Health inspection·January 20, 2023

F 0641 Ensure each resident receives an accurate assessment. 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 clinical records and the Resident Assessment Instrument and staff interviews, it was determined that the facility failed to ensure that the Minimum Data Set Assessments (MDS - a federally mandated standardized assessment conducted at specific intervals to plan resident care) accurately reflected the status of two residents out of 17 sampled (Resident 29 and 42). Residents Affected - Few Findings include: A review of the clinical record of Resident 29 revealed a quarterly MDS assessment dated [DATE], noted the resident's ADL assistance as extensive assistance - (resident involved in activity, staff provide weight-bearing support), and a two + persons physical assist. However, the resident was totally dependent, full staff performance every time during entire 7-day period) and a two + persons physical assist. A review of Resident 42's quarterly MDS assessment dated [DATE], indicated in Section N0410 Medications Received that an antibiotic medication was received seven times in the last seven days. Review of the Resident 42's November 2022 Medication Administration Record (MAR) revealed that no antibiotic medication was received during the 7 day lookback making the November 11, 2022 quarterly MDS Assessment inaccurate. Interview with the Administrator on January 20, 2023, at 9:20 a.m. she confirmed that Resident 29's MDS assessment dated [DATE], was inaccurate, with respect to completion of Section G0110 related to Activities of Daily Living and confirmed that no antibiotic medication was received during the 7 day lookback for Resident 42, making the November 11, 2022 quarterly MDS Assessment inaccurate. 28 Pa. Code 211.5(g)(h) Clinical records 28 Pa. Code 211.12(c)(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 2 of 20 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 395824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Center for Nursing 600 School House Road Danville, PA 17821 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 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. Based on clinical record review and staff interview, it was determined that the facility failed to complete a discharge summary, which included a recapitulation of the resident's stay, the course of illness, corresponding treatment, discharge instructions, and post-discharge care plan for one of three closed records reviewed (Resident 64). Findings include: A review of the clinical record review revealed that Resident 64 was admitted to the on October 4, 2022, with diagnosis to include ventral hernia without obstruction (any protrusion of intestine or other tissue through a weakness or gap in the abdominal wall). The resident was discharged to a personal care home on October 25, 2022. Review of Resident 64's closed clinical record revealed a Discharge Instructions form, which included the resident's diet and reconciliation of the resident's pre-discharge and post-discharge medications. However, at the time of the survey ending January 20, 2023, there was no documented evidence a discharge summary was provided to the resident and personal care home, which included a recapitulation of the resident's stay, the course of illness, corresponding treatment, discharge instructions, and post-discharge care plan. The documented discharge summary failed to include an accurate and current description of the clinical status of the resident and sufficiently detailed, individualized care instructions to ensure that the resident transitions safely from the facility to the personal care home. During an interview conducted on January 20, 2023, at approximately 11:00 AM the Nursing Home Administrator confirmed that a discharge nursing summary was not accurately and fully completed for Resident 64. 28 Pa. Code 211.12 (a)(c)(d)(3)(5) Nursing services 28 Pa. Code 201.25 Discharge policy FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 3 of 20 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 395824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Center for Nursing 600 School House Road Danville, PA 17821 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0680 Ensure the activities program is directed by a qualified professional. Level of Harm - Minimal harm or potential for actual harm Based on staff interview and a review of employee personnel records it was determined that the facility failed to ensure the qualified part-time professional activities director responsibilities included directing the development, implementation, supervision and ongoing evaluation of the activities program, which includes the completion and/or directing/delegating the completion of the activities component of the comprehensive assessment; and contributing to and/or directing/delegating the contribution to the comprehensive care plan goals and approaches that are individualized to match the skills, abilities, and interests/preferences of each resident. Residents Affected - Some Findings include: Interview with the administrator on January 17, 2023 at 11:30 AM revealed that the previous full-time qualified activities director resigned on November 19, 2022. The administrator stated that no qualified candidates have applied or been interviewed. The administrator stated that since November 19, 2022, Employee 3 (facility corporation Wellness Director) has had oversight of the activities program at the facility and was assisting to develop monthly activity calendars and answer questions that the activities staff may have regarding implementation of the activities program. Review of employee 3's personnel file confirmed that Employee 3 was a certified therapeutic recreation specialist. However, further interview with the administrator on January 19, 2023 at 1:00 PM confirmed that Employee 3's role at the facility was limited and failed to include directing/delegating the completion of the activities component of the comprehensive assessment; and contributing to and/or directing/delegating the contribution to the comprehensive care plan goals and approaches that are individualized to match the skills, abilities, and interests/preferences of each resident. 28 Pa. Code 201.3 Definitions. 