Health inspection·March 19, 2025

F 0660 Plan the resident's discharge to meet the resident's goals and needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical record review, and staff interview, it was determined that the facility failed to provide discharge planning that focuses on the resident's discharge goals and preparation of resident to be active partners in the discharge planning process that focuses on the resident's discharge planning and process for one of three residents (Resident R4). Residents Affected - Few Findings include: Review of the clinical record indicated Resident R4 was admitted to the facility on [DATE]. Review of Resident R4's Minimum Data Set (MDS - a periodic assessment of care needs) dated 11/13/24, indicated diagnoses of hyperlipidemia (high levels of fat in the blood), dementia (a group of symptoms that affects memory, thinking and interferes with daily life), and chronic pain syndrome. Review of a physician order dated 12/27/24, indicated to discharge resident home with meds and home care. Resident verbalizes understanding. Review of a Social Services progress note dated 12/27/24, stated, Resident discharged to her daughter's home. DME (Durable Medical Equipment, products prescribed by a health care provider for everyday or extended use) ordered, bari electric bed delivered to daughter's home. Patient was picked up by access to take her home to her daughter's residence. Review a Discharge Summary completed by a Certified Registered Nurse Practitioner dated 12/27/24, stated, Discharge Plan and Follow Up: HH (home health), physical therapy, occupational therapy, Registered Nurse. Follow up with PCP (primary care physician). Review of a Resident Representative Concern dated 2/25/25, indicated the following: Patient was discharged to home on [DATE] and has still not received in home services. Staff failed to submit paperwork needed to start in home services. During an interview on 3/18/25, at 2:59 p.m. the Nursing Home Administrator (NHA) confirmed that the facility was able to provide documentation that home health services had been set up by the facility for Resident R4's discharge on [DATE]. During an interview on 3/18/25, at 2:59 p.m. the NHA confirmed that the facility failed to implement to implement a discharge plan for Resident R4 as required. 28 Pa. Code 201.18 (b)(1) Management. Page 1 of 11 395666 395666 03/19/2025 Spring Hill Rehabilitation and Nursing Center 2170 Rhine Street Pittsburgh, PA 15212

F 0660 28 Pa. Code 211.10 (c) Resident care policies. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12 (c)(d)(3)(5) Nursing services. Residents Affected - Few 395666 Page 2 of 11 395666 03/19/2025 Spring Hill Rehabilitation and Nursing Center 2170 Rhine Street Pittsburgh, PA 15212

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical record review, and staff interview, it was determined that the facility failed to provide Activity of Daily Living (ADL) assistance for two of four residents (Residents R2 and R3). Residents Affected - Few Findings include: Review of facility policy Activities of Daily Living dated 12/9/24, indicated the facility will, based on the resident's comprehensive assessment and consistent with the resident's needs and choices, ensure a resident's abilities in ADLs do not deteriorate unless deterioration is unavoidable. Care and services will be provided for the following activities of daily living: - Bathing, dressing, grooming, and oral care; - Transfer and ambulation; - Toileting; - Eating to include meals and snacks; and - Using speech, language or other functional communication systems A resident who is unable to carry out activities of daily living will receive the necessary services to maintain good nutrition, grooming, and personal and oral hygiene. Review of the clinical record indicated Resident R2 was admitted to the facility on [DATE]. Review of Resident R2's Minimum Data Set (MDS - a periodic assessment of care needs) dated 3/3/25, indicated diagnoses of high blood pressure, hemiplegia (paralysis on one side of the body), and Chronic Obstructive Pulmonary Disease (COPD, a group of progressive lung disorders characterized by increasing breathlessness). Review of a physician order dated 10/9/24, indicated biweekly shower every Wednesday and Saturday every day shift. Review of a Resident Representative Concern dated 1/29/25, indicated the following: Patients are not being bathed regularly. My loved one had greasy hair and dirty fingernails. Review of Resident R2's January 2025 shower documentation indicated no shower or bath was provided on: 1/1/25, 1/11/25, 1/15/25, 1/18/25, and 1/29/25. Review of Resident R2's February 2025 shower documentation indicated no shower or bath was provided on: 2/5/25, 2/8/25, and 2/26/25. Review of the clinical record indicated Resident R3 was admitted to the facility on [DATE]. Review of Resident R3's MDS dated [DATE], indicated diagnoses of high blood pressure, anemia (too little iron in the blood), and age-related physical debility. 395666 Page 3 of 11 395666 03/19/2025 Spring Hill Rehabilitation and Nursing Center 2170 Rhine Street Pittsburgh, PA 15212

