Health inspection·September 19, 2025

F 0565 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few facility. Directly before the interview with Resident 95 as noted above Employee 2, environmental services, was overheard and observed speaking to Resident 95, looking in her dresser drawers and asking the resident what size pants she wore so she could find her a pair to wear. Resident 95 replied to Employee 2 that she wanted her own pants back. In an interview with Resident 108 on September 17, 2025, at 12:33 PM she stated she is missing a new pair of shorts, a pair of jeans and a pair of cut offs she sent to laundry weeks ago. Resident 108 stated the clothing was labeled. Resident 108 stated they brought her a pair of cut offs but they were not hers. Resident 108 stated she was going out of the facility the next day with family and is taking her laundry with her to wash it there, so she has her clothing. During an interview with Resident 6 on September 16, 2025, at 2:17 PM Resident 6 revealed he's had an issue for months with laundry not returning his clothes timely, and he indicated the facility is aware of the issue. Resident 6 stated that he frequently runs out of laundry. Observation of Resident 6's closet revealed no pants, two pairs of shorts, and one shirt in his closet and drawers. Follow up interview and observation with Resident 6 on September 17, 2025, at 9:52 AM revealed that Resident 6 still had no pants, and now had no shirts left in his closet or drawers. Resident 6 was wearing pajama pants with the last shirt that was hanging in his closet. Resident 6 stated I guess I am wearing my pajama pants downstairs to the activity. Further observation of Resident 6's room revealed piles of clothes on the floor under the sink in his room, visible from the hallway. Resident 6 stated that is where staff told him and his roommate to put their dirty laundry. An observation of the facility laundry room area on September 17, 2025, at 12:53 PM with Employee 2 revealed multiple carts and racks filled with resident clothing. One large, 5 feet wide and four feet deep wheeled hopper bin was observed filled and overflowing with resident clothing, which was piled three feet above the top of the bin. Two additional wheeled metal carts and another hopper bin were observed by the large cart filled and overflowing with resident clothing. Two wheeled hanging racks used to sort resident clothing by room were also observed with some resident clothing on them. Employee 2 stated one of the laundry employees had sorted some of the clothing from the piles onto the racks and delivered it to residents that day but was continuing to sort through the piles that were there for labeled clothing to make another delivery. A large six-foot-wide linen rack with several shelves packed with clothing and blankets was also observed in the area. Employee 2 indicated the rack had items that were not labeled and/or they did not know who they belonged to. Some mesh laundry bags full of articles of clothing were observed on top of some of the stacks of clothing. Employee 2 stated they were trialing the bags on some of the resident units to keep clothing together, so items do not get lost. Employee 2 stated the clothing gets washed in the bag and dried in the bag to keep the resident items together. Employee 2 stated the laundry department has been working short staffed without any applicants for open positions since at least March 2025. Employee 2 stated there was some help from company regional staff prior to the Labor Day holiday a few weeks prior and all the laundry was caught up, to get the department back on a three-day turnaround for resident laundry, but then the holiday weekend came, and laundry has not been caught up since. Employee 2 stated nursing staff has come down to laundry at times to find some clothes for the residents. Two washers and two dryers were observed in the laundry room, all in operation during the above observation. They were all filled with wash cloths, towels, and gowns. Two large gray trash bins were also observed on the washer side filled with towels/wash cloths (facility owned linens), of which Employee 2 indicated had been washed once, but needed treated, and were waiting to be washed again. Interview with Resident 5 on September 18, 2025, at 11:56 AM revealed that the laundry people are not picking up laundry timely. She said that they have blue bags now to put their dirty laundry in, but the laundry staff are not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395616 If continuation sheet Page 2 of 17 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 395616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745 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 0565 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete picking it up. She said they had not picked up her laundry since last week. She also indicated that they are bringing her laundry back in the blue bag after it is washed and dried and all her clothes are wrinkled. Observation in Resident 5's bathroom revealed a blue laundry bag hanging on the door with dirty laundry in it. The bag was noted to be half full. There were clothes hanging on a metal laundry stand belonging in her bathroom. Resident 5 indicated that she put them there. She then proceeded to show the surveyor the wrinkled green dress that was returned to her from laundry. The surveyor observed a green silk dress with wrinkled lines throughout it. Interview