Inspection visit

InspectionDecember 15, 2023

MILTON REHABILITATION AND NURSING CENTERCMS #39557014 citations on this visit

14 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 14 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

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 observations and staff interviews, it was determined that the facility failed to provide a clean, comfortable, home-like environment on two of two nursing units (East Nursing Unit and [NAME] Nursing Unit; Residents 4, 7, 25, 52, 99, and 110). Findings include: Observation of a storage room with various respiratory equipment and tube feedings with the title Coat Rack on the door located on the East Side Nursing Unit on December 13, 2023, at 12:54 PM revealed: a green lidded bowl on top of a water heater that held contents, which were covered in a white, fuzzy, mold-like substance, a large plastic fountain drink cup with a straw in the lid discarded under the rack that held tube feedings, a balled-up surgical mask on a shelf holding respiratory supplies, and half a 12-ounce can of soda on a shelf next to exam gloves. These findings were reviewed with Employee 10, a licensed practical nurse, on December 13, 2023, at 1:10 PM. Observation of a shower/bathroom located next to the nutrition room on the East Nursing Unit on December 13, 2023, at 1:14 PM revealed the following: a strong offensive odor noted upon entering the room, black spots covering the caulk in the corners of a shower stall, a hole in the wall along the lower border of a temperature gauge located above the shower control handle, a handrail near the sink was loose and starting to detach from the wall, a piece of protective wall covering under the handrail was broken and jagged. Observation of a shower/bathroom on the East Side Nursing Unit on December 14, 2023, at 1:27 PM revealed a wooden shelf located in a shower stall that had two Exelon transdermal patches stuck to the top of it and a large protective wall covering was starting to detach from the wall near the ceiling. Observation of Resident 110's room on December 13, 2023, at 1:00 PM revealed an accumulation of debris (including a plastic spoon, paper debris, crumbs, and a baked goldfish snack) and grime on the floor. The resident's bed sheet was covered in crumbs and stained especially near the foot of the bed. The above information for the East Side Nursing Unit shower and bathroom, storage closet, and Resident 110's room was reviewed with the Nursing Home Administrator and Director of Nursing on December 14, 2023, at 2:57 PM. Observation of the East Nursing Unit on December 12, 2023, at 11:31 AM, December 13, 2023, at 10:23 AM, and December 14, 2023, at 2:51 PM revealed that Resident 4's room had a very strong urine (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 21 Event ID: 395570 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 12/15/2023 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 0584 smell. Level of Harm - Minimal harm or potential for actual harm The surveyor reviewed the above information during an interview with the Nursing Home Administrator and Director of Nursing on December 14, 2023, at 3:00 PM. Residents Affected - Some Observation of the [NAME] Nursing Unit on December 12, 2023, at 10:34 AM revealed the following: Resident 25's floor in her room was dirty with brown spillage spots, trash, and food on the floor. Resident 99's floor was dirty between Bed A and the wall, there were multiple areas on the floor with dried food and spillage spots. Residents 7 and 52's floor was extremely dirty, with multiple spillage spots, dried food, and trash on the floor. 28 Pa. Code 201.18(b)(3) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 2 of 21 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 12/15/2023 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on review of employee personnel records, select facility policy review, and staff interview, it was determined that the facility failed to adequately implement its established abuse prohibition policy for two of five employees reviewed (Employees 7 and 8). Residents Affected - Few Findings include: In accordance with Act 13 Elder Abuse Mandatory Reporting and Act 169 Criminal Background Checks, nursing facilities are required to obtain a criminal background check on all newly hired employees. Facilities are required to obtain the Pennsylvania State Police background check within 30 days of hire on all prospective employees. The policy entitled Abuse last reviewed October 13, 2023, indicates that a criminal background check will be conducted on all prospective employees. A significant finding on the background check will result in denied employment consistent with the criminal background check policy in accordance with State and Federal Regulation. The policy entitled Pre-Employment Criminal Background Screening last reviewed on July 5, 2023, indicates that continued employment depends on successful completion of the criminal background check. If the results of the check are unfavorable, any offer of employment shall be withdrawn; or, if the employee has started working before the results of the check are available, employment may be terminated. The facility cannot employ anyone who has been found guilty by a court of law abusing, neglecting, or mistreating nursing facility residents. Review of Employee 7's, receptionist, personnel record revealed that the facility hired her on August 2, 2023. There was no documented evidence in Employee 7's personnel file to indicate the facility obtained a criminal history background report until December 14, 2023, when the surveyor brought it to the attention of administration. Review of Employee 8's, dietary aide, personnel record revealed that the facility hired him on October 4, 2023. There was no documented evidence in Employee 8's personnel file to indicate the facility obtained a criminal history background report until December 14, 2023, when the surveyor brought it to the attention of administration. Interview with Employee 9, human resources director, on December 14, 2023, at 11:08 AM, confirmed the above findings. 