Inspection·August 4, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm R44 refuses to allow staff to check his blood sugar by means of a capillary blood glucose test (blood is collected via a fingertip and resulted using a test strip and a blood glucose meter) and only allows staff to use the number that displays from Resident R44's personal continuous glucose monitoring device. LPN Employee E4 stated, half of the time he refuses the ordered sliding scale insulin, he likes to control his own stuff. Residents Affected - Few Review of Resident R44's current care plan failed to reveal goals and interventions related to noncompliance regarding diabetes management and insulin therapy. Review of admission record indicated Resident R81 was admitted to the facility on [DATE]. Review of Resident R81's MDS dated [DATE], indicated the diagnoses of anemia, heart failure (heart doesn't pump blood as well as it should), and coronary artery disease (CAD - narrow arteries decreasing blood flow to heart). Review of Resident R81's physician order dated 3/21/23, indicated Eliquis (medication to inhibit blood clots) 2.5mg (milligrams) every twelve hours. Review of Resident R81's current care plan failed to reveal goals and interventions related to management of anticoagulant management and monitoring. Interview on 8/2/23, at 11:45 a.m. Registered Nurse Assessment Coordinator (RNAC) Employee E7 confirmed the facility failed to include a plan of care for Eliquis management and monitoring. During an interview on 8/2/23, at 1:44 p.m. the Director of Nursing (DON) confirmed that the facility failed to develop and implement an individualized plan of care to address Resident R44's noncompliance regarding diabetes management and insulin therapy. Interview on 8/4/23, at 2:00 p.m. the Director of Nursing confirmed the facility failed to develop and implement comprehensive care plans to meet care needs for three of eight residents (Resident R34, R44, and R81). 28 Pa. Code 211.10(c)(d) Resident care policies. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395790 If continuation sheet Page 2 of 9 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 395790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seneca Place 5360 Saltsburg Road Verona, PA 15147 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy, observation, clinical record review, and staff interviews, it was determined that the facility failed to make certain that residents are free from significant medication errors for three of seven residents (Residents R44, R291, and R287) which caused a pulmonary hypertension (a condition that affects the blood vessels in the lungs and develops when the blood pressure in the lungs is higher than normal) medication not to be administered. Residents Affected - Few This failure resulted in a harm situation for one of seven residents (Resident R287). Review of facility policy Medication Administration: Injectables dated January 2023, indicated that injectable medication will be prepared for administration by verifying medication order on the Medication Administration Record (MAR) for the right resident, right drug, right dose, right route, right time, and any special instructions. Review of the clinical record indicated Resident R44 was admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS - a periodic assessment of care needs) dated 7/18/23, indicated diagnoses of diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time), hypertension (high blood pressure in the arteries), and anemia (a condition in which the blood does not have enough healthy red blood cells). Review of physician's orders dated 7/17/23, indicated an order for Humalog Insulin (fast acting insulin that decreases blood sugar) 4 units subcutaneous (beneath all the layers of the skin) before meals, give at time of meal no sooner than 15 minutes prior and no later than 15 minutes after starting meal. Review of physician's orders dated 7/28/23, indicated an order for Humalog Insulin subcutaneous before meals low dose sliding scale 70-140 = 0 unit, 141-180 = 1 unit, 181-220 = 2 units, 221-260 = 3 units, 261-300 = 4 units, 301-340 = 5 units, >340-400 = 6 units, if sugar is >300 repeat CBG (capillary blood glucose) 2 hours after meal and give additional insulin dose by the above scale. If sugar >400 on 2nd check call provider. Interview on 7/31/23 at 1:23 p.m. with Licensed Practical Nurse (LPN) Employee E3 stated Resident R44's before breakfast blood sugar level was 335, which would require 5 units of Humalog insulin per sliding scale physician order. LPN Employee E3 confirmed that the before meal scheduled 4 units of Humalog and additional 5 units of Humalog per the sliding scale were administered at 9:40 a.m. on 7/31/23, due to Resident R44 refusing