Inspection visit

InspectionJanuary 11, 2024

EMMANUEL CENTER FOR NURSINGCMS #39582425 citations on this visit

25 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 25 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records, observation, and resident and staff interviews, it was determined that the facility failed to provide care in a manner respectful of each resident's dignity for one resident (Resident 1), and failed to provide care in a manner and environment that promotes each resident's quality of life by failing to respond timely to residents' request for assistance as reported by two residents out of 11 sampled (Residents 12 and 11). Findings include: A review of Resident 1's clinical record revealed he was admitted to the facility on [DATE], with diagnoses which have included malignant neoplasm of the prostate, chronic kidney disease, diabetes, COVID-19, bronchopneumonia, and clostridium difficile [C-diff] (a bacterium infection that causes an infection of the colon). A review of a nurses progress note dated February 11, 2024, at 1:19 AM, revealed that the resident was positive for C - diff, and was placed on contact precautions, and began treatment, Vancomycin (antibiotic). Observation on February 22, 2024, at approximately 11:20 AM, revealed that a metal apron on the wall outside the resident's room, 101, containing personal protective equipment (PPE) supplies. Continued observation revealed 2 paper signs taped on the door to the resident's room. The first sign noted C-Difficile requires special care with pink highlighted words, handwashing only and a line drawn to the information stating that the C-diff spores are not killed by alcohol - based hand sanitizer. The second sign read Contact precautions. A second observation on February 22, 2024, at approximately 12:40 PM, that the above noted two signs remained posted on the door to the resident's room. Interview with alert and oriented Resident 1 on February 22, 2024, at approximately 1:50 PM, revealed that the resident was aware of his diagnosis of c-diff, treatments, and safety precautions, but verified that he would not like that information shared with others as noted on the signs on the door to his room. Interview with the Nursing Home Administrator (NHA), on February 22, 2024, at approximately 2:10 PM, confirmed that signs identifying a individual medical condition, or resident care needs, should not have been placed on the resident's door, visible to others. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 31 Event ID: 395824 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 01/11/2024 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview with Resident 11 on February 22, 2024, at 10:30 AM the resident stated that staff do not consistently answer call bells timely and provide care in a timely manner. Resident 11 stated that he prefers to get out of bed each day between 6:30 and 7:00 AM. Resident 11 stated that on Saturday February 17, 2024, agency nursing staff did not get him out of bed until 8:00 AM. Resident 11 reported that this morning, February 22, 2024, his wife (Resident 12) rang the call bell to request staff assistance to get out of bed. Resident 11 stated that the call bell rang greater than 30 minutes before staff answered her call bell and assisted Resident 12 out of bed. Interview with the nursing home administrator on February 22, 2024, at approximately 2:30 PM verified that all residents at the facility should be treated with dignity and respect. The NHA confirmed that the facility staff were to answer call bells promptly and provide assistance in a timely manner to promote each resident's quality of life. Refer F 880 28 Pa. Code 211.12 (c)(d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 2 of 31 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 01/11/2024 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 0565 Honor the resident's right to organize and participate in resident/family groups in the facility. Level of Harm - Minimal harm or potential for actual harm Based on review of select facility policy and minutes from Resident Council meetings and resident and staff interviews it was determined that the facility failed to put forth sufficient efforts to promptly resolve continued resident complaints/grievances expressed during Resident Council Meetings including those voiced by five of five residents attending a resident group meeting (Residents 29, 46, 26, 49, and 16) Residents Affected - Some Findings include: Review of the facility's current Grievance policy provided during the survey ending January 11, 2024, indicated that it is the facility's policy to provide an opportunity for residents to express concerns at any time. The facility's goal is to resolve resident and family concerns in a timely basis. Review of the minutes from the Resident Council meetings held between October 2023 through December 2023, revealed that residents in attendance at these resident group meetings voiced their concerns regarding facility services during the meetings. During the October 2023 Resident Council meeting the residents in attendance relayed concerns with staff responding their requests for assistance via the nurse call bell system, in a timely manner. During the November 2023 Resident Council meeting the residents in attendance relayed concerns with staff responding their requests for assistance via the nurse call bell system in a timely manner. During the December 2023 Resident Council meeting the residents in attendance relayed concerns with staff responding their requests for assistance via the nurse call bell system in a timely manner. During a group meeting held on January 10, 2024, at 10:30 a.m., with five (5) alert and oriented residents, five of five residents (Residents 29, 46, 26, 49, and 16) stated that they often wait longer than 25-30 minutes for staff assistance after they ring their call bells. The residents stated that they have repeatedly brought this particular complaint to the facility's attention without resolution to date. The facility was unable to provide documented evidence at the time of the survey ending January 10, 2024, that the facility had determined if the residents' felt that their complaints/grievances had been resolved through any efforts taken by the facility in response to the residents' expressed concerns regarding untimely call bell response time. During an interview with the Nursing Home Administrator (NHA) on January 11, 2024, at 11:00 a.m. the NHA was unable to provide documented evidence that the facility had followed-up with the residents to ascertain the effectiveness of the facility's efforts in resolving their complaints regarding call bell timeliness. 28 Pa. Code: 201.29 (a) Resident rights. 28 Pa. Code 201.18 (e)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 3 of 31 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 01/11/2024 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 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 a review of the facility's abuse prohibition policy and employee personnel files and staff interviews, it was determined that the facility failed to implement their established procedures for screening four of five employees for employment (Employee 1, 2, 3, and 4) Residents Affected - Some Findings include: A review of the facility's Resident Abuse policy last reviewed March 16, 2023, revealed procedures for screening potential employees that included obtaining references from current/previous employers. Review of employee personnel files revealed that Employee 1 (Activity aide) was hired October 9, 2023. The employee's application indicated that she had previous employers. There was no indication that the facility obtained any references for this employee's previous employers. Review of employee personnel files revealed that Employee 2 (dietary aide) was hired September 19, 2023. The employee's application indicated that she had previous employers. There was no indication that the facility obtained any references from the prior employers. Review of employee personnel files revealed that Employee 3 (LPN) was hired August 23, 2023. The employee's application indicated that she had previous employers. There was no indication that the facility obtained references from any prior employers. Review of employee personnel files revealed that Employee 4 (LPN) was hired November 2, 2023. The employee's application indicated that she had previous employers. There was no indication that the facility obtained references for this employee from any prior employers. Interview with the Administrator on January 11, 2024, at 12:15 p.m. the NHA verified that there was no evidence that previous employers were contacted for references according to the facility's Resident Abuse policy procedures for screening employees. 