Health inspection·April 23, 2025

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 clinical record review and staff interviews, it was determined that the facility failed to ensure that the resident assessment accurately reflected the resident's status for two of 19 residents reviewed (Residents 9 and 32). Residents Affected - Few Findings Include: Review of Resident 9's clinical record revealed diagnoses that included Multiple Sclerosis (MS - a disease that causes breakdown of the protective covering of nerves; can cause numbness, weakness, trouble walking, vision changes, and other symptoms) and neurogenic bladder (bladder dysfunction caused by nervous system conditions). Review of Resident 9's physician orders revealed an order dated June 28, 2024, for a Foley catheter (a thin, flexible tube inserted into the bladder through the urethra to drain urine; also known as an indwelling catheter). Review of Resident 9's Quarterly MDS (Minimum Data Set - an assessment tool to review all care areas specific to the resident such as a resident's physical, mental, or psychosocial needs) dated February 16, 2025, revealed in section H, it was coded that Resident 9 had an indwelling catheter and was also occasionally incontinent of urine. During an interview with the Nursing Home Administrator (NHA) and Director of Nursing (DON) on April 23, 2025, at 10:45 AM, the DON confirmed that the MDS was coded in error, as Resident 9 was not occasionally incontinent of urine due to her Foley catheter. Review of Resident 32's clinical record revealed diagnoses that included heart failure (a condition where the heart cannot pump enough blood to meet the body's needs) and chronic kidney disease (a progressive condition where the kidneys gradually lose their ability to filter waste and excess fluid from the blood). Review of Resident 32's clinical record revealed she had an unwitnessed fall on March 2, 2025, at 2:00 AM, which resulted in an abrasion on the left thigh. Review of Resident 32's Significant Change MDS dated [DATE], revealed in section J, it was coded that Resident 32 has not had any falls since admission/entry or reentry or prior assessment. During an interview with the NHA and DON on April 23, 2025, at 10:03 AM, the DON confirmed that the MDS was coded in error, as Resident 32's fall on March 2, 2025, should have been reflected. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395915 If continuation sheet Page 2 of 12 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 395915 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Transitions Healthcare Allens Cove 25 Cove Road Duncannon, PA 17020 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on facility policy review, clinical record review, and resident and staff interviews, it was determined that the facility failed to ensure a resident who is unable to carry out activities of daily living (ADLs) receives the necessary services to maintain good grooming and personal hygiene for one of two residents reviewed for ADLs (Resident 23). Residents Affected - Few Findings Include: Review of the facility policy, titled Activities of Daily Living last reviewed May 31, 2024, read, in part, Residents will gain and/or maintain as much independence as possible in ADLs which are essential to the individual's lifestyle. This refers to activities an individual performs on a regular basis, such as eating, dressing, hygiene (make-up, shaving, washing), transfers, reading, writing, housework, smoking, walking, and even driving. The resident's performance may vary depending on the time of day, how the resident feels, setting, and the person with him/her. Review of Resident 23's clinical record revealed diagnoses that included spinal stenosis (a condition that narrows the space in the spine, putting pressure on the spinal cord or nerves), repeated falls, and muscle weakness. During an interview with Resident 23 on April 21, 2025, at 10:22 AM, she revealed she has sometimes not received a shower for over two weeks at a time, and recently did not receive a shower for eight days. Review of Resident 23's clinical record revealed she has a preferred shower schedule of Wednesday and Saturday on the 2-10 shift. Review of Resident 23's nurse aide task for showers revealed she did not receive a shower per her preferred schedule on January 8 and 11, 2025; February 5, 15, 22, and 26, 2025; March 1, 5, and 15, 2025; and April 16, and 19, 2025. During an interview with the Nursing Home Administrator on April 22, 2025, at 2:15 PM, he revealed sometimes Resident 23 refuses to get out of bed for the staff during her shower days. Further review of Resident 23's clinical record failed to revealed notation to indicate she refused to get out of bed or was reapproached for a shower at a later time on the aforementioned days. Interview with the Director of Nursing on April 23, 2025, at 10:41 AM, revealed he would expect staff to document refusal of showers and reapproach residents at a later day or time who refused a shower as per their preferred schedule. 