Health inspection·August 20, 2025

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some parking lot, and eventually traveled approximately 455 feet from the front door, beyond the facility property line, to a public sidewalk. During an interview on [DATE], at 1:05 PM, Resident 2 declined to discuss the incident. During an interview on [DATE], at 1:20 PM, Employee 1 (RN Supervisor) confirmed being called to the front door where Employees 2 Registered Nurse (RN) and Employee 3 Licensed Practical Nurse (LPN) were trying to prevent the resident from leaving. Employee 1 RN Supervisor reported being directed by the Nursing Home Administrator (NHA) and the physician to contact police, have the resident sign AMA paperwork, and permit her departure. In an interview on [DATE], at 3:30 PM, Employee 2 (RN) stated she was aware of Resident 2's guardianship status and understood the resident was not permitted to leave independently. Employee 2 (RN) retrieved her car keys to follow the resident while Employee 3 (LPN) stayed with the resident. Resident 2 exited the facility, yelling and acting erratically, and proceeded toward the public sidewalk in her motorized wheelchair. In an interview on [DATE], at 5:00 PM, Employee 3 (LPN) stated that a housekeeper alerted her to the resident's intent to leave. Despite attempts to prevent exit, Resident 2 was allowed to leave after AMA forms were signed. Employee 3 followed the resident into the parking lot. The resident indicated she intended to take the bus to the bank. Efforts to contact the resident's legal guardian on [DATE], while onsite at the facility were unsuccessful. Subsequently in a telephone interview on [DATE], at 9:45 AM, Resident 2's court-appointed Guardian stated she was contacted by the facility on [DATE], regarding the resident's intent to leave AMA. The guardian stated she explicitly informed the facility that Resident 2 was not capable of making such decisions and must not be allowed to leave. The guardian was later informed that the resident had left the building despite this instruction and that two staff members were with her outside. During an interview on [DATE], at approximately 12:30 PM, the NHA confirmed that Resident 2 exited the facility in her motorized wheelchair after signing AMA paperwork, despite the facility's knowledge of her guardianship status and cognitive impairment. The resident returned approximately one hour later with support from staff and Emergency Medical Services (EMS). The facility's failure to ensure appropriate supervision and safety interventions for a resident lacking decision-making capacity and under court-appointed guardianship represents a significant breach of its responsibility to prevent avoidable accidents and ensure resident safety. A review of the facility policy dated [DATE] entitled Elopement management and prevention revealed, Elopement occurs when a resident leaves the premises or a safe area without authorization and/or any necessary supervision to do so. The policy revealed that the facility will identify residents who are at risk of unsafe wandering and strive to prevent harm while maintaining the least restrictive environment for residents. If identified as at risk for wandering, elopement or other safety issues, the resident's care plan will include strategies and interventions to maintain the resident's safety. Residents will be evaluated for wandering upon admission/readmission, quarterly and/or a significant change by a licensed nurse using the facility forms. Photographs of residents taken upon admission and incorporated into the electronic medical record. When a resident is identified as at risk, the interdisciplinary team (IDT) will develop a plan of care to include interventions to reduce risk of elopement and maintain safety. Residents identified as being at risk will have the Resident Identification Form completed with a current picture. The completed form will be placed in the Elopement Risk Binder, located at each nursing station and the front desk. An elopement bracelet (Wander guard system, an electronic bracelet that is associated with the electronic locking system on certain doors at the facility. When a resident gets within a few feet of the door, the mechanism will automatically lock the door and alert staff that a resident is near the exit door). Elopement drills will be conducted monthly. In the event of a missing resident, the following steps will be followed: Determine if the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395651 If continuation sheet Page 2 of 11 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 395651 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Rehabilitation & Healthcare Center 395 Middle Road Nanticoke, PA 18634 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 - Immediate jeopardy to resident health or safety Residents Affected - Some resident is out of the facility on an approved leave of absence. The charge nurse or designee will initiate the elopement procedure by announcing Code green and the resident name and room number. The staff will initiate room-to-room searches to include common areas. Nurse supervision will assign staff to initiate a search of the outdoor areas.A review of facility records for residents identified as being at risk for elopement revealed the facility had identified five residents with elopement risk.A review of clinical records revealed Resident 5 was identified by the facility as an elopement risk on [DATE]. The documentation showed a wander guard bracelet (a