28 Pa. Code 201.19 (1) Personnel records 28 Pa. Code 201.29 (a) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 4 of 31 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 01/11/2024 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 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on a review of clinical records, select facility incident reports, and the facility's abuse prohibition policy and staff interview it was determined that the facility failed to thoroughly investigate injuries of unknown origin to rule out abuse, neglect, or mistreatment as a potential cause of the injury sustained by one resident out of 18 sampled (Resident 19). Residents Affected - Few Findings included: A review of the facility's policy, entitled Investigation of Abuse last reviewed by the facility March 16, 2023, indicated that a complete investigation will be conducted. In case of injury of unknown origin, the facility will try to determine the source of the injury and rule out neglect or abuse. When investigating injuries of unknown origin the facility will interview staff and anyone coming in contact with the resident over the course of 24 hours prior to the noted injury. The investigation will include the signed statements of these contact people. Additionally, the facility will identify anyone who provided services to the resident during this 24 hour period and document the specific services provided and any unusual event occurring during the delivery of service. A review of the clinical record revealed that Resident 19 had diagnoses. which included Alzheimer's disease and osteoporosis. An annual Minimum Data Set assessment (MDS-standardized assessment completed at specific intervals to identify specific resident care needs) dated September 8, 2023, indicated that the resident was severely cognitively impaired, non-ambulatory, and required the assistance of two staff for bed mobility and transfers. A late entry nurses note dated October 9, 2023, at 8:03 AM indicated that nursing observed Resident 19's left lower extremity to present +2 edema and warmth. The resident did not express signs or symptoms of pain when edema was assessed. The physician assistant was made aware. Staff were to monitor the resident's left lower extremity and the physician assistant planned to see the resident on October 10, 2023; staff were to call with any changes. A physician order dated October 10, 2023, was noted to obtain a venous doppler to the left lower extremity for left lower extremity edema, redness, warmth, and pain. A nurses note dated October 10, 2023, at 2:04 PM indicated that the doppler study was completed and the results were negative for DVT (deep vein thrombosis- blood clot in a deep vein) of the resident's left lower extremity. A late entry nurses note dated October 12, 2023, at 9:00 AM revealed that swelling was observed to the resident's left lower extremity with no improvement with elevation. Nursing contacted the physician and an order was received to obtain an Xray of the left lower extremity and a CBC (complete blood count). The resident's representative made aware. A nurses note dated October 13, 2023, at 9:02 AM revealed that the facility received the Xray results which indicated that the resident had acute fractures of distal left tibia (shin bone) and fibula (calf bone). The MD was made aware. A new order was received to send the resident to emergency room for evaluation. Resident representative aware. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 5 of 31 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 01/11/2024 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A nurses note dated October 13, 2023, at 10:39 PM indicated that the resident returned from the emergency room. The emergency room reported that orthopedics saw the resident and returned the bone to its appropriate place and applied a splint. The resident will need to follow-up with ortho as outpatient according to the discharge instructions. Review of a facility investigation summary report dated October 12, 2023, indicated that swelling of the resident's extremity was observed on October 10, 2023, in the morning and the provider was notified. A doppler was ordered, and resident was seen by the medical provider on October 10, 2023. On October 12, 2023, the resident's leg was still swollen with no improvement, the medical provider was contacted, and Xray of the left lower extremity was ordered. Xray results were positive for tibia/fibula fracture. Medical provider was made aware and orders for urgent ortho consult. The resident was not able to provide details related to the incident. Review of the facility's summary and outcome of investigative findings revealed that staff witness statements did not recall/indicate any potential mechanism or means of injury. The resident was noted to be at increased risk for bone related injuries due to medical history including osteoporosis with contractures and vitamin D deficiency. Possible mechanism of injury was noted to be not limited to transfers via Hoyer lift to/from bed to chair, repositioning, and transport of resident in chair. Mandatory nursing education sessions were to be scheduled for proper lift use and transfer/positioning of residents with contractures. However, further review of the facility investigation and provided witness statements, failed to provide documented evidence that the facility interviewed all staff and anyone coming in contact with the resident over the course of 24 hours prior to when the signs of injury (edema and warmth) were first noted on October 9, 2023. There was no documented evidence that all staff who provided care and services to the resident during that time period were identified and that the specific services provided to the resident were identified and documented, including any unusual event which occurred during the delivery of services prior to the fracture. Interview with the administrator and director of nursing on January 12, 2024, at 10:00 AM confirmed that Resident 19 was non-ambulatory and totally dependent on staff for care. The NHA and DON confirmed that the facility was unable to provide a completed thorough investigation to rule out abuse, neglect, or mistreatment as a potential cause of Resident 19's injury of unknown origin, fractured lower leg. 28 Pa Code 201.29 (a)(c) Resident rights 28 Pa. Code 211.12(c) Nursing services 28 Pa. Code 201.18 (e)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 6 of 31 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 01/11/2024 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 0622 Level of Harm - Potential for minimal harm Residents Affected - Some Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. Based on clinical record review and staff interview, it was determined that the facility failed to ensure that the necessary resident information was communicated to the receiving health care provider for four residents out of 18 residents sampled (Residents 10, 29, 39, and 3). The findings include: A review of Resident 39's clinical record revealed that the resident was transferred to the hospital on September 7, 2023, and returned to the facility on September 11, 2023. A review of Resident 10's clinical record revealed that the resident was transferred to the hospital on November 10, 2023, and returned to the facility on November 15, 2023. A review of Resident 29's clinical record revealed that the resident was transferred to the hospital on December 5, 2023, and returned to the facility on December 6, 2023. A review of Resident 3's clinical record revealed that the resident was transferred to the hospital on April 27, 2023, and returned to the facility on May 1, 2023. Resident 3 was also transferred to the hospital on May 4, 2023, and returned to the facility on May 10, 2023. There was no documented evidence that the facility had communicated the necessary specific information to the receiving health care institution or provider for the resident is transferred and expected to return. For those transferred residents noted above, the facility failed to provide evidence that the resident's comprehensive care plan goals and all information necessary to meet the resident's immediate needs were communicated to the receiving health care institution. Interview with the Nursing Home Administrator and Director of Nursing on January 11, 2024, at approximately 1:40 PM, confirmed that there was no evidence that the necessary information was communicated to the receiving health care institution or provider upon transfer or discharge. 28 Pa. Code 211.12 (d)(3)(5) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 7 of 31 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 01/11/2024 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 0623 Level of Harm - Potential for minimal harm Residents Affected - Some Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Based on clinical record review and staff interview, it was determined that the facility failed to send copies of the written notices of facility initiated transfers to a representative of the Office of the State Long Term-Care Ombudsman for three out of 18 residents sampled (Resident 10, 29 and 39). Findings include: A review of Resident 39's clinical record revealed that the resident was transferred to the hospital on September 7, 2023, and returned to the facility on September 11, 2023. A review of Resident 10's clinical record revealed that the resident was transferred to the hospital on November 10, 2023, and returned to the facility on November 15, 2023. A review of Resident 29's clinical record revealed that the resident was transferred to the hospital on December 5, 2023, and returned to the facility on December 6, 2023. There was no documented evidence that the facility sent copies of the written transfer notices to a representative of the Office of the State Long-Term Care Ombudsman for these facility-initiated transfers. Interview with the Nursing Home Administrator on January 11, 2024, at approximately 1:40 PM, confirmed that there was no evidence that copies of the written notifications of facility initiated transfers were provided to the Office of the State Long-Term Care Ombudsman. 