Inspection·January 31, 2024

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of the facility's abuse prohibition policy, select investigative reports and clinical records, and interview with staff it was determined that the facility neglected to provide the care and services necessary to avoid physical harm and maintain physical health for one resident out of five residents sampled (Resident 2). Findings include: A review of the facility's Resident Abuse policy, last revised January 2023, revealed that the facility will provide each resident with the highest practicable physical, mental, and psychological services to meet their individual needs and to promote or maintain the resident at their highest level of well-being. This includes the protection of Resident's Rights. Each resident has the right to privacy, dignity and confidentiality for all aspects of care and services. A review of the clinical record revealed that Resident 2 was admitted to the facility on [DATE], 2022, with diagnoses, which included dementia, muscle weakness and the need for assistance with personal care A quarterly Minimum Data Set assessment (MDS- a federally mandated standardized assessment process conducted at specific intervals to plan resident care) dated November 20, 2023, indicated that the resident required the assistance of staff for activities of daily living and and utilized a sit to stand lift for transfers. A review of the resident's current plan of care, initially dated July 8, 2023, revealed a care plan in place for ADL (activities of daily living) self-care performance deficit. Planned interventions were that upon admission the resident needed to utilize a sit to stand lift (devices used to assist with transfers and movement of individuals who require support for mobility beyond the manual support provided by caregivers alone). A review of a facility investigation report dated December 19, 2023, at 9:55 PM revealed that Employee 3, an agency nurse aide, and Employee 4, an agency nurse aide, were transferring Resident 2 from the wheelchair to the bed via a sit to stand lift. The nurse aides placed the resident into the lift and had her hovering {in the lift sling} over her bed. Employee 3, an agency nurse aide, left the room to get a clean brief. At the same time, Employee 4, an agency nurse aide, left the resident in the lift to get a washcloth from the bathroom sink. When Employee 4 looked back from the bathroom, she observed Resident 2 opening the velcro ties to the sling (on the lift), falling onto the bed, and then onto the floor, hitting her buttocks and back. The RN supervisor assessed the resident. The Physician was contacted. No injuries were noted. An interview with the Nursing Home Administrator and Director of Nursing on January 31, 2024, at approximately 2 PM confirmed that Employees 3 and 4 were aware that the resident's transfer was to performed with two people, utilizing a sit to stand lift, but both employees left the resident unattended in the lift sling resulting in the resident's fall. 28 Pa. Code 201.29(a)(c) Resident Rights (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 If continuation sheet Page 2 of 13 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 01/31/2024 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 0600 28 Pa. Code 211.12 (d)(5) Nursing Services Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 If continuation sheet Page 3 of 13 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 01/31/2024 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 0602 Protect each resident from the wrongful use of the resident's belongings or money. 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 facility policy and investigative reports it was determined that the facility failed to ensure that one of five residents sampled were free from misappropriation of property, medications (Resident 3). Residents Affected - Some Findings include: A review of the facility's Resident Abuse policy, last revised January 2023, revealed that misappropriation of Resident Property is the deliberate misplacement, exploitation or wrongful, temporary or permanent use of a resident's belongings or money without the resident's consent. Examples of misappropriation include, but are not limited to taking resident's monies, using their phone to make personal calls, administering a resident's medication to another resident, or eating food items off a resident's tray. Clinical record review revealed Resident 3 was admitted to the facility on [DATE], with diagnoses of peripheral vascular disease and chronic pain and readmitted to the facility after a hospital stay on December 22, 2023. A physician order was noted, December 22, 2023, for Oxycodone -APAP ( an opioid narcotic combination pain medication) 5-325 mg, one tablet by mouth, as needed, every 4 hours for pain level rated 4-10. A review of a prescription dated and signed by the resident's attending physician on December 22, 2023, revealed the order for Oxycodone-APAP 5-325 mg, one tablet by mouth as needed every 4 hours for pain. The prescription indicated that 180 pills were to be