monitoring device designed to alert staff when a resident at risk approaches an exit or restricted door) was applied on [DATE].Resident 4 was identified by the facility as an elopement risk on [DATE], and a wander guard bracelet was applied on the same date.Resident 1 was identified by the facility as an elopement risk on [DATE], and a wander guard bracelet was applied on [DATE]. Clinical record review revealed Resident 3 was admitted on [DATE], with diagnoses including type II diabetes mellitus (a metabolic disease causing prolonged high blood sugar), hypertension (high blood pressure), and weakness and difficulty walking with impaired mobility requiring wheelchair use. A review of Resident CR1's quarterly Minimum Data Set assessment (MDS- a federally mandated standardized assessment process conducted periodically to plan resident care) dated [DATE], revealed that the resident's cognition was moderately impaired with a BIMS score of 12 (brief interview for mental status a section of MDS that assesses cognition) (a score of 08-12 indicates moderately impaired cognition) and utilized a wheelchair for mobility. A review of the care plan dated [DATE], revealed the resident was identified as having impaired cognitive function. The care plan noted the resident was at risk for falls and included interventions such as implementing planned measures to prevent falls and monitoring for changes in mobility. However, the care plan did not address the resident's wandering behaviors throughout the facility. A review of a quarterly nursing evaluation was conducted on [DATE], which indicated that the resident wandered throughout the building and was physically capable of leaving the building. A review of a wandering/elopement assessment dated [DATE], revealed that Resident 3 remained at a low risk despite his elopement from the facility the day before, [DATE]. A review of nursing documentation and facility investigative documentation dated [DATE], at 1:00 A.M., revealed, Resident 3 was observed by staff coming down the facility driveway into lower parking lot and due to incline of the hill, the resident's wheelchair accelerated, and he lost control. The wheelchair flipped forward, and the resident landed on the roadway. It was undetermined if the resident hit his head. An abrasion measuring 5 cm x 4cm x 0.1 cm to right outer elbow was noted. The resident reported tenderness to the right hip. The right leg appeared to be shortened (a symptom of a fractured hip). Resident 3 stated that he was looking for an exit to go downstairs and visit his daughter, who is an LPN on this shift, on the first-floor nursing unit. He also stated, I found one!(an exit to the first floor). The responsible party and the Physician were called, and the resident was sent to the hospital for evaluation. A review of hospital documentation dated [DATE], revealed that Resident 3 was assessed by hospital staff. A CT scan (computed tomography) or CAT (computed axial tomography scan is a type of imaging test that helps detect diseases and injuries. It uses X-rays and a special computer to create detailed pictures of the bones, organs and soft tissues) of the abdomen and pelvis. Results revealed an acute comminuted fracture (a severe type of bone fracture where the bone breaks into three or more pieces, often requiring surgical intervention for proper healing.) of the right acetabulum (the large socket the head of the hip bone fits into) extending into the iliac crest (a part of the pelvic bone), anterior column. Comminuted fracture lines extend into the superior pubic ramus/acetabular root. Acute displaced fracture of the right inferior pubic ramus (the front of the pelvis). An acute nondisplaced (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395651 If continuation sheet Page 3 of 11 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 395651 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Rehabilitation & Healthcare Center 395 Middle Road Nanticoke, PA 18634 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 - Immediate jeopardy to resident health or safety Residents Affected - Some sacrococcygeal fracture (involves injury to the sacrum and coccyx, often resulting from trauma such as falls or direct blows) and a mild presacral stranding/contusion (fat stranding means that the normally dark fat is replaced by a brighter fuzzy appearance. This can be a small area or involving most of the pelvis. Fat stranding is an important finding that identifies an abnormality on CT scan. Fat stranding can be from many causes but most commonly inflammation. It can also be seen after trauma, surgery, cancer, scarring, in addition to others), and trace right pelvic sidewall contusion (commonly referred to as a bruised pelvis, is an injury that occurs when an impact or blunt force trauma is applied to the pelvic region, but not with enough severity to break the bones). The resident was readmitted to the facility on [DATE], at 4 :27 PM with instructions for an orthopedic consult appointment as well as physician's orders for the facility to make a trauma follow up appointment. Nursing documentation dated [DATE], at 1:30 AM revealed, upon investigation into the incident, nursing staff documented the resident had awoken at 12:15 A.M., he got into his wheelchair and came to the nurse's station inquiring about his surgery in the morning. Resident wakes at this time every night and goes to the first floor to visit his daughter, a facility LPN. The resident was slightly confused and was self-propelling in the hallways. At 