Inspection·January 16, 2025

F 0623 Level of Harm - Potential for minimal harm Residents Affected - Some had not submitted any transfer notices to the office of the stated ombudsman for September, October, and December 2024, until January 14, 2025, after it was brought to facility staff's attention during the survey process. Interview with Resident 63 on January 13, 2025, at 12:12 PM revealed that he was hospitalized with symptoms that were questionably indicative of a stroke (cerebrovascular accident, interruption of blood flow or bleeding in the brain), but he returned to the facility after his hospitalization. Clinical record review for Resident 63 revealed nursing documentation dated September 28, 2024, at 6:55 PM that indicated Resident 63 was diaphoretic (sweating), had an altered mental status, reported that he was going to pass out, and that he wanted to go to the hospital. Nursing documentation dated September 28, 2024, at 7:24 PM indicated that Resident 63 went to the hospital via an ambulance. Nursing documentation dated September 30, 2024, at 12:45 PM indicated that Resident 63 returned to the facility from the hospital. Nursing documentation dated October 12, 2024, at 12:24 PM indicated that Resident 63 was calling for help, had an elevated temperature, increased confusion, and agreed to transfer to the hospital for evaluation. Nursing documentation dated October 12, 2024, at 12:47 PM revealed that Resident 63 left the facility via an ambulance in route to the hospital. Nursing documentation dated October 12, 2024, at 1:25 PM revealed that staff spoke to Resident 63's sister to inform her of his transfer to the emergency department; however, the documentation did not indicate that staff forwarded a written notice that included the required contents to Resident 63's sister (resident representative). Nursing documentation dated October 12, 2024, at 6:11 PM indicated that the emergency department admitted Resident 63 to the hospital. The surveyor requested evidence that facility staff provided written notices of transfer to Resident 63, Resident 63's representative (sister), and the State Ombudsman when he was hospitalized on [DATE], and October 12, 2024, during an interview with the Nursing Home Administrator and the Director of Nursing on January 14, 2025, at 1:30 PM, and January 15, 2025, at 12:28 PM and 2:07 PM. The facility failed to provide evidence that Resident 63, his responsible party, or the State Ombudsman received the required written notices of transfers for the above hospitalizations. 28 Pa. Code 201.14 (a) Responsibility of license 28 Pa. Code 201.29(a) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395683 If continuation sheet Page 2 of 17 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 395683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Rehabilitation and Healthcare 918 Main Street Laporte, PA 18626 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 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. Based on resident interview, clinical record review, and staff and resident interview, it was determined that the facility failed to provide written notice regarding the facility's bed-hold policy for one of five residents reviewed for hospitalization concerns (Resident 63). Findings include: Interview with Resident 63 on January 13, 2025, at 12:12 PM revealed that he was hospitalized with symptoms that were questionably indicative of a stroke (cerebrovascular accident, interruption of blood flow or bleeding in the brain), but he returned to the facility after his hospitalization. Clinical record review for Resident 63 revealed nursing documentation dated October 12, 2024, at 12:24 PM that indicated Resident 63 was calling for help, had an elevated temperature, increased confusion, and agreed to transfer to the hospital for evaluation. Nursing documentation dated October 12, 2024, at 12:47 PM revealed that Resident 63 left the facility via an ambulance in route to the hospital. Nursing documentation dated October 12, 2024, at 1:25 PM revealed that staff spoke to Resident 63's sister to inform her of his transfer to the emergency department. The documentation did not indicate that staff forwarded written information to Resident 63's sister (resident representative) regarding the facility's bed-hold policy. Nursing documentation dated October 12, 2024, at 6:11 PM indicated that the emergency department admitted Resident 63 to the hospital. Review of a Bed Hold Notice (document that the facility utilizes to communicate the duration of the bed-hold policy) dated October 12, 2024, revealed that staff documented, Resident unable to sign, on October 14, 2024, on the signature line designated for the resident or resident representative name. The notice stipulated both that Resident 63 did not wish to authorize the facility to retain his bed and that he or his representative wanted to hold his bed for 15 days. The document did not indicate that staff forwarded written information to Resident 63's sister (resident representative) regarding the facility's bed-hold policy. The surveyor requested evidence that facility staff provided written information to Resident 63 and Resident 63's representative (sister) regarding the facility's bed-hold policy at the time of his October 12, 2024, hospitalization during an interview with the Nursing Home Administrator and the Director of Nursing on January 14, 2025, at 1:30 PM, and January 15, 2025, at 12:28 PM and 2:07 PM. The facility failed to provide evidence that Resident 63's responsible party received written information related to holding beds during absences from the facility within 24 hours of his emergency transfer. 