with Resident 115 on September 16, 2025, at 1:30 PM revealed that about two weeks ago she was completely out of shirts to wear. She stated that the laundry was not being done and when it was it was not coming back timely. She said her daughter is now doing her laundry because of issues with the laundry at the facility. Concerns regarding laundry services were reviewed with the Nursing Home Administrator and Director of Nursing on September 17, 2025, at 2:40 PM. 28 Pa. Code 201.18 (e)(1)(4) Management28 Pa. Code 201.29(a) Resident rights Event ID: Facility ID: 395616 If continuation sheet Page 3 of 17 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 395616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745 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 a clean, comfortable, homelike environment on four of four nursing units (Units 1, 2, 3, and 4; Residents 5, 8, 12, 14, 15, 28, 38, 71, 95, 108 115, and 129), and maintain comfortable water temperatures on two of four nursing units (Unit 1, and 4; Resident 71). Findings include: An observation of Resident 28 and Resident 38's shared room on September 16, 2025, at 2:00 PM revealed dried spills on the flooring in the room, and a significant number of crumbs and debris surrounding Resident 38's recliner. Resident 28 stated a housekeeper was just in to empty the trash can, but that was it. Resident 28 stated when staff does sweep and mop it is only in the middle of the floor or just inside the door where they can see, they don't move anything. An observation of Resident 12's room on September 16, 2025, at 2:24 PM revealed a garbage can by the sink area in the room. The garbage can did not have a liner and contained trash including medicine cups, tissues, etc. The interior of the can had dust/debris built up in the bottom of the can and contained some dried brown liquid spills on the interior sides of the can. In an interview with Resident 12 on September 17, 2025, at 11:06 AM the resident indicated that staff change his roommates brief and then dispose of it in the trash can by this sink and take the bag with them and don't put a new liner in the can, so things get thrown in the can without a liner. Resident 12 stated It gets pretty rancid (unpleasant smell) at times. An observation of Resident 15's room on September 16, 2025, at 2:49 PM revealed debris on the resident's flooring, debris beside and under the resident's bed, and black buildup on the flooring in front of the bathroom door and the transition strip between the room and bathroom. The floor was sticky to walk on. Resident 15 stated staff come into clean the room, but they don't do a very good job. An observation of Resident 95's room on September 17, 2025, at 12:20 PM revealed multiple stains on the privacy curtain between the resident and the roommate's bed. In an interview with Resident 108 on September 17, 2025, at 12:33 PM the resident stated her room hasn't been cleaned in three days. Debris, wrappers, and food crumbs were observed on the floor beside the resident's bed. A broom was observed leaning against the wall at the front of the resident's room. Resident 108 stated she brought her own broom in for when it gets too bad, she can sweep up the dirt and debris into piles in the room for housekeeping. In an interview with Resident 71 on September 16, 2025, at 11:42 AM the resident stated the water from the sink in her room doesn't get warm and she uses the sink to get cleaned up in the morning and evenings before bed. Resident 71 also stated at times the shower water temperature is cold. Observation of Resident 71's water temperature at the sink in the room was tepid (slightly warm) at 104.1 degrees Fahrenheit after allowing the water to run for four minutes. An observation of the Unit 1 shower room on September 19, 2025, at 1:45 PM revealed the water temperature from the shower head after the hot water was running at the highest setting for six minutes only reached a slightly warm temperature of 91 degrees Fahrenheit. A sink in the shower room running for three minutes on the highest hot water setting only reached 81 degrees Fahrenheit. In an interview with Employee 11, maintenance director, on September 19, 2025, at 2:07 PM Employee 11 indicated he had checked water temperatures in the Unit 1 shower room earlier that morning and had a temperature of 106 degrees Fahrenheit, and indicated the dietary staff was currently running the dishwasher and it may be drawing down the water temperature to the nursing unit. Employee 11 concurrently retested the water temperature in the Unit 1 shower room and indicated the temperature was 91 degrees initially but reached 105 degrees Fahrenheit after seven minutes. The above concerns regarding the cleanliness of Residents 12, 15, 28, 38, 95 and 108 rooms were reviewed with the Nursing Home Administrator and Director of Nursing on September (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395616 If continuation sheet Page 4 of 17 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 395616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745 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 FORM CMS-2567 (02/99) Previous Versions Obsolete 17, 2025, at 2:30 PM. Concerns regarding comfortable water temperatures and the length of time to reach comfortable warm water temperature was reviewed with the Nursing Home Administrator on September 19, 2025, at 2:07 PM. Observation of Unit 4 on September 17, 2025, at 9:49 AM revealed