Inspection visit

Health inspectionApril 18, 2025

CARNEGIE PARK POST ACUTECMS #39574322 citations on this visit

22 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 22 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy, resident interviews, observation, and staff interviews, it was determined that the facility failed to provide prompt assistance to meet residents care needs for three of fourteen residents who require care (Residents R63, R67, and R8). Findings included: Review of facility policy Resident Rights last reviewed 3/14/25, indicated employees shall treat all residents with kindness, respect, and dignity. Federal and state laws guarantee certain basic rights to all residents of this facility. The Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual, which provides instructions and guidelines for completing required Minimum Data Set (MDS) assessments (mandated assessments of a resident's abilities and care needs), dated October 2023, indicated that a BIMS (Brief Interview of Mental Status) is a brief screener that aids in detecting cognitive impairment. Scores from a BIMS assessment suggests the following distributions: 13 - 15: cognitively intact 8 - 12: moderately impaired 0 - 7: severe impairment Review of the clinical record revealed Resident R67 was originally admitted to the facility on [DATE]. Review of the MDS dated [DATE], included diagnoses of coronary artery disease (reduced blood flow to the heart muscle) and heart failure (heart cannot keep up with its workload). Review of Section C: Cognitive Patterns, indicated, intact cognition with a BIMS Score of 15. Review of Section GG: 0130 Functional Abilities, indicated Resident R67 required partial/moderate assistance with toileting hygiene. During an interview with Resident R67 on 4/16/25, at 1:34 p.m., the following was stated: I have sat in a dirty brief for more than an hour. Last week was the most recent time it happened to me. It regularly takes them an hour to answer the call lights no matter what you need. Review of the clinical record revealed Resident R63 was originally admitted to the facility on (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 34 Event ID: 395743 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0550 [DATE]. Level of Harm - Minimal harm or potential for actual harm Review of the MDS dated [DATE], included diagnoses of seizure disorder (abnormal electrical activity in the brain) and bipolar disorder (extreme mood swings). Review of Section C: Cognitive Patterns, indicated, intact cognition with a BIMS Score of 15. Review of Section GG: 0130 Functional Abilities, indicated Resident R63 was independent for toileting hygiene. Review of Section GG: 0170 Mobility toilet transfer, indicated Resident R63 requires supervision or touch assistance (helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently). Residents Affected - Some During an interview with Resident R63 on 4/16/25, at 1:45 p.m., the following was stated: I can change my brief myself, I need some help in the bathroom. I have had accidents in bed and need help getting things cleaned up. I can only do so much of it and the bed needs changed. Sometimes the staff come in and wake me up at 2:00 a.m. for me to change my brief so I don't have an accident, and I don't like them waking me at 2:00 a.m . Monday night (4/14/25) it happened to me again. I had an accident and had to wait for more than an hour for help to get things cleaned up. Waiting an hour or longer when you call for help is normal here. Review of the clinical record revealed Resident R8 was admitted to the facility on [DATE]. Review of the MDS dated [DATE], included diagnoses of heart failure and sepsis (infection in the bloodstream). Review of Section C: Cognitive Patterns, indicated, intact cognition with a BIMS Score of 15. Review of Section GG: 0130 Functional Abilities, indicated Resident R8 required partial/moderate assistance for lower body dressing. During an interview and observation on 4/15/25, at 2:20 p.m., Resident R8 was observed dressed in a shirt and a brief. Resident R8 stated that he did not like not having any pants on. During an interview on 4/17/25, at approximately 9:00 a.m. the Nursing Home Administrator and the Director of Nursing confirmed the facility failed to provide an environment and care to promote dignity for each resident's quality of life for three of fourteen residents. 28 Pa. Code 211.12 (a)(c)(d)(4)(5) Nursing Services 28 Pa. Code 201.29 (j) Resident Rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 2 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0577 Allow residents to easily view the nursing home's survey results and communicate with advocate agencies. Level of Harm - Potential for minimal harm Based on observation and staff interview, it was determined the facility failed to ensure the Department of Health most recent survey results were readily accessible to residents and visitors, for four of four locations (first floor lobby, nursing units ground, second and third floors). Residents Affected - Many Findings Include: During an observation on 4/14/25, at 9:20 a.m. in the lobby, no survey result book could be located. During an observation on 4/14/25, at 9:25 a.m. on the second floor, no survey result book could be located. During an observation on 4/14/25, at 9:28 a.m. on the third floor, no survey result book could be located. During an observation on 4/14/25, at 9:32 a.m. on the ground floor, no survey result book could be located. During an interview on 2/12/25, at 9:25 a.m. the Nursing Home Administrator (NHA) confirmed the facility failed to ensure the Department of Health most recent survey results were readily accessible to residents and visitors for four of four locations, (first floor lobby, nursing units ground, first, and second floors). 28 Pa. Code 201.14(a) Responsibility of licensee. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 3 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 review of facility policy, clinical records, and resident and staff interviews, it was determined that the facility failed to notify the resident representative of changes in appointment and transportation times for one of four residents (Resident R69). Findings include: Review of the facility policy, Notification for Medical Appointments dated 3/14/25, previously dated 8/13/24, indicated when a medical appointment is scheduled: - Document the appointment details in the resident's medical record. - Notify the responsible party at least 48 hours in advance, unless the appointment is emergent. - Use the resident's preferred communication method (e.g., phone, email, written notice). The notification to the responsible party should include: - Date and time of the appointment. - Name and specialty of the healthcare provider. - Purpose of the appointment. - Any special instructions or preparations required. Review of the clinical record indicated Resident R69 was admitted to the facility on [DATE]. Review of Resident R69's Minimum Data Set (MDS - periodic assessment of resident care needs) dated 4/6/25, included diagnoses diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time) and multiple fractures. Review of Resident R69's demographic profile indicated her son as her emergency contact and medical power-of-attorney. Review of a physician's progress note dated 4/8/25, at 6:54 p.m. indicated, Spoke with patient's son regarding her appointment with plastics and the outcome of that appointment which was a referral to an orthopedic surgeon for her shoulder and otherwise no new orders. Patient's son voiced frustration over not being made aware of the appointment ahead of time which I passed along to administrative staff. During an interview on 4/16/25, at 2:15 p.m. Resident R69's son stated he was upset that his mother had gone to her appointment by herself soon after she was admitted . The son stated that it should be in the record that he is notified of all appointments and any time that Resident R69 was to be taken out of the facility, to which Resident R69 agreed. Resident R69's son stated that he had previously voiced concern to with facility administration, and was assured it would never happen again, but (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 4 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 that it had just happened again. Resident R69's son stated that he was going to accompany his mother to her appointment (4/15/25), with her traveling in wheelchair transportation. Resident R69's son said when he arrived at the facility, his mother had already departed, as there had been a change in the transportation time that he had not been informed of. Resident R69's son stated, I don't want my [resident's age, greater than 90 years] old mother having to go anywhere by herself. Residents Affected - Few During an interview on 4/18/25, at approximately 1:00 p.m. the Nursing Home Administrator confirmed that this concern had been previously brought to facility administration and further confirmed that the facility failed to notify resident representative of changes in appointment and transportation times for one of four residents. 28 Pa. Code 201.18 (b)(1) Management. 28 Pa. Code 201.29(d) Resident rights. 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: 395743 If continuation sheet Page 5 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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. Based on review of facility policy , observations, and staff interviews it was determined that the facility failed to maintain a homelike environment in the facility (resident dining rooms) for one of four resident dining locations (first floor nursing unit). Findings include: A review of the facility Homelike Environment Policy dated 3/14/25, indicated residents are provided with a safe, clean, comfortable environment and encouraged to use their personal belongings to the extent possible. During an observation of the facility on 4/14/25, at 10:00 a.m., the following was revealed: First floor resident dining room had a bed, mattress, and two treatment carts stored in this location. During an interview on 4/14/25 at 10:32 a.m. Employee E1 unit manager confirmed the bed, mattress, and two treatment carts were stored in this location. During an interview on 4/15/25, at 10:30 a.m., the Nursing home Administrator and Director of Nursing confirmed that the facility failed to maintain the facility in a homelike environment for one of four resident dining locations (first floor nursing unit). Pa Code: 207.2 (a) Administrator's responsibility FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 6 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 - Potential for minimal harm Residents Affected - Many 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 review of facility policy, posted documents, observations, resident and staff interviews, it was determined that the facility failed to make certain grievance/concern forms can be filed anonymously for all residents and/or their representatives on five of five locations where grievance/complaint forms are provided (four nursing units and the lobby). Findings include: A review of the facility policy Grievances/Complaints, Filing last reviewed 3/14/25, indicated grievances and/or complaints may be submitted orally or in writing and may be filed anonymously. During an observation on 4/14/25 approximately 11:00 a.m. revealed no grievance boxes are available in the facility. Posted signage directs completed grievance/complaint forms be provided to social services, in the event the office is closed slide the document under the door. During an interview on 4/14/25, at 11:30 a.m. the Nursing Home Administrator confirmed that grievance boxes do not exist in the facility and confirmed the facility failed to make certain grievance/concern forms can be filed anonymously for all residents and/or their representatives on five of five locations where grievance/complaint forms are provided. 28 PA Code: 201.18(e)(4) Management. 28 PA Code: 201.29(a)(b)(c) Resident rights. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 7 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 Based on review of facility policy, facility records, and resident and staff interviews, it was determined that the facility failed to provide Activity of Daily Living (ADL) assistance for 15 of 22 residents as required (Resident R500, R501, R502, R503, R504, R505, R506, R507, R508, R509, R8, R68, R69, R125, and R243). Residents Affected - Some Findings include: The facility policy Call System, Residents dated 3/14/25, indicated calls for assistance are answered as soon as possible, but no later than 5 minutes. Urgent requests for assistance are addressed immediately. The Long-Term Care Facility Resident Assessment Instrument (RAI) User's Manual, which provides instructions and guidelines for completing required Minimum Data Set (MDS) assessments (mandated assessments of a resident's abilities and care needs), dated October 2023, indicated that a BIMS (Brief Interview of Mental Status) is a brief screener that aids in detecting cognitive impairment. Scores from a BIMS assessment suggests the following distributions: 13 - 15: cognitively intact 8 - 12: moderately impaired 0 - 7: severe impairment During a resident group interview on 4/14/25, at 1:30 p.m., ten of fourteen residents in attendance stated that they consistently wait one hour or longer for their call light to be responded to. (Residents R500, R501, R502, R503, R504, R505, R506, R507, R508, and R509). The residents in attendance expressed frustration regarding the wait time. The residents stated they have reported this at their resident council meeting. Review of the 2/26/25, resident council meeting minutes, under the nursing section, reveals complaints regarding the agency staff they don't care. If you need help no one answers, they are always on their phones. During an interview on 4/18/25, at 8:00 a.m. Director of Nursing (DON) confirmed the facility failed to make certain call bells were answered timely for ten of fourteen residents as required (Resident R500, R501, R502, R503, R504, R505, R506, R507, R508, and R509). During an interview on 4/14/25, at 12:59 p.m. Resident R243 stated that the call light response time is long. During an interview on 4/14/25, at 1:16 p.m. Resident R68 stated that he waits a long time for his clothes to be returned from being laundered. Stated staff keeps saying they will look, but he doesn't have his clothes back. Stated he is wearing facility clothing, and the pants are too tight. Observation at this time revealed long, unkempt fingernails and that Resident R68 was malodorous. During an observation on 4/14/25, at 1:20 p.m. Resident R125 was observed to have long, unkempt fingernails. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 8 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview and observation on 4/15/25, at 2:20 p.m. Resident R8 was observed dressed in a shirt and a brief. Resident R8 stated that he did not like not having any pants on. During an interview on 4/15/25, at 2:36 p.m. Resident R69 stated that sometimes call lights can be long. Resident R69 stated that she has only had two showers since admission. Resident R69 stated she was given a bed bath, but that she prefers showers. Review of Resident R69's nurse aide task list indicated Resident R69 is scheduled to receive showers on Mondays and Thursdays, during evening shift. Review of Resident R69's bathing record (from 4/2/25, through 4/18/25) Resident R69 did not include a shower for the scheduled shower date of 4/7/25. During an interview on 4/18/25, the Nursing Home Administrator and the Director of Nursing confirmed that the facility failed to provide Activity of Daily Living (ADL) assistance for 15 of 22 residents. 28 Pa. Code: 211.10(c)(d) Resident care policies. 28 Pa. Code: 211.12(d)(1)(2)(3)(5) Nursing services. 28 Pa Code: 201.29 (I)(o) Resident rights. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 9 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 staff interviews and review of facility provided documentation, it was determined the facility failed to provide a qualified professional to direct the activities program as required for one of 12 months (3/3/25 through 4/14/25). Residents Affected - Few Findings include: Review of the Activities Director job description required Qualifications Certificates, Licenses, Registrations - Activity Director certificate. During an interview on 4/16/25, at 1:30 p.m. the Nursing Home Administrator (NHA) confirmed the facility failed to provide a qualified professional to direct the activities program for one of 12 months (3/3/25 through 4/14/25). 28 Pa Code 201.18(b)(3) Management. 28 Pa Code 201.18(e)(6) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 10 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 review of facility policies and documents, clinical records, and staff interviews, it was determined that the facility failed to provide care and services after hospitalization for one of three residents (Resident R68). Residents Affected - Few Review of the clinical record indicated that Resident R68 was admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS - periodic assessment of resident care needs) dated 3/24/25, included diagnoses of anemia (too little iron in the body causing fatigue), chronic kidney disease (gradual loss of kidney function), and osteomyelitis (inflammation of bone or bone marrow, usually due to infection). Review of hospital discharge instructions dated 3/19/25, indicated for the facility to reinforce the dressing. No direction for changing the dressing was documented. Review of a progress note dated 3/20/25, at 9:07 a.m. indicated, Pt (patient) has dressing intact to RLE (right lower extremity). Orders state to reinforce only, DO not change until F/U (follow-up) appointment in 2 weeks. Review of a progress note dated 3/21/25, at 2:44 p.m. indicated, this nurse spoke with dr. office regarding right foot wound care. per md office do not remove dressing only reinforce until f/u pt in 1 1/2 weeks. Review of a physician's order dated 3/21/25, indicated, DO NOT REMOVE RIGHT LEG DRESSING PER SURGEON. ONLY REINFORCE CALL OFFICE IF EXCESSIVE DRAINAGE. Review of a progress note dated 3/22/25 at 6:29 p.m. indicated, The resident has an excessive amount of drainage to the right leg. He has orders in the system not to remove surgical dressing to reinforce and notify Dr of excessive drainage to site. Current CNA (nurse aide) stated she told [Unit Manager Employee E1 and Registered Nurse (RN) Employee E3] the Nurse cut off the white cast and wrapped the wound with the dirty ace wrap. And nothing was done. The dirty ace wrap has been on since Wednesday. Today on my shift 3-11 the wound has excessive drainage when checking the system the order states do not remove call reinforce dressing call the doctor for excessive drainage when reading off the order my hall partner called [Unit Manager Employee E1] if he was aware the cast had been removed since Wednesday he stated no, told her to tell [LPN Employee E4]. [RN Employee E3] told us that she had told both [Unit Manager Employee E1 and [RN Employee E3] the cast was cut off and that she wrapped the fresh dressing with a soiled bandage. He said [LPN Employee E5] to take pictures with her phone send it to him he was going to call, the Dr. As I was writing the note in the system. And calling the Dr. I have been asked to leave. During an interview on 4/18/24, at 10:40 a.m. Unit Manager Employee E1 confirmed that Resident R68's dressing was changed without an order. During an interview on 4/18/24, at approximately 1:00 p.m. the Nursing Home Administrator confirmed that the facility failed to provide care and services after hospitalization for one of three residents. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 11 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 28 Pa. Code: 201.18(b)(1) Management. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code: 211.10(c)(d) Resident rights. 28 Pa. Code: 211.12(d)(1)(3)(5) Nursing services. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 12 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0730 Observe each nurse aide's job performance and give regular training. Level of Harm - Minimal harm or potential for actual harm Based on review of personnel records and staff interview it was determined that the facility failed to provide nursing staff annual performance evaluations based on the date of hire for five of five nurse aides (Employees E11, E12, E13, E14, and E15). Residents Affected - Many Findings include: Review of employee personnel files indicated no nursing staff annual performance evaluations. During an interview on 4/16/25, at approximately 1:00 p.m. the Nursing Home Administrator confirmed the facility failed to provide nursing staff annual performance evaluations based on the date of hire for five of five nurse aides. 28 Pa Code: 201.20 (a)(b)(c)(d) Staff development. 28 Pa Code: 201.14 (a) Responsibility of licensee. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 13 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical records, and staff interview, it was determined that the facility failed to implement procedures to ensure availability of prescribed medications for one of five residents (Residents R244). Findings include: Review of the facility policy, Pharmacy Services Overview dated 3/14/25, the facility shall accurately and safely provide or obtain pharmaceutical services, including the provision of routine and emergency medications and biologicals, and the services of a licensed consultant pharmacist. Review of the clinical record indicated Resident R244 was admitted to the facility on [DATE]. Review of the facility diagnosis list included chronic obstructive pulmonary disease (COPD - a group of progressive lung disorders characterized by increasing breathlessness), spinal stenosis (a narrowing of the spaces within the spine, which causes pain and weakness), and chronic pain syndrome. Review of a physician's orders dated 4/11/25, indicated Resident R244 was to receive oxycodone (a narcotic pain medication to treat moderate to severe pain) 10 mg (milligrams), 1.5 tablet (15 mg) by mouth every four hours as needed for severe pain. Review of a physician's orders dated 4/11/25, indicated Resident R244 was to receive Methocarbamol (muscle relaxant that works by calming overactive nerves in the body) 1000 mg four times a day for muscle spasms for ten days. Review of a physician's orders dated 4/11/25, indicated Resident R244 was to receive Ketorolac Tromethamine (nonsteroidal anti-inflammatory drug (NSAID) specifically recommended for moderate to severe pain) 10 mg, one tablet by mouth four times a day. Review of Resident R244 ' s documented pain levels indicated the following levels based on a zero to ten scale with zero being no pain and ten being the worst: 4/12/25, at 9:10 a.m. - 8 4/12/25, at 5:09 p.m. - 7 4/12/25, at 9:38 p.m. - 8 4/13/25, at 5:59 a.m. - 7 4/13/25, at 12:22 p.m. - 9 4/14/25, at 9:10 a.m. - 8 4/14/25, at 8:38 a.m. - 10 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 14 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0755 Review of Resident R1's Medication Administration Record (MAR) for April 2025, indicated: Level of Harm - Minimal harm or potential for actual harm 4/11/25: No documentation of oxycodone provided. Residents Affected - Few 4/11/25: Ketorolac, documented as 9 (9 is code for order Other/See Nurse Notes). The pain level noted with this scheduled administration was 10. Review of the associated progress note dated 4/11/25, at 11:07 p.m. indicated, per [physician] ok to give when arrives from pharmacy. 4/12/25: Methocarbamol, documented as 9. Review of the associated progress note dated 4/12/25, at 11:55 a.m. indicated, indicated that the medication was on order from the pharmacy. Review of an admission progress note dated 4/11/2025, at 10:13 p.m. indicated, explained to us she has several bone fractures on the right side of her lumbar spine and 8 pins and 8 rods on left side of spine. c/o pain of 10. Review of the facility provided inventory for the automated medication dispensing machine included oxycodone 5 and 10 mg tablets and Methocarbamol 500 mg tablets. During a follow-up communication on 4/18/25, at 1:30 p.m. the Director of Nursing was made aware that the facility failed to implement procedures to ensure availability of prescribed medications for one of five residents. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 15 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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, observations, and staff interview, it was determined that the facility failed to make certain that medications were properly stored and/or disposed of in the unused dining room on the first floor. Findings include: Review of facility policy Storage of Medications dated 3/14/25, stated that if the facility has discontinued, outdated, or deteriorated medications or biologicals, should be returned to the dispensing pharmacy or destroyed. During an observation of the first-floor dining room(unused) on 4/14/24, at 9:35 a.m. the following was observed: -(1) box of Midline blood glucose test strips expiring 7/8/23. -(1) adult manual resuscitator expiring 7/8/23 During an interview on 4/14/25, at 10:32 a.m. Unit Manager Employee E1 confirmed the above observations. During in observation of the ground floor clean utility room on 4/14/25, at 1:14 p.m. the door was noted to have a keypad lock, but the door was not closed. Within that room, an unlocked treatment cart was observed with the following items inside: -(3) open, partially used tubes of medical honey ointment, without names, date of opening, and allowed to commingle without being individually bagged. -(5) wound dressing packages, with an expiration date of 07/2022. During an interview on 4/14/25, at 1:20 p.m. Licensed Practical Nurse Employee E5 confirmed the above observations. During an interview on 4/15/25, at approximately 10:30 a.m. the Director of Nursing confirmed that the facility failed to make certain that medications were properly stored and/or disposed of in the unused dining room on the first floor. 28 Pa. Code: 201.14 (a) Responsibility of licensee. 28 Pa. Code: 201.18 (b)(1)(e)(1) Management. 28 Pa. Code: 211.9 (a)(1) Pharmacy services. 28 Pa. Code: 211.12 (d)(1)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 16 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on a review of facility policies, the Four-week Spring Summer (SS) cycle menu diet extension sheets, and staff interviews it was determined that the facility failed to follow a preplanned cycle menu (lunch meal on 4/14/25), as required and failed to provide resident's their preferences and standing order food choices (Residents R47 and R90). Findings include: Review of the facility policy Menus, last reviewed on 3/14/25, with a previous review date of 8/13/24, indicated that menus are developed and prepared to meet resident choices while following established national guidelines for nutritional adequacy. Review of the facility policy Resident Food Preferences, last reviewed on 3/14/25, with a previous review date of 8/13/24, indicated individual food preferences are assessed upon admission, and communicated to the interdisciplinary team. The facility has documented food preferences and dislikes on each resident food ticket. During a resident group interview on 4/14/25, at 1:30 p.m., the resident consensus identified that the facility had provided pot pie for lunch on 4/14/25, however, they were expecting chicken tenders which had been on the menu. During an observation of the posted menu for 4/14/25, indicated chicken tenders while the posting on the wall indicated that the pot pie had been substituted however, the residents were not made aware of the change. During an interview on 4/15/25, at 12:35 p.m., the Nursing Home Administrator confirmed that the facility failed to notify the residents of the menu change prior to the date, as required. During an observation on 4/15/25, at 8:20 a.m., Resident R 47 stated that she was provided toast and a bagel and one cup of coffee. Resident R47 stated that she has a preference indicated on her ticket. The ticket shows standing orders of two cups of coffee, orange juice and a boiled egg. Resident R47 had no protein on her breakfast tray. During an observation on 4/15/25, at 8:30 a.m., Resident R90 was provided a scrambled egg. Observation of her standing orders indicated a boiled egg and her dislike is identified as a scrambled egg. The resident stated that they never give her a boiled egg and you never know what you're gonna get. During an interview on 4/15/25, at 1:20 p.m., the Dietary Services Director Employee E6 confirmed that he has made menu changes to see what the residents like. The residents have dislikes and preferences and I could track them easier in a different computer system so if they don't get what they want, I cannot track there preferences. He was shown the incorrect tickets which indicated standing orders and preferences. No comment was made. During an interview on 4/18/25, at approximately 1:00 p.m. the Nursing Home Administrator confirmed that the facility failed to follow a preplanned cycle menu and failed to provide resident's their preferences and standing order food choices. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 17 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0803 Pa Code: 211.6(a) Dietary services. Level of Harm - Minimal harm or potential for actual harm Pa Code: 201.14(a) Responsibility of licensee Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 18 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy, observations, and staff interviews, it was determined that the facility failed to ensure that the call bell system was in full working order for one of four nursing units (Second Floor Nursing unit). Residents Affected - Few Findings include: Review of the facility policy Call System, Residents 3/14/25, indicated that the call system communication will be audible and visual and the resident call system will be functional at all times. During an observation of the Second Floor Nursing Unit, central call bells identified in the A, B, and C halls did not illuminate when resident call bells in their rooms of each hall had been activated. During an interview on 4/15/25, at 9:10 a.m., the Director of Nursing confirmed that the central call bells were not functioning to provide unobstructed visual communication of which hall the call bell was coming from due to the ceiling bulkhead. 28 Pa. Code 201.14 (a) Responsibility of licensee. 28 Pa. Code 201.18 (b) (1) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 19 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation and staff interview, it was determined that the facility failed to ensure a safe, functional and clean environment for two of 33 residents of the Third floor B wing nursing unit (Resident R99 and R112). Findings include: During an observation on 4/16/25, at 8:50 a.m., of the Third Floor Nursing Unit, two maintenance workers were observed exiting Resident R99 and R112's resident room. Upon entering the resident room, a four foot by four foot area (approximately) wall behind Resident R99's bed had been removed exposing wires and insulation. When asked, Maintenance Director Employee E7 stated that the wall had pulled away, from the television being too heavy and it needed repaired. Resident R99 and R112's belongings were scattered all over the room allowing debris to fall onto them and into their personal items. During an interview on 4/16/25, at 9:25 a.m., the Nursing Home Administrator confirmed that the facility failed to provide a safe, functional resident room for Residents R99 and R112. 28 Pa. Code: 207.2(a) Administrator's responsibility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 20 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0941 Level of Harm - Potential for minimal harm Residents Affected - Many Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members. Based on review of facility policy, personnel in-service training records, and staff interview, it was determined that the facility failed to provide training on Effective Communication for seven of eight staff members (Employee E11, E12, E13, E14, E15, E16, and E19). Findings include: Review of the facility policy, In-Service Training, All Staff most recently reviewed 3/14/25, indicated all personnel will receive education and training related to resident care. Required training topics include the following: a. Effective communication with residents and family (direct care staff); b. Resident rights and responsibilities; c. Preventing abuse, neglect, exploitation, and misappropriation of resident property including: d. Elements and goals of the facility QAPI program; e. The infection prevention and control program standards, policies and procedures; f. Behavioral health; and g. The compliance and ethics program standards, policies and procedures. (Compliance and ethics training is conducted annually when this organization is operating five or more facilities.) Review of facility provided documents and training records revealed the following staff members did not have documented training on effective communication: Nurse Aide Employee E11 had a hire date of 3/26/23, failed to have Effective Communication in-service education between 3/26/24, and 3/26/25. Nurse Aide Employee E12 had a hire date of 3/8/22, failed to have Effective Communication in-service education between 3/8/24, and 3/8/25. Nurse Aide Employee E13 had a hire date of 3/14/05, failed to have Effective Communication in-service education between 3/14/24, and 3/14/25. Nurse Aide Employee E14 had a hire date of 1/12/95, failed to have Effective Communication in-service education between 1/12/24, and 1/12/25. Nurse Aide Employee E15 had a hire date of 4/14/14, failed to have Effective Communication in-service education between 4/14/24, and 4/14/25. Registered Nurse Employee E16 had a hire date of 4/15/22, failed to have Effective Communication in-service education between 4/15/24, and 4/15/25. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 21 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0941 Level of Harm - Potential for minimal harm Registered Nurse Employee E19 had a hire date of 3/12/07, failed to have Effective Communication in-service education between 3/12/24, and 3/12/25. During an interview on 4/18/25, at approximately 1:00 p.m. the Nursing Home Administrator confirmed that the facility failed to provide training on Effective Communication for of seven of eight staff members. Residents Affected - Many 28 Pa Code: 201.14 (a) Responsibility of licensee. 28 Pa Code: 201.18 (b)(1) Management. 28 Pa Code: 201.20 (a)(c) Staff development. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 22 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0942 Level of Harm - Potential for minimal harm Residents Affected - Many Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents. Based on review of facility policy, personnel in-service training records, and staff interview, it was determined that the facility failed to provide training on Resident Rights for eight of ten staff members (Employee E11, E12, E13, E14, E15, E16, E17, E19, and E20). Findings include: Review of the facility policy, In-Service Training, All Staff most recently reviewed 3/14/25, indicated all personnel will receive education and training related to resident care. Required training topics include the following: a. Effective communication with residents and family (direct care staff); b. Resident rights and responsibilities; c. Preventing abuse, neglect, exploitation, and misappropriation of resident property including: d. Elements and goals of the facility QAPI program; e. The infection prevention and control program standards, policies and procedures; f. Behavioral health; and g. The compliance and ethics program standards, policies and procedures. (Compliance and ethics training is conducted annually when this organization is operating five or more facilities.) Review of facility provided documents and training records revealed the following staff members did not have documented training on Resident Rights; Nurse Aide Employee E11 had a hire date of 3/26/23, failed to have Resident Rights in-service education between 3/26/24, and 3/26/25. Nurse Aide Employee E13 had a hire date of 3/14/05, failed to have Resident Rights in-service education between 3/14/24, and 3/14/25. Nurse Aide Employee E14 had a hire date of 1/12/95, failed to have Resident Rights in-service education between 1/12/24, and 1/12/25. Nurse Aide Employee E15 had a hire date of 4/14/14, failed to have Resident Rights in-service education between 4/14/24, and 4/14/25. Registered Nurse Employee E16 had a hire date of 4/15/22, failed to have Resident Rights in-service education between 4/15/24, and 4/15/25. Medical Records Employee E17 had a hire date of 4/6/10, failed to have Resident Rights in-service education between 4/6/24, and 4/6/25. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 23 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0942 Level of Harm - Potential for minimal harm Registered Nurse Employee E19 had a hire date of 3/12/07, failed to have Resident Rights in-service education between 3/12/24, and 3/12/25. Dietary Employee E20 had a hire date of 4/6/17, failed to have Resident Rights in-service education between 4/6/24, and 4/6/25. Residents Affected - Many During an interview on 4/18/25, at approximately 1:00 p.m. the Nursing Home Administrator confirmed that the facility failed to provide training on Resident Rights for eight of ten staff members. 28 Pa Code: 201.14 (a) Responsibility of licensee. 28 Pa Code: 201.18 (b)(1) Management. 28 Pa Code: 201.20 (a)(c) Staff development. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 24 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0943 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation. Based on review of facility policy, personnel in-service training records, and staff interview, it was determined that the facility failed to provide training on Prevention of Abuse and Neglect for one of ten staff members (Employee E18). Findings include: Review of the facility policy, In-Service Training, All Staff most recently reviewed 3/14/25, indicated all personnel will receive education and training related to resident care. Required training topics include the following: a. Effective communication with residents and family (direct care staff); b. Resident rights and responsibilities; c. Preventing abuse, neglect, exploitation, and misappropriation of resident property including: d. Elements and goals of the facility QAPI program; e. The infection prevention and control program standards, policies and procedures; f. Behavioral health; and g. The compliance and ethics program standards, policies and procedures. (Compliance and ethics training is conducted annually when this organization is operating five or more facilities.) Review of facility provided documents and training records revealed the following staff members did not have documented training on Prevention of Abuse and Neglect: Therapy Employee E18 had a hire date of 2/9/09, failed to have Prevention of Abuse and Neglect in-service education between 2/9/24, and 2/9/25. During an interview on 4/18/25, at approximately 1:00 p.m. the Nursing Home Administrator confirmed that the facility failed to provide training on Prevention of Abuse and Neglect for one of ten staff members. 28 Pa Code: 201.14 (a) Responsibility of licensee. 28 Pa Code: 201.18 (b)(1) Management. 28 Pa Code: 201.20 (a)(c) Staff development. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 25 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 Residents Affected - Many Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program. Based on review of facility policy, personnel in-service training records, and staff interview, it was determined that the facility failed to provide training on Quality Assurance and Performance Improvement (QAPI) for ten of ten staff members (Employee E11, E12, E13, E14, E15, E16, E17, E18, E19, and E20). Findings include: Review of the facility policy, In-Service Training, All Staff most recently reviewed 3/14/25, indicated all personnel will receive education and training related to resident care. Required training topics include the following: a. Effective communication with residents and family (direct care staff); b. Resident rights and responsibilities; c. Preventing abuse, neglect, exploitation, and misappropriation of resident property including: d. Elements and goals of the facility QAPI program; e. The infection prevention and control program standards, policies and procedures; f. Behavioral health; and g. The compliance and ethics program standards, policies and procedures. (Compliance and ethics training is conducted annually when this organization is operating five or more facilities.) Review of facility provided documents and training records revealed the following staff members did not have documented training on the QAPI program: Nurse Aide Employee E11 had a hire date of 3/26/23, failed to have QAPI in-service education between 3/26/24, and 3/26/25. Nurse Aide Employee E12 had a hire date of 3/8/22, failed to have QAPI in-service education between 3/8/24, and 3/8/25. Nurse Aide Employee E13 had a hire date of 3/14/05, failed to have QAPI in-service education between 3/14/24, and 3/14/25. Nurse Aide Employee E14 had a hire date of 1/12/95, failed to have QAPI in-service education between 1/12/24, and 1/12/25. Nurse Aide Employee E15 had a hire date of 4/14/14, failed to have QAPI in-service education between 4/14/24, and 4/14/25. Registered Nurse Employee E16 had a hire date of 4/15/22, failed to have QAPI in-service education between 4/15/24, and 4/15/25. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 26 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 Medical Records Employee E17 had a hire date of 4/6/10, failed to have QAPI in-service education between 4/6/24, and 4/6/25. Therapy Employee E18 had a hire date of 2/9/09, failed to have QAPI in-service education between 2/9/24, and 2/9/25. Residents Affected - Many Registered Nurse Employee E19 had a hire date of 3/12/07, failed to have QAPI in-service education between 3/12/24, and 3/12/25. Dietary Employee E20 had a hire date of 4/6/17, failed to have QAPI in-service education between 4/6/23, and 4/6/25. During an interview on 4/18/25, at approximately 1:00 p.m. the Nursing Home Administrator confirmed that the facility failed to provide training on QAPI for ten of ten staff members. 