28 Pa. Code 201.14(a) Responsibility of license 28 Pa. Code 201.29(a) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395683 If continuation sheet Page 3 of 17 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 395683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Rehabilitation and Healthcare 918 Main Street Laporte, PA 18626 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and staff interview, it was determined that the facility failed to ensure a complete and accurate Minimum Data Set (MDS) assessment for one of 22 residents reviewed (Resident 34). Residents Affected - Few Findings include: Review of Resident 34's clinical record revealed that the facility admitted her with a diagnosis of Schizophrenia. Further review revealed a PASRR (Pennsylvania Preadmission Screening Resident Review Identification Level 1 form) completed on May 22, 2019, that indicated the resident had a mental health condition or suspected mental illness that may lead to a chronic disability and the resident met the criteria (positive screen) to have a PASRR Level 2 evaluation done. A completed PASRR Level 2 by the Pennsylvania Department of Human Services Office on Mental Health and Substance abuse services dated August 1, 2019, indicated Resident 34 had evidence of a Mental Health condition that met the criteria, and the resident was determined as eligible for Mental Health services. Review of Resident 34's last comprehensive (annual) MDS (minimum Data set - an assessment completed at periodic intervals of time to determine resident care needs) completed on May 6, 2024, revealed facility staff assessed the resident as not being considered by the state level II PASRR process to have a serious mental illness and/or intellectual disability or a related condition. The above information was reviewed with the Nursing Home Administrator and Director of Nursing on January 15, 2025, at 2:00 PM. The Nursing Home Administrator confirmed on January 16, 2025, at 9:38 AM the MDS noted above for Resident 34 was not accurately completed and the facility submitted a corrected MDS after the information was reviewed as noted above. 28 Pa. Code 211.5(f)(ix) Medical records 28 Pa. Code 211.12(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395683 If continuation sheet Page 4 of 17 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 395683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Rehabilitation and Healthcare 918 Main Street Laporte, PA 18626 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 0657 Level of Harm - Minimal harm or potential for actual harm Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on clinical record review and resident, family, and staff interview, it was determined that the facility failed to revise residents' care plans for three of 21 residents reviewed (Residents 79, 81, and 86). Residents Affected - Few Findings include: Interview with Resident 79's daughter on January 13, 2025, at 10:29 AM indicated that she believed that her mother could become verbally and/or physically abusive to staff when she gets anxious. She stated that she believed that her mother has an anxious response when approached by two staff to perform care and that she suggested to the facility that her mother receive care by one staff. Resident 79's daughter also indicated that she provides soda for staff to give her mother to provide caffeine since she no longer smokes cigarettes or drinks coffee to lessen her behaviors and improve her compliance with care. Clinical record review for Resident 79 revealed social services documentation dated November 26, 2024, at 1:39 PM that during a care plan meeting, Resident 79's daughter expressed concerns that Resident 79 may be more combative in the morning with care because she no longer smokes cigarettes or drinks coffee. Resident 79's daughter provided diet soda for Resident 79 to have in the morning to provide some caffeine. Resident 79's daughter also suggested attempting care with only one staff member to see if Resident 79 would be less combative. The documentation indicated that staff updated resident 79's care plan. Plans of care developed by the facility to record Resident 79's problem areas, goals, and interventions revealed areas that addressed Resident 79's impaired cognitive function related to dementia (decline in cognitive function that affects memory, thinking, judgement, and behavior); psychotropic medication use to treat dementia, depression, and anxiety; behaviors that include physical aggression and resistance to care; and communication deficits due to dementia. The plans of care did not include an intervention to attempt care with one staff to minimize Resident 79's anxiety, aggression, and refusal to cooperate with care. Review of Task Documentation (electronic documentation by nurse aide staff to record care provided and the level of staff assistance utilized) dated November 