Inspection·June 23, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on review of select facility policy and clinical records, and staff interview, it was determined that the facility failed to timely consult with the physician and notify the resident's interested representative of a change in condition for one resident out of 16 sampled (Resident 37). Findings include: A review of facility policy entitled Resident Change in Condition Notification last reviewed November 6, 2022, revealed the physician and responsible party will be notified timely whenever a change in condition is identified. A review of the clinical record revealed that Resident 37 was admitted into the facility on March 23, 2017, with diagnoses which included dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities). A review of a nursing note dated for June 14, 2023, at 7:17 PM, but entered into the clinical record later, revealed that staff found a new skin issue as Resident 37 presented a fluid filled area behind her left knee. There was no documented evidence that the resident's attending physician was informed of the area or that the resident's interested representative was notified. An interview with the Director of Nursing on June 22, 2023, at approximately 2:00 PM confirmed the facility failed to notify the physician and the resident's representative in a timely manner of the fluid filled area behind the resident's left knee. 28 Pa. Code 201.29 (d)(l)(1) Resident rights 28 Pa Code 211.12 (a)(c)(d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 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 395625 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marywood Heights 2500 Adams Avenue Scranton, PA 18509 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 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. **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 complete a discharge summary, which included a recapitulation of the resident's stay, the course of illness, corresponding treatment, discharge instructions, and a post-discharge care plan for one of three closed records reviewed (Resident 57). Findings include: A review of the closed clinical record revealed that Resident 57 was admitted to the facility on [DATE], with diagnoses including non-ST-elevation myocardial infarction (a type of heart attack) and urinary tract infection (UTI-an infection in any part of the urinary system such as the kidneys or bladder). A closed clinical records review revealed that Resident 57 was discharged home on March 24, 2023. A review of Resident 57's closed clinical record revealed a Discharge Record form dated March 24, 2023, which included the resident's admitting diagnosis as UTI and MI (Urinary Tract Infection and Myocardial Infarction), the resident's final diagnosis section was left blank, the resident's course of treatment as antibiotics, the resident's condition on discharge as good, the resident's prognosis as good and the resident's disposition as good. Further review of Resident 57's closed clinical record revealed a Discharge Summary form dated March 24, 2023, which included a reason for discharge as discharged to home, and the discharge diagnosis section of the form was left blank. At the time of the survey ending June 23, 2023, there was no documented evidence that a discharge summary was provided to the resident or the resident's representative, which included a recapitulation of the resident's stay, the course of illness, corresponding treatment, discharge instructions, and a post-discharge care plan. The documented discharge summary failed to include an accurate and current description of the clinical status of the resident and sufficiently detailed, individualized care instructions to ensure that the resident transitions safely from the facility to home. During an interview conducted on June 22, 2023, at approximately 2:00 PM, the Nursing Home Administrator was not able to provide evidence that a discharge summary was accurately and fully completed for Resident 57. 28 Pa. Code 211.12 (a)(c)(d)(3)(5) Nursing services 28 Pa. Code 201.25 Discharge policy FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 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 395625 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marywood Heights 2500 Adams Avenue Scranton, PA 18509 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records, select incident reports and facility policies and staff interviews it was determined that the facility failed to provide nursing services consistent with professional standards of quality to ensure that licensed nurses promptly assessed and evaluated residents' skin injuries to assure the resident timely received necessary care and services for two residents (Resident 36 and 37) out of 19 residents reviewed and failed to ensure that licensed nurses administered medications as prescribed to two residents of 19 sampled residents (Resident 31 and 32) Residents Affected - Some Findings included: According to the Pennsylvania Code, Title 49, Professional and Vocational Standards, State Board of Nursing, 21.11 (a)(1)(2)(4) indicates that the registered nurse was to collect complete ongoing data to determine nursing care needs, analyze the health status of individuals and compare the data with the norm when determining nursing care needs, and carry out nursing care actions that promote, maintain, and restore the well-being of individuals. The Pennsylvania Code, Title 49, Professional and Vocational Standards, State Board of Nursing, 21.145 Functions of the Licensed Practical Nurse (LPN) (a) The LPN is prepared to function as a member of the health-care team by exercising sound judgement based on preparation, knowledge, skills, understandings and past experiences in nursing situations. The LPN participates in the planning, implementation, and evaluation of nursing care in settings where nursing takes place. 