Health inspection·January 19, 2024

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of facility policy, resident interviews, clinical record reviews, family interview, and staff interviews it was determined the facility failed to ensure the resident's right to voice grievances and to act promptly in the resolution of grievances for two of two residents (Resident R55 and Resident R163). Findings include: A review of the facility policy Resident Grievance last reviewed 6/26/23, indicated a grievance is an official statement of a complaint over something believed to be wrong or unfair. Complaint is defined as knowledge someone believes they have been wronged or treated unfairly. The policy indicated the facility will provide resident centered care that meets psychosocial, physical, and emotional needs and concerns of the residents. The grievance official will complete an investigation of the resident's grievance. This may include a review of facility processes, programs and policies, as well as interviews with staff, residents and visitors, as indicated, and any other review deemed necessary by the Grievance Official. The grievance review will be completed in a reasonable time frame. Upon completion of the review, the Grievance Official will complete a written grievance decision that includes the date the grievance was received, a summary of the statement of the resident's grievance, the steps taken to investigate the grievance, a summary of the pertinent findings or conclusions regarding the resident(s) concerns, a statement as to whether the grievance was confirmed or not, whether any corrective action was or will be taken, and the date the written decision was issued. Residents will be notified, and the grievance official will meet with the resident and inform the resident of the investigation and how the resident's grievance will be resolved. A copy of the written grievance decision will be provided to the resident, upon request. The facility's Social Service Director (SSD) is the Grievance Offical, SSD/Grievance Official Employee E10. Review of Resident R55's clinical record indicated the resident was admitted to the facility on [DATE]. Diagnoses included chronic obstructive pulmonary disease (COPD - chronic lung disease that leads to difficulty in breathing, shortness of breath and wheezing), diabetes, asthma, chronic kidney disease and major depression-single episode (an individual experiencing only one major depressive episode in their lifetime, with no history of previous depressive episodes.) Review of Resident R55's current physician orders dated 1/19/24, included Mirtazapine for depression and Venlafaxine for depression. Review of Resident R55's Minimum Data Set (MDS - a periodic assessment of needs) dated 12/7/23, indicated the diagnoses remained current. The Brief Interview for Mental Status (BIMS - a screening tool to determine cognition) recorded a score of 15, indicating the resident is cognitively intact. Review of Resident R55's care plan dated 11/20/23, addressed care needs relating to depression with interventions of psychological counseling, suicidal ideations resulting from the loss of her husband with interventions of behavioral health counseling, and anxiety with interventions of behavioral health counseling. Review of Resident R55's psychological consultant note dated 1/10/24, documented while she was out (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395745 If continuation sheet Page 2 of 16 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 01/19/2024 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some [at] hospital, apparently some items were stolen from her room, including a necklace that had great sentimental value as it was a gift from her husband almost 50 years ago. Discussed her frustration in efforts to discuss this issue with nursing and administrative staff. During an interview on 1/17/24, at 1:45 p.m. Resident R55 disclosed her diamond solitaire necklace went missing when she was being transferred to the hospital in early January, 2024. Resident R55 stated she had reported the missing item to several staff members and has not heard any developments from an investigation for the lost item from any staff. During an interview on 1/18/24, at 4:19 p.m. Resident Family RF1 informed that Resident R55 was transferred to the hospital on [DATE]. Resident Family RF1 reported meeting Resident R55 at the hospital and the only jewelry items the resident had on were a silver bracelet and a watch and was not wearing a 16 gold chain with diamond solitaire pendant. Resident R55 returned from the hospital to the facility late in the evening on 1/6/24. Resident Family RF1 visited the the resident on 1/7/24 and reported the resident's room was a mess. Resident Family RF1 spoke