Health inspection·January 10, 2024

F 0565 January 2024 revealed no evidence of the complaints voiced by Residents 14, 40, 44, or 88 were recorded. Level of Harm - Minimal harm or potential for actual harm A review of the minutes from resident group meetings held from October 2023 through January 2024 revealed no evidence that complaints or grievances raised by Resident 14, 40, 44, or 88 regarding concerns with residents screaming and yelling or residents entering their rooms were recorded or addressed. Residents Affected - Some In response to surveyor inquiry during the survey ending January 18, 2024, grievance forms were completed with Residents 14, 40, 44, and 88 dated January 9, 2024, regarding their concerns. During an interview on January 9, 2024, at approximately 10:30 AM, the Director of Nursing (DON) was not able to provide evidence that the facility promptly responded to complaints and grievances voiced by Residents 14, 40, 44, or 88 prior to surveyor inquiry during the survey ending January 10, 2024. The DON confirmed that the facility must act promptly upon the grievances concerning resident life in the facility and must be able to demonstrate the facility's response and rationale for responses to resident complaints and grievances. Refer F584 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: 395566 If continuation sheet Page 2 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on interviews with residents it was determined that the facility failed to maintain comfortable sound levels and reasonable protection of the resident's private space to maintain a homelike environment for residents including four of five interviewed during a group meeting (Residents 14, 40, 44, 88). Findings included: During the resident group interview on January 8, 2024, at 10:00 AM, Resident 14 stated that he has complained many times to facility staff that other residents screaming and yelling near his bedroom is noisy. He explained that he is frustrated because staff tell him that the other residents have a right to yell. Resident 14 reported that the facility has not addressed these disruptive behaviors displayed by other residents. During the resident group interview on January 8, 2024, at 10:00 AM, Resident 40 stated that that she has complained to facility staff about other residents screaming and yelling in the hallway near her room. She stated that she is upset by this disruptive behavior and noise but when she raised this issue with staff, staff told her that the residents have the right to scream. Resident 40 stated that the facility has not taken measures to prevent this disruptive behavior and control the noise. During the resident group interview on January 8, 2024, at 10:00 AM, Resident 44 stated that she has complained many times about residents entering her room uninvited and residents yelling and screaming in the hallway. She explained that she is frustrated, because staff tell her that these other residents don't know any better and that the residents have the right to yell and scream. Resident 44 stated that the facility has not addressed the residents' intrusive wandering and noise. During the resident group interview on January 8, 2024, at 10:00 AM, Resident 88 stated that she has voiced complaints multiple times about residents entering her room uninvited and residents yelling and screaming in the hallway. She explained that she is angry and frustrated by their behavior because she staff tells her that that she has to be more understanding of the other residents. She stated that she is angry because the facility has not taken measures to stop this intrusive wandering and control the noise level. The facility failed to maintain comfortable sound levels that do not interfere with residents' hearing and privacy by failing to to assure a resident's ability to control unwanted noise. The facility failed to maintain a homelike environment by including the residents' opinion of the living environment, to include preventing other residents from entering their rooms uninvited and controlled unwanted noise. Refer F565 28 Pa. Code 201.29 (a) Resident rights 28 Pa. Code 201.18 (e)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 3 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 0637 Assess the resident when there is a significant change in condition Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records and the RAI manual and staff interview, it was determined that the facility failed to timely complete a significant change Minimum Data Set assessment for one of the 24 residents reviewed (Resident 98). Residents Affected - Few Findings include: The Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual, which provides instructions and guidelines for completing Minimum Data Set (MDS) assessments (mandated assessments of a resident's abilities and care needs), dated October 2023, indicates that a significant change MDS assessment must be completed no later than the assessment reference date (ARD) plus 14 calendar days. A clinical record review revealed a significant change MDS assessment for Resident 98 with an ARD dated October 8, 2023. However, the MDS assessment was not signed as completed until November 1, 2023, which was 10 days late. During an interview on January 9, 2024, at approximately 1:00 PM, the facility's Registered Nurse Assessment Coordinator (RNAC) confirmed that Resident 98's significant change MDS assessment dated [DATE], was completed late. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 4 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of the Resident Assessment Instrument Manual and clinical records, and staff interviews, it was determined that the facility failed to transmit Minimum Data Set (MDS, a federally mandated standardized assessment conducted at specific intervals to plan resident care) assessments to the required electronic system, the CMS Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) System, within the required time frame for one of three closed records reviewed (Resident 111). Residents Affected - Few Findings included: The Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual, which provides instructions and guidelines for completing the Minimum Data Set (MDS) dated [DATE], requires that MDS Discharge Assessment-Return Not Anticipated (Non-Comprehensive) be completed no longer than the resident's discharge date + 14 calendar days. A clinical record review revealed that Resident 111 left the facility against medical advice to live in the community on November 10, 2023. A clinical record review revealed that a MDS Discharge Assessment-Return not anticipated was signed as completed on November 26, 2023 (2 days late). During an interview on January 9, 2024, at approximately 1:00 PM, the facility's Registered Nurse Assessment Coordinator (RNAC) confirmed that Resident 111's MDS Discharge Assessment-Return Not Anticipated, dated November 10, 2023, was completed late. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 5 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records and the Resident Assessment Instrument and staff interviews, it was determined that the facility failed to ensure the Minimum Data Set Assessments (MDS - a federally mandated standardized assessment conducted at specific intervals to plan resident care) accurately reflected the status of one resident out of 24 sampled (Residents 29). Residents Affected - Few Findings include: A review of Resident 29's Quarterly MDS assessment dated [DATE], Section P0100 Physical Restraints, indicated the resident had a restraint. Review of Resident 29's clinical record and observations performed during survey failed to provide evidence that the resident had a restraint in place. Interview with the Director of Nursing on January 8, 2024, at approximately 1:44 PM confirmed the resident's quarterly MDS assessment was inaccurate. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 6 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, a review of clinical records, and resident and staff interviews, it was determined that the facility failed to consistently implement planned care and services consistent with professional standards of practice and the resident's plan of care to prevent the development and worsening of pressure ulcers for two residents out of the 24 sampled residents (Residents 49 and 29). Residents Affected - Some Findings include: According to the US Department of Health and Human Services, Agency for Healthcare Research & Quality, the pressure ulcer best practice bundle incorporates three critical components in preventing pressure ulcers: comprehensive skin assessment, standardized pressure ulcer risk assessment, and care planning and implementation to address the areas of risk. The American College of Physicians (ACP) is a national organization of internists who specialize in the diagnosis, treatment, and care of adults (the ACP is the largest medical-specialty organization and second-largest physician group in the United States). Clinical Practice Guidelines indicate that the treatment of pressure ulcers should involve multiple tactics aimed at alleviating the conditions contributing to ulcer development (i.e., support surfaces, repositioning, and nutritional support); protecting the wound from contamination and creating and maintaining a clean wound environment; promoting tissue healing via local wound applications, debridement, and wound cleansing; using adjunctive therapies; and considering possible surgical repair. A clinical record review revealed that Resident 49 was admitted to the facility on [DATE], with diagnoses of chronic respiratory failure, diabetes mellitus, and heart failure. An Minimum Data Set assessment (MDS - a federally mandated standardized assessment process conducted periodically to plan resident care) dated October 15, 2023, revealed that Resident 49 is cognitively intact with a BIMS score of 15 (Brief Interview for Mental Status- a tool within the Cognitive Section of the MDS that is used to assess the resident's attention, orientation, and ability to register and recall new information; a score of 13-15 indicates cognition