21.148 Standards of nursing conduct (a) A licensed practical nurse shall: (5) Document and maintain accurate records. According to the American Nurses Association Principles for Nursing Documentation, nurses document their work and outcomes and provide an integrated, real-time method of informing the health care team about the patient status. Timely documentation of the following types of information should be made and maintained in a patient's EHR (electronic health record) to support the ability of the health care team to ensure informed decisions and high quality care in the continuity of patient care: · Assessments · Clinical problems · Communications with other health care professionals regarding the patient · Communication with and education of the patient, family, and the patient ' s designated support person and other third parties. A review of facility policy entitled Identification of Skin Issues last reviewed by the facility November 16, 2022, revealed that it is the policy of the facility to treat any skin issues identified. When a skin issue is identified, the charge nurse is immediately notified. The area will be assessed and reported to the physician. A review of clinical record revealed Resident 36 was admitted to the facility on [DATE], with diagnoses, which included chronic kidney disease. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 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 395625 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marywood Heights 2500 Adams Avenue Scranton, PA 18509 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 A review of an incident report dated May 22, 2023, indicated the resident was outside visiting with his granddaughter and her dog. The dog bit the resident on the left hand, and the resident sustained a small laceration to the forefinger and middle finger. There was no documentation in the resident's clinical record that the Registered Nurse assessed the resident's wound at that time on May 22, 2023. There was no nursing documentation in the resident's clinical record to indicate the size of the laceration, the appearance of the wound, or if any drainage was present. There was no documentation that the physician was notified. A review of the clinical record revealed that Resident 37 was admitted into the facility on March 23, 2017, with diagnoses, which included dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities). A review of a nursing note dated for June 14, 2023, at 7:17 PM but entered in the clinical record on a later date revealed that the resident had a new fluid filled area behind her left knee. There was no documentation in the resident's clinical record that the Registered Nurse assessed the area when it was found on June 14, 2023. There was no nursing documentation in the resident's clinical record to indicate the size of the area, appearance of the area and surrounding skin or other characteristics. There was no indication of the treatment or care provided and there were no physician orders for treatment to the fluid filled area. Interview with the Nursing Home Administrator on June 23, 2023, at approximately 2:15 PM confirmed there was no documented evidence in the resident's clinical record that the facility's professional nursing staff had timely and fully assessed the above skin impairments/skin injuries Review of the clinical record revealed that Resident 31 was admitted to the facility on [DATE], with diagnoses which included hypertension, congestive heart failure, and heart disease. A physician order dated June 15, 2023, was noted for Midodrine HCL 10 mg, give one tablet three times a day for orthostatic hypotension (a form of low blood pressure that happens when standing up from a sitting or lying position), hold for systolic blood pressure (SBP - top number on blood pressure reading) greater than 110. The medication was scheduled for 8 AM, 1 PM, and 8 PM. Review of Resident 31's Medication Administration Record for the month of June 2023, revealed that on June 16, 2023, at 8 PM the Midodrine was administered for a blood pressure of 132/74. Further review of MAR revealed that the medication was administered on June 17, 2023, at 8 AM for a blood pressure of 130/68, at 1 PM for a blood pressure of 130/68, and at 8 PM for a blood pressure of 136/64, on June 18, 2023, at 1 PM for a blood pressure of 130/76, and at 8 PM for a blood pressure of 136/78. Each time, the medication was administered when the resident's SBP was greater than 110. Interview with the Director of Nursing on June 22, 2023, at approximately 2:00 PM confirmed that the nursing staff failed to administer Resident 31's Midodrine medication as prescribed by the physician. A clinical records review revealed that Resident 32 was admitted to the facility on [DATE], with diagnoses that include dementia (a chronic or persistent disorder