2024, revealed that two staff provided assistance with dressing and transfers November 27 through 30, 2024. Two staff provided assistance with personal hygiene on November 27 and 28, 2024. The November 2024, documentation did not indicate that staff offered the diet soda to Resident 79. Review of Task Documentation dated December 2024, revealed that two staff provided Resident 79 assistance with dressing on 27 of the 31 days reviewed; with transfers on 22 of the 31 days reviewed; and with personal hygiene on 25 of the 31 days reviewed. The December 2024, documentation did not indicate that staff offered the diet soda to Resident 79. Review of Task Documentation dated January 1 through 16, 2025, revealed that two staff provided Resident 79 assistance with dressing on 12 of the 16 days reviewed; and with personal hygiene on 11 of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395683 If continuation sheet Page 5 of 17 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 395683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Rehabilitation and Healthcare 918 Main Street Laporte, PA 18626 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 0657 the 16 days reviewed. Level of Harm - Minimal harm or potential for actual harm The January 2025, documentation did not indicate that staff offered the diet soda to Resident 79. Residents Affected - Few Interview with Employee 1 (nurse aide) on January 16, 2025, at 11:05 AM revealed that she often provides care to Resident 79. Employee 1 stated staff, typically go in with two (staff), to provide Resident 79's care. Employee 1 stated that two staff provide care because Resident 79 is combative. Employee 1 confirmed that staff do not document that care was unsuccessfully attempted by one staff before two staff attempt to provide care. Employee 1 also confirmed that there was no instruction in the nurse aide computer tablet (that is used to inform nurse aide staff of resident care needs) to provide Resident 79 a diet soda. Interview with the Nursing Home Administrator and the Director of Nursing on January 16, 2025, at 10:36 AM confirmed that Resident 79's plans of care did not include the new intervention to attempt care with one staff assistance. The interview also confirmed that the available documentation failed to indicate that staff offer Resident 79 a diet soda as part of her daily care. Interview with Resident 81 on January 14, 2025, at 11:54 AM revealed that he has a tooth that is bothering him. Clinical record review for Resident 81 revealed documentation by the facility's consultant dentist dated January 11, 2024, that Resident 81 had two missing teeth and retained roots (fragments of the tooth roots that remain in the jawbone after tooth loss or extraction) for three teeth (tooth number four, 17, and 32). Documentation by the facility's consultant dentist dated March 22, 2024, indicated that the facility referred Resident 81 for services due to a complaint of tooth pain. An annual MDS (Minimum Data Set, an assessment tool completed at specific intervals to determine resident care needs) dated June 8, 2024, assessed Resident 81 without any obvious or likely cavity or broken natural teeth. The MDS assessment did not trigger facility staff to develop a plan of care to address Resident 81's potential for dental health concerns. Interview with Employee 2 (registered nurse assessment coordinator) on January 16, 2025, at 12:00 PM indicated that she did not review the dental progress notes when completing the MDS assessment. Employee 2 confirmed the June 8, 2024, annual MDS assessment was inaccurate and because the assessment did not note Resident 81's broken teeth, the assessment did not trigger a dental care area that required a plan of care. Documentation by the facility's consultant dentist dated July 8, 2024, indicated that Resident 81's thirteenth tooth was, non-restorable (tooth damage that cannot be fixed to prevent the tooth from removal); and that he recommended extraction of the tooth as needed. Resident 81 did not exhibit symptoms to warrant extraction at that time. Nursing documentation dated December 19, 2024, at 9:42 AM indicated that Resident 81 complained of a toothache, and the physician provided a new order to refer Resident 81 to a dentist. Nutritional staff documentation dated December 25, 2024, at 6:00 PM noted that Resident 81 complained of tooth pain. The writer indicated that it was difficult to see which tooth was symptomatic due (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395683 If continuation sheet Page 6 of 17 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 395683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Rehabilitation and Healthcare 918 Main Street Laporte, PA 18626 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 0657 to multiple decaying teeth. Level of Harm - Minimal harm or potential for actual harm Interview with the Director of Nursing and the Nursing Home Administrator on January 15, 2025, at 12:28 PM confirmed that no plan of care was developed or revised to include the above available information that Resident 81 had episodes of tooth pain, had retained tooth roots, and had multiple decaying teeth. Residents Affected - Few Interview with Resident 86 on January 14, 2025, at 11:37 AM revealed that she had