is intact). A physician's order, dated October 11, 2023, was noted for the application of a pressure redistribution device to the resident's chair every day and evening shift when the resident was out of bed. Resident 49's plan of care initiated November 8, 2023, indicated that the resident was at risk for developing pressure ulcers due to a history of ulcers, immobility, and diabetes with planned interventions for turning and repositioning the resident at least every two hours, more often as needed or requested, and putting a pressure-reducing mattress and chair cushion in place. A wound consultant note dated December 14, 2023, at 3:56 PM revealed preventative measure recommendations for ongoing pressure reduction and turning and repositioning, and pressure reduction to the heels. A weekly skin check evaluation, dated December 19, 2023, at 11:01 AM, indicated that Resident 49 had no newly identified alteration in skin integrity. A wound consultant note dated December 21, 2023, at 11:33 AM revealed preventative measure (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 7 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some recommendations for ongoing pressure reduction and turning and repositioning precautions, including pressure reduction to the heels. A review of facility task tracking from December 21, 2023, through December 26, 2023, revealed that the resident required partial to moderate assistance (staff does less than half the effort) for the resident to roll left and right in bed on 10 shifts and substantial to maximum assistance (staff does more than half the effort) to roll left and right in bed on 6 shifts. Facility turning and repositioning tracking dated from December 21, 2023, through December 26, 2023, revealed no documented evidence that staff turned and repositioned Resident 49 at least every two hours as noted in the resident's plan of care. The turn and reposition task indicated that the frequency of the task was every shift. During an interview on January 7, 2024, at 12:40 PM, Resident 49 stated that staff do not turn or reposition him every two hours. A weekly skin check evaluation, dated December 26, 2023, at 11:21 AM, indicated that Resident 49 had no newly identified alteration in skin integrity. A progress note dated December 26, 2023, at 2:45 PM indicated that during routine podiatry care, pressure areas were observed on Resident 49's feet. A physician phone order was initiated on December 26, 2023, to maintain bilateral heel lift boots at all times, which may be removed for skin checks. The resident's clinical record failed to include any further wound assessment or evaluation of the resident's pressure sores conducted on December 26, 2023, or on December 27, 2023, following podiatry's identification of the new pressure sores on the resident's feet. Wound consultant documentation dated December 28, 2023, at 7:39 AM indicated Resident 49 had two new wounds, a new unstageable pressure ulcer measuring 3.0 cm x 2.0 cm x 0.1 cm on Resident 49's right heel with a scant amount of serosanguineous (yellowish liquid with small amounts of blood). The periwound is intact with erythema (redness of the skin). The wound base has 100% granulation (pink tissue that is an indicator of healing). No odor was present. The second area was a new unstageable pressure ulcer measuring 4.0 cm x 3.5 cm x 0.1 cm on Resident 49's left heel with a scant amount of serosanguineous. The wound base has 100% granulation. No odor was present. An observation on January 10, 2024, at 11:30 AM of the resident's right heel wound, revealed that the area measured 1.0 cm x 0.5 cm x 0.1 cm with soggy tissue, no odor, and a scant amount of clear drainage around the wound. Brown, tan, and yellow stains were observed on the bandage. The resident's left heel wound measured 0.5 cm x 0.5 cm x 0.0 cm with dry tissue, no odor, and a scant amount of tan and yellow stains on the bandage. The resident stated he was not experiencing pain related to his heel injuries at the time of the observation. During an interview on January 10, 2024, at approximately 8:30 AM, the Director of Nursing (DON) was not able to provide documented evidence that facility staff were consistently turning and repositioning the resident at least every two hours according to the resident's plan of care and assuring pressure reduction to the resident's heels to prevent the development of the pressure sores on the resident's heels. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 8 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of Resident 29's clinical record revealed admission to the facility on March 19, 2021, with diagnoses which included Parkinson's disease, dementia, and heart disease. A review of Resident 29's care plan, last revised March 19, 2021, revealed a problem of risk for skin breakdown as evidenced by decline in self-mobility and decrease in appetite with planned interventions to float resident's heels when in bed as he allows, heel boots and float heels off pillows, pressure re-distribution surface to bed and chair, observe skin condition daily with ADL care and report any changes, provide peri-care/incontinence care as needed and apply barrier cream after each cleansing, shower weekly, and skin prep to right heel every shift. A review of a Quarterly MDS assessment dated [DATE], revealed that the resident was moderately cognitively impaired, dependent on staff for personal hygiene, and required substantial/maximal assistance with toileting hygiene, bathing, and transfers, and was at risk for pressure ulcer development. The resident utilized a wheelchair for mobility and did not ambulate. Review of the clinical record revealed that on December 18, 2023, nursing staff identified an open area to the resident's right heel measuring 2 cm x 2.5 cm. The wound bed was white, and no drainage was noted. Review of Treatment Administration Record (TAR) dated December 2023, revealed no evidence that the resident's heels were floated off the pillows per the resident's plan of care to prevent skin break down until December 18, 2023, when the open area was identified. There was no documented evidence in the clinical record that heel boots were implemented for Resident 29, as per his plan of care, dated March 19, 2021. Review of a Skin and Wound note dated December 21, 2023, at 1:53 PM, completed by a consultant wound care physician, indicated that the condition of the resident's wound worsened. The wound care consultant recommended vascular dopplers of the right lower extremity. According to the documentation, the wound was a stage 3 pressure ulcer which now measured 2 cm x 2 cm x 0.1 cm with 1-24% granulation tissue (healthy tissue), and 50-74% slough (yellow/white material in the wound bed, dead skin cells that accumulate in the wound drainage). Interview with the Director of Nursing on January 9, 2024, at approximately 10 AM revealed that Resident 29 had a prior diagnosis of peripheral vascular disease as noted in podiatry documentation dated September 8, 2023, therefore, doppler studies were not performed as recommended by the wound care physician. The facility was unable to provide evidence that doppler studies were performed to confirm the diagnosis of PVD. There was no documented evidence in the resident's clinical record by attending physician that the resident had a diagnosis of peripheral vascular disease (PVD). Review of clinical record revealed that on December 27, 2023, nursing staff identified an open area on the resident's right 2nd toe, which measured 0.5 cm x 1 cm, with slight redness noted. Review of Skin and Wound note dated December 28, 2023, at 8:36 AM, completed by the consultant wound care physician, revealed that the stage 3 right heel pressure ulcer had not shown improvement and the right 2nd toe was identified as an abrasion. Recommendations were to continue with turning and repositioning for pressure prevention, float heels while in bed with use of heel boots, a low (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 9 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 0686 air-loss mattress, and vascular dopplers of the right heel wound. Level of Harm - Minimal harm or potential for actual harm Review of Skin and Wound note dated January 3, 2023, at 9:52 AM, revealed that the resident's heel wound continued to decline and had been reclassified from a stage 3 to unstageable (full-thickness pressure injury in which the base of the wound is obscured by dead tissue) and measured 2.2 cm x 3 cm x 0.2 cm with 50% deep purple tissue and 50% slough. The recommendation were to float the resident's heels while in bed with use of pillows, float heels while out of bed with use of heel boots, turning/repositioning per protocol, obtain an alternating air/low air loss mattress for pressure redistribution and ensure settings are maintained at an appropriate level based on the patient's needs and body habitus. According to the wound care consultant documentation, all prevention measures were discussed with the staff at the time of the visit. Residents Affected - Some Review of the resident's clinical record failed to provide evidence that interventions recommended by the wound care physician were timely and/or consistently implemented to prevent further skin break down and/or prevent worsening of existing wounds. Review of Resident 29's clinical record revealed that on January 7, 2024, nursing staff identified an open area to the resident's sacrum that measured 2 cm x 1.5 cm, wound bed yellow with pink surrounding tissue. Observation of Resident 29 on January 10, 2024, at approximately 10 AM revealed that the resident was in bed, and at that time, there was an alternating air mattress in place. Interview with the Director of Nursing on January 10, 2024, at approximately 1:30 PM, confirmed that there was no evidence that the facility implemented Resident 29's plan of care for pressure sore prevention and had failed to timely implement the wound care physician recommendations to promote healing and prevent worsening of pressure sores. 