piles of dirt in the corners and along the edges in the hallways. An observation of Resident 14's room on September 16, 2025, at 11:42 AM revealed trash on the floor, and multiple black sticky spots. During an interview with Resident 71 on September 16, 2025, at 1:43 PM the surveyor closed Resident 71's door and there were dirty gloves and a pile of dirt behind the door. Resident 71 stated that housekeeping usually comes into her room and only cleans the main area. A follow up observation of Resident 71's room on September 17, 2025, at 9:48 AM revealed the dirt and gloves were still on the floor behind Resident 71's door. The above concerns regarding the cleanliness of Unit 4's hallway floors, and Resident 14 and 71's rooms were reviewed with the Nursing Home Administrator and Director of Nursing on September 17, 2025, at 2:10 PM Observation of Resident 5's room on September 17, 2025, at 11:16 AM revealed the nonskid adhesive that was left after the strips were removed remained on the floor as you walk towards the bathroom. The non-skid strip in front of her recliner was dirty and there were scuff marks noted by the closet. Concurrent interview of Resident 5 revealed that most of the time housekeeping only dust mops the floor and only the part that you can see. Observation of Resident 8's room on September 16, 2025, at 1:20 PM revealed the floor was dirty with crumbs and lose dirt. Behind the door to the room were crumbs, paper, and dirt particles in a small pile. There were two plastic medication cups near the head of her bed on the side near the window. The top of the air conditioner unit was dirty. The bathroom toilet seat was dirty. Behind the toilet was dirty with built up dirt around the cove base. Interview with Resident 8 revealed that they never clean too much and when they do it is just what they can see. Observation of Resident 115's room on September 16, 2005, at 1:30 PM revealed her floor was dirty and there was a clear sticky dried liquid substance in front of her recliner. Interview with Resident 115 revealed that they run the dust mop every day, but they hardly ever scrub the floor. Interview of Resident 129 on September 16, 2025, at 1:16 PM reveled that all they ever do is dust mop her room. She said they never mop the floor. Observation of her room during the interview revealed dirty nonskid strips in front of her recliner, beside her bed, and in her bathroom. There was loose dirt under the bed. There was a buildup of dirt around the cove base and behind the toilet. The toilet was dirty. The environmental concerns related to Residents 5, 8, 115, and 129 were reviewed with the Nursing Home Administrator and Director of Nursing on September 17, 2025, at 2:20 PM 483.10(i)(1)-(7) Safe/clean/comfortable/homelike EnvironmentPreviously cited deficiency 10/18/2428 Pa. Code 201.18(b)(3) (e)(2.1) Management Event ID: Facility ID: 395616 If continuation sheet Page 5 of 17 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 395616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745 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 facility policies and procedures, and staff interview, it was determined that the facility failed to thoroughly investigate a resident's injury of unknown origin for one of 29 sampled residents (Resident 14) and failed to implement an abuse prohibition policy that required a thorough investigation of prospective employee's employment history for three of five newly hired employees reviewed (Employees 3, 4, and 5). Findings The facility policy entitled Lock Haven Rehabilitation and Senior Living Abuse Policy and Procedure, last reviewed without changes in January 2025, revealed at the time of application all prospective employees will be required to submit with the application, a report of criminal history record information. The application will not be processed without a properly processed background check. The Pennsylvania State Police must do background checks for all Pennsylvania residents. For all applicants who are not current Pennsylvania residents and have not been Pennsylvania residents for the last two years prior to their application for employment, an FBI criminal background investigation is to be performed through the Department of Aging. In accordance with Act 13 Elder Abuse Mandatory Reporting and Act 169 Criminal Background Checks, nursing facilities are required to obtain a criminal background check on all newly hired employees. Facilities are required to obtain the Pennsylvania State Police (PSP) background check within 30 days of hiring on all prospective employees. If the applicant has not been a Pennsylvania resident for the two years before application, they will need to have a PSP criminal history background check completed and a Federal Bureau of Investigation (FBI) Background Check. Review of Employee 3 (nurse aide), Employee 4 (licensed practical nurse), and Employee 5's (registered nurse) personnel records revealed no evidence that the facility determined whether these three employees resided in Pennsylvania for the last two years or completed an FBI background check on them. Interview with the Nursing Home Administrator on September 18, 2025, at 9:32 AM confirmed the above findings for Employees 3, 4, and 5. Review of facility policy entitled Lock Haven Rehabilitation and Senior Living Investigation of Injuries of Unknown Origin, last reviewed without changes in January 2025, revealed the form entitled Investigation of