12:45 A.M., a funeral home arrived at the second floor to transport an expired resident's body and went down to first floor entrance via elevator. At 12:50 AM, the second floor LPN heard a door alarm sound and went to the second-floor front entrance to investigate and saw no one outside. At this point she reset the door alarm and returned to the nurse's station. The second floor LPN was not aware that the funeral director had gone downstairs and thought he had set off the alarm. Approximately 10 minutes later at 1:00 AM the resident was seen rolling down the facility driveway in his wheelchair. Upon inspecting the front door entrance, the door alarms are noted to not be functioning correctly. When the right door is pushed or pulled upon, the alarm does not sound and the 15 second fire release does not engage, it requires excessive force to do so. The left door is functioning correctly. A review of a witness statement dated [DATE] (11 PM to 7 AM shift), employee 6 (nurse aide) stated, at 11:40 PM, Resident 3 was in his bed and attempting to get into his wheelchair. He was confused at the time, stating where am I and why am I here. I put him in his wheelchair and put his oxygen on him. The oxygen tank was on the back of his wheelchair. He was roaming around the hallway the last time I saw him at 12:00 AM. A review of nursing documentation written by Employee 3 (RN supervisor) [DATE], at 1:30 AM, upon investigating the front door entrance after the incident, the door alarms were not functioning correctly. When the right door is pushed or pulled on, the alarm does not sound and the 15 second fire release does not engage, it requires excessive force to do so. The left door is functioning correctly. The left door is functioning correctly. The note continued, Resident 3 was up and ambulating in his wheelchair. He was noted to be slightly confused and was self-propelling in his wheelchair. At 12:45 AM the funeral home director was in the building to make transport. The funeral director went down the elevator to the first floor. Employee 5 (LPN) heard the front door alarm and went to the second-floor front entrance to investigate and saw no one outside. She then reset the alarm and returned to the nurse's station. Employee 5 (LPN) was not aware that the funeral director did not go to the front door entrance to exit the building. She thought he had set off the alarm. At 1:00 AM. Resident 3 was observed rolling down the driveway in his wheelchair. A review of a written witness statement dated [DATE], at 1:30 A.M., from Employee 7 (LPN), revealed: I was outside speaking to the off-going nurse and aides when someone said, ‘Who is that?' I turned around and someone said, ‘It's your dad.' Resident 3 was coming down the hill in his wheelchair into the lower parking lot. The wheelchair accelerated down the hill, hit the curb, and flipped onto its right side. I ran over to him and asked what he was doing and how he got (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395651 If continuation sheet Page 4 of 11 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 395651 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Rehabilitation & Healthcare Center 395 Middle Road Nanticoke, PA 18634 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 - Immediate jeopardy to resident health or safety Residents Affected - Some outside. He stated, ‘The door.' I asked how, since it was locked, and he said, ‘I pushed on it, and it opened up.' A review of a written witness statement dated [DATE], at 1:30 A.M., from Employee 8 (LPN), revealed: This nurse was on a break with a few other staff members. I was sitting with my back towards the parking lot. One staff member said, Who the hell is that? I turned around and saw someone coming down the parking lot on the pavement on the lower level. Before I could do anything, the person in the wheelchair flipped onto his right side. I ran into the building after confirming it was a resident and notified the RN supervisor. A review of a written witness statement dated [DATE], at 1:30 A.M., from Employee 9 (Nurse Aide), revealed: While I was on a break, I saw someone coming down the hill. I said, who the hell is that. The resident was coming down the hill (the driveway incline) into the lower parking lot in his wheelchair with an oxygen tank on the back of the wheelchair. The resident lost control, and the wheelchair flipped over onto the right side. Resident 3 stated, I just pushed the door, and it opened. A review of a written witness statement dated [DATE], at 1:30 A.M., from Employee 10 (Nurse Aide), revealed: I was on the lower level patio and witnessed the incident. I saw Resident 3 wheel himself down the driveway hill into the parking lot and fall. A review of a written witness statement dated [DATE], at 1:30 A.M., from Employee 11 (Nurse Aide), revealed: I was on break. While I was speaking with fellow co-workers, someone said who the hell is that? When I looked up, I said, is that Resident 3? As soon as I said that I got up from my chair. The resident started flying down the driveway into the parking lot at a high rate of speed and hit the curb resulting in the wheelchair flipping over. I went to the resident to help him get up and check him. I asked the resident how he got outside. Resident 3 responded, Through the door over there while pointing to the front door, main entrance. We then waited for the RN supervisor to arrive. An in person interview [DATE], at 9:30 AM, with Resident 3 stated that on the night of the incident he had