Inspection·February 12, 2023

F 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Level of Harm - Minimal harm or potential for actual harm Based on facility policy, facility documents, and staff interviews, it was determined that the facility failed to provide the Notice of Medicare Non-Coverage in a timely manner, for one of three residents (Resident R52). Residents Affected - Few Findings include: Review of Centers for Medicare & Medicaid Services (CMS), Form Instructions for the Notice of Medicare Non-Coverage (NOMNC) CMS-10123, (a notice that informs the recipient when care receive from skilled nursing facility is ending and how you can contact a Quality Improvement Organization (QIO) to appeal) dated 1/1/20, indicated that A Medicare provider or health plan must deliver a completed copy of the Notice of Medicare Non-Coverage (NOMNC) to beneficiaries/enrollees receiving covered skilled nursing, home health (including psychiatric home health), comprehensive outpatient rehabilitation facility, and hospice services. The NOMNC must be delivered at least two calendar days before Medicare covered services end or the second to last day of service if care is not being provided daily. Review of the facility provided NOMNC form indicated that the resident has a right to appeal non-payment of services, your request must be made no later than noon of the day before the effective date of non-coverage. Review of the facility provided NOMNC form for Resident R52 indicated payment for skilled nursing services will end 12/31/22. Handwritten documentation on the form indicated this information was communicated to Resident R52's resident representative on 12/31/22. During an interview on 2/12/23, at 6:45 p.m. the Nursing Home Administrator and the Director of Nursing confirmed that the facility failed to provide the Notice of Medicare Non-Coverage in a timely manner, for one of three residents (Resident R52). 28 Pa. Code 201.29(a): Resident rights. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 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 395742 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southwestern Nursing and Rehabilitation Center 500 North Lewis Run Road Pittsburgh, PA 15122 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 - Few 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 and staff interview it was determined that the facility failed to provide a homelike environment for one of four resident room hallways (2nd floor 207 hallway) Findings include: During an observation on 2/10/23, from 4:50 through 5:30 p.m., the following was noted: -paint scuffs along both side of the hallway at wheelchair level -missing paint along the handrails on both sides of the hallway -the tile floor outside and between room [ROOM NUMBER]-213 is cracked and uneven in the middle of the hallway. During an interview on 2/10/23, at 5:45 p.m., Licensed Practical Nurse Employee E4, confirmed the above findings. 28 Pa. Code 207.2(a) Administrators responsibility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 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 395742 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southwestern Nursing and Rehabilitation Center 500 North Lewis Run Road Pittsburgh, PA 15122 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy, facility provided documentation and resident and staff interviews, the facility failed to ensure residents were free from misappropriation of funds for one of two residents reviewed (Resident R51). Findings include: Review of the facility Resident Abuse and Neglect Prevention Program dated 2/17/21, defines misappropriation of resident property as the deliberate misplacement, exploitation, or wrongful, temporary, or permanent use of a resident's belongings or money without the resident's consent. Examples include but are not limited to: stealing, cashing checks without permission. A review of the clinical record revealed that Resident R51 was admitted to the facility on [DATE]. The Minimum Data Set (MDS - a periodic assessment of care needs) dated 12/26/22, indicated the diagnoses of heart failure (a progressive heart disease affecting pumping action of the heart muscles impacting circulation, swelling and shortness of breath), high blood pressure, and depression. During an interview on 2/10/23 at 4:45 p.m. Resident R51 reported that the facility opened her mail from the credit union and removed checks and she did not give consent for them to do so. Resident R51 reported that she had contacted her credit union inquiring about the status of the checks and the credit union provided copies of the cashed checks to her. Review of the correspondence indicated that the checks dated 11/22/21, and 10/25/22, had been cashed by the facility on 11/26/21, and 10/28/22 respectively. Resident R51 reported that she had never received or agreed to sign the checks over to the facility. During an interview on 2/12/23, at 3:10 p.m. the Nursing Home Administrator confirmed that the former Business Office Manager misappropriated Resident R51's funds by opening the mail, removing the checks, and posting them to Resident R51's facility balance due account without obtaining consent from Resident R51. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(e)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 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 395742 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southwestern Nursing and Rehabilitation Center 500 North Lewis Run Road Pittsburgh, PA 15122 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm Based on review of activity calendars, resident group interview, observations, and staff interviews, it was determined that the facility failed to meet the activity needs for two of two nursing units (First and Second Floor) Residents Affected - Some Findings include: During the resident group meeting on 2/11/23, at 1:00 a.m., revealed that three out of three residents agreed that there is not much to do, most evening activites do not occur, and there is not a way to go on any outings outside of the facility. During a review of the resident council meeting minutes for the last six months showed that the residents wished for more things to do. During a review of the facility provided activity calendar for 2/10/23, the 6:00 p.m. activity was to be a movie. During an observation of the activity room on the second floor from 6:00 p.m., through 7:30 p.m., revealed that no one was in the activity room and the television was off. During a review of the facility provided activity calendar for 2/11/23, the 2:00 p.m. activity was to be a craft (unspecified) and the 6:30 p.m. activity was to be a card game of UNO. During an observation of the activity room on 2/11/23, at 2:10 p.m. revealed that the Activity Room had a family in visiting a resident but no activity was taking place. During an observation of the activity room on 2/11/23, at 6:45 p.m., revealed the room to be empty. During an interview on 2/12/23, at 12:00 p.m., Resident R11 stated, there is not much to do for the residents who do not get out of bed. During an interview on 2/12/23, 5:17 p.m., the Nursing Home Administrator (who is overseeing the program) was unaware that evening activities were not being done and that the residents were unhappy with the current activity program. 28Pa. Code 211.10(d) Resident Care Policies. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 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 395742 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southwestern Nursing and Rehabilitation Center 500 North Lewis Run Road Pittsburgh, PA 15122 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 0680 Ensure the activities program is directed by a qualified professional. Level of Harm - Minimal harm or potential for actual harm Based on a review of federal code, facility documentation and staff interview, it was determined that the facility failed to ensure that the Activities Department had a qualified director to oversee the activities program. Residents Affected - Some The findings include: Review of the United States Code of Federal Regulations (CFR), §483.24(c)(2) indicted the activities program must be directed by a qualified professional. Review of facility documentation and an interview indicated that the facility has not had an Activity Director employed since 8/8/22. During an interview on 2/11/23, at 4:00 p.m., the Nursing Home Administrator confirmed she is filling in until the faiclity can hire an Activity Director. During an interview on 2/12/23, at 1:45 p.m., Nursing Home Administrator confirmed that the facility did not employ an Activity Director to oversee the Activites Department. 28 Pa. Code: 201.18(b)(3) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 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 395742 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southwestern Nursing and Rehabilitation Center 500 North Lewis Run Road Pittsburgh, PA 15122 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, national accepted guidelines for Pressure Ulcers, and staff interview, it was determined that the facility failed to prevent the development and accurately assess pressure ulcers for two of five residents (Resident R2 and Resident R56). Residents Affected - Few Findings include: The facility policy entitled Pressure Ulcers/Skin Breakdown - Clinical Protocol last reviewed 10/31/22, indicated the nursing staff will assess and document an individual's significant risk factors for developing pressure ulcers. It also indicated that the nurse will describe and document: full assessment of pressure indicating location, stage, length, width and depth, presence of exudate (drainage) or necrotic (dying) tissue. The National Pressure Ulcer Advisory Panel (NPUAP) defines Moisture Associated Skin Damage (MASD) as inflammation and erosion of the skin caused by prolonged exposure to moisture and its contents, including, urine, stool, perspiration, wound exudate, mucus or saliva; occurs in the perineum (area between anus and vulva or scrotum), groin, buttocks, gluteal cleft and possibly down the thighs. Review of the Minimum Data Set (MDS - periodic assessment of care needs) dated 8/22/22, indicated that Resident R2 had diagnoses that included history of stroke, cancer, anemia, heart failure, high blood pressure, diabetes, and cellulitis of the right and left lower limb. Review of the MDS dated [DATE], Section GG 0170 Mobility, indicated Resident R2 was partial/moderate assistance for bed mobility. Review of the care plan dated 8/29/22, indicated that Resident R2 has the potential for skin breakdown and interventions to include a pressure relieving