Inspection·December 15, 2023

F 0575 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Post a list of names, addresses, and telephone numbers of all pertinent State agencies and advocacy groups and a statement that the resident may file a complaint with the State Survey Agency. Based on review of facility policy, observations and staff interview, it was determined the facility failed to display the contact information (name, address, email address, and phone number) for the local State Survey Agency and a statement that the resident may file a complaint with the State Survey Agency concerning any suspected violation of state or federal nursing facility regulation on 3 of 3 resident information areas (Reception, 100 unit and 200 unit). Findings include: Review of facility policy titled Contact with External Agencies last reviewed 11/30/23, informed residents have unrestricted access to officials from outside agencies. Residents are not prohibited in any way from communicating with officials or agencies that are independent from or have oversight of the facility. These agencies/individuals include (but are not limited to): federal or state surveyors; federal or state health department employees; and/or any adult protection or advocacy agency employees or representatives. Contact information for resident advocacy agencies and services is posted in the resident common area. During an observation on 12/11/23, at 8:30 a.m. contact information was not displayed for the State Survey Agency, and there was no information that the resident may file a complaint with the State Survey Agency concerning any suspected violation of state or federal nursing facility regulation on the 100 unit. During an observation on 12/11/23, at 8:38 a.m. contact information was not displayed for the State Survey Agency, and there was no information that the resident may file a complaint with the State Survey Agency concerning any suspected violation of state or federal nursing facility regulation on the 200 unit. During an observation on 12/11/23, at 8:45 a.m. contact information was not visible, covered with a licensure certificate, for the State Survey Agency, and there was no information that the resident may file a complaint with the State Survey Agency concerning any suspected violation of state or federal nursing facility regulation in the reception area. During an interview on 12/12/23, at 8:45 a.m. the Nursing Home Administrator confirmed the facility failed to display the contact information (name, address, email address, and phone number) for the local State Survey Agency and a statement that the resident may file a complaint with the State Survey Agency concerning any suspected violation of state or federal nursing facility regulation. 28 Pa. Code: §201.29(i) Resident rights. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 2 of 25 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 12/15/2023 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy and clinical record review and staff interview, it was determined the facility failed to notify the physician of a change in condition for one of four residents (Resident R59). Findings include: A review of the facility policy Change in a Resident's Condition or Status dated 11/30/23, indicated the nurse will notify the resident's physician when there has been a significant change in the resident's physical/emotional/mental condition. A review of the clinical record indicated Resident R59 was admitted to the facility on [DATE], with diagnoses that included right knee replacement, syncope (fainting caused by low blood pressure), mood disorder, and cognitive impairment. A review of the Minimum Data Set (MDS-periodic assessment of care needs) resident assessment dated [DATE], indicated the diagnoses remain current. A review of a nurse note dated 12/2/23, at 1:26 p.m., indicated resident R96 had been awake for over a day and combative and non-compliant with care and unable to follow simple instructions, at 21:32 Ativan (anti-anxiety medication) was ineffective and the resident continued with behaviors and was unable to be redirected. There was no indication the physician was notified. A review of a nurse note dated 12/3/23, at 04:55 a.m., indicated Resident R56 was extremely combative with staff when attempting to redirect and hitting and kicking staff when they attempt to keep him in his chair or provide care. All medications were administered per physician order but do not appear to be helping with residents behaviors. There was no indication the physician was notified. During an interview on 12/14/23, at 11:53 a.m., the Assistant Director of Nursing (ADON) Employee E1 confirmed the above findings and the physician should have been notified for change in condition. 28 Pa. Code 201.14(a) Responsibility of Licensee. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 3 of 25 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 12/15/2023 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 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of facility documentation and staff interview, it was determined the facility failed to issue the Skilled Nursing Facility Advanced Beneficiary Notice form published by the Centers for Medicare and Medicaid Services (SNF ABN CMS-10055) which provides information to residents/resident representatives so they can decide if they wish to continue skilled nursing services that may not be paid for by Medicare and assume financial responsibility for one of three residents (Resident R700). Residents Affected - Few Findings include: A review of Resident R700's clinical record documented the resident was admitted to the facility on [DATE] and discharged [DATE]. A review of the SNF (Skilled Nursing Facility) Beneficiary Protection Notification Review form CMS-20052 (published by the Centers for Medicare and Medicaid Services and used to determine if nursing care facilities are in compliance with notifying residents/resident representatives of a termination/denial/resident discharge from Medicare Part A services) documented Resident R700 had a Medicare Part A last day of coverage date of 6/16/23, (the resident remained in the facility as private pay). The facility failed to provide Resident R700 with a Skilled Nursing Facility Advanced Beneficiary Notice form (SNF ABN CMS-10055). During an interview on 12/15/23, at 9:45 a.m. Social Service Director Employee E2 confirmed Resident R700 was not issued a Skilled Nursing Facility Advanced Beneficiary Notice form (SNF ABN CMS-10055). 