28 Pa Code 211.12(c)(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395915 If continuation sheet Page 3 of 12 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 395915 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Transitions Healthcare Allens Cove 25 Cove Road Duncannon, PA 17020 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 clinical record review, observation, and staff interviews, it was determined that the facility failed to ensure care and services are provided in accordance with professional standards of practice that will meet each resident's physical, mental, and psychosocial needs for one of one of 16 residents reviewed (Resident 24). Residents Affected - Few Findings include: Review of Resident 24's clinical record revealed diagnoses that included Alzheimer's disease (a chronic disorder of the mental processes caused by brain disease, and marked by memory disorders, personality changes, and impaired reasoning), atrioventricular heart block (a type of heart block that occurs when the electrical signal traveling from the atria, or the upper chambers of the heart, to ventricles, or the lower chambers of the heart, is impaired), and presence of a cardiac pacemaker. Observation of Resident 24 on April 21, 2025, at 10:02 AM, revealed the presence of a [NAME] at Home (a remote telephonic pacemaker check device) on her bedside stand. Review of Resident 24's current physician orders failed to reveal any orders for a cardiology consult or pacemaker checks. Review of Resident 24's physician order history revealed an order for a yearly cardiology appointment on November 29, 2024, with a completion date of November 30, 2023; and an order for pacemaker check in 3 months by remote monitoring, with a completion date of January 25, 2023. Review of Resident 24's care plan revealed a care plan focus for a pacemaker with an intervention for pacemaker checks as ordered by cardiology and document in chart: Heart rate, Rhythm, Battery check, with a last revision date of July 7, 2022. Review of Resident 24's clinical record revealed that her last pacemaker remote check was completed on September 18, 2024. During a staff interview the Director of Nursing (DON) on April 23, 2025, at 9:19 AM, the DON indicated that, after being made aware of the concern regarding Resident 24's cardiology and pacemaker testing was shared, that he began to investigate. The DON indicated that Resident 24 should have a yearly cardiology appointment and would have been due for an appointment in November 2024 or December 2024. The DON indicated that the cardiology office did not call to set up the yearly appointment as was their typical practice. The DON said when he called the cardiology office yesterday and they indicated that they had sent letters in November 2024 and December 2024 to a local address that they had on file for Resident 24, which was not the facility address. He said that the office said since they did not receive a response to the letters, they dropped it. The DON indicated that the cardiology office indicated that the pacemaker was still transmitting, and they would notify the emergency contacts if there was an issue; however, they did not have the facility listed as the primary contact. The DON confirmed that Resident 24 has a cardiology office appointment the following week, and that the three-month remote pacer checks will be scheduled at that time. He also indicated that he had once again notified the cardiology office that Resident 24 plans to permanently reside at the facility. During a final staff interview with the Nursing Home Administrator and DON on April 23, 2025, at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395915 If continuation sheet Page 4 of 12 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 395915 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Transitions Healthcare Allens Cove 25 Cove Road Duncannon, PA 17020 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 10:53 AM, the DON confirmed that facility staff should have followed up and made sure Resident 24 had her annual cardiology appointment and remote pacemaker checks when the cardiology office did not follow up with the facility. 28 Pa. Code 211.12(c)(d)(1)(3)(5) Nursing services Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395915 If continuation sheet Page 5 of 12 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 395915 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Transitions Healthcare Allens Cove 25 Cove Road Duncannon, PA 17020 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on review of clinical records and staff interviews, it was determined that the facility failed to provide restorative nursing care for range of motion exercises for one of three residents reviewed for position and mobility (Resident 29). Findings include: Review of Resident 29's clinical record revealed diagnoses that included peripheral vascular disease (a slow and progressive circulation disorder) and hypertension (high blood pressure). Review of Resident 29's clinical record revealed a Restorative Program Progress Note written on February 24, 2025, at 12: 17 PM, that read, in part, restorative nursing programs from passive range of motion (PROM) of right upper extremity (RUE) and right lower extremity (RLE) and active range of motion (AROM) of left lower extremity (LLE) continue. Resident 29 has a diagnosis of flaccid hemiplegia to right side; she is able to tolerate both PROM programs to right upper and lower extremities and continues to participate and complete three sets of ten reps for each of the exercises listed within the AROM LLE programs. Review of Resident 29's clinical record revealed