Inspection·January 10, 2023

F 0623 Clinical record review for Resident 95 revealed that they were transferred to the hospital on the following dates after there was a change in their condition: Level of Harm - Potential for minimal harm September 28, 2022 Residents Affected - Some October 9, 2022 October 18, 2022 November 6, 2022 There was no documentation that the facility provided written notification to Resident 95 or their responsible party regarding the transfer that included the required components. The surveyor reviewed the above information for during an interview with the Nursing Home Administrator on January 6, 2023, at 11:19 and 11:21 AM. Clinical record review for Resident 92 revealed that the resident was transferred to the hospital on October 19, 2022, after there was a change in condition. There was no documentation that the facility provided written notification to the resident or their responsible party regarding the transfer that included the required components. The surveyor reviewed the above information for Resident 92 with the Director of Nursing on January 6, 2023, at 1:26 PM who confirmed that there was no record of the transfer notice. 483.15(c)(3) Notice Requirements Before Transfer/Discharge Previously cited deficiency 1/21/2022 28 Pa. Code 201.29(a) Resident rights 28 Pa. Code 201.14 (a) Responsibility of licensee FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 2 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 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 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. Based on clinical record review and staff interview, it was determined that the facility failed to ensure that the resident and/or their responsible party received written notice of the facility bed hold policy at the time of transfer for two of 11 residents reviewed for hospitalization concerns (Residents 68 and 92). Findings include: Clinical record review for Resident 68 revealed nursing documentation dated November 24, 2022, at 1:14 PM that indicated the resident was more lethargic. The physician assistant was notified, and new orders were received to send Resident 68 to the emergency room. He was admitted to the hospital for hypercarbia (an increase in carbon dioxide in the blood stream) related to his lung function. Resident 68's clinical record did not contain evidence that the facility provided a written copy of the facility's bed hold policy to Resident 68's responsible party when he was transferred to the hospital on November 24, 2022. Interview with the Nursing Home Administrator and the Director of Nursing on January 5, 2023, at 2:30 PM confirmed that the facility failed to provide Resident 68's responsible party written notification of the facility bed hold policy at the time of Resident 9's transfer to the hospital. Clinical record review for Resident 92 revealed that the resident was transferred to the hospital on October 19, 2022, after a change in her condition. There was no documentation available that the facility provided written notice regarding a bed hold to the resident and/or resident's responsible party upon transfer out to the hospital. The surveyor reviewed the above information for Resident 92 with the Director of Nursing on January 6, 2023, at 1:26 PM who confirmed that there was no record of the bed hold notice. 483.15(d)(1)(2) Notice of Bed Hold Policy Before/upon Transfer Previously cited deficiency 1/21/2022 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.29(f) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 3 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0657 Level of Harm - Minimal harm or potential for actual harm Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on clinical record review and resident and staff interview, it was determined that the facility failed to promote resident involvement with care plan development for one of one resident reviewed (Resident 48). Residents Affected - Few Findings include: During an interview with Resident 48 on January 4, 2023, at 9:16 AM revealed that the resident received letters concerning the date of his care plan conferences and would have liked to attend conferences about his care. Resident 48 reported that he did not attend because he assumed that they would be held in his room because he is dependent on staff to get out of bed. He reported that he did not know where the conferences were held, and no one came to get him. Clinical record review for Resident 48 revealed he had a quarterly MDS (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) assessment on August 23, 2022, and an annual MDS assessment on November 2, 2022. MDS documentation dated November 2, 2022, revealed that the resident had a BIMS (BIMS, Brief Interview for Mental Status, assessment that scores a resident's response to memory questions; a score of 13-15 indicates intact cognitive response) of 15. There was no documented evidence that Resident 48 attended his last two care plan conferences that were associated with the last two MDS assessments. The surveyor reviewed the above findings for Resident 48 during an interview with the Nursing Home Administrator on January 5, 2023, at 2:30 PM. 483.21(b)(2)(i)-(iii) Care Plan Timing And Revision Previously cited 1/21/22 28 Pa. Code 201.18(e)(1) Management 28 Pa. Code 211.10(a) Resident care policies 28 Pa. Code 211.12(d)(3) Nursing services 28 Pa. Code 211.11(e) Resident care plan FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 4 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and resident and staff interview, it was determined the facility failed to provide activities of daily living assistance for resident's dependent on staff assistance for three of four residents reviewed for activity of daily living concerns (Residents 35, 37, and 162). Residents Affected - Some Findings include: During an interview with Resident 35 on January 3, 2023, at 12:03 PM the resident reported that he prefers bed baths. He reported that he is not always washed up, and sometimes the agency staff do not wash him or give him a bed bath until 12:00 PM or 1:00 PM, and some agency staff give him a washcloth and they don't use a wash basin with soap and water. He reported the reason being is that staff are too busy. Review of Resident 35's quarterly MDS (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) dated November 16, 2022, documentation revealed that he required extensive assistance from staff for bathing. Review of Resident 35's task documentation for bathing from November 1 through November 30, 2022, revealed the resident received bed baths on November 3, 7, 10, 17, and 28, 2022. Resident 35 was scheduled for bed baths on November 21 and November 24, 2022. There was no documented evidence that the resident received or refused bed baths on these dates resulting in a 10-day period without a bed bath. Review