Inspection·December 30, 2022

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on a review of the facility's policy, clinical records review, and staff interview, it was determined that the facility failed to thoroughly investigate a bruise of unknown origin for one of the 28 residents reviewed (Resident 91). Residents Affected - Few Findings include: Review of the facility's policy titled Abuse Reporting and Investigation, undated revealed that the facility will thoroughly investigate all reports of suspected or alleged abuse, neglect, or exploitation. Review of Resident 91's diagnosis list revealed Dementia (term used to describe a group of symptoms affecting memory, thinking, and social abilities severely enough to interfere with daily life), Psychotic Disturbances, Mood Disturbances, and Anxiety disorder. Review of Resident 91's Minimum Data Set (MDS- A standardized assessment tool that measures health status in long-term care residents), dated November 23, 2022, revealed resident had severe cognitive impairment. The same MDS revealed resident required limited with one personal assistance with transferring, ambulation, and locomotion. Review of the nursing progress notes dated December 3, 2022, at 8:23 a.m., revealed that while taking the resident's blood pressure, a bruise was observed on the resident under left eye measuring 2.3cm (centimeter) x 0.5 cm, right eye measuring 1.7 x 0.4 cm, and forehead measuring 2.5 x 3.4 cm. Review of the facility's documentation, Incident Report, dated December 3, 2022, revealed Resident 91 was observed with a bruise to the left and right eye and forehead on December 3, 2022, at 8:23 a.m. The same report revealed resident was on Eliquis (A blood-thinning medication) which placed the resident at risk for increased bruising. The resident also wears glasses and lays on the tables at times. The report also indicated that staff was interviewed, revealed no signs of abuse, and interventions were in place. Interview with the Director of Nursing (DON) and the Assistant Director of Nursing (ADON) was conducted on December 30, 2022, at 10:00 a.m. The DON reported that statements from staff member that worked 72 hours before the discovery of an injury of unknown origin need to be taken as part of the facility's procedure. The DON reported that she/he was aware of the incident, but the Unit Manager had conducted the investigation and revealed that the bruise on the resident's both eyes and forehead was from resting face down on a table. On December 30, 2022, at 11:30 a.m., the DON confirmed that no written staff statement can be provided to the surveyor. The facility failed to thoroughly investigate Resident 91's bruise to both eye and forehead. 483.13 - Resident Behavior and Facility Practices, 10-1-1998 edition 28 Pa. Code 201.18(b)(1)(3)(c) Management Previously cited 11/1/21 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396083 If continuation sheet Page 2 of 18 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 396083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063 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 211.5(f) Clinical records Level of Harm - Minimal harm or potential for actual harm Previously cited 11/1/21 28 Pa. Code 211.12 (c)(d)(1)(5) Nursing services Residents Affected - Few Previously cited 11/1/21 FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396083 If continuation sheet Page 3 of 18 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 396083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and staff interview, it was determined that the facility failed to ensure that assessments accurately reflected the resident's status for one of 32 residents reviewed (Resident 8). Residents Affected - Few Findings include: Review of Resident 6's care plan initiated on January 25, 2018, revealed resident had a colostomy (a surgical procedure that brings one end of the large intestine out through an opening (stoma) made in the abdominal wall). Review of Resident 6's annual MDS (Minimum Data Set - periodic assessment of resident needs) of June 1, 2022, Section H 0100 Appliances indicated that the resident did not have an ostomy (surgically created opening in your abdomen that allows waste or urine to leave your body - including colostomy). Interview with licensed staff, Employee E5, on December 30, 2022, at 9:45 a.m. confirmed that the MDS was coded incorrectly and that the resident had a colostomy at the time of the assessment. 