Health inspection·December 22, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a resident group interview on December 20, 2023, at 10:30 AM, two residents out of the four residents interviewed stated that they experience long wait times for staff to respond to their calls for assistance. During the resident group interview, the other two residents in attendance, Residents 10 and 82, reported that they are independent and do not need to ring their call bells for assistance. During the resident group interview on December 20, 2023, at 10:30 AM, Resident 71 indicated that he regularly waits 30 minutes or longer for staff to respond after he rings his call bell for assistance. He explained that once he had an accident while waiting for staff to provide care. During the resident group interview on December 20, 2023, at 10:30 AM, Resident 45 stated that she often waits 30 minutes for staff to respond after she rings her call bell for assistance. Resident 45 explained that she sometimes is not able to hold her urine and accidentally soils her brief while waiting. She stated that she feels embarrassed and blames herself when she is unable to hold her urine while waiting for staff assistance with toileting. A clinical record review revealed that Resident 308 was admitted to the facility on [DATE]. A review of an admission MDS assessment dated [DATE], revealed that Resident 308 is cognitively intact with a BIMS score of 13. During an interview on December 21, 2023, at approximately 1:15 PM Resident 308 stated that she requires assistance from staff and often waits up to 45 minutes for staff assistance after ringing her call bell. During an interview on December 21, 2023, at approximately 1:30 PM, the Director of Nursing (DON) verified that all residents at the facility should be treated with dignity and respect. The DON was unable to explain why residents are reporting untimely staff responses to residents' requests for assistance, which is negatively affecting their quality of life in the facility. 28 Pa. Code 201.18 (e)(1) Management 28 Pa. Code 201.29 (a) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395701 If continuation sheet Page 2 of 14 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 12/22/2023 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 0565 Honor the resident's right to organize and participate in resident/family groups in the facility. Level of Harm - Minimal harm or potential for actual harm Based on a review of select facility policy, the minutes from resident group meetings and grievances lodged with the facility, and resident and staff interviews, it was determined that the facility failed to demonstrate their response to resident complaints and grievances raised at group meetings, including resident complaints and grievances raised during two of the three Resident Food Committee meeting minutes reviewed (November 2023 and December 2023) and one of the three Resident Council Meeting minutes reviewed (October 2023). Residents Affected - Some Findings include: A review of facility policy titled Grievance Process Procedure, last reviewed by the facility on July 1, 2023, revealed that the facility has developed a grievance procedure to address the process for filing, investigating, and responding to the grievances or concerns. Further review of the facility policy revealed that if a concern is made to a staff member and cannot be resolved on-the-spot, it should be documented on the grievance form. Any new grievance shall be brought to the morning meeting to be reviewed and validate that they have been entered into the grievance log and assigned for follow-up. A review of facility policy titled Frequency of Meals, last reviewed by the facility on July 1, 2023, revealed that residents will be offered nourishing snacks if the time span between the evening meal and the next day's breakfast exceeds fourteen (14) hours. A review of facility mealtimes revealed that residents on Nursing Unit 2 [NAME] are served their evening meal at 4:30 PM and receive breakfast at 7:30 AM. The time span between evening meal and the next day's breakfast exceeds 14 hours. Residents on Nursing Unit 3 [NAME] are served their evening meal at 4:20 PM and receive breakfast at 7:40 AM. The time span between evening meal and the next day's breakfast exceeds 14 hours. Residents on Nursing Unit 2 East are served their evening meal at 4:50 PM and receive breakfast at 7:50 AM. The time span between evening meal and the next day's breakfast exceeds 14 hours. Residents on Nursing Unit 3 East are served their evening meal at 4:40 PM and receive breakfast at 8:00 AM. The time span between evening meal and the next day's breakfast exceeds 14 hours. A review of Resident Council Meeting Minutes dated October 31, 2023, revealed that residents on the second floor Nursing Unit raised concerns that they were not consistently getting nightly snacks. A review of grievances lodged with the facility failed to reveal a grievance filed on behalf of residents following the October 31, 2023, Resident Council Meeting as noted in facility policy. A review of the Food Committee Meeting Minutes dated November 15, 2023, indicated that residents in attendance raised concerns about not receiving a snack at bedtime. The meeting minutes indicated that residents