28 Pa. Code 201.18(b)(3) (e) (2)(6) Management 28 Pa. Code 201.19 Personnel policies and procedures FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 4 of 20 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 395824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Center for Nursing 600 School House Road Danville, PA 17821 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, and staff interview, it was determined that the facility failed to provide restorative nursing services planned to maintain the functional abilities of two of seven sampled residents (Residents 34 and 43). Findings include: Review of Resident 34's clinical record indicated that the resident was admitted to the facility on [DATE], with diagnoses that included muscle weakness and diabetes. A quarterly Minimum Data Set assessment (MDS- a federally mandated standardized assessment process conducted at specific intervals to plan resident care) dated January 4, 2023, indicated that the resident's cognition was intact and the resident required staff assistance for bed mobility, transfer, dressing, personal hygiene, and toilet use. A physical therapy Discharge summary dated [DATE], indicated that the resident was to receive Restorative Nursing and Active range of motion (AROM) to the right lower extremity (RLE) in all planes at hip, knee and ankle and passive range of motion (PROM) to the left lower extremity (LLE) in all planes at hip, knee, & ankle. The resident's care plan, in effect at the time of the survey ending January 20, 2023, revealed that the resident was to receive AROM to RLE in all planes at hip, knee and ankle 3 x 15 each daily to maintain strength and flexibility, and PROM to LLE in all planes at hip, knee, & ankle 3 x 15 each daily to maintain strength and flexibility. Review of the facility Documentation Survey Report for the months of December 2022 and January 2023 revealed that staff documented that the resident's RNP was being completed. However, interview with Resident 34 on January 19, 2023, at 11:30 a.m. revealed that the resident stated that staff are not providing her the RNP program as planned. Review of Resident 43's clinical record indicated that the resident was admitted to the facility on [DATE], with diagnoses that included a fractured left femur and anxiety. An annual MDS dated [DATE], indicated that the resident's cognition was intact, and the resident required staff assistance for bed mobility, transfer, dressing, personal hygiene, and toilet use. A physical therapy Discharge summary dated [DATE], indicated that the resident was to receive Restorative Nursing and to ambulate 100 feet with a front wheeled walker daily. Review of the resident's plan of care, in effect at the time of the survey ending January 20, 2023, revealed the plan for the resident to ambulate 100 feet with a front wheeled walker and staff assistance of 1 person with the wheelchair to follow daily. Review of the facility Documentation Survey Report for the months of December 2022 and January 2023 indicated that staff documented that the resident's RNP was being completed as planned. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 5 of 20 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 395824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Center for Nursing 600 School House Road Danville, PA 17821 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 However, interview with Resident 43 on January 19, 2023 at 1:30 p.m. revealed that the resident stated that some days the staff walk her in the hall, but most days the only walking she does it to the bathroom and back ( possibly 10 feet each way). The resident stated that she feels she is not walking the 100 feet as per her therapy recommendations. Interview with the Administrator on January 19, 2023 at 10:30 a.m. failed to explain why the residents stated that they are not consistently receiving the RNP services as per therapy recommendations and care planned 28 Pa. Code: 211.5(f) Clinical records 28 Pa Code 211.12 (a)(c)(d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 6 of 20 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 395824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Center for Nursing 600 School House Road Danville, PA 17821 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records and select facility policy and staff interview it was determined that the facility failed to implement planned fall prevention interventions and effective safety measures, including necessary staff supervision of two residents identified at risk for falls with known unsafe behaviors, to prevent falls with serious injuries, femur/hip fractures, for two residents out of four sampled (Resident 215 and Resident 19). Findings include: A review of the facility policy entitled Falls and injury prevention program last reviewed by the facility April 1, 2022, revealed that the facility will promote an environment that remains as free of accidents as possible, staffing and programming that emphasizes fall prevention and provide resident with adequate supervision and assistance to prevent accidents. A multi-disciplinary falls committee has been developed to ensure each resident receives adequate supervision and assistance to prevent accidents, and review accidents/incidents and investigations of accidents/incidents for completeness. A review of Resident 215's clinical record revealed that she was admitted to the facility on [DATE], with diagnoses including diabetes, hypertension, dementia, depression, atrial fibrillation (an irregular and often very rapid heart rhythm), and glaucoma (a group of eye diseases that can cause vision loss and blindness). A review of a discharge Minimum Data Set assessment (MDS - a federally mandated standardized assessment process conducted periodically to plan resident care) dated January 1, 2023, revealed that the resident had short term memory problems, was severely cognitively impaired with daily decision making, required extensive assistance with bed mobility, locomotion on and off unit, and limited assistance with transfers, and walking in room. A review of the resident's care plan, initiated December 29, 2022, revealed that the resident was at risk for falls related to medical and physical status, medications, and had a history of falls at home. The interventions