mattress, float heels while in bed and to provide incontinence care after each incontinent episode. Review of a nurses note dated 9/16/22, indicated a new skin issue to the left lower leg, noting Moisture Associated Skin Damage (MASD). The note does not give any further description of this wound to include, length, width, depth, or presence or absence of drainage. Review of a nurse note dated 9/20/22, refers to the skin area now as erythema (superficial reddening of the skin, usually in patches as a result of injury or irritation). The note does not give any further description of the wound or why it has changed from MASD to erythema. Further review of Resident R2's clinical record from 9/27/22, through 12/22/22, indicated this area as erythema with no other clinical indicators. Review of a nurses note dated 12/22/22, indicated the left lower leg area has scabs. No further clinical description is noted. Review of Resident R2's clinical record from 12/22/22, through 2/10/23, refered to Resident R2's skin area as scabs, erythema, or cellulitis. Review of a physician's order dated 12/1/22, indicated to give Resident R2 Bactrium 400-80 mg (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 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 395742 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southwestern Nursing and Rehabilitation Center 500 North Lewis Run Road Pittsburgh, PA 15122 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 0686 (antibiotic) for cellulitis. Level of Harm - Minimal harm or potential for actual harm During an interview on 2/11/23, at 1:20 p.m., Resident R2 indicated he always has some problem going on with his legs. Residents Affected - Few During an interview on 2/12/23, at 12:00 p.m., the Director of Nursing (DON), stated the nurse (no longer employed) probably called Resident R2's lower leg wound MASD because he pees a lot down his leg. A statement was unable to be obtained from the former employee. During an interview on 2/12/23, at 12:10 p.m. the DON confirmed that the facility policy on pressure ulcers does not contain information on MASD, and that the facility failed to prevent and accurately assess a wound to Resident R2's left lower leg. Review of the clinical record indicated Resident R56 was admitted to the facility on [DATE]. Review of the MDS dated [DATE], included diagnoses of coronary artery disease (damage or disease in the heart's major blood vessels), diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time), and muscle weakness. Section G - Functional Status indicated that Resident R56 required assistance of at least one staff member for bed mobility, and two or more staff members for transfers. Section M - Skin Conditions indicated that Resident R56 was at risk for pressure ulcer development, but had no current pressure ulcers. Review of the admission skin assessment completed on 12/3/22, at 1:15 p.m. indicated that Resident R56 had one skin issue upon admission (excoriation on his throat). Review of Resident R56's plan of care for skin breakdown due to incontinence and decreased mobility initiated 12/12/22, and resolved 1/19/23, failed to inlcude interventions related to repositioning. Further review of Resident R56's plan of care did not include an intervention of assisting to reposition until 1/31/23. Review of Resident R56's care record, between 1/10/23, through 1/31/23, included 66 opportunities for documentation that Resident R56, with care being documented 42 times (approximately 64%). During an interview on 2/12/23, at 6:15 p.m. the Director of Nursing confirmed the facility failed to prevent the development and accurately assess pressure ulcers for two of five residents. 28 Pa. Code: 211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 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 395742 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southwestern Nursing and Rehabilitation Center 500 North Lewis Run Road Pittsburgh, PA 15122 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on review of facility policy, observation, and staff interview, it was determined that the facility failed to store drugs and biological properly on one of two medication rooms (100 Unit) and one of two medication carts (F Hall Cart). Findings include: Review of a facility policy entitled Medication Storage, dated 10/31/22, indicated that the facility stores all drugs and biologicals in a safe, secure, and orderly manner including Drugs and biologicals used in the facility are stored in locked compartments under proper temperature, light and humidity controls. Drug containers that have missing, incomplete, improper, or incorrect labels are returned to the pharmacy for proper labeling before storing. Discontinued, outdated, or deteriorated drugs or biologicals are returned to the dispensing pharmacy or destroyed. Manufacturer recommendations for pneumococcal vaccine indicate that the biological should be refrigerated between 36-46 degrees Fahrenheit and is only stable at temperatures up to 77 degrees Fahrenheit for up to 4 days. Manufacturer guidelines for Lantus, Humalog, Novolog and Insulin Aspart indicate that once accessed or no longer refrigerated, the insulin should be dated and discarded after 28 days. Manufacturer guidelines for Lantaprost eye drops indicate that once opened the medication should be discarded