28 Pa. Code 201.18(e)(1) Management 28 Pa. Code 201.29(a)(c) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 3 of 21 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 12/15/2023 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 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 clinical record review and staff interview, it was determined that the facility failed to ensure assessments accurately reflected resident status for two of 23 residents reviewed (Residents 12 and 58). Residents Affected - Few Findings include: Clinical record review for Resident 58 revealed the resident was admitted to the facility on [DATE]. An admission MDS (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) for Resident 58 dated September 24, 2023, noted the facility staff assessed the resident as receiving an anticoagulant six days in the assessment period. Further clinical record review revealed no evidence that Resident 58 received an anticoagulant during the assessment period for the MDS noted above. An interview with Employee 11, the Registered Nurse Assessment Coordinator, on December 14, 2023, at 11:09 AM confirmed that Resident 58 did not receive an anticoagulant. The above information was reviewed in a meeting with the Nursing Home Administrator and Director of Nursing on December 14, 2023, at 2:57 PM. Clinical record review for Resident 12 revealed that the facility completed an annual MDS assessment on November 27, 2023, which indicated that the resident was not on dialysis. Review of Resident 12's clinical record revealed a physician's order dated November 15, 2023, and a care plan dated August 4, 2022, for her to attend dialysis on Monday, Wednesday, and Friday. The surveyor reviewed the above MDS discrepancy for Resident 12 during an interview with the Nursing Home Administrator and Director of Nursing on December 13, 2023, at 2:42 PM. 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 4 of 21 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 12/15/2023 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on review of select facility policy and procedures, clinical record review, and staff interview, it was determined that the facility failed to maintain an acceptable parameter of nutritional status for one of six residents reviewed for nutrition concerns (Resident 58). Residents Affected - Few Findings include: The policy entitled Weight Assessment and Intervention Policy, last reviewed without changes on October 13, 2023, revealed that, Any weight change of greater than or less than five pounds within 30 days will be retaken for confirmation. A significant weight change is defined as: more or less than five percent within 30 days, and more or less than 10 percent within six months. The policy further noted that if the weight loss meets the definition of significant then the dietitian should discuss with the interdisciplinary team and make recommendations. The policy noted the dietitian will also review the monthly weights by the 10th of the month to follow individual weight trends over time. Negative trends will be assessed and addressed by the dietitian whether the definition of significant weight change is met. Review of Resident 58's current care plan revealed the resident has a nutritional problem or potential nutritional problem and inadequate intake related to impaired vision. Some interventions included: monitor, record, and report to the physician as needed signs and symptoms of malnutrition: emaciation (cachexia being abnormally thin or weak), muscle wasting, and significant weight loss of three pounds in one week, greater than five percent in one month, greater than 7.5 percent in three months, or greater than 10 percent in six months; weigh per physician orders and notify the physician, responsible party, and dietitian of any significant changes. Clinical record review for Resident 58 revealed assessments of the weights as follows: November 1, 2023, 174.6 pounds November 8, 2023, 175.2 pounds November 15, 2023, 175.0 pounds December 1, 2023, 156.2 pounds Resident 58 experienced an 18.4 pound significant weight loss of 10.5 percent in 30 days, from November 1, 2023, to December 1, 2023. There was no evidence that Resident 58's 30-day weight loss from November 1, 2023, to December 1, 2023, was addressed by the registered dietitian or physician as of December 13, 2023, nor any evidence Resident 58's registered dietitian or physician was made aware of Resident 58's weight loss as of December 13, 2023. There was also no evidence that Resident 58 was reweighed to ensure accuracy of the weight obtained on December 1, 2023. The above information was reviewed with the Nursing Home Administrator and Director of Nursing on December 13, 2023, at 2:30 PM. 28 Pa. Code 211.10(c) Resident care policies (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 5 of 21 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 12/15/2023 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 0692 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 6 of 21 