Health inspection·January 15, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Further observation on January 13, 2025, at 12:01 p.m. revealed that there was still a strong odor of bowel movement in Resident R79's room. Observation on January 15, 2025, at 10:26 a.m. revealed a strong odor of urine in Resident R79's room. Employee E8, licensed nurse, confirmed the odor. Residents Affected - Few 28 Pa Code 201.18(d.2)(2.1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395989 If continuation sheet Page 2 of 16 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 395989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Rehab and Hlthcare Ctratmercyfitzgerald 600 South Wycombe Ave Yeadon, PA 19050 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 0602 Protect each resident from the wrongful use of the resident's belongings or money. 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, review of clinical records and staff interview, it was determined that the facility did not ensure that residents were free of misappropriation of resident property related to diversion of a narcotic medication for two of seven residents prescribed narcotic medications reviewed. This deficiency was cited as past non compliance. (Resident R20, Resident R21) Residents Affected - Few Findings include: Review of facility policy on Controlled Substances dated November 2022, revealed that under section Policy Statement: The facility complies with laws, regulations, and other requirements related to handling, storage, disposal, and documentation of controlled medications. Under Section Policy Interpretation and Implementation Handling Controlled substances #1, only authorized licensed nursing and or pharmacy personnel have access to Schedule 2 controlled substances maintained on premises. #2. The Director of Nursing Services identifies staff members who are authorized to handle controlled substances. #3 Controlled substances are counted upon delivery. The nurse receiving the medication along with the person delivering the medication must count on the controlled substances together. Both individual sign the designated controlled substance record. #4. If the count is correct, an individual resident control substance record is made for each resident who will be receiving controlled substance. Do not enter more than one prescription per page. This record contains: a. name of the resident, b. name and strength of the medication, c. quantity received, d. number on hand, e. name of the prescriber, f. prescription number, g. name of issuing pharmacy, h. date and time received, i. time of administration, j. method of administration, k. signature of person receiving medication and l. signature of nurse administering medication. Under section Storing Control Substances #1. Control substances are separately locked in permanently affixed compartments except when using single unit packaged drug distribution system in which the quantity stored is minimal and missing. Those can be readily detected. #2. All keys to control substance containers are on a single key ring that is different from any other keys. #3. The charge nurse on duty maintains the keys to controlled substance containers. The Director of Nursing Services maintains a set of backup keys for all medication storage areas, including keys to controlled substance containers. Under a section Dispensing and Reconciling Controlled Substances: #1. Controlled substance inventory is monitored and reconciled to identify loss or potential diversion in a manner that minimizes the time between laws diversion and detection follow up. #2. The system of reconciling the receipt, dispensing, and disposition of controlled substances includes the following. a. records of personal access and usage, b. medication administration records, c. declining inventory records and d. destruction and waste and returned to pharmacy records. #3 Nursing staff count controlled medications inventory at the end of each shift, using these records to reconcile the inventory count. #4 the nurse coming on duty and the nurse going off duty makes the count together and document and report any discrepancies to the Director of Nursing. Review of Resident R320's clinical record revealed that Resident R320 was admitted to the facility on [DATE], with diagnoses of Malignant neoplasm of Sigmoid Colon, Status post surgery on the Digestive System. Further review of Resident R320's clinical record revealed a physician's order for Oxycodone HCl Oral Tablet 5 MG (Oxycodone HCl) *Controlled Drug* Give 1 tablet by mouth every 6 hours as needed for moderate to severe c/o pain for 10 Days-dated 10/7/2024. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395989 If continuation sheet Page 3 of 16 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 395989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Rehab and Hlthcare Ctratmercyfitzgerald 600 South Wycombe Ave Yeadon, PA 19050 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident R321's clinical record revealed that Resident R321 was admitted to the facility on [DATE], with diagnoses of Burn of Unspecified Degree on Left Foot, Chronic Ulcer of Left Foot with Necrosis of Bone, Diabetic Peripheral Angiopathy with Gangrene. Further review of Resident R321's clinical record revealed a physician's order for oxycodone HCl Oral Tablet 5 MG (Oxycodone HCl) Give 1 tablet by mouth every 12 hours as needed for Moderate to Severe Pain- dated 10.10.24 Review of facility investigation record revealed that on October 9, 2024, 8 tablets Oxycodone 5mg tablets was delivered and was received and signed off by Employee E19 unit manager and Licensed nurse, Employee E19. The eight tablets of Oxycodone were placed in the narcotic box and logged into the Narcotic book. On October 10, 2024, licensed nurse, Employee E20 signed out 1 tablet of Oxycodone leaving 7 tablets of Oxycodone in the narcotic box. Narcotic count on October 10, 2024, during change of shift between night shift outgoing licensed nurse Employee E20 and day shift incoming licensed nurse Employee E21 revealed the correct count for Resident R321's Oxycodone 5 mg tabs (7 tablets) Narcotic count on October 10, 2024, during change of shift between day shift outgoing nurse Employee E21 and evening shift incoming nurse Employee E22, revealed the correct count for Resident R321's Oxycodone 5 mg tabs (7 tablets) During the evening shift resident tested positive for covid and was moved to another room during the 3-11 shift. licensed nurse Employee E23 collected med cart keys from Employee E22 and removed the routine meds from the cart and moved to the cart for the wing where Resident R321 was moved to. Further Employee E23 revealed that that she did not remove the Oxycodone from the narcotic box. Narcotic count on October 11, 2024, during change of shift between evening shift shift outgoing licensed nurse Employee E22 and night shift incoming licensed nurse Employee E24, revealed the correct count for Resident R321's Oxycodone 5 mg tabs (7 tablets) On October 11, 2024, during the 11 to 7 shift. Resident R321 requested for an oxycodone pill from licensed nurse Employee E18 . Employee E18 was not able to locate the oxycodone in the medication cart she was assigned to. Employee E18 asked Employee E24 who counted with Employee E22 and confirmed that the count was correct (7), which was when it was discovered that the narcotics and the narcotoc page was missing. Further investigation revealed that the page from the narcotic book containing the accountability record for Resident R321's oxycodone has been ripped off the narcotic book. On October 10, 2024, at 1:01 a.m., 30 oxycodone tablets were delivered for Resident R320. On October 11, 2024, at 2:30pm unit manager Employee E25 and licensed nurse Employee E21 indexed a new narcotic book to replace the narcotic book that was full. Employee E25 and Employee E21 counted Resident R320's Oxycodone 5 mg tablets, and confirmed that there were 30 5 mg tablet of Oxycodone belonging to Resident R320 in the medication cart and transferred all information from the old narcotic book to the new narcotic book (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395989 If continuation sheet Page 4 of 16 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 395989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Rehab and Hlthcare Ctratmercyfitzgerald 600 South Wycombe Ave Yeadon, PA 19050 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 0602 Level of Harm - Minimal harm or potential for actual harm On October 11, 2024 at 1600pm (4pm), licensed nurse Employee E21 and licensed nurse Employee E26 counted 30 5 mg Oxycodone tabs. Count was correct. On October 12, 2024, Saturday, at 7:30 am during count in coming licensed nurse Employee E27 and outgoing nurse Employee E18 revealed that the 30 tabs of 5mg Oxycodone tabs were missing. Residents Affected - Few Interview with Director of Nursing (DON) Employee E2 conducted on January 13, 2025 at 1:15pm revealed that the staff did not follow the facility's policy on counting controlled substances. DON revealed that the nurses were only counting the narcotics in the narcotic box and did not reference the narcotic index in the front of the narcotic book where list of narcotics stored in the narcotic box was listed, resulting in not identifying missing narcotics during the shift-to-shift count. Further, DON revealed that he was not able to identify who the perpetrator was because the previous shifts also did not reference the narcotic index before counting the narcotics Review of facility abatement plan revealed that the facility initiated their investigation on the missing narcotic the day it was identified with narcotic audit initiated on October 11, 2024, the day when the missing narcotic was identified. Interview with Assistant Director of Nursing Employee E12 revealed that the facility started educating their licensed staff on October 14, 2024, with 27.3% of staff in-serviced and completed in servicing 92.7% of licensed staff on October 15, 2024. The facility alleged compliance date of October 15, 2024. This deficiency was identified as past non compliance. 