28 Pa. Code 201.14(a) Responsibility of Licensee FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 8 of 31 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 01/11/2024 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **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 person-centered comprehensive care plans to meet the current needs and problems of three out of 18 residents sampled (Residents 33, 64, and 22). Findings include: A review of the clinical record revealed that Resident 33 was admitted to the facility on [DATE], with diagnoses that included hypertensive heart disease. A review of Resident 33's laboratory results report dated January 2, 2024, revealed that the resident had tested positive for RSV (Respiratory Syncytial Virus). However, the resident's care plan, in effect at the time of the survey ending January 11, 2024, failed to reflect the resident's diagnosis of RSV and interventions to treat and manage the resident's symptoms. A review of the clinical record revealed that Resident 64 was admitted to the facility on [DATE], with diagnoses that included Alzheimer's disease with late onset and epileptic seizures. A review of Resident 64's laboratory results report dated January 3, 2024, revealed that the resident tested positive for RSV. However, the resident's care plan, in effect at the time of the survey ending January 11, 2024, failed to reflect the resident's diagnosis of RSV and interventions to treat and manage the resident's symptoms. Interview with the Nursing Home Administrator and Director of Nursing on January 11, 2024, at approximately 1:40 PM confirmed the facility failed to ensure that comprehensive care plans were developed for Residents 33 and 64. A review of the clinical record revealed that Resident 22 was admitted to the facility on [DATE], with diagnoses that included depression. A review of a nurse's note Employee 5, LPN, entered into the clinical record dated December 3, 2023, at 10:19 PM indicated that the resident's resident representative approached the desk and stated that he was upset because the resident stated that he wanted to kill himself. Employee 5 (LPN) sat with the resident and the resident stated, I'm just down in the dumps. One to one supervision and reassurance were offered to resident. Resident stated,I would never hurt myself. Every 15 minute checks were initiated. The registered nurse supervisor was made aware of the situation. A nurses note dated December 4, 2023, at 1:43 PM indicated that Resident 22 stated that he feels safe and that he does not want to harm himself or others. Nursing noted that the resident was resident resting comfortably in bed watching television. Review of a Psychiatric New Evaluation dated December 11, 2023, indicated that Resident 22 was evaluated for anxiety and adjustment issues. When the resident was asked about past suicidal statements the resident stated that was just to get attention. The resident was diagnosed with adjustment disorder with anxiety, depressed mood and mild neurocognitive disorder. The plan was to continue current medications, supportive care, reorient, redirect, psychiatric team to monitor mood and behavior, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 9 of 31 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 01/11/2024 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 0656 encourage resident to participate in activities on the unit, and follow-up in four weeks. Level of Harm - Minimal harm or potential for actual harm Resident 22's clinical record revealed nurses notes dated December 24, 2023, December 28, 2023, December 30, 2023, January 1, 2024, January 4, 2024, January 6, 2024, and January 7, 2024, which indicated that the resident had displayed inappropriate verbal and physical sexual behaviors towards staff. Residents Affected - Few A review of Resident 22's current comprehensive care plan initially dated October 11, 2023, revealed that the resident's diagnosis of depression, suicidal statements, newly diagnosed adjustment disorder with anxiety and depressed mood, mild neurocognitive disorder, and inappropriate sexual behaviors were not identified along with corresponding treatment and management interventions. Interview with the Nursing Home Administrator and Director of Nursing on January 11, 2024, at approximately 1:50 PM confirmed the facility failed to include the above residents' current problems and needs on their comprehensive plans of care. 28 Pa Code 211.12 (d)(3)(5) Nursing Services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 10 of 31 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 01/11/2024 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of select facility policies and clinical records it was determined that the facility failed to provide nursing services consistent with professional standards of quality by failing to demonstrate that licensed nurses evaluated and recorded the provision of necessary nursing care for a change in condition for one resident out of 18 sampled residents (Resident 39). Residents Affected - Few Findings included: According to the Title 49, Professional and Vocational Standards, Department of State, Chapter 21 State Board of Nursing Subsection 21.11 (a) The register nurse assesses human responses and plans, implements and evaluates nursing care for individuals or families for whom the nurse is responsible. In carrying out this responsibility, the nurse performs all of following functions: (4) Carries out nursing care actions which promote, maintain, and restore the well-being of individuals (6)(b) The registered nurse is fully responsible for all actions as a licensed nurse and is accountable to clients for the quality of care delivered and Subsection 21.18. (a)(5) document and maintain accurate records. The Pennsylvania Code, Title 49, Professional and Vocational Standards, State Board of Nursing, 21.145 Functions of the Licensed Practical Nurse (LPN) (a) The LPN is prepared to function as a member of the health-care team by exercising sound judgement based on preparation, knowledge, skills, understandings and past experiences in nursing situations. The LPN participates in the planning, implementation and evaluation of nursing care in settings where nursing takes place. 21.148 Standards of nursing conduct (a) A licensed practical nurse shall: (5) Document and maintain accurate records. According to the American Nurses Association Principles for Nursing Documentation, nurses document their work and outcomes and provide an integrated, real-time method of informing the health care team about the patient status. Timely documentation of the following types of information should be made and maintained in a patient's EHR (electronic health record) to support the ability of the health care team to ensure informed decisions and high-quality care in the continuity of patient care: · Assessments · Clinical problems · Communications with other health care professionals regarding the patient · Communication with and education of the patient, family, and the patient ' s designated support person and other third parties. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 11 of 31 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 01/11/2024 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 0684 Level of Harm - Minimal harm or potential for actual harm A review of Resident 39's clinical record revealed that the resident was re-admitted to the facility on [DATE], with diagnoses of Parkinson's Disease (a chronic and progressive movement disorder that initially causes tremor in one hand stiffness or slowing of movement), Depression (a mood disorder of persistent symptoms of depressed mood and sadness and Unspecified Convulsions (seizures that are classified as unknown onset). Residents Affected - Few A review of a quarterly Minimum Data Set assessment (MDS-a federally mandated standardized assessment process conducted at specific intervals to plan resident care) dated December 18, 2023, revealed Resident 39 was cognitively intact and required moderate to maximum assistance for activities of daily living. The facility policy entitled Notification to Physician/Family/Resident Representative of Change in Resident Health Status dated as reviewed March 16, 2023, revealed that acute illness or significant change in a resident's physical, mental or psychosocial status (i.e., deterioration in health, mental or psychosocial status in either life-threatening condition or clinical complications). A need to alter treatment or change an existing form of treatment due to adverse consequences. A need to alter treatment significantly means to stop of form of treatment because of adverse consequences notification depending on the nursing assessment, appropriate notification may be immediate to 48 hours. A nursing note dated December 17, 2023, at 11:55 PM indicated that several times, nursing observed the resident asleep in her wheelchair, slumped over to her left side, needing verbal cues to sit up. The resident's medications were withheld due to resident's inability to swallow. Nursing noted that they will continue to monitor the resident. A review of the Resident 39's December MAR (medication administration record) revealed that on December 17, 2023, the following medications were held at approximately 8:00 PM due to the resident's inability to swallow; Melatonin 3 milligrams (mg), Mirtazapine (antidepressant medication) 7.5 mg, Carbidopa-levodopa 25-250 mg, Carboxymethlycellulose Sodium ophthalmic solution (eye drops) one drop in both eyes, Colace (stool softener) 100 mg, Tylenol arthritis extended release (ER) 650 mg, Multivitamin with minerals, Lamotrigine (anticonvulsant medication) 100 mg. There was no documented evidence that licensed professional nursing staff conducted had fully assessed the resident, to include measured vital signs, or notified the nursing supervisor and/or physician of the resident's inability to swallow and observed lethargy. There was no documented evidence of physician orders to hold the Resident 39's medications on the evening of December 17, 2023. Interview with the Director of Nursing (DON) on January 10, 2024, at 11:00 AM, confirmed the facility's licensed and professional nursing staff failed to record complete and accurate assessment of the resident's change in condition in the resident's clinical record. 