of Resident 35's task list for December 1 through December 31, 2022, revealed the resident received bed baths on December 1, 5, 8, 19, 25, and 29, 2022. He was scheduled for bed baths on December 12, 15, and 22, 2022. There was no documented evidence that the resident received or refused bed baths on these dates resulting in a 10-day period and a five-day period without bed baths. The above findings for Resident 35 were reviewed with the Nursing Home Administrator and Director of Nursing on January 5, 2022, at 2:30 PM. Observation and interview with Resident 37 on January 3, 2023, at 1:42 PM revealed that the resident's hair was greasy. The resident reported that she likes her hair clean. Review of Resident 37's quarterly MDS documentation dated December 7, 2022, revealed the resident required extensive assistance of two staff for personal hygiene. Bathing did not occur during this assessment period. Review of the shampoo task documentation for Resident 37 revealed that she last had a shampoo on December 29, 2022. The above findings for Resident 37 were reviewed with the Nursing Home Administrator and Director of Nursing on January 4, 2023, at 2:20 PM. Clinical record review for Resident 162 revealed the facility admitted him on December 22, 2022, with a diagnosis of quadriplegia (paralysis of all extremities). Review of Resident 162's December 2022 and January 2023 task intervention (an action intended to improve the resident's health and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 5 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 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 0677 Level of Harm - Minimal harm or potential for actual harm comfort) revealed that staff was to provide oral care (brushing teeth) on day, evening, and night shifts. There was no documentation that staff provided oral care or indicated that oral care was not provided during their assigned shift on the following dates: December 23, 24, 26, and 27, 2022, day shift Residents Affected - Some December 22, 23, 24, 25, 27, 29, 30, and 31, 2022, evening shift December 22, 23, 25, 26, 27, 28, 29, 30, and 31, 2022, night shift January 2, 2023, day shift January 1 and 2, 2023, evening shift January 2, 2023, night shift Interview with Resident 162 on January 3, 2023, at 11:25 AM and January 4, 2023, at 11:24 AM confirmed that staff are not providing oral care and/or brushing his teeth. The above findings for Resident 162 were reviewed during an interview with the Nursing Home Administrator and Director of Nursing on January 4, 2023, at 2:00 PM. The facility failed to provide dependent residents with oral care, shampoos, and bathing assistance. 483.24(a)(2) ADL Care Provided for Dependent Residents Previously cited 11/16/22 and 1/21/22 28 Pa. Code 211.12 (d)(1)(2)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 6 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, select facility policy review, and staff interview, it was determined that the facility failed to provide the highest practicable care regarding physician ordered interventions for one of 23 residents reviewed (Resident 59), assessment and treatments of non-pressure wounds for one of three residents reviewed (Resident 48), and glucose monitoring and insulin administration for two of three residents reviewed (Residents 35 and 48). Residents Affected - Some Findings include: A review of the current physician orders for Resident 59 revealed an order dated September 12, 2022, that instructed staff to utilize geri-sleeves (a type of sleeve worn to help protect the arms from injuries) and to remove for hygiene and when soiled. A review of the current care plan for Resident 59 revealed the resident has a potential for skin breakdown. An intervention included geri-sleeves as ordered. Observation of Resident 59 on January 3, 2023, at 11:07 AM revealed the resident was sitting in a wheelchair in his room. The resident was wearing a short-sleeved shirt with no noted geri-sleeves. A large scab was located on his left elbow/forearm area. Observation of Resident 59 on January 5, 2023, at 10:00 AM revealed the resident was sitting in his wheelchair in a short-sleeved shirt. A kerlix wrap was noted on his left elbow. The resident did not have geri-sleeves on. Employee 4, licensed practical nurse (LPN), verbalized that sometimes the resident takes the geri-sleeves off and throws them on the floor. There were no geri-sleeves located on the floor or in the bathroom of the resident's room. An interview with Employee 5, nurse aide, on January 5, 2023, at 10:07 AM revealed the geri-sleeves for Resident 59 could not be found in the resident's room. Employee 5 further reported that she never saw him wear geri-sleeves. There was no clinical documentation to indicate that Resident 59 had refused the geri-sleeves, taken them off, staff removed them, or applied them. The above information was reviewed in a meeting with the Nursing Home Administrator and Director of Nursing on January 5, 2023, at 2:00 PM. A handwritten note dated January 5, 2023, at 4:51 PM from the Nursing Home Administrator indicated that the geri-sleeves were located in the laundry and the resident was given a new pair and an extra pair. Review of the facility policy entitled Administering Medications, last reviewed December 2, 2022, indicated that medications may not be prepared in advance and must be administered within one hour of their prescribed time, unless otherwise specified (for example, before and after meal orders). During an interview with Resident 35 on January 3, 2023, at 10:02 AM, it was revealed that there are times he does not get his glucometer (sample of blood taken from finger to determine glucose level and the amount of insulin needed) and insulin until after meals when they are ordered before meals. Review of a physician's order for Resident 35 dated November 17, 2022, revealed the nurse was to monitor the resident's blood sugar before meals and at bedtime and administer Novolog FlexPen Solution (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 7 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Pen-Injector (insulin, a medication to lower blood sugar) 100 units/milliliter and inject as per the following sliding scale: Level of Harm - Minimal harm or potential for actual harm If blood sugar is 0-150, give no insulin Residents Affected - Some 51-200, give 2 units 201-250, give 4 units 251-300, give 6 units 301-350, give 8 units 351-400, give 10 units 401-450, give 12 units subcutaneously (injected below the skin), at 7:30 AM, 11:30 AM, 4:30 PM and 9:00 PM. Review of the meal tray delivery schedule provided by the facility indicated the meals times served on the hallway where Resident 35 resided were delivered as follows: Breakfast at 8:10 AM Lunch at 12:00 PM Supper at 4:35 PM Review of Novolog FlexPen Injector administration records for Resident 35 