Health inspection·July 24, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete stated Resident 2 was upset and crying briefly after the incident. However, this incident was not reported to the Department of Health. In interviews, the Director of Nursing (DON) and the Nursing Home Administrator (NHA) stated they did not believe the event was reportable, as they did not perceive intent on Resident 1's part. The only intervention implemented was to increase supervision. A second incident occurred on July 14, 2025, during lunch hour in the dining room. Facility documentation revealed that at approximately 11:45 a.m., Resident 1 reached through the back of Resident 2's chair and touched her buttocks. The incident was witnessed by Employee 2 (cook), who provided a written statement and confirmed the contact. Resident 2 expressed discomfort and described Resident 1 as gross. Following this incident, the facility reported the matter to the Department of Health, Adult Protective Services, and local law enforcement. The facility also notified Resident 2's representative. Resident 1 was then placed on one-to-one supervision, and staff were instructed to ensure separation between the two residents. The above findings were reviewed with the NHA during an interview on July 24, 2025, at 1:15 PM, the NHA acknowledged that Resident 1 displayed sexually inappropriate behaviors and was unable to provide evidence the facility ensured that Resident 2 was free from sexual harassment perpetrated by Resident 1 and could provide no evidence the facility had implemented sufficient safeguards to protect Resident 2 from recurring sexual harassment or abuse. 28 Pa. Code 201.14 (a) Responsibility of licensee. 28 Pa. Code 201.18 (e)(1) Management. 28 Pa. Code 201.29 (a) Resident Rights. 28 Pa. Code 211.10 (d) Resident care policies. 28 Pa. Code 211.12 (d)(1)(5) Nursing Services. Event ID: Facility ID: 395875 If continuation sheet Page 2 of 5 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 395875 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenwood Center for Nursing and Rehab 149 Lafayette Avenue Tamaqua, PA 18252 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of select facility policy, facility investigative reports, clinical records and staff interviews it was determined the facility failed to ensure a complete and accurate investigation into sexual abuse was completed for one resident out of 9 sampled (Resident 2). Findings included: A review of the current facility policy titled Abuse Policy, last reviewed by the facility on September 2024, revealed the resident has the right to be free from abuse, neglect, and misappropriation of resident property. Further review of the facility abuse policy revealed under the area of investigation all reports of resident abuse, neglect, exploitation, misappropriation, shall be promptly reported to local, state and federal agencies as defined by current regulations, and thoroughly investigated by the administrator and or designee. The administrator or his/her designee will provide appropriate agencies or individuals within five working days of the occurrence of the incident. A review of Resident 2's clinical record revealed admission to the facility on May 23, 2025, with diagnoses to include dementia (a group of symptoms affecting memory, thinking and social abilities. The symptoms interfere with a person's daily life). An admission MDS dated [DATE], revealed the resident was severely cognitively impaired with a BIMS score of 1 (brief interview of mental status to a tool to assess the resident's attention, orientation and ability to register and recall new information 0-7 represents severe cognitive impairment). A review of the facility's investigative documentation dated July 4, 2025, revealed that Employee 1 (Activities Aide) reported observing Resident 1 grab Resident 2's breast and genital area during an activity in the activity room. The investigation summary, completed by the Director of Nursing (DON), referenced input from staff on duty and alert and oriented residents present at the time of the incident; however, no additional written statements or interview documentation from those individuals were included in the investigation file. The only written statement obtained was from Employee 1, which clearly described that she observed Resident 1 grab Resident 2's genital area over her clothing. Further review of the facility's investigative documentation revealed a written conclusion by the Director of Nursing (DON) dated July 4, 2025, which stated: After a full investigation, per reporting guidelines, if both residents are incapable and there is no injury, you do not have to report. At this point, there is no valid proof of any type of inappropriate touching or behaviors that happened. No injuries. Both residents cannot recall what happened. However, this rationale is inconsistent with federal regulatory guidance. Despite the DON's written conclusion, the facility did not document any efforts to interview other staff or alert, and oriented residents present during the incident, nor did it follow up on the eyewitness account from Employee 1, who documented that she observed Resident 1 grab Resident 2's genital area over her clothing. The incident was not reported to the Department of Health. In interviews on July 24, 2025, the DON and Nursing Home Administrator (NHA) stated they did not believe the incident was reportable due to a lack of intent by Resident 1.An interview conducted with the DON and NHA on July 24, 2025, at approximately 1:30 PM, revealed they were unable to provide evidence that the investigation into the potential sexual abuse of Resident 2 was complete or compliant with facility policy and federal reporting requirements. 