Inspection·January 25, 2024

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of the resident's Quarterly Minimum Data Set assessment dated [DATE], revealed that the resident was severely cognitively impaired. A review of a facility investigation dated January 23, 2024, revealed Resident 2 was in the hallway in front of the dayroom near the nursing station. Staff heard yelling and reported a noisy environment. Staff witnessed Resident 2 open handed slap Resident 1 in the face. Resident 2 attempted to punch Resident 1 in the face after the slap, but staff intervened and separated the residents. At that time Resident 2 reported that everyone was yelling, and he was afraid Resident 1 was going to hurt the staff, so he hit her. Resident 3 witnessed the interaction between Resident 1 and Resident 2. Resident 3 then slapped Resident 2 in the face. Resident 3 stated at that time, He hit my friend. A review of a witness statement from Employee 1, a nurse aide, dated January 23, 2024, revealed that the Employee 1 was standing in the dayroom doorway. The employee stated she heard a lot of yelling behind her. The employee indicated that when she turned around, she saw Resident 2 hit Resident 1. The employee went to intervene, and she stated at that time Resident 3 then slapped Resident 2. Further Employee 1 stated that she and Employee 2, a nurse aide, got into a verbal altercation about showering residents prior to the incident. Employee 1 indicated that she told Employee 2 whatever has gotten you in a bad mood, don't take it out on me. A review of a witness statement from Employee 2, a nurse aide, dated January 23, 2024, indicated that she did not see the incident because she was in the shower room. A review of a witness statement from Employee 3, LPN (license practical nurse), dated January 23, 2024, indicated that prior to the escalation of behaviors and the incident, residents were loud in the dayroom. Employee 3 indicated that Employee 1 told Employee 3 that Employee 2 had dismissed Employee 1 after a verbal disagreement. Employee 3 then indicated that Employee 2 appeared angry and was slamming things on the counter on the unit. A review of a witness statement from Employee 4, LPN, dated January 23, 2024, revealed that employee heard Resident 1 saying why did he hit me? At that time Employee 4 saw Resident 2 picking his glasses up off the floor. The employee asked Resident 3 what happened and he replied he hit my friend and she is a woman, so I hit him. Employee 4 indicated she then asked Resident 2 what happened and he replied I was afraid she was going to hurt you guys. Everyone was yelling. Employee 4 indicated that immediately prior to this incident Employee 2 was upset and opened the shower room door and began yelling that Employee 1 needs to start cleaning up after herself and slammed the shower room door shut, which created more noise and sensory stimulation. A follow up telephone interview was completed with Employee 4 on January 24, 2024. The telephone interview indicated that Employee 4 stated that on January 23, 2024, from 4:15 PM to 6:15 PM the mood on the unit was tense. Employee 2 was saying a lot of things under her breath. She was slamming things and every time she walked by staff, she would be mumbling things. Employee 4 stated the entire afternoon was very tense. Employee 4 stated prior to the incident occurring, a resident was banging on the door and was upset. At that same time Employee 2 opened the shower room door and started yelling that Employee 1 needs to start cleaning up after herself and that Employee 2 was sick of towels being everywhere and slammed the shower door behind her. Employee 4 stated that at the same time there was another resident that was upset and crying and when she turned around the incident between Residents 1, 2, and 3 had occurred. Employee 4 stated after the incident she did voice to the staff that they need to get along and work together and be professional especially on the unit they were working because the residents feel the tension and it triggers their behaviors. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395564 If continuation sheet Page 2 of 14 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 395564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Ridge Rehabilitation & Healthcare Center 500 West Hospital Street Taylor, PA 18517 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The facility concluded from their investigation that the energy and environment was determined to be a contributing factor to Resident 2 hitting Resident 1 and in return Resident 3 hitting Resident 2. An interview with the Nursing Home Administrator and Director of Nursing on January 25, 2024, at approximately 3:10 PM confirmed the facility failed to ensure that Resident 1 and 2 was free from physical abuse perpetrated by Resident 2 and Resident 3. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(e)(1) Management 28 Pa. Code 201.29 (a) Resident Rights 28 Pa. Code 211.12 (c)(d)(1)(5) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395564 If continuation sheet Page 3 of 14 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 395564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Ridge Rehabilitation & Healthcare Center 500 West Hospital Street Taylor, PA 18517 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 0741 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, a review of clinical records, facility investigations, and staff interview, it was determined that the facility failed to provide sufficient staff, providing direct services to residents, who possess the necessary competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident as evidenced by five residents out of six sampled (Residents 1, 2, 3, 4 and CR1). Findings include: A review of Resident 1's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses, which included alcohol induced dementia (a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning. A review of the resident's Quarterly Minimum Data Set Assessment (MDS - a federally mandated standardized assessment conducted at specific intervals to plan resident care) dated December 22, 2023, revealed the Brief Interview for Mental Status (BIMS section of the MDS which assesses cognition) indicated the resident cognition was severely impaired. A review of Resident 2's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses, which included schizoaffective disorder (a mental health disorder that is marked by a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as depression or mania) and traumatic brain injury. A review of the resident's Quarterly Minimum Data Set assessment dated [DATE], revealed the Brief Interview for Mental Status indicated the resident cognition was severely impaired. A review of Resident 3's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses, which included dementia. A review of the resident's Quarterly Minimum Data Set assessment dated [DATE], revealed the Brief Interview for Mental Status indicated the resident cognition was severely impaired. A review of a facility investigation dated January 23, 2024, revealed Resident 2 was in the hallway in front of the dayroom near the nursing station. Staff heard yelling and reported a noisy environment. Staff witnessed Resident 2 open hand slap Resident 1 in the face. Resident 2 was attempted to punch Resident 1 in the face after the slap, but staff intervened and separated the residents. At that time Resident 2 indicated that everyone was yelling, and he was afraid Resident 1 was going to hurt the staff, so he hit her. Resident 3 witnessed the interaction between Resident one and Resident 2. Resident 3 then slapped Resident 2 in the face. Resident 3 stated at that time, He hit my friend. A review of a witness statement from Employee 1 NA (nurse aide) dated January 23, 2024, revealed the employee was standing in the dayroom doorway. The employee stated she heard a lot of yelling behind her. The employee indicated when she turned around, she saw Resident 2 hit Resident 1. The employee went to intervene, and she stated at that time Resident 3 then slapped Resident 2. Further Employee 1 stated that her and Employee 2 NA and gotten into a verbal altercation about showering residents (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395564 If continuation sheet Page 4 of 14 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 395564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Ridge Rehabilitation & Healthcare Center 500 West Hospital Street Taylor, PA 18517 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 0741 Level of Harm - Minimal harm or potential for actual harm prior to the incident. Employee 1 indicated that she told Employee 2 whatever has gotten you in a bad mood, don't take it out on me. A review of a witness statement from Employee 2 NA dated January 23, 2024, indicate she did not see the incident because she was in the shower room. Residents Affected - Some A review of a witness statement from Employee 3 LPN (license practical nurse) dated January 23, 2024, indicated prior to the escalation of behaviors and the incident residents were loud in the dayroom. Further the Employee indicated that Employee 1 told Employee 3 that Employee 2 had dismissed Employee 1 after a verbal disagreement. Employee 3 then indicated that Employee 2 appeared angry and slamming things on the counter on the unit. A review of a witness statement from Employee 4 LPN dated January 23, 2024, revealed the employee heard Resident 1 saying why did he hit me. The employee at that time saw Resident 2 picking his glasses up off the floor. The employee asked Resident 3 what happened in which he stated, he hit my friend and she is a woman, so I hit him. The employee indicated she then asked Resident 2 what happened in which he stated, I was afraid she was going to hurt you guys. Everyone was yelling. Employee 4 further indicated right prior to this incident Employee 2 was upset and opened the shower room door and began yelling that Employee 1 needs to start cleaning up after herself and slammed the shower room door shut. A follow up telephone interview was completed with Employee 4 on January 24, 2024. The telephone interview indicated Employee 4 stated on January 23, 2024, from 4:15 PM to 6:15 PM the unit was tense. Employee 2 was saying a lot of things under her breath. She was slamming things and every time she walked by staff, she would be mumbling things. Employee 4 stated the entire afternoon was very tense. Employee 4 stated prior to the incident occurring a resident was banging on the door and upset. At that same time Employee 2 had opened the shower room door and started yelling that Employee 1 needs to start cleaning up after herself and that Employee 2 was sick of towels being everywhere and slammed the shower door behind her. Employee 4 indicated at the same time there was another resident that was upset and crying and when she turned around the incident between Residents 1,2, and 3 had occurred. Employee 4 indicated after the incident she did voice to the staff that they need to get along and work together and be professional especially on