28 Pa Code 211.12 (c)(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 10 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on an observation, review of clinical records, select facility policy and fall incident reports, and staff interviews, it was determined that the facility failed to consistently implement, and evaluate the effectiveness, of planned individualized fall prevention measures and provide sufficient staff supervision at the level and frequency required, of residents identified as at high risk for falls and known unsafe behaviors to prevent falls resulting in serious injuries, a fractured femur, for one resident (Resident 98) and a fractured neck for one resident (Resident 56), and failed to provide necessary assistance devices and assure that the resident's environment was free of potential accident hazards to prevent a fall and injuries, abrasions and bruises, to one resident (Resident 39) out of nine residents sampled for accidents. Findings include: A review of the facility policy titled Managing Falls and Fall Risk, last reviewed by the facility on January 2, 2024, indicated that it is the facility's policy to identify interventions related to the resident's specific risks and causes to try to prevent the resident from falling and to try to minimize complications from falling. Also, the policy indicates that if interventions have been successful in preventing falling, staff will continue the interventions or reconsider whether these measures are still needed if a problem that required the intervention has resolved. A clinical record review revealed that Resident 98 was initially admitted to the facility on [DATE], with diagnoses to include dementia (a condition characterized by the loss of cognitive functioning such as thinking, remembering, and reasoning, to such an extent that it interferes with a person's daily life and activities) and a history of repeated falls with significant injuries including a fracture of the right femur (thigh bone) and a fracture of the left radius (the radial bone is one of the two large bones of the forearm). Resident 98's care plan, initially dated October 25, 2022, revealed that Resident 98 was at-risk for falls with behaviors that do not allow staff to assist, including swinging at staff during redirection. The resident's care plan also noted the use of both chair and alarms, initiated November 12, 2022 and December 5, 2022, respectively. A Physical Therapy Discharge summary dated [DATE], indicated that Resident 98 required the assistance of one staff member for ambulation. A quarterly Minimum Data Set assessment (MDS - a federally mandated standardized assessment process conducted periodically to plan resident care) dated July 27, 2023, revealed that Resident 98 was severely cognitively impaired with a BIMS score of 01 (Brief Interview for Mental Status- a tool within the Cognitive Section of the MDS that is used to assess the resident's attention, orientation, and ability to register and recall new information; a score of 0-7 indicates severe cognitive impairment). This quarterly MDS assessment dated [DATE], Section G0300 Balance during Transition and Walking, indicated that Resident 98 was not steady when moving from a seated to a standing position or when walking and was only able to stabilize with staff assistance. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 11 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 - Actual harm Residents Affected - Few A review of facility fall reports revealed that between July 2023 and September 2023 Resident 98 fell five times before falling on September 29, 2023, and sustaining a serious injury. The facility's fall investigations identified that Resident 98 had four unwitnessed falls during this time period. A facility fall report noted that Resident 98 had an unwitnessed fall on July 13, 2023, at 7:00 PM in her bathroom. Staff found the resident on the bathroom floor, near her wheelchair. No injuries were noted. The facility developed an intervention for staff to toilet Resident 98 each day at 7:00 PM. Facility fall reports revealed that Resident 98 had an unwitnessed fall on July 14, 2023, at 4:15 PM in the hallway. Staff found the resident on the floor lying in front of her wheelchair. No injuries were noted. An intervention was developed to evaluate labs and obtain a urine analysis A physician progress note dated July 31, 2023, indicated that the resident's recent labs, urine, medications, and medication management were reviewed. The entry noted that Resident 98's plan was being formulated. A facility fall report noted that Resident 98 had an unwitnessed fall on July 29, 2023, at 2:15 PM in the hallway. Staff found the resident on the floor in the doorway outside of her room. No injuries were noted. A care plan intervention was developed for staff to conduct 15-minute safety checks of the resident. The 15 minute safety checks of the resident were discontinued on July 31, 2023. A fall risk assessment dated [DATE], indicated that Resident 98 was at high risk for falls. A facility fall report noted that Resident 98 had an unwitnessed fall on August 19, 2023, at 9:05 PM near her room doorway. Staff found the resident lying on the floor in the doorway of her room. The preventative approach was developed for staff to restart every 15 minute safety checks, which was planned after the fall on July 29, 2023. An additional care plan intervention was developed for staff to check the resident's alarm pads to ensure proper placement. A review of the resident's clinical record and task and intervention tracking documentation revealed no evidence that staff were conducting every 15-minute checks of Resident 98 as a safety measure, after the resident's fall on August 19, 2023. Nursing documentation dated August 2023, indicated that the resident continued frequent attempts to ambulate without staff assistance. A nursing progress note dated August 22, 2023, at 2:04 PM indicated that Resident 98 was self-rising and attempting to ambulate at times. Nursing noted that redirection was unsuccessful at times but does well with one-to-one interaction. A nursing note dated August 22, 2023, at 7:06 PM indicated Resident 98 was frequently yelling out and attempting to stand and ambulate from the wheelchair. A nursing progress note dated August 23, 2023, at 3:22 AM indicated that Resident 98 was attempting to self-transfer out of bed. Staff assisted the resident into a wheelchair and to the nurse's station. Nursing progress note dated August 23, 2023, at 2:45 PM indicated that Resident 98 displayed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 12 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 frequent self-rising attempts. Level of Harm - Actual harm A nursing progress note dated August 23, 2023, at 6:11 PM indicated that the resident made multiple attempts at standing and ambulating without assistance this shift. The also entry noted that the resident does well with one-on-one assistance. Residents Affected - Few Nursing noted on August 24, 2023, at 2:32 PM that Resident 98 continued with impulsive self-rising or attempting to ambulate unassisted. A nursing progress note dated August 25, 2023, at 11:19 PM indicated that Resident 98 displayed multiple behaviors, to include standing up frequently, kicking at staff, slapping, and poking staff. The entry noted Resident 98 enjoys one-on-one (interaction) but reverts to the same behavior when left by herself. Nursing noted on September 21, 2023, at 1:34 AM that Resident 98 made multiple attempts to get out of bed without assistance. The entry further noted that that reorientation, redirection, and distraction were attempted and failed. The resident's care plan included interventions to mitigate Resident 98's risk of falls as of September 29, 2023, including a chair alarm, ensuring the resident was wearing appropriate footwear when ambulating or mobilizing in a wheelchair, giving the resident a cat to hold to keep her busy in one spot, keeping frequently used articles within reach of the resident, 15 minute safety checks, and keeping the resident out at the nurse's station when restless to have staff around for close observation. However, review of the resident's clinical record, Resident 98's task and intervention tracking and fall investigation reports for September 29, 2023, revealed no documented evidence that staff had implemented all planned interventions in accordance with her care plan for mitigating her risk of falling. Specifically, the clinical record, task documentation and intervention tracking failed to reveal documented evidence that staff had implemented the follow care planned interventions: (1) provided Resident 98 with her toy cat to hold to keep her busy in one spot: (2) ensured that frequently used articles were within reach of Resident 98: or (3) conducted 15-minute safety checks. A nursing progress note dated September 29, 2023, at 11:16 AM indicated that staff found Resident 98 lying on her back with her left leg flexed near her wheelchair near the nurse's station. The resident was yelling out in pain. The note indicated that neurological checks were initiated and that a cold pack was provided to the resident. A mobile x-ray report dated September 29, 2023, at 11:44 AM indicated that Resident 98 had a mildly displaced, impacted, and angulated acute subcapital fracture of the proximal left femur. The nursing progress note dated September 29, 2023, also noted that the resident's x-ray was positive for a proximal femur fracture and the Certified Registered Nurse Practitioner (CRNP) evaluated the resident. The resident was transferred to the emergency room (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 13 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 - Actual harm Residents Affected - Few A facility investigation report dated September 29, 2023, indicated that Resident 98 had an unwitnessed fall near the nurse's station at 11:15 AM. Staff found the resident lying on her back with her wheelchair alarm sounding. A witness statement dated September 29, 2023, provided by Employee 5, a Licensed Practical Nurse (LPN), indicated that she did not witness Resident 98 fall. Employee 5, LPN, indicated that