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 12/15/2023 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 observation, clinical record review, and staff interview, it was determined that the facility failed to provide appropriate respiratory care and services for five of five residents reviewed (Residents 6, 25, 29, 44, and 69). Residents Affected - Some 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 44 revealed a current physician's order for staff to administer Albuterol Sulfate nebulizer solution 0.083% one vial inhale orally via nebulizer every 6 hours as needed for wheezing or shortness of breath. Observation of Resident 44's bedside stand on December 12, 2023, at 11:23 AM and December 13, 2023, at 10:22 AM revealed that there was a nebulizer machine with nebulizer tubing, cannister, and mouthpiece connected. The canister and mouthpiece were unbagged and lying directly on the resident's bedside stand. The surveyor reviewed the above information during with the Director of Nursing and the Nursing Home Administrator on June 15, 2023, at 2:30 PM. Clinical record review for Resident 25 revealed a physician's order dated July 4, 2023, for staff to administer Resident 25 oxygen at two liters per minute via the nasal cannula (medical tubing with two nasal prongs used to deliver supplemental oxygen into the nose) continuously. Observation of Resident 25's Room on December 12, 2023, at 10:34 AM revealed Resident 25 was out of the room and her oxygen tubing was hanging on the overbed table unbagged, with the nasal cannula piece directly touching the floor. The surveyor reviewed the above information for Resident 25 with the Director of Nursing and the Nursing Home Administrator in a meeting on December 14, 2023, at 2:18 PM. Clinical record review for Resident 29 revealed a current physician's order dated November 17, 2023, that indicated the resident was to wear BiPAP (Bi-level positive airway pressure; a mask worn during sleep that helps to keep the airways open) every night with oxygen at two liters per minute. Observation of Resident 29's BiPAP on December 13, 2023, at 9:43 AM and 12:48 PM and again on December 14, 2023, at 12:38 PM revealed the resident was awake and sitting upright in bed. The resident's BiPAP mask was draped over the resident's BiPAP machine located on a dresser next to the bed. The mask was not bagged or protected from contamination from the ambient environment during any of these observations. Clinical record review for Resident 69 revealed a current physician's order dated September 5, 2023, that indicated the resident was to wear supplementary oxygen via nasal cannula continuously at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 7 of 21 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 12/15/2023 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 four liters per minute. Level of Harm - Minimal harm or potential for actual harm Nursing documentation for Resident 69 dated December 9, 2023, at 11:43 PM revealed the resident was sent to the hospital. Further documentation dated December 10, 2023, at 9:00 AM revealed the resident was admitted to the hospital. Residents Affected - Some Observation of Resident 69's bedroom on December 13, 2023, at 9:45 AM and again on December 14, 2023, at 12:38 PM revealed a nebulizer mask on the bedside table. The mask was not bagged or protected from contamination from the ambient environment. Clinical record review for Resident 6 revealed a current physician's order dated November 28, 2023, that indicated the resident was to receive ipratropium-albuterol inhalation solution (a combination of medication that helps to reduce inflammation in the airways and increase airflow to the lungs) 0.5 - 2.5 milligrams in 3 milliliters and inhale orally via nebulizer every six hours as needed for wheezing and shortness of breath. Observation of Resident 6's room on December 14, 2023, at 12:30 PM revealed that there was a nebulizer mask hanging from the nebulizer machine on a dresser next to the bed. The mask was not bagged or protected from contamination from the ambient environment. The above findings for Residents 6, 29, and 69 were again noted on December 14, 2023, at 1:45 PM during a walk through with the Nursing Home Administrator who reported the oxygen equipment should be bagged. 483.25(i) Respiratory/tracheostomy Care and Suctioning Previously cited 1/10/23 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 8 of 21 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 12/15/2023 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 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policies, clinical record review, and staff interview, it was determined that the facility failed to provide the highest practicable care regarding physician ordered pain medications for one of three resident reviewed (Resident 83). Residents Affected - Few Findings include: The facility policy entitled, Administering Pain Medications, last reviewed without changes on October 13, 2023, revealed that the facility will assess a resident's level of pain prior to administering non-narcotic or narcotic analgesics. Staff will follow the medication administration per the physician's order and utilize standardized pain assessment tools including the 10-point pain intensity scale. The facility policy did not identify what mild, moderate, and/or severe pain was per the 10-point pain intensity scale. Review of Physiopedia's and Wikipedia's definition of the numeric pain rating scale (parameters) from zero to 10 indicated that no pain was identified as zero, mild pain was