of the mental processes caused by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 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 395625 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marywood Heights 2500 Adams Avenue Scranton, PA 18509 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 brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning), atrial fibrillation (an irregular and often very rapid heart rhythm), and hypertension (blood pressure that is higher than normal). A physician order, initially dated July 24, 2022, indicated that the resident was to receive Norvasc Tablet 2.5 MG (amlodipine besylate) with directions to give one tablet by mouth one time a day related to hypertension (high blood pressure) with instructions to hold the medication if the resident's systolic blood pressure is less than 100 or the resident's heart rate is less than 60 beats per minute. According to the resident's Medication Administration Records Resident 32 received Norvasc Tablet 2.5 mg on 80 days from April 1, 2023, through June 21, 2023 with no evidence that Resident 32's heart rate was monitored prior to administering Norvasc 2.5 mg tablets in accordance with the physician's orders from April 1, 2023 through June 21, 2023. During an interview on June 22, 2023, at approximately 9:00 a.m., the Nursing Home Administrator and Director of Nursing were not able to provide evidence that Resident 32's heart rate was being monitored prior to the administration of Norvasc 2.5 mg in accordance with the physician's orders. 28 Pa. Code 211.12 (a)(c)(d)(1)(3)(5) Nursing Services 28 Pa. Code 211.5 (f)(g)(h) Clinical Records FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 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 395625 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marywood Heights 2500 Adams Avenue Scranton, PA 18509 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of select facility policy and clinical records, observations, and staff and interviews it was determined that the facility failed to consistently provide care and services to prevent the development and promote healing of pressure sores for two of 16 residents sampled (Resident 1 and 43). Residents Affected - Some Findings include: According to the US Department of Health and Human Services, Agency for Healthcare Research & Quality, the pressure ulcer best practice bundle incorporates three critical components in preventing pressure ulcers: Comprehensive skin assessment, Standardized pressure ulcer risk assessment and care planning and implementation to address areas of risk. ACP (The American College of Physicians is a national organization of internists, who specialize in the diagnosis, treatment, and care of adults. The largest medical-specialty organization and second-largest physician group in the United States) Clinical Practice Guidelines indicate that the treatment of pressure ulcers should involve multiple tactics aimed at alleviating the conditions contributing to ulcer development (i.e., support surfaces, repositioning and nutritional support); protecting the wound from contamination and creating and maintaining a clean wound environment; promoting tissue healing via local wound applications, debridement and wound cleansing; using adjunctive therapies; and considering possible surgical repair. A review of facility policy entitled Identification of a Skin Issue last reviewed by the facility November 16, 2022, revealed that it is the policy of the facility to treat any skin issue identified, to promote healing of wound and if resident is not responding to established treatment regimen, the nurse/therapist shall evaluate for: need for treatment change, referral to wound care specialist for wound assessment, referral for consultation by physician or wound clinic, re-assess need for interdisciplinary services and/or appropriate DME (durable medical equipment), and referral for nutritional consult. When a skin issue is identified, the charge nurse is immediately notified. The area will be assessed and reported to the physician. The physician will be contacted, and orders obtained for treatment. The registered nurse will assess the wound. A wound tracking sheet is initiated by the registered nurse for all identified pressure areas. The dietician, therapy department and family are notified by the charge nurse of the issue. The registered nurse assesses and documents on pressure areas weekly. At least every week, the wound assessment and documentation will include measurement of length, width, depth, and undermining and tunneling if present. Presence/absence of odor and drainage should be noted. A review of the clinical record revealed that Resident 43 was admitted to the facility on [DATE], with diagnoses to include heart failure, peripheral vascular disease, and hypertension. On May 17, 2023, Resident 43 was admitted to the hospital and returned to the facility on May 24, 2023, with diagnoses of hydronephrosis with kidney stone obstruction with stent placement and myocardial infarction (heart attack). A review of the resident's Braden scale for predicting pressure sores dated May 24, 2023, revealed the resident was at risk for developing a pressure sore. A review of a significant change Minimum Data Set assessment dated [DATE], (MDS - a federally (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 