the unit they were working because the residents feel the tension and it triggers their behaviors. The facility concluded from their investigation that the energy and environment determined to be a contributing factor to Resident 2 hitting Resident 1 and in return Resident 3 hitting Resident 2. A review of the clinical record revealed that Resident CR1 was admitted to the facility on [DATE], with diagnoses to include dementia (irreversible, progressive degenerative disease of the brain, resulting in loss of reality contact and functioning ability). An admission MDS Assessment (Minimum Data Set - a federally mandated standardized assessment completed periodically to plan resident care) dated November 22, 2023, revealed the resident was severely cognitively impaired. A review of the clinical record revealed that Resident 4 was admitted to the facility on [DATE], with diagnoses to include dementia. An admission MDS Assessment (Minimum Data Set - a federally mandated standardized assessment (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395564 If continuation sheet Page 5 of 14 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 395564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Ridge Rehabilitation & Healthcare Center 500 West Hospital Street Taylor, PA 18517 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 0741 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some completed periodically to plan resident care) dated October 23, 2023, revealed the resident was severely cognitively impaired. A review of a nursing note dated January 2, 2024, at 2:07 AM reveled Resident CR1 was ambulating in the hallways cursing at any person she came in contact with. At approximately 1:00 PM Resident CR 1 was yelling out obscenities towards Resident 4 who was yelling out for help. Staff noted Resident 4 lying on the floor and Resident CR1 yelling at her. A review of a facility incident report dated January 2, 2024 revealed Resident CR1 was seen wandering the hallways exhibiting aggressive behaviors. Staff heard a thud and screaming. Resident 4 was found lying on the floor in pain with her right lower extremity externally rotated. Both residents were transferred out to the hospital for evaluations. Further review of the facility investigation revealed a security camera timeline of the incident. It was indicated at 12:06 AM through 12:09 AM The resident were seen on camera passing by each other on multiple occasions. At 12:07 AM Employee 6 NA (nurse aide) walks down the hall and interacts with the residents out of camera view. At 12:09 Am Employee 6 was observed walking up the hall with both Resident CR1 and Resident 4. At 12:11 AM Resident CR1 was walking down the hall from the nursing station. At 12:16 AM Resident 4 walks into her room the comes out of her room and begins walking down the hall during the nursing station. At 12:16:40 Resident CR1 walks directly towards Resident 4 and makes contact with (hits) Resident 4. A review of Employee 6's witness statement dated January 6, 2023, revealed prior to the incident Resident CR1 was being aggressive, pacing the halls, and wandering into rooms. A statement from Employee 7 NA dated January 2, 2024, revealed the employee state she was not assigned Resident CR1. The employee stated prior to the incident Resident CR1 was agitated during the shift. When asked what the staff do for the resident when she is like that the employee stated they attempt to redirect her. When asked what redirect means the employee stated to give her something to eat or drink and direct her in another direction. The employee stated that resident will still swing out after those attempts are made. A follow up statement was obtained from Employee 6. The statement was not dated. The follow-up statement revealed the employee was witnessed to have checked in with Resident CR1 and Resident 4 multiple times leading up to the incident. Employee 6 stated that prior to the incident Resident CR1 has been yelling at Resident 4 and she had approached the residents to redirect them. The employee further indicated that as soon as Resident CR1 had gotten out of bed she began yelling and every time she walked past Resident 4, she would yell at her and into other resident rooms. Employee 6 indicated she tried to redirect her, but she was just angry. Employee 6 revealed that she went around the nursing station and Employee 7 went to the bathroom when Resident CR1 was unsupervised and hit Resident 4. The facility staff failed to implement effective individualized interventions or increase supervision to manage the aggressive behaviors of Resident CR1 who was actively seeking out and engaging with Resident 4 resulting in the physical abuse of Resident 4 causing a fractured hip. Observations of the facility's second floor on January 25, 2024, at 12:03 PM, revealed that Resident C3 was walking with Employee 5, a nurse aide (NA) assigned to provide 1:1 supervision to Resident C3, and stopped at the nurses station. Resident C3 was observed engaging in a conversation with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395564 If continuation sheet Page 6 of 14 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 395564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Ridge Rehabilitation & Healthcare Center 500 West Hospital Street Taylor, PA 18517 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 0741 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some another employee and asked if she could come along with her. Employee 5 was heard to comment rudely why don't you take her with you