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of a physician order dated 4/11/23, indicated biweekly showers every Wednesday and Saturday evening shift. Review of Resident R3's January 2025 shower documentation indicated no shower or bath was provided on: 1/8/25, 1/18/25, 1/22/25, 1/25/25. 1/11/25, and 1/15/25, were documented Not Applicable. No further documentation was available to explain why bathing was not applicable for Resident R3. Review of Resident R3's February 2025 shower documentation indicated no shower or bath was provided on: 2/1/25, 2/12/25, and 2/19/25. 2/8/25, 2/15/25, and 2/26/25, were documented Not Applicable. No further documentation was available to explain why bathing was not applicable for Resident R3. Review of Resident R3's March 2025 shower documentation indicated no shower or bath was provided on: 3/5/25, 3/12/25, and 3/15/25. 3/1/25, was documented Not Applicable. No further documentation was available to explain why bathing was not applicable for Resident R3. During an interview on 3/18/25, at 3:24 p.m. the Director of Nursing confirmed that the facility failed to provide activities of daily living assistance for two residents as required. 28 Pa. Code: 211.10(a)(c)(d) Resident care policies. 28 Pa. Code: 211.12(c)(d)(1)(2)(3)(5) Nursing services. 395666 Page 4 of 11 395666 03/19/2025 Spring Hill Rehabilitation and Nursing Center 2170 Rhine Street Pittsburgh, PA 15212

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 a review of facility policy, clinical record, and staff interview, it was determined that the facility failed to provide medications as ordered by the physician for one of five residents (Resident R5). Residents Affected - Few Findings include: Review of facility policy Medication Administration dated 12/9/24, indicated medications are administered by licensed nurses, or other staff who are legally authorized to do so in this state, as ordered by the physician and in accordance with professional standards of practice, in a manner to prevent contamination or infection. Sign MAR (medication administration record) after administered. Review of the clinical record indicated Resident R5 was admitted to the facility on [DATE]. Review of Resident R5's Minimum Data Set (MDS - a periodic assessment of care needs) dated 2/5/25, indicated diagnoses of high blood pressure, anxiety, and depression. Review of a physician order dated 3/31/24, indicated to administer Lipitor (used to treat high cholesterol) 40 mg (milligrams) by mouth every bedtime. Review of Resident R5's January 2025 MAR indicated the medication was not administered on 1/19/25. Review of a physician order dated 11/22/24, indicated to administer Trazodone 150 mg by mouth at bedtime for anxiety. Review of Resident R5's January 2025 MAR indicated the medication was not administered on 1/19/25. Review of a physician order dated 1/11/25, indicated to administer Methocarbamol 500 mg by mouth two times a day for neck pain/stiffness. Review of Resident R5's January 2025 MAR indicated the medication was not administered on 1/19/25, at 9 p.m. Review of a physician order dated 1/11/25, indicated to administer Sennosides 17.2 mg by mouth two times a day for constipation. Review of Resident R5's January 2025 MAR indicated the medication was not administered on 1/19/25, at 9 p.m. Review of a physician order dated 1/11/25, indicated to administer Voltaren Gel 1% 2 grams apply to right knee topically two times a day for pain. Review of Resident R5's January 2025 MAR indicated the medication was not administered on 1/19/25, at 9 p.m. Review of Resident R5's March 2025 MAR indicated the medication was not administered on 3/14/25, at 9 a.m. 395666 Page 5 of 11 395666 03/19/2025 Spring Hill Rehabilitation and Nursing Center 2170 Rhine Street Pittsburgh, PA 15212

