Health inspection·November 25, 2025

F 0604 Level of Harm - Minimal harm or potential for actual harm facility failed to make certain a resident was free from the use of physical restraints without a physician's order for one of eight residents reviewed.28 Pa. Code 201.18 (e)(1) Management.28 Pa. Code 201.29 (a)(c)(d) Resident Rights.28 Pa. Code 211.12 (d)(5) Nursing Services.28 Pa. Code 211.8 (d)(e)(f) Use of Restraints. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395643 If continuation sheet Page 2 of 4 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 395643 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE John J Kane Regional Center-Gl 955 Rivermont Drive Pittsburgh, PA 15207 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policies and documents, clinical record review, and staff interviews, it was determined that the facility failed to provide adequate supervision to prevent falls that resulted in a laceration (deep cut) for one of eight residents (Resident R1).Findings include:Review of the facility policy, Abuse-Resident and Reasonable Suspicion of a Crime reviewed 1/7/25, indicated the facility is to treat every resident with consideration, respect and full recognition of his/her dignity and individuality. This policy is part of the centers overall prevention of abuse, neglect, exploitation of residents, and misappropriation of resident property program. Neglect is the failure of the facility, the staff, or service providers to provide goods and services to a resident that are necessary to avoid or may result in physical harm, pain, mental anguish, or emotional distress. Neglect may be the result of a pattern of failures or may be the result of one or more failures involving one resident and one staff person.Review of the Resident Assessment Instrument 3.0 User's Manual effective October 2024, indicated that a Brief Interview for Mental Status (BIMS) is a screening test that aides in detecting cognitive impairment. The BIMS total score suggests the following distributions:-13-15: cognitively intact-8-12: moderately impaired-0-7: Severe impairmentReview of the clinical record indicated Resident R1 was admitted to the facility on [DATE].Review of the Minimum Data Set (MDS- periodic assessment of resident care needs) dated 10/26/25, included diagnoses of diabetes (high blood glucose (sugar) levels), cardiomyopathy (disease of the heart muscle which makes it hard for the heart to pump blood), congestive heart failure (chronic condition where the heart can't pump enough oxygenated blood to meet the body's needs), morbid obesity (extremely overweight). Review of Section C: Cognitive Patterns, Question C0500 BIMS Summary Score revealed Resident R1's score to be 0.Review of the MDS dated [DATE], Section GG: Functional Abilities indicated Resident R1had no impairment of upper or lower extremities, is partial to moderate assistance with rolling from lying on back to left or right and return to back when lying on the bed.Review of a progress note dated 11/2/25, at 1:58 a.m. Documents sent with resident to the hospital.Review of a progress note dated 11/2/25, at 2:07 a.m. Called report to [NAME] hospital, doctor took report of wound on resident's leg was a large open wound down to the tendon. Pressure applied till bleeding stopped then pressure dressing applied. Patient sent to [NAME] hospital.Review of progress notes dated 11/2/25, at 5:46 a.m. facility spoke with nurse at [NAME] hospital ER stated an x-ray was done on the right leg. No breaks that they are numbing the area and are going to stitch up, and he should be headed back our way shortly.Review of progress notes dated 11/2/25, at 6:30 a.m. nurse called from [NAME] ER stated, they stitched him up and would be sending hm back on Keflex. Supervisor notified.Review of a progress note dated 11/2/25, at 8:02 a.m. indicated Resident R1 was being changed by CNA, started to cough and rolled out of bed receiving a laceration to the right lower leg.Resident R1's orders on 10/22/25 are for bed mobility assist of 1, on 11/3/25, resident orders changed to bed mobility assist of 2.Resident's R1 plan of care for Falls on 10/27/25, monitor resident's position in bed every two hours. On 11/3/25, plan of care updated to assist of 2 with bed mobility and Hoyer lift due to declining functional ability. Ensure fall mats are down when in bed.Review of the facility incident report dated 11/3/25, indicated, Resident rolled out of bed at 0030, 11/2/25, during care. Was being changed by CNA when he started to cough and rolled out of bed. Assessed by RN. Sustained laceration to right calf, after hitting it off incremental unit. Resident care planned for 1 assist. Resident on bariatric air mattress. Care provided. MD notified. Order to transfer to ED for evaluation. Family notified. Abuse training was conducted with all staff completing training 11/4/25 through 11/6/25.During an interview on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395643 If continuation sheet Page 3 of 4 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 395643 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE John J Kane Regional Center-Gl 955 Rivermont Drive Pittsburgh, PA 15207 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 0689 Level of Harm - Minimal harm or potential for actual harm 11/25/25, at approximately 1:00 p.m. the Nursing Home Administrator and Director of Nursing confirmed the facility failed to provide adequate supervision to prevent falls that resulted in a laceration that required sutures in one of eight residents (Resident R1).28 Pa. Code 201.14(a) Responsibility of licensee.28 Pa. Code 201.18(b)(e)(1) Management.28 Pa. Code 201.29(a) Resident Rights.28 Pa. Code 211.10(C)(d) Resident Care policies.28 Pa. Code 211.12(d)(1)(2)(5) Nursing services. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395643 If continuation sheet Page 4 of 4