Health inspection·January 4, 2024

F 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the Resident Assessment Instrument User's Manual and residents' clinical records, as well as staff interviews, it was determined that the facility failed to ensure that comprehensive admission and annual Minimum Data Set assessments were completed in the required timeframe for two of five residents reviewed (Residents 29, 279). Findings include: The Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual, which provides instructions and guidelines for completing required Minimum Data Set (MDS) assessments (mandated assessments of a resident's abilities and care needs), dated October 2019, indicated that an admission MDS assessment was to be completed no later than 14 days following admission, that the Assessment Reference Date (ARD - the last day of an assessment's look-back period) must be set within 366 days after the ARD of the previous comprehensive assessment, and that the assessment was to be completed no later than the ARD plus 14 calendar days. An annual comprehensive MDS assessment for Resident 29, with an ARD of November 21, 2023, was due to be completed by December 4, 2023, but was not signed as completed until December 5, 2023, which was one day from the ARD until completion. The RAI User's Manual, dated October 2023, indicated that an admission MDS assessment was to be completed no later than 14 days following admission (admission date plus 13 calendar days). An admission MDS assessment for Resident 279 revealed that the resident was admitted to the facility on [DATE], and the resident's admission MDS assessment was incomplete as of January 4, 2024, which was 19 days after admission. Interview with the Registered Nurse Assessment Coordinator (RNAC - a registered nurse who is responsible for the completion of MDS assessments) on January 4, 2024, at 4:05 and 4:37 p.m. confirmed that the above comprehensive and admission MDS assessments were not completed in the required time frame. 28 Pa. Code 211.5(f) Medical records. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395563 If continuation sheet Page 2 of 13 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 395563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morrisons Cove Home 429 South Market Street Martinsburg, PA 16662 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Potential for minimal harm Based on a review of the Resident Assessment Instrument User's Manual and clinical records, as well as staff interviews, it was determined that the facility failed to complete accurate Minimum Data Set assessments for two of 32 residents reviewed (Residents 32, 34). Residents Affected - Some Findings include: The Resident Assessment Instrument (RAI) User's Manual, which gives instructions for completing Minimum Data Set (MDS) assessments (required assessments of a resident's abilities and care needs), dated October 2023, revealed that Section N0415I Antiplatelet Medications (medication used to prevent blood from clotting) was to be coded if the resident took the medication during the seven-day look-back period. Physician's orders for Resident 32, dated October 4, 2019, included an order for the resident to receive 81 milligrams of aspirin (an antiplatelet) every day. The resident's Medication Administration Record (MAR) for October 2023 revealed that the resident received aspirin daily during the seven-day look-back assessment period. A significant change MDS for Resident 32, dated October 2, 2023, revealed that Section N0401I was not coded, indicating that the resident did not receive antiplatelet medication during the seven-day look-back assessment period. The RAI User's Manual, dated October 2023, indicated that Section B0700 (make self understood) should be coded with either clearly understood, usually understood, sometimes understood, or rarely/never understood. Section C0100 (should brief interview for mental status be conducted) should be completed if the resident is at least sometimes understood verbally, in writing, or using another method. Section C0100 was to be coded No (0) or Yes (1) to determine whether a Brief Interview for Mental Status (BIMS) (an assessment to determine a resident's cognitive status) should be attempted with the resident. The instructions for determining if a BIMS interview should be attempted indicated that if the resident was at least sometimes understood (verbally or in writing) then the BIMS interview was to be attempted with the resident and coded in Sections C0200 through C0500. If the resident was rarely/never understood, then the BIMS interview was not to be attempted, and a Staff Assessment of Mental Status was to be completed instead and coded in Sections C0600 through C1000. A quarterly MDS for Resident 34, dated October 20, 2023, revealed that Section B0700 was coded rarely/never understood and Section C0100 was coded (yes), indicating that the BIMS interview was attempted. An interview with the Registered Nurse Assessment Coordinator (RNAC- a registered nurse who is responsible for the completion of MDS assessments) confirmed on January 4, 2024, at 4:32 p.m. that the assessments for Residents 32 and 34 were coded incorrectly. 