28 Pa. Code 201.14(a)(b) Responsibility of licensee 28 Pa. Code 201.18(b)(1)(2)(3) Management 28 Pa. Code 201.29(a) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395989 If continuation sheet Page 5 of 16 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 395989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Rehab and Hlthcare Ctratmercyfitzgerald 600 South Wycombe Ave Yeadon, PA 19050 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on review of facility policies, clinical record reviews and interviews with staff, it was determined that the facility failed to develop a comprehensive care plan related to diabetes management for one of 34 residents reviewed (Resident R80). Findings include: Review of facility policy, Comprehensive Person-Centered Care Plans dated March 2022, revealed, A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. Continued review revealed, The comprehensive, person-centered care plan . reflects currently recognized standards of practice for problem areas and conditions. Review of Resident R80's Quarterly MDS (Minimum Data Set - a mandatory periodic resident assessment tool), dated October 11, 2024, revealed that the resident was admitted to the facility February 17, 2024, and had a diagnosis of diabetes (ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of sugar in the blood). Continued review revealed that the resident required insulin injections (medication used to lower blood sugar levels). Review of active physician orders for Resident R80, revealed an order dated April 2, 2024, to check the resident's blood sugar levels before meals and bedtime. Continued review revealed an order dated October 3, 2024, to inject 35 units of Basaglar (long acting) insulin at bedtime. Further review revealed an order, dated April 2, 2024, for Humalog (rapid acting) insulin, inject per sliding scale (variable dosing based on blood sugar level) before meals. Review of Resident R80's care plan, dated April 1, 2024, revealed that no care plan was developed related to diabetes management or dependence on insulin medications. Interview on January 15, 2025, Employee E12, licensed nurse, confirmed that no care plan was developed for Resident R80 related to diabetes and insulin. 28 Pa Code 211.10(c) Resident care policies FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395989 If continuation sheet Page 6 of 16 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 395989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Rehab and Hlthcare Ctratmercyfitzgerald 600 South Wycombe Ave Yeadon, PA 19050 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 observations, interviews with residents and staff and a review of facility documentation and review of clinical records, it was determined that the facility failed to ensure that a safe environment was maintained related to medication being left on a residents over bed table on two occasions for one of 34 residents reviewed (Resident R213). Findings include: Observation during the initial tour of the facility in room [ROOM NUMBER], Bed A on January 12, 2025, at 10:15 a.m. revealed a pill in a 1-ounce dose cup sitting on Resident R213's over-bed table. When asked about the pill Resident 213 indicated that she refused to take it because she believed it would cause her to urinate more and she did not want that. Observation in room [ROOM NUMBER], Bed A on January 13, 2025, at 9:45 a.m. revealed a pill in a 1-ounce dose cup sitting on Resident R213's over-bed table. When Licensed nurse, Employee E7, entered the room she took the pill in the cup and asked Resident R213 why the pill was on the table. The resident said that she does not want to take this pill because she does not need to urinate more that she is now. The nurse quickly left the room and threw the pill in the garbage bag on the side of the med cart. The nurse went and spoke to the unit manager, stating that the resident must have spit the pill out after she left the room because she saw her put all the pills in her mouth. When asked what pill was in the cup, Employee E7 said that it was her potassium chloride, and that she gets this with her diuretic so her potassium level does not get to low and affect her heart. Review of the clinical record for Resident R213 revealed the resident was admitted to the facility on [DATE], with diagnoses of non-ST-elevation myocardial infarction (a type of heart attack that happens when a part of your heart is not getting enough oxygen). Further review revealed that she was getting a 10 meq potassium chloride tablet, Bumex 0.5 mg tablet (a diuretic, used to get rid of extra fluid) and 5 other pills at 9 a.m. each day. An interview was conducted with the Administrator and Director of Nursing on, January 13, 2025, at 2:40 p.m. confirmed that pill should not have been left on Resident 213's over-bed table as it could have been taken by another resident and that this did not provide a safe environment for nursing home residents. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.12(c) Nursing services 28 Pa. Code 211.12(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395989 If continuation sheet Page 7 of 16 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 395989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Rehab and Hlthcare Ctratmercyfitzgerald 600 South Wycombe Ave Yeadon, PA 19050 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 - Few 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 observations, review of facility policies, review of clinical records and interview with staff, it was determined that the facility failed to ensure that medications were properly and accurately labeled in accordance with currently accepted professional principles for one of twenty-six medications. (Resident R42) Findings include: Review facility Policy on Medication administration revealed that under section Policy Statement: Medications are administered in a safe and timely manner, and as prescribed. Under section Policy Interpretation and Implementation #2. The director of nursing services supervises and directs all personnel who administer medications and/or have related functions. #9. The individual administering medications verifies the resident ' s identity before giving the resident his/her medications. Methods of identifying the resident include: a. checking identification band; b. checking photograph attached to medical record; and c. if necessary, verifying resident identification with other facility personnel. #10. The individual administering the medication checks the label THREE (3) times to verify the right resident, right medication, right dosage, right time and right method (route) of administration before giving the medication. Review of R42's clinical record revealed that Resident R42 was admitted to the facility on July2, 2024 with diagnoses of Acute Sinusitis. Review of Resident R42's physician's orders revealed an order for Fluticasone Propionate Nasal Suspension 50 MCG/ACT (Fluticasone Propionate (Nasal) 1 spray in each nostril one time a day for allergy relief Gently shake, before use prime pump. After use, clean tip and replace the cap -dated 7/2/24. Review of Resident R78's clinical record revealed that Resident R78 was admitted to the facility on [DATE], with diagnoses of Gastroesophageal Reflux Disease, Centrilobular Emphysema. Review of Resident R78's physician's orders revealed an order for Fluticasone Propionate Nasal Suspension 50 MCG/ACT (Fluticasone Propionate (Nasal) 1 spray in both nostrils every 24 hours as needed for Allergies-ordered 12/9/24 and discontinued 1/6/25 Further review of Resident R78's clinical record revealed that Resident R78 was discharged from the facility on January 6, 2025. Medication administration observation with licensed nurse Employee E7 for Resident R42 conducted on January 13, 2024, at 10:37am revealed that Employee E7 picked up a box labelled Fluticasone 50 mcg with Resident R42's name and room number handwritten on it. Further, Employee E7 proceeded to go to Resident R42's room and administered the nasal spray to Resident R42. Inspection of the Fluticasone nasal spray bottle revealed that a typewritten paper label with Resident R78's name was affixed to the bottle. Interview with the nurse conducted at the time of the observation confirmed that the bottle of fluticasone that she administered to Resident R42 was labelled with Resident R78's name on it. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395989 If continuation sheet Page 8 of 16 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 395989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Rehab and Hlthcare Ctratmercyfitzgerald 600 South Wycombe Ave Yeadon, PA 19050 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 28 Pa. Code 201.18(b)(1) Management Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12(1)(2)(5) Nursing services. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395989 If continuation sheet Page 9 of 16 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 395989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Rehab and Hlthcare Ctratmercyfitzgerald 600 South Wycombe Ave Yeadon, PA 19050 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 - Few 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of facility policies, review of clinical records and interview with staff, it was determined that the facility failed to ensure that medications were properly and accurately labeled in accordance with currently accepted professional principles for one of twenty-six medications. Findings include: Review facility Policy on Medication administration revealed that under section Policy Statement: Medications are administered in a safe and timely manner, and as prescribed. Under section Policy Interpretation and Implementation #2. The director of nursing services supervises and directs all personnel who administer medications and/or have related functions. #9. The individual administering medications verifies the resident ' s identity before giving the resident his/her medications. Methods of identifying the resident include: a. checking identification band; b. checking photograph