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 25 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 12/15/2023 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 0585 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. Based on facility observations and staff interviews, it was determined the facility failed to provide grievance forms for filing anonymous grievances on one of two units (100 unit). Residents Affected - Few Findings include: During an observation on 12/11/23, at 11:35 a.m. the 100 unit grievance form receptacle did not contain grievance forms available to file an anonymous grievance. During an interview on 12/12/23, at 11:40 a.m. Unit Secretary Employee E5 confirmed confirmed the facility failed to make certain grievance forms for filing anonymous grievances were available to residents on the 100 unit. 28 Pa. Code: 201.18(e)(4) Management 28 Pa. Code: 201.29(i) Resident Rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 5 of 25 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 12/15/2023 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 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 a review of facility policy, resident record, observation, resident interview and staff interview, it was determined the facility failed to provide necessary services to maintain good grooming and personal hygiene for thirteen of 43 residents (Resident R28, R22, R40, R29, R46, R201, R200, R250, R50, R81, R1, R90 and R15). Residents Affected - Few Findings include: Based on review of facility policy titled Activities of Daily Living (ADLs) last reviewed 11/30/23, informed residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. Review of Resident R28's clinical record indicated she was admitted on [DATE]. Review of the Minimum Data Set (MDS, periodic assessment of resident care needs) dated 11/16/23, included the diagnoses of diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time) and muscle wasting. During an observation on 12/12/23, at 9:18 a.m. Resident R28 was noted to have food spilled on her clothing and a spoon wrapped in the blanket on her stomach. The breakfast tray had already been removed. Review of the clinical record indicated Resident R22 was admitted on [DATE]. Review of the MDS dated [DATE], included the diagnoses of dementia (a group of symptoms that affects memory, thinking and interferes with daily life) and muscle wasting. During an observation on 12/12/23, at 9:18 a.m. Resident R22 was noted to have a beard and mustache. During a second observation on 12/15/23, at 11:40 a.m. Resident R22 was noted to still have a beard and mustache. Review of Resident R40's clinical record indicated he was admitted on [DATE]. Review of the MDS dated [DATE], included the diagnoses of chronic obstructive pulmonary disease (COPD, a group of progressive lung disorders characterized by increasing breathlessness) and atrial fibrillation (disease of the heart characterized by irregular and often faster heartbeat). During an observation on 12/12/23, at 9:22 a.m. Resident R40 was noted to have long fingernails. Review of Resident R29's clinical record indicated she was admitted on [DATE]. Review of the Minimum Data Set (MDS, periodic assessment of resident care needs) dated 11/21/23, included the diagnoses of dementia (a group of symptoms that affects memory, thinking and interferes with daily life) and fracture of the left fibula (lower leg bone). During an interview on 12/12/23, at 9:34 a.m. the family member for Resident R29 stated Resident R29 was wearing the same clothing she had dressed her in the previous day. The family member displayed the soiled brief that she had just removed from Resident R29 that had dried fecal matter in it. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 6 of 25 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 12/15/2023 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 0677 Level of Harm - Minimal harm or potential for actual harm Review of Resident R200's clinical record indicated she was admitted on [DATE]. Review of the MDS dated [DATE], included the diagnoses of osteoporosis (condition when the bones become brittle and fragile) and Alzheimer's disease (a type of brain disorder that causes problems with memory, thinking and behavior). During an observation on 12/12/23, at 9:40 a.m. Resident R200 was noted to have a beard and mustache. Residents Affected - Few Review of Resident R46's clinical record indicated she was admitted on [DATE]. Review of the MDS dated [DATE], included the diagnoses of heart failure (a progressive heart disease that affects pumping action of the heart muscles) and lymphedema (the build-up of fluid in soft body tissues). During an observation on 12/14/23, at 9:50 a.m. Resident R46 was noted to have a messy, unbrushed hair. Review of Resident R201's clinical record indicated she was admitted on [DATE]. Review of the facility diagnosis list, included the diagnoses of diabetes and aftercare following joint replacement surgery. During an observation on 12/12/23, at 9:51 a.m. Resident R201 was noted to have a beard and mustache. Review of Resident R90's record indicated the resident was admitted to the facility on [DATE]. Diagnoses included diabetes, peripheral vascular disease (narrowing and hardening of the arteries restricting blood flow to the heart), and heart failure. Review of Resident R90's care plan dated 11/22/23, included the focus of ADL self-care performance deficit. During an observation on 12/14/23, at 12:20 p.m. Resident R90 had fingernails that extended approximately 1/4 to 1/2 over the fingertip. The cuticle areas and under the fingernails were significantly layered with an orange and brown substance. During an interview on 12/14/23, at 12:20 p.m. Resident R90 reported they do not like their fingernails that long, had asked for the past three weeks to have them trimmed, and had attempted to bite them shorter. During an interview on 12/14/23, at 12:35 p.m. Assistant Director of Nursing Employee E1 confirmed the facility failed to provide necessary services to maintain good grooming and personal hygiene Review of Resident R250's clinical record indicated he was admitted on [DATE]. Review of the MDS dated [DATE], included the diagnoses of heart failure and osteoarthritis (degeneration of the joint causing pain and stiffness). During an observation on 12/15/23, at 11:35 a.m. Resident R250 was noted to have long, jagged fingernails. Review of Resident R50's clinical record indicated he was admitted on [DATE]. Review of the MDS dated [DATE], included the diagnoses of spinal stenosis (a narrowing of the spaces within the