Inspection·December 1, 2023

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of clinical records, facility documents, and resident and staff interviews, it was determined that the facility failed to provide appropriate assistance to prevent avoidable falls for one of five residents reviewed (Resident R7), and failed to document the appropriate assistance level for seven of eighteen residents (R8, R9, R10, R11, R12, R13, and R14) Findings include: Review of the clinical record indicated Resident R7 was admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS - periodic assessment of resident care needs) dated 8/29/23, revealed diagnoses of high blood pressure, and syncope and collapse (loss of consciousness with subsequent fall). Review of Section G: Functional Status indicated Resident R7 required extensive assistance of two or more persons for bed mobility, transfers, dressing, toilet use, and personal hygiene. Review of Resident R7's physician orders dated 10/8/22, indicated Transfers with assist x2. Review of Resident R7's [NAME] (document that outlines the patients' ADLs, continence levels, and behaviors, as well as physician, advanced directives, diet, and allergies. utilized by nurse aide staff) as of 11/24/23, indicated Provide two persons guidance and physical assist. Review of a progress note for Resident R7 dated 11/25/23, at 2:58 p.m. indicated Resident witnessed slide on floor during transfer to bed. No Injuries. Review of facility provided documentation dated 11/25/23, indicated Call to unit due to staff report that resident had witnessed fall while transferring from W/C (wheelchair) to bed. Review of a facility provided witness statement dated 11/25/23, indicated, This CNA (NA, nurse aide) attempted to transfer (Resident R7) into bed. Resident then threw herself to ground on her butt. RN (registered nurse) notified. Charge nurse notified. During an interview and observation on 12/1/23, at 1:32 p.m. NA Employee E3 was asked how she knows what level of staff assistance for transfers is appropriate for a resident. NA Employee E3 demonstrated entering the electronic point of care charting portal, and opening the resident's [NAME] to see the assistance level. During an interview and observation on 12/1/23, at 1:35 p.m. NA Employee E4 was asked how she knows what level of staff assistance for transfers is appropriate for a resident. NA Employee E4 stated that she utilizes paper resident lists with the transfer level printed on the sheets. NA Employee E4 further stated that this resident list was updated yesterday. Review of the resident list, containing 18 residents, indicated the following: -Resident R8's physician's order dated 7/14/22, indicated transfers with assist of a Hoyer lift (mechanical device to lift patients), the facility transfer sheet indicated assist of two without including the need of a Hoyer lift. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395948 If continuation sheet Page 2 of 8 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 395948 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center at Jefferson Hills, The 540 Coal Valley Road Jefferson Hills, PA 15025 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 - Minimal harm or potential for actual harm -Resident R9's physician's order dated 9/8/23, indicated transfers with assist of one, the facility transfer sheet did not provide an assistance level. -Resident R10's physician's order dated 10/18/22, indicated transfers with assist of two, the facility transfer sheet indicated transfers with assist of one. Residents Affected - Some -Resident R11's physician's order dated 11/29/23, indicated transfers with assist of one, the facility transfer sheet did not provide an assistance level. -Resident R12's physician's order dated 11/17/23, indicated transfers with assist of two, the facility transfer sheet indicated transfers with assist of one. -Resident R13's physician's order dated 10/12/23, indicated transfers with assist of two, the facility transfer sheet indicated transfers with assist of one or two. -Resident R14's physician's order dated 11/3/23, indicated transfers with assist of two, the facility transfer sheet indicated assist of one. During an interview on 12/1/23, at approximately 2:30 p.m. the Nursing Home Administrator confirmed that the facility failed to provide appropriate assistance to prevent avoidable falls for one of five residents reviewed, and failed to document the appropriate assistance level for seven of eighteen residents. 28 Pa. Code 201.18(e)(1) Management. 28 Pa. Code 201.20(a)(b) Staff development. 28 Pa. Code 201.29(a)(c)(d) Resident rights. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395948 If continuation sheet Page 3 of 8 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 395948 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center at Jefferson Hills, The 540 Coal Valley Road Jefferson Hills, PA 15025 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, resident clinical record and staff interviews it was determined that the facility failed to make certain that appropriate treatment and services were provided for three of six residents with a urinary catheter (Resident R4, R5, and R6). Findings include: Review of the Centers for Disease Control guidance Guideline for Prevention of Catheter-Associated Urinary Tract Infections updated 6/6/19, indicated to not rest the collecting bag on the floor. The facility policy Catheter Care dated 7/1/23, indicated catheter care is provided to prevent infection and reduce irritation. Review of admission record indicated that Resident R4 was admitted on [DATE]. Review of Resident R4's Minimum Data Set (MDS, periodic assessment of resident care needs) dated 9/26/23, included diagnoses of diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time) and history of a stroke. Review of a physician's order dated 9/29/23, indicated the insertion of an indwelling urinary catheter. During an observation on 12/1/23, at 11:49 a.m. Resident R4 was in bed, with her urinary drainage bag, laying uncovered on its side on the floor, with no privacy cover. Review of admission record indicated that Resident R5 was admitted on [DATE]. Review of Resident R5's MDS dated [DATE], included diagnoses of Parkinson's disease (neuromuscular disorder causing tremors and difficulty walking) and diabetes. Section H - Bladder and Bowel indicated the utilization of an indwelling catheter. During an observation on 12/1/23, at 1:52 p.m. Resident R5 was in her room, with the catheter bag on the door side of her bed, visible from the door. Resident R5's catheter bag did not have a privacy cover. Review of admission record indicated that Resident R6 was admitted on [DATE]. Review of Resident R6's MDS dated [DATE], included diagnoses of chronic obstructive pulmonary disease (COPD, a group of progressive lung disorders characterized by increasing breathlessness) and obstructive uropathy (condition where the flow of urine is blocked). Section H - Bladder and Bowel indicated the utilization of an indwelling catheter. During an observation on 12/1/23, at 1:59 p.m. Resident R6 was in his room, with the catheter bag on the door side of his bed, visible from the door. Resident R6's catheter bag did not have a privacy cover. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395948 If continuation sheet Page 4 of 8 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 395948 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center at Jefferson Hills, The 540 Coal Valley Road Jefferson Hills, PA 15025 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 0690 Level of Harm - Minimal harm or potential for actual harm During an interview on 12/1/23, at 2:30 p.m. the Nursing Home Administrator and the Director of Nursing confirmed the facility failed to make certain that appropriate treatment and services were provided for three of six residents with a urinary catheter. 28 Pa Code: 201.14 (a) Responsibility of licensee Residents Affected - Some 28 Pa code: 211.10 (c)(d) Resident care policies 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395948 If continuation sheet Page 5 of 8 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 395948 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center at Jefferson Hills, The 540 Coal Valley Road Jefferson Hills, PA 15025 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records, and staff interview, it was determined that the facility failed to implement procedures to ensure availability of prescribed medications for three of four residents (Residents R1, R2, and R3). Findings include: Review of the facility census information indicated Resident R1 was admitted to the facility on [DATE]. Review of the facility diagnosis list included rheumatoid arthritis (chronic, painful inflammatory disorder affecting many joints, including those in the hands and feet) and aftercare following joint replacement surgery. Review of a physician's order dated 9/29/23, written at 12:52 p.m. indicated Resident R1 was to receive gabapentin (medication that can be used to treat pain) 100 mg (milligrams) by mouth every 24 hours as needed pain. Review of a physician's order dated 9/29/23, written at 1:37 p.m. indicated Resident R1 was to receive oxycodone (opioid medication to relieve pain) 10 mg by mouth every six hours as needed for severe pain. Review of a physician's order dated 9/29/23, written at 1:40 p.m. indicated Resident R1 was to receive oxycodone 5 mg by mouth every six hours as needed for moderate pain. Review of a physician's order dated 9/29/23, written at 9:19 p.m. indicated Resident R1 was to receive acetaminophen (Tylenol, medication used to treat pain) 650 mg by mouth every six hours as needed for pain. Review of a physician's order dated 9/30/23, written at 12:29 p.m. indicated Resident R1 was to receive daptomycin (intravenous antibiotic medication) 500 mg one time per day. Review of a