Health inspection·October 19, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observations, and staff interviews, it was determined that the facility failed to maintain a safe, homelike environment for one of two elevators (Elevator 1). Residents Affected - Few Findings include: Observation on 10/17/23, at 9:05 a.m., revealed a broken number one button in Elevator 1, where the center of the button was missing, which exposed sharp edges. Observation on 10/18/23, at 9:00 a.m. revealed that the number one button on Elevator 1 remained broken. Observation on 10/19/23, at 10:30 a.m. revealed that the number one button on Elevator 1 remained broken. During an interview on 10/19/23, at 1:23 p.m. the Director of Nursing confirmed that the number one button on Elevator 1 was not appropriate and required repair. 28 Pa. Code 201.18 (b)(1)(3) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395890 If continuation sheet Page 2 of 10 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 395890 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Snu Armstrong CO Memorial Hosp One Nolte Drive Kittanning, PA 16201 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. Based on observation and review of facility policy the facility failed to make certain that a grievance official is posted with contact information and that the facility had a policy and procedure that met federal guidelines for 15 of 15 residents. Findings include: Review of the facility policy Complaints, dated October 2022, stated that any resident, family, friend, or staff person may register a complaint alleging a violation of applicable laws/regulations by the unit. The individual receiving the complaint shall make every effort to resolve the problem. However, whether resolved or not, complaints of a serious nature, whether verbal or in writing, shall be directed to the administrator/director of nursing. Each employee shall be instructed in the proper handling of complaints about resident care and/or services. The administrator/director of nursing shall be responsible for maintaining the Complaint Log. During an observation on 10/19/23, at 10:58 a.m., a box with Resident/Family Compliment/Concern Forms, was noted to be in the Activity/Dining Room, as well as at the Nurses Station, however no information was present regarding the Grievance Official ' s name, address (mailing and email), and business phone number. Review of the facility policy failed to include the following: §483.10(j)(4) The facility must establish a grievance policy to ensure the prompt resolution of all grievances regarding the residents' rights contained in this paragraph. Upon request, the provider must give a copy of the grievance policy to the resident. The grievance policy must include: (i) Notifying resident individually or through postings in prominent locations throughout the facility of the right to file grievances orally (meaning spoken) or in writing; the right to file grievances anonymously; the contact information of the grievance official with whom a grievance can be filed, that is, his or her name, business address (mailing and email) and business phone number; a reasonable expected time frame for completing the review of the grievance; the right to obtain a written decision regarding his or her grievance; and the contact information of independent entities with whom grievances may be filed, that is, the pertinent State agency, Quality Improvement Organization, State Survey Agency and State Long-Term Care Ombudsman program or protection and advocacy system; (ii) Identifying a Grievance Official who is responsible for overseeing the grievance process, receiving and tracking grievances through to their conclusions; leading any necessary investigations by the facility; maintaining the confidentiality of all information associated with grievances, for example, the identity of the resident for those grievances submitted anonymously, issuing written grievance decisions to the resident; and coordinating with state and federal agencies as necessary in light of specific allegations; (iii) As necessary, taking immediate action to prevent further potential violations of any resident right while the alleged violation is being investigated. During an interview on 10/19/23, at 11:32 p.m. with Director of Nursing confirmed that the facility failed to post information regarding the grievance official with contact information and that the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395890 If continuation sheet Page 3 of 10 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 395890 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Snu Armstrong CO Memorial Hosp One Nolte Drive Kittanning, PA 16201 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 0585 facility had a grievance policy that included all the required components of the federal regulation. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 201.29(1) Resident rights 28 Pa. Code 201.18 e(4) Management Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395890 If continuation sheet Page 4 of 10 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 395890 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Snu Armstrong CO Memorial Hosp One Nolte Drive Kittanning, PA 16201 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of Resident Assessment Instrument (RAI) User's Manual, clinical records, and staff interviews, it was determined that the facility failed to ensure that MDS assessments accurately reflected the resident's status for one five residents (Resident R80). Residents Affected - Few Findings include: The Resident Assessment Instrument (RAI) User's Manual, which gives instructions for completing Minimum Data Set (MDS) assessments (mandated assessments of a resident's abilities and care needs), dated October 2023, indicated the following instructions: -Section I: Active Diagnoses, that a diagnosis should be checked if they had had an active diagnosis for a disease or condition in the last seven days. Review of the clinical record revealed that Resident R80 was admitted to the facility on [DATE]. Review of Resident R80's Manage Patent Problems list indicated that Resident R80 had an Active Problem of post-traumatic stress disorder (PTSD- a disorder in which a person has difficulty recovering after experiencing or witnessing a terrifying event and may have triggers that can bring back memories of trauma accompanied by intense emotional and physical reactions). Review of Resident R80 ' s MDS dated [DATE], did not include diagnosis of PTSD. During an interview on 10/20/23, at 1:20 pm. Director of Nursing confirmed that the facility failed to ensure that MDS assessments accurately reflected the resident's status for one of five residents. 28 Pa. Code: 211.12(d)(1)(2)(3)(5) Nursing Services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395890 If continuation sheet Page 5 of 10 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 395890 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Snu Armstrong CO Memorial Hosp One Nolte Drive Kittanning, PA 16201 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 facility policy, clinical records, and staff interviews, it was determined that the facility failed to ensure that a comprehensive resident care plan was implemented related to post traumatic stress disorder status for one of five residents (Residents R80). Findings include: Review of facility policy Care Plan last reviewed October 2022, indicated that an interdisciplinary plan of care for the resident will be developed which includes measurable objectives to meet the resident ' s medical, nursing, and psychological needs. Review of the clinical record revealed that Resident R80 was admitted to the facility on [DATE]. Review of Resident R80 ' s Manage Patient Problems list indicated that Resident R80 had an Active Problem of post-traumatic stress disorder (PTSD- a disorder in which a person has difficulty recovering after experiencing or witnessing a terrifying event and may have triggers that can bring back memories of trauma accompanied by intense emotional and physical reactions). Review of Resident R4's plan of care revealed no care plan was developed to address Resident R80's post-traumatic stress disorder. During an interview on 10/19/23, at 12:49 p.m. the Director of Nursing confirmed that the facility failed to implement a comprehensive care plan for Resident R80 to address post-traumatic stress disorder. 28 Pa. Code: 211.11(a) Resident care plan. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395890 If continuation sheet Page 6 of 10 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 395890 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Snu Armstrong CO Memorial Hosp One Nolte Drive Kittanning, PA 16201 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 facility policy, clinical record review, observation, and staff interview, it was determined the facility failed to implement measures to prevent the potential for cross contamination during a dressing change for one of three residents (Resident R77). Residents Affected - Few Findings include: During an interview on 10/19/23, at 11:50 a.m. the Director of Nursing (DON) stated the facility references the textbook Clinical Nursing Skills and Techniques copyrighted 2022, by [NAME], [NAME], [NAME], and [NAME] for guidance as to how to properly perform dressing changes. Review of Title 42 Code of Federal Regulations (CFR) §483.80 - Infection Control defines hand hygiene as hand washing with soap and water and/or alcohol-based hand rub (ABHR). Staff involved in direct resident contact must perform hand hygiene (even if gloves are used): - Before and after contact with the resident - Before performing an aseptic (preventing infection) task - After contact