the insulin injection prior to breakfast. Review of the Tray Delivery Times schedule revealed that the 4th floor Cart 1 breakfast is delivered between 6:55 a.m. - 7:05 a.m. and the 4th floor Cart 2 breakfast is delivered between 7:05 a.m. - 7:15 a.m. Interview on 8/4/23, at 11:57 a.m. with 4th floor Health Unit Coordinator (HUC) Employee E10 confirmed that breakfast trays were delivered on time on 7/31/23. Review of facility policy Medication Administration: Oral dated January 2023, indicated oral medications will be prepared for administration by verifying the order on the MAR for the right resident, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395790 If continuation sheet Page 3 of 9 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 395790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seneca Place 5360 Saltsburg Road Verona, PA 15147 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 0760 right drug, right dose, right route, right time, and any special considerations. Level of Harm - Minimal harm or potential for actual harm Review of the clinical record indicated Resident R291 was admitted to the facility on [DATE], with diagnoses pulmonary hypertension (a condition that affects the blood vessels in the lungs and develops when the blood pressure in the lungs is higher than normal), heart failure (progressive heart disease that affects pumping action of the heart muscles), and muscle wasting. Residents Affected - Few Review of physician's orders dated 7/27/23, indicated an order for Metolazone (medication that increases elimination of sodium and water by inhibiting sodium reabsorption in the kidneys) 2.5 milligrams (MG) by mouth three times weekly on Monday, Wednesday, and Friday, give 30 minutes prior to furosemide (generic name for Lasix) dose. Review of physician's orders dated 7/28/23, indicated an order for Lasix (a medication that treats fluid retention and swelling caused by heart failure, liver disease, kidney disease, and other medication conditions) 40 milligrams by mouth two times a day. During a mediation administration observation on 7/31/23, at 9:26 a.m. LPN Employee E3 was observed administering the Metolazone and Lasix medications at the same time to Resident R291. Interview on 7/31/23, at 12:15 p.m. LPN Employee E3 confirmed that she did not follow the physician's order by administering Metolazone and Lasix at the same time to Resident R291. Review of the facility's admission Policy reviewed January 2023, indicated Prior to/at the time of admission, the following information must be received by the Skilled Nursing Facility: Physician's discharge orders from acute care, recent history and physical, discharge summary, medication administration record, and lean medical record if from parenting hospital. Review of Order Entry reviewed January 2023, indicated all orders will be entered in myUnity (electronic health record system). This document will provide the direction for medication, treatments, labs, diagnostic, and advanced order entry. Review of Checking Orders -(Redlining) Using the 24-Hour Report reviewed January 2023, indicated that checking all new orders were addressed is a daily requirement for nurses. The 24-hour report includes all new orders for a specific assignment and period of time. Review of the admission record indicated Resident R287 was admitted to the facility on [DATE], with the diagnoses of acute and chronic respiratory failure (a serious condition that makes it difficult to breathe on your own), pulmonary hypertension, and diabetes (too much sugar in the blood). Review of Resident R287's care plan dated 7/12/23, indicated a problem for altered breathing pattern, with a goal to have optimal gas exchanges and be able to participate in activities of daily living. Intervention included to see medication administration record for respiratory maintenance and as needed medications. Review of hospital discharge paperwork dated 7/11/23, indicated a physician order for Resident R287 of sildenafil 20mg (milligrams) three times a day (a medication used to treat high blood pressure in the lungs) on the Final Medication list and indicated the last dose provided at the hospital was 7/11/23, at 8:16 a.m. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395790 If continuation sheet Page 4 of 9 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 395790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seneca Place 5360 Saltsburg Road Verona, PA 15147 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 0760 Level of Harm - Minimal harm or potential for actual harm Review of the facility's original physician order sheet dated 7/11/23, at 11:47 a.m. included sildenafil 20 mg three times a day. Review of the facility's Resident Medication Profile dated 7/12/23, at 2:19 p.m. a transcription approval medication listing did not include the order for sildenafil. Residents Affected - Few Review of facility submitted event details dated 7/11/23, indicated on 7/19/23, the facility was informed during the transition of care review there was a concern that Resident R287's sildenafil was omitted from the medication list. It was identified that the medication was ordered upon admission to facility and deleted as part of a transcription approval error on 7/12/23. Indicating R287 missed four doses of the medication. The facility reinstated the prescribed medication on 7/17/23; however, resident was being transferred to the emergency room and was admitted with acute hypoxemic and hypercapnic respiratory failure. Review of R287's medication administration record and physician orders indicated the prescribed sildenafil 20 mg three times a day was omitted for 17 doses (7/11/23 - 7/17/23). Review of Licensed Practical Nurse (LPN) Employee E5's statement dated 7/25/23, via email communication at 9:53 a.m. indicated during my shift of 3am-3pm I was instructed by RN Supervisor, that we needed to change orders for Resident R287 as some of his medication orders had (0) zero in parenthesis next to the medications. While doing this process I did input all the medications with the exception of the residents BPH medication. This was not done intentionally. I have since been showed how to change a medication without completely deleting an order so that this does not happen again. Interview with LPN Employee E5 on 8/3/23, at 11:00 a.m. indicated I'm still in training with the RN supervisor for redlining (that's when you go through the orders and make sure they are correct), I was working alone and R287 had several orders that needed re-entered due to an extra zero (20 mg showed as 20.0 and pharmacy needed the extra zero removed from the orders). I worked on those orders and missed the sildenafil. It wasn't intentional, I just overlooked it. Interview with the Director of Nursing on 8/4/23, at 12:16 p.m. the Director of Nursing confirmed that the Midnight RN Supervisor who normally does the Redlining called off that day, the redlining process did not occur as it should have, and would have caught the omission of the sildenafil if it were completed correctly. Interview on 8/4/23, at 1:30 p.m. the Director of Nursing confirmed the facility failed to make certain that residents are free from significant medication errors for three of seven residents (Residents R44, R291, and R287). 28 Pa. Code: 201.14(a)(c)(d)(e) Responsibility of licensee. 28 Pa. Code: 201.18(e)(1) Management 28 Pa. Code: 201.20(b) Staff development. 28 Pa. Code: 211.12(d)(1)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395790 If continuation sheet Page 5 of 9 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 395790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seneca Place 5360 Saltsburg Road Verona, PA 15147 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 interviews it was determined that the facility failed to maintain sanitary conditions in the Main Kitchen which created the potential for cross contamination. Residents Affected - Many Findings include: During an observation on 7/31/23, at 9:10 a.m. it was revealed the ice machine in the main kitchen contained a brown substance inside the machine. Web Request Work Order revealed the ice machine in the main kitchen was last cleaned 2/24/23. During an interview on 7/31/23, at 9:23 a.m. the Dietary Manager Employee E9 confirmed the brown substance in ice machine, and it has not been cleaned since 2/24/23, creating the potential for cross contamination. 28 Pa Code: 201.14(a) Responsibility of licensee FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395790 If continuation sheet Page 6 of 9 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 395790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seneca Place 5360 Saltsburg Road Verona, PA 15147 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 0847 Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse. 