planned were to place the resident's bed in low position, the call light positioned for easy access with reinforcement for need to use call light, check for unmet needs, an environment free of clutter, commonly used articles within reach, and encourage/assist the resident with non-skid shoes/socks. The resident's care plan did not include the resident's need for staff supervision or safety checks based on the resident's risk for falls, cognitive impairment, history of falls and need for staff assistance with transfers and ambulation. The plan of care planned to reinforce the need to use the call light with the resident. However, the resident was severely cognitively impaired with short-term memory problems. A review of a fall risk assessment dated [DATE], indicated that Resident 215 was at risk for falls. A physician order was noted December 29, 2022, to transfer/ambulate the resident with the walker and assistance of one staff. Nursing progress notes dated December 30, 2022, at 2:08 PM, indicated that staff found the resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 7 of 20 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 395824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Center for Nursing 600 School House Road Danville, PA 17821 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 0689 Level of Harm - Minimal harm or potential for actual harm ambulating independently in the hallway and transferring herself in her room. At the recommendation of therapy, the facility implemented bed/chair alarms for safety at that time. Nursing noted on December 30, 2022, at 2:10 PM, that the resident was in the bathroom, toileting herself and getting dressed without staff assistance. Residents Affected - Few Nursing notes dated December 31, 2022, at 5:57 AM, indicated that staff had to redirect the resident as she was non-compliant with using the call bell. Nursing educated the resident about the importance of the call bell for safety and noted that the resident verbalized understanding, although the resident was severely cognitive impairment and had short-term memory problems. A nurse progress note dated January 1, 2023, at 12:40 PM, indicated that staff heard an alarm and found the resident on the floor of her room. The resident assessed with no visible signs of injury, but was complaining of left sided hip pain. She was unable to stand on her left leg and her left foot turned outward. Nursing noted on January 1, 2023, at 12:52 PM, that when asked what happened the resident said the floor was slippery. The resident was sent to the hospital and subsequently admitted to the hospital with a fractured left femur as a result of this fall. The facility's fall investigation dated January 1, 2023, at 12:07 PM, indicated that a nurse aide responded to the resident's alarm and went into resident's room. The aide observed the resident on floor on her buttocks and her legs were under the bed in front of her recliner. Staff helped the resident up and the resident immediately complained of left hip pain. The staff member questioned the resident if she fell on the floor and the responded no that she just sat down. The resident was readmitted to the facility on [DATE], at 7:15 PM, following left hip hemiarthroplasty relating to the fall. During interview conducted on January 19, 2023, at 1:55 PM the NHA and DON were unable to provide evidence that the facility had determined what type of footwear the resident was wearing at the time of the resident's unwitnessed fall on January 1, 2023. The resident's care plan indicated that the resident would be assisted/encouraged to wear non-skid shoes or non-skid socks. The resident also stated that the floor was slippery when interviewed by staff at the time of the fall. The facility's investigation also failed to identify what time the resident had last been observed by staff prior to responding to the alarm. The resident was identified at risk for falls and history of falls and known unsafe behaviors of unassisted self-transfers and ambulation. The staff re-educated the resident on the use of the call bell, but the resident had severe cognitive impairment and short-term memory problems. The facility failed to assure that the planned safety measure of non-skid footwear was in place at the time of the resident fell and sustained a fractured femur. The facility also failed to plan and provide necessary supervision of the resident based on the resident's fall risk and history of falls. During an interview January 19, 2023, at approximately 2:00 PM, the NHA confirmed that the facility did not conduct, or complete a thorough incident/accident investigation, and that the facility failed to implement effective preventative measures to prevent the resident's fall and fracture of her left femur. Review of Resident 19's clinical record revealed the resident had diagnoses, which included ALS (amyotrophic lateral sclerosis- a nervous system disease that weakens muscles and impacts physical (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 8 of 20 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 395824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Center for Nursing 600 School House Road Danville, PA 17821 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 0689 function). Level of Harm - Minimal harm or potential for actual harm A review of an annual MDS assessment dated [DATE], 2023, indicated that the resident was cognitively intact with a BIMS score (brief interview mental screener that aids in detecting cognitive impairment) of 15 (a score of 13 -15 indicates cognitively intact), required one person assistance for transfers, ambulation, and toileting, and was occasionally incontinent of urine and was always continent of bowel. Residents Affected - Few A review of the resident's annual fall risk assessment dated [DATE] indicated Resident 19 was at risk for falls due to unsteadiness and need for assistance. A nurses note dated September 18, 2022, at 8:18 PM indicated that resident was assessed due to a fall in the bathroom. The resident was standing at the bathroom sink independently, lost his balance, and fell backwards, onto his backside. The resident stated that he did not hit his head. A skin tear was noted to the resident's right hand. The resident was educated