28 Pa. Code 211.5(f) Clinical records. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395563 If continuation sheet Page 3 of 13 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 395563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morrisons Cove Home 429 South Market Street Martinsburg, PA 16662 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on review of clinical records, as well as staff interviews, it was determined that the facility failed to develop care plans for individualized resident care needs for one of 32 residents reviewed (Resident 41). Residents Affected - Few Findings include: An admission Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 41, dated November 24, 2023, indicated that the resident was cognitively impaired, required substantial assistance from staff for her daily care needs, and had a diagnosis of peripheral vascular disease (a condition that reduces blood flow to the arms and legs). Observations of Resident 41 on January 2, 2024, at 11:20 a.m. revealed that the resident was sitting in her room in a wheelchair and she was wearing a geri leg (a stocking that protects the skin) on her right lower extremity. A nurse's note for Resident 41, dated December 28, 2023, at 11:15 a.m. revealed that she had complained of right lower extremity tenderness while at therapy. Documentation revealed that there was diffuse redness and moderate swelling and tenderness with warmth to her right lower extremity. Physician's orders for Resident 41, dated December 28, 2023, included an order for the resident to wear a geri leg to her right lower extremity that may be removed with care and Keflex (an antibiotic) two times a day for cellulitis (a bacterial skin infection) of her right lower extremity through January 7, 2024. There was no documented evidence that a care plan was developed to address Resident 41's cellulitis and antibiotic treatment. An interview with the Director of Nursing on January 4, 2024, at 3:10 p.m. confirmed that Resident 41 did not have a care plan for cellulitis and antibiotic therapy and there should have been one. 28 Pa. Code 211.11(d) Resident care plan. 28 Pa. Code 211.12(d)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395563 If continuation sheet Page 4 of 13 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 395563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morrisons Cove Home 429 South Market Street Martinsburg, PA 16662 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on review of clinical records and observations, as well as resident and staff interviews, it was determined that the facility failed to ensure that care plans were updated to reflect changes in care needs for three of 32 residents reviewed (Residents 40, 48, 53). Findings include: A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 40, dated October 25, 2023, revealed that the resident was cognitively impaired, required assistance with care needs, and had diagnoses that included dementia, Parkinson's and stroke. A care plan for Resident 40, last revised on October 25, 2023, indicated that the resident was taking a sleep aid for insomnia. Physician's orders, dated October 25, 2023, included an order to discontinue Resident 40's melatonin. Interview with the Director of Nursing on January 4, 2024, at 3:10 p.m. confirmed that Resident 40's care plan should have been revised when her melatonin was discontinued, and it was not. A quarterly MDS assessment for Resident 48, dated September 29, 2023, revealed that the resident was cognitively impaired, required extensive assistance with care needs, had a Stage 2 pressure ulcer (partial-thickness skin loss into but no deeper than the dermis) and had diagnoses that included venous insufficiency (valves in the veins do not close properly causing blood to back-flow), non-pressure ulcer to left lower leg, and skin cancer of left lower limb including the hip. A care plan for Resident 48, last revised on October 19, 2023, indicated that the resident was receiving a treatment to her mid back, right lower side, and right achilles. Physician's orders, dated October 27, 2023, included an order to discontinue treatment to Resident 48's right achilles because it was healed. Physician's orders, dated December 29, 2023, included an order to discontinue treatment to Resident 48's mid back and right lower side because they were healed. There was no documented evidence in Resident 48's clinical record to indicate that her care plan was revised when the treatments were discontinued. Interview with the Director of Nursing on January 4, 2024, at 3:10 p.m. confirmed that Resident 48's care plan should have been revised when her areas were healed and treatments were discontinued, and it was not. An entry MDS assessment for Resident 53, dated December 12, 2023, revealed that the resident was cognitively impaired, required assistance of two staff for her daily care needs, and had an indwelling catheter (a flexible tube used to empty the bladder) placed after hip surgery. A care plan for Resident 53, last revised December 12, 2023, indicated that the resident had an indwelling catheter and included