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 documents and resident clinical record and staff and resident interviews it was determined that the facility failed to ensure a resident had the capacity to understand the terms of a binding arbitration agreement for two of three residents (Resident R60 and Resident R128). Residents Affected - Few Findings include: Review of the Resident Assessment Instrument 3.0 User's Manual effective October 2019, indicated that a Brief Interview for Mental Status (BIMS) is a screening test that aides in detecting cognitive impairment. The BIMS total score suggests the following distributions: 13-15: cognitively intact 8-12: moderately impaired 0-7: severe impairment Review of admission record indicated Resident R60 admitted to the facility on [DATE]. Review of Resident R60's Minimum Data Set (MDS - a periodic assessment of care needs) dated 7/7/23, indicated the diagnoses of atrial fibrillation (irregular heart rhythm), renal insufficiency (condition where the kidneys lose the ability to remove waste and balance fluids), and muscle wasting (decrease in tissue). BIMS score indicated 11 - moderately impaired cognition. Review of Resident R60's Binding Arbitration Agreement (a binding agreement by the parties to submit to arbitration all or certain disputes which have arisen or may arise between them in respect of a defined legal relationship, whether contractual or not. The decision is final, can be enforced by a court, and can only be appealed on very narrow grounds) indicated she signed the document on admission on [DATE]. Interview with Resident R60 on 8/4/23, at 11:15 a.m. indicated she couldn't remember if she signed a Binding Arbitration Agreement and was not sure what it meant. Review of admission record indicated Resident R128 admitted to the facility on [DATE]. Review of R128's MDS dated [DATE], indicated the diagnoses of symptoms and signs involving cognitive functions and awareness, disorientation (a state of mental confusion), and atrial fibrillation. BIMS score indicated 11 - moderately impaired cognition. Review of Resident R128's Binding Arbitration Agreement indicated she signed it on admission on [DATE]. Interview with R128 on 8/3/23, at 2:00 p.m. indicated she couldn't remember if she signed a Binding Arbitration Agreement and was not sure what it meant and indicated her husband would know. Interview on 8/3/23, at 2:06 p.m. Licensed Practical Nurse (LPN) Employee E11 indicated Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395790 If continuation sheet Page 7 of 9 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 395790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seneca Place 5360 Saltsburg Road Verona, PA 15147 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 0847 Level of Harm - Minimal harm or potential for actual harm R128 is confused and delusional (holding false beliefs about external reality that are held despite incontrovertible evidence to the contrary). Interview on 8/4/23, at 2:00 p.m. the Nursing Home Administrator confirmed the facility failed to ensure Residents R60 and R128 had the capacity to understand the terms of a binding arbitration agreement. Residents Affected - Few 28 Pa. Code: 201.14(a)(c)(d)(e) Responsibility of licensee. 28 Pa. Code: 201.18(e)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395790 If continuation sheet Page 8 of 9 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 395790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seneca Place 5360 Saltsburg Road Verona, PA 15147 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 Based on a facility tour, review of facility policies, staff interviews, and review of Centers for Disease Control (CDC) guidelines, it was determined that the facility failed to maintain infection control practices to prevent the potential for cross contamination for one of two sides of the laundry room (the soiled side). Residents Affected - Few Findings include: Review of facility policy SRC-Infection Control - Linen Handling dated January 2023, indicated all linen will be handled, stored, transported, and processed to contain and minimize exposure to waste products. All soiled linen will be handled the same, using Standard Precautions, staff may wear gloves, gowns, and or eye protection as indicated. Review of the CDC Guidelines for Environmental Infection Control in Health-Care Facilities dated 11/5/15, indicated laundry workers should wear appropriate personal protective equipment (e.g., gloves, and protective garments) while sorting soiled fabrics and textiles. During a tour of the laundry facility 8/4/23, at 8:57 a.m. it was noted that no gloves or protective gowns were located in the soiled side of the laundry room. Interview with Environmental Manager Employee E8 stated that the personal protective equipment (gloves and gowns) are located on the clean side of the laundry room. Employee E8 stated, staff rarely wear a gown unless they know the laundry is soiled with blood or something else. During an interview on 8/4/23, at 9:24 a.m. Environmental Manager Employee E8 confirmed the facility failed to maintain infection control practices to prevent the potential for cross contamination on the soiled side of the laundry room. 28 Pa. Code: 205.26(a)(b)(c)(d) Laundry. 28 Pa. Code: 207.2(a) Administrator's responsibility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395790 If continuation sheet Page 9 of 9