Injuries of Unknown Origin will be completed by the licensed staff. The investigation is conducted initially by the registered nurse supervisor and findings are given to the Director of Nursing and/or Assistant Director of Nursing and Social Services. The investigation will include an interview of the resident by social services, documentation of any medications the resident is currently taking that may be a contributing factor, any behaviors, documentation of any recent falls, and statements from caregivers in the previous 24 hours, and any other pertinent witness statements. If the investigator's conclusion is that suspected or actual mistreatment, abuse, or neglect has taken place, the Director of Nursing and/or Assistant Director of Nursing and Social Service must be notified immediately. Clinical record review revealed nursing documentation for Resident 14 dated August 20, 2025, at 4:38 AM, noting scattered bruising to the left side of Resident 14's neck. Bruising was also noted to her left forearm, right forearm, and hand. The facility was unable to provide any documentation of an investigation into Resident 14's bruising. An interview with the Director of Nursing on September 19, 2025, at 9:49 AM confirmed that the facility did not investigate Resident 14's injuries of unknown origin to rule out abuse. She stated the nurse did not report the bruising; therefore, Resident 14, nor potential staff witnesses were interviewed to rule out abuse. The facility failed to investigate Resident 14's injuries of unknown origin to rule out abuse. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa Code 201.18(b)(1)(3)(e)(1) Management 28 Pa Code 201.19(8) Personnel policies and procedures Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395616 If continuation sheet Page 6 of 17 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 395616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to ensure assessments accurately reflected a resident's status for two of 29 residents reviewed (13 and 30). Findings include:Clinical record review for Resident 30 revealed a quarterly MDS (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) dated July 3, 2025, that facility staff assessed Resident 30 as receiving an anticoagulant medication during the last seven days in the assessment period. Further clinical record review revealed no evidence that Resident 30 received an anticoagulant medication during the assessment period for the MDS noted above. Interview with the Director of Nursing on September 19, 2025, at 9:49 AM confirmed that Resident 30's July 3, 2025, MDS was coded in error regarding receiving an anticoagulant medication. Clinical record review for Resident 13 revealed an annual MDS assessment dated [DATE]. Review of the assessment revealed that Resident 13's diagnosis of cataracts was not documented under the diagnosis section of the MDS. Interview with Employee 15 (Registered Nurse Assessment Coordinator) on September 19, 2025, at 10:00 AM confirmed the above noted findings related to Resident 13. 28 Pa. Code 211.5(f)(ix) Medical records28 Pa. Code 211.12(d)(1)(3)(5) Nursing services Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395616 If continuation sheet Page 7 of 17 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 395616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined the facility failed to ensure that a resident with a limited range of motion received appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion for two of 29 residents reviewed (Residents 9 and 17).Findings Clinical record review revealed the facility readmitted Resident 9 on June 2, 2025. Review of Resident 9's most recent MDS (Minimum Data Set, an assessment completed at specific intervals to determine care needs) dated September 7, 2025, noted staff assessed Resident 9 as having impairment to his range of motion (ROM, movement of the body to maintain a resident's ability) of his bilateral lower extremities. Review of Resident 9's plan of care-initiated June 23, 2023, revealed Resident 9 has a potential for decreased function in functional abilities due to dementia, immobility, poor attention span, weakness, and deconditioning. An intervention the facility noted was may participate with restorative nursing programs. Further review of Resident 9's clinical record revealed no services to treat his bilateral lower extremity limitations or prevent further decline in his range of motion. The facility submitted a therapy screening form on September 18, 2025, following the surveyor questioning. Therapy noted Resident 9 would benefit from implementation of a restorative nursing program to bilateral upper and lower extremities to maintain his current level of function. These findings were reviewed during an interview with the Director of Nursing on September 19, 2025, at 9:45 AM. Clinical record review revealed the facility admitted Resident 17 on August 30, 2022. Review of Resident 17's recent MDS assessment dated [DATE], noted staff assessed Resident 17 as having impairment to her range of motion of her bilateral lower extremities. Review of Resident 17's plan of care-initiated May 16, 2023, revealed Resident 17 has a potential for decreased functional abilities due to anxiety, debility, and dementia. An intervention the facility implemented was Resident 17 may participate with restorative nursing programs. Review of Resident 17's occupational therapy's Discharge summary dated [DATE], noted therapy recommended staff complete passive range of motion to Resident 17's bilateral upper and lower extremities. Further review of Resident 17's clinical record revealed no services to treat her bilateral lower extremity limitations or prevent further decline in her range of motion. Interview with the Director of Nursing on September 18, 2025, at 1:40 PM confirmed these findings for Resident 17. There was no documentation the facility attempted the recommended range of motion program for Resident 17. 