Health inspection·September 29, 2023

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, review of facility documents, and resident and staff interview, it was determined that the facility failed to thoroughly investigate an incident to rule out potential neglect for one of one resident reviewed (Resident 116). Residents Affected - Few Findings include: Clinical record review revealed the facility admitted Resident 116 on September 1, 2022. A review of nursing documentation dated February 18, 2023, at 9:50 AM revealed a nurse aide was providing morning care and rolled Resident 116 to her right when she fell out of bed. Resident 116 stated she struck her head on the nightstand and had a small abrasion on her finger. A review of the facility investigation into Resident 116's February 18, 2023, fall revealed the facility's interdisciplinary team's follow-up action dated February 20, 2023, noting Resident 116 is to have two staff members for care. A review of Resident 116's plan of care for her activities of daily living deficit initiated on February 20, 2027, revealed Resident 116 required two people for care. Further review of Resident 116's clinical record revealed nursing documentation dated April 23, 2023, at 3:15 AM noting Resident 116 was being given incontinent care and was positioned on her left side, when she rolled out of bed and onto the floor. There were no injuries noted with this fall. An interview with the Director of Nursing on September 29, 2023, at 10:06 AM confirmed the nurse aide was not following Resident 116's plan of care for appropriate level of assistance during Resident 116's fall out of bed on April 23, 2023. The facility did not investigate and rule out potential neglect. 28 Pa. Code 201.18(b)(1)(e)(1) Management 28 Pa. Code 201.29(a) Resident rights 28 Pa. Code 211.12(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395779 If continuation sheet Page 2 of 12 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 395779 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Centre Care Rehabilitation and Wellness Services 250 Persia Road Bellefonte, PA 16823 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 clinical record review and resident and staff interview, it was determined that the facility failed to provide appropriate bathing assistance for residents dependent on staff assistance for 2 of 2 residents reviewed (Residents 22 and 97). Residents Affected - Few Findings include: An interview with the Director of Nursing on September 27, 2023, at 1:10 PM revealed that the facility baths residents according to their preference. Clinical record review for Resident 22 revealed an annual Minimum Data Set Assessment (MDS, an assessment completed at specific intervals to determine care needs) dated July 10, 2023, that revealed nursing staff assessed Resident 22 as totally dependent on one-person physical assistance for bathing. A review of Resident 22's current care plan last reviewed on July 17, 2023, revealed a care plan for Activities of Daily Living (ADL) self-care deficit that indicated Resident 22's bathing preference was to receive a shower. A review of PCC (Point Click Care, a computerized documentation system) task documentation (documentation of the care provided to the resident) for her showers revealed that she was to have a shower every Monday and Thursday on the evening shift. A review of the documentation revealed the following dates of concern related to Resident 22's showers: Resident 22 was showered on June 27, 2023, and her next shower was not provided until July 6, 2023, 7 days later. Resident 22 was showered on July 13, 2023, and her next shower was not provided until July 19, 2023, Resident 22 was showered on July 27, 2023, and her next shower was not given until August 16, 2023, 20 days later. Resident 22 was showered on August 27, 2023, and her next shower was not given until September 16, 2023, 20 days later. Further clinical record review revealed that there was no documentation indicating why Resident 22 was not showered as per her care plan for the dates reviewed, June 27-September 27, 2023. The Director of Nursing confirmed the above noted findings related to Resident 22's showers in an interview on September 27, 2023, at 1:10 PM. Observation of Resident 97 on September 26, 2023, at 11:51 AM revealed she was in bed in her nightgown and her hair was unkempt. Resident 97 stated she does not remember the last time she received a shower. She stated recently there is usually not enough staff, and they just give her a bed bath. A review of Resident 97's most recent MDS (Minimum Data Set, an assessment completed at specific intervals to determine care needs) dated September 10, 2023, indicated nursing staff assessed Resident 97 as being totally dependent of one staff physical assistance for bathing. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395779 If continuation sheet Page 3 of 12 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 395779 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Centre Care Rehabilitation and Wellness Services 250 Persia Road Bellefonte, PA 16823 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 A review of Resident 97's task documentation revealed her bathing preference was identified as preferring a shower twice a week. Further review of Resident 97's task documentation revealed she had a shower on August 29, 2023, and then not again until September 15, 2023 (17 days later). An interview with the Director of Nursing on September 29, 2023, at 11:01 AM confirmed these findings. Residents Affected - Few The facility failed to provide dependent residents with bathing assistance as per their preferences. 28 Pa. Code 211.12 (d)(1)(2)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395779 If continuation sheet Page 4 of 12 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 395779 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Centre Care Rehabilitation and Wellness Services 250 Persia Road Bellefonte, PA 16823 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observation, and staff and resident interview, it was determined that the facility failed to properly assess and monitor pressure areas for one of eight residents reviewed (Resident 187) and implement ordered pressure sore prevention devices for one of eight residents reviewed (Resident 205). Residents Affected - Few Findings include: The policy entitled Pressure Injury-Risk Assessment, Prevention of Skin Breakdown and Skin Care Management, last reviewed July 25, 2023, indicates that pressure and non-pressure wounds will be monitored at least weekly with measurements and the status of the wound by documenting in the medical record. Review of Resident 187's clinical record revealed a risk assessment dated [DATE], indicating that the facility assessed her as being at moderate risk of developing pressure ulcers. A nursing note dated July 20, 2023, at 7:32 AM indicated that nursing staff assessed Resident 187's buttocks and indicated that a previous pressure ulcer area on her right buttock had resolved. A nursing noted dated September 15, 2023, at 6:08 AM indicated that there was an open area on Resident 187's left buttock and that Resident 187 said it was painful. There was no documented evidence in Resident 187's clinical record to indicate that the facility assessed the wound to obtain its status or measurements. A skin observation form dated September 21, 2023, indicated that Resident 187 had a small area on her left buttock. The form indicated that the area was being treated until resolved. There was no documented evidence that the facility assessed the wound to obtain its status or measurements. Interview with the Administrator and Director of Nursing on September 28, 2023, at 2:30 PM acknowledged the above findings for Resident 187. Review of the diagnosis list for Resident 205 revealed a history that included Type 2 Diabetes Mellitus with a Foot Ulcer. Clinical record review for Resident 205 revealed a health status noted dated June 8, 2023, at 7:45 PM that indicated the resident had a purple colored area that measured 3 x 2 centimeters (cm) on the right heel and a purple colored area that measured 1.5 x 1.5 cm on the left heel. Interventions noted included skin prep and a Heelz up pillow (a padded pillow that suspends the feet and heels to prevent pressure related skin injuries). Clinical record review for Resident 205 revealed a skin/wound note dated August 22, 2023, at 7:05 AM that revealed the right heel unstageable has resolved and preventative measures are in place. A medical provided note for Resident 205 dated August 21, 2023, at 9:41 AM revealed the resident had a history of a pressure sore to the right heel that was resolved. The plan noted by the medical provider recommended to continue offloading and prevention measures per the facility protocol. Preventative measures noted included pillows for heel offloading. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395779 If continuation sheet Page 5 of 12 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 395779 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Centre Care Rehabilitation and Wellness Services 250 Persia Road Bellefonte, PA 16823 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 Physician orders for Resident 205 revealed a current order for a Heelz Up pillow. Level of Harm - Minimal harm or potential for actual harm The current care plan for Resident 205 revealed the resident has a potential for impairment to skin integrity related to decreased mobility. An intervention included a Heelz Up pillow. Residents Affected - Few A review of the current [NAME] for Resident 205 revealed the preventative skin care and mobility sections listed the Heelz Up pillow. An order administration note for Resident 205 for the Heelz Up pillow dated September 26, 2023, at 1:05 AM and 10:26 PM revealed that the pillow was noted by staff as not in room. Observation of Resident 205 on September 26, 2023, at 10:04 AM revealed the resident was resting in bed. The resident's heels were positioned directly on the bed with no pressure relief measures or Heelz Up pillow in place. Observation of Resident 205 on September 27, 2023, at 9:35 AM revealed the resident in bed and the resident's heels were positioned directly