identified as one to three, moderate pain was identified as four to six, and severe pain was identified as seven to 10. Clinical record review for Resident 83 revealed physician's orders for the following pain medications: Ordered on August 16, 2023, Acetaminophen (for mild pain) 500 milligrams (mg) 1 tablet by mouth (PO) every 6 hours as needed (PRN) for pain. Ordered on September 21, 2023, Morphine (for severe pain) 100 mg/5 ml (milliliters) 0.25 ml PO every 4 hours PRN for pain/shortness of breath. There was no documentation that the facility identified which pain medication that staff were to administer for mild, moderate, and/or severe pain parameters or that the facility identified that multiple medications were available for the same pain parameter. Review of Resident 83's September, October, November, and December 2023 MAR (medication administration record, a form to document medication administration) revealed that staff administered the following PRN pain medications: Acetaminophen 500 mg 1 tablet PO every 6 hours PRN for pain September 22, 2023, at 9:11 PM for a pain level of 6. September 23, 2023, at 3:34 AM for a pain level of 4. October 4, 2023, at 3:35 PM for a pain level of 7. October 5, 2023, at 3:21 PM for a pain level of 7. October 6, 2023, at 12:23 PM for a pain level of 5. October 15, 2023, at 1:00 PM for a pain level of 7. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 9 of 21 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 12/15/2023 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 0697 October 19, 2023, at 11:28 AM for a pain level of 5. Level of Harm - Minimal harm or potential for actual harm October 19, 2023, at 7:43 PM for a pain level of 7. October 20, 2023, at 1:55 AM for a pain level of 5. Residents Affected - Few October 30, 2023, at 3:47 AM for a pain level of 5. November 21, 2023, at 5:44 AM for a pain level of 5. November 23, 2023, at 7:17 PM for a pain level of 7. November 26, 2023, at 3:21 PM for a pain level of 7. November 29, 2023, at 5:18 PM for a pain level of 7. December 3, 2023, at 6:30 PM for a pain level of 4. December 10, 2023, at 8:32 PM for a pain level of 6. December 12, 2023, at 8:23 PM for a pain level of 5. Morphine 100 mg/5 ml 0.25 ml PO every 4 hours PRN for pain/shortness of breath November 5, 2023, at 10:28 AM for a pain level of 6. November 8, 2023, at 11:30 AM for a pain level of 5. December 7, 2023, at 6:43 PM for a pain level of 6. December 8, 2023, at 7:35 PM for a pain level of N/A (not applicable). The surveyor reviewed Resident 83's pain information during an interview with the Nursing Home Administrator and Director of Nursing on December 14, 2023, at 2:18 PM. 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 10 of 21 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 12/15/2023 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 0699 Provide care or services that was trauma informed and/or culturally competent. Level of Harm - Minimal harm or potential for actual harm **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 identify triggers related to a resident's diagnosis of Post-Traumatic Stress Disorder, to provide culturally, competent, trauma-informed care, and to eliminate or mitigate re-traumatization for one of five residents reviewed for mood/behavior (Resident 18). Residents Affected - Few Findings include: Clinical record review for Resident 18 revealed a diagnosis of Chronic Post Traumatic Stress Disorder (PTSD, a mental and behavioral disorder that develops related to a terrifying event) since admission on [DATE]. During an interview with Resident 18 related to her diagnosis of PTSD on December 12, 2023, at 10:47 AM revealed that she did not want to discuss her triggers, she stated that she has talked to a professional about it. A review of Resident 18's most recent quarterly minimum data set (MDS, an assessment completed by the facility at intervals to determine care needs) assessment, dated September 1, 2023, indicated PTSD was an active diagnosis for Resident 18. Further review of Resident 18's current care plan revealed an identified behavioral-emotional problem indicating Resident 18 has a psychosocial well-being problem related to a diagnosis of PTSD and anxiety. There were no identified triggers (everyday situations that cause a person to re-experience the traumatic event as if it was reoccurring). Clinical record review of Resident 18's current care plan revealed an identified problem of trauma-informed care related to PTSD, with no identified triggers (everyday situations that cause a person to re-experience the traumatic event as if it were reoccurring). Resident 18 saw a nurse practitioner with psychological services six times in the last year with the PTSD diagnosis listed with no treatment plan or triggers noted. Further review of Resident 18's clinical record revealed documentation by a licensed clinical social worker on October 19, 2023, noting that the diagnosis of PTSD is related to neglect, verbal, and emotional abuse by Resident 18's ex-husband/caretaker. An interview with the Nursing Home Administrator and Director of Nursing on December 14, 2023, at 2:20 PM confirmed these findings. The facility failed to identify and care plan triggers that may retraumatize Resident 18 related to her diagnosis of PTSD. 28 Pa Code 211.12 (a)(d)(3)(5) Nursing services 28 Pa Code 211.11(d) Resident care plan FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 11 of 21 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 12/15/2023 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 