Inspection·March 7, 2024

F 0658 Review of a physician's order dated 10/26/23, indicated for Resident R37 to receive a psychology consult. Level of Harm - Minimal harm or potential for actual harm Review of Resident R37's clinical record failed to include a consultation completed with a psychological provider. Residents Affected - Few Review of Resident R37's plan of care for the use of psychotropic medications related to risk for negative mood/behavior related to a history of depression dated initiated 3/5/24, failed to include any goals or interventions related to behavior monitoring. Review of behavior charting from October 2023, through February 2024, revealed the following: October - Resident R37 documented as having no behaviors. November - Behaviors not assessed. December - Resident R37 documented as having no behaviors. January - Resident R37 documented as having no behaviors. February - Resident R37 documented as having no behaviors. During an interview on 3/7/24, at approximately 2:00 p.m. the Nursing Home Administrator confirmed that the facility failed to make certain that each resident's drug regimen was free from unnecessary drugs used without adequate indications and failed to provide medications in accordance with manufacturer's instructions for use for one of five 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 2 of 11 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 03/07/2024 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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 policy, clinical record review, and staff interview, it was determined that the facility failed to provide prescribed treatment and services related to the care of pressure ulcers for one of five residents (Resident R35). Residents Affected - Few Findings include: Review of the facility policy Pressure Ulcer Review dated 12/11/23, previously reviewed 7/1/23, indicated that a resident with a pressure ulcer receives the necessary treatment and services to promote healing, prevent infections, and prevent new development. Review of the clinical record indicated Resident R35 was admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS - periodic assessment of care needs) dated 1/31/24, included the diagnoses of diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time) and Down syndrome (a genetic disorder causing developmental and intellectual delays). Review of a physician's order dated 1/3/24, to start on 1/4/24, indicated for staff to cleanse coccyx (area at the base of the spinal column) with normal saline, pat dry, apply collagen cover with calcium alginate (absorptive wound dressing ), cover with bordered gauze every day and as needed. Review Resident R35's care plan dated for actual/potential for skin integrity impairment initiated 12/21/22, indicated for staff to administer treatments as ordered and monitor for effectiveness. Review of Resident R35's Treatment Administration Record for January 2024 revealed that no documentation for completion of Resident R35's coccyx wound treatment completed from 1/4/24, through 1/15/24. Review of a wound nurse nurse practitioner's progress note dated 1/17/24, at 6:51 p.m. indicated Wound has deteriorated since last evaluation. Over the last few evaluations, the wound bed has been very clean with beefy red tissue. The wounds have converted to two separate areas; left and right buttock. They both have new foul drainage & slough (dead tissue that needs to be removed for wound to heal); as well as deeper depth. Concern for abscess pocket on the left buttock at the 5 o'clock location, when probed there is increased yellow drainage. Wound culture was sent due to abrupt change in wound appearance. Review of a progress note dated 1/20/24, at 3:47 a.m. indicated This nurse was called to residents room to look at wound on coccyx (right/left top buttock). Foul smell is present with gross amounts of foul smelling yellow/brown purulent (containing or producing pus) drainage. Left open area is 1 centimeter (cm) in diameter with tunneling (a wound that's progressed to form passageways underneath the surface of the skin) at 3 o'clock, 1cm tunneling six o'clock. Right open area slough is present with gross amounts or yellow foul smelling purulent drainage and tunnels at 3 o'clock of 1cm. Review of a progress note dated 1/21/24, at 3:49 a.m. indicated This nurse was called to room by staff due to dressing being saturated with foul copious amounts of purulent drainage. While performing wound care it was discovered that resident now has an open area in gluteal fold (horizontal crease (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395948 If continuation sheet Page 3 of 11 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 03/07/2024 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few of the buttock) midline to anus that tunnels to the original wound that measured 5 x 5 cm. As a nursing measure I cleaned entire area with normal saline and packed with 1/4 packing and Dakins (antiseptic solution) as calcium alginate and Santyl (ointment to remove dead skin) are futile at this time. Review of a progress note dated 1/22/24, at 6:42 p.m. indicated Wound Care Nurse was sent pictures of wound to coccyx and wanted the resident sent to the hospital for intravenous antibiotics. Resident was sent to [the hospital]. Review of a progress note dated 1/26/24, at 1:26 p.m. indicated Resident R35 returned to the facility. Review of a nurse practitioner follow-up dated 1/30/24, indicated that Resident R35 was hospitalized last week for a worsening wound. During an interview on 3/7/24, at approximately 2:00 p.m. the Nursing Home Administrator confirmed the facility failed to provide prescribed treatment and services related to the care of pressure ulcers for one of five residents. 