Inspection·February 5, 2026

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on review of the Resident Assessment Instrument User's Manual, clinical records, and staff interviews it was determined that the facility failed to make certain comprehensive Minimum Data Set (MDS- periodic assessment of care needs) assessments were accurate and fully completed for one of eight residents (Resident R21).Findings include:The Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual, which gives instructions for completing Minimum Data Set Assessments dated October 2025, indicated:Section B: Hearing, Speech and Vision, Question B0700: Makes Self Understood: Ability to express ideas and wants (consider both verbal and non-verbal expression) should be coded as 0 Understood, 1 Usually understood (difficulty communicating some words or finding thoughts but is able if prompted or given time), 2 Sometimes understood (ability is limited to making concrete requests), 3 Rarely/never understood. Section C: Cognitive Patterns, Question C0100: Should Brief Interview for Mental Status Be Conducted? (BIMS) should be coded as 0 if the resident is rarely/never understood, or it should be coded as 1 Repetition of 3 words meaning the assessment should be completed (Questions C0200-C0500) if the resident is at least sometimes understood. Section D: Mood, Question D0100 Should Resident Mood Interview Be Conducted? should be coded as 0 if the resident is rarely/never understood, and or it should be coded 1, and the assessment should be completed if the resident is at least sometimes understood. Resident R21 had a MDS completed on 4/21/25. Review of Section B: Hearing, Speech and Vision indicated Resident R21 is sometimes understood. Review of Section C: Cognitive Patterns, Question C0100 indicated that Resident R21 is coded as 1 repetition of 3 words, BIMS assessment was completed as Resident R21 scored 00, meaning the resident has severe cognitive decline. Review of Section D: Mood, Question D0100 indicated that Resident R21 is understood and the Resident Mood Interview assessment was not completed. Resident R21 had a MDS completed on 8/15/25. Review of Section B: Hearing, Speech and Vision indicated Resident R21 is usually understood. Review of Section C: Cognitive Patterns, Question C0100 indicated the Resident R21 is rarely/never understood and the BIMS assessment was not completed. Review of Section D: Mood, Question D0100 indicated that Resident R21 is rarely understood and the Resident Mood Interview assessment was not completed. Resident R21 had a MDS completed on 11/15/25. Review of Section B: Hearing, Speech and Vision indicated Resident R21 is usually understood. Review of Section C: Cognitive Patterns, Question C0100 indicated the Resident R21 is rarely/never understood and the BIMS assessment was not completed. Review of Section D: Mood, Question D0100 indicated that Resident R21 is understood and the Resident Mood Interview assessment was not completed. During an interview on 2/5/26, at 9:55 a.m. the Registered Nurse Assessment Coordinator (RNAC) confirmed the facility failed to make certain that comprehensive Minimum Data Set assessments were accurate and fully completed. During an interview on 2/5/26, at 10:55 a.m. the Nursing Home Administrator confirmed that the facility failed to make certain that comprehensive Minimum Data Set assessments were accurate and fully completed for one of eight residents (Resident R21). 28 Pa. Code: 211.5(f) Clinical Records. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395675 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 395675 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/05/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Waynesburg Nursing and Rehab 300 Center Avenue Waynesburg, PA 15370 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 0699 Provide care or services that was trauma informed and/or culturally competent. 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 ensure that residents received trauma-informed care to eliminate or mitigate triggers for residents with the diagnosis of post-traumatic stress disorder (PTSD - a mental and behavioral disorder that develops related to a terrifying event) for one of three residents reviewed (Resident R7).Findings include: Review of the facility policy, Trauma Informed Care dated 1/7/26 with a prior review date of 1/31/25, indicated that A trauma-informed approach to care delivery recognized the widespread impact and signs and symptoms of trauma in residents, and incorporates knowledge about trauma into care plan, policies, procedures and practices to avoid re-traumatization. Review of the facility policy, Care Plans, Comprehensive Person-Centered dated 1/7/26 with a prior review date of 1/31/25, indicated that A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, and functional needs is developed and implemented for each resident. Review of the clinical record indicated Resident R7 was admitted to the facility on [DATE]. Review of Resident R7's Minimum Data Set (MDS - a periodic assessment of care needs) dated 12/1/25, indicated the diagnoses of post-traumatic stress disorder (PTSD - a psychiatric disorder that may occur in persons that have witnessed a traumatic event causing intense, disturbing thoughts and feelings related to the experience), diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time), and anxiety. Section I6100 indicated PTSD is present. Review of Resident R7's facility diagnosis list indicated that the diagnosis of PTSD was added on 10/16/24. Review of Resident R7's care plan reveals a trauma care plan was not initiated until 2/2/26 during the full health survey. During an interview on 2/2/26, at 10:30 a.m. Resident R7 verbalized his history of being sexually victimized by predators for multiple years as a youth, while living in a group home. During an interview on 2/5/26, at approximately 10:45 a.m. the Nursing Home Administrator and the Director of Nursing confirmed that the facility failed to ensure that residents received trauma-informed care to eliminate or mitigate triggers for residents with the diagnosis of post-traumatic stress disorder. 28 Pa Code 201.24(e)(4) admission Policy.28 Pa Code 211.12(a)(d)(3)(5) Nursing Services.28 Pa. Code 211.16(a) Social Services. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395675 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 395675 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/05/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Waynesburg Nursing and Rehab 300 Center Avenue Waynesburg, PA 15370 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 0801 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Based on review of job descriptions, and staff interviews, it was determined that the facility failed to employ a full-time qualified dietary services manager in the absence of a full-time qualified dietitian for 12 of 12 months. (February 2025 - February 2026) Findings include:Review of facility policy Dietary Services Staffing reviewed 1/31/25 and 1/7/26, indicated the facility employs sufficient staff with the appropriate competencies and skill set to carry out the functions of the Food and Nutrition Services. The facility will employ a qualified dietitian or other clinically qualified nutrition professional on a full time, part time, or consultant basis. If a qualified dietician is not employed full-time, the facility will designate a person to serve as director of food services who is a certified dietary manager, certified food service manager, has an associate's degree in food service management or two or more years of experience in the position of food and nutrition services in a nursing facility.Review of the job description for Registered Dietician (RD) indicated one of the essential functions in this position is to plan, organize, coordinate, and evaluate the nutritional components of dietary services for the facility. The essential job function included the following:Assist in developing safety standards for the food and nutrition services department.- This position has supervisory responsibility for all dietary/kitchen personnel.Review of the job description for Dietary Supervisor indicated the dietary supervisor must demonstrate ability to organize, develop, and direct the overall operations of the Food Service Department in accordance with current state and local standards as well as established facility policies and procedures; assure that proper food quality and service is always provided. The essential job function included the following: - Assist in the development of, and participation in, programs designed for in-service education, on-the-job training, and orientation classes.- Inspect daily the food service area for compliance with current applicable regulations.- Develop and maintain a file of tested standard recipes.- Review the dietary requirements of each resident admitted to the facility and assist in planning of the resident's prescribed diet plan.- Check food production and food services to ensure proper procedures are always maintained.Education/Experience needed for the Dietary Supervisor position included: - High school diploma or equivalent required. - Successful completion of a reputable course in food service operation preferred. - College degree in culinary art and management.- Previous Experience in food service, preparation, and management.- Previous experience in institutional food service preferred During an interview on 2/4/26, at 8:35 a.m. Dietary Manager Employee E2 stated she completed her SERV Safe certification. she did not complete a Certified Dietary Manager (CDM) course. She started the current position on 12/28/25. She stated that she currently did not have her CDM (Certified Dietary Manager) and was not currently enrolled in the program.Review of the facility employee files indicated the following:Employee E3 was hired 8/10/18, as a cook. Employee E3 accepted the position of Dietary Supervisor 11/7/23. His employee file did not include proof that he was qualified for the position, or a signed job description. Employee E3 left the facility's employ on 6/9/25.- Employee E5 was offered the Certified Dietary Manager position on 5/27/25. Employee E5 employee file failed to reveal proof she was qualified for the position as CDM or was enrolled in a CDM course. Employee E5 left the facility's employ on 7/30/25.Employee E2 was offered the Certified Dietary Manager position on 8/25/25. Employee E2 employee file failed to reveal proof she was qualified for the position of CDM or was enrolled in a CDM course.During an interview on 2/4/26, at 9:20 a.m. Registered Dietician Employee E1 stated she is shared between two facilities. She works at the facility three days a week, and at a different facility two days a week. She confirmed she provides part-time services to the residents.During an interview (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395675 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 395675 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/05/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Waynesburg Nursing and Rehab 300 Center Avenue Waynesburg, PA 15370 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 0801 Level of Harm - Minimal harm or potential for actual harm on 2/4/26, at 2:00 p.m. the Nursing Home Administrator confirmed there was not a full-time dietitian employed at the facility and that the facility did not employ a qualified dietary manager in the absence of a full-time dietitian. 28 Pa. Code 201.18(b)(3) Management. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395675 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 395675 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/05/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Waynesburg Nursing and Rehab 300 Center Avenue Waynesburg, PA 15370 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility documents, clinical record review, and resident and staff interview, it was determined that the facility failed to complete a significant change on the Minimum Data Set (MDS - core set of screening, clinical, and functional status data elements, including common definitions and coding categories, which form the foundation of a comprehensive assessment for all residents of nursing homes certified to participate in Medicare or Medicaid) for one of three residents (Resident R9).Findings include:Review of facility policy Coordination of Hospice Services reviewed 1/31/25 and 1/7/26, indicated when a resident chooses to receive hospice care and services, the facility will coordinate and provide care in cooperation with hospice.Review of the clinical record revealed Resident R9 was admitted to the facility on [DATE], with diagnoses that included cancer, high blood pressure, and depression.A review of a physician's order dated 5/21/21, indicated that Resident R18 was admitted to hospice services. Review of a physician's order dated 9/26/25, indicated admit to hospice.Review of the MDS dated [DATE], failed to indicate Resident R9 was receiving hospice care and services.A review of the communication between the facility and the hospice service, failed to reveal any documentation of nurse or home health aide visits to Resident R18. A review of the care plan dated 9/27/25, indicated the hospice Resident R9 was receiving hospice care and services.During an interview on 2/5/25, at 9:20 p.m. Registered Nurse Assessment Coordinator (RNAC) Employee E4 confirmed the MDS dated [DATE], failed to indicate Resident R9 was receiving hospice care and services and confirmed the facility failed to ensure provision of ordered hospice services for two residents. 28 PA Code: 211.10(c) Resident Care Policies28 PA Code: 211.10(d) Resident Care Policies28 PA Code: 201.18 (b)(1)(e)(1) Management. 28 PA Code: 211.12 (d)(2) Nursing Services. 28 PA Code: 211.12 (d)(1)(3)(5) Nursing Services. Event ID: Facility ID: 395675 If continuation sheet Page 6 of 6