with Registered Nurse Unit Manager (RNUM) Employee E9 about the missing necklace. Resident Family RF1 reported phoning the Emergency Medical Service that transported Resident R55 to the hospital, and they reported the only jewelry the resident had on was a watch and silver bracelet. Resident Family RF1 informed the resident did not have the dexterity to remove the necklace herself and the necklace was sentimental as it was given to Resident R55 by her late husband. Resident Family RF1 ask RNUM Employee E9 if she could investigate the loss further. Resident Family RF1 also spoke to SSD/Grievance Official Employee E10 and Social Worker (SW) Employee E11 and told Resident Family RF1 to file a police report. During an interview on 1/18/24, at 4:33 p.m. SSD/Grievance Official Employee E10 and SW Employee E11 confirmed a grievance form was not filed on behalf of Resident R55 for the missing necklace. During an interview on 1/18/24, at 5:25 p.m. RNUM Employee E9 confirmed seeing Resident R55 wearing the necklace in the facility and that Resident R55 did not have the dexterity to remove the necklace. RNUM Employee E9 reported she placed a call to the hospital about the necklace, and the hospital had no knowledge of it. RNUM Employee E9 also reported the missing necklace to SW Employee E11. Review of Resident R163's record indicated the resident was admitted to the facility on [DATE]. Diagnoses included compression fracture of vertebrae (small bones of the backbone) with surgical aftercare, diabetes, cirrhosis of the liver, pressure ulcer of the sacral region (above the tailbone region), muscle weakness and difficulty in walking. Review of Resident R163's current physician orders dated 1/19/24, included pressure reducing/relieving mattress, physical therapy, occupational therapy, Hoyer lift (a device used to transfer persons with serious mobility issues) for all transfers, and wound care. Review of Resident R163's MDS dated [DATE], indicated the diagnoses remained current. The BIMS recorded a score of 15, indicating the resident was cognitively intact. Review of Resident R163's care plan dated 12/22/23, addressed a self care deficit with interventions to include a Hoyer lift for transfers, and compression fracture of the vertebrae with interventions to include assistance with activites of daily living (ADLs - bathing/showering, dressing, eating, mobility, and personal hygiene and grooming). Review of Resident R163's record indicated they had a room change on 11/10/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395745 If continuation sheet Page 3 of 16 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 01/19/2024 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 1/16/24, at 1:30 p.m. Resident R163 reported their green blanket had been missing since their room change in November, 2023. The resident informed they told everyone about it - nursing staff and social workers, and has not heard any developments from an investigation for the lost item from any staff. During an interview on 1/18/24, at 5:58 p.m. SSD/Grievance Official Employee E10 confirmed a grievance form was not filed on behalf of Resident R163 for the missing green blanket. During an interview on 1/18/24, at 6:00 p.m. the SSD/Grievance Official Employee E10 confirmed the facility failed to ensure the resident right to voice grievances and the facility failed to act promptly in the resolution of grievances. 28 Pa. Code: 201.29(i)(j) Resident Rights. 28 Pa. Code: 201.18(e)(4) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395745 If continuation sheet Page 4 of 16 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 01/19/2024 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of facility policy, resident record review, and staff interview, it was determined the facility failed to review and revise a resident care plan to reflect current status and needs for one of eight residents (Resident R47). Findings include: Review of facility policy titled Plan of Care Overview last reviewed 6/23/23, informed the purpose of this policy the Plan of Care, also Care Plan, is the written treatment provided for a resident that is resident-focused and provides for optimal personalized care. The facility will provide an Registered Nurse assessment of the resident as an on-going, periodic review that provides the foundation for resident focused care and the care planning process. The facility will review care plans quarterly and/or with significant changes of care. Review of Resident R47's record indicated the resident was admitted to the facility on [DATE]. Diagnoses included diabetes, dementia, schizophrenia (a serious mental disorder in which a person interprets reality abnormally), cognitive communication deficit (difficulty in thinking and use of language), dysphagia (difficulty in swallowing liquids and food), depression, and has a need for personal care. Review of Resident R47's Minimum Data Set (MDS - a periodic assessment of needs) dated 11/20/23, indicated the diagnoses remained current. Review of Resident R47's current physician orders dated 12/1/23, included staff to feed meals effective 12/17/23, and a dysphagia pureed texture meal effective 12/18/23. Review of Resident R47's care plan dated 12/30/23, addressed nutritional problem with the intervention of staff to provide assistance with meals, and an activities of daily living deficit with the intervention of staff to assist with meals. Review of Resident R47's meal ticket for the lunch meal on 1/17/24, included Staff Feed and a pureed meal of roast pork, bread, brown gravy, green beans, mashed potatoes, and lemon cake. During an observation on 1/17/24 at 12:40 p.m. through 12:59 p.m. Resident R47 had their lunch meal, uncovered and on the tray table in front of them. Staff were not present to feed the resident. The resident was observed multiple times attempting to put their finger in the food and placing their finger to their lips. During an interview on 1/17/24, at 4:40 p.m. Registered Nurse Assessment Coordinator (RNAC) Employee E13 informed order reports are reviewed every morning and care plans are updated accordingly. During an interview on 1/17/24, at 4:45 p.m. the Registered Nurse Assessment Coordinator confirmed the facility failed to review and revise a resident care plan to reflect current status and needs. 28 Pa. Code 211.5(f) Clinical records. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395745 If continuation sheet Page 5 of 16 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 01/19/2024 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 0657 28 Pa. Code 211.11(a) Resident care plan. Level of Harm - Minimal harm or potential for actual harm 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: 395745 If continuation sheet Page 6 of 16 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 01/19/2024 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 a review of facility policy, resident record reviews, resident interviews, observations, and staff interviews, it was determined the facility failed to ensure that a resident who is unable to carry out activities of daily living in eating receives the necessary services to maintain good nutrition for one of four residents (Resident R47). Residents Affected - Few Findings Include: Review of facility policy titled Routine Resident Care last reviewed 6/23/23, informed it is the policy of this facility to provide resident centered care by attending to the total medical, nursing, physical, emotional, mental, social and spiritual needs and to provide routine daily care by a certified nursing assistant including but not limited to maintaining adequate fluid and nutritional intake. Review of Resident R47's record indicated the resident was admitted to the facility on [DATE]. Diagnoses included diabetes, dementia, schizophrenia (a serious mental disorder in which a person interprets reality abnormally), cognitive communication deficit (difficulty in thinking and use of language), dysphagia (difficulty in swallowing liquids and food), depression, and has a need for personal care. Review of Resident R47's Minimum Data Set (MDS - a periodic assessment of needs) dated 11/20/23, indicated the diagnoses remained current. The Brief Inventory for Mental Status (BIMS - a test to determine cognitive ability) recorded a score of 06, indicating the resident had a severe cognitive impairment. Review of Resident R47's current physician orders dated 12/1/23, included staff feed effective 12/17/23, and a dysphagia pureed texture meal effective 12/18/23. Review of Resident R47's care plan dated 12/30/23, addressed nutritional problem with the intervention of staff to provide assistance with meals, and an activities of daily living deficit with the intervention of staff to assist with meals. Review of Resident R47's meal ticket for the lunch meal on 1/17/24, included Staff Feed and a pureed meal of roast pork, bread, brown gravy, green beans, mashed potatoes, and lemon cake. During an observation on 1/17/24, at 12:40 p.m. through 12:59 p.m. Resident R47 had their lunch meal, uncovered and on the tray table in front of them. The resident could be seen multiple times attempting to put their finger in the food and placing their finger to their lips. During an interview on 1/17/24, at 1:00 p.m. Registered Nurse (RN) Unit Manager Employee E9 confirmed the lunch meal arrived on the unit at 12:30 p.m. RN Unit Manager Employee E9 also confirmed the meal ticket stated Staff Feed and approximately two bites of mashed potatoes and lemon cake was consumed. RN Employee E9 commented the resident doesn't eat much, and the Nursing Assistant assigned to Resident R47 was busy feeding another resident. During an interview on 1/17/24, at 1:00 p.m. the RN Unit Manager Employee E9 confirmed the facility failed to ensure that a resident who is unable to carry out activities of daily living in eating (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395745 If continuation sheet Page 7 of 16 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 01/19/2024 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 receives the necessary services to maintain good nutrition. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code: 201.18(b)(1)(e)(1) Management. 28 Pa. Code 201.29(j) Resident Rights. Residents Affected - Few 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 8 of 16 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 01/19/2024 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 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 policy, clinical records, and staff interviews, it was determined that the facility failed to notify physicians of increased and decreased Capillary Blood Glucose (CBG) levels and failed to assess residents for hyperglycemia (high blood glucose) and hypoglycemia (low blood glucose), for six of eight residents reviewed (Residents R34, R69, R70, R97, R106 and R134). Residents Affected - Some Findings include: The Centers for Disease Control defines diabetes as: Diabetes Mellitus is a chronic (long-lasting) health condition that affects how your body turns food into energy. Most of the food you eat is broken down into sugar (also called glucose) and released into your bloodstream. When your blood sugar goes up, it signals your pancreas to release insulin. Insulin acts like a key to let the blood sugar into your body's cells for use as energy. If you have diabetes, your body either doesn't make enough insulin or can't use the insulin it makes as well as it should. When there isn't enough insulin or cells stop responding to insulin, too much blood sugar stays in your bloodstream. Over time, that can cause serious health problems, such as heart disease, vision loss, and kidney disease. Hypoglycemia is a condition that occurs when blood glucose is lower than normal, usually below 70 milligrams per deciliter (mg/dl). If left untreated, hypoglycemia may lead to weakness, confusion, unconsciousness, arrhythmias and even death. People with Diabetes Mellitus may be prescribed injectable insulin to assist in maintaining acceptable levels of CBG's. Hyperglycemia, or high blood glucose, occurs when there is too much sugar in the blood. This happens when your body has too little insulin. Hyperglycemia is blood glucose greater than 125 mg/dL while fasting (not eating for at least eight hours, or a blood glucose greater than 180 mg/dL one to two hours after eating. If you have hyperglycemia and it ' s untreated for long periods of time, you can damage your nerves, blood vessels, tissues and organs. Damage to blood vessels can increase your risk of heart attack and stroke, and nerve damage may also lead to eye damage, kidney damage and non-healing wounds. Review of the facility policy Blood Glucose Point of Care Testing reviewed 6/26/23, indicated the facility would provide resident centered care that meets the psychosocial, physical, and emotional needs and concerns of the resident. Step G of the procedure indicated to record the results and contact the provider per physician ' s orders if out of range. Review of the facility policy Notification of Change in Condition reviewed 6/26/23, indicated the facility must inform the resident, consult with the resident's physician and the resident's representative when there is a change requiring such notification. The attending practitioner is promptly notified of significant changes in condition, and the medical record must reflect the notification, response, and interventions implemented to address the resident's condition. Review of the clinical record indicated Resident R34 was re-admitted to the facility on [DATE], with diagnoses that included diabetes, cerebral palsy (group of disorders that affect movement, muscle tone, balance, and posture), and high blood pressure. Review of Resident R34's Minimum Data Set (MDS - a mandated assessment of a resident's abilities and care needs) dated 12/12/23, indicated the diagnoses remain current. Review of a physician orders dated 8/24/23 and 11/18/23, indicated to inject Lispro (fast-acting insulin that starts to work about 15 minutes after injection, peaks in about 1 hour, and keeps working (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395745 If continuation sheet Page 9 of 16 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 01/19/2024 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some