revealed that glucose monitoring was performed, and Novolog FlexPen Injector Insulin was administered on the following times after meals in December 2022: December 1, at 9:09 AM December 2, at 9:27 AM, 12:44 PM, and 5:35 PM December 4, at 12:57 PM December 6, at 12:46 PM December 8, at 9:51 AM and 1:10 PM December 9, at 5:54 PM December 10, at 10:29 AM and 1:42 PM December 11, at 9:49 AM and December 12, at 1:11 PM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 8 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of a physician's order for Resident 48 dated September 26, 2022, indicated the nurse was to administer Lantus SoloStar Solution Pen-Injector (insulin, to reduce blood sugar) 100 units/milliliter, 34 units subcutaneously two times a day at 9:00 AM and 9:00 PM. Review of a physician's order for Resident 48 dated November 17, 2022, indicated the nurse was to monitor the resident's blood glucose and administer Novolog FlexPen Solution Pen-Injector 100 units/milliliter subcutaneously before meals and at bedtime, at 7:30 AM, 11:00 AM, 4:00 PM, and 9:00 PM. Review of the meal tray delivery schedule provided by the facility indicated the meals times served on the hallway where Resident 48 resided were delivered as follows: Breakfast at 8:35 AM Lunch at 12:35 PM Supper at 5:00 PM Review of Lantus SoloStar Pen-Injector administration records for Resident 48, indicated the insulin was administered on the following times out of compliance in December 2022: December 1, at 11:08 AM for 9:00 AM dose December 22, at 10:13 AM for 9:00 AM dose Review of Novolog FlexPen administration records for Resident 48, indicated the glucose monitoring was performed after meals and the insulin was administered on the following times after meals in December 2022: December 1, at 11:08 AM for routine dose of 4 units and as needed dose of 2 units for blood glucose of 161 mg/dL (milligrams per deciliter, ordered for 7:30 AM dose) December 1, at 12:29 PM for routine dose of 4 units and as needed dose of 2 units for blood glucose of 166 mg/dL(ordered for 11:00 AM and administered under 1.5 hours of previous dose) December 10, at 8:48 AM for routine dose of 4 units and as needed dose of 2 units for blood glucose of 172 mg/dL December 10, at 1:17 PM for routine dose of 4 units and as needed dose of 2 units for blood glucose of 152 mg/dL December 18, at 12:53 PM for routine dose of 4 units and as needed dose of 2 units for blood glucose of 177 mg/dL During an interview with Employee 1, assistant director of nursing, on January 5, 2023, at 10:00 AM confirmed the findings for Residents 35 and 48's blood glucose monitoring and insulin administration. During an interview with Resident 48 on January 4, 2023, at 9:37 AM it was revealed that he has wounds on his legs and his dressing changes do not always occur. The resident could not remember any (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 9 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 details of when his dressing was not changed. Level of Harm - Minimal harm or potential for actual harm Review of a physician's order dated December 9, 2022, revealed an order that instructed the nurse to cleanse the left lower leg wound with 1/4 strength Dakin's (a cleansing solution used to prevent infection) moistened gauze, pat dry, apply honey fiber (a fiber dressing containing Medi-Honey to aide in removal of dead tissue and promote healing) to open areas, and cover with Kling (a wrap-type bandage) every dayshift. Residents Affected - Some Review of a wound consultation for Resident 48 dated December 14, 2022, revealed the resident had two vascular (a wound that develops due to a circulation problem) wounds as measured below: Left lateral lower extremity (leg), 8.5 cm (centimeters) length by 1 cm width by 0.5 cm depth (Measurements were converted to millimeters by the surveyor to correspond with facility documentation, 85 mm by 10 mm by 5 mm) Left anterior lower extremity, 1.6 cm length by 0.4 cm width by 0.2 cm depth (16 mm by 4 mm by 2mm) During an observation of a dressing change for Resident 48 on January 5, 2023, at 10:46 AM by Employee 3, licensed practical nurse, it was revealed that the dressing on the resident's leg was dated and initialed as last changed on January 3, 2023. After Employee 3 removed the Kling bandage, a white non-adherent dressing was present with an orange-brown substance that resembled Medi-Honey gel. Employee 3 confirmed it was Medi-Honey gel and not the Medi-Honey fiber dressing. Review of a Treatment Administration Record for Resident 48 dated January 2023 revealed that the above dressing change was not signed as completed on January 4, 2023. The surveyor informed the Director of Nursing on January 5, 2023, at 11:30 AM of Resident 48's leg wound dressing that was not performed, and the incorrect dressing was used. Clinical record review for Resident 48 revealed there were no documented wound assessments since December 14, 2022, until January 6, 2023, after the surveyor asked for assessments on January 5, 2023, at 2:30 PM and again on January 6, 2023, at 10:38 AM. Review of a Wound Weekly Observation Tool dated January 6, 2023, revealed the following measurements: Wound 1, left lateral lower extremity, 41 mm length by 13 mm width x 3 mm depth Wound 2, left anterior lower extremity, 10 mm length by 10 mm width x 0 mm depth During an interview with the Director of Nursing on January 6, 2023, at 10:38 AM it was revealed that the wound consultant quit and no one in the facility knew of that until recently. The surveyor questioned as to who assesses and manages wounds on a weekly basis other than the consultant and was told there is no system in place at the time as most of the administrative staff are new. The facility failed to provide wound assessments of non-pressure wounds and follow physician orders regarding treatments. 