28 Pa. Code 201.14 (a) Responsibility of licensee 28 Pa. Code 201.18(e)(1) Management 28 Pa. Code 201.29(a)(c) Resident Rights 28 Pa. Code 211.10(d) Resident care policies. 28 Pa. Code 211.12(c)(d)(5) Nursing Services. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395875 If continuation sheet Page 3 of 5 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 395875 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenwood Center for Nursing and Rehab 149 Lafayette Avenue Tamaqua, PA 18252 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of the facility's plan of correction from the survey ending July 24, 2025, the outcome of the activities of the facility's quality assurance committee, a review of clinical records, and staff interviews, it was determined the facility failed to maintain compliance with nursing home regulations and ensure that plans to improve the delivery of care and services effectively addressed recurring deficiencies for one of six residents reviewed related to ensuring residents are free from sexual abuse (Resident 3) perpetrated by another resident (Resident 1). Findings include: As a result of the deficiencies cited under the requirements related to ensuring residents are free from sexual abuse during the survey of July 24, 2025, the facility developed a plan of correction to serve as their allegation of compliance, which included a quality assurance monitoring component to ensure that solutions were sustained. This corrective plan was to be completed and functional by August 19, 2025. However, during the survey ending August 28, 2025, continuing deficient facility practice was identified with these same requirements.According to the facility's plan of correction for the deficiency cited on July 24, 2025, relating to ensuring residents are free from sexual abuse, implemented to ensure deficient practice was corrected, included (1) The perpetrator is now 1:1 (level of staff to resident supervision) when out of bed. The recipient of sexual abuse was discharged from the facility. (2) The facility completed a baseline audit of abuse allegations for two weeks, and interventions have been implemented if applicable. (3) Facility educated staff regarding facility abuse policy. The facility will ensure that allegations of abuse will follow a facility policy that includes safeguards to be in place to protect residents from abuse. (4) The Nursing Home Administrator (NHA) or designee will audit the allegation of abuse to ensure facility policy is followed weekly for four weeks and then monthly for two months. (5) Audits will be submitted to the quality assurance performance improvement committee for review.A clinical record review revealed Resident 3 was admitted to the facility on [DATE]. A clinical record review revealed that Resident 1 was admitted to the facility on [DATE], with a history of known maladaptive behaviors such as inappropriate sexual comments to staff, touching staff inappropriately, wandering into female residents' rooms, and grabbing residents' wheelchairs. Further clinical record review revealed on August 27, 2025, Resident 1 sexually abused another resident when he was witnessed by facility staff touching Resident 3's genital area over her clothing without consent. A review of QAPI documentation revealed no evidence that the facility's performance improvement plan identified or addressed Resident 1's known maladaptive behaviors as risk factors requiring specific interventions. The QAPI plan focused only on the incident identified during the July 24, 2025, survey, without examining whether systemic failures in supervision, behavioral monitoring, or abuse-prevention interventions contributed to the current event. During an interview on August 28, 2025, at 11:00 AM, the Nursing Home Administrator (NHA) reviewed the concern regarding the August 27, 2025, incident in which Resident 1 was witnessed touching Resident 3 over her clothing without consent. The NHA did not provide documented evidence the facility's internal audits conducted after the July 24, 2025, survey identified Resident 1's history of maladaptive behaviors or that he was included in the audits intended to monitor and prevent recurrence of sexual abuse incidents.Further review revealed no documented evidence the Quality Assurance and Performance Improvement (QAPI) committee evaluated Resident 1's behavioral history, implemented targeted prevention strategies, or monitored the effectiveness of corrective actions beyond the initial audits.As a result, the facility's QAPI activities did not identify or correct the underlying causes of the original deficiency, contributing to the recurrence of resident-to-resident sexual abuse under the same (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395875 If continuation sheet Page 4 of 5 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 395875 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenwood Center for Nursing and Rehab 149 Lafayette Avenue Tamaqua, PA 18252 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 0867 regulatory requirement. Cross Refer to F600 28 Pa. Code 201.18(e)(4) Management.28 Pa. Code 211.12 (d)(5) Nursing services. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395875 If continuation sheet Page 5 of 5