attached to medical record; and c. if necessary, verifying resident identification with other facility personnel. #10. The individual administering the medication checks the label THREE (3) times to verify the right resident, right medication, right dosage, right time and right method (route) of administration before giving the medication. Review of R42's clinical record revealed that Resident R42 was admitted to the facility on July2, 2024 with diagnoses of but not limited to: Acute Sinusitis. Review of Resident R42s physician's orders revealed an order for Fluticasone Propionate Nasal Suspension 50 MCG/ACT (Fluticasone Propionate (Nasal) 1 spray in each nostril one time a day for allergy relief Gently shake, before use prime pump. After use, clean tip and replace the cap -dated 7/2/24. Review of Resident R78's clinical record revealed that Resident R78 was admitted to the facility on [DATE], with diagnoses of \Gastroesophageal Reflux Disease, and Centrilobular Emphysema. Review of Resident R78's physician's orders revealed an order for Fluticasone Propionate Nasal Suspension 50 MCG/ACT (Fluticasone Propionate (Nasal) 1 spray in both nostrils every 24 hours as needed for Allergies-ordered 12/9/24 and discontinued 1/6/25 Further review of Resident R78's clinical record revealed that Resident R78 was discharged from the facility on January 6, 2025. Medication administration observation with licensed nurse Employee E7 for Resident R42 conducted on January 13, 2024, at 10:37am revealed that Employee E7 picked up a box labelled Fluticasone 50 mcg with Resident R42's name and room number handwritten on it. Further, Employee E7 proceeded to go to Resident R42's room and administered the nasal spray to Resident R42. Inspection of the Fluticasone nasal spray bottle revealed that a typewritten paper label with Resident R78's name was affixed to the bottle. Interview with the nurse conducted at the time of the observation confirmed that the bottle of fluticasone that she administered to Resident R42 was labelled with Resident R78's name on it. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395989 If continuation sheet Page 10 of 16 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 395989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Rehab and Hlthcare Ctratmercyfitzgerald 600 South Wycombe Ave Yeadon, PA 19050 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 201.18(b)(1) Management Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12(1)(2)(5) Nursing services. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395989 If continuation sheet Page 11 of 16 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 395989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Rehab and Hlthcare Ctratmercyfitzgerald 600 South Wycombe Ave Yeadon, PA 19050 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 - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations and interviews with staff, it was determined that the facility did not ensure that food was stored, prepared, distributed, and served in accordance with professional standards for food service safety. Findings include: An initial tour of the Food Service Department was conducted on January 12, 2025, at 9:05 a.m. with Employee E3, Food Service Director (FSD), which revealed the following: Observation in the walk-in freezer revealed two cardboard boxes of bread sitting directly on the floor. Observation in the dish room area revealed standing water on the floor and a clogged floor drain in the middle of the room, and the dietary staff using a shop vacuum to collect the water off the floor which was wet throughout the dish room. Observation of the under-table shelves in the prep area and cooks area revealed visible dirt and, dust and crumbs on the shelves and floor underneath, and the tray slides in the area under the coffee urn were stained with dark brown splashed liquid. Observation of the inside of the convection oven revealed dark black burned on food substances on all surfaces. Observation of the plate heater revealed dirt and crumbs on the inside surfaces where the clean plates are stacked. Interview with the FSD 10:00 a.m. on January 12, 2025, at 9:20 a.m. confirmed the above findings. 28 Pa. Code: 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(3) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395989 If continuation sheet Page 12 of 16 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 395989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Rehab and Hlthcare Ctratmercyfitzgerald 600 South Wycombe Ave Yeadon, PA 19050 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on observations, review of facility policies, clinical record reviews and interviews with staff, it was determined that the facility failed to ensure that tube feedings were properly labeled for one of three residents reviewed for tube feedings (Resident R79). Findings include: Review of facility policy, Enteral Nutrition [a form of nutrition that is delivered into the digestive system as a liquid] dated November 2018, revealed Adequate nutritional support