the last time she saw the resident was at 9:30 AM when administering medication. Employee 5, LPN, indicated that she was in the hallway administering medications when she heard a thump and saw the resident on the floor next to her wheelchair. Employee 5, LPN, indicated that Resident 98 was evaluated, and nursing supervisor notified about the incident. A witness statement dated September 29, 2023, provided by Employee 7, Nurse Aide (NA), indicated that she did not witness Resident 98 fall. Employee 7, NA, indicated that she last saw Resident 98 at 9:30 AM. A witness statement dated September 29, 2023, provided by Employee 6, Nurse Aide (NA), indicated that she did not witness Resident 98 fall. Employee 6, NA, indicated that the last time she saw Resident 98 was at 9:30 AM in front of the resident's room. A witness statement dated September 29, 2023, provided by Employee 8, Registered Nurse (RN), indicated that she did not witness Resident 98 fall. Employee 8, RN, indicated that the last time she saw Resident 98 was 11:00 AM in her wheelchair near the nurse's station. A hospital discharge summary indicated that Resident 98 was admitted on [DATE], due to a fall with hip pain and a fracture. The report indicated that Resident 98 underwent open reduction and internal fixation surgery (ORIF- a type of surgery that is used to repair broken bones) to repair a fracture of her left femoral neck. The resident was discharged from the hospital on October 2, 2023. Nursing noted on October 2, 2023, at 9:20 PM that Resident 98 was readmitted to the facility with intact surgical wound dressings. During an observation on January 7, 2024, at 12:51 PM, Resident 98 was observed seated in a wheelchair near the nurse's station. Resident 98 was observed moving from a seated position to a standing position multiple times, which caused her alarm to engage and disengage. There were no employees present at the nursing station, but after 60 seconds, Employee 3, Registered Nurse (RN), responded to Resident 98's alarm. Employee 3, RN, was observed talking to Resident 98. During an interview on January 9, 2024, at approximately 9:30 AM, the Director of Nursing (DON) confirmed that the facility was unable provide documented evidence of consistent implementation of planned safety and fall prevention measures, including sufficient staff supervision, to prevent Resident 98's fall and serious injury on September 29, 2023. A review of the clinical record of Resident 39 revealed admission to the facility on September 19, 2019, with a history of falls with fracture and heart failure. A review of the resident's annual MDS assessment dated [DATE], revealed that the resident was moderately cognitively impaired and required extensive staff assistance with activities of daily living, including bed mobility, transfers, and toileting. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 14 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 - Actual harm Residents Affected - Few Review of Resident 39's care plan, last revised February 25, 2020, indicated that the resident was at risk for falls related to a history of falls, non-compliance with transfer status, impaired balance, impaired coordination, weakness, pain, and medication. Planned interventions for prevention included a high-density contour mattress, bilateral fall-[NAME] mats to the bedside, transfer via mechanical lift, keep pathways clear and free of clutter, maintain call bell within reach, and non-skid footwear at all times. According to the care plan, Resident 39 also utilized bilateral bed enablers (side rails) to assist in bed mobility, which was initiated October 7, 2019. Nursing noted on November 24, 2023, at 1:28 PM that the resident was transferred to another room for isolation precautions after testing positive for COVID. Nursing progress notes dated November 28, 2023, at 7 PM indicated that staff found the resident found face down on the floor next to the bed with arm of bed side table underneath right upper leg. The resident sustained abrasions to right upper thigh, the bridge of her nose was swollen with slight bruising, redness and swelling was observed on the left temporal area, and the resident complained of left shoulder pain. An x-ray was ordered due to complaints of left shoulder pain, which was negative for fracture or dislocation. A review of a facility investigation dated November 28, 2023, at 5:45 PM indicated that the resident had an unwitnessed fall from the bed. At time of event, the resident stated that she forgot I didn't have my handrails (side rails on the bed {enablers}). Facility description of potential contributing factors identified that when the resident was moved to another room for isolation, the temporary room's bed had an air mattress versus a high-density contour mattress, no bilateral bed enablers, and fall mats were not in place on each side of the bed. The facility failed to implement the resident's fall prevention measures when the resident was transferred to the temporary room for isolation precautions for COVID. The bed in which the resident was placed had a different type of mattress, no enabler bars and no fall mats were placed on the floor at the bedside. In response to the resident's fall from bed on November 28, 2023, the facility planned the immediate interventions of removing the air mattress and replace it with the appropriate mattress and apply bilateral enablers (side rails on the bed). Interview with the Director of Nursing on January 9, 2024, at approximately 2:00 PM confirmed that the facility failed to implement Resident 39's planned interventions, and assure that the resident's temporary environment was free of potential accident hazards, to prevent the resident's fall with injuries. Clinical record review revealed that Resident 56 was admitted to the facility on [DATE], for short-term therapy after a fall at home during which the resident sustained a hip fracture. The resident had a history of repeated falls and a diagnosis of rheumatoid arthritis. The resident's care plan, dated November 5, 2023, indicated that the resident was at risk for falls with an intervention for staff to be sure that the resident's call light was within reach, to encourage the resident to use it for assistance, and education to the resident on safety issues. The care plan also included an intervention for the resident's bed to be in lowest position, dated November 8, 2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 15 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 - Actual harm Residents Affected - Few A review of a facility fall investigation report dated November 6, 2023 at 2:53 PM revealed that staff observed Resident 56 on the floor, next to the foot of the resident's bed. According to the report, he stood up and stepped out of the wheelchair. The investigation indicated that it appeared that he was attempting to pick up something from the floor. The noted intervention was to refer the resident to therapy for a reacher with associated education. A review of a facility investigation report dated December 10, 2023 at 5:30 AM revealed that staff found Resident 56 laying on the floor, on his right side, between the beds in his room. He told staff he was going to the ball game. He had a small bump on the top of his forehead approximately one inch under his hairline. Neuro checks were initiated. He had non skid socks on and was last given care at 5 AM The physician was contacted and because this resident was taking an anticoagulant medication (Eliquis) he was transferred to the hospital for evaluation. New interventions to prevent falls dated December 10, 2023, was for the resident to wear non-skid socks, although the facility's fall investigation report indicated that the resident was wearing non-skid socks at the time of this fall. Nursing documentation dated December 10, 2023 at 5:48 AM revealed that staff in the hall, heard Resident 56 say I hope that doesn't happen again. Staff went into the resident's room and found the resident lying on the floor, between both beds. The resident was facing his bed. Staff assessed the resident to have two small superficial open areas noted to the top of the forehead, approximately one inch inside the hairline. The area had a small, elevated purplish discolored lump at the site of the open area, no further bleeding or drainage noted. The resident's physician and responsible party notified. The ambulance was called and the resident was transported to the hospital for treatment. The emergency room staff contacted the facility and relayed information that the resident was being admitted to the hospital for a non-displaced fracture of the base of the odontoid in the cervical region (of the neck), and was to be seen by neurology services and also that the resident had a urinary tract infection. A review of hospital documentation dated December 12, 2023 at 7:39 A.M. revealed a CT scan (a computerized x-ray imaging procedure) revealed that Resident 56 had an acute type 2 odontoid fracture, undisplaced fractures of posterior arch C1 (cervical 1 vertibra). The hospital placed an Aspen collar (cervical collar, also known as a neck brace) on the resident and the resident was admitted to the facility on [DATE]. A significant change MDS assessment dated [DATE], revealed that the resident was moderately cognitively impaired with a BIMS score of 8 and was dependent on staff for activities of daily living. A review of a facility investigation dated December 26, 2023 at 4:30 P.M., revealed Resident 56 was found on the floor. His Aspen collar was in place. He had been sitting in the wheelchair at the time of the fall and was incontinent of bowel at that time. The resident stated that he was trying to go to the bathroom for a bowel movement. The noted intervention was to offer toileting at 4 PM daily and the additions of bed and chair alarms. A review of a facility investigation report dated December 30, 2023 at 3:45 P.M. revealed that Resident 56 was found on the floor in his room from bed. Planned interventions added at the time of this fall was to add bilateral fall mats next to his bed. A nurses note dated December 30, 2023 at 6:08 PM revealed that at 3:45 PM that date staff found the resident sitting on the floor next to his bed. He stated he was trying to get to call his wife. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 16 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 - Actual harm Residents Affected - Few The facility failed to demonstrate the implementation of necessary fall prevention approaches, including sufficient staff supervision of resident with a known history of falls and identified at risk for falls to prevent repeated falls and serious injury. The facility failed to re-evaluate the effectiveness of existing planned safety measures as the resident continued to fall and revise the resident's fall prevention plan accordingly to include increased supervision of the resident, which was confirmed during interview conducted on January 10, 2024, at 10 AM with the Director of Nursing. 28 Pa. Code 201.18 (e)(2.1) Management 28 Pa. Code 211.12 (c)(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 17 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records, and staff interview, it was determined that the facility failed to implement individualized approaches to prevent declines in bowel continency and restore normal bowel function to the extent possible for two residents (Resident 18 and 56) and failed to assess a resident's bladder function following removal of indwelling foley catheter for one resident (Resident 165) out of five sampled. Findings include: A review of Resident 18's clinical record revealed admission to the facility on October 20, 2022, with diagnoses of osteoarthritis, transient cerebral ischemic attack (mini stroke - TIA), protein-calorie malnutrition, and hypertension. A review of Resident 18's quarterly Minimum Data Set assessment (MDS- a federally mandated standardized assessment process conducted periodically to plan resident care) dated April 5, 2023, section H, bowel and bladder, revealed that the resident was always continent of bowel. A review of Resident 18's quarterly MDS assessment dated [DATE], section H, bowel and bladder, revealed that the resident was now occasionally incontinent of bowel, and was not on a bowel toileting program. A review of Resident 18's annual MDS assessment dated [DATE], section H, bowel and bladder, revealed that the resident was now frequently incontinent of bowel, and was not on a bowel toileting program. A review of the resident's current care plan (a guide used to assist in directing resident care) failed to identify the resident's bowel incontinence status and specific interventions to address the resident's incontinence. During an interview with the Director of Nursing (DON) on January 10, 2024, at approximately 10:15 AM, it was confirmed that the facility failed to act upon the resident's decline in bowel continence and implement measures to restore normal bowel function to the extent possible for the resident. Clinical record review revealed that Resident 56 was admitted to the facility on [DATE], for short-term therapy after a fall at home during which the resident sustained a hip fracture. The resident had a history of repeated falls and a diagnosis of rheumatoid arthritis and urinary retention with a foley catheter. A review of an admission MDS assessment dated [DATE], revealed that the resident was moderately, cognitively impaired, required staff assistance for activities of daily living, including toileting and was frequently incontinent of bowel. As of the survey ending January 10, 2023, there was no further evaluation of the resident' bowel function. A review of a facility investigation dated December 26, 2023 at 4:30 PM revealed Resident 56 was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 18 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some found on the floor. He had been sitting in the wheelchair prior to the fall and had been incontinent of bowel at that time. The resident stated that he was trying to go to the bathroom for a bowel movement. The noted intervention was to offer toileting at 4 PM daily and the additions of bed and chair alarms. A review of a care plan initiated December 27, 2023, revealed that Resident 56 required assistance with ADL care, including toileting. There was no evidence at the time of the survey that the facility had evaluated the resident's bowel habits and status to develop an individualized bowel retraining program to decrease episodes of bowel incontinence. The facility noted an intervention to toilet the resident at 4 PM daily in response to a fall that occurred at 4:30 PM, but there was no indication that the facility had fully evaluated and assessed the resident's habits and patterns of elimination to plan scheduled toileting times. Clinical record review revealed that Resident 165 was admitted to the facility on [DATE], with diagnoses of cerebral vascular accident (stroke) and dementia and was admitted with an indwelling foley catheter. Nursing documentation indicated that Resident 165's indwelling foley catheter was removed on December 14, 2023. An MDS assessment dated [DATE], indicated the resident was severely cognitively impaired, required assistance with activities of daily living including toileting and was always incontinent of urine. A review of a bowel and bladder screen document dated December 21, 2023, revealed that Resident 165 was always incontinent of urine. However, following removal of the resident's foley catheter on December 14, 2023, two days after the resident's admission, there was no documented evidence that the facility had evaluated the resident's bladder function, including voiding habits and patterns, in an attempt to develop and implement an individualized toileting plan to restore normal bladder function to the extent practicable. During an interview with the Director of Nursing (DON) on January 10, 2024, at approximately 10:20 AM, it was confirmed that when the foley catheter was removed a full evaluation of the resident's bladder function in an attempt to restore bladder function. Refer F689 28 Pa. Code 211.12 (d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 19 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of select facility policy and clinical records, observations, and staff interview it was determined that the facility failed to ensure that the facility provided enteral feedings as prescribed and services designed to prevent potential complications associated with tube feedings for one resident out of two residents sampled receiving enteral tube feedings (Resident 67). Findings include: A review of facility policy entitled Enteral Tube Feeding via Continuous Pump last reviewed by the facility January 2, 2024, revealed procedures that when initiating the feeding, on the formula label staff are to document initials, date and time the formula was hung/administered prior to starting pump. Review of Resident 67's clinical record revealed that she was most recently admitted to the facility on [DATE], with diagnoses, which included Downs syndrome, sacral pressure ulcer (bed sore), protein-calorie malnutrition, and hypertension. According to the clinical record, Resident 67 required a percutaneous endoscopic gastrostomy (a tube is passed into the stomach through the abdominal wall to provide a means of feeding when oral intake is not adequate for enteral feeding [enteral nutrition generally refers to any method of feeding that uses the gastrointestinal (GI) tract to deliver part or all of a person's caloric requirements). The resident had a current physician orders dated November 22, 2022, for an enteral feeding, Vital 1.2. Provide 60 cubic centimeters (cc) per hour for 12 hours from 7 PM to 7 AM which provided 864 calories and 50 grams (g) protein, 534 cc free water. Free fluid water flush 100 cc every 6 hours via pump to provide additional 400 cc water daily. Observation of the resident's tube feeding pump on January 7, 2024, at approximately 12:20 PM revealed dried tube feed solution was observed on the pole, floor, and that the end of the tube, the port, was uncapped. The tube feeding revealed an enteral feeding Vital 1.2, was not labeled with the rate of delivery, resident's name, or staff initials, date, and time hung. In addition, observed was a clear bag containing a clear liquid substance unlabeled. There was no identifying details on the bag, to include the name of the content, rate of delivery, residents name, or staff initials, date, and time hung as noted in facility policy. A second observation of the resident's tube feeding pump on January 7, 2024, at approximately 1:10 PM revealed dried tube feed solution was observed on the pole, floor, and that the end of the tube, the port, was uncapped. The enteral feeding Vital 1.2, was not labeled with the rate of delivery, residents name, or staff initials, date, and time hung. In addition, a clear bag containing a clear liquid substance was unlabeled and lacked identifying details on the bag, to include the name of the content, rate of delivery, resident's name, or staff initials, date, and time hung. A third observation of the resident's tube feeding pump on January 7, 2024, at approximately 2:00 PM, in the presence of Employee 3, Registered Nurse (RN), confirmed the observations. Employee 3 stated that the enteral feeding, and the bag should be labeled, and verified that the end of the feeding (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 20 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few tube was uncapped, and a possible source of contamination, which had the potential to cause complications. Interview with the Director of Nursing (DON) on January 8, 2024, at approximately 10:15 AM, confirmed that the staff failed to follow facility policy for labeling/documenting the initiation of enteral feedings and fluids and ensure that tube feeding equipment was maintained in a sanitary manner. 