with a cord wrapped around their neck twice. NA, Employee E1 stated they told the residents to take it off their neck and the residents started crying. I didn't really think too much to tell anyone. NA, Employee E1 stated I told someone later that same day. NA, Employee E1 indicated RN Supervisor, Employee E2 was notified about Resident R96 while having a conversation later that day. NA, Employee E1 confirmed Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395538 If continuation sheet Page 2 of 6 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 395538 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Cheswick 3876 Saxonburg Boulevard Cheswick, PA 15024 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few R96 did not have Q15 minutes checks or a 1:1 supervision implemented after the incident on 10/18/25. NA, Employee E1 stated I am not aware where to document it, I never have a 1:1 in that facility. On 10/27/25, at 2:01 p.m., the NHA and DON were made aware that Immediate Jeopardy (IJ) existed. The NHA provided the IJ Template, the facility failed to keep a resident free from hazards and provided the necessary monitoring and supervision for a resident with known suicidal ideation and history of suicide attempt (Resident R96), and a corrective action plan was requested. On 10/27/25, at 4:35 p.m. an acceptable Corrective Action Plan was received which included the following interventions: Immediate Action: The facility will keep residents free from hazards and self-harm and monitor and supervise residents identified at risk for suicidal ideations. -Resident R96 will be provided with a safe environment by securing bed control cord, call bell cord, and telephone cord so cords are not accessible to resident to harm self. Roommate's cords have also been secured. The room has also been checked for any other hazardous items to ensure a safe environment. Physician orders for monitoring resident BP will be completed by nursing staff every 15 minutes to ensure resident safety. Residents will be evaluated by psychiatric services for safety on 10/27/25. Care plan will be reviewed and updated by 10/27/25. Completed on 10/27/25 by EOD. -The Director of Nursing or designee will complete a house audit by end of day 10/27/25 of all residents for suicidal ideations. A resident questionnaire on suicidal ideation will be used for all residents with a BIMS of 9 or above. Residents with a BIMS of 8 or below, a resident skin check and review of risk management to determine resident's safety. -Care plans will be updated to reflect the residents' current condition by Licensed Practical Nurse Assessment Coordinator (LNAC) or designee by end of day 10/27/25. - A house audit of environment will be completed by Environmental Services Supervisor or designee by end of day 10/27/25 to validate no hazards are identified for residents with suicidal ideations. -The NHA, DON and Regional Clinical Consultant will review and update the facility policy and procedures for Suicidal Threats and Supervision of Residents with suicidal ideations on 10/27/25 by end of day. -All staff will be re-educated before their next scheduled shift on the facility policy and procedures for Suicidal Threats, Care Plans and Supervision of residents identified with suicidal ideations on 10/28/25 by end of day. -All incidents and accidents will be reviewed daily and results reported to the Monthly Quality Assurance and Process Improvement Committee for review and frequency of audits. Resident R96 room was assessed on 10/29/25, and bed control cords, call bell cords, and telephone cords were not accessible to resident to harm self. The resident's roommate also had cords secured. Review of the physician order revealed the resident has been ordered Q15 minute safety checks on 10/27/25. Review of Q15 minute check sheet revealed facility completed Q15 minute check as ordered. The resident was evaluated by psychiatrist services on 10/27/25, and revealed the resident is not at risk of harm at that time. A house audit was completed on 10/28/25, of 100/100 residents. Residents with BIMS of 9 or above were asked a questionnaire of three questions that included if they had a history of suicidal ideation, if they are having thoughts of hurting themselves, and if so, what is their plan. Residents were also asked if they felt safe. Residents who have BIMS of 8 or below were assessed by Registered Nurse and a body check was completed. 3/100 residents were identified as suicidal ideation risk. 3/3 residents care plans were updated on 10/28/25, to include their suicidal ideation risk and individualized interventions to prevent harm. A final house audit was completed on 10/29/25, by NHA and DON. During an observation on 10/29/25, from 11:00 a.m. to 11:05 a.m. 3/3 residents' room no hazards were identified. Facility Suicide Threats policy was revised on 10/27/25, to include supervision of residents. A staff member must remain with the resident until the nurse supervisor/charge nurse arrives to examine residents. The resident will be placed on 1:1 observation until the acute episode has been (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395538 If continuation sheet Page 3 of 6 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 395538 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Cheswick 3876 Saxonburg Boulevard Cheswick, PA 15024 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete resolved. The facility's MDS/RAI/Care Planning policy was reviewed on 10/27/25, and no changes were made. 113/113 in-house staff and the facility utilizes one staffing agency. 21/31 agency staff were educated. During in-person interviews completed on 10/29/25, from 9:37 a.m. to 10:15 a.m. 16 in-house staff members (nursing and ancillary) confirmed they were educated on the facility policy and procedures for suicidal threats, supervision, and care plans of residents. During phone interviews completed on 10/29/25, from 9:46 a.m. to 10:45 a.m. 9 staff members confirmed they were educated on suicide risks, supervision, and care planning. Facility will ensure all agency staff members verify education prior to the start of their next scheduled shift. The facility's next scheduled QA is 11/18/2025. The Immediate Jeopardy was lifted on 10/29/25, at 11:14 a.m. when the action plan implementation was verified. During an interview on 10/31/25, at 2:15 p.m. the NHA confirmed the facility failed to keep a resident free from hazards and provide the necessary monitoring and supervision for a resident with known suicidal ideation and history of suicide attempt for one of three residents (Resident R96). This failure created an immediate jeopardy situation. 