on the bed without any pressure relief measures. A concurrent interview with the resident revealed his heels are supposed to be elevated. An interview with Employee 4, licensed practical nurse, on September 27, 2023, at 9:37 AM regarding Resident 205, confirmed the resident did not have his heels elevated. The cover to the Heelz up pillow was in the resident's room; however, Employee 4 could not locate the Heelz up pillow. The above information for Resident 205 was reviewed in a meeting with the Nursing Home Administrator and Director of Nursing on September 27, 2023, at 2:00 PM. 483.25(b)(1) Pressure Ulcers Previously cited 9/23/22 28 Pa. Code 211.10(d) Resident care policies 28 Pa. Code 211.12(d)(1)(3)(5) Nursing care services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395779 If continuation sheet Page 6 of 12 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 395779 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Centre Care Rehabilitation and Wellness Services 250 Persia Road Bellefonte, PA 16823 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on clinical record review and staff interview, it was determined that the facility failed to provide services to maintain a resident's range of motion and mobility for two of five residents reviewed (Residents 44 and 176). Findings include: Clinical record review for Resident 44 revealed a care plan from June 1, 2023, through July 10, 2023, for staff to provide restorative ambulation with limited assist and a walker to and from the bathroom and dining room as tolerated. Review of task documentation for Resident 44 for July 2023, revealed that staff did not document completion of the restorative task on the following dates: July 2, 4, and 7, 2023 Further review for Resident 44 revealed a current care plan for staff to provide restorative ambulation 50 to 150 feet with supervision and with a rolling walker as tolerated Review of task documentation for Resident 44 for July, August, and September 2023, revealed that staff did not document completion of the restorative task on the following dates: August 3, 4, 5, 6, 12, 19, and 20, 2023 September 2, 3, 4, 9, 10, 16, 17, 23, and 24, 2023 Clinical record review for Resident 176 revealed a current care plan for staff to provide a restorative active ROM (range of motion, movement of the body to maintain a resident's ability) to their bilateral lower extremities (leg, BLE) while lying supine as tolerated during care. Review of task documentation for Resident 176 from August and September 2023, revealed that staff documented not applicable or did not document completion of the restorative task on the following dates: Day shift August 14, 19, 20, 25, 29, and 31, 2023 September 2, 10, 24, and 26, 2023 Evening shift August 9, 15, 16, 17, 18, 19, 20, 24, 25, 26, 27, 28, 30, ad 31, 2023 September 1, 2, 3, and 15, 2023 Further review for Resident 176 revealed a current care plan for staff to provide a restorative (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395779 If continuation sheet Page 7 of 12 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 395779 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Centre Care Rehabilitation and Wellness Services 250 Persia Road Bellefonte, PA 16823 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 0688 Level of Harm - Minimal harm or potential for actual harm ambulation from zero to 75 feet with supervision as tolerated. Encourage resident to use a rolling walker with ambulation. Review of task documentation for Resident 176 from August and September 2023, revealed that staff documented not applicable or did not document completion of ambulation on the following dates: Residents Affected - Some August 19, 20, 30, and 31, 2023 September 2, 2023 The surveyor reviewed the above information on September 28, 2023, at 2:00 PM with the Nursing Home Administrator and Director of Nursing. 483.25(c)(1)-(3) Increase/prevent Decrease In Rom/mobility Previously cited 9/23/22 28 Pa. Code 211.10(a)(c)(d) Resident care policies 28 Pa. Code 211.12(c)(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395779 If continuation sheet Page 8 of 12 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 395779 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Centre Care Rehabilitation and Wellness Services 250 Persia Road Bellefonte, PA 16823 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of select facility policies and procedures, and staff and resident interview, it was determined that the facility failed to ensure an environment free from the potential spread of infection regarding transmission-based precautions on two of five nursing units (Rehab and [NAME]; Residents 10, 29, 55, 83, 107, and 174 ). Residents Affected - Some Findings include: Review of the policy entitled Transmission Based Precautions, last reviewed on July 25, 2023, indicates that when a resident is on transmission-based precautions, appropriate notifications in the room or unit entrance door so that personnel or visitors are aware of the need for and type of precautions. The signage informs the staff of the type of precautions, instructions for use of