on risks of falls. Review of the facility incident report dated September 18, 2022 indicated that the immediate intervention included a verbal reminder to ring the call bell. A review of the resident's care plan, initiated September 22, 2022, revealed a problem of safety/falls related to medications and the resident's diagnosis that can/may affect falls. The interventions to prevent falls were that the resident's call light be positioned for easy access, encourage/assist with non-skid socks/shoes, ensure environment is free of clutter, commonly used articles within reach, and reinforce need to use call light to request assistance. A review of the resident's care plan date initiated, September 30, 2022, also identified the resident's non-compliance placing the resident at risk for injuries related to transfers and refusing preventative treatments. Interventions planned were to educate/remind as needed about potential negative outcomes related to their, involve family or friends as able, and seek reasons for non-compliance. However, there was no documented evidence that the facility had evaluated the resident's potential reasons for non-compliance. The resident's care plan for safety and falls did not include planned interventions for staff supervision or safety checks to ensure the resident's needs were being met or the use of safety alarms to alert staff of resident's unsafe transfers based on the resident's non-compliance and medical diagnosis. Review of a nurse's note (late entry) dated December 31, 2022, at 1:11 AM noted that on December 30, 2022, at 3:10 PM the registered nurse supervisor was called to the resident's room. The resident was found lying in a pool of blood. Upon entering the room, the resident was observed lying on the floor, primarily on the right side, with his upper torso curved with his face down, lying on his right arm. The resident was noted to have a large laceration top of forehead that was actively bleeding. He was alert and oriented to person, place, time. The resident stated that he had been sitting on the toilet, stood up, lost balance, and fell striking his head against his wheelchair that was parked adjacent to him. The resident denied loss of consciousness or dizziness, denies straining on commode to have bowel movement, denies pain with exception of his head and right hip lying on hard floor, able to move all extremities, denied tingling or shooting sensation. The resident remained conscious and alert. A sterile gauze, pressure, ice applied were in attempt to stop the bleeding. The resident was wearing shoes and the floor free from debris. The physician and responsible party made aware, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 9 of 20 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 395824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Center for Nursing 600 School House Road Danville, PA 17821 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 0689 and in agreement, to transfer the resident to the emergency room. Level of Harm - Minimal harm or potential for actual harm A nurses note dated December 30, 2022 at 11:42 PM noted that the resident was admitted to the hospital with a right femur fracture. Residents Affected - Few The facility investigation report dated December 30, 2022, at 3:15 PM noted in the nursing description of the event that an aide was passing linen and went into the resident's room to find him on the bathroom floor on his side, right side facing down on floor with blood under his head. The resident description of the event as reported by the resident is that the resident stated he was transferring himself from the toilet to the wheelchair and fell. He couldn't reach the call bell. The immediate intervention was to call 911 and to send the resident to the hospital for evaluation. The resident was admitted to the hospital with hip fracture and 2 cm laceration to the head. The report noted that resident was non-compliant with transfer orders and did not ring for assistance. The facility's investigation failed to include when staff had last visually checked on the resident and provided care or assisted the resident with toileting. Review of information dated December 31, 2022, at 10:55 AM, submitted by the facility noted that the resident was admitted to the hospital following the above fall. The resident required eight staples and was diagnosed with a comminuted (broken in at least two places) nondisplaced fracture of the right greater trochanter (hip) which will required surgery. An incidental finding of possible malignancy was also noted. Review of the hospital history and physical report dated December 30, 2022, at 5:58 PM indicated that the resident had a fall transferring from toilet to wheelchair. The cognitively intact resident reported to the hospital staff that he was on the floor for about an hour before the nurse aide at the facility found him. Interview with the director of nursing (DON) on January 20, 2023 at approximately 1:00 PM confirmed that Resident 19's incident/accident investigation was not thoroughly completed. The DON verified that the facility was unable to provide documented evidence that the facility had attempted adequate preventative measures, such as safety alarms or had planned and provided increased supervision to prevent Resident 19's fall that resulted in serious injury. 28 Pa. Code 211.12(a)(c)(d)(1)(5) Nursing services 28 Pa. Code 211.11(d) Resident care plan 28 Pa. Code 211.10(a)(d) Resident care policies FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 10 of 20 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 395824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Center for Nursing 600 School House Road Danville, PA 17821 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 0697 Provide safe, appropriate pain management for a resident who requires such services. 