28 Pa Code: 201.14 (a) Responsibility of licensee. 28 Pa Code: 201.18 (b)(1) Management. 28 Pa Code: 201.20 (a)(c) Staff development. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 27 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0945 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program. Based on review of facility policy, personnel in-service training records, and staff interview, it was determined that the facility failed to provide training on Infection Control for seven of ten staff members (Employee E11, E13, E14, E15, E16, E17, and E18). Findings include: Review of the facility policy, In-Service Training, All Staff most recently reviewed 3/14/25, indicated all personnel will receive education and training related to resident care. Required training topics include the following: a. Effective communication with residents and family (direct care staff); b. Resident rights and responsibilities; c. Preventing abuse, neglect, exploitation, and misappropriation of resident property including: d. Elements and goals of the facility QAPI program; e. The infection prevention and control program standards, policies and procedures; f. Behavioral health; and g. The compliance and ethics program standards, policies and procedures. (Compliance and ethics training is conducted annually when this organization is operating five or more facilities.) Review of facility provided documents and training records revealed the following staff members did not have documented training on Infection Control: Nurse Aide Employee E11 had a hire date of 3/26/23, failed to have Infection Control in-service education between 3/26/24, and 3/26/25. Nurse Aide Employee E13 had a hire date of 3/14/05, failed to have Infection Control in-service education between 3/14/24, and 3/14/25. Nurse Aide Employee E14 had a hire date of 1/12/95, failed to have Infection Control in-service education between 1/12/24, and 1/12/25. Nurse Aide Employee E15 had a hire date of 4/14/14, failed to have Infection Control in-service education between 4/14/24, and 4/14/25. Registered Nurse Employee E16 had a hire date of 4/15/22, failed to have Infection Control in-service education between 4/15/24, and 4/15/25. Medical Records Employee E17 had a hire date of 4/6/10, failed to have Infection Control in-service education between 4/6/24, and 4/6/25. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 28 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0945 Level of Harm - Minimal harm or potential for actual harm Therapy Employee E18 had a hire date of 2/9/09, failed to have Infection Control in-service education between 2/9/24, and 2/9/25. During an interview on 4/18/25, at approximately 1:00 p.m. the Nursing Home Administrator confirmed that the facility failed to provide training on Infection Control for seven of ten staff members. Residents Affected - Some 28 Pa Code: 201.14 (a) Responsibility of licensee. 28 Pa Code: 201.18 (b)(1) Management. 28 Pa Code: 201.20 (a)(c) Staff development. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 29 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0946 Provide training in compliance and ethics. Level of Harm - Potential for minimal harm Based on review of facility policy, personnel in-service training records, and staff interview, it was determined that the facility failed to provide training on Compliance and Ethics for four of ten staff members (Employee E11, E15, E16, and E19). Residents Affected - Some Findings include: Review of the facility policy, In-Service Training, All Staff most recently reviewed 3/14/25, indicated all personnel will receive education and training related to resident care. Required training topics include the following: a. Effective communication with residents and family (direct care staff); b. Resident rights and responsibilities; c. Preventing abuse, neglect, exploitation, and misappropriation of resident property including: d. Elements and goals of the facility QAPI program; e. The infection prevention and control program standards, policies and procedures; f. Behavioral health; and g. The compliance and ethics program standards, policies and procedures. (Compliance and ethics training is conducted annually when this organization is operating five or more facilities.) Review of facility provided documents and training records revealed the following staff members did not have documented training on Compliance and Ethics: Nurse Aide Employee E11 had a hire date of 3/26/23, failed to have Compliance and Ethics in-service education between 3/26/24, and 3/26/25. Nurse Aide Employee E15 had a hire date of 4/14/14, failed to have Compliance and Ethics in-service education between 4/14/24, and 4/14/25. Registered Nurse Employee E16 had a hire date of 4/15/22, failed to have Compliance and Ethics in-service education between 4/15/24, and 4/15/25. Registered Nurse Employee E19 had a hire date of 3/12/07, failed to have Compliance and Ethics in-service education between 3/12/24, and 3/12/25. During an interview on 4/18/25, at approximately 1:00 p.m. the Nursing Home Administrator confirmed that the facility failed to provide training on Compliance and Ethics for four of ten staff members. 28 Pa Code: 201.14 (a) Responsibility of licensee. 28 Pa Code: 201.18 (b)(1) Management. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 30 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0946 28 Pa Code: 201.20 (a)(c) Staff development. Level of Harm - Potential for minimal harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 31 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0947 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. Based on review of facility policy, staff education records, and staff interviews, it was determined that the facility failed to conduct at least 12 hours of in-service education, within 12 months of their hire date anniversary, for nurse aides as required for two of five nurse aides (Employees Employee E11 and E15). Findings include: Review of the facility policy, In-Service Training, All Staff most recently reviewed 3/14/25, indicated all personnel will receive education and training related to resident care. Review of Nurse Aide (NA) Employees Employee E11 and E15 ' s education records, with hire date greater than 12 months, revealed the following: NA Employee E11 had a hire date of 3/26/23, with approximately four of in-service education between 3/26/24, and 3/26/25. NA Employee E15 had a hire date of 4/14/14, with approximately four hours of in-service education between 4/14/24, and 4/14/25. During an interview on 4/18/25, at approximately 1:00 p.m. confirmed that the facility failed to provide the required 12 hours annual in-service education within 12 months of their hire date anniversary for two of five nurse aides. 