been wandering around the second floor, checking that all the doors were locked. He wheeled himself to the front door, went through the first door. He stated that the outside door was open. He could not remember if the alarm sounded. He stated the door was open so I went through it to the outside. He stated his wheelchair started to go down the driveway incline and he attempted to stop it with the wheelchair brake handles. He stated that he made it around the corner at the end of the driveway, but the chair hit the concrete curb, and the wheelchair tipped over on top of him. He stated that the staff helped him, and he went to the hospital. He stated that his hip is broken and doesn't know if he will need an operation. He stated that he has hip pain at this time. An in person interview [DATE], at 12:00 PM., (staff member was not available for interview on [DATE]) Employee 4 (RN supervisor) stated that he was the nursing supervisor on duty on [DATE], 11 PM to 7 AM shift. He stated that he was off the floor when the resident left the building. He confirmed that there was a door lock release button behind the second-floor nurses' desk. He stated that the staff on duty were interviewed, and it could not be determined how the front door was opened that night prior to Resident 3 leaving the building. Employee 4 stated that several nursing staff had exited the building through the second-floor front doors that night at 12:30 AM. He stated that the doors were unlocked after the staff exited the building. He stated that the alarm was not sounding at that time to alert staff that the front door was open. He stated that about 1:00 AM he got called to come to the first floor outside patio area, that a resident got out of the facility and had an accident with his wheelchair. After taking care of the resident, he did check on the front doors by pushing on the doors and making sure that the doors were locked. He did confirm that he wrote the above noted nurses note [DATE], at 1:30 AM, after the incident noting the condition of the front doors at the time of the incident. A telephone interview [DATE], at 10 AM, Employee 5 (LPN) stated she was the LPN on duty on the second floor on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395651 If continuation sheet Page 5 of 11 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 395651 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Rehabilitation & Healthcare Center 395 Middle Road Nanticoke, PA 18634 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 - Immediate jeopardy to resident health or safety Residents Affected - Some the night of the incident. She stated that she last saw the resident on [DATE], at 12:50 AM, sitting in his wheelchair in the second-floor hallway. She stated that the resident's daughter worked on the first floor of the facility 11 PM to 7 AM shift and the resident often independently got onto the elevator and traveled from the second floor to the first floor during this overnight shift. She arrived at 12:00 AM that night for her shift (late for the shift). The funeral director was already on the floor when she arrived for her shift. She and the 2 nurse aides assisted him with another resident. Employee 5 (LPN) then returned to her medication cart. Staff were unaware of Resident 3's whereabouts at the time. The funeral director left the floor. Employee 5 (LPN) assumed that the funeral director exited the building through the second-floor front doors. The funeral director took the elevator and exited through the first floor exit doors. Employee 5 stated within one minute, the front door buzzer sounded. She estimated that it took her 3 to 4 minutes to get to the front door. The door was noted to be open when she arrived. She stated that she looked outside the door and did not see or hear anything. She stated that she assumed that the funeral director had exited through the doors and the doors did not close behind him. Employee 5 stated that she attempted to close the doors and re-alarm the locking mechanism by entering the code 4 times before the system would work again. She stated that it was very difficult to close the door. She also stated that the automatic handicap door opener on the inside front door had not been functioning for months. She stated that the front door locking mechanism had also been broken for months. Employee 5 explained the second-floor main entrance doors will be unlocked during specific hours (8:00 AM to 4:00 PM) and free access is possible. These doors are equipped with a safety feature. If you push on the door handlebar for a continuous 15 seconds, the lock will disengage and open the door. An alarm sounds at the door during the 15 second time frame. This alarm does not sound on the nursing units. An observation [DATE], at 1 PM at the second-floor nurses' station in the presence of the NHA and DON, there was an intercom system located on the wall behind the nurse's desk. The intercom was audio only and utilized only for the front entrance to the building. The system included a button to release the locking mechanism of the front door. The NHA and DON could not state which staff utilized this system. During an interview on [DATE], at 1:30 PM, the facility maintenance director and the corporate maintenance director both stated that the remote door unlocking mechanism at the second-floor nurses' station had been disconnected a long time ago and was not functional. However, an observation on that date at 1:35 PM, along with the surveyor, the maintenance director and corporate