28 Pa. Code 201.14(a) Responsibility of licensee.28 Pa. Code 201.18(b)(1)(e)(1) Management.28 Pa. Code 211.10(d) Resident care policies.28 Pa. Code 211.12(d)(1)(3)(5) Nursing services. Event ID: Facility ID: 395538 If continuation sheet Page 4 of 6 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 395538 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Cheswick 3876 Saxonburg Boulevard Cheswick, PA 15024 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 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical records and facility policy review, and staff interview, it was determined that the facility failed to ensure that a resident who displayed mental or psychosocial adjustment difficulties received appropriate treatment and services for one of three residents (Resident R96).Based on clinical records and facility policy review, and staff interview, it was determined that the facility failed to ensure that a resident who displayed mental or psychosocial adjustment difficulties received appropriate treatment and services for one of three residents (Resident R96).Findings include: Review of facility policy Suicide Threats dated 11/24, indicated resident suicide threats must be taken seriously and immediately reported to the nurse supervisor charge nurse. A staff member must remain with the resident until the nurse supervisor/charge nurse arrives to examine the resident. A behavioral health professional consult is indicated whenever the resident suggests suicide. Review of the clinical record indicated Resident R96 was admitted to the facility on [DATE]. Review of Resident R96's Minimum Data Set (MDS - a periodic assessment of care needs) dated 8/5/25, revealed diagnoses of depression and adjustment disorder with depressed mood. Section D0150. Resident Mood Interview revealed the resident had felt down, depressed, or hopeless nearly every day. Residents R96 care plan dated 8/13/25, indicated the resident was a suicide risk as evidence by feelings/actions which indicate suicidal ideation. Information the facility submitted to the Department of Health revealed on 10/18/25, Nurse Aide (NA), Employee E1 entered Resident R96's room to complete care, and the resident was attempting to wrap their telephone cord around their neck and expressing suicidal ideation. Resident R96 expressed wanting to die, was upset and crying. Review of Resident R96's October Medication Administration Record revealed the facility monitors Resident R96 for suicidal ideations. Review of documentation on 10/18/25, failed to include documentation that the resident displayed suicidal ideations. The facility documented no, the resident did not display any behavioral issues on any shift on 10/18/25. Review of Resident R96's hospital record dated 10/19/25, instructed the residents to follow up with psychiatry within one week. Review of Resident R96 physician order dated 10/20/25, stated to see psychiatry as soon as possible. Review of Resident R96 clinical record on 10/27/25, failed to include evidence the resident was seen by psychiatry as ordered. During an interview on 10/27/25, at 10:48 a.m. Registered Nurse, Employee E2 confirmed a RN failed to assess the resident immediately after suicide attempt on 10/18/25. During an interview on 10/27/25, at 11:05 a.m. the Director of Nursing stated if someone expresses suicidal ideation, a staff member should stay with the resident until someone is notified. Safety is always number one, nursing skin and pain assessment should be conducted, and the resident is monitored either 1:1 or Q15 minutes check after assessed. Psych should be consulted. During an interview on 10/27/25, at 11:08 a.m. the Nursing Home Administrator and Director of Nursing confirmed the facility failed to ensure that a resident who displayed mental or psychosocial adjustment difficulties received appropriate treatment and services for one of three residents (Resident R96). 28 Pa. Code 201.18(b)(1) Management.28 Pa. Code 211.12(d)(3)(5) Nursing services. Event ID: Facility ID: 395538 If continuation sheet Page 5 of 6 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 395538 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Cheswick 3876 Saxonburg Boulevard Cheswick, PA 15024 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 0868 Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Level of Harm - Minimal harm or potential for actual harm Based on facility policy review, review of Quality Assurance attendance records, and staff interview, it was determined that the facility failed to conduct Quality Assessment and Assurance (QAA) meetings at least quarterly with all the required committee members for one of four quarterly meetings (Quarter Three of 2025). Findings Include: The facility Quality Assurance/Performance Improvement policy dated 9/4/25, indicated the facility will conduct quality assurance/improvement and assessment committee meeting at least quarterly to identify areas of service that are non-complaint, or with potential for improvement. Review of Quality assurance and Performance Improvement sign in sheets and attendance records for Quarter Three of 2025, failed to reveal the Infection Preventionist, Director of Nursing, and Medical Director were in attendance. During an interview on 10/31/25, at 12:59 p.m. the Nursing Home Administrator confirmed that the facility failed to conduct Quality Assessment and Assurance (QAA) meetings at least quarterly with all the required committee members for one of four quarterly meetings (Quarter three of 2025), as required. 28 Pa Code: 201.18(e)(1)(2)(3)(4) Management. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395538 If continuation sheet Page 6 of 6