partial dentures for her upper and lower jaw but they went missing. Resident 86 stated that they (the facility's consultant dental provider) are supposed to be making new ones. Resident 86 indicated that it was eight months to one year that she did not have her partial dentures. Progress note documentation by the facility's consultant dental provider dated October 29, 2024, revealed that Resident 86 presented for an assessment of her bite for the casts (molds) of upper and lower partial dentures. The documentation indicated that it was the second assessment of Resident 86's bite. Review of a plan of care created by the facility on Resident 86's admission date of December 8, 2023, to address her self-care deficits in her activities of daily living (ADL), revealed that she had partial upper and lower dentures. Facility staff did not revise this plan of care to reflect Resident 86's missing partial dentures. Interview with the Nursing Home Administrator and the Director of Nursing on January 15, 2025, at 12:20 PM confirmed that facility staff did not revise Resident 86's plan of care in response to Resident 86's missing partial dentures. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395683 If continuation sheet Page 7 of 17 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 395683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Rehabilitation and Healthcare 918 Main Street Laporte, PA 18626 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 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and resident and staff interview, it was determined that the facility failed to provide care and services to maintain or improve the ability to perform activities of daily living for one of two residents reviewed for rehabilitation concerns (Resident 12). Residents Affected - Few Findings include: Interview with Resident 12 on January 13, 2025, at 12:58 PM revealed that she had a walker device in her room that is used when staff walk with her; however, that does not occur, too much because they (the facility) don't have too many people (staff). A discharge summary by physical therapy staff dated November 29, 2023, indicated that services included patient and caregiver training, and instruction regarding an in-home exercise program (HEP) to preserve Resident 12's current level of function and prevent functional decline. Resident 12's prognosis was assessed as good with consistent staff follow-through. Discharge recommendations included that Resident 12 was to continue with the HEP restorative nursing program for gait and independent transfers and wheelchair mobility. Review of Task Documentation (electronic documentation by nurse aide staff to record care provided and the level of staff assistance utilized) dated November 2024, revealed that staff documented Resident 12's program to ambulate for 100 feet was not applicable (NA) on November 12 and 27, 2024. Staff documented that Resident 12 refused to ambulate on eight days; however, there was no indication that staff re-approached Resident 12 to give her an opportunity to complete the program after her initial refusal on seven of the eight occasions. Nursing documentation dated December 3, 2024, at 10:55 AM revealed that staff reviewed Resident 12's nursing ambulation program and made no changes at that time. Review of Task Documentation dated December 2024, revealed that staff documented Resident 12's program to ambulate for 100 feet was, NA, on December 9, 10, and 24, 2024. Staff documented that Resident 12 refused the program on December 1, 6, 8, 17, 19, 23, 25, 30, and 31, 2024; however, there was no indication that staff re-approached Resident 12 to give her an opportunity to complete the program after her initial refusal on those nine days. Staff documented that Resident 12 completed the program on only 19 of the 31 days reviewed for December 2024. Review of Task Documentation dated January 1 through 15, 2025, revealed that staff documented Resident 12's program to ambulate for 100 feet was, NA, on January 2, 4, 9, and 13, 2025. Staff documented that Resident 12 refused the program on January 5, 6, 12, and 15, 2025; however, there was no indication that staff re-approached Resident 12 to give her an opportunity to complete the program after her initial refusal on those four days. Staff documented that Resident 12 completed the program on only seven of the 15 days reviewed for January 2025. The surveyor reviewed the above concerns regarding Resident 12's restorative nursing program for ambulation during an interview with the Nursing Home Administrator and the Director of Nursing on January 16, 2025, at 10:36 AM. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395683 If continuation sheet Page 8 of 17 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 395683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Rehabilitation and Healthcare 918 Main Street Laporte, PA 18626 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on review of select facility policies, clinical record review, and staff interview, it was determined that the facility failed to provide services to maintain or improve a resident's range of motion (ROM) and mobility for four of five residents reviewed (Resident 19, 48, 59, and 74). Findings include: Review of the facility policy entitled, Restorative Nursing Services, last reviewed without changes on August 15, 2024, revealed that residents will receive restorative nursing care as needed to help promote optimal safety and independence. Restorative nursing care consists of nursing interventions that may or may not be accompanied by formalized rehabilitative services. Restorative goals and objectives are individualized and resident-centered and outlined in the resident's plan of care. Restorative goals may include but are not limited to supporting and assisting the resident in adjusting or adapting to changing abilities; developing, maintaining, or strengthening their physiological and psychological resources; maintaining their dignity, independence, and self-esteem; and participate in development and implementation of their plan of care. The policy does not speak to the expectations and frequency (how often) staff are to complete the resident's restorative nursing program interventions. Clinical record review for Residents 19 revealed a therapy restorative referral dated November 8, 2024, which identified they had a decrease in their active ROM (movement of the body to maintain a resident's ability). Therapy staff indicated nursing staff should provide PROM (passive range of motion) to their BLE's (bilateral [both] lower extremities [legs]) for 10 repetitions, all available planes, and ranges. Therapy staff did not indicate the frequency (how often) or specific shift(s) that nursing staff should complete Resident 19's restorative nursing program. Review of Resident 19's task documentation for Resident 19 revealed that nursing staff implemented their PROM restorative nursing program during each shift, however, opened the PROM task to be completed/documented only during day shift. There was no documentation that staff completed Resident 19's PROM restorative nursing program during evening or night shifts throughout the three months (November and December 2024, and January 2025) reviewed. Clinical record review for Residents 48 revealed a therapy restorative referral dated November 26, 2024, which identified they had a decrease in their independent ambulation. Therapy staff indicated nursing staff should ambulate Resident 48 up to 110 feet with a FWW (front wheeled walker) with assist of one and w/c (wheelchair) to follow for safety. Therapy staff did not indicate the frequency (how often) or specific shift(s) that nursing staff should complete Resident 48's restorative nursing program. Review of task documentation for Resident 48 revealed that nursing staff implemented their ambulation restorative nursing program during each shift, however, opened the ambulation task to be completed/documented only during day shift. There was no documentation that staff completed Resident 48's ambulation restorative nursing program during evening or night shifts throughout the three months (November and December 2024, and January 2025) reviewed. Further review revealed that staff noted NA (not applicable) for Resident 48's ambulation restorative nursing program on December 15, 2024, day shift. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395683 If continuation sheet Page 9 of 17 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 395683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Rehabilitation and Healthcare 918 Main Street Laporte, PA 18626 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Further review for Residents 48 revealed a therapy restorative referral dated January 7, 2025, which identified they had a decrease in AROM active range of motion) for their right elbow. Therapy staff indicated nursing staff should perform slow, gentle, and sustained PROM to their right elbow into extension for 2 sets of 10 repetitions for joint integrity/mobility. Therapy staff did not indicate the frequency (how often) or specific shift(s) that nursing staff should complete Resident 48's restorative nursing program. Nursing staff initialed the therapy referral, which indicated that they acknowledged the information and implemented the therapist's restorative program. Review of task documentation for Resident 48 revealed that they had an AROM restorative nursing program for their RUE (right upper extremity) and right elbow, 2 sets of 10 repetitions in sitting position for every shift already implemented when therapy made the PROM restorative referral to nursing staff. There was no documentation that nursing staff discontinued Resident 48's AROM restorative nursing program and implemented their PROM restorative nursing program as indicated by therapy's restorative referral. Clinical record review for Residents 59 revealed a therapy restorative referral dated January 1, 2025, which identified they had a decrease in ROM for their BLE's and RUE (right upper extremity [arm]). Therapy staff indicated nursing staff should provide PROM to their BLE's and LUE (left upper extremity) for 10 repetitions, all available planes, and ranges to prevent decline in current ROM. Therapy staff did not indicate the frequency (how often) or specific shift(s) that nursing staff should complete Resident 59's restorative nursing program and indicated the decline was in Resident 59's RUE but implemented a restorative nursing program for their LUE. Therapy did not address the noted