spine, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 7 of 25 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 12/15/2023 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 0677 which causes pain and weakness) and diabetes. Level of Harm - Minimal harm or potential for actual harm During an interview and observation on 12/15/23, at 11:36 a.m. Resident R50 was noted to have a long, unbrushed hair and a long beard. Resident R50 stated that while he does prefer to have a beard, he would like it trimmed up. Residents Affected - Few Review of Resident R81's clinical record indicated she was admitted on [DATE]. Review of the MDS dated [DATE], included the diagnoses of heart failure and COPD. During an observation on 12/15/23, at 11:42 a.m. Resident R81 was noted to have messy, unbrushed hair. Review of Resident R1's clinical record indicated she was admitted on [DATE]. Review of the MDS dated [DATE], included the diagnoses of end stage renal disease (ESRD, an inability of the kidneys to filter the blood) and cerebral palsy (group of disorders that affect a person's ability to move and maintain balance and posture). During an observation on 12/15/23, at 11:43 a.m. Resident R1 was noted to have messy, unbrushed hair. Review of Resident R15's clinical record indicated he was admitted on [DATE]. Review of the MDS dated [DATE], included the diagnoses of ESRD and hemiplegia (paralysis on one side of the body). During an interview and observation on 12/15/23, at 11:50 a.m. Resident R15 was noted to have long fingernails. Resident R15 stated that he would like to have them cut. During an interview on 12/15/23, at 3:30 p.m. the Nursing Home Administrator confirmed that the facility failed to provide necessary services to maintain good grooming and personal hygiene for one of residents. 28 Pa. Code: 211.10(a)(c)(d) Resident care policies. 28 Pa. Code: 211.12(d)(1)(2)(3)(5) Nursing services. 28 Pa. Code: 201.29(j) Resident Rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 8 of 25 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 12/15/2023 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 facility policy, staff record review and staff interview it was determined the facility failed to have a qualified Activities Director to oversee the activities department for all 101 current residents in the facility. Residents Affected - Few Findings include: Based on a review of facility policy titled Activity Program last reviewed 11/30/23, informed our activity programs are staffed with personnel who have appropriate training and experience to meet the needs and interests of each resident. Our activities programs are under the direct supervision of a qualified professional who is a qualified therapeutic recreational specialist or an activities professional who is licensed or registered, if applicable, by the state in which practicing: AND is eligible for certification as a therapeutic recreational specialist or as an activities professional by a recognized accrediting body; OR has two years of experience in a social or recreational program within the last 5 years; OR is a qualified occupational therapist or occupational therapy assistant; OR has completed a training course approved by the state. Review of Activity Director Employee E10's personnel record documented the date of hire as 3/16/23. The job application included education of a Bachelor's of Arts degree in Human Development and Family Services awarded on 12/31/22. Past employment included seven months as a Community Living Supervisor and eight months as a case manager Support Coordinator. The personnel record also included a Family Life Educator license/certificate issued in October, 2022. During an interview on 12/12/23, at 10:33 a.m. Regional Human Resource Director Employee E3 confirmed the facility failed to have a qualified Activities Director to oversee the activities department for all 101 current residents in the facility. 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 9 of 25 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 12/15/2023 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 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 observations and resident and staff interviews, it was it was determined that the facility failed to correctly apply elastic ACE wraps for one of four residents (Resident R74) and failed to follow physician's orders for two of four residents (Resident R60, R74, and R89). Residents Affected - Some Findings include: Review of Resident R60's admission record indicated he was admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS, periodic assessment of resident care needs) dated 11/6/23, included diagnoses of abnormality of gain and mobility and atherosclerosis of native arteries of extremities, bilateral legs (narrowing of the arteries in both of the legs). Review of an active physician order dated 10/12/23, indicated Resident R60 should have ACE wraps applied to both legs, wrapped from toes to below the knee, on in the morning and off at the hour of sleep. During observations completed on 12/14/23, at 9:50 a.m., 11:30 a.m., 1:40 p.m., and 3:30 p.m. and on 12/15/23, at 9:00 a.m. and 11:45 a.m. all revealed that Resident R60 did not have ACE wraps applied to his legs. Review of Resident R74's admission record indicated she was admitted to the facility on [DATE]. Review of the MDS dated [DATE], included diagnoses of heart failure (a progressive heart disease that affects pumping action of the heart muscles) and pulmonary hypertension (a type of high blood pressure that affects arteries in the lungs and in the heart). Review of an physician order dated 10/7/23, indicated Resident R89 should have ACE wraps applied to both lower extremities every morning and off at bedtime. During observations completed on 12/14/23, at 9:50 a.m., 11:30 a.m., 1:40 p.m., and 3:30 p.m. revealed Resident R74's ACE wraps to have been applied beginning at the knees, and ending at the ankles. Review of Resident R89's admission record indicated he 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) and high blood pressure. Review of an physician order dated 8/31/23, indicated Resident R89 should have ACE wraps applied to both lower extremities every morning and off at bedtime. During observations completed on 12/14/23, at 9:50 a.m., 11:30 a.m., 1:40 p.m., and 3:30 p.m. and on 12/15/23, at 9:00 a.m. and 11:45 a.m. all revealed that Resident R60 did not have ACE wraps applied to his legs. During the observation at 9:00 a.m., Resident R89's legs were visibly swollen with indentations in the legs from the elastic at the top his socks. During an interview on 12/15/23, at 3:30 p.m. the Nursing Home Administrator confirmed that ACE (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 10 of 25 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 12/15/2023 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 0684 wraps need to be applied from the foot, then moving toward the knee, and confirmed that the facility failed to follow physicians' orders for two of four residents. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code: 201.14(a) Responsibility of licensee. Residents Affected - Some 28 Pa. Code: 201.18(a)(b)(3) Management. 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 25 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 12/15/2023 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, clinical record review, and staff interview, it was determined that the facility failed to consistently provide prescribed treatments for three of four residents (Resident R46, R49 and R63). Residents Affected - Some Findings include: Review of the facility policy Pressure Ulcers/Skin Breakdown - Clinical Protocol last reviewed 11/30/23, 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. Review of the clinical record indicated Resident R46 was admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS - periodic assessment of care needs) dated 10/18/23, included the diagnoses of heart failure (a progressive heart disease that affects pumping action of the heart muscles) and lymphedema (the build-up of fluid in soft body tissues). Review of Section GG: Functional Abilities and Goals indicated that Resident R46 had range of motion impairment of both lower extremities. Review Resident R46's care plan dated 1/31/23, indicated that Resident R46 is to have heels protected from friction and pressure by offloading heels (to alleviate pressure against the heels, such as by elevating the heels under the ankle, or by placing heel protector boots on the resident). Review of the nurse aide task list indicated the task dated 7/12/22, of Positioning: float heels in bed if needed. During observations completed on 12/14/23, at 9:50 a.m., 11:30 a.m., 1:40 p.m., and 3:30 p.m. and on 12/15/23, at 9:00 a.m. and 11:45 a.m. revealed that Resident R46 to have her heels flat on the mattress for each observation. Review of the clinical record indicated Resident R49 was admitted to the facility on [DATE]. Review of the MDS dated [DATE], included the diagnoses of chronic obstructive pulmonary disease (COPD, a group of progressive lung disorders characterized by increasing breathlessness) and rheumatoid arthritis (chronic, painful inflammatory disorder affecting many joints, including those in the hands and feet). Review of Section O: Special Treatments, Procedures, and Programs indicated Resident R49 received hospice services while at the facility. Review Resident R49's care plan dated 3/30/23, indicated that Resident R49 is to have heels protected from friction and pressure by offloading heels and Resident R49 is to be turned/repositioned every two hours, more often as needed or requested. Review of the nurse aide task list indicated the task dated 3/29/23, of Monitor: turn and reposition. During observations completed on 12/14/23, at 9:50 a.m., 11:30 a.m., 1:40 p.m., and 3:30 p.m. and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 12 of 25 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 12/15/2023 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some on 12/15/23, at 9:00 a.m. and 11:45 a.m. revealed that Resident R49 to be positioned on her back for each observation. Review of the clinical record indicated Resident R63 was admitted to the facility on [DATE]. Review of the MDS dated [DATE], included the diagnoses of peripheral vascular disease (PVD, circulatory condition in which narrowed blood vessels reduce blood flow to the limbs) and muscle weakness. Review of Section O: Special Treatments, Procedures, and Programs indicated Resident R63 received hospice services while at the facility. Review of a physician's order dated 10/1/22, indicated that Resident R63 was to have her legs elevated when in bed when possible. Review Resident R63's care plan dated 7/1/22, indicated that Resident R63 is to have heels protected from friction and pressure by offloading heels and Resident R63 is to be turned/repositioned every two hours, more often as needed or requested. Review of the nurse aide task list indicated the task dated 7/1/22, of Offer and assist with offloading heels while in bed as tolerated. During an observation completed on 12/14/23, at 11:30 a.m., and on 12/15/23, at 9:00 a.m. Resident R49 was in bed with her heels not elevated for both observations. During an interview on 12/16/23, at 3:30 p.m. the Nursing Home Administrator confirmed the facility failed to consistently provide prescribed treatments for pressure ulcers for three of four 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 13 of 25 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 12/15/2023 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 0710 Obtain a doctor's order to admit a resident and ensure the resident is under a doctor's care. 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 facility policy, observations, resident record reviews, resident interviews and staff interviews, it was determined the facility failed to obtain physician orders for smoking and to ensure the medical care of each resident is supervised by a physician for eight of eight residents (Residents R2, R5, R31, R32, R55, R56, R70, and R199). Residents Affected - Some Findings include: Review of facility policy titled Smoking Policy - Residents last reviewed 11/30/23, informed the facility shall establish and maintain safe resident smoking practices. The staff shall consult with the attending physician and the director of nursing services to determine if safety restrictions need to be placed on a resident's smoking privileges based on the safe smoking evaluation. Review of the facility's list of residents who smoke included Residents R2, R5, R31, R32, R55, R56, R67, R70 and R199. Review of Resident R2's record indicated the resident was admitted to the facility 9/6/18. Diagnoses included left side hemiplegia and hemiparesis (paralysis and muscle/weakness/partial paralysis), vascular dementia, schizophrenia (chronic brain disorder that include delusions, hallucinations, disorganized speech and difficulty with thinking) and seizures (a burst of uncontrolled electrical activity between brain cells that causes temporary abnormalities