Health inspection·January 6, 2025

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few Based on review of facility policies, job descriptions, staff education records, clinical records, and investigation reports, as well as staff interviews, it was determined that the facility failed to ensure that residents were free from neglect while being transported to dialysis for one of 12 residents reviewed (Resident 1), resulting in harm to Resident 1 due to a fall that resulted in a fracture. Findings include: The facility's policy regarding abuse and neglect, dated November 24, 2024, indicated that the resident had the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, involuntary seclusion, neglect, and misappropriation of property. Neglect was defined as the failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness. Neglect referred to failure through inattentiveness, carelessness, or omission to provide timely, consistent, safety adequate, and appropriate services, treatment of care, including but not limited to: nutrition, medications, therapies, and activities of daily living. The facility's transportation policy, dated November 24, 2024, revealed that all employees who operate a vehicle would receive, upon hire, training in bus/van policies, procedures, and operations. Additionally training was to be provided on a regular basis. Both staff and clients were to wear a seatbelt at all times when the vehicle was in operation and clients in wheelchairs were to be secured with the use of wheelchair locks, as well as either a lap belt or shoulder safety belt. The job description for the transportation driver, undated, revealed that the driver was to perform all assigned tasks in accordance with established policies and procedures, and as instructed by their supervisor, and was to ensure a safe environment. Education records for Van Driver 3, dated October 4, 2024, revealed that he received training on the transportation policy and procedures. An admission Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 1, dated November 29, 2024, revealed that the resident was cognitively intact, had limited range of motion to her upper and lower extremities, used a wheelchair, received dialysis services, and had diagnoses that included renal failure. The resident's care plan, dated November 26, 2024, revealed that she required dialysis on Mondays, Wednesdays, and Fridays. A nursing note, dated December 24, 2024, at 9:20 a.m. revealed that Resident 1's wheelchair tipped over backwards while in the facility's van. On assessment by the Director of Nursing and the Registered Nurse Supervisor, Resident 1 was already returned to the upright position and being secured to the van. Resident 1 stated that her chest hurt and that her knees hit her in the chest when she tipped over backwards. She refused any further assessment and requested to go ahead to dialysis. At 11:31 a.m., dialysis sent the resident to the local hospital for further evaluation and treatment. Hospital records, dated December 24, 2024, revealed that Resident 1 reported that she was on her way to dialysis via a wheelchair van and when they attempted to start moving, her wheelchair was not locked into place, and she was ejected from her wheelchair. Her knees subsequently struck her chest, specifically her sternal (bone located in center of the chest) area. She admitted to a marked amount (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395892 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 395892 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Latrobe 576 Fred Rogers Drive Latrobe, PA 15650 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 0600 Level of Harm - Actual harm Residents Affected - Few of sternal pain since then. A CT scan (diagnostic test) report revealed that the resident had an age indeterminate, possibly chronic, sternal fracture deformity. This was to be correlated clinically at the point of tenderness in this location. Hospital records revealed that the resident was made aware of the concerning CT scan findings for a sternal fracture, and she was agreeable to transfer. Given the traumatic findings found on the scan as well as the need for emergent dialysis, she required a transfer. Resident 1 was transferred as a Level 2 trauma (a patient with a traumatic injury that is considered potentially life-threatening, meaning they have significant injuries but are currently stable with vital signs within normal ranges, requiring immediate specialized care at a Level 2 trauma center) to a hospital in Pittsburgh. A review of hospital records from Pittsburgh, dated December 24, 2024, through January 2, 2025, revealed that Resident 1 was admitted to ICU for acute respiratory insufficiency requiring significant respiratory support, treatment for a sternal fracture, and dialysis. Information submitted by the facility, dated December 24, 2024, revealed that Resident 1 was being transported to her dialysis appointment in the facility van and when the van was pulling out of the driveway, which had a slight upward grade, Resident 1's wheelchair tipped backwards causing the resident to hit her head. She reported that her chest hurt from her knees coming up and hitting her chest. Resident 1 stated that she was okay and was transported to dialysis. The facility received a call from dialysis that they were sending Resident 1 to the hospital for evaluation and treatment and that the resident sustained a sternal fracture. The facility's investigation, dated December 24, 2024, revealed that the straps to hold Resident 1's wheelchair in place in the van were not secured properly. A statement from Nurse Aide 2, dated December 24, 2024, revealed that when the transport van went to pull out of the parking lot she heard a loud noise, and when she looked back she saw that Resident 1's wheelchair tipped backwards. The resident stated that her chest hurt from her knees hitting her chest. A statement from Van Driver 3, dated December 24, 2024, revealed that when he was hooking up Resident 1's wheelchair to the back chair locks, he got distracted when someone asked about hooking up their seat belt, and he did not lock the front of Resident 1's wheelchair to the chair holders. An interview with the Director of Nursing on December 30, 2024, at 12:29 p.m. confirmed that Van Driver 3 did not lock Resident 1's wheelchair properly, which resulted in her falling backwards. 