483.25 Quality of Care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 10 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Previously Cited 9/16/22 and 1/21/22 Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.10(d) Resident care policies 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 11 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 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 Based on observation, clinical record review, and resident and staff interview, it was determined that the facility failed to provide the highest practicable care to promote optimal pressure ulcer healing for one of six residents reviewed for pressure ulcer concerns (Resident 35). Residents Affected - Few Findings include: Interview with Resident 35 on January 3, 2023, at 12:05 PM revealed that he developed a pressure ulcer of his lower back at a hospital before admission to the nursing facility. He reported that it is improving but the dressing changes are done too close together at times. Resident 35 reported his admission date as May 19, 2022. Review of a late entry skin/wound progress note by a nurse practitioner dated May 26, 2022, at 10:15 AM assessed Resident 35 as having a Stage IV (full thickness skin and tissue loss with exposed or directly felt fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer) sacral (low back) pressure ulcer that measured 32 cm (centimeter) length by 5 cm width by 2.5 cm depth. Review of the most recent wound evaluation dated December 14, 2022, by the wound care consultant, revealed the sacral ulcer was a healing Stage IV that measured 23.5 cm length by 2.1 cm width x 0.2 cm depth. Clinical record review for Resident 35 revealed that there was no documented evidence of an assessment of the pressure ulcer or measurements since December 14, 2022. Review of a physician's order dated October 13, 2022, through November 4, 2022, instructed the nurse to cleanse the sacral pressure ulcer with normal saline solution, pack area with Dakin's solution ½ strength (a diluted solution used as an antiseptic to prevent infection) soaked gauze, apply Dermaseptin (skin protectant) to the peri-wound, over with super absorbent ABD (padded gauze, called abdominal gauze) and secure with tape, every day, and every evening shift. Review of documentation on Dakin's Solution from the National Library of Medicine, dated September 26, 2022, revealed that it can be applied once or twice daily. The most common side effects include redness, swelling, and skin irritation. One of the main concerns for using Dakin's solution are allergic impaired wound healing, which can occur when using high concentrations (greater than ¼ strength). Review of a physician's order dated November 5 through November 21, 2022, instructed the nurse to cleanse the sacral pressure ulcer with ½ strength Dakin's solution, pack with calcium alginate (absorbent dressings that turn to gel when drainage is absorbed, to promote wound healing), cover with ABD pad and tape, every day and evening shift. Review of a physician's order dated November 21, 2022, through December 16, 2022, instructed the nurse to cleanse the sacral pressure ulcer with ¼ strength Dakin's solution, pack with calcium alginate, cover with ABD pad and tape, every day and evening shift for wound care. Review of a physician's order dated December 17, 2022, to current, instructed the nurse to cleanse the sacral ulcer with Acetic Acid Solution 0.25 percent, pat dry, apply calcium alginate, cover with ABD pad and tape. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 12 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 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 - Few Review of a resident concern form from Resident 35 dated October 28, 2022, indicated he reported that his wound care was not done for 24 hours. The findings indicated that the wound care was done by the in-house wound consultant. Review of a resident concern form from Resident 35 dated October 31, 2022, indicated his wound was not done for the past 24 hours. The Nursing Home Administrator reviewed the TAR (treatment administration record), and it was signed off as completed. The Nursing Home Administrator attempted to call the agency nurse to determine if it was completed and not just signed as completed but was unable to contact her. The resident was instructed to notify staff as soon as possible if not completed. Review of a nursing note for Resident 35 dated November 24, 2022, at 2:22 PM revealed the RN (registered nurse) received a call from the resident that his treatments were not done in the morning when he wanted it done. The RN explained to the resident that the LPN (licensed practical nurse) was passing medications and would be down to his room in a few minutes. Review of a nursing note for Resident 35 dated November 24, 2022, at 2:24 PM revealed the RN was called to the resident's room by the LPN as the resident was yelling at her and not allowing her to do the treatments. The resident stated he is to have his treatments done in the morning. The RN explained that the nurse was passing medications and charting between medication passes. The RN explained that the treatments were scheduled to be completed between 7:00 AM - 3 PM shift and they will get done during that shift. During an interview with Employee 1, registered nurse, on January 5, 2022, at 10:00 AM the surveyor requested documentation times that the dressing changes were completed for Resident 35. The surveyor did not have access to this information. Employee 1 indicated that the EMR (electronic medical record) would not permit review of treatment times before November 21, 2022, for this resident. Employee 1 reported that staff sign off the treatments after completing them. Review of the provided EMR report for Resident 35's treatments revealed the following dates/time in November and December 2022, when the dressing changes were omitted or were too close together or too far apart as the resident described: November 23, no day shift dressing change November 23, at 3:45 PM and November 24, at 2:45 PM (23 hours since last dressing change) November 24, at 7:30 PM (less than 5 hours between dressing changes) November 26, at 10:52 PM and November 27, at 2:24 PM (greater than 13 hours since last dressing change) November 28, at 5:34 PM (three hours since last dressing change) November 29, at 2:38 PM and November 29, at 6:11 PM (less than four hours since last dressing change) November 30, at 9:34 PM and December 1, at 2:52 PM (greater than 17 hours since last dressing change) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 13 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 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 December 2, at 11:34 PM and December 3, at 1:07 PM (greater than 12 hours since last dressing change) Level of Harm - Minimal harm or potential for actual harm December 3, at 5:24 PM (less than 5 hours between dressing changes) December 5, at 6:26 PM and December 6, at 11:36 AM (17 hours between dressing changes) Residents Affected - Few December 11, at 10:15 PM and December 12, at 2:54 PM (greater than 16 hours between dressing changes) December 12, at 6:00 PM (three hours between dressing changes) December 25, at 6:04 PM and December 26, at 3:56 PM (22 hours since last dressing change) December 26, at 6:45 PM, (less than three hours between dressing changes) December 27, at 2:05 PM (greater than 18 hours between dressing changes) December 28, at 3:16 PM (greater than 12 hours between dressing changes) December 29, at 3:52 PM (greater than 12 hours between dressing changes) December 29, at 5:49 PM (less than two hours between dressing changes) December 30, at 6:39 PM and December 31, at 4:10 PM (greater than 19 hours between dressing changes) December 31, at 5:46 PM (less than two hours between dressing changes) The facility failed to assess