a restorative nursing program task for AROM of LLE for 15 minutes twice daily. Further review of the documentation for restorative nursing revealed that for April 2025, there were 13 days where restorative nursing was not completed twice a day or was marked as not applicable. Review of Resident 29's clinical record revealed a restorative nursing program task for PROM of RLE for 15 minutes twice daily. Further review of the documentation for restorative nursing revealed that for April 2025, there were 13 days where restorative nursing was not completed twice a day or was marked as not applicable. Review of Resident 29's clinical record revealed a restorative nursing program task for PROM of RUE for 15 minutes twice daily. Further review of the documentation for restorative nursing revealed that for April 2025, there were 12 days where restorative nursing was not completed twice a day or was marked as not applicable. During an interview with the Nursing Home Administrator on April 23, 2025, at 10:35 AM, revealed that he would expect for Resident 29 to receive restorative nursing program services twice daily. 28 Pa. Code 211.12(d)(1)(5) Nursing services 28 Pa. Code 211.12(d)(3) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395915 If continuation sheet Page 6 of 12 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 395915 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Transitions Healthcare Allens Cove 25 Cove Road Duncannon, PA 17020 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on facility policy review, observation, staff interview, and facility document review, it was determined that the facility failed to store medications under proper temperature controls in one of one medication rooms reviewed. Findings include: Review of facility policy, titled Storage of Medications with a last revised date of August 2020, and a last review date of May 2024, revealed the following: II. Temperature 1. All medications are maintained within the temperature ranges noticed in the United States Pharmacopeia (USP) and by the Centers for Disease Control (CDC); c. Refrigerated: 36°F to 46°F (2°C to 8°C) with a thermometer to allow temperature monitoring; 2. Medications and biologicals are stored at their appropriate temperatures and humidity according to the USP guidelines for temperature ranges; 4. Medications requiring refrigeration are kept in a refrigerator at temperatures between 36°F (2°C) and 46°F (8°C) with a thermometer to allow temperature monitoring; and 6. The facility should maintain a temperature log in the storage area to record temperatures at least once a day or in accordance with facility policy. Observation of the medication room refrigerator on April 22, 2025, at 9:06 AM, with Employee 2, revealed that the thermometer was sitting inside the small freezer portion of the refrigerator, which had approximately one inch of ice build-up and the temperature read 20 degrees Fahrenheit (F). Review of facility provided medication room refrigerator temperature log for April 2025 revealed the following: April 1 temperature was recorded as 18 degrees F; April 2 temperature was recorded as 34 degrees F; April 3 temperature was recorded as 32 degrees F; April 6 temperature was recorded as 34 degrees F; April 7 temperature was recorded as 34 degrees F; April 8-11 no temperatures were recorded; April 12 temperature was recorded as 34 degrees F; and April 13 temperature was recorded as 32 degrees F. During a staff interview with the Nursing Home Administrator (NHA) and Director of Nursing on April 22, 2025, at 2:38 PM, the NHA indicated that he would expect medications to be stored at appropriate temperatures and that temperatures would be taken and recorded daily. 28 Pa. Code 201.18(b)(1) Management (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395915 If continuation sheet Page 7 of 12 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 395915 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Transitions Healthcare Allens Cove 25 Cove Road Duncannon, PA 17020 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 0761 28 Pa. Code 211.9(a)(1) Pharmacy services Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12(c)(d)(2)(3) Nursing services Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395915 If continuation sheet Page 8 of 12 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 395915 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Transitions Healthcare Allens Cove 25 Cove Road Duncannon, PA 17020 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 - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on facility policy review, observations, and staff interviews, it was determined that the facility failed to store food and utilize kitchen equipment in accordance with professional standards for food service safety in the main kitchen. Findings include: Review of facility policy, titled Food Storage last reviewed May 31, 2024, read, in part, All stock must be rotated with each new order received. Rotating stock is essential to assure the freshness and highest quality of all foods. All containers or storage bags must be legible and accurately labeled and dated. All foods should be covered, labeled, and dated and routinely monitored to assure that foods will be consumed by their safe use by dates, or frozen (where applicable), or discarded. Observation