through enteral nutrition is provided to residents as ordered. Review of Resident R79's Quarterly MDS (Minimum Data Set - a mandatory periodic resident assessment tool), dated December 20, 2024, revealed that the resident was admitted to the facility September 7, 2023, and had diagnoses including anoxic brain damage (brain damage caused by lack of oxygen to the brain), and dysphagia (difficulty swallowing). Continued review revealed that the resident was severely cognitively impaired and required a feeding tube to meet his nutritional needs. Review of physician orders for Resident R79 revealed an order dated October 21, 2024, for enteral feedings of Peptamen AF (nutritional formula), 375 mL (milliliter) boluses four times per day via feeding tube. Continued review revealed an order, dated September 17, 2024, to change the resident's feeding bag and administration set daily; the order specified to label the bag with the resident's name, date, time and initials. Observation on January 12, 2025, at 9:35 a.m. revealed a bag of tube feeding formula was infusing for Resident R79. The bag was labeled with a date of January 12, 2025. There was no further information on the bag of formula. Interview, at the time of the observation, Employee E8, licensed nurse, stated that the formula was a bolus feeding for Resident R79 and that the formula was Peptamen. Employee E8, licensed nurse, confirmed that the formula bag was not labeled with the resident's name, formula, infusion rate or the time and initials of the person who prepared the feeding. 28 Pa Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395989 If continuation sheet Page 13 of 16 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 395989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Rehab and Hlthcare Ctratmercyfitzgerald 600 South Wycombe Ave Yeadon, PA 19050 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policies, clinical record reviews and interviews with staff, it was determined that the facility failed to ensure that residents had the capacity to understand the terms of a binding arbitration agreement for three of five residents reviewed (Residents R44, R41 and R72). Residents Affected - Few Findings include: A Binding Arbitration Agreement is a legal process where parties in a dispute agree to have a neutral third party decide their case instead of a judge or jury. The arbitrator's decision is final and the parties usually cannot appeal it. Review of facility policy, Binding Arbitration Agreements dated November 2023, revealed, Residents (or representatives) are informed of the nature and implications of any proposed binding arbitration agreements so as to make informed decisions on whether to enter into such agreements. Continued review revealed, The terms and conditions of a binding arbitration agreement are explained to the resident (or representative) in a way that ensures his or her understanding of the agreement. Further review revealed, After the terms and conditions of the agreement are explained, the resident or representative must acknowledge that he or she understands the agreement before being asked to sign the document. A signature alone is not sufficient acknowledgement of understanding. Review of Resident R44's Quarterly MDS (Minimum Data Set - a mandatory periodic resident assessment tool), dated February 10, 2024, revealed that the resident was admitted to the facility June 1, 2017, and had diagnoses including dementia (decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities) and symbolic dysfunction (cognitive language impairment). Continued review revealed that the resident had a BIMS (Brief Interview for Mental Status) score of 00, which indicated that the resident was severely cognitively impaired. Review of progress notes for Resident R44 revealed a physician evaluation, dated February 22, 2024, at 5:40 a.m. which indicated that the resident was oriented to person only and that the resident was incapable of making decisions. Review of Resident R44's Binding Arbitration Agreement, dated February 22, 2024, revealed that in the space designated for the signature of the resident, it was noted that Resident R44 verbally signed the agreement. In the space designated for the signature of the facility's authorized agent, the agreement was signed by Employee E11, Concierge. Review of Resident R41's Annual MDS, dated [DATE], revealed that the resident was admitted to the facility on [DATE], and had diagnoses including dementia and psychotic disorder (loss of contact with reality). Continued review revealed that the resident had a BIMS score of 06, which indicated that the resident was severely cognitively impaired. Review of progress notes for Resident R41 revealed a psychiatry (mental health) evaluation, dated November 28, 2023, which indicated that the resident was oriented to person only with poor thought content, insight and judgement. Review of Resident R41's Binding Arbitration Agreement, dated December 7, 2023, revealed that in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395989 If continuation sheet