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 clinical records and select facility policy, resident and staff interview, it was determined that the facility failed to consistently attempt non-pharmacological interventions to alleviate pain prior to the administration of a narcotic pain medication prescribed on an as needed basis (PRN), failed to effectively manage a resident's consistent and repeated use of an opioid pain medication prescribed as needed (PRN), and had failed to administer pain medication as prescribed by the physician, for one resident out of four reviewed (Resident 23). Residents Affected - Some Findings include: According to US Department of Health and Human Services, Interagency Task Force, Executive Summary report May 6, 2021, for Pain Management Best Practices the development of an effective pain treatment plan after proper evaluation to establish a diagnosis with measurable outcomes that focus on improvements including quality of life (QOL), improved functionality, and Activities of Daily Living (ADLs). Achieving excellence in acute and chronic pain care depends on the following: o An emphasis on an individualized patient-centered approach for diagnosis and treatment of pain is essential to establishing a therapeutic alliance between patient and clinician. o Acute pain can be caused by a variety of different conditions such as trauma, burn, musculoskeletal injury, neural injury, as well as pain due to surgery/procedures in the perioperative period. A multi-modal approach that includes medications, nerve blocks, physical therapy and other modalities should be considered for acute pain conditions. o A multidisciplinary approach for chronic pain across various disciplines, utilizing one or more treatment modalities, is encouraged when clinically indicated to improve outcomes. These include the following five broad treatment categories -Medications: Various classes of medications, including non-opioids and opioids, should be considered for use. The choice of medication should be based on the pain diagnosis, the mechanisms of pain, and related co-morbidities following a thorough history, physical exam, other relevant diagnostic procedures and a risk-benefit assessment that demonstrates the benefits of a medication outweighs the risks. The goal is to limit adverse outcomes while ensuring that patients have access to medication-based treatment that can enable a better quality of life and function. Ensuring safe medication storage and appropriate disposal of excess medications is important to ensure best clinical outcomes and to protect the public health. o Restorative Therapies including those implemented by physical therapists and occupational therapists (e.g., physiotherapy, therapeutic exercise, and other movement modalities) are valuable components of multidisciplinary, multimodal acute and chronic pain care. o Interventional Approaches including image-guided and minimally invasive procedures are available as diagnostic and therapeutic treatment modalities for acute, acute on chronic, and chronic pain when clinically indicated. A list of various types of procedures including trigger point injections, radiofrequency ablation, cryoneuroablation, neuro-modulation and other procedures are reviewed. o Behavioral Health Approaches for psychological, cognitive, emotional, behavioral, and social (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 11 of 20 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 395824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Center for Nursing 600 School House Road Danville, PA 17821 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some aspects of pain can have a significant impact on treatment outcomes. Patients with pain and behavioral health comorbidities face challenges that can exacerbate painful conditions as well as function, QOL, and ADLs. o Complementary and Integrative Health, including treatment modalities such as acupuncture, massage, movement therapies (e.g., yoga, tai chi), spirituality, among others, should be considered when clinically indicated. o Effective multidisciplinary management of the potentially complex aspects of acute and chronic pain should be based. A review of facility policy entitled Pain Management last reviewed by the facility April 1, 2022, indicated the facility is to help a resident obtain or maintain his/her highest level of practicable well-being and to prevent and manage pain. Pain is always subjective, the resident experiencing the pain is the best authority on the existence and nature of his/her pain. A resident's statement is the most valued measurement of pain. As indicated, non-pharmaceutical and/or complimentary and alternative therapies will be initiated. On a regular basis the resident's pain management program will be evaluated for effectiveness. A pain scale of 1-10 is utilized to describe pain and amount of pain relief. When treating pain, the physician should order a drug appropriate to the resident's current level of pain, and progress by increasing the dose of that drug until the maximum benefit is obtained. When no further pain control can be achieved, progress to a higher level of medication. A review of the clinical record revealed that Resident 23 was most recently admitted to the facility on [DATE], with diagnoses that included methicillin resistant staphylococcus aureus (MRSA - a type of infection), peripheral vascular disease (PVD - a progressive circulation disorder), diabetes, pressure ulcer (bedsore), low back pain, osteoarthritis, and acquired absence of right leg below the knee. A quarterly Minimum Data Set assessment (MDS-standardized assessment completed at specific intervals to identify specific resident care needs) dated November 24, 2022, revealed that the resident was cognitively intact with a BIMS score of 15 (the Brief Interview for Mental Status a tool that assesses cognition; a score of 13-15 equates to being Cognitively Intact). Section J, Pain Management, question J0300, indicated the resident has had pain and/or was hurting within the last 5 days. A current physician's order, initially dated September 1, 2022, and November 17, 2022, for Percocet 5-325 MG tablet (an opioid - narcotic pain medication) one tablet by mouth every 4 hours, as needed, for severe pain, attempt 3 non - pharmacological interventions/effectiveness prior to administration. A review of the resident's November 2022 Medication Administration Record (MAR), revealed that staff administered this prn pain medication 38 times during the month of November 2022. Of the 38 doses given, 28 were administered without documented evidence of the non-pharmacological interventions that were attempted prior to administering the pain medication. According to the December 2022, MAR staff administered this prn pain medication 40 times during the month of December 2022. Of the 40 doses given, 27 were administered without documented evidence of the non-pharmacological interventions attempted prior to administering the pain medications. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 12 of 20 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 395824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Center for Nursing 600 School House Road Danville, PA 17821 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A review of the resident's January 2023, MAR, at the time the survey ended on January 20, 2023, revealed that staff administered this prn pain medication 34 times during the month of January 2023. Of the 34 doses given, 22 were administered without documented evidence of the non-pharmacological interventions that were attempted prior to administering the pain medications. During an interview with the Director of Nursing (DON) on January 19, 2023, at approximately 11:50 AM the DON stated that the facility was using a pain scale of 1 -10 and severe pain would be rated at the level 8 and above. A further review of the November 2022, MAR revealed that staff administered this pain medication for a pain level of 6 or below on November 2, 3, 7, 8, 10, 18, 21, 22, 25, and 30th, 2022. The December 2022, MAR revealed that staff administered this pain medication for a pain level of 6 or below on December 1, 5, 6, 7, 8, 10, 11, 12, 13, 14, 16, 19, 20, 23, 24, 25, 29, and 31st, 2022. According to the January 2023, MAR, as of the time the survey ending January 20, 2023, staff administered this pain medication for a pain level of 6 or below on January 2, 5, 7, 9, 10, 11, 12, 13, 14, 16, 17, and 19th, 2023. Interview with alert and oriented Resident 23, on January 20, 2023, at approximately 11:20 AM, revealed that the resident stated that he requests the PRN opioid pain medication nearly everyday to manage the pain in his feet and hands. Review of Resident 23's November 2022, MAR, revealed that nursing staff administered the PRN opioid pain medication to the resident daily, with the exception of the days between November 12 -17, 2022, when Resident 23 was hospitalized . Review of the resident's December 2022, MAR, revealed that nursing administered the PRN opioid pain medication to the resident daily, with the exception of 3 days, December 2, 9, and 26th, 2022. Review of Resident 23's January 2023, MAR, as of the time of the survey ending January 20, 2023, revealed that nursing administered the PRN opioid pain medication to the resident daily, with the exception of 1 day, January 4, 2023. Interview with the Nursing Home Administrator (NHA) on January 20, 2023, at approximately 11:48 AM, confirmed that there was no documented evidence that non-pharmacological interventions were consistently attempted, and proved ineffective, prior to administration of prn narcotic pain medication. The NHA also verified that nursing staff failed to follow physician orders for administration of pain medications based on assessed level of pain severity, and the resident had shown excessive daily use of the PRN opioid pain medication. The NHA stated that the physician should have been notified timely to revise the resident's treatment plan for pain. 28 Pa. Code 211.2(a) Physician Services 28 Pa. Code 211.5(f)(g) Clinical records 28 Pa. Code 211.12(a)(c)(d)(1)(3)(5) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 13 of 20 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 395824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Center for Nursing 600 School House Road Danville, PA 17821 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Based on observation, review of nurse staffing, the minutes from Resident Council Meetings and clinical records, observations and staff and resident interviews it was determined that the facility failed to provide and/or efficiently deploy sufficient nursing staff to consistently provide timely and quality of care to residents, including timely provision of assistance from the dining room back to the residents rooms and monitoring during meal service in the main dining room and timely response to requests for assistance to maintain resident safety and promote the physical and psychosocial well-being of residents, including Residents 24, 28, 43, 47, 66, 42 and 32. Findings include: During a group meeting with residents on January 18, 2023, at 10:30 a.m. the five residents in attendance, Residents 24, 28, 43, 47, and 66, all voiced concerns with the long waits for nursing staff to assist them from the dining room back to their rooms after meals. The residents stated that these long waits have been an ongoing problem for them during the last few months and the have discussed the problem during their monthly Resident Council meetings. The residents also stated that in the past it was activity staff transporting them from the dining room and usually never nursing staff. The residents stated that recently they have waited up to an hour to be transported back to their rooms after their meals. All five residents also voiced a concern that there is no nursing staff being present in the main dining room during meals to assist or supervise residents while eating. During the interview conducted on January 18, 2023, at 10:30 a.m. all five residents, Residents 24, 28, 43, 47, and 66, also voiced concerns that staff do not answer their call bells timely and meet their needs for assistance in a timely manner. All five residents stated that staff take longer than 30 minutes, and sometimes up to 45 minutes, to respond to their call bells and/or provide requested care. All residents stated that these long waits and delays may occur at any time of day and any shift of nursing duty. The residents stated that they feel the the facility was short staffed and that insufficient nurse staffing was a part of the problem as to why they wait so long for assistance from staff when requested. During interview with Resident 42 on January 18, 2023 at 11:35 a.m. the resident stated that the he waits at least 30 minutes, and up to one hour, for staff to answer his call bell and provide needed care. The resident stated that his observations are that the facility needs more