in the dry storage area on April 21, 2025, at 10:03 AM, revealed four bags of white bread with a use by date of March 22, 2024, and six packs of English muffins not dated. Observation of the dish machine in the main kitchen on April 21, 2025, at 10:07 AM, revealed it was heavily soiled with a brown substance on the top; further observation revealed a brown substance consistent with food debris was observed in the corners of the top of the dish machine. Observation of the exhaust vent over top of the dish machine in the main kitchen on April 21, 2025, at 10:08 AM, revealed it was soiled with a fuzzy black substance. Interview with Employee 4 (Dietary Manager) on April 21, 2025, at 10:08 AM, revealed she was unsure of where the substance on the dish machine was coming from, that a kitchen staff member had just wiped the entire machine down three days prior, and she was unsure about when maintenance staff had last cleaned the exhaust hood. Observation of the dish machine temperature log in the main kitchen on April 21, 2025, at 10:09 AM, revealed the record final rinse temperature was below the minimum safe temperature during breakfast on April 7, 10, and 20, 2025. Further observation of the log failed to reveal any corrective action noted on those days. Observation in the walk-in refrigerator on April 21, 2025, at 10:11 AM, revealed a tub of hard-boiled eggs that was dirty on the top and not properly sealed. Further observation of the tub revealed the eggs had a use by date of February 23, 2025. Observation in the main kitchen on April 21, 2025, at 10:14 AM, revealed one bag of white bread open with a half of a loaf left. Further observation of the bread revealed a use by date of March 11, 2025. Review of the March 2024 dish machine temperature log revealed the record final rinse temperature was below the minimum safe temperature during breakfast on March 22-24, 30, and 31; during lunch on March 12-14, 18, 20, 21, 24, and 27; and during dinner on March 1, 11-13, 15, 19, 20, 24, 25, 27, 29, and 30. Further observation of the log failed to reveal any corrective action noted on those days. Return visit to the kitchen on April 22, 2025, at 12:29 PM, revealed the dish machine remained (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395915 If continuation sheet Page 9 of 12 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 395915 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Transitions Healthcare Allens Cove 25 Cove Road Duncannon, PA 17020 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 - Some dirty with a brown substance on the top and a brown substance consistent with food debris was observed in the corners of the top of the dish machine. Observation of the exhaust vent over top revealed it was soiled with a fuzzy black substance. Interview with Employee 4 on April 22, 2025, at 12:46 PM, revealed staff should be regularly cleaning kitchen equipment and surfaces daily, but that she does not have a routine cleaning schedule checklist for review. Follow-up interview with Employee 4 on April 22, 2025, at 12:54 PM, revealed she was unable to locate dish machine temperature logs from July 2024 to December 2024. During an interview with the Nursing Home Administrator (NHA) on April 22, 2025, at 2:12 PM, the surveyor revealed the concern with food storage in the kitchen, as well as the dirty kitchen equipment, rinse temperature below safe minimum temperature on select days, and lack of dish machine temperature logs for review from July 2024 to December 2024. The NHA revealed his expectation that expired items are discarded, foods items are labeled and dated per facility policy, and food items and kitchen equipment are stored, cleaned, and utilized in accordance with professional standards. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 211.6(f) Dietary services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395915 If continuation sheet Page 10 of 12 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 395915 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Transitions Healthcare Allens Cove 25 Cove Road Duncannon, PA 17020 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 review of facility policies, observations, and staff interviews, it was determined that the facility failed to maintain an effective infection control program related to the preparation and administration of medications for three of three residents observed (Residents 9, 27, and 155). Residents Affected - Few Findings include: Review of facility policy, titled General Guidelines for Medication Administration with a last revised date of August 2020, and a last review date of May 2024, revealed the following, The person administering medications adheres to good hand hygiene, which includes washing hands thoroughly: i. Before beginning a medication pass; ii. Prior to handling any medication; iii. After coming into direct contact with a resident and Hand sanitization is done with a facility approved sanitizer ii. At regular intervals during the medication pass such as after each room, again assuming handwashing is not indicated. Review of facility policy, titled Transitions Healthcare Allen's Cove IC-Infection Control Plan 2024 with a last revision date of September 1, 2024, revealed, Enhanced Barrier Precautions (EBP) are an infection control intervention designed to reduce transmission