28 Pa. Code 211.12 (c)(d)(1)(3)(5) Nursing Services 28 Pa. Code 211.5 (f) Medical Records FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 12 of 31 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 01/11/2024 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 - Some 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 review of clinical records and resident incident/accident reports, and staff interviews, it was determined that the facility failed to provide necessary staff supervision to monitor a resident's whereabouts to prevent an elopement from the facility for two residents (Resident 25 and 73) out of 18 reviewed. Findings included: Review of clinical record of Resident 25 revealed that the resident was admitted to the facility on [DATE], with diagnoses including anxiety and depression. A review of an Elopement Risk assessment dated [DATE], revealed that the resident was considered at high risk for elopement and a wanderguard bracelet was applied. A review of Resident 25's Quarterly Minimum Data Set Assessment (MDS - a federally mandated standardized assessment conducted at specific intervals to plan resident care) dated September 28, 2023, revealed that the resident was cognitively intact. A review of a nursing progress note dated September 27, 2023, revealed that At around 13:25 (1:25 PM) {Resident 25} was observed to be out under carport of front entrance/exit by therapy employee through therapy room window. Alarm sounding. Therapy staff and administration staff responded to alarm. {Resident 25} approached by staff and was observed starting to stand up from wheelchair. {Resident 25} was assisted to sit down in wheelchair and was brought back into the facility. {Resident 25} was unable to state where she was trying to go or what she was trying to do when brought back in. Follow up interview by DON and therapist who responded and resident stated that she was not outside and wished she had gone outside. Resident did not incur any injury related to incident and was ordered to have a medical workup by provider to rule out medical etiology related to increase in behaviors. Review of facility incident report dated September 26, 2023, revealed that the resident was last seen in the hallway across from the conference room at 1:15 p.m., alarm was sounding at 1:25 p.m., and the resident was seen through window in front of main doors, and brought back into facility without injury. A review of a written statement from the Director of Nursing, dated September 26, 2023, revealed that the DON saw the resident reading a magazine sitting outside the conference room and said hello to her at 1:15 p.m. Further review of Resident 25's clinical record revealed a consistent escalation of exit seeking behavior by the resident beginning on September 8, 2023, when a visit with her daughter had to be cancelled, and through September 26, 2023, when the elopement occurred. A review of a progress note dated December 2, 2023, revealed At approximately 1500 (3 PM) alarm was sounding in short hallway on unit 200. Staff responded and found resident, observed sitting in wheelchair and holding the emergency exit door on unit 200 on short hall with door open. Wheelchair was observed to be past exit entrance with resident sitting in wheelchair. Resident was brought back into facility. She was unable to state where she was trying to go or what she was trying to do when brought back in. Resident did not have any injuries noted. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 13 of 31 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 01/11/2024 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 - Some Review of facility incident report dated December 2, 2023, revealed that the resident was last seen in the common area of unit 200 at 2:50 p.m. Resident 25 was observed holding the emergency exit open and outside the door at approximately 3:00 p.m. Resident was brought back inside facility without injury. Review of clinical record revealed resident had been out of facility with family for holiday leave and was previously noted to have an increase in exit seeking behavior when her routine changed and/or she spent time with family. There was no documented evidence that the facility increased supervision of the resident due to the increase noted in the resident's exit seeking behavior. Review of clinical record of Resident 73 revealed admission to the facility on November 15, 2022, with diagnoses including dementia. A review of Resident 73's Quarterly Minimum Data Set assessment dated [DATE], revealed that the resident was cognitively impaired. A review of an Elopement Risk assessment dated [DATE], revealed that the resident was considered at high risk for elopement. A review of a progress note dated August 25, 2023, revealed Resident was observed walking in secure courtyard off main dining room on Friday, 8/25/23 around 1630 (4:30 PM). Resident was redirected back into the facility, stated she was trying to go home. Resident did not incur any injury related to incident. Resident did recently have family visit on 8/23/23, resident observed to have increased anxiety and behaviors after visit concluded. Review of facility incident report dated August 25, 2023, revealed that the resident was seen outside the dining room in the locked courtyard. According to the report the dining room door was not locked as it should have been at time of incident. A review of a written statement from the Employee 6 (LPN), dated August 25, 2023, revealed that the LPN was giving medications to other residents and saw Resident 73 in the courtyard and went to get her and brought her back in without injury at approximately 4:30 p.m. A review of a progress note dated September 19, 2023, revealed Resident 73 was observed in employee parking lot on backside of the building on Tuesday, September 19, 2023, around 1000 (10 AM). Resident was redirected back into facility, stated she was trying to find her mom. Resident did not incur any injury related to incident. Resident was last observed at 0930 (9:30 AM) sitting in recliner in common area on unit 200. Resident is care-planned, non-compliance with plan of care. Resident is continually non-compliant with transfer and ambulation orders. Resident with history of self-ambulating throughout facility with rolling walker. Resident has wanderguard to right ankle. Resident with history with inability to sit still for prolonged duration of time, inability to stay focused on task/activity provided to resident for redirection. Review of a facility incident report dated September 19, 2023, revealed that a maintenance staff person was observed exiting the 200 hallway and the door was not closed completely. A staff member saw Resident 73 headed to the door and attempted to stop her, Resident 73 went out the (partially open) door. The wanderguard system was triggered and other staff members went outside and brought resident back inside without injury. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 14 of 31 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 01/11/2024 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 - Some Resident 73 was transferred to a memory care unit after the second elopement on September 19, 2023. Surveyors tested the wanderguard system during survey ending January 11, 2023. The wanderguard system was functioning. Observation revealed elopement books on the units and at receptionist desk. An interview with the Nursing Home Administrator and Director of Nursing on January 10, 2024, at approximately 2:00 PM confirmed the facility failed to provide adequate supervision of residents with an increased risk for elopement and exit seeking behaviors and ensure that means of exit, doors to the outside, were appropriately secured. 28 Pa. Code: 211.12 (d)(3)(5) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 15 of 31 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 01/11/2024 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on resident interviews, clinical records, and staff interview, it was determined that the facility failed to timely provide prescribed respiratory care for one resident reviewed for one of 18 residents reviewed (Resident 49). Residents Affected - Few Findings include: Resident 49's clinical record revealed an admission date of November 4, 20220 with diagnoses that included asthma, and sleep apnea. Nursing progress notes revealed that the resident told nursing staff on January 7, 2024, that he was experiencing a sore throat, cough, and congestion. A physician's order was obtained for Albuterol Inhalation Solution 0.5-2.5 (3) MG/3ML (Ipratropium-Albuterol) 1 vial inhale orally every 4 hours as needed for shortness of breath. The resident's January 2024 Medication Administration Record (MAR) indicated that staff administered the above noted breathing treatment to Resident 49 on January 7, 2024, at 4:00 p.m., and January 10, 2024, at 7:00 a.m. During an interview with Resident 49 at approximately 10:30 a.m., on January 10, 2024. Resident 49 stated he had requested a breathing treatment the previous evening January 9, 2024, at 7:00 p.m., so he could sleep better, but he did not receive the treatment at that time, He stated that he requested it again at 9:00 p.m., but staff still did not provide the breathing treatment. Resident 49 further stated that staff did not provide the breathing treatment until the day shift nurse came into facility at approximately 7:00 a.m., on January 10, 2024 During an interview on January 10, at 11:55 a.m. the Nursing Home Administrator and Director of Nursing were unable to provide evidence that Resident 49 had been provided the respiratory care as prescribed. 