Health inspection·February 28, 2025

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 policy, review of facility provided documents, clinical records, and staff interview, it was determined that the facility failed to identify and/or investigate and/or report potential abuse for two of five residents (Resident R4 and R3). Residents Affected - Some Findings include: Review of the facility policy Abuse, Neglect and Exploitation last reviewed on 1/16/25, indicated that it is the policy of the facility to provide protections for the health, welfare and rights of each resident by developing and implementing written policies and procedures that prohibit abuse, neglect and exploitation and misappropriation of resident property. An investigation is warranted when suspicion of abuse, neglect, etc., occur. Written procedures include investigating different types of alleged violations. The facility will provide complete and thorough documentation of the investigation. Review of the clinical record indicated that Resident R4 was admitted to the facility on [DATE], with diagnoses which included dementia, abnormalities of gait and mobility and a stroke. A Minimum Data Set (MDS- periodic assessment of resident care needs) dated 11/19/24, indicated the diagnoses remained current. Review of a progress note dated 2/11/25, indicated Resident R4 developed a skin tear to her right lower extremity. The documentation indicated that the area was cleansed with saline, and a dry dressing was applied. Review of a skin observation tool dated 2/17/25, indicated a skin tear of Resident R4 right ankle measuring 1 cm x 0.8 cm which required Xeroform (mesh occlusive dressing impregnated with petroleum for use on low drainage wound that required non adhesion). The note indicated that staff stated she had the skin tear for over a week. No further documentation was available to determine an investigation into this injury. During an interview on 2/28/25, at 9:33 a.m., the Director of Nursing (DON), confirmed that the facility failed to thoroughly investigate the injury of unknown origin to determine the root cause and rule out potential for abuse. Review of the clinical record indicated that Resident R3 was admitted to the facility on [DATE], with diagnoses which included a heart attack and pacemaker insertion, kidney disease, diabetes and lung disease. A MDS dated [DATE], indicated the diagnoses remained current. Review of a facility provided document dated 1/29/25, indicated Resident R3 had developed multiple bruises of her right arm and a large bruise that wrapped around her right upper arm. The report indicated that the resident stated that she had the bruising for a long time and the facility could not identify a perpetrator. During an interview on 2/26/25, at 2:19 p.m., the DON stated that there was no further information that a the facility failed to determine the root cause and although the facility indicated they ruled out abuse and the information provided did not indicate a thorough investigation had been completed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396059 If continuation sheet Page 2 of 6 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 396059 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Concordia at the Cedars 4363 Northern Pike Monroeville, PA 15146 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 28 Pa. Code: 201.14(c)(d)(e) Responsibility of licensee. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code: 201.18(b)(1)(2)(e)(1) Management. 28 Pa. Code: 201.19 Personnel policies and procedures. Residents Affected - Some 28 Pa. Code: 201.20(a)(b)(c)(d) Staff development. 28 Pa. Code: 201.29(a)(c)(d)(j)(m) Resident rights. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396059 If continuation sheet Page 3 of 6 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 396059 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Concordia at the Cedars 4363 Northern Pike Monroeville, PA 15146 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records and staff interview, it was determined that the facility failed to make certain that residents were provided appropriate treatment and services to maintain bowel function for one of two residents (Resident R53). Residents Affected - Few Findings include: Review of the clinical record revealed that Resident R53 was admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS - periodic assessment of care needs) dated 8/9/24, included diagnoses of atrial fibrillation (disease of the heart characterized by irregular and often faster heartbeat), traumatic brain injury (a disruption in the normal function of the brain), and history of a stroke. Section GG: Functional Abilities substantial/maximal assistance with toileting. Section H: Bladder and Bowel indicated that Resident R53 was occasionally incontinent of bowel. Review of the physician orders dated 11/7/24, indicated that Resident R53 had orders for: -Milk of magnesia, give 30 ml by mouth every 72 hours as needed for Constipation no bowel movement by the morning of the 3rd day (72 hours) AND Give 30 ml by mouth every 24 hours as needed for constipation. -Bisacodyl suppository, insert 10 mg rectally every 96 hours as needed for constipation, if MOM is unsuccessful