Inspection visit

InspectionNovember 22, 2024

BRADFORD HILLS NURSING & REHABILITATION CENTERCMS #39558626 citations on this visit

26 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 26 deficiencies, 1 of them serious (actual harm or immediate jeopardy). The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. Based on observations and resident and staff interview, it was determined that the facility failed to ensure that residents could make choices about aspects of their lives that were significant to them, such as rising for the day, for one of four residents reviewed (Resident 108). Findings include: Clinical record review for Resident 108 revealed an initial MDS (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) dated May 26, 2024, that indicated Resident 108 believed that it was very important to care for her personal belongings, choose between a bed bath, shower, or a sponge bath, choose the clothes to wear, to have snacks available between meals, and choose a bedtime, and have a family member or close friend involved in care discussion(s). Interview with Resident 108 on November 19, 2024, at 10:41 AM revealed that she preferred to get up at 7:00 AM and go to bed between 7:00 PM and 7:30 PM. She revealed that there were some days when she was still in bed at 12:00 PM and did not get to bed until 9:00 PM or 9:30 PM, due to late supper meal delivery (7:00 PM) most nights. Observation on November 20, 2024, at 10:40 AM revealed that Resident 108 was still in bed. She again reiterated her preference of getting up for the day between 7:00 AM and 7:30 AM. The surveyor reviewed the information for Resident 108 during an interview with the Nursing Home Administrator and the Director of Nursing on November 20, 2024, at 1:45 PM. 28 Pa Code: 201.29(a) Resident rights 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 38 Event ID: 395586 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **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 establish clear advance directives for one of five residents reviewed (Resident 15). Findings include: A review of the census for Resident 15 revealed the resident was admitted to the facility on [DATE]. Current physician orders for Resident 15 revealed an order dated [DATE], that indicated the resident was a Full Code (attempt resuscitation and CPR when the person has no pulse and is not breathing). Nursing documentation for Resident 15 dated [DATE], at 1:19 PM revealed the resident is a full code. Facility documentation titled, Code Status for Resident 15 and dated [DATE], indicated the resident was marked with a check indicating Do Not Resuscitate (do not attempt CPR when the person has no pulse and is not breathing). The form was signed by Resident 15 and the medical provider and dated [DATE], by both. The above discrepancy between the resident's signed wishes and the physician order was reviewed in a meeting with the Nursing Home Administrator (NHA) and Director of Nursing (DON) on [DATE], at 2:35 PM. Nursing documentation for Resident 15 dated [DATE], at 5:37 PM after speaking with the NHA and DON, revealed, Chart currently listed as full code; however, documentation signed on [DATE], indicates wishes to be DNR. After discussion the resident does wish to be a full code. Further review of the orders for Resident 15 dated [DATE], revealed that staff entered the resident order as a DNR (do not attempt resuscitation and CPR when the person has no pulse and is not breathing). The above information was reviewed again with the NHA and DON on [DATE], at 1:00 PM. 483.10(c)(6)(8)(g)(12)(i)-(v) Request/refuse/discontinue Treatment; Formulate Advance Directive Previously cited deficiency [DATE] 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 2 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation and staff and resident interview, it was determined that the facility failed to provide adequate housekeeping and maintenance services to ensure a clean, safe, and orderly environment on two of five nursing units (2E and 2W Nursing Units, Residents 15, 32, 73, 84, and 134). Findings include: Observation of the 2 E Nursing Unit on November 19, 2024, at 9:45 AM revealed that there was a damp odor upon entry to the unit's shower room. Observation of the 2 W Nursing Unit on November 19, 2024, at 12:31 PM revealed that there was a damp odor and fecal material upon entry to the unit's shower room. There was a one-half tile piece missing and another tile that was cracked on the corner of the wall near the sink and entry door. On the lower part of the tiled wall and floor in the shower area, there was a black substance in the grout lines of the tile. The surveyor reviewed the above information during an interview with the Nursing Home Administrator and Director of Nursing on November 20, 2024, at 1:45 PM. Observation of Resident 15's room on November 19, 2024, at 11:18 AM revealed the following: A large portion of the bathroom ceiling had pain peeling off it. Some paint flakes were observed hanging from at least two cobwebs. The exhaust fan in the bathroom was making a loud, rattling-like noise when turned on which was in conjunction with the ceiling light. A concurrent interview with Resident 15 reported it has been like that since his admission to the facility on October 11, 2024. The wall behind Resident 15's bed was marred with missing paint in several locations. The privacy curtain had brown stains on it especially near the bottom of the curtain. Observation of the room labeled Patient Lounge on the Two [NAME] Nursing Unit on November 19, 2024, at 1:30 PM and again on November 20, 2024, at 10:31 AM revealed the following: A maroon colored Geri-chair labeled for Resident 73 had brown colored and dried stains on a black colored seat cushion. There was a significant build-up of crumbs and debris under the cushion. The bilateral arm rests had a build-up of a white colored, dry skin appearing substance. An unlabeled flower pattern resident chair had a significant amount of debris under a pressure pad located on the seat of the chair. The perimeter of the seat cushion contained various debris and crumbs. A wheelchair labeled for Resident 84 had a build-up of debris under the pressure cushion located on the seat. There was an additional black colored cushion on the seat that had significant fraying. The canvas storage area located on the rear of the back rest was almost completely torn down the left side and had multiple pieces of thread from the fabric hanging from the damaged section. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 3 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some There was a yellow/red/gray colored striped chair with wooden arm rests and legs that had significant stains and dried liquid stains on the seat cushion of the chair. Observations on November 20, 2024, at 10:31 AM, in addition to the above, included the following: A light green colored Geri-chair labeled for Resident 134 had a pressure cushion located on the seat that contained multiple crumbs and debris. There was a brown colored, dried stain on the seat of the cushion. The bilateral arm cushions were frayed with the underlying foam visible. A light green colored Geri-chair labeled for Resident 32 had a blue colored pad on top of a pressure cushion located on the seat that contained brown stains and strands of hair. The bilateral arm cushions were frayed with the underlying foam visible. Employee 8, housekeeping staff, was informed of the above findings for the resident lounge on November 20, 2024, at 10:52 AM. The Nursing Home Administrator and Director of Nursing were informed of the above findings for Resident 15 and the resident lounge on Two [NAME] Nursing Unit on November 20, 2024, at 2:15 PM. 28 Pa. Code 201.18(b)(3) Management 28 Pa. Code 207.2(a) Administrator's responsibility FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 4 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 0585 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. Based on observation and resident and staff interview, it was determined that the facility failed to ensure resident grievances were addressed timely for four of six residents (Residents 22, 24, 65, and 95 ). Residents Affected - Some Findings include: Review of resident grievances revealed the following: Resident 24 filed a grievance on August 6, 2024, and August 13, 2024. Resident 95 filed a grievance on August 7, 2024. Resident 65 filed a grievance regarding a concern on September 24, 2024. There was no documentation available that the facility investigated and addressed Resident 24, 65, and 95's concerns until November 13, 2024. The surveyor reviewed the above information during an interview with the Nursing Home Administrator and the Director of Nursing on November 20, 2024, at 1:45 PM. Review of a grievance filed by Resident 22 on September 15, 2024, revealed that there was no evidence that the facility addressed the concern until November 13, 2024. Interview with the Nursing Home Administrator on November 21, 2024, at 2:15 PM confirmed that Resident 22's grievance was not addressed in a timely manner. 