after six weeks. Manufacturer guidelines for Tubersol (tuberculin Purified Protein Derivative) instruct a vail of Tubersol which has been entered and in use for 30 days should be discarded. During an observation on 2/10/23, at 5:06 p.m. in the 100 Unit medication room the following was observed: Seven doses of Prevnar Pneumococcal Vaccine were noted to be sitting on the countertop unrefrigerated and undated. Two bottes of Tubersol were noted to be in the medication refrigerator opened and undated. One vial of Lantus insulin was noted to be in the refrigerator opened and undated. During an interview at that time, Registered Nurse Employee E6 confirmed the above findings and that the medications were not being stored properly. During an observation on 2/10/23, at 8:43 p.m. in the F Hall medication cart the following was observed: Two vials of Lantus insulin, undated. One vial of Insulin Aspart, undated. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 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 395742 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southwestern Nursing and Rehabilitation Center 500 North Lewis Run Road Pittsburgh, PA 15122 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 0761 One vial of Humalog, undated, Level of Harm - Minimal harm or potential for actual harm One Novolog pen with no name or date. 2 bottles of latanoprost eye drops, opened and undated. Residents Affected - Some During an interview at that time, Licensed Practical Nurse Employee E7 confirmed the above findings. 28 Pa. Code 211.9(a)(1)(i) Pharmacy services 28 Pa. Code 201.18(b)(1)(d) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 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 395742 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southwestern Nursing and Rehabilitation Center 500 North Lewis Run Road Pittsburgh, PA 15122 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Based on clinical record review, review of facility provided documents, review of facility diet manual and staff interview, it was determined that the facility failed to provide the appropriate diet to meet the needs for one of eight residents reviewed. (Resident R11). Findings include: Review of the facility approved diet manual indicated a Mechanical Soft Meat and Mechanical Soft Ground Meat diet contain foods of an appropriate consistency of foods that have been altered in which can be more easily chewed and managed by a person with dysphagia. Review of the clinical record indicated Resident R11 was admitted to the facility 10/26/10. Review of the Minimum Data Set (MDS - periodic assessment of care needs)dated 8/8/22, included diagnoses of cerebral palsy (condition of impaired muscle conditions), aphasia (language disorder affecting the ability to communicate), and dysphagia (difficulty swallowing), Review of a physician order dated 11/14/21, indicated Resident R11 was to receive a regular mechanical soft diet with thin liquids, puree fruits, to be fed in an upright position with small bites and sips. Review of a nurses note dated 8/19/22, indicated that .resident was choking .breakfast tray ticket revealed a mechanical soft diet and the dietary had placed regular sausage links on the tray. Review of facility provided documents dated 8/23/22, indicated the aide feeding Resident R11 cut up the sausage with a fork and fed it to the resident. Ground sausage should have been served to the resident. The facility did not provide Resident R11 food consistent with Resident R11's diet order and according to the facility diet manual. During an interview on 2/12/23, at 11:30 a.m., Registered Dietitian Employee E5, confirmed that the kitchen served Resident R11 the wrong food consistency on 8/19/22, that was not consistent with the physician order and the facility approved diet manual. 28 Pa. Code: 211.6(c) Dietary services. 28 Pa. Code: 211.12(d)(1)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 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 395742 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southwestern Nursing and Rehabilitation Center 500 North Lewis Run Road Pittsburgh, PA 15122 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 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. Based on resident and staff interviews, it was determined that the facility failed to routinely offer bedtime snacks for seven of seven residents (Resident R3, R26, R57, R59, R 500, R 501, and R 502). Findings include: During a resident group interview on 12/11/23, at 11:10 a.m., the residents indicated that that they do not receive bedtime snacks. Residents stated that there are snacks available in the vending machine but that it is expensive. During an interview on 12/12/23, at 9:37 a.m., Dietary Manager Employee E1 stated that dietary provides a bin of snacks daily to the nursing units at approximately 8:30 p.m., and that nursing is responsible for offering and passing the snacks. During an observation on 12/12/23, at 10:05 a.m., of the First floor and Second floor Pantry, bins of snacks were available and in large supply. During an interview on 2/12/23, at 1:15 p.m. Resident R3 stated she does not consistently receive a snack at bedtime but that she would like to have one. I only got a snack about five times in the past month. During an interview on 2/12/23, at 1:18 p.m. Resident R57 