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 395625 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marywood Heights 2500 Adams Avenue Scranton, PA 18509 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some mandated standardized assessment process completed periodically to plan resident care) revealed that the resident was required extensive assistance of two people with bed mobility (how the resident moves about in bed), dressing, toilet use, and transfers (how the resident moves between the bed and the chair), and was at risk for developing pressure areas. A review of the resident's plan of care, initially dated January 19, 2022, revealed that the resident had potential for pressure related skin failure related to limited mobility. Interventions planned were to apply preventative barrier cream for skin/incontinence care to bilateral buttocks with AM/PM care and prn (as needed), maintain adequate nutrition and hydration, keep skin clean and dry, weekly body/skin eval on shower days, pressure redistribution mattress, assist resident to turn and reposition every two hours and PRN, as tolerated, and pressure reducing cushion (to chair). A review of Resident 43's readmission assessment dated [DATE], revealed that the resident had bruising to her right hand and right antecubital and a large wart on her chest. No additional skin concerns were identified on the skin portion of the readmission assessment. Review of documentation dated May 24, 2023, at 1:38 PM indicated that the resident's bilateral buttocks were slightly pink and blanchable (skin that remains white or pale for longer than normal when pressed, indication that normal blood flow to a given area does not return promptly). Calmoseptine (multipurpose barrier ointment that protects and helps heal skin irritations) applied. Review of documentation dated May 31, 2023, at 1:56 PM revealed that the resident complained of a sore bottom. According to the documentation, a small excoriated are near coccyx was identified. The area was cleansed and prevention cream put on. There was no evidence that the area was assessed by the registered nurse due to changes in appearance. According to the resident's clinical record, weight loss and poor fluid/food intake was also identified since readmission on [DATE], with interventions implemented by dietitian on May 31, 2023. Review of Documentation Survey Report dated May 2023 revealed that Resident 43 was assisted out of bed once from May 24, 2023 through May 31, 2023. Documentation dated June 5, 2023, at 12:42 PM indicated that the resident's restorative nursing program was discontinued due to frequent refusals, overall decline in condition and currently a hoyer (mechanical lift) for transfers. Documentation dated June 5, 2023, at 2:45 PM by social services revealed that the resident continued to decline and was losing weight. A referral to hospice was discussed with the resident's responsible party. Review of hospice progress note dated June 15, 2023, revealed that there was worsening of buttocks wound and that a request for treatment change would be obtained. Documentation dated June 15, 2023, at 11:32 AM by Employee 1, licensed practical nurse, revealed that a new order was obtained for a pressure ulcer on right medial buttocks. There was no evidence that the registered nurse evaluated the pressure ulcer. Review of hospice progress note dated June 21, 2023, revealed that the resident's wound continued to decline. There was no evidence that the registered nurse evaluated the declining pressure ulcer. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 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 395625 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marywood Heights 2500 Adams Avenue Scranton, PA 18509 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Observation of Resident 43 on June 21, 2023, at approximately 10:30 AM revealed resident lying in her bed, flat on her back. The resident was awake, but declined to participate in an interview. She simply closed her eyes. Documentation completed by the registered nurse on June 21, 2023, at 4:28 PM, revealed that a treatment change was ordered to Stage II area on buttocks. The registered nurse further indicated that the resident's wound resembled a Kennedy ulcer between 10 o'clock and 2 o'clock, a deep purple intact area with overall area measuring 9 cm x 9.5 cm x <0.2 cm. According to the documentation, the area encompasses both left and right buttocks and sacral area, pink, non-blanchable, no odor, no drainage, no pain observed. There was no documented evidence prior to June 21, 2023, that Resident 43's declining wound was evaluated or monitored for healing or worsening by the registered nurse. Observation of Resident 43's buttock pressure ulcer on June 22, 2023, at approximately 9:30 AM in the presence of hospice staff and Employee 2, graduate licensed practical nurse, revealed that the resident had an open area on her left buttock which measured approximately 2cm x 0.5cm x <0.1 cm, an unstageable darkened area just above the open area which measure approximately 1cm x 2cm x 0 cm, with surrounding skin reddened. An interview with the Director of Nursing on June 23, 2023, at approximately 1:30 PM confirmed that there was no evidence that Resident 43's declining pressure ulcer was monitored by the facility and was unable to demonstrate implementation of