no bowel movement by the morning of the 4th day (96 hours) AND Insert 10 mg rectally every 24 hours as needed for constipation. -Enema, insert 1 application rectally every 120 hours as needed for constipation, if suppository is unsuccessful no bowel movement by the morning of the 5th day (120 hours) AND Insert 1 application rectally every 24 hours as needed for constipation. Review of Resident R53's plan of care since admission failed to include goals and interventions related to bowel management and/or bowel continence. Review of Resident R53's plan of care for the use of psychotropic medications dated 11/28/24, indicated that Resident R53 will remain free of psychotropic drug related complications, including constipation. Review of Resident R53's bowel record, dated 11/23/24, at 1:59 p.m. through 11/30/24, at 9:29 p.m. (21 shifts) did not include documentation of a bowel movement. Review of Resident R53's medication administration record (MAR) failed to reveal any administrations of milk of magnesia, bisacodyl, or an enema from 11/23/24, through 11/30/24. Review of Resident R53's bowel record, dated 12/1/24 at 1:59 p.m. through 12/7/24, at 1:59 p.m. (18 shifts) did not include documentation of a bowel movement. Review of Resident R53's MAR failed to reveal any administrations of milk of magnesia, bisacodyl, or an enema from 12/1/24, through 12/7/24. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396059 If continuation sheet Page 4 of 6 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 396059 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Concordia at the Cedars 4363 Northern Pike Monroeville, PA 15146 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident R53's bowel record, dated 12/15/24 at 9:35 p.m. through 12/22/24, at 1:07 p.m. (20 shifts) did not include documentation of a bowel movement. Review of Resident R53's MAR failed to reveal any administrations of bisacodyl or an enema from 12/15/24, through 12/22/24. One administration of milk of magnesia was administered on 12/21/24, at 10:20 a.m. Review of Resident R53's bowel record, dated 12/23/24 at 7:30 p.m. through 12/31/24, at 8:57 p.m. (23 shifts) did not include documentation of a bowel movement. Review of Resident R53's MAR failed to reveal any administrations of milk of magnesia, bisacodyl, or an enema from 12/23/24, through 12/31/24. Review of Resident R53's bowel record, dated 1/7/25 at 9:37 a.m. through 1/14/25, at 3:04 a.m. (19 shifts) did not include documentation of a bowel movement. Review of Resident R53's January MAR failed to reveal any administrations of milk of magnesia, bisacodyl, or an enema. Review of Resident R53's bowel record, dated 2/6/25 at 5:04 p.m. through 2/19/25, at 9:47 p.m. (33 shifts) did not include documentation of a bowel movement. Review of Resident R53's February MAR failed to reveal any administrations of milk of magnesia, bisacodyl, or an enema. During an interview on 2/28/25, at approximately 12:00 p.m. the Director of Nursing confirmed that the facility failed to administer medications to maintain bowel function for one of two residents. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(1) Management. 28 Pa. Code 201.29(a) Resident rights. 28 Pa. Code 211.10(c)(d) Resident care policies. 28 Pa. Code:211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396059 If continuation sheet Page 5 of 6 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 396059 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Concordia at the Cedars 4363 Northern Pike Monroeville, PA 15146 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, manufacturers' instructions, observations, and staff interviews it was determined that the facility failed to prevent the potential for cross-contamination during medication administration for two of four residents (Resident R9 and R21). Residents Affected - Some Findings Include: Review of the facility policy Medication Administration, last reviewed on 1/26/25, indicated that medications are administered in accordance with professional standards of practice in a manner to prevent contamination or infection. During a medication administration completed by Registered Nurse Employee E1 the following was observed: Three oral medication tablets for Resident R9 were removed from the cards into RN Employee E1's ungloved left hand then placed into medication cup. Two oral medications tablets for Resident R21 were removed from the cards into RN Employee E1's ungloved left hand then placed into medication cup. During an interview on 2/27/25, at 8:35 a.m., RN Employee E1 confirmed that she had removed the tablets and placed into ungloved hand allowing for the potential of cross contamination. During an interview on 2/28/25, at approximately 12:15 p.m. the Nursing Home Administrator and the Director of Nursing confirmed that the facility failed to prevent the potential for cross-contamination during medication administration for two of four residents. 28 Pa. Code §201.14(a) Responsibility of licensee. 28 Pa. Code §201.18(b)(1)(3)(e)(1) Management. 28 Pa. Code §201.20(c) Staff development. 28 Pa. Code §201.29(d) Resident rights. 28 Pa. Code §211.12(d)(1)(2)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396059 If continuation sheet Page 6 of 6