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 Based on clinical record review and staff interview, it was determined that the facility failed to develop and implement an individualized person-centered care plan to address dementia and cognitive loss displayed by one of one resident reviewed (Resident 52). Residents Affected - Few Findings include: Clinical record review for Resident 52 revealed the facility admitted her on May 4, 2022, with a diagnosis including Dementia (loss of memory, language, problem-solving, and other thinking abilities that interfere with daily life). A review of Resident 52's most recent annual Minimum Data Set Assessment (MDS, a form completed at specific intervals to determine care needs) dated March 1, 2023, indicated that the facility assessed Resident 52 as having a diagnosis of dementia. The facility determined that a care plan for dementia and cognitive loss would be developed. A review of Resident 52's care plan revealed that there was no indication that the facility had developed and implemented a person-centered care plan to address the resident's dementia and cognitive loss. The findings were reviewed with the Director of Nursing and Nursing Home Administrator during a meeting on December 13, 2023, at 2:15 PM. Further interview with the Director of Nursing on December 15, 2023, at 9:35 AM confirmed the facility had no further documentation that the facility developed and implemented an individualized person-centered care plan to address Resident 52's dementia and cognitive loss. 28 Pa Code 211.12 (d)(1)(3)(5) Nursing services 28 Pa Code 211.11(d) Resident care plan FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 12 of 21 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 12/15/2023 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on review of select facility policies, observation, clinical record review, and staff interview, it was determined that the facility failed to ensure a medication error rate below five percent (Residents 17 and 52). Residents Affected - Some Findings include: The facility's medication error rate was 15.15 percent based on 33 medication opportunities with two medication errors. The facility policy entitled, Administering Medications, last reviewed without changes on October 13, 2023, revealed that medications must be administered in accordance with physician orders. The individual administering the medication must check the label to verify the right medication, right dosage, right time, and the right method of administration before giving the medication. Observation of a medication administration pass on December 12, 2023, at 8:42 AM revealed Employee 1, licensed practical nurse, preparing to administer Spiriva (treats breathing disorders) one capsule to inhale orally, Fenofibrate (treats high cholesterol) 145 mg (milligrams), Raloxifene (treats osteoporosis) 60 mg, and Ditropan XL (treats overactive bladder) 5 mg to Resident 52. Employee 1 handed the Spiriva inhaler to Resident 52, and instructed her to take a deep breath in. Employee 1 took back the Spiriva inhaler after Resident 52 inhaled on the medication one time. Review of the manufacture's guidelines for Spiriva, revised November 2021, indicated that two inhalations are to be completed for the same capsule, to ensure that the full medication dose is delivered each day. Employee 1 did not provide further education or prompting to Resident 52 to complete a second inhalation of the Spiriva capsule. Employee 1 crushed the Fenofibrate, Raloxifene, and Ditropan XL and mixed them with pudding prior to administering them to Resident 52. Review of the Fenofibrate and Ditropan medication cards (a blister pack of the medication sent by pharmacy) revealed a sticker indicating that the medications should not be crushed. Review of the facility pharmacy's do not crush list, copyrighted in 2020, indicates that Raloxifene should not be crushed. Interview with Employee 1 on December 12, 2023, at 10:26 AM confirmed the above findings for Resident 52. Interview with the Administrator and Director of Nursing on December 13, 2023, at 2:00 PM acknowledged the above findings regarding Resident 52's medication errors. Observation of a medication administration pass on December 12, 2023, at 9:18 AM revealed that Employee 2, licensed practical nurse, administered Fluticasone Propionate 50 mcg (micrograms) per spray two sprays per nostril to Resident 17. Clinical record review for Resident 17 revealed a current physician's order for Fluticasone Furoate 27.5 mcg per spray two sprays in both nostrils daily for allergies. Interview with Employee 2 on December 12, 2023, at 10:09 AM confirmed that she administered Fluticasone Propionate 50 mcg per spray not Fluticasone Furoate 27.5 mcg per spray as ordered to Resident 17. Employee 2 acknowledged that she administered the incorrect medication and incorrect dosage of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 13 of 21 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 12/15/2023 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 0759 the medication to Resident 17. Level of Harm - Minimal harm or potential for actual harm The surveyor reviewed the above information during an interview on December 12, 2023, at 1:18 PM with the Director of Nursing and on December 13, 2023, at 2:41 PM with the Nursing Home Administrator. Residents Affected - Some 28 Pa. Code 211.9 (a)(1)(k) Pharmacy services 28 Pa. Code 211.10(a)(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 14 of 21 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 12/15/2023 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 