Health inspection·January 23, 2026

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete him let go of the bed. Resident 2 then became agitated and grabbed back onto the bed. Nurse Aide 2 ripped the resident's hand off again and the resident grabbed Nurse Aide 2's arm and said, stop it. Nurse Aide 2 then forced the resident's hands off him and with his fist slammed down on the resident's left wrist bone area. The resident said, ouch that hurt and was holding his arm. Nurse aide 2 then pushed him out of his room and into the lounge. Interview with the regional director of clinical services on January 21, 2026, at 2:25 p.m. revealed that the allegation of abuse to Resident 2 by Nurse Aide 2 was immediately investigated upon report of it, the allegation was substantiated, and Nurse Aide 2 was terminated from employment. Following identification of the allegation of abuse, the facility's corrective actions included: Nurse Aide 2, who was involved in the allegation of abuse to Resident 2, was terminated upon completion of the facility's investigation. To identify like residents that have the potential to be affected, nursing staff/designee completed skin checks on incapable residents for signs and symptoms of abuse. To identify like residents that have the potential to be affected, nursing staff/designee completed interviews on capable residents on that unit. No capable residents were identified on that unit. Education was provided to all staff on the facility's abuse policy and abuse and de-escalation of behaviors on December 15 and 16, 2025. To monitor and maintain ongoing compliance, observations of residents were to be performed weekly four times, then monthly twice to ensure there are no issues with abuse. A review of the facility's corrective actions revealed that they were in compliance with F600 on December 16, 2025. 28 Pa. Code 201.14(a) Responsibility of Licensee. 28 Pa. Code 201.18(b)(1)(e)(1) Management. 28 Pa. Code 201.29(j) Resident Rights.28 Pa. Code 211.12 (d)(5) Nursing services. Event ID: Facility ID: 395828 If continuation sheet Page 2 of 4 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 395828 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Maple Heights Health & Rehab Center, LLC 429 Manor Drive Ebensburg, PA 15931 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge. Based on a review of policies, clinical record review and staff interviews, it was determined that the facility failed to develop and implement a discharge planning process to align with the resident's goals and failed to provide discharge instructions, including medication times and doses for one of five residents reviewed (Resident 3). Findings include: Review of Resident 3's clinical record revealed that the facility admitted him on December 8, 2025 after falling at home and suffering a traumatic brain bleed. A comprehensive Minimum Data Set (MDS) assessment (a mandatory assessment of a residents abilities and needs) dated December 14, 2025, indicated that the resident was cognitively intact, required assistance from staff for daily care needs, and that his overall goal was to remain in the facility for long term care. The resident's care plan, dated December 10, 2025, indicated that the resident was to reside in the facility for long term care.Social services note for Resident 3, dated December 10, 2025, revealed that the resident told the social worker that he did not want to return home to his townhouse because he could not manage the stairs necessary to get in and out, he lived alone and had no one to help him and that he preferred to stay in the nursing facility for long term care.A Certified Registered Nurse Practioner's (CRNP, a higher practice nurse) note for Resident 3, dated December 11, 2025 revealed that the resident told her he had no family in the area and that he could not return home alone as he was unable to care for himself as evidenced by his recent fall with subdural hematoma (brain bleed).An Interdisciplinary Team meeting for Resident 3 on December 12, 2025, revealed that the resident did not want to return to his prior living arrangements and was willing to apply for the state insurance to stay at the nursing facility for long term care.A social services note for Resident 3, dated December 18, 2025 indicated that the resident was issued a Notice of Medicare Non-Coverage (NOMNC) letter and that he would be discharging home to his previous living arrangements on December 21.A review of Resident 3's physical therapy and occupation therapy assessments, dated December 9, 2025, revealed that the resident's goal was long term care, and not discharge to home. There was no evidence in Resident 3's clinical record that the facility followed up with the resident or the resident's family regarding the change in his plans to assure his safety upon discharge.A review of Resident 3's discharge instructions revealed that he was not provided with a list of medications with the times and dosages that he would need to take, or instructions on the medications that he should no longer take.Interview with the Social Services Director on January 21, 2026 at 12:42 p.m. revealed that the resident did want to stay long term and that he applied for the state's insurance. However, he had to spend down his $40,000 Individual Retirement Account (IRA) by paying the nursing facility for his stay before he would qualify for the state's insurance. When he learned he would have to use his IRA monies, he decided to return to his apartment. She stated that his goal in therapy was not changed in order for him to receive the training needed to return to his home.An interview with the Rehab Program Manager on January 21, 2026 at 12:57 p.m. revealed that the resident's goals while in therapy were for him to remain in the facility for long term care, therefore, the resident was to be cut from therapy. She stated that the therapy department was not notified that the resident's goal had changed from long term care to home until December 18, and that therapy should have made changes to his plan in therapy at that time. She stated that therapy had not worked with the resident on any home goals, such as housework, cooking, laundry, or stairs. She stated she was aware that he had 12 stairs to get in and out of his apartment, but that therapy had not worked with him on stairs because his goal was long term care. Interview with Casemanager on January 21, 2025 at 1:21 p.m. revealed that he did not inform the resident's insurance that the resident's goal had changed from long term care to going home and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395828 If continuation sheet Page 3 of 4 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 395828 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Maple Heights Health & Rehab Center, LLC 429 Manor Drive Ebensburg, PA 15931 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 0627 Level of Harm - Minimal harm or potential for actual harm therefore the NOMNC cut letter was issued and the resident had decided to go home instead of paying for his room.Interview with the Nursing Home Administrator on January 22, 2026 at 8:39 p.m. revealed that the resident was not provided with discharge instruction which included a list of medications that he was to take and when to take them. 28 Pa. Code 201.18 (3)(e)(1) Management28 Pa. Code 211.10(a) Resident care plan Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395828 If continuation sheet Page 4 of 4