F 0684 Level of Harm - Minimal harm or potential for actual harm Review of a physician order dated 1/11/25, indicated to administer Gabapentin 400 mg by mouth three times a day for headaches related to migraine. Review of Resident R5's January 2025 MAR indicated the medication was not administered on 1/11/25, at 10 p.m. Residents Affected - Few Review of a physician order dated 1/12/25, indicated to administer Gabapentin 400 mg by mouth three times a day for headaches related to migraine. Review of Resident R5's January 2025 MAR indicated the medication was not administered on 1/19/25, at 9 p.m. and on 1/22/25, at 2:30 p.m. Review of Resident R5's March 2025 MAR indicated the medication was not administered on 3/7/25, at 2:30 p.m., 3/8/25, at 2:30 p.m., 3/14/25, at 2:30 p.m., and 3/18/25, at 2:30 p.m. Review of a physician order dated 1/11/25, indicated to administer Tylenol 1000 mg by mouth three times a day for pain. Review of Resident R5's January 2025 MAR indicated the medication was not administered on 1/11/25, at 10 p.m. and 1/19/25, at 10 p.m. Review of Resident R5's February 2025 MAR indicated the medication was not administered on 2/5/25, at 6 a.m. and 2/8/25, at 6 a.m. Review of Resident R5's March 2025 MAR indicated the medication was not administered on 3/5/25, at 6 a.m., 3/7/25, at 2 p.m., 3/14/25, at 2 p.m. and 10 p.m. and 3/18/25, at 2 p.m. Review of a physician order dated 1/8/25, indicated to administer Nurtec 75 mg by mouth every 48 hours related to migraine. Review of Resident R5's January 2025 MAR indicated the medication was not administered on 1/22/25. Review of a physician order dated 1/8/25, indicated to administer a Scopolamine 1 mg patch, apply transdermally every 72 hours for nausea and remove per schedule. Review of Resident R5's March 2025 MAR indicated the medication was not administered on 3/18/25, at 2:30 p.m. During an interview on 3/19/25, at 3:55 p.m. the Director of Nursing confirmed that the facility failed to provide medications as ordered by the physician for one of five residents as required. 28 Pa. Code 201.18 (b)(1) Management. 28 Pa. Code 211.10 (c)(d) Resident Care policies. 28 Pa. Code 211.12 (d)(1)(2)(3)(5) Nursing services. 395666 Page 6 of 11 395666 03/19/2025 Spring Hill Rehabilitation and Nursing Center 2170 Rhine Street Pittsburgh, PA 15212

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interviews, and clinical record review, it was determined that the facility failed to provide appropriate respiratory care for two of four residents (Residents R1 and R2). Residents Affected - Few Findings include: Review of facility policy Oxygen Concentrator dated 12/9/24, indicated to change oxygen tubing and mask/cannula weekly and as needed if it becomes soiled or contaminated. Review of the clinical record indicated Resident R1 was admitted to the facility on [DATE]. Review of Resident R1's Minimum Data Set (MDS - a periodic assessment of care needs) dated 2/27/25, indicated diagnoses of high blood pressure, hyperlipidemia (high levels of fat in the blood), and obstructive sleep apnea. Review of a physician order dated 6/4/24, indicated to change oxygen tubing weekly and label each component with date and initials every night shift every Sunday. Review of a physician order dated 6/14/24, indicated to administer oxygen at 2 liters/minute via nasal cannula (a lightweight tube that delivers oxygen into the nostrils) continuously. During an observation on 3/18/25, at 10:45 a.m. Resident R1 was observed receiving oxygen via a nasal cannula. The date written on the nasal cannula tubing was 2/17. During an interview on 3/18/25, at 10:54 a.m. Registered Nurse RN Employee E1 confirmed the above observation and confirmed that the facility failed to provide appropriate respiratory care for Resident R1. Review of the clinical record indicated Resident R2 was admitted to the facility on [DATE]. Review of Resident R2's MDS dated [DATE], indicated diagnoses of high blood pressure, hemiplegia (paralysis on one side of the body), and Chronic Obstructive Pulmonary Disease (COPD, a group of progressive lung disorders characterized by increasing breathlessness). Review of a physician order date 6/12/24, indicated to administer oxygen at 2 liters via nasal cannula continuously. Review of a physician order dated 6/16/24, indicated to change oxygen tubing weekly and label each component with date and initials every night shift every Sunday. During an observation on 3/18/24, at 9:30 a.m. Resident R2 was observed receiving oxygen via a nasal cannula. The date written on the nasal cannula tubing was 3/3/25. During an interview on 3/18/25, at 9:30 a.m. Licensed Practical Nurse (LPN) Employee E3 confirmed the above observation and confirmed that the facility failed to provide appropriate respiratory care for Resident R2. 395666 Page 7 of 11 395666 03/19/2025 Spring Hill Rehabilitation and Nursing Center 2170 Rhine Street Pittsburgh, PA 15212

F 0695 28 Pa. Code: 201.14(a) Responsibility of licensee. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code: 211.10(c)(d) Resident care policies. 28 Pa. Code 211.12(d)(1)(2)(3)(5) Nursing services. Residents Affected - Few 395666 Page 8 of 11 395666 03/19/2025 Spring Hill Rehabilitation and Nursing Center 2170 Rhine Street Pittsburgh, PA 15212