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and resident and staff interview, it was determined that the facility failed to assist a resident to obtain routine dental services for one of two residents reviewed for dental concerns (Resident 18). Residents Affected - Few Findings include: Interview with Resident 18 on December 12, 2023, at 12:46 PM revealed that she could not remember when she last saw the dentist. Clinical record review for Resident 18 revealed that the facility admitted her on October 1, 2020, with payment sources that included the state Medicaid benefit. Further review of Resident 18's clinical record revealed she last saw the dentist on March 2, 2023. A review of this progress note revealed that Resident 18 was scheduled for her next visit for prophylactic dental cleaning on July 27, 2023. Further review of the progress note revealed Resident 18's oral condition would benefit from Peridex (medication used to treat swelling, redness, and bleeding gums), and daily use of high-concentrate fluoride toothpaste, noting that the facility should consult Resident 18's physician regarding these recommendations. There were no further dental visits, or documentation indicating the facility addressed the dentist's recommendations with Resident 18's physician. An interview with the Nursing Home Administrator on December 15, 2023, at 9:12 AM confirmed that Resident 18 should have seen the dentist in July 2023 for cleaning. An interview with the Director of Nursing on December 15, 2023, at 11:55 AM confirmed these findings and had no further information to indicate that Resident 18 received routine dental services every six months as the State plan allows. She stated there was no evidence that the facility followed up with Resident 18's physician regarding the dentist's recommendations. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 28 Pa. Code 211.15. Dental services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 15 of 21 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 12/15/2023 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and staff interview, it was determined that the facility failed to store food in a manner to prevent the potential spread of foodborne illness in the main kitchen and one of two nursing units (East Nursing Unit). Findings include: Observation of the facility's kitchen on December 12, 2023, at 10:11 AM revealed Employees 3 and 4, dietary aides, were utilizing the dishwasher to clean breakfast dishes. Concurrent observation of the dishwasher gauges revealed that the wash temperature was 110 degrees Fahrenheit, and the final rinse temperature was 142 degrees Fahrenheit. There was no sanitizing agent connected to the dishwasher. Employee 5, dietary manager, acknowledged the low wash and rinse temperatures on the dishwasher and began cleaning out the three-tiered sink to hand wash dishes. She indicated that the concern was identified that morning and a contractor was onsite to fix the hot water boiler currently. Employees 3 and 4 did not identify the low water temperatures and that the facility's dishes were not being sanitized by high temperatures prior to being identified by the surveyor. Review of the dishwasher's temperature log dated December 2023 revealed the standard dishwasher wash temperatures should be between 140 and 160 degrees Fahrenheit and the rinse temperatures should be between 180-194 degrees Fahrenheit. Staff were to notify the supervisor if not within standard. Review of the December 12, 2023, dishwasher temperatures for breakfast revealed that the wash temperature was 165 degrees Fahrenheit, and the rinse temperature was 150 degrees Fahrenheit. Interview with Employee 5 on December 12, 2023, at 10:44 AM revealed that she was not aware of these temperatures prior to staff washing dishes and acknowledged that staff should not have utilized the dishwasher that morning. Interview with Employee 6, maintenance, on December 12, 2023, at 1:58 PM revealed that a concern was identified with the facility's boiler that supplies the kitchen on December 11, 2023, with a contractor fixing the concern. Employee 6 again noted issues when he arrived on-site December 12, 2023, at 6:00 AM and again notified the contractor, with them arriving at the facility shortly thereafter. Employee 6 revealed that the contractor had again fixed the concern and that the boiler was back online. He also noted that there was a hot water booster for the dishwasher to meet the hot water sanitizing requirements. The facility's dishwasher temperatures did not meet temperatures to properly sanitize the facility's dishes. This surveyor reviewed the above concerns with the Nursing Home Administrator and Director of Nursing during an interview on December 13, 2023, at 2:30 PM. Observation of the East Side Nursing Unit nutrition closet on December 14, 2023, at 1:30 PM revealed the following: a cupboard door under the sink had brown colored stains dried on the inside of the door wooden shelves in the overhead cupboards had debris and grime on the shelves and the wood appeared to be coming off on some areas of the shelving (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 16 of 21 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 12/15/2023 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 0812 there was a can of expired fruit with a best by date of December 4, 2023, in the cupboard Level of Harm - Minimal harm or potential for actual harm a pink wash basin with brown colored dried stains on the inside of it was located on the top of the refrigerator and had a hard oatmeal crème pie in it Residents Affected - Some the bottom grates below the refrigerator door had a significant build-up of a brown colored and dried substance there were multiple snacks that had fallen on the ground and were accumulating behind the refrigerator there was a coffee ground-like substance in a plastic zip bag with no label or use by date located in one of the cupboards The Nursing Home Administrator and Director of Nursing were notified on December 14, 2023, at 1:30 PM. 