stated she does not receive snacks at bedtime, and that it would be nice if I did. During an interview on 2/12/23, at 1:19 p.m. Resident R59 stated he does not receive snacks at bedtime and that I have my family bring me snacks. During an interview on 2/12/23, at 1:22 p.m., Resident R26 stated that he does not receive bedtime snacks consistently, and when I ask them for a snack, sometimes they don ' t ever come back with one. During an interview on 2/12/23, at 1:30 p.m., Licensed Practical Nurse (LPN) Employee E2 was shown the full bin of snacks from the Second-Floor unit pantry. When asked if it appeared that the bedtime snacks were passed, the reply was it doesn ' t look like it. LPN Employee E2 also confirmed that it is nursing ' s responsibility to offer and pass bedtime snacks. During an interview on 2/12/23, at 2:35 p.m. Nursing Home Administrator confirmed that the facility failed to routinely offer residents a bedtime snack. 28 Pa. Code: 211.6(b)(c) Dietary services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 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 395742 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southwestern Nursing and Rehabilitation Center 500 North Lewis Run Road Pittsburgh, PA 15122 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, observations, and staff interview, it was determined that the facility failed to maintain a sanitary environment and store foods in accordance with professional standards for food service safety for one of two nursing units (100 Unit.) Findings include: The facility policy Foods Brought by Family/Visitors dated 10/31/22, states food or beverage brought in to consume later will be labeled, sealed in containers and containers will be labeled with the resident ' s name, the item, and a use by date. During an observation on 2/10/23 at 5:10 p.m. of the 100-unit pantry revealed the following: Five packets of thick-n-easy (a drink thickening agent) in drawer dated best by 7/9/22. In the upper cabinet, an opened bag of cheese crackers, unlabeled or dated, and a loaf of bread with a best by date of [DATE]. In the refrigerator was a container marked pork with no date. A container marked chicken with no date. Two styrofoam bowls of cake with no dates. A container with shrimp in it with no date. A container with chicken in it with no date. Three open containers of thickened beverages with no dates with manufacturer guidelines to discard after 7 days of opening. An opened container of almond [NAME] dated 12/29/22 with manufacturer guidelines to discard within 7 days of opening. During an interview on 2/10/23 at 5:16 p.m. Registered Nurse Employee E6 confirmed the above findings and that the items were not being stored according to accepted standards. 28 Pa. Code 211.6(c) Dietary Services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 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 395742 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southwestern Nursing and Rehabilitation Center 500 North Lewis Run Road Pittsburgh, PA 15122 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of hospice contracts, clinical record review and staff interviews, it was determined that the facility failed to ensure that the facility received the required information from and communicated with the contracted hospice provider for one of two residents receiving hospice services (Resident R92) Findings include: An agreement between the facility and a hospice provider (provider of end-of-life services), dated 12/30/15, revealed that the hospice will designate an interdisciplinary group and ensure services as furnished in accordance with the Hospice plan of care. The Hospice shall furnish the facility with a copy of the plan of care and that hospice shall maintain the Hospice Plan of Care, including services provided by the hospice staff, in a separate section in the nursing facility clinical record and ensure it contains the following information: Election of Hospice Care Form, MDS assessments, physician certification of terminal illness form, Election Statement, Hospice Interdisciplinary Assessments, Hospice plan of care, and current interdisciplinary notes including nurses notes and summaries, physician orders and progress notes, and medication and treatment sheets during the hospice period. A review of the clinical record revealed that R92 was admitted to the facility on [DATE]. The minimum Data Set (MDS- a periodic assessment of care needs) dated 7/31/22 included diagnoses of Cerebrovascular Accident (stroke), Dysphagia (difficulty swallowing) and muscle weakness. On 8/22/22 Resident R92 was admitted to hospice services. Upon inquiry, facility staff reported that hospice information was kept in separate binders behind the nurse ' s station. Review of the facility's hospice binder for Resident R92 revealed that the binder failed to contain a Hospice Election of Benefits (EOB) form, a current care plan, and recent visit notes. During an interview on 2/11/23, at 8:48 p.m. the Director of Nursing confirmed that the documentation failed to contain the required EOB, a current care plan, and that there were no hospice progress notes since 11/7/22. Further discussion revealed that hospice staff was documenting visits on a sign in log with vague information such as Routine Visit and RN visit which failed to identify in detail