28 Pa. Code 211.12 (d)(1)(5) Nursing services Event ID: Facility ID: 395616 If continuation sheet Page 8 of 17 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 395616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on clinical record review, and resident and staff interview, it was determined that the facility failed to provide appropriate treatment and services regarding incontinence care for one of one resident reviewed (Residents 5). Findings include: Interview with Resident 5 on September 17, 2025, at 11:42 AM revealed that she has repeated issues with getting a urinary tract infection (UTI) and that she is scheduled to see a urologist but not until after the first of the year. She also indicated that she does not get help and that she feels as though she is not always able to get herself clean. Clinical record review for Resident 5 revealed a diagnosis of stress incontinence (when movement or activity puts pressure on the bladder causing urine to leak) and urge incontinence (an uncontrollable urge to pee). She also has chronic cystitis with hematuria (inflammation of the bladder accompanied by blood in the urine). Further clinical record review for Resident 5 revealed that she had a UTI on April 8, 2025, that revealed greater than 100,000 Escherichia (E. coli, a type of bacteria) present in the urine. On May 19, 2025, that revealed greater than 100,000 E. coli present in the urine, and July 28, 2025, that revealed again E. coli present in the urine. Review of Resident 5's last occupational therapy plan of treatment and discharge summary revealed that Resident 5 was independent with toileting hygiene. There was no evidence to indicate that Resident 5 was educated on proper toileting hygiene in order to prevent urinary tract infections to include proper peri care and handwashing. Further clinical record review revealed no documentation indicating that Resident 5 was educated on UTI prevention related to her recurrent infections related to E. coli in her urine. The above noted concerns related to Resident 5's recurrent urinary tract infections were discussed with the Director of Nursing on September 19, 2025, at 12:30 PM. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.10(c)(d) Resident care policies 28 Pa. Code 211.12(d)(1)(5) Nursing services Event ID: Facility ID: 395616 If continuation sheet Page 9 of 17 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 395616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. Based on review of facility documentation and staff interview, it was determined that the facility failed to ensure that nursing staff possessed the appropriate competencies and skill sets related to the care and assessment of residents dressing changes for four of four employees reviewed for competencies (Employees 7, 8, 9, and 10). Findings The Centers for Medicare and Medicaid Services (CMS) QSO-24-13-NH memo dated June 18, 2024, noted that requirements specify that the facility assessment must include an evaluation of diseases, conditions, physical or cognitive limitations of the resident population, acuity (the level of severity of residents' illnesses, physical, mental, and cognitive limitations, and conditions) and any other pertinent information about the resident population as a whole that may affect the services the facility must provide. The assessment of the resident population should drive staffing decisions and inform the facility about what skills and competencies staff must possess to deliver the necessary care required by the residents being served. The facility assessment reviewed during the onsite survey on September 18, 2025, revealed that LPN (licensed practical nurse) competency and training would include blood glucose monitoring, finger sticks, hand hygiene, donning and doffing PPE (personal protective equipment), cleaning/disinfection/sterilization, Heimlich maneuver, urine specimen collection, foley catheter insertion, and medication administration. The facility assessment did not include competencies for RNs (registered nurses). Further review of the facility assessment revealed wound care is a service provided by facility staff. Interview with the Director of Nursing on September 19, 2025, at 9:52 AM revealed the facility currently had 12 residents with pressure ulcers, and 54 residents with dressing changes. A request for nursing staff competencies of dressing change-wound care for Employees 7 and 8 (licensed practical nurses) and Employees 9 and 10 (registered nurses) revealed the facility was unable to provide any competencies addressing these areas. These findings were reviewed during an interview with the Director of Nursing and Nursing Home Administrator on September 19, 2025, at 10:14 AM. 28 Pa Code 201.20(a) Staff development Event ID: Facility ID: 395616 If continuation sheet Page 10 of 17 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 395616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0730 Observe each nurse aide's job performance and give regular training. Level of Harm - Minimal harm or potential for actual harm Based on employee personnel record review and staff interview, it was determined that the facility failed to complete a performance evaluation of each nurse aide at least once every 12 months for one of two nurse aides reviewed (Employees 6).Findings include: The facility noted Employee 6, nurse aide, was hired on September 5, 2023. A request to review the annual performance evaluations (EPR, employee performance review) revealed no documented evidence that the facility completed performance evaluations for Employee 6 at least once every 12 months. Interview with the Director of Nursing on September 18, 2025, at 10:14 AM confirmed that Employee 6's performance evaluation was not completed annually. 