residing in Nursing Unit 2 East are not being offered snacks. A review of grievances lodged with the facility failed to reveal a grievance filed on behalf of residents following the November 15, 2023, Resident Food Committee Meeting. A review of the Food Committee Meeting Minutes dated December 13, 2023, indicated that residents in attendance raised concerns about not receiving a snack at bedtime. The meeting minutes indicated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395701 If continuation sheet Page 3 of 14 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 12/22/2023 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 0565 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some that residents residing in Nursing Unit 2 East are not being offered snacks. A review of grievances lodged with the facility failed to reveal a grievance filed on behalf of residents following the December 13, 2023, Resident Food Committee Meeting. During an interview with Resident 6 on December 19, 2023, at approximately 10:49 AM the resident stated that she does not receive a bedtime snack unless she requests one. The resident explained that she is a diabetic and is concerned about her blood sugar levels being affected if she does not eat something prior to bed. During a resident group interview on December 20, 2023, at 10:30 AM, one resident out of the four interviewed (Resident 82) reported that staff's failure to consistently provide snacks remains a concern for residents residing in Nursing Unit 2 East. Resident 82 explained that she does not consistently receive snacks as desired. She stated that she enjoys having a snack in the evening but only receives snacks two or three times a week. Resident 82 indicated that she has brought this concern up over the last few months at Resident Council Meetings and Food Committee Meetings, but nothing has been done to resolve the issue. During an interview on December 21, 2023, at approximately 1:00 PM with Resident 308 stated that she is not offered and does not receive a bedtime snack. During a resident group interview with alert and oriented residents on December 20, 2023, at 10:30 AM, four of the four residents in attendance (Residents 10, 45, 71, and 82) reported that noise level in the facility at night is not comfortable. The residents in attendance stated that they are disrupted by the noise and loud sounds in the facility during the night shift. During the group interview on December 20, 2023, Resident 10 stated that her roommate receives care at 5:30 AM each morning. She explained that when staff enter her room, they talk very loudly and sometimes talk on their cell phones while giving care to her roommate. Resident 10 stated that this wakes her up almost every day early in the morning before her desired time for awakening. She stated that she has brought up this concern to facility staff in the past, but the problem continues. During the group interview on December 20, 2023, Residents 45 and 82 stated that their sleep is often disrupted when they hear staff talking loudly in the middle of the night and in the early morning hours. They explained that staff talk on their cell phones quite a bit and are often very loud during the night. During the group interview on December 20, 2023, Resident 71 stated that staff place the laundry and trash bins outside of his room. He stated that he hears the laundry and trash bins slamming shut, and the noise bothers him. Resident 71 explained that he is frustrated because he has brought this issue to the facility staff in the past, but nothing has been done to resolve his concern. A review of the minutes from Resident Council Meeting Minutes dated October 31, 2023, revealed that residents raised concerns about nursing staff being loud during the 6:00 AM nursing medication pass. The Resident Council Meeting Minutes dated November 15, 2023, indicated that residents raised concerns that nursing staff are being too loud during the 11:00 PM to 7:00 AM shift. During an interview on December 22, 2023, at approximately 10:00 AM, the Nursing Home Administrator (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395701 If continuation sheet Page 4 of 14 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 12/22/2023 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 0565 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some and Director of Nursing (DON) confirmed that the facility is to be maintained in a manner that supports the resident's right to the maintenance of comfortable sound levels. During an interview on December 22, 2023, at approximately 10:30 AM, the Director of Nursing (DON) and Nursing Home Administrator (NHA) were unable to provide evidence that the facility responded to residents' concerns raised at resident group meetings regarding not consistently receiving snacks on Nursing Unit 2 East. The NHA and DON were unable to provide evidence of the facility's efforts to resolve the concerns raised by residents during group meetings and that the facility had communicated any follow-up actions to residents regarding those concerns. The DON and NHA confirmed that it is the policy of the facility to respond to resident concerns raised during resident group meetings and to provide resident groups with responses, actions, and rationale taken to resolve grievances and concerns. Refer F584 28 Pa. Code: 201.18 (e)(1) Management. 