personal protective equipment (PPE, gowns, gloves, masks, etc.), and/or instructions to see the nurse before entering the room. Interview with Resident 83 on September 26, 2023, at 10:51 AM revealed that she was on an antibiotic for an infection but could not recall for what. There was no evidence on Resident 83's doorway to indicate the need for visitors to adhere to any type of precautions or use of PPE. Review of Resident 83's clinical record revealed a current physician's order initiated on August 31, 2023, for nursing staff to place Resident 83 on contact precautions for an ESBL (Extended Spectrum Beta-Lactamase, a difficult to treat infection that is resistant to certain types of antibiotics) infection. An admission document dated August 17, 2023, indicated that Resident 83 was being transferred into the facility on contact precaution for the ESBL infection. The facility did not obtain a physician's order for contact precautions until August 31, 2023. Observation of Resident 83's room on September 27, 2023, 10:26 AM revealed no signage on her door regarding the need for contact precautions or use of any PPE. Interview with Employee 1, licensed practice nurse, at this time, confirmed the observation. Interview with Employee 2, infection control preventionist, on September 28, 2023, at 11:22 AM indicated that Resident 83's signage might have been taken down when she went for a hospital stay and did not get put back up. Employee 2 indicated that Resident 83's signage for contact precautions and PPE use was put back up on her door after the concerns were identified. Clinical record review for Resident 55 revealed the resident was currently on contact precautions due ESBL. Further review of the clinical record revealed the resident was incontinent of urine. Observation of Resident 55's room on September 27, 2023, at 9:30 AM revealed signage on the door that instructed visitors and staff to perform the following: don gloves upon entry into the room, hand hygiene according to Standard Precautions, don gowns upon entry into the room, and remove the gown and observe hand hygiene before leaving the patient care environment. Observation of Employee 5, hospitality staff, on September 27, 2023, at 9:49 AM revealed the staff member exited the Resident 55's room and immediately doffed her protective gown in the hallway just (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395779 If continuation sheet Page 9 of 12 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 395779 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Centre Care Rehabilitation and Wellness Services 250 Persia Road Bellefonte, PA 16823 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some outside Resident 55's doorway. Employee 5 proceeded to walk down the hallway past two non-isolation rooms while holding the doffed gown under her left arm. Employee 5 proceeded to stop and speak to Employee 6, hospitality aide, while still holding the isolation gown under her left arm. Employee 5 then discarded the isolation gown in a trash receptacle in the main hallway. There was no observed hand hygiene after discarding the gown or upon exiting from Resident 55's room. There was no observed trash can at the entrance to Resident 55's room to dispose of isolation gowns or gloves upon exit. Observation of Employee 5 on September 27, 2023, at 9:55 AM revealed the employee emptied a resident trash can without utilizing gloves. Review of the Centers for Disease Control and Prevention (CDC) Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, last updated July 2023, noted the type of precautions utilized for ESBL infections included Contact + Standard. Observation of Employee 7, housekeeping staff, on September 27, 2023, at 10:01 AM revealed the employee cleaned Resident 55's room with no isolation gown. Clinical record review for Resident 10 revealed the resident tested positive for COVID 19 on September 20, 2023. The resident's current care plan revealed the resident was on droplet isolation precautions due to testing positive. An intervention included staff had to wear appropriate personal protective equipment (PPE) according to guidelines. Clinical record review for Resident 174 revealed the resident tested positive for COVID 19 on September 21, 2023. The resident's current care plan revealed the resident was on droplet isolation precautions due to testing positive. An intervention included for staff to wear appropriate personal protective equipment (PPE) according to guidelines. Observation of Resident 10's and Resident 174's room had signage on the door indicating an isolation room. Observation of Employee 7 on September 27, 2023, at 10:15 AM revealed the employee donned a gown and gloves (the employee already had on an N95 respirator and protective eyewear) and entered Resident 10's and Resident 174's room to clean. Employee 7 was then observed on September 27, 2023, at 10:21 AM to exit the isolation room with the gown and gloves still on and gather supplies from his housekeeping mobile cart that was positioned in the hallway just outside the door, thus potentially contaminating the mobile cart. Employee 7 then