interventions for indwelling catheter care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395563 If continuation sheet Page 5 of 13 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 395563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morrisons Cove Home 429 South Market Street Martinsburg, PA 16662 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 0657 Level of Harm - Minimal harm or potential for actual harm Physician's orders, dated December 18, 2023, indicated that Resident 53's indwelling catheter was discontinued. Interview with Director of Nursing on January 4, 2024, at 1:05 p.m. confirmed that Resident 53's care plan should have been revised to indicate that the indwelling catheter was discontinued and it was not. Residents Affected - Few 28 Pa. Code 211.11(d) Resident care plan. 28 Pa. Code 211.12(d)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395563 If continuation sheet Page 6 of 13 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 395563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morrisons Cove Home 429 South Market Street Martinsburg, PA 16662 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 review of facility policies and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that weekly skin checks were performed accurately for one of 32 residents reviewed (Resident 49) and failed to administer chewable aspirin as ordered by the physician for one of 32 residents reviewed (Resident 279). Residents Affected - Few Findings include: The facility's policy regarding preventative skin care, dated February 9, 2023, revealed that the facility will maintain or improve current skin integrity through identification of residents at risk for skin break down and placing interventions which meet their individual needs to minimize their risk for altered skin integrity. Care plans would be established for all residents at risk, which would include interventions to reduce the risk of skin breakdown. A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 49, dated November 3, 2023, revealed that the resident was severely cognitively impaired, was dependent on staff for daily care needs, and had diagnoses that included Parkinson's disease (progressive nerve disorder that causes abnormal movements). Current care plans for Resident 49 indicated that the resident was on anticoagulant therapy (blood thinning medication) and was to have a daily skin assessment with any abnormalities reported to the nurse, and that the resident has fragile skin with the potential for breakdown with an intervention to consult dermatology for the treatment of actinic keratosis (precancerous dry rough skin) on her neck. Observations of Resident 49 on January 2, 2024, at 11:58 a.m. revealed that she was lying in bed sleeping, the head of the bed was elevated, and there was a lunch tray in front of her. There was a reddened scabbed area on her left temple at the end of her eyebrow line. A bath communication form, dated January 2, 2024, at 8:00 p.m., indicated that Resident 49 had no concerns with rashes, bruises, redness, or open areas. The form was completed by a nurse aide, then signed by two other licensed staff. Observations of Resident 49 on January 3, 2024, at 3:55 p.m. revealed that she was in bed sleeping. There was a dark red area approximately the size of a quarter on her left temple at the end of her eyebrow line with dried blood. Interview with Nurse Aide 3 on January 3, 2024, at 4:01 p.m. revealed that the resident has anxiety issues and may have done that to herself. Interview with Licensed Practical Nurse (LPN) 4 on January 3, 2024, at 4:06 p.m. revealed that she had not rounded yet to she the resident, confirmed that there was a reddened area with dried blood, and said the resident will pick and scratch herself. LPN 4 did not receive any report of a new skin concern or find any recent documentation regarding a new skin concern. An incident report for Resident 49, dated January 3, 2024, at 4:30 p.m., revealed that there was an observed area on the left temple measuring 1.0 centimeters (cm) x 0.5 cm. The area appeared to be scratched open, with a scant amount of blood. Resident 49 had a complete bed bath last evening and no areas were noted during that time when the skin assessment was completed. An interview with the Director of Nursing on January 4, 2024, at 9:19 a.m. revealed that a weekly skin assessment was completed every Tuesday evening with showers and bathing for Resident 49. The Director of Nursing confirmed that there were no skin areas of concern documented during that weekly (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395563 If continuation sheet Page 7 of 13 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 395563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morrisons Cove Home 429 South Market Street Martinsburg, PA 16662 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 skin assessment, and if the area was visible it should have been documented. Level of Harm - Minimal harm or potential for actual harm The facility's policy, dated August 18, 2023, indicted that the five rights of medication were to be followed, which includes checking for