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 17 of 21 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 12/15/2023 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 0840 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Employ or obtain outside professional resources to provide services in the nursing home when the facility does not employ a qualified professional to furnish a required service. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed clinical record review and staff interview, it was determined that the facility failed to provide and arrange appointments for outside services for one of 24 residents reviewed (Resident 115). Findings include: Review of Resident 115's closed clinical record revealed that the facility admitted her on October 19, 2023. A review of Resident 115's hospital Discharge summary dated [DATE], indicated that the hospital prescheduled Resident 115 for a follow up with her neurologist to be completed October 24, 2023, at 1:30 PM. There was no documented evidence in Resident 115's closed clinical record to indicate that the facility acknowledged the follow up appointment for Resident 115's neurologist or planned arrangements for Resident 115 to attend the appointment. There was also no documented evidence to indicate the facility rescheduled or cancelled Resident 115's appointment with her neurologist. Interview with the Administrator on December 14, 2023, at 10:05 AM confirmed the above findings for Resident 115. 28 Pa. Code: 201.21(c) Use of Outside Resources 28 Pa Code:201.18(b)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 18 of 21 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 12/15/2023 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 observation, clinical record review, and staff interview, it was determined that the facility failed to ensure an environment free from the potential spread of infection regarding transmission-based precautions and linen containment on one of two nursing units (East Nursing Unit, Resident 110). Residents Affected - Few Findings include: Nursing documentation for Resident 110 dated December 4, 2023, at 11:19 AM revealed the resident was on isolation precautions for Methicillin-resistant Staphylococcus aureus (MRSA; a bacteria that infects the body and is resistant to certain antibiotics). Review of the current physician orders for Resident 110 revealed the resident was on contact precautions (transmission based precautions that requires additional personal protection equipment such as a gown and gloves to avoid direct or indirect contact with a resident and/or their environment to prevent the spread of infection) due to MRSA. Observation of Resident 110's room on December 13, 2023, at 11:48 AM and again at 1:00 PM revealed a sign on the door that indicated the resident was on contact isolation. Inside the door was a smaller sized red isolation bin with a lid that had the contents (which appeared to be a blue disposable gown and multiple white ties hanging over the edge) protruding from under the lid and almost touching the floor. An interview with Employee 10, licensed practical nurse, on December 13, 2023, at 1:10 PM revealed that the nurse aides are responsible for emptying the bin. Observation of the East Nursing Unit hallway on December 13, 2023, at 12:12 PM revealed an overflowing linen cart with the lid ajar due to protruding linens. Observation of the shower/bathroom located next to the nutrition room on the East Nursing Unit on December 13, 2023, at 1:14 PM revealed an overflowing linen cart with the lid ajar due to protruding linens. It appeared to be the same cart as previously seen in the hallway and was still overflowing and not emptied. The Nursing Home Administrator and Director of Nursing were notified of the above findings on December 13, 2023, at 3:00 PM and further noted that the linen carts are pushed into the shower rooms during lunch time. Observation of Resident 110's room on December 14, 2023, at 12:26 PM again revealed a smaller sized red isolation bin with a lid that had the contents (which appeared to be a blue disposable gown and multiple white ties hanging over the edge) protruding from under the lid. A second red isolation bin inside the room, which held soiled linens and laundry items had a plastic cup that was partially filled with a white colored liquid and a plastic bowl sitting on top of the lid. The above findings for Resident 110's room were reviewed with the Nursing Home Administrator and Director of Nursing on December 14, 2023, at 2:57 PM. 483.80(a)(1)(2)(4)(e)(f) Infection Prevention & Control Previously cited 1/10/23 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 19 of 21 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 12/15/2023 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 28 Pa. Code 201.18(b)(1) Management Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.10(d) Resident care policies Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395570 If continuation sheet Page 20 of 21 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 12/15/2023 