what services were performed, any findings, or that communication occurred between the hospice and the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 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 395742 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southwestern Nursing and Rehabilitation Center 500 North Lewis Run Road Pittsburgh, PA 15122 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 facility policy, clinical record review and staff interview, it was determined that the facility failed to make certain that a pneumococcal immunization was offered to two of seven residents (R45 and R90). Residents Affected - Few Findings include: The facility policy Pneumococcal Vaccine dated 10/31/22, indicated Residents will be assessed for eligibility to receive the pneumococcal vaccine series, and when indicated, will be offered the vaccine series within thirty (30) days of admission to the facility unless medically contraindicated or the resident has already been vaccinated. Review of the Centers for Disease Control (CDC) document, Pneumococcal Vaccination: Summary of Who and When to Vaccinate last reviewed 1/24/22, indicated that CDC recommends pneumococcal vaccination for all adults 65 years or older, and for adults 19 through [AGE] years old who have certain chronic medical conditions or other risk factors. Included in this list were: alcoholism, chronic liver disease, chronic lung disease, chronic renal failure, cigarette smoking, diabetes, and heart failure. Review of the admission Record indicated that Resident R45 was admitted to the facility on [DATE]. At the time of the survey, Resident R14 was less than [AGE] years old. Review of Minimum Data Set (MDS-periodic assessment of care needs) dated 12/5/22, included diagnoses of dementia (a group of symptoms that affects memory, thinking and interferes with daily life) and [NAME] ' s encephalopathy (a neurological disorder caused by thiamine deficiency due to alcohol abuse, and marked by mental confusion, abnormal eye movements, and unsteady gait). Section O0300 Pneumococcal Vaccine indicated Resident R45 was offered the pneumonia vaccine, but declined. Review of hospital discharge paperwork dated 12/24/21, indicated that Resident R45's pneumococcal immunization status was documented as No or unknown. Review of the clinical record revealed a blank document titled, Pneumococcal Vaccine Consent Form. Review of Resident R45's progress notes dated 12/24/21, through 2/12/23, failed to reveal if Resident R45 was provided an opportunity to receive the pneumonia vaccination or education on refusing. Review of Resident R45's MARs from 12/24/21, through 2/12/23, failed to reveal an administration of the pneumonia vaccination for Resident R45. Review of the admission Record indicated that Resident R90 was admitted to the facility on [DATE]. At the time of the survey, Resident R90 was less than [AGE] years old. Review of MDS dated [DATE], included diagnoses of cardiomyopathy (disease of the heart muscle), peripheral vascular disease (circulatory condition in which narrowed blood vessels reduce blood flow to the limbs), and a seizure disorder. Section O0300 Pneumococcal Vaccine indicated Resident R90 was offered the pneumonia vaccine, but declined. Review of the clinical record revealed a blank document titled, Pneumococcal Vaccine Consent Form. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 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 395742 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southwestern Nursing and Rehabilitation Center 500 North Lewis Run Road Pittsburgh, PA 15122 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 Review of Resident R90's progress notes dated 4/8/22, through 2/12/23, failed to reveal if Resident R90 was provided an opportunity to receive the pneumonia vaccination or education on refusing. Review of Resident R90's MARs from 4/8/22, through 2/12/23, failed to reveal an administration of the pneumonia vaccination for Resident R90. Residents Affected - Few During an interview on 2/12/23, at 4:49 p.m. the Director of Nursing confirmed that the facility failed to make certain that a pneumococcal immunization was offered to two of seven residents. 28 Pa. Code 211.5(f) Clinical records FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 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 395742 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southwestern Nursing and Rehabilitation Center 500 North Lewis Run Road Pittsburgh, PA 15122 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 0924 Put firmly secured handrails on each side of hallways. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and staff interviews it was determined that the facility failed to provide handrails in a safe and functional environment for residents use in corridors in one four resident room hallways (2nd floor 207 hallway) Residents Affected - Few Findings include: During an observation on 2/10/23, from 4:45 p.m. through 5:30 p.m. the handrail outside of room [ROOM NUMBER] was separated at the connector adjoining the wall and the handrail outside of room [ROOM NUMBER] was uneven. During an interview on 2/10/23, at 5:45 p.m Licensed Practical Nurse Employee E4, confirmed the above finding. 28 Pa. Code 205.9(a) Corridors. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 17 of 17