Health inspection·October 4, 2023

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 clinical record review and staff interviews, it was determined that the facility failed to provide nursing services consistent with professional standards of practice by failing to follow physcian's orders for treatment of one resident out of nine sampled (Resident CR1) Residents Affected - Few Findings include: A review of the clinical record revealed that Resident CR1 was admitted to the facility on [DATE], with diagnoses that included pleural effusion, diabetes, chronic kidney disease on dialysis and asthma. A review of a hospital history and physical dated September 6, 2023, revealed Resident CR1 was admitted to the hospital with complaints of shortness of breath. She has a past medical history of recurrent pleural effusions with weekly thoracentesis. The patient was seen by thoracic surgery and was scheduled for PleurX (placement) surgery on Wednesday August 16, 2023. Post procedure X-Ray showed a small right apical pneumothorax. The patient had intermittant bouts of respiratory distress associated with fluid drainage. Thoracic notes drainage taken off resident should not excees 1500 ml/day. The resident's admission physician orders dated September 11, 2023, did not include the specific care and services required related to the resident's PleurX catheter A review of Resident CR1's care plan, initiated, September 11, 2023, for the resident's risk for respiratory impairment revealed interventions to administer medications/treatments as per physicians order, evaluate lung sounds and vital signs as needed, report significant changes to physician, obtain labs/diagnostic tests as ordered the notify physician of results, obtain labs/diagnostic tests as ordered the notify physician of results, obtain pulse oximetry as clinically indicated and report abnormal findings, encourage deep breathing exercises and head of bed to be maintained at greater than 30 degrees A review of nursing documentation dated September 12, 2023 at 12:30 PM noted that a Call placed to cardiothoracic physician regarding PleurX clarification orders, left message x 2 waiting return call. A nurses note dated September 12, 2023, at 2:20 P.M. revealed Call received from cardiothoracic physician regarding PleurX drain. New order noted, Drain PleurX Monday-Wednesday-Friday, drain no more than 1500 ml per drain. Resident her own responsible party and aware of same. A physician order dated September 12, 2023, was noted to Change PleurX catheter (A PleurX drainage catheter is a thin, flexible tube placed in the chest to drain fluid from the pleural space. This can make it easier to breathe) dressing Monday-Wednesday-Friday and Drain PleurX chest catheter Monday-Wednesday-Friday. Drain no more than 1500 ml at one time. A nurses note dated Friday September 15, 2023 at 10:25 AM noted Call placed to cardiothoracic physician's office regarding leakage around PleurX tube right chest and redness to peri wound around catheter insertion site. Resident drained this AM 1500 ml clear yellow drainage, resident tolerated well. Left message waiting return call. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395701 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 395701 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Abington Manor 100 Edella Road Clarks Summit, PA 18411 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A nurses note dated September 15, 2023, at 1:07 PM. revealed Call received from cardiothoracic physician. New order received to drain PleurX drain daily maximum drainage amount 1000 ml. Made aware of redness around insertion site, stated some redness is expected, new order noted for same. The physician order dated September 15, 2023, was noted to drain PleurX catheter Monday-Wednesday-Friday. Drain no more that 1000 ccs at a time. A nurses note dated Saturday, September 16, 2023 at 07:41 AM revealed Resident CR1 alert able to make needs known. Pleurex vac applied drained 1000 cc of tan drainage. Resident tolerated well no ill effects noted. Vital signs stable for this residents baseline. Resident offers no other complaints at this time. Resident left in bed with all safety measures in place. A nurses note dated Sunday, September 17, 2023 at 08:07 A.M. revealed, at 03:45 AM indicated that {Resident CR1} yelling that she cannot breathe. (Oxygen) sat 90-91% on room air, attempting to get out of bed on her own, encouraged to stay in bed, head elevated and oxygen 2 L administered. {Resident CR1} said 'she panicked.' 1000 cc was tapped from abdomen. Temperature, 98.1, pulse rate 90. respirations 20, blood pressure 109/64 oxygen saturation 96-97% with oxygen on. She settled and slept. At 0700 A.M. she offered no complaints. The resident required draining of the chest tube more frequently than ordered by the physician on Mondays, Wednesdays and Fridays. There was no documented evidence that nursing had timely consulted with the physician regarding the need to drain the resident's PleurX catheter, on Saturday September 16, 2023, and again on Sunday September 17, 2023, along with the resident's increased anxiousness and complaint of being unable to breathe. The physician was not notified until Monday September 18, 2023. A nurses dated Monday September 18, 2023 at 12:31 P.M. revealed that the resident's son was made aware that resident was refusing to go to dialysis. Stated he was going to call the resident and see if he can get her to go. Nursing noted that the resident was Still refusing same. A nurses note dated September 18, 2023 at 12:30 PM revealed RN notified by floor nurse that {Resident CR1} is refusing to go to dialysis. Responsible party notified of same. Resident CR1 said she is short of breath. Spo2 99%. Received new orders for stat CXR, CBC, BMP. A nurses note dated September 18, 2023, at 12:27 PM revealed Spoke to the resident's son and made aware that resident tested positive for COVID 19 today. A nurses note dated September 18, 2023, at 12:58 PM revealed that the resident was leaving to go to the emergency room due to a change in vital signs and increased shortness of breath. During an interview on October 4, 2023, at approximately 1 PM, with the Director of Nursing (DON) it was confirmed that the resident required more frequent draining of the chest tube than ordered by the physician and that nursing staff did not inform the physician of the resident's need for more frequent draining of the chest tube, anxiousness and shortness of breath over the weekend and notification did not occur until Monday September 18, 2023. 