Resident 35's pressure ulcer since December 14, 2022, and promote a wound healing environment by performing the dressing changes too close together or too far apart. During an interview with the Nursing Home Administrator and Director of Nursing on January 5, 2023, at 2:30 PM the surveyor reviewed the findings for Resident 35. The Director of Nursing reported that the dressing changes were ordered on first shift and second shift, and she is aware that sometimes the dressing changes are done at the end of first shift and the start of second shift. When the surveyor asked what the policy is on dressing changes and frequency, the Director of Nursing said there are no times, they are done by shifts. The surveyor questioned what a reasonable time would be between dressing changes to promote wound healing. The Director of Nursing said that eight hours from the last time would be reasonable. The Director of Nursing reported that the nurse must complete medication passes before doing treatments and each nurse manages the schedule their own way. 483.25(b)(i)(1)(2) Treatment/Services to Prevent/Heal Pressure Ulcer Previously cited 1/21/22 28 Pa. Code 211.10(d) Resident care policies 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 14 of 27 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 395570 B. Wing (X3) DATE SURVEY COMPLETED A. Building 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on review of select facility policies, clinical record review, and staff interview, it was determined that the facility failed to provide physician ordered services to maintain a resident's range of motion for two of four residents reviewed (Residents 43 and 57). Findings include: Review of the facility policy entitled, Restorative Nursing, last reviewed without changes on December 12, 2022, revealed that the facility will provide a restorative nursing program with interventions that promote the resident's ability to adapt and adjust to living as independently. The restorative program is found in the clinical record and care plan. The restorative record is initialed as programs are completed daily. Clinical record review for Resident 43 revealed that therapy staff discharged her on December 21, 2022, with recommendations for her to utilize a left elbow extension splint from breakfast time and doff (remove) at lunch time. A current physician's order for her to utilize a left elbow extension splint from breakfast time and doff at lunch time as needed (PRN), not daily per therapy's recommendations. Observation of Resident 43 on January 4, 2023, at 9:11 AM, 9:54 AM, and 11:31 AM revealed that she was not wearing a left elbow splint. Interview on January 4, 2023, at 2:15 PM with the Nursing Home Administrator (NHA) and Director of Nursing (DON) revealed that staff should follow the therapy recommendations to apply Resident 43's left elbow splint daily. They indicated that Resident 43's physician's order for her left elbow splint was input/ordered incorrectly. Staff should have ordered the left elbow splint daily per the therapy recommendations, not PRN. The DON corrected the left elbow splint order after identified by the surveyor Further review of therapy staff discharge recommendations dated December 21, 2022, revealed that Resident 43 was to continue with current PROM (passive range of motion, staff complete ROM for resident, movement of the body in an attempt to maintain a resident's ability) of bilateral upper extremities in all joints. Review of Resident 43's task intervention (an action intended to improve the resident's health and comfort) dated November 30, 2022, revealed that staff are to complete PROM to her bilateral upper extremities (shoulder, elbows, and wrists) and bilateral lower extremities (hips, knees, and ankles) for 5 repetitions 2 sets twice a day. Review of Resident 43's PROM task documentation from November and December 2022, and January 2023 revealed that staff documented either 0 (zero) minutes or did not document that they completed her PROM on the following dates: November 5, 6, 11, 12, 13, 14, 16, 19, 20, 21, 25, 26, and 27, 2022, day shift November 10, 11, 15, 18, 19, 24, 26, and 29, 2022, evening shift December 3, 4, 17, 18, 24, and 25, 2022, day shift (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 15 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0688 December 2, 6, 8, 9, 16, 23, and 27, 2022, evening shift Level of Harm - Minimal harm or potential for actual harm The surveyor reviewed the above information on January 4, 2023, at 2:15 PM with the Nursing Home Administrator and Director of Nursing. Residents Affected - Some Clinical record review for Resident 57 revealed that he was to receive active range of motion program (AROM, staff monitor the action, but the resident completes the ROM without hands on assistance) of both lower extremities all areas for three sets of 10 repetitions. Review of Resident 57's AROM task documentation from November 22, 2022, through January 4, 2023, revealed that staff failed to document program completion on the following dates: November 28, 29, 30 December 3, 4, 8, 10, 11, 13, 15, 16, 17, 18, 19, 21, 22, 23, 25, 27, 28, and 29 January 2, 2023 Interview with the Nursing Home Administrator and Director of Nursing confirmed the above noted findings related to Resident 57's AROM program during a meeting on January 5, 2023, at 2:40 PM. 483.25(c)(1)-(3) Increase/prevent Decrease In Rom/mobility Previously cited 1/21/22 28 Pa. Code 211.10(a)(c)(d) Resident care policies 28 Pa. Code 211.12(c)(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 16 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 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 clinical record review and staff and resident interview, it was determined that the facility failed to implement interventions to care for and monitor a resident's urinary catheter for one of three residents reviewed (Resident 162) and care for and monitor a resident's colostomy for one of two residents reviewed (Resident 162). Findings include: Clinical record review for Resident 162 revealed that he was admitted on [DATE], with a urinary catheter and colostomy (a surgical opening in the abdominal wall to remove fecal material from the large or small bowel). Review of Resident 162's task interventions (an action intended to improve the resident's health and comfort) revealed that staff was to provide ileostomy (a surgical opening in the abdominal wall to remove fecal material from the small bowel) care. Empty bag and clean as needed on day, evening, and night shift. Review of Resident 162's December 2022 and January 2023 task documentation revealed that staff did not provide ileostomy care to Resident 162 on the following dates: December 29, 30, 31, 2022, evening shift December 29, 2022, night shift January 2, 2023, day shift January 1, 2023, evening shift Further