and began to loudly vocalize that she was upset that she didn't get to take a break from her duties yet. Employee 5 proceeded to walk away from Resident C3 and went behind the nurses desk to search for the staff break schedule and was not within one arm reach of the resident. Further observations of Resident C3 on January 25, 2024, revealed that she was walking with Employee 5 down the hallway and became agitated. Resident C3 put her arms up to strike Employee 5, and Employee 5 put her hands on the resident to stop her from striking her. Employee 5 then walked away from Resident C3 and was leaning up against the hallway wall and proceeded to look at her phone and with an earbud present in her ear and was not paying attention to Resident C3. Interview with the Nursing Home Administrator on January 25, 2024, at approximately 3:10 PM confirmed that the facility failed to employ sufficient staff with the necessary competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being. Refer F600 and F744 28 Pa Code 211.12 (d)(3)(4)(5) Nursing services 28 Pa. Code 201.18 (e)(1)(3) Management 28 Pa. Code 201.20 (a)(6) Staff development FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395564 If continuation sheet Page 7 of 14 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 395564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Ridge Rehabilitation & Healthcare Center 500 West Hospital Street Taylor, PA 18517 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 - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records, information submitted by the facility, and select incident reports and staff interview, it was determined that the facility failed to develop and implement an individualized person-centered plan to address a resident's dementia-related behavioral symptoms displayed by one resident (Resident CR1) which, resulted in one resident (Resident 4) out of 6 residents sampled sustaining a serious injury, a fractured hip, caused by Resident CR1's dementia-related behavioral symptoms. Residents Affected - Few Findings include: A review of the clinical record revealed that Resident CR1 was admitted to the facility on [DATE], with diagnoses to include dementia (irreversible, progressive degenerative disease of the brain, resulting in loss of reality contact and functioning ability). An admission MDS Assessment (Minimum Data Set - a federally mandated standardized assessment completed periodically to plan resident care) dated November 22, 2023, revealed that the resident was severely cognitively impaired. A review of the resident's current plan of care initially dated November 15, 2023, revealed a care plan in place for behaviors related to care, wandering into resident's rooms, refusal of care, yelling out or striking staff, resistive to going to the bathroom, cursing at staff, residents, and inanimate objects, striking out at others, and initiating arguments revealed interventions such as attempt to redirect when resident is experiencing behaviors and keep resident safe during episodes of behaviors. However, the resident's plan of care failed to address person specific interventions designed to address the resident's aggressive behaviors and the approaches staff should implement to deescalate the resident's behaviors to maintain the safety of both the resident, and other residents residing on the unit. A review of a nursing note dated November 15, 2023, at 9:49 PM revealed the resident self ambulates up and down the hallways in the facility. Staff redirected the resident back to her room, several times, but she will not lay down. The nursing documentation did not identify the approaches used to re-direct the resident or that staff had attempted other diversional activities designed for the resident to manage the resident's wandering behavior. A nursing note dated November 17, 2023, at 10:13 PM revealed that the resident became aggressive when staff was providing care. Staff were able to complete the task but with difficulty. This nursing documentation did not identify the approaches used by staff to de-escalate the resident's aggressive behaviors and to allow the staff to safely provide the nursing care. Nursing notes dated November 18, 2023, at 2:52 AM indicated that the resident was pacing the halls of the nursing unit and attempting to enter other resident rooms. Nursing noted that the interventions offered were snacks and toileting, which the resident refused. A nursing note dated November 21, 2023, at 4:45 AM revealed that the resident was combative with staff. The resident was kicking, hitting, scratching, and yelling at staff. The entry did not identify (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395564 If continuation sheet Page 8 of 14 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 395564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Ridge Rehabilitation & Healthcare Center 500 West Hospital Street Taylor, PA 18517 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 the behavior modification or management interventions staff attempted in response to the resident's combative behavior. Level of Harm - Actual harm Residents Affected - Few A nursing note dated December 18, 2023, at 5:59 PM indicated that the resident was ambulating in the hallways of the unit, yelling, swearing, and getting into other residents' personal space. Resident CR1 was raising her fists to other residents and staff. There was no documented evidence of the individual person centered non-pharmacological interventions attempted to divert the resident's attention and redirect her from her