28 Pa. Code 201.19 (2) Personnel policies and procedures Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395616 If continuation sheet Page 11 of 17 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 395616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, observation, and staff interview, it was determined that the facility failed to assist residents to obtain routine dental care for one of three residents reviewed (Resident 1). Findings include: Observation of Resident 1 on September 16, 2025, at 9:55 AM revealed that she had natural teeth, with several teeth that appeared to be broken. Clinical record review revealed the facility admitted Resident 1 on December 10, 2024, with payment sources that included the state Medicaid benefit. Further review of Resident 1's clinical record revealed that she has not been offered dental care. Review of Resident 1's admission MDS (Minimum Data Set, an assessment completed at specific intervals to determine resident care needs) dated December 13, 2025, revealed staff assessed Resident 1 as having obvious or likely cavities or broken natural teeth. Further review of Resident 1's clinical record revealed a plan of care initiated December 17, 2024, noting Resident 1 has impaired dentition related to carious teeth. There was no documentation that indicated Resident 1 was offered routine dental services every six months as the State Plan allows. Interview with the Director of Nursing on September 18, 2025, at 12:02 PM confirmed these findings for Resident 1. The facility did not provide any evidence that Resident 1 received or refused professional dental services since his admission to the facility. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 28 Pa. Code 211.15. Dental services Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395616 If continuation sheet Page 12 of 17 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 395616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745 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 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. Based on observations, review of facility documents, and resident and staff interview, it was determined that the facility failed to provide sufficient staff to carry out the functions of the food and nutrition services in the main kitchen and one of four nursing units (Unit 3, Residents 37 and 38).Findings include: During an interview and observation in the facility's main kitchen on September 16, 2025, at 9:00 AM Employee 2, food service director, indicated he was working as a dietary aide because he had to fill in for the position. Employee 2 stated regular staffing for the shift would include one cook, four dietary aides, and himself as the director, but currently, they only had one cook, himself, and one additional dietary aide. Employee 12, regional food service director, was present during the observation and indicated he had recently started with the company, and it was his first time at the facility. Employee 12 stated he was now going to plan on being at the facility a few days a week to help and cover some of the directors' duties. In an interview with Resident 37 on September 16, 2025, at 11:40 AM the resident stated she was served an early lunch due to an appointment, but it was the first day in several that she got her food on real plates with real silverware. It often comes served in all disposables the resident stated, I guess they only had two workers in the kitchen. Interview with Resident 38 on September 17, 2025, at 12:10 PM in the resident's room, she stated she had not wanted to go to the main dining room because she has to wait too long to get served her meal. The resident stated, We are to go to the main dining room at 11:30 AM and don't get served any food until 12:30 PM, we should not have to go and wait an hour for our meals. An observation of the lunch meal service on September 17, 2025, on Unit 3 revealed the first meal cart for residents who eat in their rooms arrived on the unit at 12:26 PM, the second meal cart for the unit arrived at 12:51 PM, delivered by Employee 12, regional food service director. Employee 12 stated the kitchen staff was working short, and a cook had also gone home sick earlier in the morning. A review of facility meal service times revealed the first cart for Unit 3 was delivered at 12:26 PM was to start being plated in the kitchen at 11:25 PM, and the second cart for Unit 3 noted above was to start at 11:40 AM but did not arrive on the unit until 12:51 PM over an hour later. In an interview with Employee 2, and Employee 12 on September 18, 2025, at 3:20 PM, it was confirmed paper products (foam containers and plastic