in muscle tone or movements). Review of Resident R2's current physician orders revealed the resident did not have an order for smoking. Review of Resident R5's record indicated the resident was admitted to the facility on [DATE]. Diagnoses included morbid obesity, acquired absence of the right leg above the knee, schizophrenia, corneal ulcer in the left eye, abnormalities of gait and mobility, and muscle weakness. Review of Resident R5's current physician orders revealed the resident did not have an order for smoking. Review of Resident R31's record indicated the resident ws admitted to the facility on [DATE]. Diagnoses included diabetes, abnormalities of gait and mobility, and bipolar disorder (a psychiatric disorder characterized by both manic and depressive episodes). Review of Resident R31's current physician orders revealed the resident did not have an order for smoking. Review of Resident R32's record indicated the resident was admitted to the facility on [DATE]. Diagnoses included muscle weakness, depression, anxiety, and abnormalities of gait and mobility. Review of Resident R32's current physician orders revealed the resident did not have and order for smoking. Review of Resident R55's record indicated the resident was admitted to the facility on [DATE]. Diagnoses included muscle weakness, abnormalities of gait and mobility, acquired absence of right toes, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 14 of 25 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 12/15/2023 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 0710 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some acquired absence of left leg below the knee, seizures, and cognitive communication deficit (difficulty in thinking and use of language). Review of Resident R55's current physician orders revealed the resident did not have an order for smoking. Review of Resident R56's record indicated the resident was admitted to the facility on [DATE]. Diagnoses included muscle weakness, abnormalities of gait and mobility, cognitive communication deficit, and depression. Review of Resident R56's current physician orders revealed the resident did not have an order for smoking. Review of Resident R70's recorded indicated the resident was admitted to the facility on [DATE]. Diagnoses included rheumatoid arthritis (a chronic progressive disease causing inflammation in the joints resulting in deformity and immobility especially in the fingers, wrists, feet and ankles), muscle weakness, abnormalities of gait and mobility, and osteoarthritis (degeneration of joint [NAME]). Review of Resident R70's current physician orders revealed the resident did not have an order for smoking. Review of Resident R199's record indicated the resident was admitted to the facility on [DATE]. Diagnoses included acquired absence of right leg below the knee, epilepsy (seizure disorder), intellectual disability (limited ability in learning and functioning in daily life), paranoid schizophrenia (feelings of distrust and suspiciousness towards others), muscle weakness, and abnormalities of gait and mobility. Review of Resident R199's current physician orders revealed the resident did not have an order for smoking. During an interview on 12/14/23, at 8:50 a.m. the Nursing Home Administrator confirmed the facility failed to obtain physician orders for smoking and to ensure the medical care of each resident is supervised by a physician. 28 Pa. Code: 211.2(a)(b)(c)(d)(1)(2) Physician Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 15 of 25 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 12/15/2023 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 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 clinical record review, review of facility policy, and staff interview, it was determined that the facility failed to ensure that the resident's attending physician addressed pharmacy recommendations for one of five residents reviewed (Resident R36). Findings include: Review of the facility policy Medication Regimen Review, dated 11/30/23, indicated the consultant pharmacist performs a medication regimen review and provides a written report to the physician for any irregularity. The physician documents in the medical record in a timely manner that the irregularity has been reviewed and what action was taken to address it. Review of the clinical record indicated Resident R36 was admitted to the facility on [DATE], with diagnoses that included dementia and insomnia. Review of the MDS (Minimum data set- resident assessment and care screening) dated 10/27/23, indicated the diagnoses remain current. Review of Resident R36's clinical record revealed that the facility's pharmacist made recommendations to the physician on 8/30/23, and 9/27/23, for the diagnosis and use of an antipsychotic medication. The pharmacy recommendation was not addressed by Resident R36's physician as of the date of review on 12/15/23. During an interview on 12/15/23 at 12:45 p.m. Regional Clinical Consultant Employee E4 revealed the pharmacy irregularities should be addressed monthly, and confirmed the above findings that the facility attending physician failed to address pharmacy recommendations in a timely manner for Resident R36. 28 Pa. Code 211.2(a)(k) Physician services 28 Pa. Code 211.12(d)(3) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 16 of 25 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 12/15/2023 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 review of facility policy, facility observations, facility documentation, resident and staff interviews, it was determined the facility failed to routinely offer evening snacks or provide snacks as requested for seven of seven residents (Resident R500, R501, R502, R503, R504, R505 and R506). Findings include: Review of facility policy titled Snacks/Hydration last reviewed 11/30/23, informed it is the [facility's] policy to provide the following: 1) Bulk snacks and beverages to be available for residents upon request located at each resident care area, 2) snacks to residents in which their individual plan of care specifies, and 3) offer all residents a bedtime snack. Food Service Department assembles bulk snack items and beverages and delivers them to resident care areas and to be offered as bedtime snack to each resident care areas. During a resident group meeting conducted on 12/12/23, at 1:30 p.m. Residents R500, R501, R502, R503, R504, R505, and R506 reported snacks are not given at bedtime, or even when they ask for a snack. Resident R501 reported buying their own snacks from