28 Pa. Code 211.12(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 16 of 31 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 01/11/2024 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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident must receive and the facility must provide necessary behavioral health care and services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, clinical record review and staff interviews, it was determined that the facility failed to ensure each resident received the necessary behavioral health care in a timely manner to attain or maintain the highest practicable mental and psychosocial well-being for one of 18 residents sampled (Resident 25). Findings include: Review of clinical record of Resident 25 revealed that the resident was admitted to the facility on [DATE], with diagnoses including anxiety and depression. A review of Resident 25's Quarterly Minimum Data Set Assessment (MDS - a federally mandated standardized assessment conducted at specific intervals to plan resident care) dated September 28, 2023, revealed that the resident was cognitively intact. Further review of Resident 25's clinical record revealed that the resident exhibited multiple behaviors, including exit seeking and eloping from facility. Resident 25 was noted to display exit seeking behaviors almost daily, throughout the month of September 2023 through end of the survey January 11, 2024, according to a review of nursing progress notes. Review of Resident 25's care plan, initiated by the facility on January 21, 2023, indicated that the resident has a behavioral problem regarding exit seeking/ elopement risk . However, the resident's care plan did not address the resident's specific behavioral health needs or the specific behavioral symptoms that were noted in the nursing documentation. According to nursing progress notes and the plan of care, the resident's exit seeking increases when family visits or routine changes. However, the care plan failed to include approaches developed to address this triggering factor. Review of a Psychological evaluation dated October 17, 2023, indicated that Resident 25 continued to express the desire to return home and recommended that Resident 25 would benefit from continued psychological services every 6 months. Further review of resident's clinical record revealed no further documented visits from psychological services after October 17, 2023, through the end of survey January 11, 2024. The facility failed to demonstrate that qualified staff, with the competencies and skills necessary, had provided appropriate services and that the facility had implemented individualized approaches to the resident's care, including direct care and activities, directed toward understanding, preventing, relieving, and/or accommodating the resident's distress or loss of abilities, including the resident's desire to return home. During an interview with the Nursing Home Administrator (NHA), on January 11, 2024, at approximately 10:00 a.m., the NHA was unable to provide evidence that Resident 25 was being provided the necessary behavioral health services. Refer F689 28 Pa. Code 211.10 (d) Resident care policies FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 17 of 31 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 01/11/2024 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 18 residents reviewed (Resident 57). Residents Affected - Few Findings include: A review of Resident 57's, clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses to include vascular dementia with behavioral disturbances (a condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change). A review of Resident 57's Significant Change Minimum Data Set Assessment (MDS - a federally mandated standardized assessment conducted at specific intervals to plan resident care) dated December 13, 2023, revealed that the resident was severely cognitively impaired. A review of behavior tracking dated from May 2023 to December 2023, revealed that the resident displayed behaviors of repeat movements, yelling, and screaming, kicking, and hitting, pushing, grabbing, abusive language, threatening behavior, and rejection of care. Further review of the resident's clinical record revealed that staff did not document the specific interventions attempted to address the above noted resident behaviors along with the effectiveness of any interventions employed to reduce, manage or modify the resident's dementia related behavioral symptoms. The resident's current care plan, included a problem/need of the potential for complications with cognition related to dementia. This problem area was not initiated until January 3, 2024, despite the resident's admission diagnosis in January 2023, and tracking of behavioral symptoms from May 2023 through December 2023, noting multiple behavioral symptoms. The care plan did identify the specific behaviors that the resident exhibits and the interventions designed to address those behaviors. The facility failed to develop and implement an individualized person-centered interdisciplinary plan to address, modify and manage this resident's dementia-related behaviors. The resident's care plan for dementia failed to include individualized interventions based on an assessment of the resident's preferences, social/past life history, customary routines, and interests in an effort to manage the resident's dementia-related behavioral symptoms. Interview with Nursing Home Administrator on January 11, 2024, at approximately 1:40 PM, confirmed the facility was unable to provide evidence of the development and implementation of an individualized person-centered plan to address dementia-related behaviors. 28 Pa Code 211.12 (d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 18 of 31 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 01/11/2024 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records and pharmacy recommendations and staff interview it was determined that the pharmacist failed to identify irregularities in the drug regimen of one resident (Resident 57) out of 18 residents reviewed. Findings include: A review of Resident 57's, clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses to include vascular dementia with behavioral disturbances (a condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change). A review of the resident's clinical record revealed a physician's order dated May 16, 2023, for Seroquel (an antipsychotic medication) 25 mg by mouth at bedtime for altered mental status. Review of a consultant pharmacist drug regimen reviews conducted from May 2023 to January 2024 revealed that the pharmacist failed to identify the lack of a clinically supportable diagnosis for Resident 57's antipsychotic drug use. Resident 57's Medication Administration Records (MAR) for December 2023 through January 2024, revealed that the resident continued to receive Seroquel daily for altered mental status. An interview with the Director of Nursing on January 11, 2024, at approximately 1:40 PM, confirmed that the pharmacist failed to identify this drug irregularity in the resident's drug regimen. 28 Pa. Code 211.9 (k) Pharmacy services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 19 of 31 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 01/11/2024 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm Based on a review of clinical records and staff interviews it was determined that the facility failed to ensure that one resident's drug regimen was free of unnecessary antibiotic drugs for one out of 18 residents sampled (Resident 64). Residents Affected - Few Findings included: A review of the clinical record revealed that Resident 64 was admitted into the facility on February 24, 2023, and has diagnoses including Alzheimer's disease, dementia and chronic kidney failure. A review of nursing progress notes dated January 3, 2024, at 2:30 PM revealed that the resident was observed to have light hematuria (blood in urine) with a foul smell. The resident was unable to verbalize discomfort due to cognitive impairment. A physician order dated January 3, 2024, was noted to obtain a urine analysis and culture and sensitivity (microscopic study of the urine culture performed to determine the presence of pathogenic bacteria in patients with suspected urinary tract infection [UTI]). A review of a laboratory report for a urinalysis dated January 3, 2024, revealed that the results were abnormal with blood, protein, nitrates and bacteria in the sample. A review of laboratory test results dated January 4, 2024, at 12:26 PM, revealed multiple flora suggesting contamination of the sample or colonization. The report noted that clinical correlation was needed and to consider repeat testing if symptoms worsen. A review of McGeer's Criteria, used by the facility as part of antibiotic stewardship, dated January 4, 2024, indicated that the resident had a single symptom of fever and leukocytosis (higher than normal level of white blood cells in the blood) and no other symptoms of a UTI and the UTI criteria was not met to treat for a UTI. A physician order dated January 4, 2024, at 7:13 PM was note for Keflex (antibiotic medication) 500 milligrams (mg) by mouth four times daily for UTI, although the urine culture and sensitivity report was inconclusive. A review of the resident's medication administration record for the month of January 2024, revealed that the resident received 24 doses of Keflex, with the last dose received on January 10, 2024. There was no corresponding physician documentation to indicate the clinical necessity of initiating antibiotic treatment with Keflex to treat the resident's suspected urinary tract infection prior to receiving accurate results of a repeat culture and sensitivity test. At the time of the survey ending January 11, 2024, there was no evidence that a repeat urinalysis was completed. Interview with the Infection Preventionist on January 10, 2024, at 9:45 AM, confirmed that the administration of Keflex was not clinically justified for treatment of Resident 64's urinary tract infection. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 20 of 31 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 01/11/2024 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 0757 28 Pa. Code 211.2(d)(3)(5) Medical Director Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12 (d)(1)(3) Nursing Services 28 Pa. Code 211.5 (f) Medical records Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 21 of 31 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 01/11/2024 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review clinical records and staff interviews, it was determined that the facility failed to ensure that a resident was free from unnecessary psychoactive medications by failing to attempt a gradual dose reduction, failing to ensure the presence of documented clinical rationale for the continued use of psychotropic medication and failing to monitor for potential adverse consequences of psychoactive drug use for two residents of 18 residents reviewed. (Resident 57 and 51) Findings include: A review of Resident 57's, clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses to include vascular dementia with behavioral disturbances (a condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change). The resident was transferred to the hospital on May 8, 2023, for a change in mental status and returned to the facility on May 16, 2023, after being treated for acute hypoxemic respiratory failure (difficultly breathing causing a lack of oxygen in the blood) and a urinary tract infection. Review of Resident 57's clinical revealed a physician's order dated May 16, 2023, for Seroquel (an antipsychotic medication) 25 mg by mouth at bedtime for altered mental status. A review of the resident's clinical record revealed no documented evidence that the facility had been monitoring the resident for potential adverse side effects for the newly prescribed antipsychotic medication. A review of a Pharmacy Consultation Report dated May 17, 2023, indicated the resident had an acute illness and an antipsychotic was initiated due to worsening behavioral symptoms. The report noted that if acute illness has resolved, and behaviors have subsided, consider a gradual taper to discontinuation (of the antipsychotic drug). A review of the facility's CRNP (certified registered nurse practitioner) response to the recommendation revealed that the CRNP solely noted that the resident is stable. The CRNP or prescribing physician failed to document the resident specific clinical rationale for continuing the newly prescribed antipsychotic. A review of the resident's clinical record revealed revealed one incident documented of the resident record that she had a behavior of yelling out on October 3, 2023. There was no documentation of any attempted non-pharmacological interventions to address the resident's behavior on that occasion. A nursing note dated November 12, 2023, at 2:23 AM revealed that the resident continued to ring her call bell all evening and night. She rang the bell, to make sure her bell worked, have her blanket put over her feet, and because she thinks she has already slept for 12 hours. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 22 of 31 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 01/11/2024 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A review of behavior tracking dated November 2023, revealed from November 1, 2023 through November 17, 2023, the resident only had two incidents of yelling out. There was no documentation of any attempted non-pharmacological interventions to address the resident's behavior on those occassions. A physician orders dated November 18, 2023, was noted to increase the resident's dosage of Seroquel, to Seroquel 12.5 mg in the morning for paranoid behaviors in addition to the 25 mg she was already receiving at night. A review of the resident's clinical record revealed no documentation of paranoid behaviors. Interview with the acting Nursing Home Administrator on January 11, 2024, at approximately 1:40 PM confirmed that nursing staff failed to record adequate monitoring of potential side effects and confirmed the absence of physician documentation of the clinical necessity for the resident's antipsychotic drug use and dose increase. A review of the Resident 51's clinical record revealed that the resident was admitted to the facility on [DATE], with diagnoses which included late onset Alzheimer's Disease (a brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks) and anxiety. Current physician orders were noted for Risperidone (antipsychotic medication) 0.25 mg (milligram) one tablet by mouth daily at 8:00 AM and 12:00 PM, and Risperidone 0.5 mg one tablet daily at 8:00 PM related to dementia with other behavioral disturbances. Pharmacy consultations dated February 2023, July 2023, and October 2023, revealed that the pharmacist recommended a gradual dose reduction (GDR) of the physician prescribed medication Risperidone. The pharmacist identified that the resident had been receiving Risperidone since September 16, 2021, for expressions or indications of distress related to dementia, and a dose reduction was never attempted. The response documentation provided to pharmacy solely noted that the resident is stable and failed to include resident specific clinical rationale for declination of a dose reduction attempt. The Certified Registered Nurse Practitioner (CRNP) response documented noted that the resident's power of attorney (POA) was not in agreement with a reduction. However, failed to include prescriber clinical justification for the continued use of the antipsychotic medication and its benefit to the resident and how it maintained or improved the resident's functional abilities. A review of a pharmacy consultation dated March 2023, revealed that the pharmacist identified that there was no documentation of specific target behaviors being treated requiring treatment with the antipsychotic drug or individualized behavioral interventions attempted to alleviate and behavioral symptoms in the resident's medical record. Recommendations to update the person-centered care plan and medical record to include specific target behaviors and the frequency and impact of the behaviors. The pharmacist identified that the diagnosis alone is insufficient to justify the use of an antipsychotic medication. The resident's clinical record lacked documented clinical rationale from the resident's attending physician for administering antipsychotic drug, based upon an assessment of the resident's current condition and therapeutic goals and consistent with manufacturer's recommendations and clinical (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 23 of 31 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 01/11/2024 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 0758 practice guidelines and clinical standards of practice Level of Harm - Minimal harm or potential for actual harm A review of a psychiatric consultation report dated August 7, 2023, at 9:45 AM, revealed that the resident was seen on that day for a psychiatric evaluation, to evaluate mental status and adjust medications for behavioral disturbance. The consult report noted that her mood has been stable, and she has not had any distressing behavior. Appeared to be more frail than prior the resident was hospitalized the month prior for a stroke. Her mood was calm and content and was cooperative with the staff. The report noted that the resident has been stable with no recent behavioral abnormalities, easily redirectable when she was sundowning. Residents Affected - Some A review of Documentation Survey Report v2 intervention of monitoring behavior symptoms, dated from September 2023 through January 2024, revealed staff observed that the resident displayed no behaviors. A review of the facility's Behavioral Tracking for use of an antipsychotic medication dated from September 2023 until December 2023, revealed no behaviors documented requiring continued treatment with Risperidone medication. A review of the clinical record revealed that the resident's dose of Risperidone was increased on November 9, 2023, despite the recommendation from pharmacist to attempt a GDR. A review of a psychiatric consultation report dated December 11, 2023, at 3:00 PM, revealed that the resident was seen on that day for psychiatric evaluation, to evaluate mental status and adjust medications for behavioral disturbances. The consult report noted that Risperidone dose was increased on November 9, 2023, to better manage distressing and irritable behavior after lunch time and into the afternoon. Staff reports that the resident's mood and behavior have improved with the medication adjustment. The report noted that there was a recent up-tick in distressing behavior that has subsided with the increase in the Risperdal dose, more easily re-directed now when she has sundowning. When reviewed during the survey ending January 11, 2024, the resident's clinical record, documentation survey report and behavior tracking failed to reflect the above behaviors noted in the psychiatric consultation report. An interview with the nursing home administrator (NHA) and director of nursing (DON) on January 11, 2024, at approximately 1: 00 PM confirmed no attempts at gradually reducing the dose of Risperidone had been made and confirmed that there was no documented evidence of the clinical assessments and prescriber documentation identifying the justification for the use of an antipsychotic medication. 