with blood, body fluids, visibly contaminated surfaces or after contact with objects in the resident's room - After removing personal protective equipment (PPE - e.g., gloves, gown, facemask) Appropriate use of PPE includes, but is not limited to, the following: - Gloves worn before and removed after contact with blood or body fluid, mucous membranes, or non-intact skin - Gloves changed and hand hygiene performed before moving from a contaminated-body site to a clean-body site during resident care The facility must prevent infections through indirect contact transmission. This requires the decontamination (i.e., cleaning and/or disinfecting an object to render it safe for handling) of resident equipment, medical devices, and the environment. Equipment or items in the resident environment likely to have been contaminated with infectious fluids or other potentially infectious matter must be handled in a manner so as to prevent transmission of infectious agents (e.g., wear gloves for handling soiled equipment and properly clean and disinfect or sterilize reusable equipment before use on another resident). Review of the clinical record indicated that Resident R77 was admitted to the facility on [DATE]. Review of the Resident R77's clinical record indicated active diagnoses of hypertension (high blood pressure), diabetes (too much sugar in the blood), and cellulitis (a skin infection caused by bacteria). Review of a physician order dated 10/10/23, indicated to remove old dressings from bilateral (both (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395890 If continuation sheet Page 7 of 10 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 395890 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Snu Armstrong CO Memorial Hosp One Nolte Drive Kittanning, PA 16201 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few sides) legs, wash the wounds and legs (as needed as it can be painful for her) gently with baby shampoo, rinse well, and pat intact skin dry. Apply Aquaphor (ointment that protects skin and promotes hydration) to the feet and heels. Apply nickel thick Santyl (ointment that removes dead tissue from wound to promote healing) to the open areas with 1-2 layers of Xeroform (a dressing that keeps air out and decreases the risk of infection), then abdominal pads (ABDs - an extra thick gauze dressing that absorbs fluid), Kerlix (a gauze bandage roll), tape. Change daily and as needed. During an observation of a dressing change on 10/19/23, at 10:30 a.m. Licensed Practical Nurse (LPN) Employee E1 had already prepared the dressing supplies field on a chair in Resident R77's room prior to surveyor arrival. Observation of the chair included a Chux (an absorbent pad intended to catch fluids and allow for easy cleanup) open on the chair surface with a basin of dressing supplies inside of the basin. Observation of Resident R77 revealed the resident to be sitting in bed with a Chux placed under the resident's right leg. LPN Employee E1 performed hand hygiene at Resident R77's sink and donned a clean pair of gloves from a box located next to the sink. LPN Employee E1 removed a pair of scissors from her right front pocket of her uniform and cut off the dressing that was located on Resident R77's right leg. Once cut complete, LPN Employee E1 placed the scissors back in the right front pocket of her uniform. LPN Employee E1 removed her gloves and performed hand hygiene at the sink and stated, I better put a handful of these in my pocket before removing a handful of gloves from the box and placing them in the front right pocket of her uniform. LPN Employee E1 donned new gloves and proceeded to open dressing supplies from the basin on the chair. LPN Employee E1 asked Resident R77 if she should would like the wound to be cleansed with baby shampoo and Resident R77 stated, not today, they used it yesterday, let's use saline today and the shampoo tomorrow. LPN Employee E1 then fully removed the dressing from Resident R77's right leg and proceeded to cleanse the open areas of the wound with saline soak gauze. LPN Employee E1 then disposed of the old dressing in the garbage can, removed her gloves, performed hand hygiene at the sink, and donned a new pair of gloves form the box located next to the sink. During this observation, LPN Employee E2 entered Resident R77's room to assist with the dressing change. LPN Employee E2 performed hand hygiene at the sink and donned gloves from the box located next to the sink. LPN Employee E2 opened a pack of cotton tip applicators and Santyl ointment. LPN Employee E2 applied Santyl to the cotton tip applicator and handed it to LPN Employee E1, who applied the Santyl to the open wound areas. LPN Employee E1 was holding Resident R77's bare right heel with her left hand while applying the Santyl with her right hand. LPN Employee E2 opened packages of Xeroform and handed them to LPN Employee E1 who