Inspection·September 17, 2025

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete There was no documentation the facility NHA, DON, attending physician, or the resident's responsible party were made aware of the alleged sexual abuse at the time of the incident. Review of the facility's internal investigation revealed the facility did not initiate an investigation until August 28, 2025, two days after the alleged incident. Review of reports submitted to the State Survey Agency revealed the facility failed to notify the agency within the required two-hour timeframe following the allegation of sexual abuse. During an interview with the Assistant Director of Nursing on September 17, 2025, at 10:15 AM, it was confirmed that Employee 3 did not report the allegation of abuse in accordance with facility policy, resulting in delayed identification, notification, and investigation. The facility failed to implement its abuse prohibition procedures by not promptly identifying the alleged sexual abuse of Resident 2, not ensuring timely notification of administration, physician, responsible party, and State Survey Agency, and by delaying the initiation of an investigation into the allegation. 28 Pa. Code 201.18 (e)(1) Management. 28 Pa. Code 201.29 (a)(c) Resident Rights. 28 Pa. Code 201.14(a)(c) Responsibility of Licensee. 28 Pa. Code: 211.12 (c)(d)(1)(3)(5) Nursing Services. 28 Pa. Code: 211.10 (c)(d) Resident care policies. Event ID: Facility ID: 395651 If continuation sheet Page 2 of 6 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 09/17/2025 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 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records, facility investigative reports, and staff interviews, it was determined the facility failed to adequately investigate resident falls and timely develop and implement effective safety interventions to prevent falls for residents with a known history of falls and unsafe behaviors. This deficient practice resulted in repeated falls for one resident (Resident 3) and a serious injury (fracture of knee) requiring hospitalization for another resident (Resident 1), affecting two of the seven sampled residents.Findings include: A review of Resident 3's clinical record revealed admission to the facility on May 7, 2025, with a diagnosis to include hemiplegia (paralysis of one side of the body) and hemiparesis (weakness on one side of the body) following a cerebral infarction (stroke), legal blindness, and end stage heart disease (advanced and irreversible stage of heart failure, where the heart is severely weakened and unable to pump blood effectively). The resident expired on September 5, 2025. A review of a quarterly MDS (Minimum Data Set- a federally mandated standardized assessment conducted at specific intervals to plan resident care) dated August 15, 2025, revealed Resident 3 was moderately cognitively impaired with a BIMS score of 11 (BIMS-Brief Interview for Mental Status is a tool to screen and identify the cognitive condition of long-term care residents. A score of 8-12 represents moderate cognitive impairment). Resident 3 required substantial to maximal assistance of staff for activities of daily living. A review of the plan of care initiated May 12, 2025, identified Resident 3 was at risk for falls due to decreased strength, endurance, generalized weakness, and hemiplegia. Planned interventions included: educate the resident and family to call for assistance before transferring, keep call light, food/fluids and personal belongings within reach, keep bed in low position (not the lowest), keep environment free of clutter, provide activities that promote exercise and strength, and therapy evaluation. Nursing documentation revealed the resident exhibited increased anxiousness, self-ambulation, physical and verbal aggression toward staff, disruptive behaviors such as turning off roommate's air mattress, pushing roommate's belongings onto the floor, yelling obscenities and racial slurs, and removing oxygen tubing. Nursing documentation and facility investigative documentation from August 2, 2025, to September 3, 2025, revealed Resident 3 experienced ten falls: 7 unwitnessed falls and 3 witnessed falls. The incidents were as follows: August 2, 2025, at 1:15 PM: Resident 3 was found sitting on floor in his room with bruising and raised area to the left side of his head. The resident stated he slipped when going to the bathroom. Neurological checks (at a minimum assessment of pulse, respiration, and blood pressure measurements; assessment of pupil size and reactivity; and equality of hand grip strength following a head injury) were initiated. August 7, 2025, at 10:00 AM: Resident 3 was found sitting on the left side of bed on his buttocks. The housekeeper witnessed the fall. Resident 3 reported he was sitting on the side of the bed and tried reaching for his soda on the floor and fell forward onto his knees. Incontinence care provided. August 8, 2025, at 2:10 AM: Resident 3 attempted to self-ambulate and his legs gave out. The resident reported he had a cramp in his leg and tried to walk it off. He stated his legs gave out and he fell. Neurological checks initiated. August 12, 2025, at 1:56 AM: Resident 3 was found sitting on the floor at the foot of his bed. Neurological checks initiated. The care plan revised to provide tap bell. August 24, 2025, at 7:30 AM: Resident 3 was found sitting on the floor in front of the nightstand. Noticeable red marks on his mid to upper right side of his back. Skin tears noted to the right lower extremity from scab removal from fall. Neurological checks initiated and treatment to right lower extremity provided. August 25, 2025, at 1:30 AM: Resident 3 was found sitting on the floor near his closet with both legs extended in front of him. The bedside table was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395651 If continuation sheet Page 3 of 6 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 09/17/2025 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 - Actual harm Residents Affected - Few knocked over. The resident