the facility's vending machines. During a review of Resident Council Minutes dated 11/29/23, recorded snacks are not available. During an observation on 12/15/23, at 10:00 a.m. the 100 unit pantry had 10 chocolate milks, 2 white milks, and 1 fruit drink. No other snacks were available in the pantry. During an interview on 12/15/23, at 10:00 a.m. Unit Secretary Employee E5 confirmed the snacks in the 100 unit pantry, The Unit Secretary confirmed the 100 unit census was 45 residents, and the 200 unit census was 50 residents. During an observation on 12/15/23, at 10:05 a.m. the 200 unit had 25 jello cups and 16 white milks. During an interview on 12/15/23, at 10:05 a.m. Nurse Aide Employee E8 confirmed the snacks in the 200 unit pantry. The Nurse Aide also reported no snacks were brought to the unit the night before and that it happens often. During an observation on 11/15/23, at 10:10 a.m. the kitchen Chef Employee E9 was observed filling bins with snacks. The kitchen pantry had a variety of snacks and beverages and in sufficient supply. During an interview on 12/15/23, at 10:12 the kitchen Chef Employee E9 reported snacks are delivered to the units every two days or as needed and no one has called the kitchen requesting snacks. During an interview on 12/15/23, at 10:18 a.m. the kitchen Chef Employee E9 confirmed the facility failed to routinely deliver snacks to the units so evening snacks could be offered or provided as requested. 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 17 of 25 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 12/15/2023 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 0838 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. Based on review of facility documents and staff interview it was determined that the facility failed to complete the Facility Assessment annually. Findings include: A review of the Facility Assessment Tool, dated 10/31/22, through, 10/31/23, revealed the facility did not complete the template to indicate accurate information on: For the sections titled Function Care Requirements instructions for completing the template indicated to address in the description: -Types of care required. -Services required. -Staff/Personnel required. -Staff competencies required. -Physical plant environment required - such as campus buildings and physical structures. -Medical and non-medical equipment required (including vehicles). -Health information technology resources required - such as systems for electronically managing patient records and electronically sharing information with other organizations. -Policies and procedures required in the provision of care to meet current professional standards. A description of this section with this information was not included in the Facility Assessment, and this information was not addressed in any other area of the Facility Assessment. For the sections titled Acuity Care Requirements instructions for completing the template indicated to address in the description: -Types of care required (including trauma and substance abuse disorders as applicable). -Services required (including behavioral health services as applicable). -Staff/Personnel required. -Staff competencies required. -Physical plant environment required - such as campus buildings and physical structures. -Medical and non-medical equipment required (including vehicles). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 18 of 25 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 12/15/2023 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 0838 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few -Health information technology resources required - such as systems for electronically managing patient records and electronically sharing information with other organizations. -Policies and procedures required in the provision of care to meet current professional standards. A description of this section with this information was not included in the Facility Assessment, and this information was not addressed in any other area of the Facility Assessment. For the sections titled Cognitive Care Requirements instructions for completing the template indicated to address in the description: -Types of care required. -Services required. -Staff/Personnel required. -Staff competencies required. -Physical plant environment required - such as campus buildings and physical structures. -Medical and non-medical equipment required (including vehicles). -Health information technology resources required - such as systems for electronically managing patient records and electronically sharing information with other organizations. -Policies and procedures required in the provision of care to meet current professional standards. A description of this section with this information was not included in the Facility Assessment, and this information was not addressed in any other area of the Facility Assessment. For the sections titled Cultural Care Requirements instructions for completing the template indicated to address in the description: -Types of care required. -Services required. -Staff/Personnel required. -Staff competencies required. -Physical plant environment required - such as campus buildings and physical structures. -Medical and non-medical equipment required (including vehicles). -Health information technology resources required - such as systems for electronically managing patient records and electronically sharing information with other organizations. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 19 of 25 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 12/15/2023 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 0838 -Policies and procedures required in the provision of care to meet current professional standards. Level of Harm - Minimal harm or potential for actual harm A description of this section with this information was not included in the Facility Assessment, and this information was not addressed in any other area of the Facility Assessment. Residents Affected - Few Review of the Staff, Training, Services, & Personnel section of the Facility Assessment included 68 different skills to be documented for: -Overall Staffing. -Staff Training/Competencies. -Services. -Action/Plan in Place. All 68 skills were blank for each of the four items above. Physical Environment: No contracts, memorandum of understanding, or third-party agreements provided with Facility Assessment for services not directly provided by the facility or in the instance of emergency. Health Information: No information was provided on electronic record management. A facility-based and community-based risk assessment was not provided. During a follow-up interview on 12/19/23, at 6:18 p.m. the Nursing Home Administrator confirmed that the facility failed to complete the Facility Assessment document as necessary. 