dispensed by the pharmacy and sent to the facility for the resident. A review of a pharmacy delivery sheet dated December 22, 2023, revealed that 180 Oxycodone-APAP pills were dispensed for Resident 3 and received at the facility. Three separate cards of oxycodone-APAP, containing 60 pills each, were noted in the delivery received by the facility. A review of a facility investigation dated January 11, 2024, revealed that the facility's pharmacy notified Employee 1 (RN Supervisor) that it was too soon to refill Resident 3's prescription for Percocet Oral Tablet 5-325 MG (Oxycodone w/ Acetaminophen); the pharmacy informing the facility that the pharmacy sent 180 tablets on December 22, 2023. Facility records revealed that only one card of 60 was present in the facility with only 11 doses remaining on January 11, 2024. A review of an employee witness statement dated January 14, 2024, revealed that Employee 2 (LPN) stated that 3 cards of 60 pills were sent and received at the facility on December 22, 2023 on the 11 PM to 7 AM shift. The three cards of the opioid narcotic controlled medication were placed in the locked narcotic box in the med cart and the corresponding narcotic sign sheets were placed in the narcotic book according to Employee 2's statement. The facility's investigation noted that the facility conducted an immediate search of med carts, med room, but no Percocet cards and corresponding narcotic reconciliation forms were found for Resident 3 to indicate the amount of opioid medication present in the med cart. Two of the three cards of 60 pills each could not be located, 120 doses of the Oxycodone-APAP 5-325 mg were missing. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 If continuation sheet Page 4 of 13 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 01/31/2024 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 0602 Level of Harm - Minimal harm or potential for actual harm During an interview January 31, 2024, the Director of Nursing and the Nursing Home Administrator confirmed that the facility confirmed that Resident 3's property, medications, had been misappropriated from the facility. Refer F755 Residents Affected - Some 28 Pa. Code 201.29 (a)(d) Resident rights 28 Pa. Code 211.12 (c)(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 If continuation sheet Page 5 of 13 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 01/31/2024 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 review of clinical records and facility provided documentation and staff interviews it was determined that the facility failed to provide nursing services consistent with professional standards of practice for one resident (Resident 1) out of 5 residents reviewed by failing to show ongoing monitoring, identification and documentation of changes in resident condition to assure prompt and necessary treatment of fracture. 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 clinical record revealed Resident 31 was admitted to the facility on [DATE], with diagnoses, which included moderate intellectual disabilities and a history of falling. A review of a quarterly MDS (Minimum Data Set - a federally mandated standardized assessment conducted at specific intervals to plan resident care) dated November 20, 2023, revealed that Resident 1 was moderately cognitively impaired with a BIMS score of 9 (Brief Interview for Mental Status tool used to screen cognitive condition of residents) and required staff assistance with activities of daily living and had a history of falls. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 If continuation sheet Page 6 of 13 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 01/31/2024 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 nurses notes dated October 20, 2023 at 11:07 AM revealed that the report of the resident's Dexa scan (an imaging test to measure the bone density) was received and that the resident was identified to be at risk for fractures. A review of nursing documentation dated November 7, 2023 indicated that Resident 1 had pain in her left shoulder. There was no further nursing documentation of a nursing assessment of the resident's left shoulder at that time or follow-up nursing documentation regarding the status of the resident's left shoulder pain. The nurse's notes dated November 23, 2023, at 9:43 PM revealed that Resident 1 complained of discomfort to the left arm and told her family about the discomfort. The entry noted that the resident recently, July 21, 2023, received tetanus vaccine to that arm and Tylenol was offered to the resident. On November 24, 2023 at 7:26 PM revealed that nursing Received call from resident's niece/POA, with concerns for resident complained of pain and limited mobility in left upper extremity. Resident told her that she fell in her bathroom last month but states that she has very poor short term memory and is not cognizant of time. The POA thinks that maybe resident overstretched arm. Resident able to move left arm out to a 90 degree angle but did not complained of pain for me. She had received Tdap vaccine on July 21, 2023 but niece states that