intrusive wandering and aggressive behavior towards other residents. The facility administered a dose of Ativan (anti-anxiety medication) to manage her behavior. A nursing note dated December 19, 2023, at 2:32 PM revealed that the resident was ambulating in the hallways of the nursing unit and was verbally aggressive towards staff. Nursing noted that staff tried to redirect the resident with food and fluids with no effect. This intervention was attempted on November 18, 2023, and was ineffective in diverting the resident's behavior at that time as well. Nursing noted on December 26, 2023, at 5:54 PM that the resident was continually walking up and down the hallways, stopping and yelling at the residents, yelling I'll f**k you up. The resident would walk away from one resident, and then approach another resident yelling at them. Staff noted that the resident was observed clenching her fist, motioning at another resident. Nursing noted that attempts were made to redirect the resident but the resident then continued to pace the hallways and dining room yelling at other residents. A review of a nursing note dated December 27, 2023, at 4:34 AM revealed that the resident saw staff in the bathroom of the resident's room, with her roommate. The resident blocked the doorway of the bathroom and began punching towards staff members. Staff stood in front of the resident's roommate who was sitting on the toilet at that time. Nursing indicated that they tried to redirect the resident, which was ineffective. The entry did not identify the interventions used in an attempt to redirect the resident. The resident began to seek out any person in the halls or in rooms and tried to {physically} attack anyone within her reach. A medication administration note dated December 31, 2023, at 1:00 AM indicated that staff administered Ativan to the resident in response to resident's pacing, up and down the halls, cursing under her breath. The resident was observed, stopping at any person, residents and staff, in the common area and tell them to, F**k off. The entry noted that staff continued to redirect the resident but she continued to pace the hallways of the unit. A review of a nursing note dated December 31, 2023, at 3:01 AM revealed the resident was ambulating in the hallway and approached a male resident sitting in a chair at the nursing station who was yelling and agitated. The resident began yelling at the male resident in the hallway and the male resident swung at Resident CR1. The facility failed to identify, address and/or obtain necessary services for the dementia care needs of this resident and develop and implement a person-centered care plan that included and supported the dementia care needs. The facility failed to develop individualized interventions related to the resident's aggressive behaviors, including designing specialized activities and/or environmental modifications in an attempt to manage, modify or respond to the resident's behaviors. A review of the clinical record revealed that Resident 4 was admitted to the facility on [DATE], with diagnoses to include dementia. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395564 If continuation sheet Page 9 of 14 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 395564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Ridge Rehabilitation & Healthcare Center 500 West Hospital Street Taylor, PA 18517 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 An admission MDS assessment dated [DATE], revealed that the resident was severely cognitively impaired. Level of Harm - Actual harm A nursing note dated January 2, 2024, at 2:07 AM reveled that Resident CR1 was ambulating in the hallways cursing at any person she came in contact with. At approximately 1:00 PM Resident CR1 was yelling out obscenities directed towards Resident 4 who was yelling out for help. Staff responded and found Resident 4 lying on the floor and Resident CR1 yelling at her. Residents Affected - Few According to information dated January 3, 2024, submitted by the facility upon RN assessment, Resident 4 noted with external rotation to lower extremity. Neuro checks WNL. MD/RP made aware. Orders received to send to ER for eval and treatment for suspected injury. Investigation into unwitnessed incident immediately initiated. Per staff, a thump and yelling out was heard. When staff arrived on the scene around the corner, {Resident 4 -BIMs 00} was on the ground. {Resident 4} was transported to the hospital due to external rotation of RLE upon discovery and assessment. {Resident CR1 - BIMs 2} was witnessed to be wandering hall in vicinity at the time of incident exhibiting behaviors and was also transferred to the hospital for change in mental status. Facility investigation completed. Investigation revealed {Resident CR1} had quickly approached {Resident 4} and pushed her to the ground. Staff interviewed states {Resident CR1} was agitated per her norm, and made multiple attempts to redirect and provide safe environment. Resident CR1 was on q 15 minute checks related to behaviors, which were maintained without concerns. Staff was observing and redirecting residents throughout time prior to incident. Staff interviewed denies any circumstances at the time that Resident CR1 turned and approached Resident 4 that would have been a trigger. AAA, PDA and [NAME] PD made aware. MDs and RPs made aware of incident and updated on investigation. Resident CR1 returned to the facility at approximately 9:10AM 1/2/24 with no recommendations from ER visit. Resident received follow-up visit from NP and Psychiatric