28 Pa Code: 201.29(a) Resident rights 28 Pa Code: 201.29(b)(c) Resident rights 28 Pa Code: 201.18(e)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 5 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few **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 protect a resident's right to be free from physical abuse from another resident that resulted in actual harm with a serious injury of a left femoral neck fracture for one of two residents reviewed for resident-to-resident interactions. (Resident 399 [Resident 90], Unit 1 East). Findings include: Clinical record review for Resident 399 revealed that she was admitted to the facility on [DATE], with a diagnosis of Alzheimer's Disease (a progressive disease that destroys memory and other mental functions related to brain cell connections and the cells degenerate and die). Clinical record review for Resident 399 revealed a progress note dated October 24, 2024, at 2:02 PM that indicated a nurse aide witnessed Resident 399 get kicked in the right side and she was threatened by Resident 90. Resident 399 was immediately removed from the room to the lounge area. Resident 90 was interviewed as to what happened and she indicated that she was defending herself. Further clinical record review for Resident 399 revealed a nursing progress note dated October 24, 2024, at 2:43 PM that indicated she was kicked in her right torso by Resident 90. No injuries were noted to the resident, and she denied complaints of pain or discomfort. The note also indicated that Resident 399 had no recollection of the event. Review of the facility's investigation into the Resident-to-Resident event involving Resident 399 and Resident 90, dated October 24, 2024, at 1:35 PM revealed that the two residents were separated, and 15-minute checks were initiated. Review of the 15-minute check monitoring form provided by the facility revealed that they were completed and have been ongoing since the event of October 24, 2024. Review of the witness statement provided by the nurse aide that reported the above noted event revealed that she was walking by Resident 399 and Resident 90's room when she heard screaming. She stopped and went into the room, and she noted Resident 399 was on Resident 90's side of the room confused and stated that she needed help getting her daughter out of the wall because she was stuck. At that time Resident 90 kicked Resident 399 in the right side and said that she was going to kill her if she didn't leave her alone. The nurse aide provided reassurance to Resident 399 as she led her out of the room. The nurse aide also indicated in her statement that Resident 90 continued to kick at Resident 399 and tell her she was going to kill her if she came back into the room. Further clinical record review for Resident 90 revealed a physician's order dated October 24, 2024, that indicated she was to be one-to-one every shift for monitoring. The order was discontinued on November 9, 2024. When the surveyor requested documentation of the one-to-one monitoring for Resident 90, on November 22, 2024, at 12:30 PM the Nursing Home Administrator (NHA) revealed that they had initiated one-to-one on October 24, 2024, but she verbally discontinued it with the RN supervisor later that evening because Resident 90 calmed down. She also indicated that 15-minute checks remained in place and were being completed. Clinical record review for Resident 90 revealed a progress note dated October 25, 2024, at 4:04 PM that indicated Resident 90 was being combative and trying to attack Resident 399 and staff. The note (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 6 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 also indicated that Resident 90 would not get off Resident 399's bed and indicated that Resident 90 was going to slap Resident 399 and break her television. Level of Harm - Actual harm Residents Affected - Few A progress note dated October 25, 2024, at 4:41 PM for Resident 90 revealed that she was becoming increasingly physically and verbally aggressive. She hit a staff member in the face and was refusing medications. She was stating that everyone is attempting to poison her. The physician was made aware, and Resident 90 was sent to the emergency room for a psych evaluation and treatment. Resident 90 returned from the emergency room on October 26, 2024, around 5:00 AM, with no new orders. She remained in the same room with Resident 399, upon her return, with the same resident that she kicked two days earlier, and continued to threaten to kill her, slap her, and break her television Clinical record review for Resident 399 revealed a progress note date October 27, 2024, at 10:00 PM that indicated she was observed on the floor just inside her room. She complained of left hip pain and was reluctant to straighten her left leg. Her left leg was also noted to be shorter in length. The nurse practitioner was notified and ordered for Resident 399 to go to the emergency room for an evaluation. Further clinical record review for Resident 399 revealed a progress note dated October 28, 2024, at 12:39 AM that indicated she was admitted to the hospital with a comminuted intertrochanteric fracture of the left femoral neck (a bone broken in multiple pieces in the area of the femur that connects the ball joint to the shaft of the thigh bone). Review of the facility's investigation into Resident 399's fall revealed a witness statement that indicated the staff member was walking down the hallway and heard Resident 90 say, Bitch, so she went into the room. She noted that Resident 399 was on the floor complaining of pain and Resident 90 was lying in bed. When the witness asked Resident 399 what happened, Resident 90 interjected and stated she picked her up and threw her to the ground because she was attacking her. Resident 90 had no injuries when assessed. Review of the facility reported event dated October 27, 2024, at 9:27 pm revealed that Resident 399 indicated that she was coming out of the bathroom and Resident 90 pushed her and she fell. The event indicated that Resident 90 was unprovoked. Clinical record review for Resident 90 revealed an MDS (Minimum Data Set, an assessment completed at intervals by the facility to determine care needs) quarterly assessment that revealed Resident 90 had a BIMS (Brief interview for mental status, an assessment to determine a resident's cognitive status) of 13, indicating she was cognitively intact. On October 27, 2024, Resident 399 had a fall in her room and Resident 90 admitted to throwing her to the ground. The actions by Resident 90, resulted in a fracture to Resident 399's left femoral head requiring hospital admission and intervention. The NHA was made aware of the concerns related to resident-to-resident abuse on November 22, 2024, at 2:39 PM and the failure of the facility to initiate further interventions (i.e., a room move, use of outside resources, etc.) to prevent resident-to-resident abuse resulting in a major injury to Resident 399. The facility failed to protect Resident 399's right to be free from physical abuse by another resident resulting in actual harm to Resident 399, of a left femoral neck fracture. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 7 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 28 Pa. Code 201.14 (a) Responsibility of licensee Level of Harm - Actual harm 28 Pa. Code 201.18 (b)(1)(2)(e)(1) Management Residents Affected - Few 28 Pa. Code 201.19(6)(7)(8) Personnel policies and procedures 28 Pa. Code 201.20(b)(d) Staff development 28 Pa. Code 201.29 (a)(c) Resident rights 28 Pa. Code 211.12(c)(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 8 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 clinical record review, review of select policies and procedures, and staff interview, it was determined that the facility failed to implement their abuse policy regarding completion of an investigation of an unknown injury for one of six residents reviewed (Resident 118) and background check screening for one of five newly hired employees (Employee 4 ). Residents Affected - Few Findings include: The policy entitled Resident Abuse and Neglect Prevention Program last reviewed on May 28, 2024, indicates that the facility will investigate bruises and/or marks of unknown origin. An incident/accident report will be initiated by the charge nurse and an investigation is initiated to rule out the possibility of abuse. The policy does not indicate how other injuries will be investigated to rule out abuse, such as fractures. The policy indicates to refer to the policy entitled Incident/Accident Investigative Reports. The policy indicates that the facility will conduct a criminal background check on all prospective staff utilizing the State Police and Federal Bureau of Investigation if required. The criminal background check will be completed within 30 days for State Police report. The undated policy entitled Investigation of Incidents and Unusual Occurrences was received when this surveyor asked for the policy entitled Incident/Accident Investigative Reports. Review of this policy did not indicate how the facility will investigate injuries of unknown origin to rule out the potential for abuse. Review of Resident 118's clinical record revealed nursing documentation dated October 7, 2024, at 6:35 AM indicating that Resident 118 was complaining of left rib pain. Nursing indicated that Resident 118's doctor would be notified. Nursing documentation dated October 8, 2024, at 6:00 AM indicated that Resident 118 continued with complaints of left rib pain and was requesting an x-ray. Nursing documentation dated October 8, 2024, at 12:25 PM revealed that an order for an x-ray was obtained from Resident 118's physician and that Resident 118 had a previous fall. There was no documented evidence in Resident 118's clinical record to indicate he had fallen prior to this injury. Nursing documentation dated October 8, 2024, at 10:30 PM