28 Pa. Code 211.10(c)(d) Resident Care Policies. 28 Pa. Code 211.12(d)(1)(5) Nursing Services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395892 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 395892 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Latrobe 576 Fred Rogers Drive Latrobe, PA 15650 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 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few Based on review of facility policies, clinical records, and facility investigation documents, as well as staff interviews, it was determined that the facility failed to ensure that the residents' environment remained as free from accident hazards as possible for one of 12 residents reviewed (Resident 1) who used a wheelchair, resulting in a fracture. Findings include: The facility's transportation policy, dated November 24, 2024, revealed that all employees who operate a vehicle would receive, upon hire, training in bus/van policies, procedures, and operations. Additionally training was to be provided on a regular basis. Both staff clients were to wear a seatbelt at all times when the vehicle was in operation and clients in wheelchairs were to be secured with the use of wheelchair locks, as well as either a lap belt or shoulder safety belt. An admission Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 1, dated November 29, 2024, revealed that the resident was cognitively intact, had limited range of motion to her upper and lower extremities, used a wheelchair, received dialysis services, and had diagnoses that included renal failure. The resident's care plan, dated November 26, 2024, revealed that she required dialysis on Mondays, Wednesdays, and Fridays. A nursing note, dated December 24, 2024, at 9:20 a.m. revealed that Resident 1's wheelchair tipped over backwards while in the facility's van. On assessment by the Director of Nursing and the Registered Nurse Supervisor, Resident 1 was already returned to the upright position and being secured to the van. Resident 1 stated that her chest hurt and that her knees hit her in the chest when she tipped over backwards. She refused any further assessment and requested to go ahead to dialysis. At 11:31 a.m., dialysis sent the resident to the local hospital for further evaluation and treatment. Hospital records, dated December 24, 2024, revealed Resident 1 reported that she was on her way to dialysis via a wheelchair van and when they attempted to start moving, her wheelchair was not locked into place and she was ejected from her wheelchair. Her knees subsequently struck her chest, specifically her sternal (bone located in center of the chest) area. She admitted to a marked amount of sternal pain since then. A CT scan (diagnostic test) report revealed that the resident had an age indeterminate, possibly chronic, sternal fracture deformity. This was to be correlated clinically at the point of tenderness in this location. Hospital records revealed that the resident was made aware of the concerning CT scan findings for a sternal fracture and she was agreeable to transfer. Given the traumatic findings found on the scan as well as the need for emergent dialysis, she required a transfer. Resident 1 was transferred as a Level 2 trauma (a patient with a traumatic injury that is considered potentially life-threatening, meaning they have significant injuries but are currently stable with vital signs within normal ranges, requiring immediate specialized care at a Level 2 trauma center) to a hospital in Pittsburgh. A review of hospital records from Pittsburgh, dated December 24, 2024 through January 2, 2025, revealed that Resident 1 was admitted to ICU for acute respiratory insufficiency requiring significant respiratory support, treatment for a sternal fracture, and dialysis. Information submitted by the facility, dated December 24, 2024, revealed that Resident 1 was being transported to her dialysis appointment in the facility van and when the van was pulling out of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395892 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 395892 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Latrobe 576 Fred Rogers Drive Latrobe, PA 15650 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 - Actual harm Residents Affected - Few driveway, which had a slight upward grade, Resident 1's wheelchair tipped backwards causing the resident to hit her head. She reported that her chest hurt from her knees coming up and hitting her chest. Resident 1 stated that she was okay and was transported to dialysis. The facility received a call from dialysis that they were sending Resident 1 to the hospital for evaluation and treatment and that the resident sustained a sternal fracture. The facility's investigation dated December 24, 2024, revealed that the straps to hold Resident 1's wheelchair in place were not secured properly. A statement from Nurse Aide 2, dated December 24, 2024, revealed that when the transport van went to pull out of the parking lot she heard a loud noise, and when she looked back she saw that Resident 1's wheelchair tipped backwards. The resident stated that her chest hurt from her knees hitting her chest. A statement from Van Driver 3, dated December 24, 2024, revealed that when he was hooking up Resident 1's wheelchair to the back chair locks, he got distracted when someone asked about hooking up their seat belt, and he did not lock the front of Resident 1's wheelchair to the chair holders. An interview with the Director of Nursing on December 30, 2024, at 12:29 p.m. confirmed that Van Driver 3 did not lock Resident 1's wheelchair properly, which resulted in her falling backwards. 28 Pa. Code 211.10(c)(d) Resident Care Policies. 28 Pa. Code 211.12(d)(1)(5) Nursing Services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395892 If continuation sheet Page 5 of 5