Health inspection·December 13, 2023

F 0557 further documentation about the package and why there was a delay in the resident receiving the package. Level of Harm - Minimal harm or potential for actual harm During an interview on 12/12/23, at 3:56 p.m. DON confirmed that the facility failed to respect resident rights in the handling and protection of personal property for Resident R1 package being deliver opened and not upon receipt in the facility. Residents Affected - Few 28 Pa. Code 201.18 Euro(1)(h)Management. 28 Pa. Code 201.29(a)c(i)(k)Resident rights. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395745 If continuation sheet Page 2 of 4 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 395745 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rose Meadows Health & Rehab Center 1717 Skyline Drive Pittsburgh, PA 15227 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 facility policy, facility submitted reports, clinical record review and staff interviews, it was determined that the facility failed to make certain that assistance for activities of daily living were consistently provided for 16 of 93 residents (R2, R3, R4, R5, R6, R7, R8, R9, R10, R11, R12, R13, R14, R15, R16 and R17). Residents Affected - Some Review of the facility policy Routine Resident Care, last reviewed 8/21/23, indicated that routine care by a nursing assistant includes assisting or providing for personal care including timely incontinence care. Review of three facility provided documents indicated Residents R2, R3, R4, R5, R6, R7, R8, R9, R10, R11, R12, R13, R14, R15 and R16 had not been provided assistance with incontinence care timely and Resident R17 had been left on a bedpan but had refused care when staff attempted to provide care. All residents had complete assessments completed with no identified skin issues. Review of the clinical record indicated Resident R2 was admitted to the facility on [DATE], with diagnoses of dementia and agitation. An MDS (Minimum Data Set- a periodic assessment of resident needs) dated 12/7/23, indicated the diagnoses remained current and that Resident R2 requires assistance with ADL's (activities of daily living). Review of the clinical record indicated that Resident R3 was admitted to the facility on [DATE], with a diagnosis of dementia. An MDS dated [DATE], indicated the diagnosis remained current and that Resident R3 required assistance with ADL's. Review of the clinical record indicated that Resident R4 was admitted to the facility on [DATE], with diagnosis of dementia. An MDS dated [DATE], indicated the diagnosis remained current and that Resident R4 required assistance with ADL's. Review of the clinical record indicated that Resident R5 was admitted to the facility on [DATE], with diagnosis of dementia. A MDS dated [DATE], indicated the diagnosis remained current and that Resident R5 required assistance with ADL's. Review of the clinical record indicated that Resident R6 was admitted to the facility on [DATE], with a diagnosis of dementia. A MDS dated [DATE] indicated the diagnosis remained current and that Resident R6 required assistance with ADL's. Review of the clinical record indicated that Resident R7 was admitted to the facility on [DATE], with a diagnosis of dementia. A MDS dated [DATE], indicated the diagnosis remained current and that Resident R7 required assistance with ADL's. Review of the clinical record indicated that Resident R8 was admitted to the facility on [DATE], with a diagnosis of dementia. A MDS dated [DATE], indicated the diagnosis remained current and the Resident R8 required assistance with ADL's. Review of the clinical record indicated that Resident R9 was admitted to the facility on [DATE], with a diagnosis of dementia. A MDS dated [DATE], indicated the diagnosis remained current and that Resident R9 required assistance with ADL's. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395745 If continuation sheet Page 3 of 4 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 395745 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rose Meadows Health & Rehab Center 1717 Skyline Drive Pittsburgh, PA 15227 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 Review of the clinical record indicated that Resident R10 was admitted to the facility on [DATE], with diagnosis of dementia. A MDS dated [DATE]. indicated the diagnosis remained current and that Resident R10 required assistnace with ADL's. Review of the clinical record indicated that Resident R11 was admitted to the facility on [DATE], with a diagnosis of dementia. A MDS dated [DATE], indicated the diagnosis remained current and that Resident R11 required assistance with ADLs. Review of the clinical record indicated that Resident R12 was admitted to the facility on [DATE], with a diagnosis of dementia. A MDS dated [DATE], inidcated the diagnosis remained current and that Resident R12 required assistance with ADL's. Review of the clinical record indicated that Resident R13 was admitted to the facility on [DATE], with a diagnosis of dementia. A MDS dated [DATE], indicated the diagnosis remained current and that Resident R13 required assistance with ADL's. Review of the clinical record indicated that Resident R14 was admitted to the facility on [DATE], with a diagnosis of a fracture thoracic spine. A MDS dated [DATE], indicated the diagnosis remained current and that Resident R14 required assistance with ADL's. Review of the clinical record indicated that Resident R15 was admitted to the facility on [DATE], with a diagnosis of pneumonia and lung disease. A MDS dated [DATE], indicated the diagnosis remained current and that Resident R15 required assistance with ADL's. Review of the clinical record indicated that Resident R16 was admitted to the facility on [DATE], with a diagnosis of a fracture left leg. A MDS dated [DATE], indicated that the diagnosis remained current and that Resident R16 required assistance with ADL's. Resident R16 has been discharged . Review of the clinical record indicated that Resident R17 was admitted to the facility on [DATE], with a diagnosis of Multiple Sclerosis and inability to use both lower extremities. A MDS dated [DATE], indicated the diagnosis remained current and that Resident R17 required assistance with ADL's. During an interview on 12/12/23, at 2:50 p.m., the Nursing Home Administrator confirmed that the reports indicated staff had not provided timely assistance with ADL's and that the staff had been removed from care and/or terminated due to the lack of providing timely care to the residents identified. 28 Pa. Code: 211.10(a)(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: 395745 If continuation sheet Page 4 of 4