staff. Interview with Resident 32 on January 18, 2023 at 11:40 a.m. revealed that the resident stated that his feelings are that staffing is an issue because he usually waits 45 minutes, if not longer, for staff to answer his call bell and/or provide care when requested. The resident stated that the long waits for staff to respond to call bells and requests for assistance happens on all shifts. Review of the minutes from Resident Council meetings revealed that beginning July 27, 2022, the residents voiced the concern of waiting long periods of time to get staff help to return to their rooms from the dining room after meals. The problem continued during August 2022 as reported in the August 24, 2022, Resident Council meeting minutes, and was repeatedly identified as a problem at the meetings held during September 2022, October 2022 and November 2022. There was no Resident Council meeting in December 2022. The January 2023 Resident Council meeting had not been held as of the time of the survey ending January 20, 2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 14 of 20 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 395824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Center for Nursing 600 School House Road Danville, PA 17821 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Observation on January 18, 2023, at 12:00 PM revealed that 13 residents were present in the main dining room having lunch. The main dining room is located next to the facility's main kitchen, which is some distance from the nursing units. Observation revealed that nusing staff were not present in the main dining room to assist or supervise the residents during this lunch meal. Interview with Resident 165, a cognitively intact resident, at that time revealed that the resident stated that often there are no nursing staff present in the dining room at resident meals. The facility failed to provide and/or efficiently deploy sufficient nursing staff to timely assist residents back to their rooms from the dining room after meals and to supervise and assist the residents, as needed, during meals to ensure resident safety and adequate assistance and consumption at meals. Interview with the Administrator on January 20, 2023 at 10:15 a.m. revealed that she was unable to explain why residents are waiting so long for nursing staff to assist them back to their rooms after meals. The NHA verified that there should be at least one nursing staff present in the main dining room during meals. Interview with the Director of Nursing on January 20, 2023 at 11:30 a.m. also confirmed that she was aware that residents had concerns that nursing staff were not responding timely to their requests for assistance via the nurse call bell system. Refer F550 28 Pa. Code 211.12(a)(c)(d)(1)(3)(5) Nursing services 28 Pa. Code 201.18 (e)(1)(2)(3)(6) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 15 of 20 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 395824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Center for Nursing 600 School House Road Danville, PA 17821 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 0744 Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. 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 clinical records and staff interview, it was determined that the facility failed to develop and implement an individualized person-centered plan to address a resident's dementia-related behavioral symptoms for one out of 17 residents reviewed (Resident 48). Residents Affected - Few Findings include: A review of the clinical record revealed that Resident 48 was admitted to the facility on [DATE], with diagnoses that included unspecified dementia without behavioral disturbances (a decline affecting memory, normal thinking, communicating which make it difficult to perform normal activities of daily living such as dressing, eating, and bathing). An admission Minimum Data Set assessment (a federally mandated standardized assessment completed periodically to plan resident care) dated November 22, 2022, indicated that the resident was moderately cognitively impaired for decision making and exhibited a behavior of non-intrusive wandering. Review of the resident's care plan initially dated November 18, 2022, indicated that the resident had a focused care area of elopement and/or disruptive behaviors requiring a code alert bracelet and secured area due to behavioral symptoms wandering and elopement concerns, dementia diagnosis with cognitive impairment, memory loss, and significant judgement concerns. Interventions to keep the resident safe and secure included wandering assessments upon admission, quarterly, with significant change, and as needed, observe, monitor, document behaviors/mood exit-seeking concerns, and notify supervisor, social worker, and physician as needed, and Code Alert bracelet (a bracelet which alarms when exit door approached) to right ankle. The resident's current care plan, in effect at the time of the survey of January 20, 2023, did not identify based on the resident's identified dementia behavior of wandering specific individualized person-centered interventions to address the behavior based on an assessment of the resident's preferences, social/past life history, customary routines, and interests to manage the resident's dementia-related behavioral symptoms. Interview with Director of Nursing and Nursing Home Administrator on January 20, 2023, at approximately 9:00 AM, confirmed that the facility was unable to provide evidence of the development and implementation of an individualized person-centered plan to address dementia-related behaviors and any approaches used to manage or modify the resident's behavior of wandering. 