Inspection·October 24, 2024

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. Based on review of facility policy, resident grievances for 90 days, and resident and staff interviews, it was determined that the facility failed to effectively resolve and provide responses to residents and/or their responsible parties in a timely manner in relation to concerns documented via Grievance procedure and complete the reports in their entirety for four of seven grievances reviewed. Findings include: Review of facility policy Resident Grievances and Concerns Policy dated 1/2/24, indicated upon receipt of an oral, written, or anonymous grievance submitted by a resident, the Grievance Official will take immediate action to prevent further potential violations of any resident right while the alleged violation is being investigated, if indicated. The grievance review will be completed in a reasonable timeframe consistent with the type of grievance (e.g., a concern regarding resident conduct will be addressed more quickly than a concern that involves activity programming or meals), but in no event will the review exceed thirty (30) days. If the Grievance Committee/Grievance Official determines that a resident rights violation has occurred, the violation must be corrected within ten (10) days. Review of the facility's Grievance/Complaint Logs for August, September, and October of 2024 indicated the following grievances that had not been responded to in a timely manner: - 8/18/24: Resident R2 filed a grievance stating he had received burnt ham on his lunch tray, ham was black and tough. The Documentation of Facility Follow-Up section stated, Licensed Nursing Home Administrator met with resident and informed him that he can always order something else should he not like what he was given. Nothing in room to snack on and dated 8/20. The Resolution of Concern section of the Concern Form was blank. The facility failed to provide documented evidence that they made prompt efforts to resolve Resident R2's grievance. - 10/2/24: Resident R4's wife filed a grievance via telephone interview in relation to care concerns during the resident's admission to the facility and missing personal items. The Documentation of Facility Follow-Up and Resolution of Concern sections of the Concern Form were blank. The facility failed to provide documented evidence that they made prompt efforts to resolve Resident R4's wife's grievance. - 10/2/24: Resident R1 filed a grievance stating that she waited over an hour for someone to answer her call bell the previous night, and that the staff reported to her that they are not appropriately staffed to take care of so many residents. The Documentation of Facility Follow-Up and Resolution of Concern sections of the Concern For were blank. The facility failed to provide documented evidence that they made prompt efforts to resolve Resident R1's grievance. - 10/3/24: Resident R1 filed a grievance stating that she is still waiting long periods of time for a call bell response, specifically that sometimes she rings the bell and light is not on, so she thinks it must be broken. The Documentation of Facility Follow-Up and Resolution of Concern sections of the Concern For were blank. The facility failed to provide documented evidence that they made prompt efforts to resolve Resident R1's grievance. During an interview on 10/24/24, at 1:37 p.m. Food Service Director Employee E1 stated that she was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395986 If continuation sheet Page 2 of 7 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 395986 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kittanning Health & Rehab Center 120 Kittanning Care Drive Kittanning, PA 16201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0585 never made aware of Resident R2's grievance concerning burnt food on 8/18/24. Level of Harm - Minimal harm or potential for actual harm During an interview on 10/24/24, at 1:53 p.m. Maintenance Director Employee E2 stated that he was aware of Resident R1's concern regarding the functioning of her call bell and he addressed it that day and verified that her call bell was working. He also stated, I did receive that Concern Form, but I can't remember if I filled out the resolution or not. Those forms are really bogging me down right now. Residents Affected - Few During an interview on 10/24/24, at 2:42 p.m. the Nursing Home Administrator confirmed that the facility failed to effectively resolve and provide responses to residents and/or their responsible parties in a timely manner in relation to concerns documented via Grievance procedure and complete the reports in their entirety for four of seven grievances reviewed. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(e)(1) Management. 28 Pa. Code 211.10(c)(d) Resident care policies. 28 PA Code: 201.29(j) Resident rights. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395986 If continuation sheet Page 3 of 7 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 395986 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kittanning Health & Rehab Center 120 Kittanning Care Drive Kittanning, PA 16201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. 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 documents, facility policy, clinical records, and staff interviews, it was determined that the facility failed to implement written policies and procedures to ensure a complete and thorough investigation of an allegation of neglect for one of four residents (Resident R1). Residents Affected - Few Findings include: Review of facility policy Abuse, Neglect, and Exploitation dated 1/2/24, indicated it is the facility's policy to investigate all allegations, suspicions and incidents of abuse, neglect, involuntary seclusion, intimidation, exploitation or residents, misappropriation of resident property and injuries of unknown source. If a staff member is accused or suspected of abuse the facility immediately remove staff member from resident care area and request a written statement from accused staff member. The person investigating the incident should interview the resident, the accused, and all witnesses and obtain written statements from the resident, if possible, the accused, and each witness. Evidence of the investigation should be documented. Review of the clinical record indicated Resident R1 was admitted to the facility on [DATE]. Review of Resident R1's Minimum Data Set (MDS - a periodic assessment of care needs) dated 10/4/24, indicated diagnoses of high blood pressure, need for assistance with personal care, and reduced mobility. Review of a Concern Form dated 10/2/24, indicated Resident R1 filed a grievance with the facility stating she waited over an hour for someone to answer her call bell the previous night, and that staff reported to her that they are not appropriately staffed to take care of so many residents. During an interview on 10/24/24, at 2:38 p.m. the Nursing Home Administrator (NHA) indicated that she was unaware of Resident's R2 allegation of neglect and would look for an investigation regarding the allegation. The facility failed to provide documentation of an investigating regarding Resident R1's allegation of neglect on 10/2/24. During an interview on 10/24/24, at 2:42 p.m. the NHA confirmed that the facility failed to implement written policies and procedures to ensure a complete and thorough investigation of an allegation of neglect for one of four residents (Resident R1). 