RUE decline in their restorative referral. Review of task documentation for Resident 59 revealed that nursing staff implemented that their PROM restorative nursing program during each shift, however, opened the PROM task to be completed/documented only during day and evening shift. Nursing staff also added with a.m. (morning) and p.m. (afternoon) care to the ROM task. Clinical record review for Residents 74 revealed therapy restorative referral dated September 23, 2024, which identified they had a concern with the flexion of their RUE. Therapy staff indicated nursing staff should perform slow, gentle, sustained PROM exercised right hand digits 2 - 5 into extension, positive wrist mobility, and place resting orthotic (splint) on the right hand for skin integrity, contracture management, and joint alignment. Therapy staff did not indicate the frequency (how often) or specific shift(s) that nursing staff should complete Resident 74's restorative nursing program. Review of task documentation for Resident 74 revealed that nursing staff implemented their PROM restorative nursing program during each shift, however, opened the PROM task to be completed/documented only during day shift. There was no documentation that staff completed Resident 74's restorative program on evening or night shifts. Further review revealed that staff indicated NA for the restorative program January 13, 2025, day shift. Further review of Resident 74's task documentation revealed that nursing staff implemented the therapy restorative referral for their right hand orthotic, with staff to apply a right palm roll and forearm splint on the AM (morning) and remove at HS (hour of sleep). Staff may remove for care and ambulation. There was no documentation in the therapy restorative referral or a physician's order, which indicated when staff were to apply and/or remove Resident 74's orthotic, place a palm roll, or that staff may remove for care and/or ambulation. Further review revealed that staff indicated NA or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395683 If continuation sheet Page 10 of 17 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 395683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Rehabilitation and Healthcare 918 Main Street Laporte, PA 18626 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 0688 failed to document task completion on the following dates: Level of Harm - Minimal harm or potential for actual harm Day Shift: October 5, 7 and 31, 2024 Residents Affected - Some Evening Shift: December 7, 2024 The surveyor reviewed the above information on January 16, 2025, at 11:30 AM with the Nursing Home Administrator and the Director of Nursing. 28 Pa. Code 211.10(a)(c)(d) Resident care policies 28 Pa. Code 211.12(c)(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395683 If continuation sheet Page 11 of 17 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 395683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Rehabilitation and Healthcare 918 Main Street Laporte, PA 18626 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, clinical record review, and staff interview, it was determined that the facility failed to implement physician ordered supplemental oxygen consistent with professional standards of practice for one of one resident reviewed for supplemental oxygen concerns (Resident 63). Residents Affected - Few Findings include: Clinical record review for Resident 63 revealed a physician's order dated November 11, 2024, for staff to administer supplemental oxygen at two liters per minute as needed to keep oxygen saturation levels above 90 percent, use as needed for oxygen saturations of less than 90 percent. Review of Resident 63's medication administration records and treatment administration records (MAR and TAR, electronic documentation completed by staff to record the completion of medications and treatments) dated November 2024, December 2024, and January 2025, revealed that staff did not obtain routine assessments of Resident 63's oxygenation saturations to determine the need for supplemental oxygen. Observation of Resident 63 on January 13, 2025, at 12:20 PM revealed no supplemental oxygen in use. Review of Resident 63's clinical record revealed no evidence that staff obtained an assessment of Resident 63's oxygen saturation to determine that he did not need supplemental oxygen. The surveyor reviewed the above concern that Resident 63's supplemental oxygen was ordered to maintain an oxygenation saturation greater than 90 percent; however, staff are not obtaining oxygenation saturation assessments regularly during an interview with the Nursing Home Administrator and the Director of Nursing on January 14, 2025, at 2:15 PM. The facility provided a revised physician order dated January 15, 2025, at 10:45 AM that would prompt staff every shift to evaluate Resident 63's need for supplemental oxygen. 