indicated that Resident 118's x-ray results showed a fracture of his left 10th rib. Interview with the Administrator on November 21, 2024, at 1:22 PM confirmed that Resident 118 did not have any falls prior to October 11, 2024. Interview with the Administrator on November 22, 2024, at 10:00 AM confirmed that the facility did not complete an investigation into Resident 118's fractured rib to rule out the potential for abuse and/or neglect. Review of Employee 4's, licensed practical nurse, employee file reveled the facility hired Employee 4 on September 9, 2024. Employee 4 worked at the facility through October 18, 2024. There was no evidence a state police criminal background check was completed on the employee. In an interview with the Nursing Home Administrator on November 21, 2024, at 2:15 PM the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 9 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 Administrator indicated Employee 4 had not worked at the facility since October 18, 2024, and that a state police criminal background check had not been completed as required. Level of Harm - Minimal harm or potential for actual harm 483.12 (b) Development and Implementation of Abuse Policy Residents Affected - Few Previously cited 12/8/23 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 201.29(a)(c) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 10 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on review of facility documentation, clinical record review, and staff interview, it was determined that the facility failed to identify the potential for, ensure a complete and thorough investigation of, and to ensure timely reporting of an incident involving the potential for neglect for one of 29 residents reviewed (Resident 65) Findings include: Clinical record review for Resident 65 revealed nursing documentation dated November 7, 2024, at 2:19 PM that indicated that staff was notified at 11:00 AM by Resident 65 that she had a fall. Resident 65 revealed that the fall occurred prior to the change of shift. She noted that she requested to be changed (receive incontinence care). The (nurse) aide came in and when I rolled to by side, I rolled out of the bed and landed on my knees. The (nurse) aide went and got another aide and helped me back into bed. Staff noted that Resident 65 was capable and sustained two small abrasions on both of Resident 65's knees and a scratch on her right elbow. Review of Resident 65's care plan revealed that on June 17, 2024, the facility implemented that the resident required two (staff) assist to reposition and turn in bed. Review of a facility's investigation dated October 7, 2024, confirmed the nursing documentation; however, failed to identify the staff member who rolled Resident 65 out of bed, failed to identify that Resident 65 needed to have two staff with bed mobility, and failed to report this potential for neglect to the appropriate state and local agencies. Review of Employee 9's, nurse aide, statement dated October 7, 2024, revealed that a (unidentified) nurse aide came to her office regarding the above noted incident with Resident 65. The nurse aide revealed that Resident 65 was crying and requested that Employee 9 go see Resident 65. The nurse aide noted that they rolled her out of bed, just put her back in bed, and she hurt all over. Employee 9 visited Resident 65 confirmed her statement noted in the nursing documentation stating the nurse aide was a little annoyed and rolled her right out of bed onto the floor, went out of the room, and returned with another aide. They lowered the bed, and it took several attempts to get her back into bed. Employee 9 reported this information to the Nursing Home Administrator (NHA), (prior) Director of Nursing (DON), and Assistant Director of Nursing. Review of Employee 10's, nurse aide, statement received November 22, 2024, via a telephone call with the NHA, Employee 9, and the DON, revealed that a nurse aide had requested her help that night to get Resident 65 back to bed as Resident 65's bottom half had slid off the bed. Employee 10 assisted the nurse aide to get Resident 65 back into bed, noting, I did not realize she (the nurse aide) had not told anyone else (i.e., nursing staff). There were no statements available from the nurse aide who rolled Resident 65 out of bed, no documentation that the facility identified the potential for neglect, and that the facility notified the appropriate State and Local agencies regarding the incident and potential for neglect. This surveyor reviewed this information during an interview with the NHA and Director of Nursing on November 22, 2024, at 10:34 AM. 28 Pa. Code 201.14(a)(c) Responsibility of licensee (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 11 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 0609 28 Pa. Code 201.18(b)(2)(e)(1) Management 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: 395586 If continuation sheet Page 12 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. 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 and services identified to reduce a resident's decline in ADL's (activities of daily living) for five of five residents reviewed (Residents 47, 66, 73, 80, and 108). Residents Affected - Some Findings include: Clinical record review for Residents 47 revealed a current task for staff to provide: nursing rehab for dressing and grooming, staff to encourage resident to assist with all dressing and grooming every shift nursing rehab eating and swallowing, staff to encourage resident to eat 50 to 75 percent of all meals Review of task documentation for Resident 47 revealed that staff did not document completion or documented NA (Not Applicable) of the nursing rehab grooming task on the following dates: Day Shift: October 7, 13, 24, and 27 2024 November 1, and 7, 2024 Evening Shift: October 2, 5, 6, 12, 14, 16, 19, and 25, 2024 November 3 and 17, 2024 Review of task documentation for Resident 47 revealed that staff did not document completion or documented NA (Not Applicable) of the nursing rehab eating task on the following dates: Day Shift: October 3, 4, 5, 6, 7, 8, 9, 10, 12, 13, 18, 21, 22, 23, 24, 25, 26, 27, and 31, 2024 November 1, 2, 3, 4, 5, 6, 7, 8, 10, 11, 12, 13, 15, 19, and 20, 2024 Evening Shift: October 2, 6, 14, and 25, 2024 November 3, 2024 Clinical record review for Residents 66 revealed a current task for staff to provide: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 13 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 0676 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some nursing rehab for dressing and grooming, staff to encourage resident to assist with all dressing and grooming every shift nursing rehab eating and swallowing, staff to encourage resident to eat 50 to 75 percent of all meals. Review of task documentation for Resident 66 revealed that staff did not document completion or documented NA of the nursing rehab grooming task on the following dates: Day Shift: October 27 and 31, 2024 November 1, 7, and 13, 2024 Evening Shift: October 14, 16, 19, 25, 2024 Review of task documentation for Resident 66 revealed that staff did not document completion or documented NA of the nursing rehab eating task on the following dates: Day Shift: October 3, 5, 6, 7, 9, 10, 12, 13, 21, 22, 23, 25, 26, 27, and 31, 2024 November 1, 2, 3, 4, 5, 6, 7, 8, 10, 11, 12, 15, 19, and 20, 2024 Evening Shift: October 2, 14, and 25, 2024 November 3, 2024 Clinical record review for Residents 73 revealed a current task for staff to provide: nursing rehab for dressing and grooming, staff to encourage resident to assist with all dressing and grooming every shift. nursing rehab eating and swallowing, staff to encourage resident to eat 50 to 75 percent of all meals. Review of task documentation for Resident 73 revealed that staff did not document completion or documented NA of the nursing rehab grooming task on the following dates: Day Shift: October 7, 13, 24, and 27 2024 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 14 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 0676 November 1, and 7, 2024 Level of Harm - Minimal harm or potential for actual harm Evening Shift: October 2, 5, 6, 12, 14, 16, 19, and 25, 2024 Residents Affected - Some November 3 and 17, 2024 Review of task documentation for Resident 73 revealed that staff did not document completion or documented NA of the nursing rehab eating task on the following dates: Day Shift: October 3, 4, 5, 6, 7, 8, 9, 10, 12, 13, 18, 21, 22, 23, 24, 25, 26, 27, and 31, 2024 November 1, 2, 3, 4, 5, 6, 7, 8, 10, 11, 12, 13, 15, 19, and 20, 2024 Evening Shift: October 2, 6, 14, and 25, 2024 November 3, 2024 Clinical record review for Residents 80 revealed a current physician's order for staff to provide: nursing rehab walking: please ambulate 125 feet daily with a rolling walker and one staff assist, cueing to take bigger steps and stand tall nursing rehab for dressing and grooming, staff to encourage resident to assist with all dressing and grooming every shift nursing rehab eating and swallowing, staff to encourage resident to eat 50 to 75 percent of all meals. Review of task documentation for Resident 80 revealed that staff did not document completion or documented NA of the nursing rehab walking order on the following dates: October 1, 2, 3, 4, 7, 8, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 21, 22, 25, 27, 28, 29, 30, and 31 2024 November 1, 7, 10, 11, 13, 14, 15, 18, and 19, 2024 Review of task documentation for Resident 80 revealed that