review of Resident 162's task interventions revealed that staff was to provide urinary catheter care and document the urinary catheter output on day, evening, and night shift. Review of Resident 162's December 2022 and January 2023 task documentation revealed that staff did not provide urinary catheter care to Resident 162 on the following dates: December 29, 30, and 31, 2022, evening shift January 1, 2023, evening shift January 2, 2023, day shift Review of Resident 162's December 2022 and January 2023 task documentation revealed that staff did not document the urinary catheter output for Resident 162 on the following dates: December 29 and 31, 2022, day shift December 29, 30, and 31, 2022, evening shift January 1, 2023, evening shift (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 17 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 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 January 2, 2023, day shift Level of Harm - Minimal harm or potential for actual harm Interview with Resident 162 on January 3, 2023, at 11:25 AM confirmed that staff were not monitoring or providing care to his ileostomy. He revealed that the bag or wafer would blow off resulting in him lying in fecal (bowel) material. Residents Affected - Some The above information was reviewed with the Nursing Home Administrator on January 5, 2023, at 10:30 AM. 483.25(d)(1)(2) Bowel/bladder Incontinence, Continence, UTI Previously cited 11/23/22 and 1/21/22 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.10(c)(d) Resident care policies 28 Pa. Code 211.12(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 18 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, observation, and staff interview, it was determined that the facility failed to administer supplemental oxygen consistent with professional standards of practice for three of six residents reviewed (Residents 26, 36, and 94) and failed to store supplemental oxygen equipment per professional standards of practice for two of six residents reviewed (Residents 26 and 36). Residents Affected - Few Findings include: According to the American Association for Respiratory Care proper cleansing of respiratory (nebulizer) equipment reduces infection risk. The longer a dirty nebulizer sits and is allowed to dry, the harder it is to clean thoroughly. Parts of the aerosol drug delivery device should be rinsed and then washed with soap and hot water after each treatment. Once completely dry, store the nebulizer cup and mouthpiece in a zip lock bag. Clinical record review for Resident 26 revealed a diagnoses list that included chronic respiratory failure with hypoxia (blue discoloration of the skin that may result from poor oxygenation), chronic obstructive pulmonary disease (COPD, chronic disease of the lungs that can impede airflow), and unspecified asthma (a lung disease that causes the air passages of the lungs to narrow). Clinical record review for Resident 26 revealed current physician orders dated December 12, 2022, that instructed staff to administer oxygen but did not specify a flow rate, and to change the oxygen tubing and humidifier bottle weekly. A current care plan for Resident 26 indicated the resident has a potential for an altered cardiovascular status related to heart disease, hypertension, and hypotension. It instructed staff to administer oxygen via nasal prongs at five liters per minute (LPM) continuously as ordered. Observation of Resident 26's room on January 3, 2023, at 11:11 AM revealed an unbagged nasal cannula (medical tubing with two nasal prongs used to deliver supplemental oxygen into the nose) and a nebulizer (a medication delivery device used to inhale certain medications) draped across a recliner. The oxygen delivery devices were not in use. An undated gallon of distilled water was observed on the floor behind the recliner next to the oxygen concentrator. Observation of Resident 26's room on January 4, 2023, at 10:32 AM again revealed an unbagged nasal cannula draped across a recliner in the room. It was not in use. A concurrent interview with Employee 4, licensed practical nurse (LPN), revealed the cannula should be placed in a protective bag when not in use. Further observation of Resident 26's room revealed a black colored oxygen concentrator that had a significant build-up of dust on it. There was also a significant build-up of dust and debris on the floor surrounding the oxygen concentrator. A concurrent interview with Employee 4 revealed that it was unknown when the area was cleaned last. An undated gallon of distilled water that was one-quarter of the way filled remained on the floor behind the recliner. Employee 4 revealed the water is used for humidification of the resident's oxygen because he is on continuous oxygen and goes through it so fast. It was unknown when the gallon of distilled water was opened, and Employee 4 revealed the water should be dated to indicate when opened. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 19 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Level of Harm - Minimal harm or potential for actual harm There was a plastic humidification bottle attached to Resident 26's oxygen concentrator that had a hand-written date of 11/14. Another small container of water was in a plastic basin on the floor next to the oxygen concentrator and identified as prefilled humidification per the manufacturer's label. The prefilled humidification had a hand-written date marked on it as 12/5. The findings were reviewed with Employee 4 who proceeded to change the humidification bottle. Residents Affected - Few Observation and concurrent interview with Resident 26 on January 5, 2023, at 9:06 AM revealed the resident is on oxygen via nasal cannula. The resident was in the cafeteria and noted to be on portable oxygen. The resident's flow rate was set at two liters per minute. The resident verbalized he is supposed to be on four liters per minute supplemental oxygen, but only uses two when using portable oxygen. These varying flow rates were not addressed in the physician orders or care plan. Clinical record review for Resident 36 revealed a diagnosis that indicated the resident was dependent on supplemental oxygen. A current care plan for Resident 36 revealed the resident has a history of COPD and is on supplemental oxygen via nasal cannula at four liters per minute continuously. Clinical record review for Resident 36 revealed a current physician's order dated November 30, 2022, that instructed staff to administer supplemental oxygen at four liters per minute continuously via nasal cannula. Observation of Resident 36 on January 3, 2023, at 11:07 AM revealed the resident was receiving oxygen via nasal cannula at a flow rate of 2.5 liters per minute and not at the flow rate as indicated in the physician's order. Observation of Resident 36 on January 3, 2023, at 1:03 PM revealed an additional