28 Pa Code 211.12 (a)(c)(d)(1)(3)(5) Nursing services 28 Pa Code 211.11 (d) Resident care plan FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 16 of 20 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 395824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Center for Nursing 600 School House Road Danville, PA 17821 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, a review of clinical records and select facility policy and staff interview, it was determined that the facility failed to implement procedures to ensure acceptable storage and use by dates for multi-dose medications on one of two medication carts observed (B hall - 100's) and acceptable labeling of IV solutions for one of four residents reviewed (Resident 26). Findings include: A review of facility policy entitled Medication Labels and Peripheral IV insertion/infusion/maintenance guidelines, last reviewed by the facility April 1, 2022, indicated some medications must be dated upon opening and should be discarded after the expiration date has passed. When opened the following is a list of medications with their accompanying expiration dates, included in this list is all insulins. A peripheral IV is used for administration of fluids and medication. Inspect all solution containers prior to hanging for discoloration, turbidity, leaks, particulate matter and expiration date. Change IV solution containers every 24 hours minimum. Label container with time tape indicating date, time and administration rate. A review of Resident 26's clinical record revealed that the resident was admitted to the facility December 27, 2022, with diagnoses to include osteomyelitis, diabetes, peripheral vascular disease (PVD), low back pain, and rheumatoid arthritis. A nursing progress note dated January 17, 2023, at 9:42 AM, revealed critical lab result received, potassium (K+ 6.2) (blood potassium level is normally around 3.6 to 5.2 millimoles per liter, having a blood potassium level higher than 6.0 can be dangerous) and glucose 34 (a blood sugar level below 70 mg/dl is low and can harm you). New orders were noted to start a peripheral IV, infuse normal saline solution (NSS) 1000 milliliter (ML) at 100 ml/hour x 1 then discontinue IV. A physician order was noted January 17, 2023, indicated to infuse 1000 ml of NSS at 100 ml/hr then discontinue. An observation on January 17, 2023, at approximately 11:50 AM, in resident room [ROOM NUMBER] revealed Resident 26 was lying in bed with an IV solution infusing. The IV solution bag was unlabeled, without the date, time, resident's name and rate of infusion. An observation on January 17, 2023, at approximately 12:15 PM, in the presence of Employee 1, Licensed Practical Nurse (LPN), in resident room [ROOM NUMBER], revealed Resident 26 lying in bed with an IV solution infusing into the resident. The IV solution bag was unlabeled, without the date, time, residents name, and rate of infusion. An interview with Employee 1, LPN, at that time confirmed the observation and Employee 1 stated that the IV bag solution should have been labeled. Observation of the 100, B hall, medication cart on January 19, 2023, at approximately 11:38 AM, revealed a Basaglar Kwik Pen, (medication used for diabetes), and a Novolog Flex Pen (medication used for diabetes) belonging to Resident 34, opened and available for use and not dated when initially opened. The above medication cart observation was conducted in the presence of Employee 2, Licensed Practical Nurse (LPN), who confirmed that the medications were not dated when opened for resident use. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 17 of 20 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 395824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Center for Nursing 600 School House Road Danville, PA 17821 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 Interview with the Nursing Home Administrator (NHA) on January 19, 2023, at approximately 1:55 PM, confirmed that medications were to be dated when opened and the IV solution bag should have been labeled. 28 Pa. Code 211.9(a)(1)(k) Pharmacy services Residents Affected - Few 28 Pa. Code 211.12 (a)(c)(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 18 of 20 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 395824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Center for Nursing 600 School House Road Danville, PA 17821 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 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records and staff interview, it was determined that the facility failed to offer routine annual dental services for four Medicaid payor sources out of 17 residents sampled (Residents 29, 33, 34 and 42). Residents Affected - Some Findings include: Review of Resident 29's clinical record indicated that the resident was admitted to the facility on [DATE], and that the resident's payor source was Medicaid. Review of Resident 33's clinical record indicated that the resident was admitted to the facility on [DATE], and that the resident's payor source was Medicaid. Review of Resident 34's clinical record indicated that the resident was admitted to the facility on [DATE], and that the resident's payor source was Medicaid. Review of Resident 42's clinical record indicated that the resident was admitted to the facility on [DATE], and that the resident's payor source was Medicaid. There was no documented evidence that the above residents were offered or had received dental services in the past year. Interview with the Administrator on January 19, 2023 at 10:30 a.m. confirmed that the facility had no documented evidence that Residents 29, 33, 34 and 42 were offered or had been provided dental services in the last year. 28 Pa. Code 211.12(c)(d)(3)(5) Nursing services 28 Pa. Code 211.15(a) Dental services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 19 of 20 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 395824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emmanuel Center for Nursing 600 School House Road Danville, PA 17821 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 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm Based on review of clinical records and staff interview, it was determined that the facility failed to timely offer and/or provide the pneumococcal immunization to one of 17 residents reviewed (Resident 32). Residents Affected - Few Findings include: Review of the clinical record of Resident 32 revealed admission to the facility on December 7, 2022. The resident was not offered the pneumococcal immunization until surveyor inquiry on January 19, 2023. Interview with the Administrator on January 18, 2023, at approximately 9:30 a.m. confirmed that Resident 32 was not offered the pneumococcal immunization until surveyor inquiry on January 19, 2023. 28 Pa. Code 211.12 (a)(c)(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 20 of 20