CRNP, with recommendations noted and implemented. Resident CR1 was placed on 1:1 supervision and placed in a private room due to behaviors. Resident 4 was admitted with right hip fx, and had surgical repair to same on 1/2/24. A review of a facility incident report dated January 2, 2024, revealed Resident CR1 was seen wandering the hallways exhibiting aggressive behaviors. Staff heard a thud and screaming. Resident 4 was found lying on the floor in pain with her right lower extremity externally rotated. Both residents were transferred out to the hospital for evaluations. Further review of the facility investigation revealed a security camera timeline of the incident. which was indicated that at 12:06 AM through 12:09 AM {on January 2, 2024}. Resident CR1 and Resident 4 were seen on camera passing by each other on multiple occasions. At 12:07 AM Employee 6, a nurse aide, walked down the hall and interacted with the residents out of camera view. At 12:09 AM Employee 6 was observed walking up the hall with both Resident CR1 and Resident 4 in view. At 12:11 AM Resident CR1 was walking down the hall from the nursing station. At 12:16 AM Resident 4 walks into her room then comes out of her room and begins walking down the hall during the nursing station. At 12:16 AM Resident CR1 walked directly towards Resident 4 and then pushes Resident 4, and Resident 4 falls to the floor. A review of Employee 6's witness statement dated January 6, 2023, revealed prior to the incident Resident CR1 was being aggressive, pacing the halls, and wandering into other resident rooms. A written statement from Employee 7, a nurse aide, dated January 2, 2024, revealed the employee stated she was not assigned Resident CR1 on that date. The employee stated prior to the incident Resident CR1 was agitated during the shift. When asked what the staff do for the resident when she is like (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395564 If continuation sheet Page 10 of 14 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 395564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Ridge Rehabilitation & Healthcare Center 500 West Hospital Street Taylor, PA 18517 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 - Actual harm Residents Affected - Few that, the employee stated they attempt to redirect her. When asked what redirect means the employee stated to give her something to eat or drink and direct her in another direction. The employee stated that resident will still swing out after those attempts are made however. An undated follow up statement was obtained from Employee 6, which revealed that the employee checked in with both Resident CR1 and Resident 4 multiple times leading up to the incident. Employee 6 stated that prior to the incident Resident CR1 had been yelling at Resident 4 and she had approached the residents to redirect them. The employee further indicated that as soon as Resident CR1 got out of bed, she she began yelling and every time she walked past Resident 4, she would yell at her and yell into other resident rooms. Employee 6 indicated that she tried to redirect her, but she was just angry. Employee 6 indicated that she went around the nursing station, and Employee 7 went to the bathroom, and at that time, Resident CR1 was unsupervised and hit Resident 4. A review of Resident 4's hospital documentation dated January 2, 2024, revealed that Resident 4 had sustained an impacted femoral neck fracture (broken hip) as a result of Resident CR1 pushing the resident, which caused Resident 4 to fall to the floor. The facility failed to develop and implement interventions to effectively address Resident CR1's dementia care needs and behaviors. Resident CR1 seriously injured Resident 4 during an altercation, initiated by Resident CR1. An interview with the Nursing Home Administrator on January 25, 2024 at approximately 3:10 PM failed to provide evidence that an effective individualized person-centered plan was developed and implemented to address and manage the resident's dementia-related behaviors. 28 Pa. Code 211.12 (d)(3)(5) Nursing services 28 Pa. Code 201.18 (e)(1) Management 28 Pa. Code 201.29 (a) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395564 If continuation sheet Page 11 of 14 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 395564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Ridge Rehabilitation & Healthcare Center 500 West Hospital Street Taylor, PA 18517 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observations, resident and staff interview, a review of grievances lodged with the facility, and test tray results, it was determined that the facility failed to provide meals that are served at safe and palatable temperatures for a test tray completed during the lunch meal for in-room tray service. Residents Affected - Some Findings include: According to the federal regulation 483.60(i)-(2) Food safety requirements - the definition of Danger Zone, found under the Definitions section, is food temperatures above 41 degrees Fahrenheit and below 135 degrees Fahrenheit that allow rapid growth of pathogenic microorganisms that can cause foodborne illness. A review of a Grievance/Concern Form completed by on behalf of Resident A1's by her spouse dated January 18, 2024, at 12:15 PM, revealed that the resident complains of cold food during lunch. A review of a Grievance/Concern Form completed during Resident B2's care plan meeting held on January 19, 2024, no time noted, revealed that the resident complained that his food was often cold. During on-site survey ending January 25, 