28 Pa. Code 211.10(a)(d) Resident care policies 28 Pa. Code 211.12 (d)(1)(2)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 21 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of the clinical record and resident and staff interviews, it was determined that the facility failed to provide person-centered and coordinated care for one out of the one sampled resident receiving dialysis (Resident 14). Residents Affected - Few Findings include: A clinical record review revealed Resident 14 was admitted to the facility on [DATE], with a diagnosis of end-stage renal disease (final stage of kidney decline where the kidneys are no longer able to function to meet the body's needs) and with a dependence on renal dialysis (a process of purifying the blood of a person whose kidneys are not working normally), and an acquired absence of kidney. A review of the quarterly Minimum Data Set assessment (MDS - a federally mandated standardized assessment process conducted periodically to plan resident care) dated October 19, 2023, revealed that Resident 14 is cognitively intact with a BIMS score of 13 (Brief Interview for Mental Status- a tool within the Cognitive Section of the MDS that is used to assess the resident's attention, orientation, and ability to register and recall new information; a score of 13-15 indicates cognition is intact). A physician order dated March 17, 2022, was noted for Resident 14 to receive dialysis treatment three times per week on Mondays, Wednesdays, and Fridays at an external provider. The resident also had a physician order initiated on June 15, 2022, for a 1000-ml fluid restriction distributed as follows: Nursing provide: 7:00 AM to 3:00 PM shift 120 cc (ml) 3:00 PM to 11:00 PM shift 150 cc (ml) 11:00 PM to 7:00 AM shift 120 cc (ml) Dietary was to provide: 240 cc breakfast 240 cc lunch 120 cc dinner The fluid breakdown totaled 990 ml. Resident 14's care plan, initiated on January 19, 2022, indicated that the resident has a need for a therapeutic diet and was on a 1000-ml fluid restriction per day and to see order for breakdown. A clinical record review revealed no documented evidence that the facility tracked and recorded (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 22 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 0698 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident 14's fluid intake during breakfast, lunch, and dinner meals for adherence to physician's ordered fluid restriction and sufficient fluid intake to meet the resident's hydration needs. Resident 14's care plan, initiated January 18, 2022, indicated that the resident was scheduled for dialysis treatment three times per week on Mondays, Wednesdays, and Fridays for four hours and 15 minutes. The care plan also indicated that the resident would be transported to dialysis by ambulance at 3:30 PM. However, during an interview on January 7, 2024, at 12:26 PM, Resident 14 stated that his scheduled appointment times are on Mondays, Wednesdays, and Fridays at 1:30 PM. During an observation on January 8, 2024, Resident 14 was observed leaving the facility for his scheduled dialysis appointment at 1:25 PM. During an interview on January 9th, 2024, the Director of Nursing (DON) confirmed that the facility failed to track and record Resident 14's fluid intake at breakfast, lunch, and dinner meals. The DON also confirmed that Resident 14 leaves the facility for his dialysis appointments on Mondays, Wednesdays, and Fridays at 1:30 PM, not 3:30 PM as indicated in the resident's care plan. The resident also had a physician order dated October 25, 2022, for a regular renal diet (a diet designed to limit sodium, phosphorus and potassium, which becomes increasingly more restrictive as kidney function declines. It starts out with having you limit your salt and the amount of protein you eat. A full renal diet is designed for people who have advanced or end-stage kidney disease and need dialysis or when their kidneys are temporarily damaged and may recover over time). Observation of the resident's lunch tray ticket at the lunch meal on Monday January 8, 2024, revealed that the resident was to receive a regular renal diet. A review of the facility's planned weekly menu (week 4) revealed that the regular diets were to receive Chef's soup, stuffed cabbage, mashed potatoes, 2% milk, fruit juice and 1/2 cup sherbet. During an initial tour of the dietary department on January 8, 2024, the Certified Dietary Manager (CDM) provided the survey team with pre-planned facility menus with menu extensions for the cycle (planned portion sizes for each menu item). There was no written pre-planned menu planned for a Renal diet. Observation of Resident 14's lunch meal on January 8, 2024, revealed that the resident was served Chef's soup, stuffed cabbage, mashed potatoes, 2% milk, fruit juice and 1/2 cup sherbet. An interview at the time of the observation, the CDM stated that dietary staff meet with Resident 14 weekly to view the facility's regular diet menu. The CDM stated that Resident 14 has refused the renal diet since his admission to the facility. The resident chooses his diet and the kitchen complies with the resident's request. The CDM stated that the facility does not prepare a renal diet. During an interview January 9, 2024 at approximately 10 A.M., the Registered Dietitian confirmed that Resident 14 refused the physician ordered Renal diet that had been prescribed since October 2022. She confirmed that the resident's attending physician and the dialysis provider had not been informed of the resident's refusal of the prescribed therapeutic diet and that the facility was serving the resident a regular diet and not complying with the physician order. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 23 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 0698 Refer F803 Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12 (d)(3)(5) Nursing services Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 24 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0744 Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, a review of clinical records, and resident and staff interviews, it was determined that the facility failed to ensure that a resident's individualized dementia care needs are consistently met and that the facility assessed, developed, and implemented interdisciplinary care planned approaches and provided resources necessary for management of dementia related behaviors for one residents out of eight sampled residents (Resident 65). Residents Affected - Some Findings include: A review of the clinical record revealed Resident 65 was admitted to the facility on [DATE], with diagnoses that included altered mental status, anxiety, and dementia without behavioral disturbance. A review of a BIMS (brief interview for mental status - a tool to assess cognitive status) report dated November 2, 2023, indicated that the resident was severely cognitively impaired with a BIMS score of 0. Resident 65's care plan, dated October 30, 2023, noted a goal that the resident adjust to the facility and participate in activity programs of her choosing and verbalize and demonstrate positive feelings about activities through next review of February 11, 2024. Planned interventions noted that Resident 65 likes being addressed by her name and prefers independent directed activities. The activity staff will provide resources and materials, coloring books. Her daily routine or preferences were identified as sitting, coloring, hallmark channel/listening to TV, her dog Whiskey, puzzles. Staff were to check with her regularly to assess satisfaction with activities offered, obtain preferences. Give her calendar of scheduled activities and events daily and encourage to attend, introduce her to other residents with similar interests, welcome Resident 65 to facility, and introduce activity staff members. The resident's care plan, initiated November 17, 2023, indicated that she has the potential to wander aimlessly with a noted goal to maintain the resident's safety through the next review, target date of February 11, 2024. Planned interventions were to distract the resident from wandering by offering pleasant diversions, structured activities, food, conversation, television, book. The care plan noted that she prefers coloring, puzzles talking about her dog Whiskey. The care planed further noted that staff were to identify pattern of wandering: Is wandering purposeful, aimless, or escapist? Is She looking for something or someone? Does it indicate the need for more exercise? Intervene as appropriate. Monitor for fatigue and weight loss, initiated November 17, 2023. A review of nurses note dated November 22, 2023, 10:49 PM, indicated the resident wandering in and out of rooms, upsetting some residents upon entering. Nursing noted that the resident was difficult to redirect and was becoming combative towards staff. Coloring activity was effective for short time. A review of nurses note dated December 6, 2023, 10:33 PM, revealed that the resident continued to wander in and out of other rooms throughout this shift. At one point resident attempted to pull fellow resident (221B) out of the wheelchair. Resident 65 became combative towards staff when redirecting. Diversional activity provided with effect at times. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 25 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0744 Level of Harm - Minimal harm or potential for actual harm A nurse's note dated December 7, 2023, 10:04 PM, indicated that Resident 65 continued to wander in and out of fellow resident's rooms this shift. Many residents are becoming upset/agitated and fearful that Resident 65 was is in their room/rummaging through their belongings. Resident was also noted to be in room [ROOM NUMBER]A attempting to remove a sleeping resident from his bed. When staff was redirecting, Resident 65 became combative. Many attempts providing diversional activity with no effect. Residents Affected - Some Nursing noted on December 20, 2023, 11:51 AM, indicated that Resident 65 was continually walking in hallway, and in and out of rooms, going in other resident's drawers and closets. It was noted that Resident 65 was very hard to redirect and slaps staff at times. Later that same date, nursing noted on December 20, 2023, 10:19 PM, that Resident 65 continued to ambulate throughout facility, and in and out of fellow resident rooms, continued to rummage through other resident's personal belongings, making fellow residents agitated and upset. Nursing noted that Resident 65 becomes combative towards staff with redirection. Nursing noted on December 23, 2023, 9:21 PM, that Resident 65 continued to wander throughout the hallways, continuously entering other resident's rooms and taking belongings. Redirection was ineffective at times. Resident 65 was refusing care at that time, refusing to sit in chair. Fluids were given. Resident 65's clinical record revealed documentation on the following dates that Resident 65 exhibited intrusive wandering, wandering in and out of other resident rooms: November 11, 12, 13, 17, 18, 21, 22, and 25, 2023; December 3, 4, 5, 6, 7, 8, 9, 15, 16, 20, 21, and 23, 2023; and January 2, 2024. An observation on January 9, 2024, at approximately 9:45 AM revealed Resident 65 wandering the hall of the resident unit and entering, uninvited, another's resident room [ROOM NUMBER]. Resident 65 walked through the other resident's room [ROOM NUMBER] touching the residents' personal belonging and then exiting the room without apparent staff's knowledge. A second observation on January 9, 2024, at approximately 2:17 PM found Resident 65 wandering the hall of the resident unit and entering another resident's room uninvited, room [ROOM NUMBER], and then shortly afterwards exiting the room. Interview with alert and oriented Resident 88 on January 9, 2024, at approximately 1:18 PM, revealed that on a daily basis, at any time (day, evening, or night),Rresident 65 enters her room (209) uninvited. While in the room, Resident 65 touches her personal items and moves things. Resident 88 stated that she has voiced her concerns many times to nursing and is told its her (Resident 65's) condition and she's okay. Resident 88 further stated that staff indicated that she (resident 88) could keep her door closed, however, she prefers it be kept open, and besides I have seen her (Resident 65) open doors, and remove things. Interview with alert and oriented Resident 44 on January 9, 2024, at approximately 1:31 PM, revealed that on a daily basis, at any time of day or night, and at times multiple times a day, Resident 65 enters her room (207) uninvited. While in the room, Resident 65 opens her drawers, touches personal items, and at times, eats food off the food trays in her room. Resident 44 stated that she has voiced her concerns many times to nursing and is told its her (Resident 65) condition. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 26 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0744 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some The Director of Nursing (DON) was asked on January 9, 2024, at approximately 1:50 PM, for any tracking or monitoring of the resident's identified patterns of wandering and determinations if the resident's wandering was purposeful, aimless, or escapist, and was she looking for something or someone, as indicated in the resident's care plan. However, the DON confirmed that the facility had no documentation to demonstrate that the care planned interventions to monitor and evaluate the resident's wandering had been completed as noted on the resident's care plan. There was no indication that the facility had reviewed the effectiveness of the interventions planned to address the resident's dementia related behavioral symptoms and modified and revised the approaches that staff were to employ in response to the resident's dementia related behaviors, including intrusive wandering, in an attempt to manage or modify the resident's behavioral symptoms, which was confirmed during interview with DON on January 10, 2024, at approximately 12:15 PM, 28 Pa Code 211.12 (d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 27 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 - Some 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 observation, a review of select facility policy, and staff interview, it was determined that the facility failed to adhere to acceptable storage and use by dates for multi-dose medications on one of two medication carts observed (Station B, Back Hall, B Hall - Resident 4, 8, 31, 55, and 86) and failed to secure one of two medication rooms to prevent unauthorized access (A Unit Medication Room) Findings include: A review of facility policy entitled Insulin Administration last reviewed by the facility January 2, 2024, indicated that the steps in the procedure includes to check the expiration date, if drawing from an opened multi-dose vial. If opening a new vial, record expiration date and time on the vial. Observation of medication administration pass conducted on January 7, 2024, at approximately 10:45 AM, with Employee 2, Licensed Practical Nurse (LPN), on the Station B, Back Hall, B Hall medication cart revealed one (1) Insulin Levemir Flex Pen belonging to Resident 4, opened and available for use, and not dated when initially opened, and or an expiration date; one (1) Insulin Lantus vial belonging to Resident 8, opened and available for use, and not dated when initially opened, and or an expiration date; one (1) Insulin Novolog vial belonging to Resident 31, opened and available for use, and not dated when initially opened, and or an expiration date; one (1) Insulin Humalog Kwik Pen, one (1) Lantus vial (medication used for diabetes) belonging to Resident 55, opened and available for use, and not dated when initially opened, and or an expiration date; and one (1) Insulin Basaglar kwik Pen belonging to Resident 86, opened and available for use, and not dated when initially opened, and or an expiration date. Employee 2, (LPN), confirmed the medications belonged to Resident(s) 4, 8, 31, 55, and 86, were opened and in use but not dated when initially opened for resident use to determine acceptable storage time. Interview with the Director of Nursing (DON) on January 8, 2024, at approximately 10:15 AM, confirmed the that the facility failed to date multi-dose medications when opened to assure acceptable storage times. A review of facility policy entitled Storage of Medications last reviewed by the facility January 2, 2024, indicated that drugs and biologicals used in the facility are stored in locked compartments under proper temperature, light, and humidity controls. Only persons authorized to prepare and administer medications have access to locked medications. The nursing staff is responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary manner. Further review of the policy indicated that medications requiring refrigeration are stored in a refrigerator located in the drug room at the nurse's station or other secured location. Medications are stored separately from food and are labeled accordingly. Observation of the medication room on January 9, 2024, at approximately 9 AM revealed that the door to the medication room was wide open. Upon entering the medication room, purses, and a travel mug were observed on the counter, and the medication storage refrigerator was unlocked. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 28 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 Observation of the refrigerator used to store medications revealed multiple liquid supplements and a sandwich were also being stored in the refrigerator. Observation of the box used to secure controlled medications that require refrigeration revealed that the box was unlocked, and a dirty syringe was observed inside. Further observation of the medication refrigerator revealed that the inside was soiled with crumbs, dirt, and hair. Residents Affected - Some Additional observation of the medication storage room revealed that the cabinet above the sink was heavily soiled with a black substance and dirt, a heavy accumulation of a brown substance around the hot water knob and faucet base of the sink. [NAME] stains were observed along the back of the sink, and a clear plastic cup with a used tea bag was sitting on the counter along with medications intended for resident use. The cabinet beneath the sink was heavily soiled and appeared to have water damage to the bottom of the cabinet. A package of unused resident antibiotic medication was in the bottom of a cabinet next to the refrigerator (Surveyor confirmed that this medication was discontinued). A tackle box with unopened vials of multiple medications was unlocked/open atop a small medication/treatment cart, which was also unlocked. Medical supplies, syringes with needles, resident medications, and wound care supplies were observed in the open cart. These observations were confirmed by the Assistant Director of Nursing (ADON) on January 9, 2024, at 9:12 A.M. The ADON further confirmed that the medication storage room was not to be left unlocked and that the room was not kept in a safe, secure, or sanitary manner. Interview with the Director of Nursing on January 10, 2024, at approximately 1:45 PM, confirmed the that the facility failed to secure the medication room and its content and store medications in a sanitary manner. 