28 Pa. Code 211.9 (a)(1)(k) Pharmacy Services 28 Pa. Code 211.2(d)(3) Medical Director FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 24 of 31 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 01/11/2024 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observations, test tray results, resident and staff interviews, and test tray results it was determined that the facility failed to serve meals at safe and palatable temperatures. Residents Affected - Some Findings include: According to the federal regulatory guidance at 483.60(i)-(2) Food safety requirements - the definition of Danger Zone, found under the Definitions section, is food temperatures above 41 degrees Fahrenheit and below 135 degrees Fahrenheit that allow rapid growth of pathogenic microorganisms that can cause foodborne illness. During an interview on January 9, 2024, at 10:47 AM, Resident 12 stated that the food served was rarely ever hot, and she will often send it back to be reheated. She mentioned that she likes vegetables but could never eat them due to being mushy or not cooked. During an interview on January 9, 2024, at 11:00 AM, Resident 29 stated that the food has gone downhill and always comes out cold. She mentioned that she spoke with dietary staff related to a steam table and has voiced concerns during resident council meetings about the temperature of the food. During an interview on January 9, 2024, at 11:25 AM, Resident 13 stated that the food could be better, and the temperature is never hot. During an interview on January 10, 2024, at 9:27 AM, Resident 39 stated that the food is not the greatest and comes out cold. Review of December 2023 Resident Food Committee minutes revealed residents voiced concerns that food temperatures of hot food were better but meals (hot foods) were still sometimes cold. During interview with residents (Residents 29, 46, 26, 49, and 16) during a group meeting on January 10, 2024 at 10:30 AM, the residents reported that hot meals are often served cold and unpalatable. A test tray performed on the 100 Nursing Unit on January 10, 2024, at 12:10 PM revealed that the planned hot meal served was beef brisket, mashed potatoes, and Asian vegetables. At 12:25 PM, at the time the last resident was served, a test tray was completed and yielded the following results: beef brisket was 112 degrees Fahrenheit, mashed potatoes were 130 degrees Fahrenheit, and Asian vegetables were at 120 degrees Fahrenheit. The hot food tasted lukewarm and was not palatable at the temperatures served. Interview with the nursing home administrator (NHA) on January 10, 2024, at 1:15 PM, confirmed that food was to be served at safe and palatable temperatures. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 25 of 31 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 01/11/2024 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 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. Based on review of select facility policy and the minutes from Residents' Council meetings, and resident and staff interviews, it was determined that the facility failed to routinely offer bedtime snacks to residents as desired. Findings include: A review of facility policy titled Residents Snacks reviewed March 16, 2023, revealed that bedtime snacks will be offered to residents daily. During a group meeting held on January 10, 2024, at 10:30 a.m., with five (5) alert and oriented residents, five of five residents (Residents 29, 46, 26, 49, and 16) stated that they have not received bedtime snacks in a very long time. The residents stated that they have repeatedly brought this particular complaint to the facility staff's attention without resolution to date. During an interview on January 10, 2024, at 2 p.m., the Nursing Home Administrator and Director of Nursing were unable to verify that residents are routinely offered and provided snacks at bedtime as preferred by each resident on nightly basis. 28 Pa. Code 211.12 (d)(3)(5) Nursing Services 28 Pa. Code 211.10(a) Resident care policies FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 26 of 31 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 01/11/2024 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and staff interview, it was determined that the facility failed to maintain acceptable practices for the storage and service of food to prevent the potential for contamination and microbial growth in food, which increased the risk of food-borne illness in the food and nutrition services department and one of two resident pantries. Findings include: Food safety and inspection standards for safe food handling indicate that everything that comes in contact with food must be kept clean and food that is mishandled can lead to foodborne illness. Safe steps in food handling, cooking, and storage are essential in preventing foodborne illness. You cannot always see, smell, or taste harmful bacteria that may cause illness according to the USDA (The United States Department of Agriculture, also known as the Agriculture Department, is the U.S. federal executive department responsible for developing and executing federal laws related to food). During the initial tour of the food and nutrition services department with the foodservice director (FSD) conducted on January 9, 2024, at 10:00 AM the following unsanitary practices with the potential to introduce contaminants into food and increase the potential for food-borne illness were identified: There was a build-up of debris in the ceiling light shields located above the two-door refrigerator, trayline, handwashing sink, spice rack area, and food preparation area were dust covered. The ceiling vents and ceiling blocks in these areas were also dust covered. The hood vents located above the stoves had a thick layer dust and were in need of cleaning. The perimeter of the floors throughout the kitchen were visibly soiled and had an accumulation of debris. Uncovered bowls of applesauce were being stored in the roll-in refrigerator. There was a build-up of a chalky brownish colored substance (identified by the FSD as limescale) on the outside surface of the dishwasher. The exterior surfaces of two garbage cans near the trayline were heavily soiled and in need of cleaning. The interior surface of several hot beverage mugs identified as clean were stained with a brownish colored residue. Interview with the foodservice director (FSD) at this time confirmed that the food and nutrition services department was to be maintained in a sanitary manner. The FSD also confirmed that at the present time the steamer (used to cook vegetables and other food items), the upper portion of the convection oven, and the trayline steamtable (one of five wells not heating up) needed repair. The FSD confirmed that a plan to cook items that would normally be cooked in the steamer on the stove top was in place. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 27 of 31 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 01/11/2024 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Interview with the administrator on January 9, 2024, at approximately 11:30 AM confirmed that the top convection oven has not been working since March 2023 and the steamer has not been working since April 2023. The steamtable was identified as needing repair on December 30, 2023. The administrator noted that new equipment was ordered and expected to be installed on February 23, 2024. Observation of the 100 nursing unit pantry on January 10, 2024, at 12:20 PM revealed a partially eaten breakfast tray on the counter and dirty mugs and plastic cups in the pantry sink; there was a build-up of a chalky brownish substance adhered to the dispensing spout and drip tray of the automatic ice dispenser; and there was a black substance on the end of the condensation hose of the automatic ice dispenser. Observation at this time also revealed a utility cart with five partially eaten breakfast trays in the hallway located between the resident lounge and the resident pantry. Interview with the administrator on January 10, 2024, at 1:15 PM confirmed that resident meal trays were to be timely collected and returned to the food and nutrition services department following each meal and resident pantry areas were to be maintained in a sanitary manner to prevent potential contamination of food and maintain acceptable practices for food storage items. 