staff did not document completion or documented NA of the nursing rehab grooming task on the following dates: Day Shift: October 3, 7, 27, and 31, 2024 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 15 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 0676 November 7, 10, 14, and 15, 2024 Level of Harm - Minimal harm or potential for actual harm Evening Shift: October 2, 6, 14, 16, 25, and 30, 2024 Residents Affected - Some November 3 and 16, 2024 Review of task documentation for Resident 80 revealed that staff did not document completion or documented NA of the nursing rehab eating task on the following dates: Day Shift: October 3, 5, 6, 7, 8, 9, 10, 12, 13, 21, 22, 23, 25, 26, 27, and 31, 2024 November 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 15, 17, 19, and 20, 2024 Evening Shift: October 2, 6, 14, 25, and 30, 2024 November 7, 10, and 15, 2024 Clinical record review for Residents 108 revealed a current physician order for staff to provide: a restorative nursing care walk every shift with a rolling walker one assist nursing rehab for dressing and grooming, staff to encourage resident to assist with all dressing and grooming every shift nursing rehab eating and swallowing, staff to encourage resident to eat 50 to 75 percent of all meals Review of task documentation for Resident 108 revealed that staff did not document completion or documented NA of the nursing rehab walking task on the following dates: Day Shift: October 30 and 31, 2024 November 1, 4, 5, 6, 7, 8, 9, 10, 11, 12, 14, 15, and 18, 2024 Evening Shift: October 2, 5, 6, 12, 14, 16, 19, and 25, 2024 November 3, 2024 Review of task documentation for Resident 108 revealed that staff did not document completion or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 16 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 0676 documented NA of the nursing rehab grooming task on the following dates: Level of Harm - Minimal harm or potential for actual harm Day Shift: October 12 and 13, 2024 Residents Affected - Some November 1, 6, 7, and 13, 2024 Evening Shift: October 2 and 16, 2024 November 3, 2024 Review of task documentation for Resident 108 revealed that staff did not document completion or documented NA of the nursing rehab eating task on the following dates: Day Shift: October 3, 4, 5, 6, 7, 8, 9, 10, 12, 13, 21, 22, 23, 25, 26, and 31, 2024 November 1, 2, 3, 4, 5, 6, 7, 8, 10, 11, 12, 13, 15, 19, and 20, 2024 Evening Shift: October 2 and 6, 2024 November 3, 2024 The surveyor reviewed the above information during an interview with the Nursing Home Administrator and the Director of Nursing on November 21, 2024, at 1:30 PM. 28 Pa. Code 211.10(c) 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: 395586 If continuation sheet Page 17 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 and staff interview, it was determined that the facility failed to provide the highest practicable care regarding physician ordered treatments and medications for three of 29 residents reviewed (Residents 52, 131, and 300). Residents Affected - Some Findings include: Clinical record review for Resident 131 revealed a diagnosis list that included sepsis (a systemic response to infection) and resistance to multiple antimicrobial drugs. Observation of Resident 131 on November 20, 2024, at 11:00 AM revealed the resident was sitting in a wheelchair at the foot of the bed. The resident had a PICC line (peripherally inserted central catheter; a thin, soft, flexible tube inserted through a vein in the arm and passed through to the larger veins near the heart for the administration of fluids or medication) in the left arm. Current physician orders for Resident 131 revealed an order dated November 19, 2024, that noted the resident was to receive Meropenem (an antibiotic) two grams intravenously every eight hours for sepsis related to a thigh abscess (a tender mass filled with pus caused due to infection). Review of the November 2024 Medication Administration Record (MAR) for Resident 131 revealed that staff had not documented the resident as having received the medication as ordered, refused the medication, or was not available for administration on the following dates/times: The 5:00 AM dose of the antibiotic on November 4, 7, 8, and 16. The 1:00 PM dose of the antibiotic on November 14, 17, and 18. The 9:00 PM dose of the antibiotic on November 15. Further review of the clinical record for Resident 131 revealed an order dated November 10, 2024, that instructed staff to change the PICC line dressing every day shift every Sunday. Review of the current care plan for Resident 131 revealed the resident has a potential for complications at the intravenous (IV) insertion site, which also included care for a dislodged PICC line (cleanse site and place a dry dressing, inspect tubing for breakage, measure the total length compared to the insertion notes and if not whole notify the physician and send the resident to the emergency room for evaluation). The care plan for Resident 131 did not contain anything related to further assessment of possible complications related to the PICC line (such as extremity edema, infection, and/or catheter migration). The above information was reviewed with the Nursing Home Administrator and Director of Nursing on November 22, 2024, at 1:00 PM. Clinical record review for Resident 300 revealed the resident was ordered inner cannula (a tube that fits inside a tracheostomy) changes daily to his tracheostomy (a hole in the front of the neck into the windpipe) since October 17, 2024. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 18 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 During an observation of Resident 300's tracheostomy care and inner cannula change on November 21, 2024, at 11:08 AM, Resident 300 was asked if staff were performing this task daily in which the resident responded, sometimes. A review of Resident 300's November treatment record for the daily inner cannula changes revealed no evidence the changes were completed on November 10, 12, 16, 17 or 18, 2024. There was no evidence to indicate the resident refused or other reason the inner cannula changes were not completed or documented as completed as ordered. An observation of Resident 300 on November 19, 2024, at 1:03 PM revealed the resident was in the dining room with a bandage over his right elbow. Resident 300 stated he had an IV there. Clinical record review for Resident 300 revealed the resident had a fall on November 10, 2024, in which the resident sustained a skin tear to the right elbow. Review of physician orders for Resident 300 revealed an order dated November 10, 2024, for staff to apply xeroform gauze to the right elbow daily until healed and to cleanse the area with normal saline prior to application. An observation of Resident 300 on November 21, 2024, at 10:30 AM revealed the resident had a dressing on his right elbow. The dressing was dated November 19, 2024. A review of Resident 300's treatment record revealed no documented evidence the resident's treatment was completed on November 20, 2024. There was no documented refusal of the treatment or reason it was not completed. In an interview with the Nursing Home Administrator on November 21, 2024, at 11:23 AM the findings regarding Resident 300's inner cannula changes and treatment to the resident's elbow were reviewed. Clinical record review for Resident 300 revealed the resident had recently transitioned from receiving enteral (nutritional support when a person cannot eat or drink) feedings to eating by mouth. A nutrition progress note dated November 14, 2024, at 11:39 AM noted a family member of the resident was notified of the discontinuation of Resident 300's enteral feeding and the family member requested the resident receive a multivitamin (MVI) daily. It was noted Resident 300's physician would be contacted to order the MVI. Review of a physician's progress note for Resident 300 dated November 15, 2024, at 5:08 PM (late entry note documented on November 17, 2024, at 11:08 AM) indicated the plan for the resident's discontinuation of the enteral feeding and order for a daily MVI was noted. As of November 22, 2024, at 10:47 AM there was no evidence Resident 300 was ever ordered or received the daily MVI. In a telephone interview with the Nursing Home Administrator on November 22, 2024, at 11:03 AM it was confirmed Resident 300 had no evidence the MVI was ordered or administered to the resident. Clinical record review for Resident 52 revealed a physician's progress note dated November 12, 2024, at 3:26 PM noting a small blister on the resident's right foot had gotten larger and a new one was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 19 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 identified on the back of the great toe. The note indicated will have them do betadine swabs to the blisters daily to get them to shrink down. Clinical record review for Resident 52 revealed a nursing progress note dated November 14, 2024, at 5:01 PM noting a family member of the resident was inquiring about treatment to a blister on the resident's right toe. It was noted the family member was told the resident only had an order to monitor the blister daily, and no treatment order. The family member indicated the physician confirmed a treatment order was placed. It was further noted that direct messages for a treatment order were identified, but the order had not been entered in the resident's treatment record and the treatment was added at that time on November 14, 2024. Clinical record review for Resident 52 revealed a physician's order dated November 14, 2024, with a start date of November 15, 2024, for the resident to have betadine applied to blisters on her right dorsal foot every day and night shift. Review of Resident 52's treatment record for November revealed once the betadine treatment was ordered there was no documented evidence the night shift treatment was completed for November 15, or 16, 2024. In a telephone interview with the Nursing Home Administrator on November 22, 2024, at 1:00 PM the above information was reviewed regarding Resident 52. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 20 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 three of three residents reviewed (Residents 73, 122, and 300). Residents Affected - Some Findings include: Clinical record review for Resident 73 revealed a current physician's order for staff to provide oxygen at 4 liters per minute (LPM) via NC (nasal canula, tubing to deliver oxygen to the nose), monitor (Resident 73's) oxygen saturation (the amount of oxygen in the blood) every shift and ensure the appropriate flow rate every day and evening shift. Observation of Resident 73's oxygen concentrator on November 19, 2024, at 12:47 PM revealed that their oxygen level was set at 6 LPM. Observation on November 20, 2024, at 10:52 AM revealed that Resident 73's oxygen level set was at 6.5 LPM. On November 21, 2024, at 2:26 PM revealed Resident 73's oxygen level was set at 6.5 LPM. Concurrent interview with Employee 2, nurse aide, confirmed the observation. During each observation, Resident 73's oxygen concentrator was located at the head of their bed and out of their reach. Resident 73 was unable to change the oxygen level independently. Review of Resident 73's oxygen monitoring documentation for October and November 2024, revealed there was no documentation that staff monitored Resident 73's oxygen level on the following dates: October 6, 7, 24, 25, and 31, 2024, day shift October 5, 2024, evening shift November 6, 18, and 19, 2024, day shift There was documentation that staff monitored Resident 73's oxygen level on November 20 and 21, 2024, day shift, however this surveyor observed Resident 73's oxygen administration level above the physician's ordered level both days. The surveyor reviewed the above information for Resident 73 during observation and interview with the Director of Nursing and the Nursing Home Administrator on November 21, 2024, at 2:39 PM. Observations on the Second Floor [NAME] Nursing Unit on November 19, 2024, at 9:32 AM and 10:53 AM revealed a wheelchair in the main resident hallway with a nasal cannula attached to a portable oxygen cylinder. The nasal cannula was unprotected from contamination and draped over the back of the wheelchair and coiled on the seat. The nasal cannula was not labeled or dated. The wheelchair did not have a resident name tag on it. An interview with Employee 1, licensed practical nurse, on November 19, 2024, at 10:57 AM revealed it was unclear who the nasal cannula belonged to and she unsure how the nasal cannula should be stored and protected from contamination. An interview with Employee 6, nurse aide, on November 19, 2024, at 11:05 AM revealed that the wheelchair and nasal cannula belonged to Resident 122. Employee 6 proceeded to remove the nasal cannula. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 21 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 - Some The above information for Resident 122 was reviewed with the Nursing Home Administrator and Director of Nursing on November 20, 2024, at 2:47 PM. Observation of Resident 300's room on November 19, 2024, 12:30 PM revealed the resident was out of the room and the bed was made. A large plastic cart labeled tracheostomy cart was observed beside the resident's bed. A nebulizer with an attached mask was lying on top of the cart. The mask was not covered. A suction machine was observed next to the nebulizer. The end of the suction tubing was lying on top of the cart uncovered. A follow up observation of Resident 300's room on November 20, 2024, at 10:03 AM revealed the resident was out of the room. The suction tubing end and nebulizer mask remained lying on top of the cart uncovered. An oxygen concentrator beside the bed was also observed with nasal mask on the end of the oxygen tubing, which was uncovered pinned between the concentrator and the tracheostomy cart. The above findings regarding the storage of Resident 300's respiratory equipment were reviewed with the Nursing Home Administrator and Director of Nursing on November 20, 2024, at 2:45 PM. 483.25(i) Respiratory/tracheostomy Care and Suctioning Previously cited 12/8/23 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: 395586 If continuation sheet Page 22 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observation, and staff and resident interview, it was determined that the facility failed to ensure the availability of necessary emergency supplies for one of two residents reviewed receiving hemodialysis (Resident 52). Residents Affected - Few Findings include: Clinical record review for Resident 52 revealed the resident was admitted to the facility on [DATE], and was receiving hemodialysis (a machine that performs a basic function of the kidney by cleansing the blood of impurities) three days a week. A nursing progress note dated November 1, 2024, at 7:28 PM noted the resident had a right chest tunnel catheter (a central line placed under the skin allowing long term access to a vein) for dialysis. An observation of Resident 52's room on November 20, 2024, at 10:25 AM did not reveal any emergency supplies in the resident 's room for the central line to include sterile gauze, hemostat (a tool used to control bleeding), needleless connector, or tape. The above information regarding Resident 52's central line for dialysis and no evidence of an emergency kit in the resident's room was reviewed with the Nursing Home Administrator and Director of Nursing on November 20, 2024, at 2:42 PM. The Nursing Home Administrator indicated the kit may have been inside the resident's closet. A concurrent observation with the Nursing Home Administrator revealed there was no kit in Resident 52's closet or otherwise observed in the resident's room. 483.25 (1) Dialysis Previously cited 12/8/23 28 Pa. Code 211.12 (d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 23 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 Based on clinical record review and resident and staff 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 four residents reviewed for mood/behavior (Resident 22). Residents Affected - Few Findings include: Clinical record review revealed the facility admitted Resident 22 on November 2, 2015, with a diagnosis of Post Traumatic Stress Disorder (PTSD, a mental and behavioral disorder that develops related to a terrifying event). Review of Resident 22's annual MDS (Minimum Data Set Assessment, an assessment completed at least quarterly by the facility to determine the care needs of the resident) dated June 15, 2024, revealed that she had an active diagnosis of PTSD. Interview with Resident 22 on November 19, 2024, at 12:10 PM revealed that she has a diagnosis of PTSD and that she is triggered by people arguing and fighting, screaming, and doors slamming. She also indicated that she would pick at her fingernail beds and gets very anxious when she is triggered. Review of Resident 22's clinical record revealed no evidence that the facility identified Resident 22's history of trauma. A review of Resident 22's care plan revealed there were no identified triggers (everyday situations that cause a person to re-experience the traumatic event as if it was reoccurring). Resident 22's clinical record contained no evidence the facility collaborated with the resident, and as appropriate, the resident's family, friends, and any other healthcare professionals (such as psychologists, and mental health professionals) to develop and implement individualized interventions. These findings were reviewed with the Nursing Home Administrator and Director of Nursing on November 21, 2024, at 2:30 PM. 28 Pa Code 211.12 (d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 24 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on clinical record review, review of facility documentation, and staff interview, it was determined that the facility failed to ensure an appropriate physician response to the consultant pharmacist's recommendation for one of five residents reviewed for potentially unnecessary medications (Resident 122). Findings include: Current physician orders for Resident 122 revealed an order for Oxycodone HCL (an opioid analgesic pain medication used to treat moderate to severe pain) dated September 10, 2024, that instructed staff to give one tablet by mouth every four hours as needed for moderate to severe pain (4-10) with a maximum daily amount of 30 milligrams (mg). Further review of the current physician orders revealed an order for Resident 122 for Acetaminophen (Tylenol; used to treat mild to moderate pain and/or reduce fever) tablet dated September 10, 2024, that instructed staff to give 650 mg every four hours as needed for mild pain rated 1-3 and not to exceed 3000 mg in 24 hours. A consultant pharmacist recommendation dated September 17, 2024, noted the following regarding Resident 122: This resident has orders for Tylenol as needed (a few times in the evening) and Oxycodone as needed (uses at bedtime almost every day). Recommendations: Tylenol XR 650 milligrams Arthritis one by mouth daily at 5:00 PM for pain management; Oxycodone 2.5 milligrams every bedtime for 14 days. The recommendation indicated a Note written to physician. The note written to the physician for the above consultant pharmacist recommendation for Resident 122 was not provided to the surveyor by the facility. An interview with the Nursing Home Administrator on November 21, 2024, at 1:50 PM revealed that the consultant pharmacist recommendation for Resident 122 was not completed and will be followed-up on today. 