it started about two weeks ago, requests ibuprofen and MRI. Nursing left voicemail at Dr. the Physician's office. Updated the resident's POA on leaving message(with the Physician) and waiting on call back. A physician order was noted November 27, 2023, for Voltaren arthritis pain external gel 1% ( a nonsteroidal anti-inflammatory drug (NSAID) for pain management; apply to left shoulder area, twice a day for pain in the left shoulder. Following surveyor during the survey ending January 31, 2024, the facility provided physician documentation dated December 11, 2023, revealed that the physician noted that Resident 1 was having arm pain. The POA (Resident 1's niece) called to discuss. Will evaluate next week and call in Medrol (steroid medication). A physician order was noted December 12, 2023, at 3:40 PM, for a Medrol Pak, 4 mg (an oral steroid for inflammation) until December 18, 2023. A nurses note dated December 14, 2023, at 9:43 PM revealed that Resident continues on Medrol dose pack for Left shoulder. She complained of occasional pain, which is manageable with current pain medication. She denies having any radiating pain at this time. Resident able to perform range of motion with minimal difficulty. A review of a nurses note dated December 15, 2023 at 5:20 PM revealed Resident sitting in dining room. She continues on Medrol dose pack for Left shoulder pain. Resident able to perform range of motion with minimal assistance. Resident encouraged to rest periodically throughout the day/evening to aide in lessening her pain, as well. Resident continues to walk through hallways with walker frequently. A physician's assistant note dated December 29, 2023, at 2:25 PM revealed that the resident had upper respiratory symptoms. The entry included a note note; to the primary care physician as an FYI, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 If continuation sheet Page 7 of 13 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 01/31/2024 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 the resident's niece was asking about Resident 1's shoulder and asked if an x-ray was done. No notes documented that she was evaluated (by the physician) but per your note, you were going to see her. A nurse's note dated January 12, 2024, revealed that Resident 1 was seen by attending Physician and an order was received for an x-ray of the left shoulder. Residents Affected - Some A review of an x-ray report dated January 12, 2024, revealed a mildly comminuted, non-displaced, non united fracture of the lateral left humeral head (shoulder), likely acute. A late entry nurses note written on January 18, 2024 at 10:45 A.M. for January 15, 2024 at 10:44 A.M., revealed multiple attempts to contact Ortho physicians office to schedule an orthopedic appointment. Left message to return call to facility. A review of a nurses note dated January 18, 2024, at 11:02 AM., revealed that Resident 1 had an ortho appointment on January 31, 2024 at 8:30 AM There was no evidence that Resident 1's left shoulder pain, first reported by the resident on November 23, 2023, was timely and fully evaluated, assessed and treated. There was no documented evidence that nursing staff timely consulted with the physician regarding the resident's ongoing complaints of left shoulder pain. During an interview on January 26, 2024, at approximately 9:00 a.m., the Director of Nursing confirmed that Resident 1's fracture was not timely identified and treated. 28 Pa. Code 211.12 (c)(d)(1)(3)(5) Nursing Services 28 Pa. Code 211.5 (f) Medical records FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 If continuation sheet Page 8 of 13 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 01/31/2024 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records and facility investigative reports and staff and family interviews it was determined the facility failed to provide nursing staff with the appropriate competencies and skills sets necessary to provide physician ordered care and services, the use of a wound vacuum, for one resident admitted to the facility with a surgical wound, (Resident 4), out of eight sampled residents. Findings include: A review of Resident 4's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses to include, status post fracture of the humerus (the upper arm) with an open wound. Post hospitalization treatment at the facility was to include wound treatments. The resident was cognitively intact with a BIMS score of 15 (brief interview for mental status - a tool to assess cognitive function, a score of 13 to 15 indicates the resident is cognitively intact) according to a quarterly Minimum Data Set Assessment (MDS - a federally mandated standardized assessment process conducted periodically to plan resident care) dated February 26, 2024. The resident required minimal staff assistance with activities of daily living, was at risk for pressure areas, and had a surgical wound. A review of an admission nursing assessment dated [DATE], revealed that Resident 4 was admitted with an open surgical incision, area, right elbow with tendon exposed 7 cm x 5 cm x 0.4 cm, wound vac now in