28 Pa. Code: 211.5(f) Clinical records Previously cited 11/1/21 28 Pa. Code: 211.12(d)(1)(5) Nursing services Previously cited 11/1/21 FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396083 If continuation sheet Page 4 of 18 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 396083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a review of the clinical record and interview with resident and staff, it was determined that the facility failed to develop a plan of care with interventions to meet the resident needs identified in the comprehensive assessment for two of 28 residents reviewed (Residents 49 and 58). Findings include: Review of Resident 49's admission MDS (Minimum Data Set - periodic assessment of resident's needs) dated November 29, 2022, included diagnoses of but not limited to diabetes mellitus (disease that occurs when blood glucose, also called blood sugar, is too high) and dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities). Review of current physician's orders included an order for risperidone (antipsychotic medication) for unspecified psychosis Review of the Resident 49's current active care plan revealed no care plan or interventions for Diabetes Mellitus, Dementia, or the use of psychotropic medications. Interview with the Assistant Director of Nursing on December 30, 2022, at 9:30 a.m. confirmed that care plans for the above areas were not developed for Resident 49. Interview with Resident 58 on December 28, 2022, at 12:40 p.m. revealed the resident had been on an anticoagulant (blood thinning medication) since being admitted to the facility on [DATE]. Review of Resident 58's physician's orders revealed a current active order dated December 21, 2022, for apixaban (anticoagulant) 5 milligrams (mg) twice daily. Review of Resident 58's current active care plan revealed no care plan or interventions for the use of anticoagulant medication. Interview with the Director of Nursing on December 30, 2022, at 10:10 a.m., confirmed there was no care plan developed for anticoagulant use for Resident 58. 28 Pa. Code 211.5(f) Clinical records Previously cited 11/1/21 28 Pa. Code 211.12(d)(1)(5) Nursing services Previously cited 11/1/21 FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396083 If continuation sheet Page 5 of 18 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 396083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063 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 Based on clinical record review, interviews with the staff it was determined that the facility failed to assess a resident after a change in condition in a timely manner for one out of 32 residents (Resident 85) reviewed causing pain during a delay of service. Residents Affected - Few Findings include: Review of the clinical record revealed Resident 85's diagnosis including unspecified Dementia and cognitive communication deficit (how someone uses language). Further review of Resident 85's clinical record revealed Resident 85's Quarterly Minimal Data Screening (MDS - an assessment based on residents' care needs) showed a cognitive level of five out of fifteen, indicating severe cognitive impairment. Review of the clinical record revealed a nursing note dated October 3, 2022, (the) nurse was called into the resident's room by the certified nursing assistant, for a fall. The resident was laying on the floor next to her bed with complaints of pain to both of her lower extremities. An x-ray of the right hip was ordered and performed with 2 views obtained. The 3rd view was unable to be obtained due to the resident's restless behavior. Further review of the clinical record revealed the x-rays results were negative for fracture. The physician ordered lidocaine patch 5% (pain medicine through a patch) to the right hip at bedtime for pain and remove per schedule. On October 6, 2022, the resident began voicing pain when attempting to turn or repositioned. A new order for complete view right hip x-ray completed. The x-ray was performed on the same day. X ray results were received on October 7, 2022, when it was realized the wrong hip (left hip not the right hip) was x-rayed. A new order for another x-ray was performed on the right hip on the same day, with results being negative. Further review of the clinical record revealed on October 8, 2022, Resident 85 is complaining of pain 10/10 to the right hip and right upper leg. Right hip area is swollen, and Resident 85 is refusing to get out of bed. Lidocaine patch placed to her right hip per orders. Resident 85 screams and hollers every time they get turned and repositioned. (As needed) Tylenol given per orders. MD called and updated. On October 9, 2022, a nursing note states the following, (Resident 85) is complaining of pain 8-10 of 10 to the right hip and right upper leg, right upper leg swollen, warm to the touch and screams and hollers every time she gets turned and repositioned or when care is being provided. Tylenol given. There is no further documentation that this was reported to the physician. October 10, 2022, a nursing note states Resident 85 was seen by the nurse practitioner and staff reported that the resident is still in pain when turned. A new order for a CT scan (a medical imaging technique used to obtain detailed internal images of the body) of the right hip was given. Further of the clinical record reveals on October 11, 2022, nursing writes still calls out in pain when turned and refuses to get out of bed. CT scan of right hip and pelvis is pending. October 12, 2022, the resident complained of right hip pain upon movement during morning care. Right hip swelling (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396083 If continuation sheet Page 6 of 18 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 396083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063 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 observed. There is no further documentation that these instances were reported to the physician. Level of Harm - Minimal harm or potential for actual harm On October 17, 2022, the resident was taken for the CT scan and right hip fracture was confirmed. Residents Affected - Few An interview was conducted with the Director of Nursing on December 30, 2022, at 10:15 a.m. revealed that the CT scan appointment was the first available time, and the physician was not notified on October 11 that the CT scan would be 7 days after the order was given. The facility failed to assess Resident 85 after a change in condition in a timely manner causing pain and discomfort to the resident. 28 Pa. Code 211.5(f) Clinical records 28 Pa. Code 211.10(c) Resident care policies 28 Pa. Code 211.12(c)(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396083 If continuation sheet Page 7 of 18 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 396083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063 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 - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy, clinical record review, and staff interviews, it was determined the facility failed to monitor the skin of residents at risk for skin impairment causing actual harm by discovering a pressure ulcer at an advanced stage for one of eight residents reviewed (Resident 81). Residents Affected - Few Findings include: Review of the facility's policy and procedure titled Prevention of Pressure Injuries, revised in April 2020, revealed to inspect the skin daily when performing or assisting with personal care or ADLs (Activities of Daily Living). Identify any signs of developing pressure injuries. For darkly pigmented skin, inspect for changes in skin tone, temperature, and consistency. Inspect pressure points (sacrum, heels, buttocks, etc.). Review of Resident 81's diagnosis list revealed Dementia (term used to describe a group of symptoms affecting memory, thinking, and social abilities severely enough to interfere with daily life), muscle weakness, Anxiety, and Bipolar Disorder. Review of Resident 81's clinical records revealed Resident 81 was readmitted to the facility on [DATE], from the hospital after post falls with a left hip fracture requiring a surgical repair. Review of the admission assessment dated [DATE], revealed Resident 81 was admitted to the facility with the following skin condition: surgical wound to the left lower hip, left upper hip, and left outer thigh, a bruise on the left groin and left knee, and a Stage 2 (shallow, crater-like wound or blister containing clear or yellow fluid) to the sacrum (tail bone). Review of Resident 81's Braden Scale (standardized tool used to identify the risk of developing pressure injury) assessment dated [DATE], revealed resident was at risk for developing a pressure ulcer. Review of Resident 81's significant change Minimum Data Set (MDS- standardized assessment tool that measures health status in long-term care residents) dated June 6, 2022, revealed resident required extensive assistance with two people for bed mobility. Review of Resident 81's clinical record revealed a care plan for skin integrity and care with interventions including heel protector boot and daily skin inspection with ADL care. Review of Resident 81's clinical record revealed a physician's order initiated on June 2, 2022 for [NAME] stockings with instructions of Apply [NAME] Stockings in the morning and remove at HS (bedtime) for bilateral lower extremity edema. Review of Resident 81's clinical record including the June 2022 MAR (Medication Administration Record) revealed the [NAME] stockings were documented as being administered on June 2, 3, 4, 6, 7, and June 8, 2022 at 6 a.m. Additional review of the June 2022 MAR revealed the [NAME] stockings were documented as removed on June 2, 3, 4, 5, 6, and June 7, 2022 at 2100 (9 p.m.). Additional review of the [NAME] stocking order revealed the order was discontinued on June 8, 2022. Further Review of the June 2022 MAR and/or TAR (Treatment Administration Record) revealed that heel (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396083 If continuation sheet Page 8 of 18 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 396083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063 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 boot protector was documented as placed on/removed daily. Level of Harm - Actual harm Review of Resident 81's nursing progress notes dated June 8, 2022, (11:27 a.m.), revealed that upon removal of stockings, a purplish discolored area was observed on the resident's left heel, and the physician and family were notified. Residents Affected - Few Review of the wound nurse consult dated June 8, 2022, revealed a full-thickness wound to Resident 81's left