of MDRO's [multiple drug resistant organism] through gown and glove use by HCP [health care providers] in long-term care settings in accordance with the CDC [Centers for Disease Control] .EBP are recommended during high contact care .activities with residents who are at higher risk of acquiring or spreading an MDRO such as Residents with .indwelling medical devices .e[xample g[[NAME]] central line (a catheter placed into a large vein used to administer medication or fluids). Review of facility policy, titled IC-519 Glucometer Cleaning, Disinfecting and Use with a last revised date of October 1, 2017, and a last review date of May 2024, revealed, 1. All glucometers [device used to test blood sugar level] must be cleaned and disinfected after each use and between residents as follows: a) Clean the outside of the glucometer with a damp cloth with soap and water or an alcohol swab to remove any visible blood or body fluids. b) Disinfect the meter using a pre-moistened germicidal disposable wipe (PDI). During a medication pass observation on April 22, 2025, at approximately 8:30 AM, Employee 2 removed her gloves after administering an insulin injection to Resident 9, administered Resident 9 her oral medications, returned to the medication cart, and then began to prepare Resident 27's medications for administration. During the ongoing medication pass observation on April 22, 2025, at approximately 8:36 AM, Employee 2 entered Resident 27's room and was observed applying gloves to perform a blood glucose test. Resident 27 requested that the window be closed, and Employee 2 was observed using her gloved right hand to close the window and then proceeded to perform the glucose test. After completion of the test, Employee 2 returned to her medication cart and wiped down the glucometer with an alcohol pad. She then wrapped the glucometer in an alcohol pad and placed it in a clear plastic cup on top of the medication cart. Employee 2 indicated that she was not sure how the glucometer was to be cleaned, but that this is how she does it. Employee 2 removed her gloves and began to prepare the rest of Resident 27's medications when she was notified that Resident 155's intravenous medication administration pump was beeping. Employee 2 then proceeded to Resident 155's room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395915 If continuation sheet Page 11 of 12 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 395915 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Transitions Healthcare Allens Cove 25 Cove Road Duncannon, PA 17020 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 Observation of Resident 155's room on April 22, 2025, at approximately 8:39 AM, revealed that an Enhanced Barrier Precautions (EBP) sign was posted outside the door to the room, which indicated that staff were to wash/cleanse hands before entering the room and that staff should wear gloves and gowns when caring for a central line. During the ongoing medication pass observation on April 22, 2025, at approximately 8:40 AM, Employee 2 entered Resident 155's room without cleansing her hands, applied gloves, and flushed Resident 155's central line. Employee 2 then left the room and discarded intravenous fluid bag in the biohazard container in the dirty utility room. Employee 2 then cleansed her hands with hand sanitizer. This was the first observation of hand cleansing since medication pass observation began at 8:26 AM. During a medication pass observation on April 22, 2025, at approximately 8:46 AM, Employee 2 was observed to apply gloves in preparation of administering Resident 27 an insulin injection. Resident 27 requested that her trash can be moved closer to her chair. Employee 2 scooted the trash can across the floor with her feet, but when she got to Resident 27's chair, she used her gloved left hand to pick up the open top trash can and place it where Resident 27 requested. Employee 2 then proceeded to administer Resident 27's insulin injection wearing the same gloves. Employee 2 then removed her gloves and applied another pair of gloves to administer Resident 27 her nasal spray and her oral medications. Employee 2 then removed her gloves and used hand sanitizer to cleanse her hands. During a staff interview with Employee 2 on April 22, 2025, at 9:06 AM, Employee 2 indicated that she should have cleansed her hands between residents, between glove changes, and that she thought she only needed to wear a gown for a resident on EBP if she was going to be in close contact. After reading the EBP posting, Employee 2 confirmed that she should have worn a gown when flushing Resident 155's central line. During a staff interview with the Nursing Home Administrator (NHA) and Director of Nursing (DON) on April 22, 2025, at 2:36 PM, the NHA and DON confirmed that they would expect staff to follow personal protective equipment guidance for EBP and to wash and/or cleanse hands when changing gloves, between residents, and after touching dirty items. During a staff interview with the NHA on April 23, 2025, at 10:53 AM, the NHA confirmed that he would expect nursing staff to follow the facility glucometer cleaning policy. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.10(d) Resident care policies 28. Pa Code 211.12(c)(d)(1)(2)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395915 If continuation sheet Page 12 of 12