Inspection·May 13, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few orders for 400/80 milligrams of Bactrim (an antibiotic) twice daily for 10 days with probiotic and to initiate contact precautions. A wound note for Resident 2, dated May 8, 2024, revealed that the resident developed a rash on May 7, 2024, possibly due to the Bactrim and the antibiotic was changed. Physician's orders were obtained for the resident to receive Doxycycline 100 mg two times a day for 10 days. Observations of Resident 2 on May 13, 2024, at 9:19 a.m. revealed that the resident lying in bed, an isolation station was on the door, and there was a sign outside of the room indicating the resident was on contact precautions. There was no documented evidence that a care plan was developed to address Resident 2's need for contact precautions and antibiotic therapy. Interview with the Infection Preventionist on May 13, 2024, at 2:13 p.m. confirmed that there was no care plan in place to address Resident 2's need for contact precautions and antibiotic therapy and there should have been. 28 Pa. Code 201.24(e)(4) admission Policy. 28 Pa. Code 211.12(d)(5) Nursing Services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395652 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 395652 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgeview Healthcare and Rehabilitation Center 30 Fourth Avenue Curwensville, PA 16833 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on review of established infection control guidelines, facility policies, documents, residents' clinical records, and employee files, as well as observations and staff interviews, it was determined that the facility failed to follow infection control guidelines from the Centers for Medicare/Medicaid Services (CMS) and the Centers for Disease Control (CDC) to reduce the spread of infections and prevent cross-contamination for three of six residents reviewed (Residents 4, 5, 6). Residents Affected - Few Findings include: CDC guidance on isolation precautions for MRSA residents contained in Implementation of Personal Protective Equipment (PPE) use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (MDROs), dated July 12, 2022, indicates that multidrug-resistant organism (MDRO) transmission is common in skilled nursing facilities, contributing to substantial resident morbidity and mortality and increased healthcare costs. Enhanced Barrier Precautions (EBP) are an infection control intervention designed to reduce transmission of resistant organisms that employs targeted gown and glove use during high contact resident care activities. CMS updated its infection prevention and control guidance effective April 1, 2024. The recommendations now include the use of EBP during high-contact care activities for residents with chronic wounds or indwelling medical devices, regardless of their MDRO status, in addition to residents who have an infection or colonization with a CDC-targeted or other epidemiologically important MDRO when contact precautions do not apply. An annual Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 4, dated April 7, 2024, revealed that the resident was clearly understood and could understand others, required assistance with care needs, and had a feeding tube (a mechanical device surgically implanted into the stomach to provide nutrition, fluids and medications to a person who is unable to eat or drink by mouth). Physician's orders for Resident 4, dated October 15, 2019, included an order for resident to receive one can (240 cc bolus) of Osmolite 1.5 four times daily via the feeding tube for maintaining caloric and protein intake. Flush and clamp the extension tube after feeding. Physician's orders for Resident 4, dated May 11, 2021, included orders to change his Micro Tube 16 French feeding tube as needed for dislodgement/blockage, add five milliliters (ml) of sterile water to the balloon, flush his feeding tube with 60 ml of water before and after medication administration, cleanse the area around the feeding tube with soap and water every day shift, and apply drain dressing (specialized wound gauze used around tubes, drains and catheters) daily and as needed. Physician's orders, dated October 13, 2022, included an order to flush the feeding tube with 240 ml of water four times daily. Observations of Resident 4 on May 13, 2024, at 1:18 p.m. revealed that the resident had no signage at the entrance to his room or in his room to indicate that infection control measures for EBP were in place related to his feeding tube. Interview with the Infection Preventionist on May 13, 2024, at 3:00 p.m. confirmed that Resident 4 should have been on EBP, and he was not. She confirmed she was unsure of the new guidance for EBP involving feeding tubes, effective April 1, 2024, per CMS and CDC guidelines, and confirmed that she was not following the new regulatory recommendations and she should have been. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395652 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 395652 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgeview Healthcare and Rehabilitation Center 30 Fourth Avenue Curwensville, PA 16833 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An admission MDS assessment for Resident 5, dated April 5, 2024, revealed that the resident was understood, understands what is being said, required assistance with care needs, and had an indwelling foley catheter (a thin, flexible tube inserted into the bladder to drain urine from the bladder). A physician's order for Resident 5, dated April 3, 2024, included orders to change the foley catheter bag every four weeks on Thursdays and as needed and to every four weeks on Wednesdays on day shift and as needed for obstruction/dislodgement. Observations of Resident 5 on May 13, 2024, at 1:36 p.m. revealed that the resident had no signage at the entrance to his room or in his room to indicate infection control measures for EBP were in place related to his indwelling catheter. Interview with the Infection Preventionist on May 13, 2024, at 3:00 p.m. confirmed that Resident 5 should have been on EBP, and he was not. She confirmed she was unsure of the new guidance for EBP involving foley catheters, effective April 1, 2024, per CMS and CDC guidelines, and confirmed that she was not following the new regulatory recommendations and she should have been. A quarterly MDS assessment for Resident 6, dated March 21, 2024, revealed that the resident was usually understood, usually understands what is being said, and required assistance with care needs. Observations of Resident 6 on May 13, 2024, at 9:12 a.m. revealed that the resident had an isolation station (contains PPE) on her door with signage outside her door for precautions. Observations on May 13, 2024, at 1:26 p.m. revealed that the isolation station was no longer on the resident's door and signage was removed. Interview with the Infection Preventionist on May 13, 2024, at 2:13 p.m. confirmed that Resident 6 was on precautions related to a multidrug resistant organism (MDRO) (a germ that is resistant to many antibiotics making treatment difficult) in her urine and the precautions were removed this day and the isolation station was removed. She stated she is still learning the new guidance for EBP effective April 1, 2024, per CMS and CDC guidelines, and after reviewing it more, she confirmed that the resident should have remained on EBP due to her history of MDRO in the urine. 28 Pa. Code 201.14(a) Responsibility of Licensee. 28 Pa. Code 201.18(e)(1) Management. 28 Pa. Code 211.12(d)(1)(5) Nursing Services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395652 If continuation sheet Page 4 of 4