28 Pa. Code 201.18(b)(3)(e)(2) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 20 of 25 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 12/15/2023 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 0880 Provide and implement an infection prevention and control program. 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 facility policy, clinical records, and staff interview, it was determined that the agency failed to maintain surveillance data and analysis for four of ten months (August, September, October, and November 2023) which caused six reportable infections not to be documented for five residents (Resident R5, R12, R23, R67, and R197). Residents Affected - Some Findings include: Review of the facility policy Infection Prevention and Control Program dated 11/30/23, previously reviewed 10/31/22, indicated that surveillance tools are used for recognizing the occurrence of infections, recording their number and frequency, detecting outbreaks and epidemics, monitoring employee infection, monitoring adherence to infection prevention and control practices, and detecting unusual pathogens with infection control implications. Review of the clinical record indicated Resident R67 was admitted to the facility on [DATE], and readmitted on [DATE]. Review of the Minimum Data Set (MDS, periodic assessment of resident care needs), dated 8/25/23, included diagnoses of heart failure (a progressive heart disease that affects pumping action of the heart muscles) and peripheral vascular disease (PVD, circulatory condition in which narrowed blood vessels reduce blood flow to the limbs). Review of a progress noted dated 10/26/23, at 2:20 a.m. resident calling out, help, I can't breathe. vitals temp 98.2, pulse 140, resp 24, BP 118/71 and spo2 94% with O2 via n.c. (nasal canula) resident diaphoretic (sweating) with increased anxiety. abnormal lung sounds. called [provider] and updated with resident status. v.o. (verbal order) stat CXR (chest x-ray)2 views. Called mobile x-ray. Vistaril for increased anxiety. recheck pulse 114. Review of a progress noted dated 10/26/23, at 12:27 p.m. indicated that Resident R67's sister requested resident to be sent to the hospital. Resident R67 was positive for Covid-19, complaining of shortness of breath and cough on overnight shift report. Review of a progress noted dated 10/26/23, at 12:57 p.m. indicated that Resident R67 was admitted to the hospital with acute respiratory failure secondary to active RSV infection (viral infection of the respiratory tract). Review of a progress noted dated 12/9/23, at 4:48 p.m. indicated that Resident R67 complained of shortness of breath and not feeling right. Review of a progress noted dated 12/10/23, at 8:43 p.m. indicated that Resident R67 complained of shortness of breath and had lung congestion. Resident R67's sister requested that the resident be sent to the hospital if he does not feel better. Review of a progress noted dated 12/10/23, at 11:07 p.m. indicated Resident requesting to go to hospital, stating he can't catch his breath VS- 115/77 P-56 R-20 SpO2-97% on 2L T-100.1. RNS (Registered Nurse Supervisor) aware. [Provider] called, awaiting further orders. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 21 of 25 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 12/15/2023 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 0880 Level of Harm - Minimal harm or potential for actual harm Review of a progress noted dated 12/10/23, at 11:27 p.m. indicated Resident stated that he is having trouble breathing, and does not want to wait for the provider tomorrow, wants to go to the hospital now. On call provider did not want to send him to the hospital, order DuoNeb's (breathing treatments), Mucinex, (cough medicine) and chest x ray. Resident's sister called and stated that she wants him to be transferred to the hospital immediately. Residents Affected - Some Review of a progress noted dated 12/11/23, at 6:13 a.m. indicated that Resident R67 was admitted to the hospital with influenza. Review of the clinical record indicated Resident R12 was admitted to the facility on [DATE]. Review of the MDS dated [DATE], included diagnoses of heart failure and chronic obstructive pulmonary disease (COPD, a group of progressive lung disorders characterized by increasing breathlessness). Review of a progress noted dated 11/12/23, at 11:06 a.m. indicated the supervisor was called into the room for malaise (vague feeling of being unwell) type symptoms. Resident R12 had a temperature of 101.1° F (degrees Fahrenheit). The on-call provider ordered a chest x-ray, blood work, a one-time dose of antibiotics, and throat lozenges. Review of a progress noted dated 11/12/23, at 11:35 p.m. indicated Resident R12 complained of congestion. Review of a progress noted dated 11/13/23, at 4:42 a.m. indicated that Resident R12 appeared to have severe nasal and chest congestion. Review of a progress noted dated 11/13/23, at 4:54 a.m. indicated Resident R12 requested to go to the emergency room. Complained of chest congestion and painful right lower extremity. Resident scheduled for stat chest x-ray and labs this a.m. resident refusing to wait for diagnostic testing. Requesting hospital transfer at this time. Review of a progress note dated 11/14/23, at 12:14 a.m. indicated Resident R12 was admitted to the hospital with a diagnosis of RSV infection, chest pain, and bilateral lower extremity edema (swelling caused due to excess fluid accumulation). Review of the clinical record indicated Resident R23 was admitted to the facility on [DATE]. Review of the MDS dated [DATE], included diagnoses of end stage renal disease (ESRD, an inability of the kidneys to filter the blood) and COPD. Review of a progress noted dated 11/18/23 at 10:45 p.m. indicated that Resident R23 complained of difficulty breathing, at approximately 8:00 p.m. The provider made aware and new orders were entered. Review of a progress noted dated 11/18/23 at 11:31 p.m. indicated Resident complained of shortness of breath around 8pm. Pulse ox in 80s. PRN (as needed) breathing treatment was given. Pulse increased to 92%, on 4l via nasal cannula. VS at time: 102.3, 165/77, 93, 22, 92%. Optum called. New orders given: Solu-Medrol 80 mg one time stat, Rocephin (antibiotic medication) 1 gram IM (injected into the muscle), one