Page 14 of 16 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 395989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Rehab and Hlthcare Ctratmercyfitzgerald 600 South Wycombe Ave Yeadon, PA 19050 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the space designated for the signature of the resident, it was noted that Resident R41 verbally signed the agreement. In the space designated for the signature of the facility's authorized agent, the agreement was signed by Employee E11, Concierge. Review of Resident R72's admission MDS, dated [DATE], revealed that the resident was admitted to the facility on [DATE], and had diagnoses including Alzheimer's Disease (a progressive disease that destroys memory and other important mental functions) and cognitive communication deficit (problems with communication due to difficulties with thinking processes). Continued review revealed that the resident had a BIMS score of 00, which indicated that the resident was severely cognitively impaired. Review of progress notes for Resident R72 revealed a nurses note, dated August 9, 2023, at 10:30 p.m. which indicated that the resident was admitted to the facility, that the resident was confused and that he was unable to answer questions logically. Review of Resident R72's Binding Arbitration Agreement, dated August 10, 2023, revealed that in the space designated for the signature of the resident, it was noted that Resident R72 verbally signed the agreement. In the space designated for the signature of the facility's authorized agent, the agreement was signed by Employee E11, Concierge. Interview on January 14, 2025, at 12:48 p.m. Employee E11, Concierge, stated that she asks residents several times if they are able to sign the arbitration agreement and that based on this she uses her personal judgement to determine if residents are capable of signing the agreement. Continued interview revealed that Employee E11, Concierge, does not review residents' clinical records to determine their cognitive status. Employee E11, Concierge, was unaware that Residents R44, R41 and R72 were severely cognitively impaired and was unable to explain the process of determining if severely cognitively impaired residents would have the capacity to understand and sign the arbitration agreement. 28 Pa. Code 201.18(b)(3) Management 28 Pa Code 201.29(a) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395989 If continuation sheet Page 15 of 16 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 395989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Rehab and Hlthcare Ctratmercyfitzgerald 600 South Wycombe Ave Yeadon, PA 19050 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 observations, review of facility policies, clinical record reviews and interviews with staff, it was determined that the facility failed to maintain effective infection control practices related to enhanced barrier precautions for one of two residents reviewed for pressure ulcers (Resident R79). Residents Affected - Few Findings include: Review of facility policy, Enhanced Barrier Precautions dated March 2024, revealed that, Enhanced barrier precautions (EBPs) are used as an infection prevention and control intervention to reduce the transmission of multi-drug resistant organisms (MDROs) to residents. Continued review revealed, Examples of high-contact resident care activities requiring the use of gown and gloves for EBPs include . wound care (any skin opening requiring a dressing). Review of Resident R79's Quarterly MDS (Minimum Data Set - a mandatory periodic resident assessment tool), dated December 20, 2024, revealed that the resident was admitted to the facility September 7, 2023, and had a diagnosis of stage four pressure ulcer of the sacral region (the most severe stage of a pressure sore, with damage to all layers of the skin, exposing muscle, tendon and bone and has a high risk of infection). Review of Resident R79's care plan, dated April 29, 2024, revealed that the resident required enhanced barrier precautions, with interventions including the use of gloves and gowns during high-contact care activities, including wound care. Review of physician orders for Resident R79 revealed an order, dated October 3, 2024, to cleanse the sacral wound with 1/4 Dakin's solution (topical antiseptic used to clean wounds), pat dry, apply calcium alginate (soft absorbent wound dressing) to the wound bed and secure with a clean dry dressing. Observation on January 12, 2025, at 12:51 p.m. revealed Employee E8, licensed nurse, and Employee E9, nurse aide, provide wound care to Resident R79's stage four sacral wound. Both employees wore only gloves while providing the wound care. Interview on January 12, 2025, at 1:09 p.m. Employee E8, licensed nurse, confirmed that gowns were not worn while she and the other staff person provided wound care and confirmed that Resident R79 required enhance barrier precautions due to his wound. 28 Pa Code 211.10(d) Resident care policies 28 Pa Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395989 If continuation sheet Page 16 of 16