maintenance director observed that the remote unlocking mechanism at the second-floor nurses' station was operational. The unlocking mechanism was then immediately disconnected by the maintenance director. They both confirmed at that time that this remote unlocking mechanism should not have been in use at the facility. During an interview [DATE], at 11:00 AM, the NHA stated that immediately following the incident on [DATE], Employee 4 (RN supervisor) checked the functionality of the front door locking mechanism by pushing on the door bar. He stated that this indicated that there were no issues with the door. He further stated that the following morning, the NHA, DON, maintenance director and corporate administration also assessed the function of the front door locking mechanism by pushing on the front door and assuring that the alarm sounded and that the door could be reactivated by entering a code into the keypad located on the wall next to the door. The NHA stated that there was no further assessment of the function of the door and that it was not necessary to contact the manufacturer or any outside professional to ensure that the door was functioning properly. During an interview [DATE], at 9:30 AM, the Nursing Home Administrator (NHA) and Director of Nursing (DON) stated that prior to Resident 3's exit from the facility, the procedure to gain entrance to the facility after regular hours from 8:00AM until 8:00PM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395651 If continuation sheet Page 6 of 11 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 395651 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Rehabilitation & Healthcare Center 395 Middle Road Nanticoke, PA 18634 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 - Immediate jeopardy to resident health or safety Residents Affected - Some (after receptionist leaves for the day) was to:Ring the bell located outside the second-floor main entrance and staff at the second-floor nurses' station will speak to the visitor through the intercom. Staff have the ability to release the locking mechanism of the front door via a release button associated with the intercom system at the nurse station. There is no video capability at the nurses' station to identify the person at the front door.Staff should then walk to the front door to identify the visitor. Put the code into the keypad located on the wall next to the front door and admit the visitor. The NHA and DON could not confirm that at the time of the elopement incident that staff did not engage the remote unlocking mechanism from the second floor nursing station, opening the door. During interviews with the NHA, DON, and corporate administration on [DATE], they all denied that the front door locking mechanism was not functioning properly and that Resident 3 pushed on the fire release bar for the noted 15 seconds, releasing the lock, opening the door and pushing himself out of the facility. A demonstration of the 15 second release of the door was conducted [DATE], at approximately 11:00 AM by the NHA and corporate administrator observed by the surveyor. A maximum amount of force had to be applied to the bar for the entire 15 seconds for the locking mechanism to be released. Maximum pressure had to be applied to the door to manually open it. The facility's conclusion was that the resident had wheeled himself to the second-floor main exit, pushed on the fire release bars on the exit door for the 15 seconds it takes to release the locking mechanism on the door. The alert alarm sounded at the door for 15 seconds. When the lock is released, an alarm sounds at the nurse's station. The facility then stated that Employee 5 (LPN) responded to the front door (after the initial 15 seconds and walking from the nurse's station, through the closed double doors at the end of the hallway then through the lobby to the front doors). She looked outside, saw no one, shut the door and reset the alarm on the door before returning to the nursing unit. The facility confirmed that she did not conduct a search for the resident. The facility's conclusion failed to mention the intercom/front door release button located at the nurses' station as a possibility to have remotely open the door from the mechanism at the nurses' station. It could not be determined how the resident exited the front doors. Surveyor observation of the driveway revealed a steep hill that leads to a sharp left turn, another sharp left turn, traveling a total of 390 feet, finally crashing into an approximate 12-inch-high concrete curb, resulting in 2 fractures. Acute comminuted fracture (bone broken into three or more pieces) of the right acetabulum (hip socket) extending into the iliac crest and pubic ramus.Acute displaced fracture of the right inferior pubic ramusAcute nondisplaced sacrococcygeal fracture (lower spine).Pelvic contusions and soft tissue injuries. The resident had a tank of oxygen on his wheelchair at the time of the incident. The resident was wandering in the facility. Staff were unaware that the resident had eloped from the building until notified by staff on a break, outside the building. Staff failed to monitor the residents' whereabouts although the resident was at risk for wandering and was noted to be confused prior to the elopement. Immediate Jeopardy was identified on [DATE], at 12:30 PM. due to the facility's failure to timely identify a resident's absence from the facility and prevent an elopement and failed to ensure that a resident deemed incompetent by the court