returned to the isolation room to continue cleaning. At 10:31 AM Employee 7 doffed the isolation gown in the hallway just outside the door. Employee 7 was observed doffing the gown by grabbing the neckline of the gown with soiled gloved hands that had come in contact with the employee's clothing underneath and tearing the gown off. Employee 7 was then observed removing the gloves. The employee proceeded to remove his N95 mask and glasses without performing hand hygiene and putting them back on his face. The employee then utilized an alcohol based hand sanitizer. Employee 7 proceeded to clean up two piles of debris from sweeping Resident 10's and 174's room along with the combined pile of floor debris from Resident 55's room. The employee utilized a handheld dustpan and swept the debris onto it without utilizing any gloves. Employee 7 then cleaned a non-isolation room on September 27, 2023, at 10:39 AM. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395779 If continuation sheet Page 10 of 12 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 395779 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Centre Care Rehabilitation and Wellness Services 250 Persia Road Bellefonte, PA 16823 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Observation of Employee 6, hospitality aide, on September 27, 2023, at 10:24 AM revealed the staff member emptied a trash bag without gloves from a mobile cart that had two compartments (one for trash and the other for linens) located in the main hall of [NAME] Neighborhood). The linen bag was noted to be yellow in color and contained various linens. A concurrent interview with Employee 8, nurse aide, revealed the yellow bag was for isolation room linens and stated it was supposed to be a blue bag and Employee 8 was unsure why the bag was yellow thus indicating isolation items. It was unclear if the items in the linen bag were from an isolation room. Employee 6 proceeded to remove the yellow bag from the mobile cart and tie it without any gloves on. Observation of Resident 107's room on September 27, 2023, at 12:10 PM revealed signage that indicated the resident was on isolation. Clinical record review for Resident 107 revealed that the resident had Methicillin-resistant Staphylococcus aureus (MRSA, infections caused by specific bacteria that are resistant to commonly used antibiotics) in the urine and was on MRSA precautions per a current physician's order dated September 19, 2023. Clinical record review for Resident 107 revealed a medical provider note dated September 21, 2023, at 2:50 PM that revealed the resident has a chronic indwelling foley catheter. However, the orders indicated the resident utilizes a condom catheter. An interview with Employee 9, registered nurse, on September 29, 2023, at 11:45 AM revealed Resident 107 did not have a catheter and sometimes refuses. Review of the Centers for Disease Control and Prevention (CDC) Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, last updated July 2023, noted the type of precautions utilized for MRSA infections included Contact + Standard. Observation of Employee 7 on September 27, 2023, at 12:10 PM revealed the housekeeping staff member cleaned the room without an isolation gown. Employee 7 then cleaned a non-isolation room. The above information for Residents 10, 55, 107, and 174 were reviewed in a meeting with the Nursing Home Administrator and Director of Nursing on September 27, 2023, at 2:00 PM. An interview with the Director of Nursing (DON) on September 27, 2023, at 2:55 PM revealed an expectation would be that the environmental staff (housekeeping) utilize gowns to clean a room that is on contact isolation. Observation of Resident 29 on September 27, 2023, at 11:04 AM revealed the resident has a tracheostomy (trach, an opening surgically made through the neck into the windpipe, which a tube/cannula allows the passage of air and supplemental oxygen). There were no observed isolation signs indicating the resident was on isolation. A review of the diagnosis list for Resident 29 revealed the resident had a personal history of MRSA. A current task noted Resident 29 had Special Precautions: CONTACT PRECAUTIONS: MRSA to trach site. Review of staff documentation for Resident 29 revealed that staff were documenting yes, which (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395779 If continuation sheet Page 11 of 12 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 395779 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Centre Care Rehabilitation and Wellness Services 250 Persia Road Bellefonte, PA 16823 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some indicated the precautions were being followed for the resident for the following dates reviewed: August 31, September 1 - 27, 2023. An interview with Employee 2 on September 29, 2023, at 10:43 AM revealed that Resident 29 was not on contact precautions as the task indicated, the task was never removed from the electronic charting. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.10(d) Resident care policies FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395779 If continuation sheet Page 12 of 12