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(e)(1) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395986 If continuation sheet Page 4 of 7 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 395986 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kittanning Health & Rehab Center 120 Kittanning Care Drive Kittanning, PA 16201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical record review, reports submitted to the State, and staff interview, it was determined that the facility failed to report an allegation of neglect in the required timeframe one of four residents (Resident R1). Findings include: Review of facility policy Abuse, Neglect, and Exploitation dated 1/2/24, indicated neglect is the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish or emotional distress. All allegations of abuse, neglect, involuntary seclusion, injuries of unknown source, and misappropriation of resident property must be reported immediately to the Administrator, Director of Nursing, and to the applicable State Agency. All serious incidents involving a resident will be reported to the Department of Health (State Agency) field office within 24 hours. Review of the clinical record indicated Resident R1 was admitted to the facility on [DATE]. Review of Resident R1's Minimum Data Set (MDS - a periodic assessment of care needs) dated 10/4/24, indicated diagnoses of high blood pressure, need for assistance with personal care, and reduced mobility. Review of a Concern Form dated 10/2/24, indicated Resident R1 filed a grievance with the facility stating she waited over an hour for someone to answer her call bell the previous night, and that staff reported to her that they are not appropriately staffed to take care of so many residents. Review of incidents submitted to the State Agency of 10/24/24, at 2:30 p.m. did not include the neglect allegation involving Resident R1. During an interview on 10/24/24, at 2:42 p.m. the Nursing Home Administrator confirmed that the facility failed to report an allegation of neglect in the required timeframe one of four residents (Resident R1). 28 Pa. Code 201.14(a)(c.)(e.) Responsibility of licensee. 28 Pa. Code 201.18(b)(1)(3)(e)(1) Management. 28 Pa. Code 201.20(b) Staff development. 28 Pa. Code 211.10(c.)(d) Resident care policies. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395986 If continuation sheet Page 5 of 7 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 395986 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kittanning Health & Rehab Center 120 Kittanning Care Drive Kittanning, PA 16201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0610 Respond appropriately to all alleged violations. 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 documents, facility policy, clinical records, and staff interview, it was determined that the facility failed to conduct a thorough investigation of an allegation of neglect for one of four residents (Resident R1). Residents Affected - Few Findings include: Review of facility policy Abuse, Neglect, and Exploitation dated 1/2/24, indicated it is the facility's policy to investigate all allegations, suspicions and incidents of abuse, neglect, involuntary seclusion, intimidation, exploitation or residents, misappropriation of resident property and injuries of unknown source. If a staff member is accused or suspected of abuse the facility immediately remove staff member from resident care area and request a written statement from accused staff member. The person investigating the incident should interview the resident, the accused, and all witnesses and obtain written statements from the resident, if possible, the accused, and each witness. Evidence of the investigation should be documented. Review of the clinical record indicated Resident R1 was admitted to the facility on [DATE]. Review of Resident R1's Minimum Data Set (MDS - a periodic assessment of care needs) dated 10/4/24, indicated diagnoses of high blood pressure, need for assistance with personal care, and reduced mobility. Review of a Concern Form dated 10/2/24, indicated Resident R1 filed a grievance with the facility stating she waited over an hour for someone to answer her call bell the previous night, and that staff reported to her that they are not appropriately staffed to take care of so many residents. During an interview on 10/24/24, at 2:38 p.m. the Nursing Home Administrator (NHA) indicated that she was unaware of Resident's R2 allegation of neglect and would look for an investigation regarding the allegation. The facility failed to provide documentation of an investigating regarding Resident R1's allegation of neglect on 10/2/24. During an interview on 10/24/24, at 2:42 p.m. the NHA confirmed that the facility failed to conduct a thorough investigation of an allegation of neglect for one of four residents (Resident R1). 28 Pa Code: 201.18 (e)(1)(2) Management. 28 Pa Code: 201.29 (a )(c)(d) Resident Rights. 28 Pa Code: 211.12 (a)(c)(d)(1)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395986 If continuation sheet Page 6 of 7 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 395986 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kittanning Health & Rehab Center 120 Kittanning Care Drive Kittanning, PA 16201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on a review of facility policy, facility documents, a resident interview, resident representative concern, and staff interview, it was determined that the facility failed to serve food products that appeared palatable for two meals. (Lunch 8/18/24, and Breakfast 10/1/24) Residents Affected - Few Findings include: Review of facility policy Dining Experience at Mealtimes, dated 1/2/24, indicated that the facility will provide attractive, nourishing, and palatable meals. Review of facility document Concern Form, dated 8/18/24, indicated that Resident R2 had received burnt ham on lunch tray on 8/18/24, and Ham was black and tough. Review of a Resident Representative Concern dated 10/17/24, stated They served him burnt ham. It was ground up with black chunks in it and the lady across the hall was yelling about her food being burnt too. Review of facility document Concern Form, dated 10/1/24, indicated that Resident R3 stated that sausage on her breakfast tray on 10/1/24, was burnt. During an interview on 10/24/24, at 12:55 p.m. Resident R3 confirmed that she had made a complaint regarding burnt sausage and added They over-cook all their food. I won't even touch it when it is burnt. During an interview on 10/24/24, at 1:37 p.m. Food Service Director (FSD) Employee E1 stated that although she had not been made aware of the residents receiving burnt food on 8/18/24, and 10/1/24, that serving burnt food is not acceptable and confirmed that the facility failed to provide attractive and palatable meals when burnt food was served. Pa Code 211.6(b)(c)(d) Dietary Services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395986 If continuation sheet Page 7 of 7