28 Pa. Code: 201.29 (a) Resident Rights. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395701 If continuation sheet Page 5 of 14 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 12/22/2023 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, a review of the minutes from resident group meetings and resident and staff interviews, it was determined that the facility failed to maintain a clean, comfortable, and homelike environment in resident rooms on one of the four resident units (Nursing Unit 2 East) and failed to maintain comfortable sound levels as reported by four of four residents interviewed during a group meeting (Residents 10, 45, 71, and 82) Findings include: An observation on December 19, 2023, at 10:15 AM in resident room [ROOM NUMBER] revealed a heating/cooling unit with black and gray mold-like circular stains on the ventilation fins and dirt, debris, and dust inside the unit. An observation on December 19, 2023, at 10:30 AM in resident room [ROOM NUMBER] revealed the window side wall had several quarter-sized areas of scrapped paint, grey scuff marks, and cracks in the drywall. Further observation revealed additional areas of quarter-sized scrapped paint, white and tan substance spill stains, and a beige cracked coaxial outlet cover on the wall opposite the resident beds. Also observed was a six-inch by two-inch area of missing paint on the wall to the right of the resident doorway and green privacy curtains with white and brown stains. An observation on December 19, 2023, at 10:50 AM in resident room [ROOM NUMBER] revealed pink liquid stains on the wall opposite the resident's bed, a heating/cooling unit with tan substance stains on the unit's fins, and privacy curtains with a build-up of white stains. An observation on December 19, 2023, at 11:05 AM in resident room [ROOM NUMBER] revealed a jagged one-inch crack in the drywall running the height of the heating/cooling unit and brown substance stains on the wall to the left of the heating/cooling unit. Further observation revealed the bathroom door frame with black scuff marks and areas of chipped paint. The wall to the right of the bathroom was observed with tan stains, grey scuff marks, dents, and a floor light cover with areas of chipped paint. A white Tylenol pill was observed on the floor to the left of the entrance door in an area with dirt, debris, a brown substance buildup, and human hair. During a resident group interview with alert and oriented residents on December 20, 2023, at 10:30 AM, four of the four residents in attendance (Residents 10, 45, 71, and 82) reported that noise level in the facility at night is not comfortable. The residents in attendance stated that they are disrupted by the noise and loud sounds in the facility during the night shift. During the group interview on December 20, 2023, Resident 10 stated that her roommate receives care at 5:30 AM each morning. She explained that when staff enter her room, they talk very loudly and sometimes talk on their cell phones while giving care to her roommate. Resident 10 stated that this wakes her up almost every day early in the morning before her desired time for awakening. She stated that she has brought up this concern to facility staff in the past, but the problem continues. During the group interview on December 20, 2023, Residents 45 and 82 stated that their sleep is often disrupted when they hear staff talking loudly in the middle of the night and in the early morning hours. They explained that staff talk on their cell phones quite a bit and are often very loud (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395701 If continuation sheet Page 6 of 14 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 12/22/2023 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 0584 during the night. Level of Harm - Minimal harm or potential for actual harm During the group interview on December 20, 2023, Resident 71 stated that staff place the laundry and trash bins outside of his room. He stated that he hears the laundry and trash bins slamming shut, and the noise bothers him. Resident 71 explained that he is frustrated because he has brought this issue to the facility staff in the past, but nothing has been done to resolve his concern. Residents Affected - Some A review of the minutes from Resident Council Meeting Minutes dated October 31, 2023, revealed that residents raised concerns about nursing staff being loud during the 6:00 AM nursing medication pass. The Resident Council Meeting Minutes dated November 15, 2023, indicated that residents raised concerns that nursing staff are being too loud during the 11:00 PM to 7:00 AM shift. During an interview on December 22, 2023, at approximately 10:00 AM, the Nursing Home Administrator and Director of Nursing (DON) confirmed that the facility is to be maintained in a manner that supports the resident's right to a clean, comfortable, and homelike environment, including the maintenance of comfortable sound levels. Refer F565 28 Pa. Code 201.18 (e)(1)(2.1) Management 28 Pa. Code 201.29 (a) Resident Rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395701 If continuation sheet Page 7 of 14 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 