ware) were used to serve resident meals for lunch on Sunday, August 31, September 7, and September 14, as well as dinner on September 14, 2025, due to not having enough food service staff to operate the dish machine to wash dishes and silverware and complete other duties. Employee 2 stated only the plastic meal serving tray and any adaptive feeding equipment was utilized. Review of the food service staff schedule for the week of September 14 to 20, 2025, with Employee 2, on September 19, 2025, at 11:40 AM revealed the following open positions for food service workers on the schedule required to meet the needs of the department: Sunday, September 14, 2025, two morning shifts and one evening shiftMonday, September 14, 2025, three morning shiftsTuesday, September 16, 2025, two morning shifts, and replacement for one who left sickWednesday, September 17, 2025, two morning shiftsThursday, September 18, 2025, two morning shiftsFriday, September 19, 2025, one morning shift, one evening shiftSaturday, September 20, 2025, two morning shift and one evening shift Employee 2 indicated in the same meeting above interviews have been occurring to fill open positions. The above concerns regarding the timing of meals, and utilization of paper products due to staffing was reviewed with the Nursing Home Administrator on September 18, 2025, at 2:20 PM. 28 Pa. Code 201.14(a) Responsibility of licensee28 Pa. Code 201.18(b)(3) ManagementCross reference F812 Event ID: Facility ID: 395616 If continuation sheet Page 13 of 17 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 395616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745 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 FORM CMS-2567 (02/99) Previous Versions Obsolete Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and staff interview, it was determined that the facility failed to maintain food service equipment in accordance with professional standards for food service safety and store food in a sanitary manner in the facility's main kitchen and one of two nursing unit pantries (Unit 3/4).Findings include: Observation of the facility's main kitchen on September 16, 2025, at 9:00 AM with Employee 2, food service director revealed the following: Removable plastic slotted shelves holding food products in the walk-in cooler were observed with black buildup down in the slots of the shelves throughout the cooler. A large, wheeled storage bin labeled as flour in the main kitchen production area was observed with crumbs and debris on the top and sliding lid of the container. The exterior sides of the bin had dried spills and were soiled. The label indicated the product was placed in the bin on December 5, 2024, and had a use by date of March 5, 2025. The interior base of the glass two-door cooler contained dried spills and debris. Two sandwiches were observed on a shelf in the cooler with no label or date. The lower shelf of the food preparation table where cooking equipment/pans were stored was soiled with dried food, grease spots, and dust, which extended onto some of the sides of the pans. A clear plastic container with a tan colored substance in it was also observed on the lower shelf of the food preparation table. A plastic scoop was observed down in the substance. The container was not labeled with its contents or dated. Employee 2 indicated it was potato flakes. Observation of the resident food pantry located between Unit 3 and Unit 4, on September 18, 2025, at 12:03 PM revealed dried food, debris, and pieces of hair stuck in the interior of the refrigerator and freezer. A large area of dried orange/brown substance was observed under the lower drawer/rack of the refrigerator. A set of cabinets in the pantry revealed dust and debris in the drawers where coffee filters, and unwrapped plastic utensils were stored. The cabinet under the sink contained a large plastic tub under the drainpipes of the sink. A dried yellowish substance was in the tub. The interior base of the cabinet under the sink contained dirt and debris. A lower cabinet to the right of the sink where two boxes of straws were stored was dirty with dust/debris. A lower cabinet to the left of the sink contained a loose plastic cup and a plastic lid on the lower shelf among dust/dirt and a dead insect. The top shelf in the cabinet where a plastic tub of sanitizing wipes was stored contained two large spots of black substance beside the container. The above findings were reviewed with the Nursing Home Administrator and Director of Nursing on September 18, 2025, at 2:20 PM. 483.60(i)(2) Store food safe and sanitaryPreviously cited 10/18/24 28 Pa. Code 201.14 (a) Responsibility of Licensee Cross reference F802 Event ID: Facility ID: 395616 If continuation sheet Page 14 of 17 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 395616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, clinical record review, and staff interview, it was determined that the facility failed to implement appropriate Transmission Based Precautions (TBP) for one of four residents reviewed on TBP (Resident 135).Findings included: Review of the facility's current policy entitled Categories of Transmission Based-Based Precautions revealed Transmission-Based Precautions will be used whenever measures more stringent than standard based precautions (gloves and hand hygiene), are needed to prevent or control the spread of infection. The policy also indicated that Contact Precautions would be implemented for residents