measures to prevent the worsening of pressure ulcers and promote healing for a resident at risk for skin breakdown. A clinical records review revealed that Resident 1 was admitted to the facility on [DATE], with diagnoses that included dementia (a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning), chronic obstructive pulmonary disease (COPD), and heart failure. Resident 1's care plan revealed that the resident had the potential for pressure-related skin failure due to limited mobility initiated in April 2020. According to the resident's care plan, initiated April 20, 2020, staff were to assist the resident to turn and reposition every two hours, as requested, and tolerated . The resident's care plan also included the intervention to apply moisture cream or lotion to the upper and lower extremities with AM and PM care and as needed initiated on April 20, 2020. Resident 1's Moisture Cream Application Task Log revealed 57 blank entries (lacking documentation that intervention was completed) from May 1, 2023, through June 22, 2023, failing to provide evidence that moisture cream was applied to the resident's upper and lower extremities with AM and PM care, or as needed. The resident's most recent Braden Scale assessment (a standardized assessment tool utilized to determine a patient's risk of developing pressure ulcers or injuries) dated February 6, 2023, indicated that Resident 1 was at moderate risk for developing pressure ulcers or injuries. Resident 1's Turn and Reposition Task Log revealed only one documented instance when the resident was turned and repositioned in accordance with the resident's comprehensive care plan from May 1, 2023, through June 22, 2023. There was no nursing documentation indicating that the resident was turned (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 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 395625 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marywood Heights 2500 Adams Avenue Scranton, PA 18509 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 or repositioned at least every two hours on 39 days from May 1, 2023, through June 22, 2023 Level of Harm - Minimal harm or potential for actual harm A clinical records review revealed the physician's orders to admit Resident 1 to hospice care on May 25, 2023. Residents Affected - Some A comprehensive Minimum Data Set assessment dated [DATE], revealed that Resident 1 required extensive assistance (resident involved in activity; staff provide weight-bearing support) for bed mobility, transfers, dressing, toilet use, eating, and personal hygiene. A Brief Interview of Mental Status assessment, revealed a score of 7, indicating severe cognitive impairment. At the time of the assessment, Resident 1 did not have a pressure injury, but was at risk of developing a pressure ulcer or injury. A facility incident report dated June 17, 2023, indicated that Resident 1 acquired a deep tissue injury measuring 2.5 cm x 4.0 cm with unknown depth to the left heel. The report described the injury as light purple, boggy to the touch, with intact skin and no odor. Nursing progress notes dated June 22, 2023, indicated Resident 1 recently developed a deep tissue injury (a purple or maroon localized area of discolored intact skin or a blood-filled blister due to damage of underlying soft tissue from pressure) to the left heel. Observation on June 23, 2023, at approximately 11:15 a.m. conducted with the facility's Registered Nurse Supervisor, revealed that Resident 1's left heel wound measured 2.0 cm x 2.5 cm. The wound area appeared purple, with the innermost part of the wound appearing more red. The skin was intact and non-blanchable. During an interview on June 23, 2023, at approximately 1:30 p.m., the Director of Nursing (DON) was unable to provide evidence of consistent implementation of care plan interventions, turning and repositioning and application of moisture creams, to deter skin pressure sore development. 28 Pa. Code 211.11 (d) Resident care plan 28 Pa. Code 211.12 (a)(c)(d)(1)(5) Nursing services. 28 Pa. Code 211.5 (f) Clinical records. 28 Pa. Code 211.10(a)(c)(d) Resident care policies FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 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 395625 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marywood Heights 2500 Adams Avenue Scranton, PA 18509 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based on a review of select facility policy and clinical records and staff interview, it was determined that the facility failed to administer pain medication as prescribed by the physician to manage one resident's pain out of 15 residents reviewed (Resident 2). Residents Affected - Few Findings include: A review of the facility's policy entitled Pain Management provided by the facility on August 24, 2023, indicated that orders for pain medications prescribed on a PRN (as needed) basis must be delineated if they are for mild, moderate, or severe pain when the order is received from the physician. The medication for mild pain is often tried first unless the resident is demonstrating the need for a stronger pain medication. The medication administered must correlate with the pain level unless a resident specifically requests a particular medication. The pain intensity scale is based on a 0 to 10 pain intensity scale (0 = no pain, 1,2, and 3 are classified as mild