28 Pa. Code 211.2(d)(8) Physician services 28 Pa. Code 211.9(k) Pharmacy services 28 Pa. Code 211.12(d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 25 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 observation, clinical record review, review of select manufacturer's guidelines, and staff interview, it was determined that the facility failed to ensure a medication error rate below five percent (Residents 1 and 94). Residents Affected - Some Findings include: The facility's medication error rate was 16 percent based on 25 medication opportunities with four medication errors. Observation of a medication administration pass on November 19, 2024, at 9:30 AM revealed Employee 1, licensed practical nurse (LPN), preparing to administer Insulin Lispro (helps regulate blood sugars) 60 units, Dulera (used to control symptoms of asthma) inhaler, and Flonase (used to help with nasal allergies) nasal spray to Resident 1. Review of Resident 1's clinical record revealed a physician's order dated October 22, 2024, that indicated nursing staff are to administer the Insulin Lispro before meals. Employee 1 administered the Insulin Lispro almost 90 minutes after Resident 1 ate her breakfast. Review of the manufacturer's guidelines for the use of Dulera revealed that once the administration is complete, the user is to rinse their mouth out with water and spit the water out. Employee 1 handed the Dulera inhaler to Resident 1. Resident 1 administered two sprays and did not rinse her mouth out after administration. Employee 1 also did not provide any instructions to Resident 1 regarding rinsing her mouth after use. Review of the manufacturer's guidelines for the use of Flonase revealed that the user should blow their nose prior to use and to also hold closed the opposite nostril when administering. Employee 1 handed the Flonase to Resident 1. Resident 1 administered one spray to each of her nostrils. Resident 1 did not blow her nose and did not hold the opposite nostril closed. Employee 1 did not provide instructions to Resident 1 regarding blowing her nose prior to use or holding the opposite nostril closed while administering. Interview with Employee 1 on November 19, 2024, at 1:30 PM confirmed the above observations. Observation of a medication administration pass on November 20, 2024, at 9:02 AM with Employee 7, LPN, revealed she administered Glipizide (a medication used to help regulate blood sugar) 5 milligrams to Resident 94. The medication label indicated that Glipizide was to be given before meals. Employee 7 administered Glipizide after Resident 94 already ate her breakfast. Interview with Employee 7 on November 20, 2024, at 2:30 PM confirmed that she administered Resident 94's Glipizide after she already ate breakfast. The Nursing Home Administrator and Director of Nursing were made aware of the concerns with medication administration during a meeting on November 21, 2024, at 2:22 PM. 483.45(f) Medication Errors Previously cited 12/8/23 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 26 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 28 Pa. Code 211.10(a) Resident care policies Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12(d)(1)(5) Nursing services Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 27 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation and staff interview, it was determined that the facility failed to ensure appropriate medication security on one of five nursing units (Resident 83, Second Floor East) Findings include: Observation of Resident 83 on November 19, 2024, at 2:20 PM revealed the resident was in bed. A bottle of iodine solution was observed sitting on the resident's tray table in front of her amongst many personal belongings. A follow up observation on November 20, 2024, at 10:09 AM revealed the bottle was again observed on the resident's tray table in front of the resident in bed. The bottle was labeled Povidone-Iodine solution 10%. Resident 83 indicated she was applying it to a mole on her face and was to put it on daily, but she hasn't in a long time. Resident 83 indicated she purchased the solution herself, but they know about it, and that I have it. Clinical record review revealed no evidence of any iodine solution ordered for Resident 83, any order to self- administer the solution, or store it in her room. Resident 83 resided in a room with a roommate. In an interview with the Nursing Home Administrator and Director of Nursing on November 21, 2024, at 2:00 PM it was reviewed the iodine solution was in Resident 83's room, unsecured, and accessible to the resident to self-administer, and other residents on the unit. 483.45(h) Drug Storage Previously cited 12/8/23, 10/31/24 28 Pa. Code 211.9(k) Pharmacy services 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: 395586 If continuation sheet Page 28 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observation, review of facility documentation, and resident and staff interview, it was determined that the facility failed to serve food at a palatable temperature on one of five nursing units (Third Floor East, Resident 15). Residents Affected - Few Findings include: Review of the Food Committee meeting minutes dated September 14, 2024, and October 17, 2024, noted that residents replied sometimes when asked if the hot food was hot and the cold food was cold. Interview with Resident 15 on November 19, 2024, at 11:20 AM revealed concerns that sometimes the food was not hot and a little on the colder side. Observation of meal service on the Third Floor East Nursing Unit on November 21, 2024, at 1:26 PM revealed that the food trays arrived on the unit and staff began immediately serving the meals. Further observation revealed that staff had passed the last resident food tray at 1:31 PM. The surveyor obtained a test tray at this time from the meal cart and began testing the food temperatures. The oven fried chicken entrée was tested at 111.2 degrees Fahrenheit. The plain white rice was tested at 119.2 degrees Fahrenheit. The temperatures were confirmed by Employee 5, nurse aide, at the time of the testing. Further observation at the time of testing revealed the food did not feel hot to the touch nor was any steam observed rising from the food items. The oven fried chicken and rice tasted lukewarm and was not hot. The above information was reviewed with the Nursing Home Administrator on November 22, 2024, at 1:00 PM. 28 Pa. Code 201.14(a) Responsibility of licensee. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 29 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. Based on review of the facility meal schedule, observation, and resident and staff interview, it was determined that the facility failed to ensure that meals were served at regularly scheduled times in accordance with resident needs on three of five nursing units (Resident 9 and 108; Second Floor East, Second Floor West, and Third Floor East) Findings include: Review of the facility's resident food committee minutes dated October 17, 2024, revealed the residents indicated dinner is late. Observation on the Second-Floor East nursing unit on November 19, 2024, at 12:28 PM revealed staff passing lunch meal trays on the unit. Several trays remained in the cart waiting to be passed. Resident 9 who resides on the unit was observed being served lunch during an interview with the resident at 12:40 PM. Resident 9 indicated meals are often late and never when they are told they are going to be, stating she was supposed to get her lunch around noon. Resident 9 requested an alternate entrée at the time the meal tray was served to her. The alternate entrée was observed being served to the Resident 9 at 1:01 PM. Observation of the lunch tray line in the facility's main kitchen on November 21, 2024, at 12:17 PM revealed multiple dietary staff assembling resident meal trays. Staff were observed to have completed the first cart for delivery to the Second [NAME] nursing unit and the cart left the kitchen at 12:39 PM. Observation on the Second-Floor [NAME] nursing unit revealed the cart arrived on the unit at 12:43 PM when staff immediately started passing the trays. The last tray was served off the cart at 1:23 PM. A review of the facility mealtimes document revealed the lunch meal is to be served to residents on the Second-Floor East unit from 12:05 - 12:10 PM depending if the tray is on first or second cart for the unit. Resident 9 was served at 12:40 PM on November 19, 2024, a half hour after the approximate delivery time for her lunch. The approximate time for lunch service on the Second Floor [NAME] first cart noted as observed above, was 12:20 PM. The cart did not leave the kitchen until 12:39 PM and the last tray was not served off the cart until 1:23 PM over one hour past the approximate meal service time. The above findings were reviewed with the Nursing Home Administrator and Director of Nursing on November 21, 2024, at 1:30 PM. Review of the posted mealtimes for the Third Floor