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 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of select facility policies and procedures, clinical record review, and staff interview, it was determined that the facility failed to ensure a resident received the pneumococcal immunization for one of five residents reviewed for immunization concerns (Resident 107). Residents Affected - Few Findings include: Review of the policy entitled Influenza and Pneumococcal Immunizations, last reviewed without changes on October 13, 2023, revealed that the facility will provide pneumococcal immunizations to minimize the risk of residents acquiring, transmitting, or experiencing complications from pneumococcal disease. Review of the immunizations for Resident 107 revealed no evidence of a pneumococcal immunization for the resident who was admitted to the facility on [DATE]. An interview with Employee 12, Infection Preventionist, on December 15, 2023, at 12:05 PM revealed that Resident 107 did not receive and was not offered a pneumococcal immunization by the facility. Further review of Resident 107's clinical record revealed admission documents that noted facility documentation titled Pneumococcal (Pneumonia) Vaccine, that indicated the resident had received the vaccine prior to admission on [DATE]. The kind of vaccination was marked as unknown. The facility documentation indicated that Pneumococcal immunization status of all residents will be determined on admission regardless of date of admission. Vaccination will be offered to all residents who cannot provide documentation of previous vaccination. Those who are unsure of their vaccination status and consent to the vaccine will receive the vaccine. The form noted the resident consented to the vaccine and was signed and dated by the resident on October 16, 2023. After surveyor questioning, Employee 12 produced further documentation titled Patient Summary for Resident 107 that indicated the resident had received the PNU-13 vaccine on January 26, 2016. Employee 12 was unsure if Resident 107 should receive additional vaccinations based on the findings and will have to check. An interview with Employee 12 on December 15, 2023, at 2:16 PM revealed Employee 12 produced further documentation titled Pneumococcal Vaccine Timing for Adults Who Previously Received PCV13, and indicated the resident should have been offered the PPSV23 vaccine based on Centers for Disease Control and Prevention recommendations. Employee 12 confirmed that the vaccine was not offered or administered to the resident. The facility failed to follow-up with the pneumococcal vaccinations for Resident 107 and ensure the resident received the appropriate vaccinations as recommended. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management 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 21 of 21

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Citations

14 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0584GeneralS&S Epotential for harm
F584 - Safe Environment
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.
0607GeneralS&S Dpotential for harm
F607 - The facility must develop and implement written policies and procedures that:
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
0641GeneralS&S Dpotential for harm
F641 - Accuracy of Assessments
Ensure each resident receives an accurate assessment.
0692GeneralS&S Dpotential for harm
F692 - Assisted nutrition and hydration
Provide enough food/fluids to maintain a resident's health.
0695GeneralS&S Epotential for harm
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
0697GeneralS&S Dpotential for harm
F697 - Pain Management
Provide safe, appropriate pain management for a resident who requires such services.
0699GeneralS&S Dpotential for harm
F699 - Trauma-informed care
Provide care or services that was trauma informed and/or culturally competent.
0744GeneralS&S Dpotential for harm
F744 - A resident who displays or is diagnosed with dementia, receives the
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.
0759GeneralS&S Epotential for harm
F759 - Medication Errors
Ensure medication error rates are not 5 percent or greater.
0791GeneralS&S Dpotential for harm
F791 - Dental Services
Provide or obtain dental services for each resident.
0812GeneralS&S Epotential for harm
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
0840GeneralS&S Dpotential for harm
F840 - Use of outside resources
Employ or obtain outside professional resources to provide services in the nursing home when the facility does not employ a qualified professional to furnish a required service.
0880GeneralS&S Dpotential for harm
F880 - Infection Control
Provide and implement an infection prevention and control program.
0883GeneralS&S Dpotential for harm
F883 - Influenza and pneumococcal immunizations
Develop and implement policies and procedures for flu and pneumonia vaccinations.

FAQ · About this visit

Common questions about this visit

What happened during the December 15, 2023 survey of MILTON REHABILITATION AND NURSING CENTER?

This was a inspection survey of MILTON REHABILITATION AND NURSING CENTER on December 15, 2023. The surveyor cited 14 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at MILTON REHABILITATION AND NURSING CENTER on December 15, 2023?

Yes, 14 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receivin..."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.

Data from CMS Care Compare public records. Dataset last refreshed June 8, 2026. If you believe any information is inaccurate, report it here.

Inspection·December 15, 2023