pain, 4, 5, and 6 are classified as moderate pain, and 7, 8, and 9 are classified as severe pain, and 10 is classified as the worst pain imaginable). A review of the clinical record revealed that Resident 2 was admitted into the facility on April 21, 2023, with diagnoses, which included dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities) and osteoarthritis and was cognitively impaired. Review of Resident 2's care plan, dated April 20, 2023, indicated that the resident had potential for pain related to limited mobility and gout. The resident's goal was to verbalize adequate relief of pain or ability to cope with incompletely relieved pain with interventions that included to administer pain medications as per physician's orders, evaluate the effectiveness of pain interventions as needed, review for compliance, alleviating of symptoms, dosing schedules, resident satisfaction with results, and impact on functional ability and impact on cognition. Additional interventions included to notify physician if interventions are unsuccessful or if current complaint is a significant change from resident's past experience of pain. Review of current physician orders revealed an order for Tramadol HCL (opioid pain medication) 50 mg by mouth every 12 hours as needed for moderate pain (pain level of 4-6) and Acetaminophen 325 mg, two tablets every 4 hours as needed for mild pain (pain level of 1-3), and Voltaren arthritis pain external gel 1%, apply 2 gm to right hand topically every 12 hours as needed for moderate arthritis pain. Review of Resident 2's August 2023 Medication Administration Record revealed that on August 8, 2023, at 5:42 p.m., Tramadol was administered for a pain level of 8; on August 2, 2023, at 4:31 p.m., for a pain level of 8; August 3, 5, 6, and 7, 2023, for a pain level of 7, and on August 12, 2023, for a pain level of 8, which was not consistent with the physician order for moderate pain rated from 4-6. According to the resident's MAR, on August 7, 2023, at 8:30 p.m. Tramadol was not effective for relieving the resident's pain. According to the August 2023 MAR on August 15, at 11:41 p.m., and again on August 16, 2023, at 1:09 p.m., nursing administered Acetaminophen 750 mg for a pain level of 6 moderate pain. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 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 395625 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marywood Heights 2500 Adams Avenue Scranton, PA 18509 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0697 Level of Harm - Minimal harm or potential for actual harm Interview with the Director of Nursing (DON) on August 24, 2023, at 2:35 PM, confirmed that the facility failed to administer as needed pain medications as prescribed by the physician and in accordance with the facility's established pain scale. Refer F580 Residents Affected - Few 28 Pa. Code 211.2 (d)(3) Medical Director 28 Pa. Code 211.12 (d)(1)(2)(5) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 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 395625 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marywood Heights 2500 Adams Avenue Scranton, PA 18509 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 0712 Ensure that the resident and his/her doctor meet face-to-face at all required visits. 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 resident and staff interview, it was determined that the facility failed to ensure that two of 16 sampled residents were seen timely by a physician (Residents 16 and 4). Residents Affected - Few Findings include: A review of the clinical record of Resident 16 revealed admission to the facility September 14, 2022, with diagnoses which included COPD (chronic obstructive pulmonary disease- group of lung diseases that block airflow and make it difficult to breathe) and diabetes mellitus. During interview with Resident 16 on June 22, 2023 at 1:00 PM the resident could not recall the last time the physician visited and indicated that it was longer than two months ago. A review of the resident's clinical record revealed the only documented physician visit and progress note was on March 22, 2023. There was no documented evidence the resident's attending physician visited Resident 16 every 30 days for the first 90 days after admission and at least once every 60 days thereafter. Review of the clinical record of Resident 4 revealed the resident was admitted to the facility on [DATE] and had diagnoses which included COPD and insomnia (sleep disorder that can make it hard to fall and stay asleep). During interview with Resident 4 on June 23, 2023 at 9:45 AM the resident stated that the physician had not visited in months. A review of the resident's clinical record revealed the most recent documented physician visit and progress note was on March 14, 2023 (40 days past required visit of every 60 days). Interview with the director of nursing on June 23, 2023, at 10:30 AM confirmed that the physician did not visit Resident 16 and Resident 4 as required. 