place. Small amount serosanguineous drainage, surgical incision superior (3 sutures) and distal (11 sutures) well-approximated. The resident had admission physician orders, dated February 20, 2024, for Negative Pressure Wound Therapy to Right elbow: wound vac (a type of therapy to help wounds heal. During the treatment, a device decreases air pressure on the wound. This can help the wound heal more quickly). Treatments prescribed were to clean area with normal saline; Apply skin prep to perimeter of wound; Cut black foam to fit inside wound; Cut drape to fit over foam trying not to cover; sutures, pressing drape to release air bubbles and form adherence; Cut quarter sized hole in drape and apply track pad with tubing running down arm; Secure track pad with piece of drape using care; not to cover tubing; Attach tubing to wound vac, turn on - settings: 125 mmHg continuous every evening shift related to UNSPECIFIED FRACTURE OF LOWER END OF RIGHT HUMERUS, SUBSEQUENT ENCOUNTER FOR FRACTURE WITH ROUTINE HEALING. This order was Discontinued March 5, 2024. A facility investigation report and nursing documentation dated March 8, 2024, at 8:30 PM revealed that Resident 4 reported to his son-in-law during a phone conversation that his wound vacuum dressing to his right elbow had not been changed since it was put on (on February 20, 2024), when his son-in-law asked the resident how the wound was looking. Resident 4 was admitted to the facility on [DATE] status post open fracture of lower end of right humerus. Employee 4, LPN, admitted the dressing changes were not completed although she had documented that the dressing changes were completed. Facility licensed nursing staff signed the resident's February 2924 and March 2024 Treatment (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 If continuation sheet Page 9 of 13 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 01/31/2024 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Administration Records (TAR) indicating that these nursing staff members had provided the resident's wound treatment and wound vac change on February 21, 23, 26 and 28, 2024 and March 1, 2024 and March 4, 2024. An undated witness statement from Employee 5 (RN Supervisor) revealed On March 5, 2024 I received a call from {Resident 4}'s son-in-law. He was very concerned. His father-in -law told him that the resident stated that he hadn't had his wound vac changed in a while. Upon investigation, the physician ordered, three times a week wound vac changes, were documented as completed. There were no accompanying progress notes. I then interviewed Resident 4. He stated I {Employee 5} was the last person to change the wound vac after his visit to the orthopedic surgeon, a week and a half prior. At that time, upon assessing the dressing, there was no date and the dressing was intact, attached to the wound vac and the appliance was functioning. I then informed the resident that I would change the dressing/wound vac. When removing the old dressing, I did encounter difficulty getting the black sponge at the base of the wound to remove. The wound was noted to be smaller in size with a moist red wound base and no concerning findings. The Wound vac dressing changed to right elbow area. Wound measuring 6.5 cm x 3.2 cm, appearing smaller than previous. Beefy red tissue at wound base, no odor. Resident tolerated well. I informed the Director of Nursing (DON) of the findings. Employee 4 (LPN) had been documenting in the clinical chart that the wound care was completed. On numerous occasions, including the day before, which was a Monday, I asked Employee 4 (LPN) if she needed any help specifically with treatments as I knew she had a few to complete. She was sitting in the medication room charting, and stated she was fine and didn't need any help. A review of an undated witness statement from Employee 4 (LPN) revealed When {Resident 4} was admitted to the facility, {Employee 5, RN Supervisor} called me to the second floor (I was working on the third floor) so a wound vac instructor ( not an employee of the facility) would show us how to apply and use the wound vac. Once the instructor arrived, {Employee 5 (RN Supr)} and I ended up performing most if not all of the work (wound vac application) with very little helpful guidance from the instructor herself. I was under the impression I would physically be taught how to manage a wound vac, but had not received any valuable knowledge that day. Even when emptying the canister, that was something I was not taught or competent in. {Employee 5 (RN Supr)} had mentioned to me that she didn't really teach us anything (wound vac management), and I agreed. But not once did she (Employee 5 (RN Supr) had she offered to come down and assist me with the wound vac considering I need that extra hand. Because of the staffing inadequacy, I had only changed the wound dressing one other time after the instruction. A review of facility documentation revealed that Employee 4 (LPN) was hired at the facility on September 12, 2023, and received facility abuse training on the same day. A review of nursing competencies dated