2024, a test tray was conducted, on the second floor, at 12:31 PM, at the time the last resident began eating (Resident A1), revealed the following: The lunch meal consisted of a mushroom hamburger steak with gravy, garlic mashed potatoes, buttered corn, gelatin, and yogurt. The first cart, second floor cart left the kitchen at 12:12 PM and arrived on the unit at 12:15 PM and the last tray served was at 12:30 PM and the test tray was pulled to obtain temperatures. The test tray was conducted in the presence of the facility's Certified Dietary Manager (CDM) and results were as follows: mushroom hamburger steak with gravy 116.3 degrees Fahrenheit, garlic mashed potatoes with gravy 135 degrees Fahrenheit, buttered corn 122.8 degrees Fahrenheit, and gelatin 51.4 degrees Fahrenheit, and yogurt 57. The foods that were to be served hot were lukewarm and the foods to be served cold were cool-lukewarm and not served at palatable temperatures. Interview with the Nursing Home Administrator on January 25, 2024, at 1:25 PM, confirmed that the above food temperatures were not served at acceptable temperature parameters or at palatable temperatures. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395564 If continuation sheet Page 12 of 14 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 395564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Ridge Rehabilitation & Healthcare Center 500 West Hospital Street Taylor, PA 18517 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 - Few 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 maintain acceptable practices for the storage and service of food to prevent the potential for contamination and microbial growth in food, which increased the risk of food-borne illness on one of three resident pantries areas (3rd Resident Pantry/ Kitchenette). Findings include: Food safety and inspection standards for safe food handling indicate that everything that comes in contact with food must be kept clean and food that is mishandled can lead to foodborne illness. Safe steps in food handling, cooking, and storage are essential in preventing foodborne illness. You cannot always see, smell, or taste harmful bacteria that may cause illness according to the USDA (The United States Department of Agriculture, also known as the Agriculture Department, is the U.S. federal executive department responsible for developing and executing federal laws related to food). During a tour of the 3rd Unit Resident Pantry/Kitchenette on January 25, 2024, at 9:17 AM, observation of the inside of the resident freezer revealed a brownish colored substance frozen to the bottom and the back panel of the freezer. A can of cola was observed to be frozen and the can had busted open with frozen liquid on the can and interior freezer surface. Two dead small flies were observed inside of the ice storage bin. The ice scoop was stored inside the storage bin. Debris was observed inside the microwave adhering to the top and back surfaces. Upon opening refrigerator, small insects flew out of the refrigerator and were observed on the resident food items and beverages stored inside. During an interview with the Food Service Manager on January 25, 2024, at 1:00 PM, the employee confirmed the the observations of the 3rd unit pantry/kitchenette area and that the area was not maintained in a sanitary manner. 28 Pa. Code 201.18 (e) (2.1) Management 28 Pa. Code 211.6 (f) Dietary Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395564 If continuation sheet Page 13 of 14 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 395564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Ridge Rehabilitation & Healthcare Center 500 West Hospital Street Taylor, PA 18517 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm Based on observation, a review of facility pest service records and staff interview, it was determined that the facility failed to maintain an effective pest control program. Residents Affected - Some Findings include: A review of the facility's contracted pest control report dated January 8, 2024, at 2:37 PM, revealed that during a common inspection that the third-floor kitchenette floor drain had build up of organic matter that allowed drain flies to breed and noted that the drain needed to be cleaned to prevent unsanitary conditions and attractions of pests. Drain flies were found in the third-floor kitchenette and that sealing an open drain would resolve the fly problem. During a tour of the 3rd Unit Resident Pantry/Kitchenette on January 25, 2024, at 9:17 AM, revealed that inside of the ice scoop storage container there were two small black flies floating in the pooled water on the bottom of the container. Further observations revealed that upon opening the stainless-steel refrigerator, there were several small black flies that flew out and there small flying insects on the resident food items and beverages stored inside. Additionally, there were several black flies observed flying around the panty/kitchenette area that was adjoining to the 3rd floor main dining area. Interview with the Nursing Home Administrator on January 25, 2023, at 2:00 PM, reported that maintenance staff was going to seal the open drain that was identified by the contracted pest company in the 3rd Unit Pantry/Kitchenette area as a source of breeding flies, but didn't get to it yet. The NHA confirmed that the facility failed to adhere to the contracted pest control's recommendations to manage pests. 28 Pa. Code 201.18 (e)(2.1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395564 If continuation sheet Page 14 of 14