28 Pa. Code 201.18 (e)(3) Management 28 Pa. Code 211.2 (a)(d)(2) Physician services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 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 395625 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marywood Heights 2500 Adams Avenue Scranton, PA 18509 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 - Some Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records and staff interview it was determined that the facility failed to ensure the pharmacist conducted drug regimen reviews at least monthly and the attending physician failed to act on the pharmacist's recommendations for 5 out of 16 residents sampled (Residents 1, 41, 47, 10, 46). Findings include: Review of Resident 41's clinical record revealed admission to the facility on April 22, 2021, with diagnoses which included dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities). Review of Resident 41's clinical record revealed no documented evidence that the licensed pharmacist conducted drug regimen reviews for irregularities with the resident's medication regimen during the month of October 2022. A review of a pharmacy recommendation dated March 8, 2023, revealed the pharmacist noted irregularities with the resident's medication. A review of the resident's clinical record, conducted during the survey ending June 23, 2023, revealed no documented evidence that the physician had acted on the identified irregularity. Review of Resident 47's clinical record revealed admission to the facility on May 29, 2019, with diagnoses, which included congestive heart failure (chronic condition in which the heart does not pump as well as it should). Review of Resident 47's clinical record revealed no documented evidence that the licensed pharmacist conducted a drug regimen reviews during the months of October 2022 or November 2022. A review of Resident 10's clinical record revealed admission to the facility on November 22, 2022, with diagnoses, which included chronic kidney disease, hypertension, and diabetes. Review of Resident 10's clinical record revealed that the physician failed to respond to a second request pharmacy communication dated January 1, 2023, to identify the level pain for administration of Ultram (narcotic), for application schedule for Lidoderm patch, and for the physician to evaluate the continue need for Pravastatin (high cholesterol medication), Ergocalciferol (vitamin D2), and Plavix (antiplatelet). Review of Resident 10's clinical record revealed that the physician failed to respond to a third request pharmacy communication dated February 11, 2023, to evaluate the continued need for Pravastatin, Ergocalciferol, and Plavix, to identify the level of pain for administration of Ultram, and the application schedule for Lidoderm patch. Review of Resident 10's clinical record revealed that the physician failed to respond to a fourth request pharmacy communication dated April 26, 2023, regarding the need to identify a pain level prior to the administration of Ultram. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 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 395625 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marywood Heights 2500 Adams Avenue Scranton, PA 18509 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 - Some Review of Resident 10's clinical record revealed that as of June 23, 2023, the physician failed to respond to a pharmacy recommendation dated May 24, 2023, regarding clarification of the current diagnosis for the use of Cymbalta (antidepressant and nerve pain medication). Review of Resident 46's clinical record revealed admission to the facility on October 29, 2018, with diagnoses which included dementia, hypertension, and depression. Review of Resident 46's clinical record revealed that there was no evidence that a monthly pharmacy review was completed by the pharmacist for the months of October 2022, November 2022, and May 2023. A clinical records review revealed that Resident 1 was admitted to the facility on [DATE] with diagnoses that included dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities), chronic obstructive pulmonary disease (COPD), and heart failure. A clinical records review revealed no evidence that a licensed pharmacist reviewed Resident 1's medication regimen in October 2022 or in November 2022. A clinical record review revealed a document titled Note to Attending Physician/Prescriber indicating that a monthly medication review for Resident 1 was conducted by a pharmacist on December 5, 2022, with recommendations to clarify medication order directions for the Lidoderm Patch to on 12 hours and off 12 hours. However, clinical record review revealed no documented evidence that the physician acted on this recommendation. A Note to Attending Physician/Prescriber, indicating that a monthly medication review for Resident 1 was conducted by a pharmacist on February 11, 2023, with recommendations to attempt a gradual dose reduction of the psychotropic drug Remeron 30 mg. There was no documented evidence that the physician acted upon this pharmacy recommendation. Interview with the Nursing Home Administrator on June 23, 2023, at approximately 2:15 PM, confirmed that there was no documented evidence that the pharmacist had consistently conducted monthly drug regimen reviews for the residents and confirmed the attending physician did not respond to the pharmacy recommendations made, and failed to document the actions taken in the clinical record. 28 Pa. Code 211.9(a)(1)(k) Pharmacy services. 