for 2 to 4 hours) per sliding scale, if less than 70, notify doctor, if greater that 400, notify doctor. Further review of physician orders dated 10/11/23, indicated to give Glucose gel 40% by mouth if blood sugar less than 70 recheck blood sugar every 15 minutes and repeat is blood sugar remains less than 70. Hypoglycemia Protocol: Continue to check glucose every 15 minutes until blood sugar is over 80. Review of the clinical record electronic Medication Administration Record (eMAR) revealed that the resident's CBG's were as follows: On 1/12/24, at 6:28 p.m. CBG was noted to be 44. On 12/29/23, at 9:05 p.m. CBG was noted to be 487. On 11/9/23, at 12:52 p.m. CBG was noted to be 410. Review of Resident R34's eMAR and clinical progress notes indicated the resident was not assessed for hyper-/hypoglycemia, the blood glucose was not monitored for effectiveness of treatment, failed to follow interventions of the care plan, failed to follow facility protocol, and the physician was not notified of abnormal results on the above listed dates. Review of the care plan revised 2/2/23, indicated to administer medications as ordered by physician, report abnormal findings to medical provider. Observe for signs of hyperglycemia and hypoglycemia. Obtain blood sugars per orders, report abnormal findings to medical provider. Review of a clinical record indicated Resident R69 was admitted to the facility on [DATE], with diagnoses that included diabetes, high blood pressure, and sepsis (infection of the blood stream). Review of the MDS dated [DATE], indicated the diagnoses remain current. Review of a physician order dated 10/24/23, indicated to inject Novolog (fast-acting insulin that starts to work about 15 minutes after injection, peaks in about 1 hour, and keeps working for 2 to 4 hours) per sliding scale with meals. If blood sugar is 0-70 initiate hypoglycemia protocol and call doctor. If blood sugar over 450 give 14 units and call doctor. A physician order dated 11/22/23 and 11/29/23, indicated to inject Novolog insulin per sliding scale; notify doctor is less than 70 or greater than 340. Review of Resident R69's eMAR revealed that the resident's CBG's were as follows: On 12/11/23, at 6:04 p.m. CBG was noted to be 62. On 11/15/23, at 5:48 a.m. CBG was noted to be 405. On 11/13/23, at 12:42 p.m. CBG was noted to be 437. On 11/10/23, at 1:28 p.m. CBG was noted to be 419. On 11/3/23, at 6:00 a.m. CBG was noted to be 430. A review of Resident R69's eMAR and clinical progress notes indicated the resident was not assessed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395745 If continuation sheet Page 10 of 16 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 01/19/2024 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 0684 Level of Harm - Minimal harm or potential for actual harm for hypo/hyperglycemia, failed to follow interventions of the care plan, blood sugar was not rechecked, and the physician was not notified of abnormal results. A review of Resident R69's care plan dated 1/14/23, indicated to administer insulin injections per orders. Observe for signs and symptoms of hypo/hyperglycemia. Obtain blood sugars per orders. Residents Affected - Some Review of the clinical record indicated Resident R70 was re-admitted to the facility on [DATE], with diagnoses that included diabetes, heart failure (progressive heart disease that affects pumping action of the heart muscles), and difficulty in walking. Review of Resident R70's MDS dated [DATE], indicated the diagnoses remain current. Review of physician orders dated 3/7/23, indicated to inject Novolog insulin per sliding scale. If less than 70 initiate hypoglycemia protocol and call doctor, and if blood sugar is 401-600 inject 20 units and call doctor. Review of the clinical record electronic Medication Administration Record (eMAR) revealed that the resident's CBG's were as follows: On 10/12/23, at 6:25 a.m. CBG was noted to be 417. On 10/8/23, at 12:38 p.m. CBG was noted to be 414. On 10/4/23, at 4:30 p.m. CBG was noted to be 471. On 10/3/23, at 11:45 p.m. CBG was noted to be 404. Review of Resident R70's eMAR and clinical progress notes indicated the resident was not assessed for hyperglycemia, the blood glucose was not monitored for effectiveness of treatment, failed to follow interventions of the care plan, and the physician was not notified of abnormal results on the above listed dates. Review of the care plan dated 7/9/21, indicated observe for signs and symptoms of hyper/hypoglycemia. Administer medications per medical provider's orders. Report abnormal findings to medical provider. Obtain blood sugars per orders. Review of the clinical record indicated Resident R97 was admitted to the facility on [DATE], with diagnoses that included diabetes, muscle