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: 395743 If continuation sheet Page 32 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0949 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide behavior health training consistent with the requirements and as determined by a facility assessment. Based on review of facility policy, personnel in-service training records, and staff interview, it was determined that the facility failed to provide training on behavioral health for eight of ten staff members (Employee E11, E12, E13, E15, E16, E17, E18, and E19). Findings include: Review of the facility policy, In-Service Training, All Staff most recently reviewed 3/14/25, indicated all personnel will receive education and training related to resident care. Required training topics include the following: a. Effective communication with residents and family (direct care staff); b. Resident rights and responsibilities; c. Preventing abuse, neglect, exploitation, and misappropriation of resident property including: d. Elements and goals of the facility QAPI program; e. The infection prevention and control program standards, policies and procedures; f. Behavioral health; and g. The compliance and ethics program standards, policies and procedures. (Compliance and ethics training is conducted annually when this organization is operating five or more facilities.) Review of facility provided documents and training records revealed the following staff members did not have documented training on behavioral health: Nurse Aide Employee E11 had a hire date of 3/26/23, failed to have behavioral health in-service education between 3/26/24, and 3/26/25. Nurse Aide Employee E12 had a hire date of 3/8/22, failed to have behavioral health in-service education between 3/8/24, and 3/8/25. Nurse Aide Employee E13 had a hire date of 3/14/05, failed to have behavioral health in-service education between 3/14/24, and 3/14/25. Nurse Aide Employee E15 had a hire date of 4/14/14, failed to have behavioral health in-service education between 4/14/24, and 4/14/25. Registered Nurse Employee E16 had a hire date of 4/15/22, failed to have behavioral health in-service education between 4/15/24, and 4/15/25. Medical Records Employee E17 had a hire date of 4/6/10, failed to have behavioral health in-service education between 4/6/24, and 4/6/25. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 33 of 34 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 395743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carnegie Park Post Acute 1848 Greentree Road Pittsburgh, PA 15220 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 0949 Level of Harm - Minimal harm or potential for actual harm Therapy Employee E18 had a hire date of 2/9/09, failed to have behavioral health in-service education between 2/9/24, and 2/9/25. Registered Nurse Employee E19 had a hire date of 3/12/07, failed to have behavioral health in-service education between 3/12/24, and 3/12/25. Residents Affected - Some During an interview on 4/18/25, at approximately 1:00 p.m. the Nursing Home Administrator confirmed that the facility failed to provide training on behavioral health for eight of ten staff members. 28 Pa Code: 201.14 (a) Responsibility of licensee. 28 Pa Code: 201.18 (b)(1) Management. 28 Pa Code: 201.20 (a)(c) Staff development. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395743 If continuation sheet Page 34 of 34

Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.

Citations

22 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0577GeneralS&S Cno actual harm
F577 - The resident has the right to-
Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.
0584GeneralS&S Dpotential for harm
F584 - Safe Environment
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.
0585GeneralS&S Cno actual harm
F585 - Grievances
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.
0680GeneralS&S Dpotential for harm
F680 - The activities program must be directed by a qualified professional
Ensure the activities program is directed by a qualified professional.
0550GeneralS&S Epotential for harm
F550 - Resident Rights
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
0580GeneralS&S Dpotential for harm
F580 - Notification of Changes
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
0677GeneralS&S Epotential for harm
F677 - A resident who is unable to carry out activities of daily living receives
Provide care and assistance to perform activities of daily living for any resident who is unable.
0684GeneralS&S Dpotential for harm
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
0730GeneralS&S Fpotential for harm
F730 - Regular in-service education
Observe each nurse aide's job performance and give regular training.
0755GeneralS&S Dpotential for harm
F755 - Pharmacy Services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
0761GeneralS&S Epotential for harm
F761 - Labeling of Drugs and Biologicals
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.
0803GeneralS&S Epotential for harm
F803 - Menus and nutritional adequacy
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
0919GeneralS&S Dpotential for harm
F919 - Resident Call System
Make sure that a working call system is available in each resident's bathroom and bathing area.
0921GeneralS&S Dpotential for harm
F921 - Other Environmental Conditions
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
0941GeneralS&S Cno actual harm
F941 - Training Requirements
Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members.
0942GeneralS&S Cno actual harm
F942 - Training Requirements
Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents.
0944GeneralS&S Cno actual harm
F944 - Quality assurance and performance improvement
Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.
0945GeneralS&S Epotential for harm
F945 - Infection control
Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program.
0946GeneralS&S Bno actual harm
F946 - Compliance and ethics
Provide training in compliance and ethics.
0947GeneralS&S Dpotential for harm
F947 - Training Requirements
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
0949GeneralS&S Epotential for harm
F949 - Training Requirements
Provide behavior health training consistent with the requirements and as determined by a facility assessment.
0943GeneralS&S Dpotential for harm
F943 - Abuse, neglect, and exploitation
Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.

FAQ · About this visit

Common questions about this visit

What happened during the April 18, 2025 survey of CARNEGIE PARK POST ACUTE?

This was a inspection survey of CARNEGIE PARK POST ACUTE on April 18, 2025. The surveyor cited 22 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at CARNEGIE PARK POST ACUTE on April 18, 2025?

Yes, 22 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Allow residents to easily view the nursing home's survey results and communicate with advocate agencies."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.

Data from CMS Care Compare public records. Dataset last refreshed June 15, 2026. If you believe any information is inaccurate, report it here.

Health inspection·April 18, 2025