28 Pa. Code 211.12 (a)(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 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 395625 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marywood Heights 2500 Adams Avenue Scranton, PA 18509 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on review of the facility's plan of correction and the findings of the revisit survey ending August 24, 2023, it was determined that the facility's Quality Assurance Performance Improvement (QAPI) committee failed to implement effective corrective action plans to correct quality deficiencies related to the quality of care and physician notification. Findings include: The facility's plan of correction for the deficiencies cited during the survey ending June 23, 2023, revealed that the facility developed quality assurance monitoring systems to ensure that solutions to the deficiencies were sustained. However, at the time of this revisit survey ending on August 24, 2023, continuing quality deficiencies were identified in the area of physician notification and quality of care. The facility's plan of correction for the deficiency cited in the area of quality of care during the survey ending June 23, 2023, revealed that Nursing documentation will be reviewed during morning clinical meetings to ensure residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the resident's choices. DON (Director of Nursing) or designee will randomly audit nursing documentation to confirm professional standards of practice are maintained to ensure residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and resident choices. Random audits will be conducted weekly for 4 weeks, then monthly for 3 months. Findings from audits will be reported to the QAPI Committee monthly. Also, the facility's plan of correction in the area of quality of care included Resident 1's blood pressure is being monitored to ensure it is administered per ordered parameters, and Resident 1's Norvasc order was revised to include documentation of heart rate on the electronic medication administration record. However, at the time of the revisit survey ending on August 24, 2023, a clinical record review revealed that the facility failed to identify that Resident 1 was also prescribed an additional medication requiring specific parameters for administration. A physician order, initially dated July 24, 2022, indicated that the resident was to receive Coreg Tablet 12.5 mg (Carvedilol) with directions to give one tablet by mouth two times a day related to hypertension (high blood pressure) and instructions to hold the medication if the resident's systolic blood pressure is less than 100 or the resident's heart rate is less than 60 beats per minute. According to the resident's Medication Administration Records, Resident 1 received a Coreg Tablet 12.5 mg on August 23, 2023, at 5:00 p.m. without evidence that the resident's heart rate was obtained prior to administering the Coreg Tablet 12.5 mg tablet in accordance with the physician's orders. Further clinical review revealed that the facility failed to recognize that Resident 1's Coreg Tablet 12.5 mg medication was administered 22 times during the month of August 2023 without documentation that the resident's heart rate was obtained prior to medication administration in accordance with the physician's orders. In response to the deficiency cited related to notification of changes in the resident's condition (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 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 395625 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marywood Heights 2500 Adams Avenue Scranton, PA 18509 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some cited during the survey ending on June 23, 2023, the facility's plan of correction revealed the Director of Nursing (DON) or designee will randomly audit nursing documentation to ensure physicians and resident representatives have been notified when a change occurs. Random audits will be conducted weekly for 4 weeks, then monthly for 3 months. Findings from audits will be reported to the QAPI Committee monthly. However, a review of the clinical record revealed that on August 7, 2023, Resident 2 experienced unrelieved right arm pain which was categorized as severe, according to nursing documentation. Nursing noted on August 7, 2023, at 8:30 p.m. that Resident 2 was crying out in pain while in geri chair (recliner), yelling out for help. Holding right arm up and the administration of currently prescribed pain medication was ineffective. As of the time of the survey ending August 24, 2023, there was no documented evidence that Resident 2's attending physician had been notified of the resident's severe pain that was not relieved with the prescribed pain medication. The facility's QAPI committee failed to identify that the facility had failed to implement their plan of correction in a manner consistent with the regulatory guidelines for the deficiency cited to ensure that solutions to the problem were sustained. An interview with the Nursing Home Administrator (NHA) and Director of Nursing (DON) on August 24, 2023, at 1:30 p.m. confirmed that the facility's QAPI Committee failed to recognize continued deficient practice in the area of quality of care related to the administration of medication and address the failure to notify the physician of Resident 2's acute symptoms of severe pain. Refer F580 & F684 28 Pa. Code 211.12(c)(d)(1)(3)(5) Nursing services 28 Pa. Code 201.18(e)(1)(4) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 If continuation sheet Page 17 of 17