weakness, and high blood pressure. Review of Resident R97's MDS dated [DATE], indicated the diagnoses remain current. Review of physician orders dated 10/25/23, indicated to inject Humalog (fast-acting insulin that starts to work about 15 minutes after injection, peaks in about 1 hour, and keeps working for 2 to 4 hours) insulin per sliding scale before meals. If blood sugar is over 400 give 20 units and notify doctor. Review of the clinical record electronic Medication Administration Record (eMAR) revealed that the resident's CBG's were as follows: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395745 If continuation sheet Page 11 of 16 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 01/19/2024 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 0684 On 11/13/23, at 12:47 p.m. CBG was noted to be 477. Level of Harm - Minimal harm or potential for actual harm Review of a progress note dated 11/13/23, at 12:47 p.m. revealed the Licensed Practical Nurse (LPN) gave 16 units. Residents Affected - Some Review of Resident R97's eMAR and clinical progress notes indicated the resident was not assessed for hyperglycemia, the blood glucose was not monitored for effectiveness of treatment, and the physician was not notified of abnormal results on the above listed dates and failed to follow the physician ' s order. Review of the care plan dated 11/2/23, indicated to observe for signs and symptoms of hyper-/hypoglycemia. Administer insulin injections per orders. Administer medication per medical provider's order. Obtain blood sugars per orders. Review of the clinical record indicated Resident R106 was re-admitted to the facility on [DATE], with diagnoses that included diabetes, anxiety, and high blood pressure. Review of Resident R106's MDS dated [DATE], indicated the diagnoses remain current. Review of physician orders dated 12/28/23, indicated to inject Novolog insulin per sliding scale. If blood sugar less than 70 notify doctor, and if greater than 400, give 20 units and notify the doctor. Review of the clinical record electronic Medication Administration Record (eMAR) revealed that the resident's CBG's were as follows: On 1/5/24, at 10:12 p.m. CBG was noted to be 403. On 9/17/23, at 12:43 p.m. CBG was noted to be 69. Review of Resident R106's eMAR and clinical progress notes indicated the resident was not assessed for hypo-/hyperglycemia, the blood glucose was not monitored for effectiveness of treatment, failed to follow physician's order, and the physician was not notified of abnormal results on the above listed dates. Review of the clinical record indicated Resident R134 was re-admitted to the facility on [DATE], with diagnoses that included diabetes, high blood pressure, and muscle weakness. Review of Resident R70's MDS dated [DATE], indicated the diagnoses remain current. Review of physician orders dated 10/11/23, indicated to give one tube of glucose gel, recheck blood sugar every 15 minutes and repeat treatment is blood sugar remains under 70. Administer 1 mg glucagon as needed for blood sugar less than 70. Call provider after first dose. A physician order dated 9/11/23, indicated to inject Lantus (long-acting type of insulin that works slowly, over about 24 hours) 18 units in the evening. Review of the clinical record electronic Medication Administration Record (eMAR) revealed that the resident's CBG's were as follows: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395745 If continuation sheet Page 12 of 16 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 01/19/2024 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 0684 On 11/23/23, at 8:37 a.m. CBG was noted to be 62. Level of Harm - Minimal harm or potential for actual harm On 10/11/23, at 12:52 p.m. CBG was noted to be 45. On 10/11/23, a t 12:05 p.m. CBG was noted to be 45. Residents Affected - Some On 10/11/23, at 8:35 a.m. CBG was noted to be 63. Review of Resident R134's eMAR and clinical progress notes indicated the resident was not assessed for hypoglycemia, the blood glucose was not monitored for effectiveness of treatment, failed to follow interventions of the care plan, and the physician was not notified of abnormal results on the above listed dates. Review of the care plan dated 7/9/21, indicated observe for signs and symptoms of hyper/hypoglycemia. Administer medications per medical provider's orders. Report abnormal findings to medical provider. Obtain blood sugars per orders. During an interview on 1/17/24, at 1:50 p.m. LPN Employee E8 stated for blood sugar under 70, they would notify the doctor and provide a snack. If the blood sugar was over 200, they would check the orders for parameters, and call the doctor accordingly. During an interview on 1/17/24, at 1:53 p.m. LPN Employee E7 stated for blood sugars over 