28 Pa. Code 211.12(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395683 If continuation sheet Page 12 of 17 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 395683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Rehabilitation and Healthcare 918 Main Street Laporte, PA 18626 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 Based on clinical record review and staff interview, it was determined that the facility failed to develop and implement an individualized person-centered care plan to address dementia and cognitive loss displayed by one of one resident reviewed (Resident 43). Residents Affected - Few Findings include: Clinical record review for Resident 43 revealed the facility admitted her on October 31, 2024, with diagnosis including Dementia (loss of memory, language, problem-solving, and other thinking abilities that interfere with daily life). A review of Resident 43's most recent annual Minimum Data Set Assessment (MDS, a form completed at specific intervals to determine care needs) dated November 6, 2024, indicated that the facility assessed Resident 43 as having a diagnosis of dementia. The facility determined that a care plan for dementia and cognitive loss would be developed. A review of Resident 43's care plan entitled impaired cognitive function related to dementia revealed that there was no indication that the facility had implemented an individualized person-centered care plan to address the resident's dementia and cognitive loss needs, until the surveyor brought it to their attention on January 15, 2025, at 11:30 AM. The findings were reviewed with the Nursing Home Administrator and Director of Nursing on January 15, 2025, at 2:30 AM. The facility failed to develop and implement an individualized person-centered care plan to address dementia and cognitive loss for Resident 43. 28 Pa Code 211.12 (d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395683 If continuation sheet Page 13 of 17 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 395683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Rehabilitation and Healthcare 918 Main Street Laporte, PA 18626 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 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, observation, and resident and staff interview, it was determined that the facility failed to provide routine dental services related to partial dentures for one of two residents reviewed for dental concerns (Resident 86). Residents Affected - Few Findings include: Interview with Resident 86 on January 14, 2025, at 11:37 AM revealed that she had partial dentures for her upper and lower jaw but they went missing. Resident 86 stated that they (the facility's consultant dental provider) are supposed to be making new ones. Resident 86 indicated that it was eight months to one year that she did not have her partial dentures. Observation of Resident 86 on the date and time of the interview revealed that she had natural teeth and was missing teeth. Clinical record review for Resident 86 revealed a plan of care created by the facility on Resident 86's admission date of December 8, 2023, to address her self-care deficits in her activities of daily living (ADL). The plan of care noted that Resident 86 had partial upper and lower dentures. Progress note documentation by the facility's consultant dental provider dated October 29, 2024, revealed that Resident 86 presented for an assessment of her bite for the casts (molds) of upper and lower partial dentures. The documentation indicated that it was the second assessment of Resident 86's bite. Interview with the Nursing Home Administrator and the Director of Nursing on January 15, 2025, at 12:20 PM confirmed that the facility did not have a concern form, grievance form, or clinical record documentation to indicate when Resident 86's partial dentures became missing; however, confirmed that the consultant dental provider documentation dated October 29, 2024, stipulated that Resident 86 presented for an assessment of her bite for the molds of upper and lower partial dentures. The surveyor requested that the facility provide their policy or procedure when resident property (including dentures) is determined missing. The facility did not provide a policy that stipulated the facility's responsibilities when there is loss or damage of resident dentures. 28 Pa. Code 201.18(d) Management 28 Pa. Code 211.10(a) Resident care policies 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395683 If continuation sheet Page 14 of 17 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 395683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Rehabilitation and Healthcare 918 Main Street Laporte, PA 18626 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 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to ensure residents' medical records included documentation that residents' representatives were provided education regarding the risks and benefits of immunizations for two of five residents reviewed for immunization concerns (Residents 21 and 46). Residents Affected - Few Findings include: Clinical record review for Resident 21 revealed a quarterly MDS (minimum data set, an assessment completed by the facility at intervals to determine care needs) assessment dated [DATE], that indicated Resident 21 had a BIMS (Brief Interview for Mental Status) score of three, indicating she had severe cognitive impairment. A psychiatric note dated October 4, 2024, at 12:00 PM indicated that Resident 21 was awake, alert, and oriented. Review of Resident 21's Influenza Vaccination (a shot that protects against the flu) consent form revealed that there was no signature by the resident or her responsible