12/22/2023 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 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 clinical record review, observation and staff and resident interviews, it was determined that the facility failed to provide necessary staff assistance with activities of daily living to maintain good personal grooming for residents dependent on staff assistance with these activities, including experiences reported by four alert and oriented residents out of four residents interviewed during a group meeting (Residents 10, 45, 71, and 82) and for one of 25 residents sampled (Resident 6). Residents Affected - Some Findings include: During a resident group interview on December 20, 2023, at 10:30 AM, four residents out of the four residents interviewed stated that the facility does not consistently provide showers as scheduled or according to their individual plan of care. During the resident group interview, Residents 10, 45, 71, and 82 stated that their showers are frequently cancelled. Resident 45 stated that she is not receiving showers regularly because often there are not enough nursing staff to shower her on her scheduled shower day, and her shower is rescheduled for another day during the week. Resident 71 stated that he is not showered as scheduled. He explained that his scheduled shower gets canceled quite a bit, and it bothers him because he is unable to wash himself. Resident 71 stated that he has expressed this problem to staff, but nothing has changed and the problem is not fixed. Resident 10 stated that staff do not provide showers as scheduled because staff are often unable to give her a shower. She stated that last week staff informed her that she would have to take a cold shower because of an issue with the water temperatures. Resident 10 indicated that she wanted to take a shower but refused when staff told her that the water temperature was too cold. During an interview on December 22, 2023, at approximately 12:00 PM, the Director of Maintenance indicated that the facility has not had any reported issues regarding cold water temperatures. He explained that he checks the temperatures daily to ensure they are within acceptable parameters for resident safety. During an observation of the second-floor resident shower room, at the same time as the interview, the shower water temperature was observed to be 101.1 degrees Fahrenheit and felt comfortable. A review of the clinical record revealed that Resident 6 was originally admitted to the facility on [DATE], and had diagnoses which included morbid obesity, dysarthria, muscle weakness and osteoarthritis of knee. A quarterly Minimum Data Set Assessment (MDS - a federally mandated standardized assessment conducted at specific intervals to plan resident care) of Resident 6 dated November 1, 2023, indicated that the resident was totally dependent on staff for bathing/showers. The resident was cognitively intact with a BIMS score of 14 (brief interview for mental status, a tool to assess the residents' attention, orientation and ability to register and recall new information, a score of 13-15 indicates the resident is cognitive intact). The resident had functional limitation in range of motion of her lower extremities and required staff assistance for activities of daily living which included bathing and personal hygiene. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395701 If continuation sheet Page 8 of 14 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 12/22/2023 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A review of Resident 6's shower record revealed that the resident was to be showered on Wednesdays and Sundays on the 7:00 AM to 3:00 PM shift. During interview with Resident 6 on December 19, 2023, at approximately 10:49 AM the resident stated that staff have not showered her in over two months because the Hoyer lift (mechanical lift) was broken for her transport. She stated that staff have provided a bed bath, which consisted of cleaning under her breasts and armpits, but no peri care (cleaning private areas) was provided. Further interview with Resident 6 on December 20, 2023, at approximately 12:05 PM revealed that the resident did not receive her shower that morning because the facility did not have the correct Hoyer lift belt to transfer her. She stated that staff told her that the belt they had could not get wet in the shower. She stated that she used to hide one of the belts in her room because they go missing all the time and she needs a specific one (solid black), but someone took it out of her room. A review of Resident 6's shower schedule for the month of November 2023 revealed no evidence that the resident was showered during the month. The resident was provided a bed bath on November 5, 2023, November 8, 2023, November 15, 2023, and November 22, 2023. There was no evidence that the resident was showered, received a bed bath or had refused both options on November 1, November 12, or November 26, 2023, the resident's other scheduled shower days. On Sunday November 19, 2023, and Wednesday November 29, 2023, the resident was noted to have reused a shower (no reason for the refusal was noted). Resident 6's shower schedule for the month of December 2023 showed that the resident received one shower on Sunday December 