28 Pa. Code 211.9 (a)(1)(k) Pharmacy Services 28 Pa. Code 211.12 (c)(d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 29 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. Based on a review of clinical records and the facility's planned cycle menus, observation and staff interviews it was determined that the failed to assure that a resident received foods with the appropriate nutritive content as prescribed by the physician to support the resident's treatment of kidney disease for one resident out of one sampled receiving dialysis (Resident 14). Findings include: A review of the clinical record of Resident 14 revealed admission to the facility on October 25, 2022, with a diagnosis of end-stage renal disease (final stage of kidney decline where the kidneys are no longer able to function to meet the body's needs) and absence of a kidney. The resident was dependent on renal dialysis (a process of purifying the blood of a person whose kidneys are not working normally). A quarterly Minimum Data Set assessment (MDS - a federally mandated standardized assessment process conducted periodically to plan resident care) dated October 19, 2023, revealed that Resident 14 was cognitively intact with a BIMS score of 13 (Brief Interview for Mental Status- a tool within the Cognitive Section of the MDS that is used to assess the resident's attention, orientation, and ability to register and recall new information; a score of 13-15 indicates cognition is intact). The resident had a physician order dated October 25, 2022, for a regular renal diet (a diet designed to limit sodium, phosphorus and potassium, which becomes increasingly more restrictive as kidney function declines. It starts out with having you limit your salt and the amount of protein you eat. A full renal diet is designed for people who have advanced or end-stage kidney disease and need dialysis or when their kidneys are temporarily damaged and may recover over time). Observation of the resident's lunch tray ticket at the lunch meal on Monday January 8, 2024, revealed that the resident was to receive a regular renal diet. A review of the facility's planned weekly menu (week 4) revealed that the regular diets were to receive Chef's soup, stuffed cabbage, mashed potatoes, 2% milk, fruit juice and 1/2 cup sherbet. During an initial tour of the dietary department on January 8, 2024, the Certified Dietary Manager (CDM) provided the survey team with pre-planned facility menus with menu extensions for the cycle (planned portion sizes for each menu item). There was no written pre-planned menu planned for a Renal diet. Observation of Resident 14's lunch meal on January 8, 2024, revealed that the resident was served Chef's soup, stuffed cabbage, mashed potatoes, 2% milk, fruit juice and 1/2 cup sherbet. An interview at the time of the observation, the CDM stated that dietary staff meet with Resident 14 weekly to view the facility's regular diet menu. The CDM stated that Resident 14 has refused the renal diet since his admission to the facility. The resident chooses his diet and the kitchen complies with the resident's request. The CDM stated that the facility does not prepare a renal diet. During an interview January 9, 2024 at approximately 10 A.M., the Registered Dietitian confirmed that Resident 14 refused the physician ordered Renal diet that had been prescribed since October 2022. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 30 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 0808 Level of Harm - Minimal harm or potential for actual harm She confirmed that the resident's attending physician and the dialysis provider had not been informed of the resident's refusal of the prescribed therapeutic renal diet and that the facility was serving the resident a regular diet and not complying with the physician order to control the nutritive content of the resident's diet. Refer F 698 Residents Affected - Few 28 Pa. Code 211.12 (d)(3)(5) Nursing services 28 Pa. Code 211.6 (a) Dietary services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 31 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, and staff interviews it was determined that the facility failed to maintain infection control practices during medication administration on one out of two medication carts (Station A, Back Hall), failed to maintain ice machines and ice distribution areas in a sanitary manner on two of two resident units and failed to maintain the facility's laundry area in a clean and sanitary manner. Residents Affected - Many Findings include: Observation of medication administration pass, on January 7, 2024, at approximately 10:05 AM, revealed Employee 1, Registered Nurse (RN), on the Station A, Back Hall, medication cart. During the medication pass observation, the surveyor observed an open, purple can Monster energy drink, on the top left side of the medication cart. Additionally, a dark colored, winter jacket was draped over the rear, right side of the medication cart. Interview with Employee 1, RN, on January 7, 2024, at approximately 10:18 AM, confirmed the observation, and stated it was her drink, and winter coat. She further acknowledged she had not adhered to infection control procedures during this medication pass by placing personal items on the medication cart. An observation January 8, 2024, and January 9, 2024 at 10 AM and again at 1 PM on the A resident hallway, the ice machine, located outside the medication room, was observed to have large areas of a white, dried liquid on the stainless steel backsplash,, drain area and the front of the machine. There were multiple areas of a black substance at where the stainless steel back splash meets the drain area as well as in the drain area (on the front of the machine). There were dried liquid drips on the entire front of the machine. There was a styrofoam cup, multiple plastic cup lids and a metal basket with handles on the top of the ice machine. Food and liquid stains were observed on sides of the ice machine and food and liquid stains extending from the top to the bottom of the machine. The floor on both sides and underneath the ice machine was dirty and littered with paper and plastic materials as well as sticky food and liquid stains. The floor on the right side of the ice machine was dirty with a large brown stain, paper debris. There was a large build-up of a sticky substance with a large buildup of lint on the electrical lines from the machine to the outlet. There was a buildup of a black substance on the molding at the floor level. On the left side of the floor/machine, a large build-up of black substance was observed on the plastic PVC drain pipe leading from the machine to the floor drain. A large accummulation of the same black substance was observed inside of the plastic drain water collection device. Several areas of the black substance were observed on the bottom of the plastic drain pipe. The ice machine on the B resident hallway, located in the hallway was dirty with liquid stains on the front and sides. The stainless steel backsplash was covered in a dried white substance. The drain tray surrounding the ice machine drain was observed to have a large amount of white substance as well as a sticky red dried liquid substance. The floor on the right side of the machine was dirty with food and liquid debris. There was a black substance on the floor and also on the plastic PVC pipe leading into the machine drain. There was paper and plastic debris under the machine and on the left side floor. An environmental tour of the facility laundry facility, in the soiled/dirty area, January 8, 2024 at approximately 10 A.M., revealed that the floors were dirty in front and behind the washing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 32 of 33 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 395566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Manor Rehabilitation and Nursing Center 750 Schooley Avenue Exeter, PA 18643 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many machines. There was a large buildup of lint, dirt paper and plastic, used disposable gloves and spoons on the floor in the room, including around the 3 washing machines. There were clean, damp mop heads and rags used by cleaning staff in the facility, piled up on top of the washing machines. The window sill in the room had a large build up of cobwebs on the windows and the window sill. There were two pairs of resident shoes covered with cobwebs along with a used glove and 2 spoons on the windowsill. In front of the window there were 16, 5 gallon plastic pails of cleaning chemicals. There were 5 uncovered resident pillows on top of the containers of chemicals. There were multiple, just laundered floor rugs draped over large garbage cans. There was a dirty wheelchair mat on the floor next to the washing machine on the floor. A floor mop/duster and a dirty dust pan wa lying on the floor with paper and plastic debris on the floor next to the third washing machine. In between the first two washing machines there were multiple wheelchair cushions, a resident pillow, a bath blanket directly on the floor. In the clean area of the laundry room the floors were littered with dirt, paper and plastic debris. In the corner of the room there was a slop sink with multiple cleaning items including, a resident plastic basin, used scrub brushes. On the floor in this area were three dirty mop buckets with dirty brown water in them. A floor mop was directly in the dirty water in one of the buckets. There was a floor buffing machine in the area. The floor and wall areas were dirty with dirt and liquid stains as well as paper and plastic debris. The sink was observed with a large amount of a white substance on the front of the the sinks. Observation of the clean resident laundry room ( the area where resident clean clothing was received, folded/hung up prior to delivery to the resident) revealed that the floor was dirty with dirt, food and liquid debris. There was a black substance on the base board and along the floor running the perimeter of the room. There was a floor buffer stored next to the desk with clean resident clothing on and multiple floor buffer pads under the desk. There were multiple floor mops/dusters, dust pans and an overflowing garbage can in the corner of the room. There was a pair of resident shoes in between the mops and dust pans. During an interview at the time of the observation, Employee 4 (laundry) stated that there were 3 staff members in the laundry department. The last shift was completed at 3 PM. She stated that the laundry staff attempted to get residents' personal laundry back to them in 24 hours. She stated that it is the responsibility of the laundry staff to clean the laundry area and confirmed that the laundry area was not presently clean and orderly. Interview with the Director of Nursing (DON) on January 8, 2024, at approximately 1:45 PM confirmed the facility failed to ensure the consistent implementation of infection control procedures designed to prevent the spread of infection in the facility. 28 Pa. Code 211.12 (c)(d)(1) Nursing services 28 Pa. Code 205.26 (c) Laundry FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395566 If continuation sheet Page 33 of 33