nasal cannula draped across the back of the resident's wheelchair located in Resident 36's room next to the bed. The nasal cannula was not in use and unbagged. Observation of Resident 36 on January 4, 2023, at 10:38 AM revealed the resident was on supplemental oxygen via nasal cannula at a flow rate of three liters per minute. Resident 36 verbalized the flow rate is supposed to be at four. A nebulizer mask was observed not in use and unbagged on the resident's dresser next to the bed. An additional nasal cannula was again observed unbagged and draped over the back of the resident's wheelchair. A concurrent interview with Employee 4 confirmed the findings and revealed that Employee 4 was unsure what the liter per minute flow rate should be and will have to check the order. Clinical record review for Resident 94 revealed a diagnosis that indicated the resident was dependent on supplemental oxygen. A current care plan for Resident 94 revealed the resident is on oxygen therapy related to COPD. The care plan instructed staff to administer supplemental oxygen at four liters per minute continuously via nasal prongs. Clinical record review for Resident 36 revealed a current physician's order dated October 19, 2022, that instructed staff to administer supplemental oxygen at four liters per minute continuously via nasal cannula. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 20 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation of Resident 94 on January 4, 2023, at 9:55 AM revealed the resident was receiving supplemental oxygen via nasal cannula at a flow rate of 3.5 liters per minute and not at the flow rate as indicated in the physician's order. The above findings were reviewed in an interview with the Nursing Home Administrator and Director of Nursing on January 5, 2023, at 2:00 PM. 483.25 Respiratory/Tracheostomy Care and Suctioning Previously cited 1/21/22 28 Pa. Code 211.10 (c) Resident care policies 28 Pa. Code 211.12(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 21 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 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 Based on clinical record review and staff interview, it was determined that the facility failed to provide care consistent with professional standards of practice, for a resident who required dialysis services for one of one resident reviewed for dialysis concerns (Resident 26). Residents Affected - Few Findings include: Clinical record review for Resident 26 revealed a diagnoses list that included dependence on renal dialysis (requires a machine that performs a basic function of the kidney by cleansing the blood of impurities). A current care plan for Resident 26 indicated the resident needs hemodialysis related to renal failure. The care plan noted the resident received hemodialysis three times a week at a dialysis center. A review of the current physician orders for Resident 26 revealed no orders related to the assessment of the resident's left arm fistula (surgically created connection between an artery and a vein to provide an access for hemodialysis). A review of the dialysis paperwork for Resident 26 from the most recent dialysis center visits revealed the resident's left arm fistula was being accessed to provide dialysis. Clinical record review for Resident 26 for the past 30 days revealed no documentation that staff had assessed the fistula, which included palpating the thrill (to feel for a vibration to indicate blood flow) and auscultation (listen with a stethoscope) the bruit (sound produced by blood flow) of the fistula. Review of Resident 26's current care plan did not include assessing the resident's dialysis fistula for a thrill or bruit. The facility failed to provide appropriate assessment for the dialysis fistula for Resident 26. The findings regarding Resident 26's dialysis fistula were confirmed during an interview with the Director of Nursing on January 6, 2023, at 11:35 AM. 28 Pa. Code 211.11 (c)(d) Resident care plan 28 Pa. Code 211.12 (d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 22 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0730 Observe each nurse aide's job performance and give regular training. Level of Harm - Minimal harm or potential for actual harm Based on review of staff education records and staff interview, it was determined that the facility failed to ensure 12 hours of nurse aide in-service education was achieved for one of three employees reviewed (Employee 2). Residents Affected - Few Findings include: Review of staff education records revealed that Employee 2, nurse aide, only completed 3.5 hours of training for the year 2022. Interview with the Nursing Home Administrator on January 6, 2023, at 8:30 AM confirmed the above findings for Employee 2. 483.35(d)(7) Nurse Aide Perform Review-12 Hr/yr In-Service Previously cited 1/21/22 28 Pa. Code 201.20(a)(c) Staff development FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 23 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and resident and staff interview, it was determined that the facility failed to provide a physician ordered therapeutic diet for one of 23 residents reviewed (Resident 26) Findings include: Clinical record review for Resident 26 revealed a diagnoses list that included type two diabetes (high blood sugar caused by an insufficient production of insulin), morbid obesity, moderate protein-calorie malnutrition, nutritional anemia (deficiency of blood cells caused by diet), hemodialysis (a machine that performs a basic function of the kidney by cleansing the blood of impurities) and hyperglycemia (high blood sugar). A current care plan for Resident 26 indicated the resident had a nutritional problem related to morbid obesity, history of hyperkalemia (high potassium levels), end-stage renal disease (an advanced state of kidney disease), open areas, heart failure, and is on a therapeutic diet. The care plan instructed staff to provide and serve the diet as ordered and for the registered dietician to evaluate and make diet change recommendations. The care plan did not specify the therapeutic diet. A review of the current physician orders for Resident 26 revealed no current diet order for the resident. A review of the current Medication Administration Record for January 2023 reviewed the diet banner was blank, which indicated no ordered therapeutic diet. Observation and concurrent interview with Resident 26 on January 5, 2023, at 9:06 AM revealed the resident was eating breakfast in the facility's main cafeteria. The resident reported he eats a lot and needs larger portions. The resident had eaten his main entrée, which he verbalized were eggs and was currently eating two bowls of cereal. A meal ticket with Resident 26's tray indicated the resident was being served a liberated renal NAS (no added salt), LCS (low concentrated sweets), and large portions. Further