applied the Xeroform to the open wound areas with both hands. LPN Employee E2 opened packages of ABDs and Kerlix and then proceeded to hold Resident R77's right leg up while LPN Employee E1 placed the ABDs on top of the Xeroform. LPN Employee E1 then proceeded to wrap Resident R77's right leg with Kerlix using both hands. LPN Employee E1 removed the scissors from her front right uniform pocket and cut the Kerlix before placing the scissors back in the front right pocket of her uniform. LPN Employee E2 lowered Resident R77's leg and then proceeded to pick (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395890 If continuation sheet Page 8 of 10 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 395890 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Snu Armstrong CO Memorial Hosp One Nolte Drive Kittanning, PA 16201 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 up a roll of tape and cut a piece before securing the Kerlix with the tape. Level of Harm - Minimal harm or potential for actual harm LPN Employee E1 removed her gloves, threw them in the garbage can, and performed hand hygiene at the sink before removing a pair of gloves from her front right uniform pocket and put the gloves on. Residents Affected - Few LPN Employee E2 removed the Chux and all of the dressing supplies and placed them in the garbage can before removing her gloves and performing hand hygiene at the sink. LPN Employee E2 donned a new pair of gloves from the box located next to the sink. LPN Employee E1 opened a new Chux and place it under Resident R77's left leg. LPN Employee E1 removed the scissors from her right front uniform pocket and cut off the dressing from Resident R77's left leg. LPN Employee E1 then placed the scissors on the Chux located on the chair with the basin of dressing supplies. LPN Employee E1 placed the old dressing supplies in the garbage can, removed her gloves, and performed hand hygiene at the sink. LPN Employee E1 then donned new gloves from the box located next to the sink. LPN Employee E2 opened packages of Xeroform while LPN Employee E1 cleansed the open areas of the wound on Resident R77's left leg with saline soaked gauze. LPN Employee E2 opened a pack of cotton tip applicators and Santyl ointment. LPN Employee E2 applied Santyl to the cotton tip applicator and handed it to LPN Employee E1, who applied the Santyl to the open wound areas. LPN Employee E1 picked up the scissors that were on the Chux next to the basin full of dressing supplies and proceeded to cut the Xeroform. LPN Employee E1 applied the Xeroform to the open areas of the wound and then opened packages of ABDs while Employee E2 removed her gloves and left the room to get more Kerlix. LPN Employee E1 placed the scissors on the Chux located under Resident R77's left leg. LPN Employee E2 returned to the room and donned new gloves with hand hygiene not observed. LPN Employee E2 opened the package of Kerlix and LPN Employee E1 picked it up with her right hand and proceeded to wrap the Kerlix around Resident R77's left leg. LPN Employee E1 picked up the scissors from the Chux field and cut the Kerlix. LPN Employee E1 then picked up a roll of tape and ripped off a piece before securing the wrapped Kerlix. LPN Employee E2 removed the Chux from under Resident R77's left leg and placed it in the garbage can while LPN Employee E1 removed her gloves and performed hand hygiene at the sink. LPN Employee E1 donned new gloves from the box next to the sink and picked up the basin and dressing supplies and placed them on the window seal in Resident R77's room. LPN Employee E1 then picked up the Chux from the chair, disposed of it in the garbage can, removed her gloves, and performed hand hygiene at the sink. LPN Employee E1 then used the paper towel she had used to dry her hands and proceeded to wipe off the blades of her scissors with it. LPN Employee E1 then picked up the basin of dressing supplies and placed it on a shelf in Resident R77's closet. During an interview on 10/19/23, at 11:17 a.m. LPN Employee E1 confirmed the above observations during the dressing change for Resident R77 and that the facility failed to implement measures to prevent the potential for cross contamination during a dressing change. 28 Pa. code: 201.14 (a) Responsibility of licensee. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395890 If continuation sheet Page 9 of 10 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 395890 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Snu Armstrong CO Memorial Hosp One Nolte Drive Kittanning, PA 16201 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: 201.18 (b) (1) (e) (1) Management. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code: 211.10 (d) Resident care policies. 28 Pa. Code: 211.12 (d) (1) (2) (5) Nursing services. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395890 If continuation sheet Page 10 of 10