the right resident, the right drug, the right dose, the right route and the right time. The policy indicated the medication label was to be compared against the Medication Administration Record (MAR). Prior to administration of any medication, the medication and dosage schedule on the resident's MAR were to be compared to the medication label. If the label and the MAR were different, the physician's orders were to be checked for correctness. Residents Affected - Few Physician's orders for Resident 279, dated December 19, 2023, included an order for the resident to receive 81 mg of chewable aspirin daily for a diagnosis of cerebrovascular disease. Observations of Licensed Practical Nurse 5 during medication administration on January 4, 2024, at 8:47 a.m. revealed that the medication label was for aspirin EC (enteric coated) 81 milligrams (mg) daily; however, the MAR indicated aspirin chewable 81 mg daily. An interview with the Director of Nursing on January 4, 2024, at 3:13 p.m. confirmed that Resident 279 received the wrong type of aspirin. 28 Pa. Code 201.18(e)(1) Management. 28 Pa. Code 211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395563 If continuation sheet Page 8 of 13 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 395563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morrisons Cove Home 429 South Market Street Martinsburg, PA 16662 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on review of policies and clinical records, as well as staff interviews, it was determined that the facility failed to ensure the accountability of controlled medications (drugs with the potential to be abused) for two of 26 residents reviewed (Residents 29, 48). Findings include: The facility's policy regarding medication administration, dated August 18, 2023, indicated that as needed medications (PRN) were documented with the date and time of administration, dose, route of administration, complaints, or symptoms for which the medication was administered, and the signature or initials of person recording effects on the medication administration record (MAR). A nursing note for Resident 29, dated December 9, 2023, revealed that she fell and had several head and facial lacerations, her left shoulder appeared to be out of place, and she had an open laceration to the left wrist area with cartilage or bone showing. Physician's order for Resident 29, dated December 20, 2023, revealed that the resident was ordered 5 milligrams (mg) of Oxycodone immediate release (a narcotic pain medication) by mouth every six hours as needed for severe pain. Observations of Resident 29 on January 2, 2024, at 12:04 p.m. revealed that the resident was in bed wearing an ace wrap and a brace on her left wrist, and she was moaning in pain. Review of Resident 29's controlled drug records for December 2023 and January 2024 revealed that a dose of Oxycodone was signed-out once on December 24, 2023, at 9:45 p.m.; December 26, 2023, at 9:00 p.m.; and December 31, 2023, at 9:30 p.m. However, the resident's clinical record, including the MAR, contained no documented evidence that Oxycodone was actually administered to the resident on these dates. A quarterly MDS assessment for Resident 48, dated September 29, 2023, revealed that the resident was cognitively impaired; required extensive assistance with care needs; had a Stage 2 pressure ulcer; had diagnoses that included venous insufficiency, non-pressure ulcer to the left lower leg, skin cancer of the left lower limb including the hip; and was receiving controlled pain medication. Physician's orders for Resident 48, dated July 31, 2023, included an order for the resident to receive a 12 micrograms (mcg) Fentanyl (a narcotic pain patch) patch to be applied every three days for pain. Physician's orders for Resident 48, dated November 10, 2023, included an order for the resident to receive a 25 mcg Fentanyl patch to be applied every three days for pain. The Medication Administration Record (MAR) and a controlled drug count record (tracks each dose of a controlled medication) for Resident 48, dated October 2023, revealed that a 12 mcg Fentanyl patch was applied to the resident on October 8 and 23, 2023. There was no documented evidence that two licensed nurses signed that the old patch was destroyed after removal on these dates. The MAR and a controlled drug count record for Resident 48, dated December 2023, revealed that a 25 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395563 If continuation sheet Page 9 of 13 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 395563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morrisons Cove Home 429 South Market Street Martinsburg, PA 16662 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few mcg Fentanyl patch was applied to the resident on December 8, 2023. There was no documented evidence that two licensed nurses signed that the old patch was destroyed after removal on that date. Interview with the Director of Nursing on January 4, 2024, at 4:55 p.m. confirmed that the oxycodone for Resident 29 was signed out on the narcotic sheet but was not documented as administered on the medication administration record, and confirmed that there was no documented evidence that two licensed personnel performed the destruction of Resident 48's Fentanyl patches as required. 