was assessed as capable to leave the facility against medical advice to prevent the resident's absence from the facility and provide a safe environment with resident identification by staff and provision of supervision. The facility was notified of the Immediate Jeopardy on [DATE], at 12:20 PM. and the IJ template was provided to the facility. The facility's immediate action plan provided to the survey team at 9:00 AM on [DATE], was as follows:1. The facility doors were checked for security function by the RN supervisor and the maintenance department 2. Residents with wander guard monitoring devices were checked for function.3. The 2 residents affected were reassessed and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395651 If continuation sheet Page 7 of 11 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 395651 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Rehabilitation & Healthcare Center 395 Middle Road Nanticoke, PA 18634 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 - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete care plans updated4. Current residents in the facility were assessed for wandering/elopement risk and care plans updated5. Facility staff were educated on facility policy/procedures regarding wandering, elopement, and resident safety including how to conduct a complete ground search during a missing resident process activation6. The DON completed audits on [DATE], and [DATE], to ensure that no other resident had been affected7. An elopement drill was conducted [DATE], and will be conducted monthly on various shifts and results reported to QAPI8. The facility interdisciplinary team and the medical director will review residents who request to leave the facility against medical requests to determine if the resident is competent to be able to make the decision to discharge from the facility.9. The facility IDT and Medical Director will review residents who request to leave the facility AMA to determine if the resident is competent to be able to make the decision to discharge from the facility. Residents deemed incompetent to make the decision will receive support from the facility social service designee and further. Pull up for services as applicable. During the onsite visit to the facility on [DATE], verification of the implementation of the facility's removal plan was completed and the Immediate Jeopardy was lifted on [DATE], at 9:30 AM. 483.25(d)(1)(2) Free of Accidents Hazards/Supervision/Devices. 28 Pa Code 201.18(b)(1) (e)(1) Management. 28 Pa Code 201.14(a) Responsibility of Licensee. 28 Pa Code 211.12(c)(d)(1)(3)(5) Nursing Services. Event ID: Facility ID: 395651 If continuation sheet Page 8 of 11 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 395651 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Rehabilitation & Healthcare Center 395 Middle Road Nanticoke, PA 18634 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 0744 Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. 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 and staff interview, it was determined the facility failed to develop and implement an effective, individualized, person-centered care plan to address a resident's dementia-related behavioral symptoms for one of 5 residents reviewed (Resident 1).Findings include: A review of the clinical record revealed that Resident 1 was admitted to the facility on [DATE], with diagnoses including dementia (a progressive condition involving cognitive decline, memory loss, and changes in personality and behavior) and anxiety disorder (a mental health condition characterized by persistent worry or fear that interferes with daily functioning). A quarterly Minimum Data Set (MDS an assessment completed periodically to plan resident care) dated June 23, 2025, indicated that Resident 1 was moderately cognitively impaired with a BIMS score of 12 (Brief Interview for Mental Status a tool to assess the resident's attention, orientation, and the ability to register and recall new information, a score of 8-12 equates to moderate cognitive impairment). A review of nursing documentation from April 20, 2025, through August 14, 2025, revealed repeated instances of dementia related behavioral symptoms. These included verbal and physical aggression toward staff (e.g., hitting, kicking, yelling), intrusion into other residents' rooms, refusals of care, accusatory statements directed at staff, and physical aggression toward a visiting family member of another resident. Documentation also noted the resident was often difficult to redirect. The resident's current care plan for cognitive impairment related to dementia failed to identify these specific behaviors and lacked individualized, person centered interventions to address and manage each behavioral symptom. There was no documented evidence the care plan incorporated information based on a thorough assessment of the resident's preferences, social history, customary routines, or personal interests, as required to support effective behavioral management strategies. An interview with the Director of Nursing on August 14, 2025, at 4:40 PM, confirmed the facility was unable to provide evidence of the development and implementation of an individualized person-centered plan to address dementia-related behaviors.28 Pa Code 211.12 (c)(d)(1)(3)(5) Nursing services. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395651 If continuation sheet Page 9 of 11 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 395651 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Rehabilitation & Healthcare Center 395 Middle Road Nanticoke, PA 18634 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 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. Level of Harm - Minimal harm or potential for actual harm Based on a review of clinical records, select investigative reports, and employee job descriptions and staff interview it was determined the facility's administration, Nursing Home Administrator and Director of Nursing, failed to effectively use its resources to promote resident safety and maintain the highest practicable physical and mental functioning of residents in the facility by failing to monitor one resident's whereabouts and prevent an elopement for one (Resident 3) out of 5 sampled residents and failed to ensure the safety and supervision of a resident who lacked decision-making capacity and required protective oversight, allowing the resident to exit the building, placing the resident at risk for serious harm (Resident2) which created an Immediate Jeopardy situation. Findings included: A review of the job description for the Administrator dated October 7, 2024 revealed the administrator must be knowledgeable of and demonstrate the ability to provide quality care by fostering a safe environment for residents and staff; providing emotional and psychological support for the residents within the facility, direct and oversee the day to day operation of the facility to ensure the highest degree of quality of care is maintained at all times in accordance with current state and federal standards, and implement and enforce company policies and procedures. The position responsibilities include, plan, develop, organize, implement, and direct programs and activities. Assist departments in the use of departmental policies and procedures. Explain interdepartmental rapport and foster a culture of teamwork, excellence, and safety. Assure that all employees, residents, and visitors follow established policies and procedures. The facility failed to ensure these responsibilities were carried out, as evidenced by the elopement of Resident 3 and the unsafe exit of the building for Resident 2. This demonstrated a lack of effective oversight to address identified elopement risks for at-risk residents. The Job Description for Direction of Nursing Services dated January 27, 2025 outlines responsibilities including planning, organizing, developing and directing the overall operation of the resident care department in accordance with all current regulatory standards to ensure the highest degree of quality care, knowledge of professional nursing theory and practice to provide first class patient care, expert knowledge of policies, regulations and procedures governing resident care, expert knowledge of medical equipment and instruments to administer resident care, demonstrate the ability to apply the principles, methods, and techniques of professional nursing associated with long term resident care; preparing and maintaining detailed records, writing reports, and responding to correspondence; cultivate and manage effective working relationships with residents, medical staff, and the community; effectively manage regulatory and company compliant quality control standards and demonstrate effective verbal and written English communication. The position responsibilities include evaluate effects of care delivered and assign special treatments when indicated, assure resident safety through nursing staff, integrate and coordinate care with other disciplines, determine and schedule the staffing needs to meet the total care needs of the residents, develop, implement, and maintain an effective staff orientation plan, ensure that personnel follow established departmental policies and procedures and provide discipline as necessary. The DON failed to provide adequate monitoring or to implement effective interventions to prevent Resident 3's elopement and Resident 2's unsafe exit from the facility. Additionally, there was insufficient coordination of staff to ensure the safety of other residents at risk for elopement. Based on the findings the facility's inability to implement and enforce policies to monitor Resident 3 and 2 and address elopement risks and an unsafe discharge resulted in Immediate Jeopardy to the health and safety of 8 residents identified as at risk for elopement. This demonstrates a systemic failure in the administration's oversight and resource allocation to ensure a safe environment for residents. The deficiency cited Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395651 If continuation sheet Page 10 of 11 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 395651 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Rehabilitation & Healthcare Center 395 Middle Road Nanticoke, PA 18634 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 0835 Level of Harm - Minimal harm or potential for actual harm under the Code of Federal Regulatory Groups for Long Term Care, Quality of Care (F689) 483.25(d)(1)(2) Accidents, revealed the facility's administration did not fulfill essential job duties to ensure resident safety and regulatory compliance. This included a failure to evaluate and mitigate risks associated with elopement for identified at-risk residents. Refer F689. 28 Pa. Code: 201.14 (a) Responsibility of licensee. 28 Pa. Code: 201.18 (b)(1)(3) (e)(1) Management. 28 Pa. Code 211.12 (c)(d)(1) (2)(3)(5)Nursing services. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395651 If continuation sheet Page 11 of 11