10, 2023. The resident was provided a bed bath on December 3, 2023, and December 20, 2023. There was no evidence that the resident was showered, received a bed bath or had reused both options on December 6, December 13 or December 17, 2023, the resident's remaining scheduled shower days. There was no documented evidence in Resident 6's clinical record or care plan of any resident refusals or reasons for not showering this resident as scheduled. During an interview on December 22, 2023, at approximately 9:30 AM, the Director of Nursing (DON) and Nursing Home Administrator (NHA) confirmed that the facility has not been able to consistently provide residents' showers as scheduled in their individualized care plans. The NHA and DON confirmed that it is the facility's responsibility to ensure necessary staff are provided to assist residents with activities of daily living to maintain good personal grooming for resident's dependent on staff for assistance. 28 Pa. Code 211.12 (d)(4)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395701 If continuation sheet Page 9 of 14 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 12/22/2023 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 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 clinical records and select facility policies, and staff interviews, it was revealed that the facility failed to follow physician orders for bowel protocol to promote normal bowel activity and treat constipation for one resident out of 25 sampled residents (Resident 52). Residents Affected - Few Findings include: A review of clinical records revealed Resident 52 was admitted to the facility on [DATE], with diagnoses, which included dementia, hypertension, and osteoporosis. A review of Resident 52's current physician orders revealed orders for administration of Milk of Magnesia (MOM) Suspension give 30 mL orally as needed for constipation if no bowel movement (BM) in 3 days, Dulcolax suppository as needed for constipation for now BM within 24 hours after administration of MOM, and sodium phosphates enema as needed for constipation if MOM ineffective. A review of Resident 52's Documentation Survey Report dated December 2023, revealed that the resident had an extra-large BM on December 4, 2023, on the 3 PM to 11 PM shift. There was no evidence that the resident had a BM from December 5, 2023, through December 11, 2023, a total of 7 days. A review of Resident 52's Medication Administration Record (MAR) dated December 2023 revealed that there was no evidence that the resident had been offered and/or received the ordered medications for constipation. According to the physician orders and lack of bowel activity, the resident should have received MOM on December 8, 2023. A review of nursing documentation dated December 11, 2023, at 8:09 AM revealed that the resident had not had a bowel movement for seven days. The resident's bowel sounds were present in all four quadrants, but were hypoactive (sluggish, a sign that intestinal activity has slowed), the resident did not have abdominal pain or discomfort, and the resident's abdomen was not distended. The physician ordered a KUB (X-ray of Kidney, ureter, and Bladder typically performed to investigate for bowel obstruction and often used to diagnose constipation). Review of the results of the KUB dated December 11, 2023, indicated that the resident had mild to modest constipation. Documentation dated December 12, 2023, at 12:32 PM revealed that the physician ordered to begin bowel protocol as ordered. Additional review of the resident's MAR dated December 2023, failed to provide evidence that the physician ordered bowel protocol was administered as ordered to treat the resident's constipation. Review of the Documentation Survey Report dated December 2023, revealed that Resident 52 did have an extra-large BM on December 12, 2023, on the 7 AM - 3 PM shift, but had not received the physician ordered medication for treatment constipation. Interview with the Director of Nursing on December 21, 2023, at 10:30 AM confirmed that there was no documented evidence in the clinical record that the physician ordered bowel protocol was followed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395701 If continuation sheet Page 10 of 14 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 12/22/2023 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 211.12 (d)(1)(5) Nursing services. 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 11 of 14 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 12/22/2023 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records and staff interview, it was determined that the pharmacist failed to identify drug irregularities, duplicate drug therapy, in the drug regimen of one resident (Resident 27) out of five sampled residents. Findings include: A review of Resident 27's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses that included Alzheimer's dementia with behavioral disturbance, major depressive disorder, and anxiety disorder. A review of Resident 27's physician's orders revealed an order dated June 21, 2021, at 8:00 AM, for Duloxetine HCL [(Cymbalta) is used to treat depression and anxiety] capsule delayed release sprinkle 60 mg, give 60 mg by mouth one time a day for major depressive disorder. The resident also