reported that he did not want to wait. Neurological checks initiated. Resident encouraged and reminded to activate call bell for assistance. August 29, 2025, at 9:15 PM: Resident 3 found lying on the floor on the left side of the bed with his blanket covering him and holding his pillow. The resident reported he rolled out of bed. August 30, 2025, at 9:50 AM: Resident 3 attempted to stand near the wall/corner of hallway and fell on his right side. Small abrasion on his forehead. Neurological checks initiated. Care plan revised to offer toileting after meals. September 1, 2025, at 8:00 AM: Resident 3 heard yelling out and was found lying on the floor on his left side with his head towards the foot of the bed. The resident reported he slid out of bed. September 3, 2025, at 7:00 PM: Resident 3 observed throwing arms and legs over wheelchair armrest, fell as staff approached. The care plan revised September 3 to add fall mats while in bed; revised again September 4 to provide mattress on floor when agitated and unable to remain seated. Despite documented interventions, the facility failed to identify root causes or implement adequate enhanced supervision or individualized interventions. Resident 3 experienced repeated falls with injuries including bruising, abrasions, and skin tears.During an interview on September 17, 2025, at 3:45 PM, the Assistant Director of Nursing (ADON) confirmed that Resident 3 had multiple witnessed and unwitnessed falls and acknowledged that the facility's interventions were ineffective in preventing repeated falls. Clinical record review revealed that Resident 1 was admitted to the facility on [DATE], with diagnosis to include dementia, diabetes, and hypertension. A quarterly Minimum Data Set assessment dated [DATE], revealed a BIMS score of 9 (A score of 8 to 12 indicates moderate cognitive impairment). Resident 1 required two staff for transfers and toileting, was non-ambulatory, and used a wheelchair for mobility. A review of a plan of care for at risk for falling initiated March 21, 2025, revealed that staff were to keep the call bell within reach, keeping personal belongings within reach, implementing preventative fall interventions/devices, and a bariatric bed bolster overlay to the bed. A review of a care plan for ADL (activities of daily living) self-care performance deficit dated March 21, 2025, revealed the resident was an assist of two staff for bed mobility, toileting and a mechanical lift with assistance of two staff for transfers. Resident 1 was noted as non-ambulatory and utilized a wheelchair for ambulation. A review of facility investigation documentation and nursing documentation indicated between July 18, 2025, and September 2, 2025, Resident 1 sustained four falls:July 18, 2025, at 5:45 PM Resident 1 had an unwitnessed fall in his room. He was found on the floor next to his bed on his knees. He was assessed by nursing with no injury noted. He had nonskid socks on. The noted intervention to prevent future falls was to place a fall mat to the right side of the bed. There were no witness statements available at the time of the survey regarding the July 18, 2025, fall incident. There was no root cause analysis for this fall to determine the possible cause of the fall and to determine interventions to prevent future falls. August 4, 2025, at 4:05 AM Resident 1 had an unwitnessed fall from bed. He was found sitting on the floor leaning against the bed. He was on the left side of the bed. It appeared that he slid off the bed into a sitting position. The resident stated, I was going to shower. The resident was incontinent and was observed with dried BM (bowel movement). There was no documentation of the last time care was provided to this resident prior to the fall.Further review of the clinical record revealed no indication as to how this resident was toileted. The care plan-initiated March 21, 2025, for ADL care indicated that Resident 1 required the assistance of two staff for toileting, however, the plan did not include how often staff were to provide toileting care. There was no evidence that nursing assessed the resident for bowel and bladder continence and formulated a plan for toileting for this resident despite dependency on two staff for assistance.August 28, 2025, at 8:19 PM a review of facility investigative documentation and nursing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395651 If continuation sheet Page 4 of 6 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 09/17/2025 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 - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete documentation revealed Resident 1 had an unwitnessed fall from bed. He was observed lying on his back on the fall mat. The call bell was not activated. The head of the bed was noted to be at a 90-degree angle. Nursing assessed the resident. No injury was noted. There were no witness statements available at the time of the survey regarding the August 28, 2025, fall incident. There was no root cause analysis for this fall to determine the possible cause of the fall and to determine interventions to prevent future falls. A review of the care plan for at risk for falls revealed a new intervention dated August 29, 2025, to encourage Resident 1 to keep the head of the bed at 45 degrees or below at hour of sleep.On September 2, 2025, at 7:25 AM, facility investigative documentation and nursing documentation revealed the resident had another unwitnessed fall from bed. He was found naked on the right-side floormat. Nursing assessed him and noted he winced with pain upon minimal movement, though no signs of leg shortening or external rotation (potential signs and symptoms of possible hip fracture) were present. The physician was notified and ordered an X-ray of the left hip and pelvis. Documentation did not indicate if the resident was incontinent or the last time care had been provided. At 8:44 AM the resident complained of pain and staff administered Acetaminophen 650 mg. On September 3, 2025, at 1:32 PM, documentation noted an X-ray was to be obtained due to continued pain. At