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical record review, and interviews with staff, it was determined that the facility failed to ensure that residents are free of significant medication errors for one of five residents reviewed (Resident R5). Residents Affected - Few Findings include: Review of facility policy Medication Administration dated 12/9/24, indicated medications are administered by licensed nurses, or other staff who are legally authorized to do so in this state, as ordered by the physician and in accordance with professional standards of practice, in a manner to prevent contamination or infection. Sign MAR (medication administration record) after administered. Review of the clinical record indicated Resident R5 was admitted to the facility on [DATE]. Review of Resident R5's Minimum Data Set (MDS - a periodic assessment of care needs) dated 2/5/25, indicated diagnoses of hypertension (high blood pressure), anxiety, and depression. Review of a physician order dated 1/11/25, indicated to administer Carvedilol 12.5 mg (milligrams) by mouth two times day for hypertension. Review of Resident R5's January 2025 MAR indicated the medication was not administered on 1/19/25 at 9 p.m. Review of Resident R5's March 2025 MAR indicated the medication was not administered on 3/7/25, at 9 a.m. and 3/14/25, at 9 a.m. Review of a physician order dated 1/11/25, indicated to administer Hydralazine 50 mg by mouth four times a day for hypertension. Review of Resident R5's January 2025 MAR indicated the medication was not administered on 1/13/25, at 6 a.m. Review of Resident R5's February 2025 MAR indicated the medication was not administered on 2/5/25, at 6 a.m., and 2/8/25, at 12 a.m. and 6 a.m. Review of Resident R5's March 2025 MAR indicated the medication was not administered on 3/5/25, at 6 a.m., 3/14/25, at 12 p.m., and 3/18/25, at 12 p.m. During an interview on 3/19/25, at 3:55 p.m. the Director of Nursing confirmed that the facility failed to ensure that residents are free of significant medication errors for one of five residents as required. 28 Pa. Code 211.9 (k)(l)(1)(2) Pharmacy services. 28 Pa. Code 211.10(c)(d) Resident care policies. 28 Pa. Code: 211.12(d)(1)(3)(5)Nursing services. 395666 Page 9 of 11 395666 03/19/2025 Spring Hill Rehabilitation and Nursing Center 2170 Rhine Street Pittsburgh, PA 15212

F 0803 Level of Harm - Minimal harm or potential for actual harm Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on menu, observation, and staff interview, it was determined that the facility failed to follow the portion sizes for one of one meal observed. Residents Affected - Few Findings include: A review of the menu indicated that the menu for lunch was as follows: 3 oz Beef Tips/gravy 4 oz Rice 4 oz Caramelized Carrots 4 oz Gelatin During an observation of tray line in the main kitchen on 3/18/25, at 11:45 a.m., it was revealed that the following was being served: 4 oz ladle Beef Tips/gravy 2 oz Minced Beef 4 oz Rice Unlabeled pasta scoop for carrots 2 oz Minced Carrots During an interview on 3/18/25, at 12:15 p.m. Dietary Manager Employee E1 confirmed that tray line was using the wrong portion scoops to serve the meal. 28 Pa. Code: 211.6(a)(b) Dietary services 395666 Page 10 of 11 395666 03/19/2025 Spring Hill Rehabilitation and Nursing Center 2170 Rhine Street Pittsburgh, PA 15212

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations and staff interview, it was determined that the facility failed to properly label and date food products in the walk in freezer and dry storage in the designated main kitchen and failed to maintain sanitary conditions which created the potential for cross contamination (Main Kitchen). Findings include: During an observation of the main designated kitchen on 3/18/25, at 9:05 a.m. the following was observed: -2 bags of frozen biscuits-no label -1 bag of chicken nuggets-no label -1 bag of french fries- no label -4 bags of cheerios-no label -3 bags of rice krispies- no label -3 bags of fruit loops- no label -4 bags of corn flakes- no label During an trayline observation of the main designated kitchen on 3/18/25, at 11:45 a.m. the following was observed: -Cook Employee E4 holding clean plates against his shirt two times -Cook Employee E5 touched the convection oven and stove, then touched hamburger buns without changing his gloves During an interview on 3/18/25 at 12:15 p.m. Dietary Manger Employee E2 confirmed that the facility failed to properly label and date food products and maintain proper infection control which created the potential for cross contamination and food borne illness. 28 Pa. Code: 201.18(b)(1) Management. 28 Pa. Code: 211.6(f) Dietary services. 28 Pa. Code: 201.14(a) Responsibility of licensee. 395666 Page 11 of 11