September 12, 2024, completed with this employee revealed that they did not include the care and use of a wound vac system. The facility failed to ensure that Employee 4, an LPN, demonstrated knowledge of the resident's individual needs and used techniques and skills for wound maintenance as directed in the physician orders for providing wound care to this resident. The facility failed to ensure that licensed professional nursing staff consistently assessed the resident's health status, including wound management to ensure that the resident received timely treatment at the level required for treatment of the resident's serious injury. During an interview March 26, 2024 at 2 PM, the Director of Nursing and the Nursing Home (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 If continuation sheet Page 10 of 13 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 01/31/2024 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 0726 Administrator confirmed that Employee 4 (LPN) did not complete Resident 4's wound treatment as ordered. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12 (c)(d)(1)(3)(5) Nursing Services. 28 Pa. Code 211.5 (f) Medical records Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 If continuation sheet Page 11 of 13 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 01/31/2024 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of controlled drug records and select facility policy and staff interview, it was determined that the facility failed to implement pharmacy procedures for reconciling controlled drugs and records accounting for their administration for one of five residents sampled (Resident 3). Finding include: Clinical record review revealed Resident 3 was admitted to the facility on [DATE], with diagnoses of peripheral vascular disease and chronic pain. The resident was readmitted to the facility after a hospital stay on December 22, 2023. A physician order was noted November 20, 2023, for Percocet (Oxycodone-APAP, an opioid narcotic combination pain medication) 5/325 mg, one tab every 4 hours as needed for pain. A review of a pharmacy invoice dated November 20, 2023, revealed that 90 Oxycodone-APAP 5-325 mg were delivered to the facility for administration to Resident 3 A review of Medication Administration Records revealed that from November 22, 2023 through November 30 2023, revealed documented evidence that 36 doses of the Oxycodone-APAP 5-325 mg were administered to Resident 3. A review of Medication Administration Records revealed that from December 1, 2023 through December 14, 2023, 39 doses of the Oxycodone-APAP 5-325 mg were administered to Resident 3. The documentation on the MARs indicated that a total of 75 pills of Oxycodone-APAP 5-325 mg were administered during November 2023 and December 2023. However, at the time of the survey ending January 31, 2024, there was no evidence of the associated pharmacy provided controlled drug narcotic sign out record (accountability form) associated with Resident 3's supply of Oxycodone-APAP 5-325 mg 90 pills dispensed to the the facility on November 20, 2023, or of the disposition of the remaining 15 doses of the narcotic medication. The resident was admitted to the hospital on [DATE] and readmitted to the facility on [DATE]. There was no documented evidence of the remaining 15 doses of Resident 3's controlled medication at the time of the survey ending January 31, 2024. During an interview January 1, 2023 t 2 P.M., the Director stated that Resident 3's controlled drug narcotic sign out sheet for the resident's supply of Oxycodone-APAP 5-325 mg dispensed to the facility on November 20, 2023, could not be located and facility was unable to account for the remaining 15 doses of the narcotic medication. Refer F602 28 Pa Code 211.12 (c)(d)(3)(5) Nursing services. 28 Pa Code 211.9 (a)(1)(j.1)(4)(k) Pharmacy services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 If continuation sheet Page 12 of 13 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 01/31/2024 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation and and staff interview, it was determined that the facility failed to implement procedures to store medications under proper temperature controls in one of two medication storage rooms. Findings include: An observation on March 26, 2024, at approximately 1 PM, in the presence of Employee 6, Agency LPN, revealed two multi-dose containers of Ativan Oral Concentrate 2 MG/ML (Lorazepam, an antianxiety medication) were in the locked compartment of the second floor medication cart. Observation revealed that the 2 mg per ml oral concentrate was supplied as a clear colorless to light yellow solution, with labeling instructions for the drug to be stored at Cold Temperature-Refrigerate 2°-8°C (36°-46°F). Interview with the Nursing Home Administrator (NHA) on January 11, 2023, at approximately 12:40 PM, confirmed that Ativan concentrate was to be stored in the refrigerator and not the med cart. 28 Pa. Code 211.9 (a)(1)(k) Pharmacy services 28 Pa. Code 211.12 (d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395625 If continuation sheet Page 13 of 13