had a physcian order August 8, 2023, at 9:00 AM, for Lexapro [an antidepressant used to treat depression] 10 mg give one tablet per day for recurrent depressive disorder] and an order for Mirtazapine [(Remeron) [an antidepressant used to treat depression] Tablet 15 MG, give one tablet by mouth at bedtime for major depressive disorder. A review of the resident's Medication Administration Record (MAR) for the months August 2023, September 2023, October 2023, November 2023, and through survey ending December 22, 2023, revealed that the resident consistently received both antidepressant medications daily. A review of the drug regimen reviews completed by the facility's pharmacist during the months from August 2023 through the survey ending December 22, 2023, revealed that the pharmacist failed to identify the duplicate antidepressant drug therapy prescribed and administered to Resident 27 for the treatment of major depressive disorder. Interview with the Director of Nursing (DON) on December 22, 2023, at 9:15 AM, confirmed that the pharmacist failed to identify the drug irregularity in Resident 27's medication regimen. Refer F758 28 Pa. Code 211.9 (k) Pharmacy services. 28 Pa. Code 211.2 (d)(3) Medical Director. 28 Pa. Code 211.5(f) Medical records. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395701 If continuation sheet Page 12 of 14 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 12/22/2023 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **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 ensure the presence of physician documentation of the clinical rationale for the continued administration of duplicate antidepressant drug therapy for one resident out of five sampled residents (Resident 27). Findings include: A review of Resident 27's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses that included Alzheimer's dementia with behavioral disturbance, major depressive disorder, and anxiety disorder. A review of Resident 27's physician's orders revealed an order dated June 21, 2021, at 8:00 AM, for Duloxetine HCL [(Cymbalta) is used to treat depression and anxiety] capsule delayed release sprinkle 60 mg, give 60 mg by mouth one time a day for major depressive disorder. The resident also had a physcian order August 8, 2023, at 9:00 AM, for Lexapro [an antidepressant used to treat depression] 10 mg give one tablet per day for recurrent depressive disorder] and an order for Mirtazapine [(Remeron) [an antidepressant used to treat depression] Tablet 15 MG, give one tablet by mouth at bedtime for major depressive disorder. A review of the resident's Medication Administration Record (MAR) for the months August 2023, September 2023, October 2023, November 2023, and through survey ending December 22, 2023, revealed that the resident consistently received both antidepressant medications daily. At the time of the survey ending December 22, 2023, Resident 27's clinical record failed to reveal that the attending physician documented resident-specific clinical justification for the resident's need for duplicate antidepressant drug therapy for treatment of major depressive disorder Interview with the Director of Nursing (DON) on December 22, 2023, at 9:15 AM, confirmed that Resident 27's attending physician failed to provide documented clinical rationale for the use of both antidepressants. Refer F756 28 Pa. Code 211.9 (k) Pharmacy services. 28 Pa. Code 211.12 (c) Nursing services. 28 Pa. Code 211.2 (d)(3) Medical Director. 28 Pa. Code 211.5(f) Medical records. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395701 If continuation sheet Page 13 of 14 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 12/22/2023 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 - Some 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 the food and nutrition services department and one of two resident pantries. 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). The initial tour of the kitchen was conducted on December 19, 2023, at 9:28 AM, in the presence of the Certified Dietary Manager (CDM), revealed unsanitary practices with the potential to introduce contaminants into food and increase the potential for food-borne illness and the following concerns were identified: In the first-floor corridor, near the food receiving area, observation revealed multiple cases of dry food/ingredients/supplies directly on the floor. Observations during a tour of the third-floor resident pantry area on December 19, 2023, at 10:03 AM, revealed on three pitchers of juices on a push cart that were warm to touch. Observation of the third-floor resident pantry revealed that the lid on the ice machine was broken. When opened, the lid closure slid out of place and did not close properly. A screw was observed positioned to stop the lid from sliding off the ice machine. During an interview with the Nursing Home Administrator (NHA) on December 21, 2023, at 1:15 PM, confirmed that she noticed that the third-floor resident pantry ice machine lid was broken, and that maintenance should have corrected the issue and that facility's food should not have remained directly on the floor. 28 Pa. Code 201.18 (e) (2.1) Management 28 Pa. Code 211.6 (f) Dietary Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395701 If continuation sheet Page 14 of 14