time stat, DuoNeb one tine stat and every 6 hours for 3 days, VS every 4 hours for 3 days, CBC (complete blood count blood test) with differential BMP (basic metabolic panel blood (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 22 of 25 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 12/15/2023 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some test), flu/covid, RSV, PCR STAT (test for influenza, Covid-19, and RSV), chest X-ray 2 views stat. To continue giving Tylenol for fever and oxygen via nasal cannula, cool compress for fever. Resident's vital signs are stable at this time. Resident reports feeling some improvements. Will monitor. Review of a progress noted dated 11/22/23 at 2:59 a.m. indicated that lab test results were received, and that Resident R23 was positive for Influenza A. Review of the clinical record indicated Resident R197 was admitted to the facility on [DATE]. Review of the MDS dated [DATE], included diagnoses of diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time) and COPD. Review of a progress noted dated 11/27/23 at 1:44 p.m. indicated Resident in bed diaphoretic, clammy, and lethargic. Lung sounds rhonchi and wheezing. Resident slow to respond. The progress note further stated Resident R197 was sent to the hospital. Review of a progress noted dated 11/27/23, at 7:05 p.m. indicated Resident R197 was admitted to the hospital with a diagnosis of RSV. Review of the clinical record indicated Resident R5 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) and COPD. Review of a progress noted dated 11/24/23 at 9:31 a.m. indicated Resident was noted to have a harsh, productive cough. Complained of sore throat, shortness of breath, and chest congestions/ discomfort. Bilateral lungs noted to have wheezing and some scattered rhonchi. 99.2 temp and oxygen at 93% on 3 liters. Notified [Provider]. New order to obtain STAT chest x-ray, DuoNebs four times per day, Mucinex DM twice daily x 10 days and cough drops. Will notify RN supervisor. Resident aware of new orders at this time. Will continue to monitor. Review of a progress noted dated 11/24/23, at 6:32 p.m. indicated that the x-ray revealed mild atelectatic changes (atelectasis, the collapse of one or more parts of the lung) or pneumonia at right lobe. The provider was made aware, and began doxycycline (antibiotic medication). Review of a progress noted dated 11/27/23, at 10:33 p.m. indicated Notified [Provider] that increase in Doxycycline has not been effective as resident is still complaining of not feeling well as well as continued chest congestion, harsh cough, and poor lung sounds. Vital signs stable, afebrile (without a fever). New order to obtain IV (intravenous) access and start IV Rocephin (antibiotic medication) 2 grams once daily x 7days and IV push Solu-Medrol (steroid medication) every twelve hours x 5 days. Breathing treatment duration also increased. Resident aware of new orders. Unable to obtain IV access, IV team notified and stated they would be here in the morning to insert PICC (peripherally inserted central catheter, thin tube inserted through a vein in the arm and passed through to the larger veins near the heart). Resident is stable and resting in bed with call light in reach. [Provider] to be in facility tomorrow morning to see resident. Review of a progress noted dated 11/28/23, at 10:53 a.m. indicated Resident R5 continued to experience shortness of breath, cough, chest congestion, increased abdominal firmness, and distention, and was sent to the hospital. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 23 of 25 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 12/15/2023 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of a progress noted dated 11/28/23, at 10:10 p.m. indicated Resident R5 tested positive for RSV at the hospital. On 12/15/23, at 10:00 a.m. the facility infection control surveillance data was reviewed to learn the number of residents who were diagnosed with RSV. It was noted at this time that for August, September, October, and November 2023, rather than a line-listing of infections, the surveillance data included only a list of residents with antibiotic orders. This listing did not include residents with infections not treated with antibiotics, including fungal and viral infections (including influenza and RSV). During an interview on 12/15/23, at approximately 12:00 p.m. the Infection Preventionist was unable to provide a reason why the surveillance data only included residents with bacterial infections treated by antibiotics. On 12/15/23, at approximately 12:05 p.m. a list of residents that had been diagnosed with RSV was requested. On 12/15/23, at 12:54 p.m. the Nursing Home Administrator provided a list of three residents (Resident R12, R67, and R197). During clinical record reviews on 12/15/23, beginning at 1:00 p.m. it was revealed that Resident R5 had been diagnosed with RSV, that Resident R22 had been diagnosed with Influenza, and that Resident R67 had been diagnosed with Influenza. During an interview on 12/15/23, at 3:30 p.m. the Nursing Home Administrator confirmed that the facility failed to maintain surveillance data and analysis for four of ten months which caused six reportable infections not to be documented for five residents. 28 Pa. Code: 201.14 (a) Responsibility of licensee. 28 Pa. Code: 201.18 (b)(1)(3)(e)(1) Management. 28 Pa. Code: 201.20 (c) Staff development. 28 Pa. Code: 211.10 (c)(d) Resident care policies. 28 Pa. Code: 211.12 (d)(1)(2)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 24 of 25 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 12/15/2023 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 0944 Level of Harm - Potential for minimal harm Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program. Based on review of facility documents and staff interview, it was determined that the facility failed to provide Quality Assurance and Performance Improvement (QAPI) training to facility staff. Residents Affected - Many Finding include: Review of the facility provided education documents and sign-in sheets revealed that the facility did not provide mandatory training that outlines and informs staff of the elements and goals of the facility's QAPI program. During an interview on 12/15/23, at 3:30 p.m. the Nursing Home Administrator confirmed that the facility failed to provide QAPI training to facility staff. 28 Pa. Code: 201.14(a) Responsibility of Licensee. 28 Pa. Code: 201.20(c) Staff Development. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395742 If continuation sheet Page 25 of 25