East Nursing Unit revealed that the lunch food trays are scheduled to arrive on the unit at 12:45 PM. Observation of the Third Floor East Nursing Unit on November 21, 2024, at 1:20 PM revealed multiple residents in the dining room awaiting lunch trays, which had not arrived to the unit. Three staff members were also observed at the nurse's station awaiting lunch trays to arrive. Observation of the Third Floor East Nursing Unit on November 21, 2024, at 1:26 PM revealed that the lunch food trays arrived on the unit (over 45 minutes late per the posted mealtimes) via the food (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 30 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 0809 tray cart and staff began passing the meal trays. Level of Harm - Minimal harm or potential for actual harm Interview with Resident 108 on November 19, 2024, at 10:41 AM revealed that she waits almost an hour (7:00 PM) for her supper meal tray to arrive. Residents Affected - Some The above information for the Third Floor East Nursing Unit was reviewed with the Nursing Home Administrator on November 22, 2024, at 1:00 PM. 28 Pa. Code 201.14(a) Responsibility of licensee FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 31 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 - Many 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 and maintain food service equipment in a safe and sanitary manner and prevent the potential for food contamination in the facility's main kitchen and on two of five nursing units (Second Floor East, Third Floor West) Findings include: Observation of the facility's main kitchen on November 19, 2024, at 11:00 AM revealed the following: Handwashing sinks located inside the kitchen entrance, beside the three-compartment sink area, snack preparation are, and dishwashing area were observed with brown staining, and with dust, dirt, and debris buildup on the surrounding faucet area. Small tan colored trashcans located beside the above noted handwashing sinks were observed with dried liquid spills and buildup of dust/dirt on the exteriors. The wall area behind the trash receptacle by the handwashing sink in the three-compartment sink area was observed with multiple areas of dried liquid/food splatter. The frame of the linen cart stored beside the handwashing sink upon entrance to the kitchen was dusty and dirty. Large gray trash bins located throughout the kitchen were observed with dust, food crumbs, and dried liquid spills on the lids and exterior of the containers. Flooring throughout the cooking area containing, the fryer, stove top, ovens, and steamers was observed with debris and dirt buildup under the equipment and along wall edges. The conduit, wires and pipes behind the oven, stove, and fryer were covered in thick dust. Significant dirt and debris were observed on the flooring extending from the three-compartment sink area, under the pot/pan shelving unit, and into the bakery room. The pot and pan shelving unit frame appeared corroded with pieces chipping off the unit onto the floor. The shelves contained dust and debris. Large floor drains, which extended on the floor in front of three steamers, steam kettle and tilt skillet were observed with significant food debris buildup down in the drain. The metal grates, which covered the drain trough area were observed with significant dried food/debris buildup hanging from the holes in the metal grate covers. The covers were observed screwed in place. Employee 3, dietary manager, indicated maintenance would need contacted to unscrew the grates so the area could be cleaned. The lower portion of the steam kettle was observed covered with dried food splatter. The frame of the tilt skillet was observed dusty and sticky. A floor drain under the sink across from the tilt skillet was observed with dried food and debris. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 32 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 The interior base of a portable two door cooler across from the tilt skillet was observed with dust, and debris build up. A white plastic bowl was found inside the microwave covered with a piece of plastic wrap labeled butter 11/13 11/14. The butter appeared to have been melted and rehardened to the shape of the container. Residents Affected - Many A floor drain under the coffee station area contained a dried pepper pack and debris. The flooring under the ice machine contained significant dirt and debris extending to the area behind the machine. The drain under the ice machine contained debris and was covered significantly in a white substance. A dish rack full of clear two handled plastic cups was observed in the snack preparation area. Employee 3 indicated the cups were clean. Many of the cups were significantly stained brown. The interior of the snack preparation area's portable cooler contained dried food and debris. Observation of the nourishment room located on the Second-Floor East nursing unit on November 20, 2024, at 10:56 AM revealed brown stains in the sink, and a large amount of white buildup on the faucet area. The countertop was covered in crumbs, brown and black stains, and dried liquid ring spots. The interior of the microwave was covered in dried food, and brown discoloration of the white interior. A lower cabinet containing a box of plasticware, and a plastic sleeve of cup lids contained dust and debris in the interior base and interior frame of the door and dried liquid spills. A cabinet under the sink, which was labeled with a sign stating, Do not store anything in the cupboard, was observed with an empty soda can sitting in the corner of the cabinet. The interior base of the cabinet had several dried liquid spots under the sink pipes. The interior of a refrigerator/freezer in the room was observed with a frozen red substance in the interior base of the freezer and the interior of the refrigerator door was observed dirty with black and brown areas. The interior base of the refrigerator was observed with debris buildup. A drawer in the refrigerator contained several containers of Nutren nutritional supplement, and was observed with a dried red sticky substance, dirt, dust, and a straw with the wrapper covered in the red substance dried and stuck the base of the drawer. A Nursing unit kitchen check sheet was observed on the door inside the nourishment room, which was last dated 11/19/24, with checked off marks for 7 PM - 7AM, indicating the microwave, counters, refrigerator, freezer were all clean. An observation of the Third-Floor [NAME] nourishment room on November 20, 2024, at 11:16 AM revealed the exterior metal vents of the microwave were blackened and discolored. The interior of the microwave contained multiple black spots and dried food debris. A cabinet under the sink was observed with black spots on the interior wood and black debris. An additional lower cabinet where plasticware and foam cups were stored was observed with dried brown spills and debris buildup on the interior of the door frame extending into the interior base of the cabinet. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 33 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 The interior of the refrigerator contained dried spills and debris. The interior of the freezer had a black/brown substance throughout. A nursing unit kitchen check sheet, was observed in the Third-Floor [NAME] nourishment room and was checked off for November 20, 2024, 7 AM - 7 PM that the microwave and refrigerator were clean. Residents Affected - Many The above findings were reviewed with the Nursing Home Administrator on November 21, 2024, 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: 395586 If continuation sheet Page 34 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on clinical record review, facility documentation, and staff interview, it was determined that the facility failed to ensure complete and accurate clinical documentation for four of five residents reviewed for restorative nursing services (Residents 47, 66, 80, and 108). Findings include: Review of the facility's meal service times revealed that the breakfast meal tray carts for the 2W Nursing Unit were to be delivered to the unit at 7:50 AM and 8:00 AM respectively. Clinical record review for the following residents revealed that staff documented that they provided nursing rehab for eating and swallowing and encouraging residents to eat 50-75 percent of the meal prior to the facility delivering their breakfast tray. Review of Resident 47's October and November 2024 Task documentation (a document staff use to indicate the Resident's self-performance and staff support needed while completing a task and/or receiving care) revealed staff documentation prior to 7:50 AM that they provided nursing rehab for eating and swallowing on: October 1, 28, and 30, 2024 November 13, 14, 16, and 18, 2024 Review of Resident 66's October and November 2024 Task documentation revealed staff documentation prior to 7:50 AM that they provided nursing rehab for eating and swallowing on: October 1 and 30, 2024 November 13, 14, 16, and 18, 2024 Review of Resident 80's October and November 2024 Task documentation revealed staff documentation prior to 7:50 AM that they provided nursing rehab for eating and swallowing on: October 1, 4, 29, and 30, 2024 November 2, 13, 14, 16, and 18, 2024 Review of Resident 108's October and November 2024 Task documentation revealed staff documentation prior to 7:50 AM that they provided nursing rehab for eating and swallowing on: October 1, 2, 17, 18, 29, and 30, 2024 November 13, 14, and 16, 2024 This surveyor reviewed the above information during an interview on November 22, 2024, at 1:30 PM with the Nursing Home Administrator and the Director of Nursing. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 35 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 0842 28 Pa. Code 211.5 (f) Medical records Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12(d)(1)(5) Nursing Services Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 36 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, clinical record review, and resident and staff interview, it was determined that the facility failed to implement appropriate enhanced barrier transmission-based precautions for three of 29 residents reviewed (Residents 52, 83, and 131). Residents Affected - Few Findings include: Review of the memo entitled Enhanced Barrier Precautions (EBP, gown and glove use) in Nursing Homes to Prevent the Spread of Multi-drug Resistant Organisms released by the Center for Medicaid and Medicare Services (CMS) on March 20, 2024, with an implementation date of April 1, 2024, revealed that nursing care facilities are to use EBP for residents with chronic wounds or indwelling medical devices (i.e., indwelling urinary catheters) during high-contact resident care activities regardless of their multidrug-resistant organism status. High-contact activity would include things like dressing, transferring, changing linens, providing hygiene, changing briefs, wound care, or device care. Review of the facility policy titled, Infection Control Plan 2024, last reviewed without changes on September 20, 2023, revealed a policy statement that noted an infection control plan is established and maintained to provide a safe, sanitary, and comfortable environment for residents and staff to help prevent the development and transmission of communicable diseases and infections within the facility. A section of the policy noted enhanced barrier precautions are an infection control intervention designed to reduce transmission of MDROs through gown and glove use by healthcare providers in long-term care settings. EBP recommended during high contact care (such as dressing, bathing, transferring, changing briefs, or assisting with toileting, device care, wound care, etc.) activities with residents who are at a higher risk of acquiring or spreading an MDRO (such as residents with indwelling medical devices or wounds). EBP should be followed when contact precautions do not otherwise apply for residents with any of the following: open wounds requiring a dressing change, indwelling medical devices (central line, urinary catheter, feeding tubes, tracheostomy/ventilator) regardless of the MDRO status. Clinical record review for Resident 131 revealed a diagnosis list that included sepsis (a systemic response to infection) and resistance to multiple antimicrobial drugs. Current physician orders for Resident 131 revealed an order dated November 19, 2024, that noted the resident was to receive Meropenem (an antibiotic) two grams intravenously every eight hours for sepsis related to a thigh abscess (a tender mass filled with pus caused due to infection). Another order dated November 10, 2024, instructed staff to change the PICC (peripherally inserted central catheter; a thin, soft, flexible tube inserted through a vein in the arm and passed through to the larger veins near the heart for the administration of fluids or medication) dressing every day shift every Sunday. Observation of Resident 131 on November 20, 2024, at 11:00 AM revealed the resident was sitting in a wheelchair at the foot of the bed. The resident had a PICC in the left arm. There was no observed EBPs in place or evidence of EBPs being utilized (signage indicating EBPs, personal protective equipment (PPE) such as gowns/gloves, or totes/bins containing PPE). Clinical record review for Resident 131 revealed no further evidence the resident was on any isolation or EBPs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395586 If continuation sheet Page 37 of 38 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 395586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Hills Nursing & Rehabilitation Center 15900 Route 6 Troy, PA 16947 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation of Resident 131 on November 20, 2024, at 3:05 PM with the Nursing Home Administrator (NHA) confirmed the above findings that the resident had a PICC with no EBPs in place. Clinical record review for Resident 52 revealed the resident was admitted to the facility on [DATE], and was receiving dialysis (a blood purifying treatment given when kidney function is not optimum) treatments three days a week via a central line in her right chest. An observation of Resident 52's room on November 19, 2024, at 12:52 PM revealed the resident was in her room with a visitor. There was no evidence of any signage for EBP's, personal protective equipment bins, or supplies, such as gowns, or masks, in the room, on the door, or anywhere in the hallway near the resident's room. An observation of Resident 83 on November 19, 2024, at 2:29 PM revealed the resident was in bed with a foley catheter in place. Upon interview the resident sated she has had the urinary catheter since her admission to the facility in 2022. There was no evidence to indicate Resident 83 had EBP's in place. There was no signage by the resident's room, and there was no evidence of additional personal protective equipment such as gowns or masks near the resident's room in the hallway or on the resident's door. In an interview with the NHA and Director of Nursing on November 20, 2024, at 2:40 PM it was confirmed Resident 52 should have EBP's in place for a central line and Resident 83 due to her catheter. Resident 52 and 83 received physician orders for the implementation of EBP's after the above interview. 28 Pa. Code 201.18(b)(1) Management 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: 395586 If continuation sheet Page 38 of 38

Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.

Citations

26 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.

0578GeneralS&S Dpotential for harm
F578 - The right to request, refuse, and/or discontinue treatment, to participate in or
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
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.
0585GeneralS&S Epotential for harm
F585 - Grievances
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
0600SeriousS&S Gactual harm
F600 - Freedom from Abuse, Neglect, and Exploitation
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
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.
0676GeneralS&S Epotential for harm
F676 - Based on the comprehensive assessment of a resident and consistent with
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
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.
0698GeneralS&S Dpotential for harm
F698 - Dialysis
Provide safe, appropriate dialysis care/services 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.
0756GeneralS&S Dpotential for harm
F756 - Drug Regimen Review
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
0759GeneralS&S Epotential for harm
F759 - Medication Errors
Ensure medication error rates are not 5 percent or greater.
0804GeneralS&S Dpotential for harm
F804 - Food and drink
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
0842GeneralS&S Epotential for harm
F842 - Resident-identifiable information
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
0880GeneralS&S Dpotential for harm
F880 - Infection Control
Provide and implement an infection prevention and control program.
0561GeneralS&S Dpotential for harm
F561 - Self-determination
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
0609GeneralS&S Dpotential for harm
F609 - The facility must develop and implement written policies and procedures that:
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
0684GeneralS&S Epotential for harm
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
0761GeneralS&S Dpotential for harm
F761 - Labeling of Drugs and Biologicals
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
0809GeneralS&S Epotential for harm
F809 - Frequency of Meals
Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.
0812GeneralS&S Fpotential 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.
0321GeneralS&S Epotential for harm
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
0324GeneralS&S Epotential for harm
Provide properly protected cooking facilities.
0345GeneralS&S Fpotential for harm
Have approved installation, maintenance and testing program for fire alarm systems.
0363GeneralS&S Epotential for harm
Install corridor and hallway doors that block smoke.
0374GeneralS&S Epotential for harm
Install smoke barrier doors that can resist smoke for at least 20 minutes.
0914GeneralS&S Epotential for harm
F914 - Be designed or equipped to assure full visual privacy for each
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.

FAQ · About this visit

Common questions about this visit

What happened during the November 22, 2024 survey of BRADFORD HILLS NURSING & REHABILITATION CENTER?

This was a inspection survey of BRADFORD HILLS NURSING & REHABILITATION CENTER on November 22, 2024. The surveyor cited 26 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at BRADFORD HILLS NURSING & REHABILITATION CENTER on November 22, 2024?

Yes, 26 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate ..."

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·November 22, 2024