progress note written by Licensed Practical Nurse (LPN) Employee E1 on 9/29/23, at 10:39 p.m. indicated that Resident R1 arrived at the facility, and complained of eight out of ten level of pain upon admission. Review of a progress note dated 9/30/23, at 8:35 a.m. indicated Resident R1 arrival time at the facility was 9/29/23, at 9:30 p.m. Review of the facility provided inventory for the Omnicell (automated medication dispensing machine) included gabapentin 100 mg capsules, oxycodone 5 and 10 mg tablets. During an observation of the South Unit medication cart on 12/1/23, at 11:36 a.m. revealed that acetaminophen is available as a stock medication. Review of Resident R1's Medication Administration Record (MAR) for September 2023, failed to reveal documentation that Resident R1 was provided gabapentin, oxycodone, or Tylenol for her documented pain on 9/29/23. Review of Resident R1's Medication Administration Record (MAR) for October 2023, failed to reveal (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395948 If continuation sheet Page 6 of 8 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 395948 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center at Jefferson Hills, The 540 Coal Valley Road Jefferson Hills, PA 15025 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 0755 documentation that Resident R1 was provided daptomycin on 10/1/23. Level of Harm - Minimal harm or potential for actual harm Review of a progress note dated 10/1/23, at 10:32 a.m. indicated, for the daptomycin order, Waiting for pharmacy delivery of medication. Residents Affected - Some Review of the clinical record indicated Resident R2 was admitted to the facility on Tuesday, 11/21/23. Review of the facility diagnosis list included chronic obstructive pulmonary disease (COPD, a group of progressive lung disorders characterized by increasing breathlessness) and hypothyroidism (condition in which the thyroid gland doesn't produce enough hormone, affecting heart rate, temperature, and metabolism). Review of a physician's orders dated 11/22/23, at 1:56 p.m. indicated Resident R2 was to receive Cholecalciferol (Vitamin D3) 10 mcg (micrograms) once daily. Review of a physician's orders dated 11/22/23, at 2:07 p.m. indicated Resident R2 was to receive levothyroxine (medication to treat hypothyroidism) 50 mcg once daily. Review of Resident R2's Medication Administration Record (MAR) for November 2023, indicated: 11/22/23 Levothyroxine (6:00 a.m.) and Cholecalciferol (9:00 a.m.) were documented as 9 (9 is code for order Other/See Nurse Notes). Review of a progress note dated 11/22/23, at 5:16 a.m. indicated, for the levothyroxine order, Medication has not arrived. Review of a progress note dated 11/22/23, at 10:18 a.m. indicated, for the Cholecalciferol order, On order from pharmacy. RN (registered nurse) supervisor aware. Review of the facility provided inventory for the Omnicell included Levothyroxine 50 mcg tablets. Review of the clinical record indicated Resident R3 was admitted to the facility on [DATE]. Review of the facility diagnosis list included heart failure (a progressive heart disease that affects pumping action of the heart muscles) and high blood pressure. Review of a physician's order dated 11/28/23, at 4:50 p.m. indicated Resident R3 was to receive dorzolamide 2% (a medication to treat high eye pressure) 1 drop at bedtime. Review of a physician's order dated 11/28/23, at 4:54 p.m. indicated Resident R3 was to receive gabapentin 300 mg at bedtime, for nerve pain. Review of a physician's order dated 11/28/23, at 5:01 p.m. indicated Resident R3 was to receive Metoprolol (a medication to treat high blood pressure) 50 mg twice daily. Review of Resident R2's Medication Administration Record (MAR) for November 2023, indicated: 11/28/23, at 9:00 p.m.: Gabapentin, dorzolamide, and metoprolol were documented as 16 (16 is code for order Hold/See Nurse Notes). Review of progress notes for Resident R3 dated 11/14/23 at 9:07 a.m. and 9:08 a.m., revealed that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395948 If continuation sheet Page 7 of 8 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 395948 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rehabilitation Center at Jefferson Hills, The 540 Coal Valley Road Jefferson Hills, PA 15025 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 0755 the above medications were documented as on order. Level of Harm - Minimal harm or potential for actual harm Review of the facility provided inventory for the Omnicell included gabapentin 300 mg capsules and metoprolol 50 mg tablets. Residents Affected - Some During an interview on 12/1/23, at approximately 2:30 p.m. the Nursing Home Administrator and the Director of Nursing confirmed that the facility failed to implement procedures to ensure availability of prescribed medications for three of four residents. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395948 If continuation sheet Page 8 of 8