28 Pa. Code 211.12 (c)(d)(1)(3)(5) Nursing services. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395701 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 395701 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Abington Manor 100 Edella Road Clarks Summit, PA 18411 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 0684 28 Pa. Code 211.5(f)(g)(h) Clinical records. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395701 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 395701 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Abington Manor 100 Edella Road Clarks Summit, PA 18411 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records, observations and family and staff interviews it was determined that the facility failed to provide person-centered care for one resident out of two residents sampled (Resident CR1) receiving hemodialysis. Residents Affected - Few Findings include: A review of the clinical record revealed that Resident CR1 was admitted to the facility on [DATE], with diagnoses to include end-stage kidney disease with dependence on kidney dialysis (process of removing waste products and excess fluid from the body when the kidneys are not able to adequately filter the blood), heart disease, and diabetes. According to the clinical record, the resident had a left arm fistula (An AV fistula is a connection that's made between an artery and a vein for dialysis access. A surgical procedure, done in the operating room, is required to stitch together two vessels to create an AV fistula) which was not being used, and a tunneled central catheter, in her right chest used for dialysis access. admission physician orders dated September 11, 2023, were noted for a left arm fistula and tunnel cath in right chest, Dialysis days/times: Monday-Wednesday-Friday at 1 PM; Dialysis site of AV shunt Check Bruit and Thrill every shift and No blood draws/ injections/ blood pressure from left arm; Emergency kit at bedside containing appropriate equipment. Check dialysis access site dressing every shift and reinforce as needed. Notify physician as needed. No directions specified for order; Monitor Hemodialysis site for signs/symptoms of complications (e.g. bleeding, swelling, pain, drainage, odor, hardness or redness at site); and notify the physician and dialysis center immediately with any urgent problems. The physician orders did not specify the care to be provided to the resident's tunneled central catheter in her right chest for dialysis and any care prescribed for the left arm AV fistula, which was not being used. The resident's care plan dated September 11, 2023, for Renal insufficiency related to chronic kidney disease included interventions to check access site for lack of thrill/bruit, evidence of infection, swelling or excessive bleeding per facility guidelines. Report abnormalities to physician; do not get fistula or graft site wet with bathing/showers; do NOT take blood pressure or blood specimens from LEFT arm. Emergency equipment at bedside & wheelchair. The resident's care plan did not include interventions for the planned care of the tunneled central line, dialysis access site, to include its emergency care. The resident's current dialysis access site, the tunneled central line in the right chest, was not addressed on the resident's care plan with individualized measures planned for its monitoring, care and maintenance. 28 Pa. Code 211.12 (c)(d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395701 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 395701 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Abington Manor 100 Edella Road Clarks Summit, PA 18411 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and staff interview, it was determined that the facility failed to maintain acceptable practices for the storage and service of food to prevent the potential for contamination and microbial growth in food, which increased the risk of food-borne illness in one of two resident pantries. (Third-Floor) Findings include: Food safety and inspection standards for safe food handling indicate that everything that comes in contact with food must be kept clean and food that is mishandled can lead to foodborne illness. Safe steps in food handling, cooking, and storage are essential in preventing foodborne illness. You cannot always see, smell, or taste harmful bacteria that may cause illness according to the USDA (The United States Department of Agriculture, also known as the Agriculture Department, is the U.S. federal executive department responsible for developing and executing federal laws related to food). Observation of the third-floor resident pantry refrigerator on October 4, 2023, at approximately 10 AM revealed a white plastic bag containing a Styrofoam take-out food container dated July 11 (no year). Further observation revealed that the container was filled with moldy food, which could not be identified. The bag also contained a clear plastic food container filled with spaghetti noodles, which had turned a dark grey color. On the inside door of the refrigerator there were three, 46-ounce containers of thickened fluids that were opened. There were no dates on the containers to identify when they were first opened. Interview with the Director of Nursing on October 4, 2023, at 1:30 PM confirmed that sanitary practices for food storage should be maintained in the resident pantry refrigerator 28 Pa. Code 201.18 (e)(2.1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395701 If continuation sheet Page 6 of 6