party indicating that she received and understood the risk versus benefits of the vaccination. The form revealed that she received an Influenza Vaccination on October 14, 2024. Attempted interview of Resident 21 on January 15, 2024, at 11:50 AM revealed that she was unable to answer if she gave permission to be vaccinated with the influenza vaccination on October 14, 2024. The facility could not provide evidence that Resident 21or her responsible party were given education regarding the risks and benefits of the influenza vaccination prior to it being administered on October 14, 2024. Clinical record review for Resident 46 revealed a quarterly MDS assessment dated [DATE], that indicated Resident 46 had a BIMS score of three, indicating she had severe cognitive impairment. A physician's progress note dated October 3, 2024, at 5:23 PM revealed that Resident 46 is alert with confusion and has a diagnosis of dementia (a group of thinking and social symptoms that interferes with daily functioning). Review of Resident 46's Influenza Vaccination consent form revealed that Resident 46 signed the form but did not date it, indicating that she gave consent to receive the influenza vaccination and that she understood the risk versus benefits of the vaccination. The form also indicated that she received the vaccine on October 14, 2024. Review of Resident 46's Pneumococcal Vaccination (a shot that protects against pneumonia) informed consent form revealed that Resident 46 signed it indicating that she received a copy of the pneumococcal vaccination education, but no date was present to indicate when she signed the form, and that she gave permission for the vaccine to be administered. The vaccine was administered on December 10, 2024. The facility could not provide evidence that Resident 46's responsible party was given education (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395683 If continuation sheet Page 15 of 17 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 395683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Rehabilitation and Healthcare 918 Main Street Laporte, PA 18626 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 0883 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few regarding the risks and benefits of the Influenza or the Pneumococcal vaccination (given Resident 46's incapacity to be her own responsible party for medical decisions) for her to make an informed decisions regarding the vaccination administration to Resident 46. An interview with Employee 3, Infection preventionist, on January 16, 2025, at 10:00 AM confirmed the above noted findings for Residents 21 and 46. The Nursing Home Administrator and Director of Nursing were made aware of the above noted concerns related to Resident 21 and 46's vaccinations on January 16, 2024, at 11:32 AM. 483.80(d)(1)(2) Influenza and Pneumococcal Immunizations Previously cited deficiency 2/9/24 28 Pa. Code 211.5(f) Medical records 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395683 If continuation sheet Page 16 of 17 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 395683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highlands Rehabilitation and Healthcare 918 Main Street Laporte, PA 18626 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 0887 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to ensure a residents' medical records included documentation that the residents' representative was provided education regarding the risks and benefits of receiving a COVID-19 immunizations for one of five residents reviewed for immunization concerns (Residents 46). Findings include: Clinical record review for Resident 46 revealed a quarterly MDS assessment dated [DATE], that indicated resident had a BIMS score of three, indicating she had severe cognitive impairment. A physician's progress note dated October 3, 2024, at 5:23 PM revealed that Resident 46 is alert with confusion and has a diagnosis of dementia (a group of thinking and social symptoms that interferes with daily functioning). Review of Resident 46's COVID-19 vaccine consent/administration record provided by the facility, revealed that Resident 46 signed the form on November 7, 2024, indicating that she understood the benefits and risks of the vaccine and consented to receive the updated COVID vaccine. The form also indicated that Resident 46 received the COVID-19 vaccine on November 21, 2024. The facility could not provide evidence that Resident 46's responsible party was given education regarding the risks and benefits of the COVID-19 vaccination (given Resident 46's incapacity to be her own responsible party for medical decisions) for her to make an informed decision regarding the vaccination administration to Resident 46. An interview with Employee 3, Infection preventionist, on January 16, 2025, at 10:00 AM confirmed the above noted findings for Resident 46. The Nursing Home Administrator and Director of Nursing were made aware of the above noted concerns related to Resident 46 on January 16, 2024, at 11:32 AM. 483.80(d)(3)(i)-(vii) Covid-19 Immunization Previously cited deficiency 2/9/24 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 211.5(f) Medical records 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395683 If continuation sheet Page 17 of 17