known or suspected to be infected or colonized with microorganisms that can be transmitted by direct contact with the resident or indirect contact with environmental surfaces or resident-care items in the resident's environment. Examples of infections requiring Contact Precautions included diarrhea associated with Clostridium difficile (C diff - bacteria that causes an infection of the colon). Steps for administering the contact precautions indicated in the policy to wear gloves when entering the room and remove the gloves before leaving the room and wash hands or use a waterless antiseptic agent. In addition to the gloves, wearing a gown for all interaction that may involve contact with the resident or potentially contaminated items in the resident's environment. The gown should be removed before leaving the resident's environment. Review of the facility's current policy entitled Infection Control Education, revealed it is the facility's policy that all new personnel will attend an orientation program that addresses infection control including the basic principles and the infection control policies and procedures of the facility. An observation of Resident 135's room on September 17, 2025, at 11:25 AM revealed a sign outside the door to the room indicating Contact Precautions were in place for the room. The sign indicated that everyone must clean their hands before room entry and when leaving in addition to staff and providers must put gloves and a gown on before room entry and discard them before room exit. A concurrent observation revealed Employee 14, social services, knocked on Resident 135's door and proceeded to enter the room and go to the resident's bedside and ask questions about the resident's stay at the facility. Employee 14, then walked out of the room. Employee 14 did not put gloves or a gown on to enter the room and did not perform any hand hygiene when entering or exiting the room. In an interview with Employee 14 at the time of the observation the employee indicated she was not aware of any special precautions needed to enter Resident 135's room. After reading the sign, Employee 14 stated, maybe she was supposed to put on gloves and a gown, but she did not see the sign. Employee 14 stated she was newly hired and would have to ask her boss what she needed to do for the precautions as she was not aware. Continued observation of Resident 135's room on September 17, 2025, at 11:38 AM revealed Employee 1, director of environmental services, knocked on the resident's door and entered the room walking past the resident to speak to the resident's roommate. Employee 2 then began looking in the roommate's closet and dresser drawers. Employee 1 then exited the room. Employee 1 did not put on a gown or gloves to enter the room or perform hand hygiene upon exit. A concurrent interview with Employee 1 after exiting the room noted above, Employee 1 indicated she only needed to put a gown and gloves on if she was going to do care to the resident and she wasn't providing care. Employee 1 stated she keeps track of the resident on special precautions so she can relay it to her housekeeping/laundry staff and thought there was only one resident on precautions in the building currently. Clinical record review for Resident 135 revealed the resident had a current order for contact precautions for C-diff, ordered on September 5, 2025. The above concerns regarding the proper usage of personal protective equipment (gown/gloves) were reviewed with the Nursing Home Administrator and Director of Nursing on September 18, 2025, at 2:20 PM. 483.80(a)(1)(2)(4) Infection Prevention & ControlPreviously cited deficiency 10/18/2428 Pa. Code Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395616 If continuation sheet Page 15 of 17 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 395616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745 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 201.18(b)(1) Management 28 Pa. Code 211.10(d) Resident care policies28 Pa. Code 211.12(d)(1)(3)(5) Nursing services Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395616 If continuation sheet Page 16 of 17 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 395616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lock Haven Rehabilitation and Senior Living 22 Cree Drive Lock Haven, PA 17745 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 0947 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. Based on a review of employee personnel and education records and staff interview, it was determined that the facility failed to ensure that each nurse aide received 12 hours of in-service training annually for one of one nurse aide reviewed (Employee 6). Findings include: Review of Employee 6's personnel record revealed that the facility hired her on September 5, 2023. The surveyor requested training records for Employee 6 during an interview with the Nursing Home Administrator and the Director of Nursing on September 17, 2025, at 2:15 PM. Review of training records provided by the facility for Employee 6 dated September 5, 2024, to September 5, 2025, revealed that Employee 6 completed only 8.6 hours of in-service education. Interview with the Director of Nursing on September 19, 2025, at 9:48 AM confirmed the above findings for Employee 6. 28 Pa. Code 201.19(7) Personnel policies and procedures 28 Pa. Code 201.20(a)(6)(d) Staff development Event ID: Facility ID: 395616 If continuation sheet Page 17 of 17