400, they would check the parameters, call the provider or on-call service. If the blood sugar was less than 70 they would offer a snack, call the doctor, and recheck in one hour. During an interview on 1/17/24, at 2:00 p.m. LPN Employee E6 stated for blood sugars over 300, they would check the orders for parameters, give the ordered insulin, and call the doctor or on-call service. If the blood sugar was less than 70, they would check the orders, tell the supervisor. During an interview on 1/17/24, at 2:08 p.m. LPN Employee E5 stated for blood sugars less than 70 she would give juice. notify the supervisor and recheck in two hours. For blood sugars over 230, she would call the doctor to get orders, notify the supervisor, and recheck in one to two hours. During an interview on 1/17/24, at 2:10 a.m. LPN Employee E4 stated for blood sugars under 70 she would give juice, recheck in 10-15 minutes, and call the doctor. For blood glucose over 300 without ordered parameters, she would call the doctor, monitor the resident, and document in the progress notes. During an interview on 1/17/24, at 10:20 a.m. LPN Employee E3 stated for blood sugars less than 70, she would call the provider to get orders for glucose gel and monitor the resident for signs and symptoms of hypoglycemia. If the blood sugar was over 400, she would call the provider, recheck in 30 minutes, notify the supervisor and Director of Nursing, and document in the progress notes. During an interview on 1/18/24, at 3:00 p.m. the Director of Nursing (DON) confirmed the facility failed to notify the doctor of a change in condition related to blood glucose for Residents R34, R69, R70, R97, R106, and R134. 28 Pa. Code 201.18 (b)(1) Management. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395745 If continuation sheet Page 13 of 16 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 01/19/2024 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 0684 28 Pa. Code 201.29(d) Resident rights. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.10 (c)(d) Resident care policies. 28 Pa. Code 211.12 (d)(1)(2)(3)(5) Nursing services. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395745 If continuation sheet Page 14 of 16 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 01/19/2024 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 interviews, it was determined the facility failed to secure medications in a locked compartment and allowed access to unauthorized persons and residents for one of two medication carts (B Unit). Findings include: Review of facility policy titled Storage of Medications last reviewed on 6/23/23, informed only licensed nurses, pharmacy personnel, and those lawfully authorized to administer medications are permitted to access medications. Medication rooms, carts, and medication supplies are locked when they are not attended by persons with authorized access. During an observation on 1/16/24, at 12:34 p.m. the medication cart on the B-2 wing was left unlocked and unattended. During an interview on 1/16/24, at 12:36 p.m. Graduate Practical Nurse Employee E12 confirmed the medication cart was left unlocked and unattended while they attended to a resident two rooms from the medication cart location. During an interview on 1/17/24, at 12:00 p.m. Registered Nurse (RN) Unit Manager Employee E9 confirmed the facility failed to secure medications in a locked compartment and allowing access to unauthorized persons and residents. 28 Pa. Code: 201.14(a) Responsibility of licensee. 28 Pa. Code: 211.12(d)(1)(e) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395745 If continuation sheet Page 15 of 16 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 01/19/2024 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations and staff interview, it was determined that the facility failed maintain sanitary conditions to prevent the potential for food borne illness during trayline service in the Main kitchen. Residents Affected - Some Findings include: During tray line observation on 1/16/24, from 11:30 a.m. through 12:00 p.m. the following was observed: During trayline service Dietary [NAME] Employee E1 left trayline to obtain a sandwich from the refrigerator with gloves, returned to the tray line and placed cheese on hamburgers, left trayline and obtained buns and opened buns from plastic wrapping and placed buns on plate and placed lettuce and tomatoes on buns, with no handwashing and glove change between tasks. During an interview on 1/16/24, at 12:00 p.m. Dietary Manager Employee E2 confirmed that the facility failed to maintain practices to prevent the potential for food borne illness in the Main kitchen. 28 Pa. Code: 211.6(c)(d)(f) Dietary services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395745 If continuation sheet Page 16 of 16