28 Pa. Code: 211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395948 If continuation sheet Page 4 of 11 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 03/07/2024 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 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of facility documentation and staff and resident interviews, it was determined the facility failed to ensure the provision of a substantial evening snack to the residents when up to 16 hours elapsed from the supper meal to breakfast the next day, and failed to [NAME] resident group acceptance of a meal span of greater than 14 hours. Findings include: Review of facility's scheduled meal times revealed meal times revealed greater than 14 hours between dinner and breakfast. Breakfast: North Unit 9:00 a.m.; South Unit 9:10 a.m. Lunch: North Unit 1:00 p.m.; South Unit 1:10 p.m.; Dining Hall 1:15 p.m. Dinner: North Unit 5:00 p.m.; South Unit 5:10 p.m. During a resident group interview on 3/5/24, at 2:00 p.m. the residents stated that snacks at night are usually potato chips or snack puddings. On 3/7/24, at approximately 10:30 a.m. documentation was requested from Activities Director Employee E3 that the resident group agreed to this meal span. During an interview on 3/7/24, at approximately 2:00 p.m. the Nursing Home Administrator confirmed the facility failed to ensure the provision of a substantial evening snack to the residents when up to 16 hours elapsed from the supper meal to breakfast the next day, and failed to [NAME] resident group acceptance of a meal span of greater than 14 hours. 28 Pa. Code 211.6(a)(b) Dietary services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395948 If continuation sheet Page 5 of 11 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 03/07/2024 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 0847 Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse. Level of Harm - Minimal harm or potential for actual harm Based on review of facility documents, resident and staff interviews it was determined that the facility failed to ensure the residents' right to not enter into a binding arbitration agreement as a condition of admission for 44 of 44 admitted residents. Residents Affected - Many Findings include: Review of the admission Packet list attachments as Attachment P Voluntary Arbitration Agreement. Review of the Arbitration Agreement indicated that the agreement is voluntary. The agreement has been explained to the Resident and his or her Representative in a form and manner that he or she understands. The signature section at the end of the agreement stated THE EXECUTION PAGE MUST BE SIGNED BY EITHER THE RESIDENT OR THE RESIDENT'S REPRESENTATIVE. This section did not include options to agree or disagree to enter into the binding arbitration agreement, or a refusal to sign. Review of facility census information indicated 44 residents were admitted to the facility from 1/1/24, through 3/7/24. During an interview on 3/7/24, at 11:00 a.m. Business Office Manager (BOM) Employee E2 confirmed that all residents sign the arbitration agreement. BOM Employee E2 stated that when she was trained on admissions procedures she was told that all residents needed to sign. BOM Employee E2 confirmed that the arbitration agreement forms did not provide the option of refusing to enter into the agreement, and that the signature of the resident or the resident's representative conveyed acceptance of the arbitration agreement. During an interview on 3/7/24, at 11:14 a.m. the Nursing Home Administrator confirmed that the facility failed to ensure the residents' right to not enter into a binding arbitration agreement as a condition of admission. 28 Pa. Code 201.14(a)Responsibility of Licensee. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395948 If continuation sheet Page 6 of 11 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 03/07/2024 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 0848 Provide a neutral and fair arbitration process and agree to arbitrator and venue. Level of Harm - Minimal harm or potential for actual harm Based on review of the facility's admission agreement and staff interviews, it was determined that the facility failed to ensure a neutral and fair arbitration process by ensuring both the resident or his or her representative, and the facility agree on the selection of a neutral arbitrator for 44 of 44 residents admitted . Residents Affected - Some Findings include: Review of facility's admission Agreement packet, which contained the document Voluntary Arbitration Agreement indicated that Accordingly, any dispute arising out of relating to the provision of services by the Facility to the Resident, Resident's admission to the Facility, Resident's contracts with the Facility or the subject matter thereof, any breach of contract, including any dispute regarding the execution, validity or scope of this Arbitration Agreement or any of its clauses, will be resolved through arbitration administered by [name of arbitrator services company which the facility utilized] and conducted pursuant to the [arbitrator] Rules of Procedure for Arbitration. The facility's arbitration agreement failed to provide for the selection of a neutral arbitrator agreed upon by both parties as one is designated in the facility arbitration agreement, in accordance with §483.70(n)(2)(iii). (Regulatory guidance defined a neutral Arbitrator as an impartial, or unbiased third-party decision maker, contracted with, and agreed to by both parties to resolve their dispute. To ensure a neutral arbitrator is selected, the facility should avoid even the appearance of bias, partiality, or a conflict of interest, and should promptly disclose to the resident or his or her representative the extent of any relationship which exists with an arbitrator or arbitration services company, including how often the facility has contracted with the arbitrator or arbitration service, and when the arbitrator or arbitration service has ruled for or against the facility). During an interview on 3/7/24, at 11:14 p.m. the Nursing Home Administrator confirmed the language of the arbitration agreement may appear not to afford the selection of a neutral arbitrator as it indicated that all arbitration are administered by the facility's contracted arbitration service. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(2) Management. 28 Pa. Code 201.29(a)(j) Resident rights. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395948 If continuation sheet Page 7 of 11 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 03/07/2024 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy, water testing logs and staff interview, it was determined that the facility failed to implement an effective Water Management Program for the prevention and control of water-borne contaminants, such as Legionella (a bacteria that may cause Legionnaires' Disease, a serious type of pneumonia) for eleven of eleven months (April 2023 through February 2024). Residents Affected - Many Findings include: A review of the facility policy Legionnaires' Disease Infection Control and Monitoring Policy dated 2/12/24, did not include a water management program based on framework outlined in ASHRAE and CDC Standards identified as per the Maintenance Director Employee E1 and confirmed with the Nursing Home Administrator to minimize risk for Legionella associated with the building water systems at The Rehabilitation Center at [NAME] Hills. During an interview on 3/7/24, at 1:00 p.m., Maintenance Director Employee E1 and the Nursing Home Administrator confirmed that the facility did not implement and effective water management program for the prevention and control of water-borne contaminants, such as Legionella since 2023. 28 Pa. Code: 201.14(a) Responsibility of licensee. 28 Pa. Code:201.18(b)(1)(e)(1) Management. 28 Pa. Code: 201.20(c) Staff development. 28 Pa. Code: 211.10(d) Resident care policies. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395948 If continuation sheet Page 8 of 11 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 03/07/2024 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 0941 Level of Harm - Potential for minimal harm Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members. Based on review of facility policy and staff interviews, it was determined that the facility failed to provide training on effective communication to facility staff. Residents Affected - Many Findings include Review of the policy Staff Development dated 12/11/23, previously reviewed 7/1/23, indicated the facility will provide all active employees with required training and education to include mandatory and corporately recommended staff training programs. Review of faciltiy provided education documents failed to include that provision of training the facility staff on Effective Communication. During an interview on 3/7/24, at approximately 2:00 p.m. the Nursing Home Administrator confirmed the facility failed to provide training on effective communication to facility staff. 28 Pa. Code 201.20(a)(b)(c)(d) Staff Development. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395948 If continuation sheet Page 9 of 11 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 03/07/2024 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 0944 Level of Harm - Potential for minimal harm Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program. Based on review of facility policy and staff interviews, it was determined that the facility failed to provide training on the Quality Assurance and Performance Improvement (QAPI) program to facility staff. Residents Affected - Many Findings include Review of the policy Staff Development dated 12/11/23, previously reviewed 7/1/23, indicated the facility will provide all active employees with required training and education to include mandatory and corporately recommended staff training programs. Review of faciltiy provided education documents failed to include that provision of training the facility staff on the QAPI program. During an interview on 3/7/24, at approximately 2:00 p.m. the Nursing Home Administrator confirmed the facility failed to provide training on the QAPI program to facility staff. 28 Pa. Code 201.20(a)(b)(c)(d) Staff Development. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395948 If continuation sheet Page 10 of 11 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 03/07/2024 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 0947 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. Based on review of facility policy, staff education records, and staff interviews, it was determined that the facility failed to conduct at least 12 hours of in-service education, within 12 months of their hire date anniversary, for nurse aides as required for three of three nurse aides (Employees E4, E5, and E6). Finding include: Review of the policy Staff Development dated 12/11/23, previously reviewed 7/1/23, indicated Nursing assistants shall receive at least 12 hours of in-service per year. Review of Nurse Aide (NA) Employees E4, E5, and E6 education records revealed that each NA had documentation of eight hours of in-service training, and additional plan of correction training on abuse and neglect, visitation, and transfer status. During an interview on 3/7/24, at approximately 2:00 p.m. the Nursing Home Administrator confirmed that the facility failed to provide documentation of the required 12 hours annual in-service education within 12 months of their hire date anniversary for three of three nurse aides. 28 Pa. Code: 201.14(a) Responsibility of licensee. 28 Pa. Code: 201.20(c) Staff development. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395948 If continuation sheet Page 11 of 11