28 Pa. Code 211.9(h) Pharmacy services. 28 Pa. Code 211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395563 If continuation sheet Page 10 of 13 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 395563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morrisons Cove Home 429 South Market Street Martinsburg, PA 16662 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on facility policy, observations, and staff interviews, it was determined that the facility failed to securely store medications in one of three medication carts reviewed (South cart). Findings include: The facility's policy regarding medication administration (preperation and general guidelines), dated August 18, 2023, indicated that during medication administration the medication cart is kept closed and locked when out of sight of the medication nurse. Observations of the South medication cart on January 4, 2024, at 9:14 a.m. revealed that the medication cart was left unattended and unlocked when Registered Nurse 1 entered a resident room to administer medications. The cart was not in the sight of the medication nurse. Interview with Registered Nurse 6 on January 4, 2023, at 9:23 a.m. revealed that the medication cart should be closed and locked when not in her sight. Interview with the Director of Nursing on January 4, 2024, at 1:05 p.m. revealed that the medication cart should be closed and locked at all times when not in the line of sight of the medication nurse. 28 Pa. Code 211.9(a)(1) Pharmacy services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395563 If continuation sheet Page 11 of 13 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 395563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morrisons Cove Home 429 South Market Street Martinsburg, PA 16662 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on review of the facility's plans of correction for previous surveys, and the results of the current survey, it was determined that the facility's Quality Assurance Performance Improvement (QAPI) committee failed to correct quality deficiencies and ensure that plans to improve the delivery of care and services effectively addressed recurring deficiencies. Findings include: The facility's deficiencies and plans of correction for State Survey and Certification (Department of Health) surveys ending February 8, 2023, revealed that the facility developed plans of correction that included quality assurance systems to ensure that the facility maintained compliance with cited nursing home regulations. The results of the current survey, ending January 4, 2024, identified repeated deficiencies related to following abuse policies and quality of care. The facility's plan of correction for a deficiency regarding following abuse policies, cited during the survey ending February 8, 2023, revealed that the facility would complete audits and report the results of the audits to the QAPI committee for review. The results of the current survey, cited under F607, revealed that the facility's QAPI committee was ineffective in maintaining compliance with the regulation regarding following abuse policies and conducting background checks upon hire. The facility's plan of correction for a deficiency regarding quality of care, cited during the survey ending February 8, 2023, revealed that the facility would complete audits and report the results of the audits to the QAPI committee for review. The results of the current survey, cited under F684, revealed that the facility's QAPI committee was ineffective in maintaining compliance with the regulation regarding quality of care for residents. Refer to F607 and F684. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(e)(1) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395563 If continuation sheet Page 12 of 13 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 395563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morrisons Cove Home 429 South Market Street Martinsburg, PA 16662 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 review of attendance records for the facility's Quality Assurance Committee, as well as staff interviews, it was determined that the facility failed to ensure that all required members of the Quality Assurance Committee attended quarterly meetings. Residents Affected - Some Findings include: Review of the attendance records for the facility's Quality Assurance Committee meetings revealed that the Medical Director or designee did not attend any meetings from April 2023 through December 2023. Interview with the Nursing Home Administrator on January 4, 2024, at 3:48 p.m. confirmed that there was no documented evidence that the Medical Director or designee attended any meetings in the last three quarterly meetings reviewed. Meetings were scheduled on days that the Medical Director rounded in the facility, but there was no documented evidence that his signature was obtained. 28 Pa. Code 201.18(e)(1)(2)(3) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395563 If continuation sheet Page 13 of 13