the time of this fall, interventions in place included a bed bolster overlay, a fall mat to the right side of the bed and keeping the head of the bed lower than 90 degrees when not eating. A new intervention was added to provide a stuffed animal for comfort.A review of a witness statement dated September 2, 2025, revealed Employee 12 (housekeeping) saw the resident on the floor while walking by the room and alerted the nurse. No additional witness statements were available. A review of the X-ray obtained September 2, 2025, indicated no fracture of the left hip. Documentation revealed the resident did not get out of bed again until September 6, 2025, at 8:39 PM. On September 5, 2025, at 5:15 PM, nursing documentation revealed the resident complained of leg pain during repositioning. The physician was contacted and ordered an X-ray of the left leg. Acetaminophen 650 mg was administered. On September 6, 2025, at 8:39 PM, documentation revealed the resident continued to complain of increasing pain. An X-ray of the left knee revealed an acute comminuted distal femoral fracture (a fracture in which the bone is broken into multiple pieces at the end of the femur near the knee). The physician was notified, and the resident was transferred to the hospital. Hospital documentation revealed the resident was evaluated with CT scans and X-rays that confirmed a left periprosthetic femur fracture. He was transferred to the trauma unit, admitted , and treated with pain management and therapy. The fracture was determined to be non-operative. The resident was discharged and readmitted to the facility on [DATE], at 4:31 PM. There was no evidence that Resident 1's falls were adequately investigated or that individualized fall prevention interventions, including ADL care needs, were developed and implemented to prevent falls. One of these falls resulted in a serious injury requiring hospitalization. During an interview on September 17, 2025, at 3:00 PM, the corporate nurse consultant, was unable to provide evidence that Resident 1's falls had been adequately investigated or that individualized fall interventions were implemented to prevent a fall with serious injury. 28 Pa Code 211.12 (d)(3)(5) Nursing services. Event ID: Facility ID: 395651 If continuation sheet Page 5 of 6 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 09/17/2025 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 review of clinical records, select facility policy, and staff interviews, it was determined that the facility failed to implement individualized, person-centered interventions identified in the care plan to address dementia-related behaviors for one of seven sampled residents (Resident 4). Findings include: A review of a facility policy for Dementia-Clinical Protocols, reviewed August 2025 revealed, for residents with a confirmed dementia diagnosis, the interdisciplinary team will develop and implement a resident-centered care plan designed to maximize remaining function and quality of life. Clinical record review revealed that Resident 4 was admitted to the facility on [DATE], with diagnosis to include dementia (a condition in which a person loses the ability to think, remember, learn, make decisions, and solve problems). A quarterly Minimum Data Set assessment (MDS a federally mandated standardized assessment conducted at specific intervals to plan resident care) dated September 3, 2025, revealed Resident 4 to be severely, cognitively impaired with a BIMS score of 3 (brief interview for mental status, is a cognitive screening tool that helps nursing staff measure how well residents can remember, process and recall information. A score of 0 to 7 indicates severe cognitive impairment) and required assistance of staff for activities of daily living.A care plan addressing behaviors, including yelling out and resistance with care, initiated July 24, 2024, directed staff to approach the resident in a calm manner to avoid frustration and escalation of behaviors. The care plan further instructed that if the resident became agitated and showed signs of escalation, staff were to stop the activity and re-approach the resident later to complete care when she was calmer. Review of facility investigative documentation and nursing notes dated August 30, 2025, at 7:30 PM, revealed Employee 5 (nurse aide) reported to Employee 6 (RN Supervisor) that she heard a noise from Resident 4's room that sounded like a muffled human voice. Employee 5 stated she suspected staff inside the room were holding their hand over Resident 4's mouth to prevent her from yelling. Employees 7 and 8 (nurse aides) were providing care to Resident 4 at the time. Both staff members were suspended and sent home pending the outcome of a facility investigation. A review of a witness statement dated August 30, 2025, revealed Employee 8 (nurse aide) stated, I did not cover Resident 4's mouth at any point. I understand the seriousness of this allegation, but it is not true. At the time of me changing Resident 4, she was very combative, screaming, and she was angry. A review of a witness statement dated August 30, 2025, from Employee 7 (nurse aide) indicated, I walked into Resident 4's room to assist Employee 8 (nurse aide) to put Resident 4 in her chair. At no time did either of us cover Resident 4's mouth. The resident was combative and screaming. At no point did anyone stop her from screaming. Although the facility's investigation did not substantiate abuse, there was no evidence that staff implemented the care-planned dementia interventions when Resident 4 became agitated. Specifically, there was no documentation or evidence that staff stopped the care and re-approached the resident at a later time as directed by the care plan. During an interview conducted on September 17, 2025, at 3:00 PM, the Assistant Director of Nursing and the Corporate Nurse Consultant confirmed that the individualized dementia care plan interventions were not implemented for Resident 4. 28 Pa Code 211.12 (d)(5) Nursing services. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395651 If continuation sheet Page 6 of 6