Inspection·November 13, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some risk for falling due to weakness and leg wounds. The care plan failed to indicate the resident's level of assistance for bed mobility. Review of Resident R4's admission record indicated she was admitted to the facility on [DATE], with diagnoses of high blood pressure, dementia (is the loss of cognitive functioning - thinking, remembering, and reasoning - to such an extent that it interferes with a person's daily life and activities), and insomnia (difficulty falling or staying asleep). Review of Resident R4's MDS dated [DATE], indicated diagnoses were current. Section GG0170-Mobility indicated the resident was dependent with the ability roll from lying on back to left and right side, and return to lying on back on the bed. It was indicated the helper does all of the effort. Resident does none of the effort to complete activity, and the assistance of two or more is required for the resident to complete the activity. Review of Resident R4's care plan dated 9/8/23, last revised 11/6/24, indicated the resident was at risk for falling due to poor safety awareness and unsteady gait. The care plan failed to indicate the resident's level of assistance for bed mobility. During an interview on 11/13/24, at 9:49 a.m. the Assistant Director of Nursing, Employee E7 indicated a resident's transfer status and bed mobility is found in the resident's care plan in the clinical record. During an interview on 11/13/24, at 11:35 a.m. Occupational Therapist, Employee E9 confirmed the facility failed to indicate a resident's bed mobility in the care plan for Residents R2, R3, and R4. During an interview on 11/13/24, at 1:45 p.m. the Nursing Home Administrator and Director of Nursing confirmed the facility failed to develop care plans that included instructions to provide person centered care for bed mobility for three of four residents (Resident R2, R3, and R4). 28 Pa. Code 211.10(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: 395986 If continuation sheet Page 2 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395986 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/13/2024 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 review of facility policy, clinical record, and staff interviews, it was determined that the facility failed to provide adequate assistance for bed mobility for one of four residents (Resident R1), which resulted in the resident falling out of bed and sustaining a 1.5 centimeter laceration to the upper cheekbone. Findings include: Review of the facility Fall Prevention and Management Policy dated 12/9/19, last revised 8/6/24, indicated residents are assessed for fall risk upon admission, quarterly, and as needed. It was indicated if risks are identified, preventive measure will be put in place and care planned. Review of the facility Comprehensive Care Planning Policy last reviewed 1/2/24, indicated the facility must develop a comprehensive person centered care plan for each resident that includes measurable objectives and timetables to meet the resident's medical, nursing, and mental, and psychosocial needs that are identified in the comprehensive assessments. Review of Resident R1's admission record indicated he was admitted to the facility on [DATE], with diagnoses of left below the knee amputation, encephalopathy (brain disease, damage, or malfunction that causes an altered mental state), and anemia (deficiency of healthy red blood cells in blood). Review of Resident R1's Minimum Data Set (MDS-periodic assessment of a resident's abilities and care needs) dated 10/21/24, indicated diagnoses were current. Section GG0170-Mobility indicated the resident was dependent with the ability roll from lying on back to left and right side, and return to lying on back on the bed. It was indicated the helper does all of the effort. Resident does none of the effort to complete activity, and the assistance of two or more is required for the resident to complete the activity. Review of Resident R1's care plan dated 7/23/24, through 10/30/24, indicated the resident was at risk for falling due to poor safety awareness. Review of Resident R1's active physician orders on 10/30/24, failed to include an order for bed mobility. Review of the facility's incident list, revealed Resident R1 had a witnessed fall on 10/30/24. Review of Nurse Aide, Employee E1's witness statement dated 10/30/24, indicated while he was changing and cleaning Resident R1, he began to fall out of bed and his head hit a metal chair in his room. Review of Licensed Practical Nurse, Employee E2's witness statement dated 10/30/24, indicated a nurse aide called for help. It was indicated as the nurse aide was providing care, Resident R1 slid out of bed. When she arrived his body was half in bed and his head was on a chair bedside the bed. He was laying on his stomach and he had a deep cut under his left eye. Review of Resident R1's progress note dated 10/30/24, at 11:30 p.m. entered by Registered Nurse, Employee E4 indicated she was called to the resident's room by a Licensed Practical Nurse who stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395986 If continuation sheet Page 3 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395986 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/13/2024 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few that the resident had fallen out of bed. Arrived to resident's room and observed resident lying supine in bed with a nurse aide holding a towel to the resident's face. The nurse aide indicated while he was performing care on the resident, he rolled the resident out of bed. The resident struck the left side of his face on a metal folding chair that was in the room. A laceration was observed to the left upper cheekbone with swelling and bruising extending under the eye and into the eyelid area. The resident was on Eliquis (medication that thins the blood and increases risk of bleeding). The resident was transferred to the hospital for further evaluation. Review of Resident R1's hospital report dated 10/30/24, indicated the resident sustained a 1.5 cm facial laceration and a periorbital (refers to the tissues surrounding or lining the orbit of the eye) hematoma (collection of blood outside the blood vessels) of the left eye after a fall. The resident's laceration was repaired with steri-strips (thin adhesive bandages that help close shallow cuts or wounds). Review of the facility report submitted to the Department of Health on 10/31/24, at 10:39 a.m. by the Director of Nursing (DON) indicated on 10/30/24, Resident R1 was rolled out of bed and struck the left side of his face on a metal folding chair that was located on the right side of the bed. Resident R1 sustained a 1.5 centimeter laceration to the left upper cheekbone with swelling and bruising that extended under the eye and into the eyelid area. It was indicated the resident was a two person assist related to being ordered a mechanical lift for transfers. At the time of the incident there was only one aide present. NA, Employee E1 did not answer the phone or return the message left by the State Agency on 11/13/24. During an interview on 11/13/24, at 9:49 a.m. the Assistant Director of Nursing, Employee E7 indicated a resident's transfer status is found in the residents care plan and tasks in the clinical record. During an interview 11/13/24, at 9:50 a.m. NA, Employee E6 was asked how she knows where to find the transfer status and bed mobility of a resident. NA, Employee E6 stated there is an order for transfer status and bed mobility in the clinical record. During an interview on 11/13/24, at 11:32 a.m. NA, Employee E5 and NA, Employee E8 stated the facility does not enter an order for bed mobility in the clinical record. During an interview on 11/13/24, at 11:35 a.m. Occupational Therapist, Employee E9 stated she evaluates residents upon admission to see how they are performing, and then communicates that information with the nursing staff, and they enter the information into the care plan. It was indicated nurse aides can find a resident's transfer status in the clinical record. OT, Employee E9 stated I really don't think we put bed mobility in an order. It was indicated the ADON is responsible for entering orders from therapy. During an interview on 10/24/24, at 1:39 p.m. the Nursing Home Administrator and Director of Nursing confirmed that the facility failed to provide adequate assistance for bed mobility for one of four residents (Resident R1), which resulted in the resident falling out of bed and sustaining a 1.5 centimeter laceration to the upper cheekbone. 28 Pa. Code 201.14(a) Responsibility of licensee. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395986 If continuation sheet Page 4 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 395986 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/13/2024 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 0689 28 Pa. Code 201.18(b)(1)(e)(1) Management. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 201.20(b)(1) Staff Development. 28 Pa. Code 201.29(a) Resident rights. Residents Affected - Few 28 Pa. Code 211.10(c)(d) Resident care policies. 28 Pa. Code 211.11(d) Resident care plan. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395986 If continuation sheet Page 5 of 5