28 Pa. Code 201.18 (e)(2.1) Management 28 Pa. Code 211.6 (f) Dietary Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 28 of 31 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 01/11/2024 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 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 a review of clinical records, select facility policy, CDC and Pennsylvania Department of Health guidelines, observations, and staff interview it was determined that the facility failed to follow infection control practices designed to deter spread of RSV (Respiratory Syncytial Virus) infections in the facility. Residents Affected - Some Findings included: Review of the facility's policy entitled Management of Respiratory Syncytial Virus last reviewed by the facility on March 16, 2023, indicated it is the policy of the facility to ensure that proper and appropriate infection control principles are utilized to help decrease the risk of transmission of RSV. RSV is a highly contagious respiratory virus that can affect any age but is greater risk for older adults. It is easily spread through air uninfected respiratory droplets or through direct contact. The use of proper infection control principles can help decrease the risk of transmission of RSV. Further it was indicated the nurse will observe residents for signs and symptoms that may be consistent with upper respiratory tract infections but could be diagnosis RSV. The facility we'll follow testing guidance for RSV per state and local guidance in accordance with physician's orders. Infection control principles will be followed to decrease the risk of transmission based on federal state and local guidance. Residents testing positive for RSD will be placed on transmission based precautions for 10 days. Symptoms persisting past 10 days require an evaluation from provider to clear transmission based precaution status. According to PA HAN 720 initially dated September 29, 2023, testing should be used to diagnose respiratory infections due to the similarity of symptoms. Virus identification is crucial for making decisions regarding cohorting, implementing treatment, among other interventions. During increased respiratory virus activity, facilities are advised to use comprehensive respiratory panels to determine if multiple pathogens are circulating in the facility. According to CDC guidelines when an acute respiratory infection is identified in a resident it is important to take rapid action to prevent the spread to others in the facility. Further it is indicated to test anyone with respiratory illness signs and symptoms. The selection of the diagnostic tests will depend on the suspected cause of the infection. The facility should investigate for potential respiratory virus spread among residents and preform active surveillance to identify any additional ill residents using symptom screening and evaluating potential exposures. A review of an RSV line listing revealed the facility had an outbreak of RSV beginning on December 21, 2023, in the 100 hall nursing unit with Resident 34. The following residents tested positive for RSV after the initial outbreak: Resident 63 on December 22, 2023 Resident 61 on December 24, 2023 Resident 33 on January 2, 2024 Resident 64 on January 3, 2024. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 29 of 31 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 01/11/2024 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 0880 Resident 223 was admitted to the facility on [DATE], and was positive for RSV on admission. Level of Harm - Minimal harm or potential for actual harm A review of these clinical records revealed that the facility did not implement additional active respiratory surveillance on the residents once the outbreak began to promptly identify any additional respiratory illnesses. Residents Affected - Some A review of Resident 47's clinical record, who resides in the 100 hall nursing unit, revealed that the resident began to experience respiratory symptoms of a cough and congestion on December 30, 2023. A nursing note dated January 1, 2024, at 7:00 AM revealed that the resident continued to have respiratory symptoms of a moist cough, moderate amounts of phlegm, a temperature of 99.1 degrees, and rhonchi (course sounds in the lungs caused by constricted airways). Nursing notes revealed that the resident continued to have respiratory symptoms from January 2, 2024 through January 7, 2024. A review of Resident 46's clinical record, who resides on the 100 hall nursing unit, revealed on December 31, 2023, the resident began to experience cough. Nursing noted that the resident continued to experience a non-productive cough and cold like symptoms from January 1, 2024, through January 11, 2024. A review of Resident 57's clinical record, who resides on the 100 hall nursing unit, revealed that on January 1, 2024, the resident began to experience respiratory symptoms of a cough. Nursing noted on January 2, 2024, at 1:00 AM that the resident was having a coughing fit and a hard time clearing her phlegm. Nursing notes revealed that from January 3, 2024, through January 11, 2024, the resident continued to experience respiratory symptoms as noted above. The facility failed to perform testing on the residents who were experiencing multiple respiratory symptoms to promptly determine if the residents had contracted RSV during the current outbreak and to prevent further spread throughout the facility. A review a of resident council meeting minutes dated December 29, 2023, revealed that the residents in attendance at the meeting raised a concern about residents not being tested for RSV. The Resident Council asked the facility why residents are not being tested for RSV if they have symptoms and there are RSV infections in the facility. The DON (director of nursing) replied that it was up to the doctor and RSV is viral and just has to run its course. An observation on January 9, 2024, at approximately 10:45 AM revealed a red bin intended for disposal of used/contaminated PPE (personal protective equipment) in the doorway to room [ROOM NUMBER]. Resident 233 resides in the room and was positive for RSV. The red bin was overflowing with PPE and dirty used contaminated PPE was hanging outside, overflowing from the bin. An interview with the Infection Preventionist on January 10, 2024, at approximately 10:35 AM revealed she stated that residents that were experiencing respiratory symptoms should have been tested since the facility had an RSV outbreak. An interview with the Director of Nursing on January 11, 2024, at approximately 1:40 PM confirmed the facility failed to implement policies and procedures to prevent the potential spread of RSV. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 30 of 31 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 01/11/2024 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 0880 28 Pa Code 211.10(a)(d) Resident care policies Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12 (c)(d)(1)(5) Nursing services. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395824 If continuation sheet Page 31 of 31

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Citations

25 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0550GeneralS&S Epotential for harm
F550 - Resident Rights
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
0656GeneralS&S Dpotential for harm
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
0684GeneralS&S Dpotential for harm
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
0689GeneralS&S Epotential for harm
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
0695GeneralS&S Dpotential for harm
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
0804GeneralS&S Epotential for harm
F804 - Food and drink
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
0809GeneralS&S Epotential for harm
F809 - Frequency of Meals
Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.
0812GeneralS&S Fpotential for harm
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
0880GeneralS&S Epotential for harm
F880 - Infection Control
Provide and implement an infection prevention and control program.
0565GeneralS&S Epotential for harm
F565 - The resident has a right to organize and participate in resident groups in the
Honor the resident's right to organize and participate in resident/family groups in the facility.
0607GeneralS&S Epotential for harm
F607 - The facility must develop and implement written policies and procedures that:
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
0610GeneralS&S Dpotential for harm
F610 - In response to allegations of abuse, neglect, exploitation, or mistreatment, the
Respond appropriately to all alleged violations.
0622GeneralS&S Bno actual harm
F622 - Transfer and discharge-
Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.
0623GeneralS&S Bno actual harm
F623 - Transfer and discharge-
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
0740GeneralS&S Dpotential for harm
F740 - Behavioral health services
Ensure each resident must receive and the facility must provide necessary behavioral health care and services.
0744GeneralS&S Dpotential for harm
F744 - A resident who displays or is diagnosed with dementia, receives the
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.
0756GeneralS&S Epotential for harm
F756 - Drug Regimen Review
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
0757GeneralS&S Dpotential for harm
F757 - Unnecessary Drugs—General
Ensure each resident’s drug regimen must be free from unnecessary drugs.
0758GeneralS&S Epotential for harm
F758 - Medication Errors
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
0293GeneralS&S Epotential for harm
Have properly located and lighted "Exit" signs.
0321GeneralS&S Epotential for harm
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
0353GeneralS&S Epotential for harm
Inspect, test, and maintain automatic sprinkler systems.
0363GeneralS&S Epotential for harm
Install corridor and hallway doors that block smoke.
0374GeneralS&S Epotential for harm
Install smoke barrier doors that can resist smoke for at least 20 minutes.
0923GeneralS&S Epotential for harm
F923 - Have adequate outside ventilation by means of windows, or mechanical
Have proper medical gas storage and administration areas.

FAQ · About this visit

Common questions about this visit

What happened during the January 11, 2024 survey of EMMANUEL CENTER FOR NURSING?

This was a inspection survey of EMMANUEL CENTER FOR NURSING on January 11, 2024. The surveyor cited 25 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at EMMANUEL CENTER FOR NURSING on January 11, 2024?

Yes, 25 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her right..."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

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Data from CMS Care Compare public records. Dataset last refreshed June 15, 2026. If you believe any information is inaccurate, report it here.

Inspection·January 11, 2024