review of Resident 26's clinical record revealed the [NAME] (an informational device that includes pertinent resident information used for care) noted the following regarding eating: Aspiration precautions. Regular diet. Thin liquids. Small bites. Take drinks. Clinical record review for Resident 26 revealed a Nutrition/Dietary note dated December 13, 2022, at 6:12 PM that indicated the resident was receiving a low concentrated sweets, renal diet, with regular level seven texture and thin liquids. Based on review of Resident 26's clinical record and lack of physician order for a diet, it was unclear what diet the resident was to receive. The above information was reviewed with the Nursing Home Administrator and Director of Nursing on January 4, 2023, at 2:00 PM. Further interview with the Director of Nursing on January 5, 2023, at 11:30 AM revealed the diet was not re-entered as an order when the resident returned from a hospital (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 24 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 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 leave on December 12, 2022. The Director of Nursing indicated it was overlooked. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.10(c) Resident care policies Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 25 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 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 review of select facility policies and procedures, clinical record review, and responsible party and staff interviews, it was determined that the facility failed to implement an infection control program to prevent the potential spread of infection for one of one resident reviewed (Resident 9). Residents Affected - Few Findings include: The facility policy entitled, Scabies, last reviewed without changes on December 12, 2022, indicated that the purpose is to use treat and prevent the spread of scabies (a contagious itchy skin condition caused by a tiny burrowing mite) to other residents, staff, and visitors. The policy indicated that residents suspected of or diagnosed with scabies should follow contact precautions (interventions implemented when a resident has a type of bacteria, virus, skin issue, or sore that can be spread to someone else if that person touches the infected individual or surfaces or equipment near the infected person) for a period of 24 hours after the last treatment. Cleaning protocols for day one for the resident's environment included to wash the cubicle curtain, remove all the bed linen except the pillow, place bed linen in a bag, and take it to the laundry, disinfect the mattress, disinfect the pillow if cover is plastic, if cloth place in dryer on hot cycle and tumble dry, wash and disinfect the bed, bedside table, nightstand, (inside and out), closet, windowsills, and bathroom. The resident should wear facility gowns while he/she is being treated. If the resident is presumed or diagnosed with scabies their clothing will be placed in a bag, and the bag will be sent to laundry for processing. If the resident has stuffed animals, they will be placed in a bag and sent to laundry for processing. Items sent to laundry will be stored in a container/box and kept in a designated area. They will be returned to the room after treatment is completed and the resident is off isolation. The facility policy entitled, Isolation Steps: Categories of Transmission Based Precautions, last reviewed without changes on December 12, 2022, indicated that contract precautions would be implemented for residents known or suspected to be infected with microorganisms that can be transmitted by direct contract with the resident or indirect contract with environmental surfaces or resident-care items in the resident's environment. Clinical record review for Resident 9 revealed a progress note dated January 1, 2023, at 4:17 PM that indicated the resident's daughter reported a rash forming on her chest. The nurse assessed Resident 9 and noted redness reaching from shoulder to shoulder. The nurse notified the on-call physician at this time. Further clinical record review for Resident 9 revealed a nursing progress note dated January 1, 2023, at 4:47 PM that indicated a new order was received for permethrin cream 5 percent to be put on resident at bedtime and washed off eight hours later. Further clinical record review of Resident 9's medication administration record revealed that the cream was applied on January 1, 2023, at 11:44 PM, and Resident 9 was given a shower on January 2, 2023, at 12:25 PM. A nursing progress note dated January 6, 2023, at 1:07 PM revealed that Resident 9 was complaining of itching on her scalp and her shoulders/chest area, and the concerns were to be added to the physician's list so that they could see her. Observation of Resident 9 on January 3, 2023, at 10:30 AM revealed she was sitting in the doorway to her room. There was a sign for contact precautions on her door and appropriate personal protective (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 26 of 27 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 395570 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Milton Rehabilitation and Nursing Center 743 Mahoning Street Milton, PA 17847 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 equipment was noted in and over the door storage. Level of Harm - Minimal harm or potential for actual harm Interview with Resident 9's responsible party on January 3, 2022, at 11:00 AM revealed concerns related to Resident 9 having scabies. The responsible party revealed that on January 1, 2023, she noted a rash on her mother that was on her chest and back and that it looked just like when she had scabies before. She also voiced concerns that Resident 9 was treated for scabies, but her laundry was never taken care of and removed from the room, and the room was never deep cleaned as it was when Resident 9 had scabies in the past. She voiced concern that the scabies will never go away if the protocol is not followed. Residents Affected - Few Interview with the Director of Nursing and the Nursing Home Administrator on January 4, 2023, at 9:30 AM revealed that Resident 9 was on contact precautions for an infection in her urine. When asked if she was on precautions related to scabies they indicated no, she doesn't have scabies. They could not provide evidence that Resident 9's rash was determined not to be scabies. They also confirmed that the facility did not deep clean Resident 9's room and that her clothing and other items were never removed from the room per protocol. The facility failed to implement an infection control program to prevent the potential spread of and infection. 483.80(a)(1)(2)(4)(e)(f) Infection Prevention & Control Previously cited deficiency 1/22/22 and 10/26/22 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 27 of 27