heel, measuring 4.0 x 5.6 cm (centimeter), wound base 100% eschar (dead or devitalized tissue that is hard or soft in texture; usually black, brown, or tan, and may appear scab-like), no drainage. The wound was identified as an unstageable wound (full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because the wound bed is obscured by slough or eschar). Review of wound consult dated December 14, 2022 revealed the wound is considered Stage 3 with full thickness of the left heel measuring 0.5 x 0.7 x 0.1 cm. Interview with the Director of Nursing was conducted on December 30, 2022, at 10:00 a.m. The DON was unable to provide an answer as to why Resident 81's left heel wound was discovered already at an Unstageable stage, when opportunities for observation were occurring twice daily. The facility failed to ensure Resident 81's skin was appropriately monitored resulting in harm and discovering a pressure ulcer at an Unstageable stage. 28 Pa. Code 201.18(b)(1)(3)(c) Management Previously cited 11/1/21 28 Pa. Code 211.5(f) Clinical records Previously cited 11/1/21 28 Pa. Code 211.12 (c)(d)(1)(5) Nursing services Previously cited 11/1/21 FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396083 If continuation sheet Page 9 of 18 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 396083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063 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 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on policy, interview, observation, and clinical record review, it was determined that the facility failed to assess a resident for safety during smoking for one of one residents reviewed (Resident 23). Residents Affected - Few Findings include: Review of facility policy, Smoking Policy - Residents, last revised August 2022, revealed: A resident's ability to smoke safely is re-evaluated quarterly, upon a significant change (physical or cognitive) and as determined by staff. Per the policy, the evaluation should include the resident's currently level of tobacco consumption, method of consumption (ie, traditional cigarettes, electronic cigarettes, pipe), the resident's desire to quit smoking, and ability to smoke safely with or without supervision (per a completed Safe Smoking Evaluation). The policy further stated, The staff consults with the attending physician and the director of nursing services (DNS) to determine if safety restrictions need to be placed on a resident's smoking privileges based on the Safe Smoking Evaluation. Interview with Resident 23 on December 28, 2022 at 12:46 p.m., revealed the resident was a current smoker who smoked three times a day at the facility. Observation of Resident 23 on December 29, 2022 at 9:34 a.m., revealed the resident was smoking outside in the designated smoking area with staff supervision. Review of Resident 23's clinical record revealed a quarterly Smoking Screen Evaluation dated July 1, 2022, which stated that the resident did not smoke. Because the question Does the resident smoke? was answered with a no, the rest of the evaluation was grayed out and unable to be completed. The surveyor asked for all quarterly Smoking Screen Evaluations for Resident 23 for the year of 2022 and the only one provided and evident in the resident's clinical record was the one dated July 1, 2022. Interview with the Director of Nursing on December 30, 2022 at 10:08 a.m. confirmed that smoking evaluations were not done quarterly on Resident 23, and the evaluation from July 1, 2022 was inaccurate in assessing the resident's safety when smoking. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1)(3) Management 28 Pa. Code 211.10(c)(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: 396083 If continuation sheet Page 10 of 18 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 396083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on policy, interview, observation, and clinical record review, it was determined that the facility failed to obtain a physician's order for oxygen therapy for one of one resident reviews (Resident 58). Residents Affected - Few Findings include: Review of facility policy, Oxygen Administration, last revised October 2010, revealed that staff should verify that there is a physician's order for oxygen administration prior to administering oxygen. Observation of Resident 58 on December 28, 2022 at 12:41 p.m. revealed the resident was receiving oxygen at 2.5 liters per minute through a nasal cannula (device used to deliver supplemental oxygen or increased airflow to a person in need of respiratory help). Interview with Resident 58 at this time revealed the resident had been on oxygen since arrival at the facility in April 2022. Review of Resident 58's physician's orders failed to reveal a current order for oxygen therapy via nasal cannula. Interview with the Director of Nursing on December 30, 2022 at 10:07 a.m., confirmed that Resident 58 did not have a physician's order for oxygen therapy until December 29, 2022. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.5(f) Clinical records 28 Pa. Code 211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396083 If continuation sheet Page 11 of 18 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 396083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063 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 0756 Level of Harm - Minimal harm or potential for actual harm Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based upon clinical record review and staff interview, it was determined that the facility failed to ensure that any irregularities were acted upon by a physician for one of five residents reviewed (Resident 49). Residents Affected - Few Findings include: Review of Resident 49's clinical record revealed that a MRR (Medication Record Review) was completed on November 24, 2022, with a recommendation to define target behavior(s) for and initiate a behavior/side effect monitoring form for Risperidone (antipsychotic medication). Additional recommendations included to evaluate the diagnosis for Risperidone and provide a diagnosis for Amantadine (medication used to treat movement disorders). Further review of the clinical record failed to reveal that the pharmacist recommendations were addressed by the physician. An interview with the Director of Nursing on December 30, 2022, at 10:15 a.m. confirmed that the recommendations were not addressed by the physician. 483.45 Drug Regimen Review, Report Irregular, Act on Previously cited 11/1/21 28 Pa. Code 211.5(f) Clinical records Previously cited 11/1/21 28 Pa. Code 211.12(c) Nursing services Previously cited 11/1/21 28 Pa. Code 211.12(d)(3) Nursing services Previously cited 11/1/21 28 Pa. Code 211.12(d)(1)(5) Nursing services Previously cited 11/1/21 FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396083 If continuation sheet Page 12 of 18 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 396083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Based on review of facility policy and clinical records, it was determined that the facility failed to ensure that the appropriate timeframe, justification, and non-pharmalogical interventions were in place for as needed (PRN) psychotropic medications for two of 28 residents reviewed (Residents 58 and 107). Findings include: Review of facility policy, Psychotropic Medication Use, last reviewed July 2022, revealed: PRN orders for psychotropic medications are limited to 14 days .If the prescriber or attending physician believes it is appropriate to extend the PRN order beyond 14 days, he or she will document the rationale for extending the use and include the duration for the PRN order. The policy further revealed: Non-pharmalogical approaches are used (unless contraindicated) to minimize the need for medications, permit the lowest possible dose, and allow for discontinuation of medications when possible. Review of Resident 58's physician's orders revealed an order dated August 17, 2022, for lorazepam (antianxiety medication) 0.5 milligrams (mg) 1 tablet by mouth as needed every 12 hours for anxiety. Further review of Resident 58's physician orders revealed the lorazepam was discontinued on September 9, 2022, a duration of 23 days. Further review of Resident 58's physician orders revealed the lorazepam order was rewritten on September 9, 2022 with a discontinue date of September 22, 2022. Further review of Resident 58's physician orders revealed the lorazepam order was rewritten on September 22, 2022 with a discontinue date of September 29, 2022. Review of Resident 58's Consultant Pharmacist Recommendations to the Physician dated September 26, 2022 revealed: PRN psychotropics must have a duration of therapy with use. The first order is limited to a maximum of 14 days, however may be renewed for 90 days with a progress note. Please add a duration for [lorazepam.] Further review of the pharmacy consult revealed the practitioner agreed to add a duration of 90 days for the lorazepam and signed the consult on September 29, 2022. Further review of Resident 58's physician's orders revealed an order dated September 29, 2022, for lorazepam 0.5 mg 1 tablet by mouth every 12 hours as needed with a stop date of December 19, 2022. Review of Resident 58's progress notes failed to reveal documented evidence from the physician or prescriber for the justification of continued use of PRN lorazepam. Review of Resident 58's Medication Administration Records (MARs) from August 2022, September 2022, October 2022, November 2022, and December 2022 failed to reveal documented evidence that non-pharmalogical interventions were attempted or offered to the resident prior to receiving PRN lorazepam. Interview with the Director of Nursing on December 30, 2022, at 10:10 a.m. confirmed Resident 58 was initially prescribed PRN lorazepam for a duration longer than 14 days, there was no physician justification for the continued usage of the medication, and there were no non-pharmalogical interventions documented as offered to or attempted with the resident prior to receiving the PRN medication. Review of Resident 107's diagnosis list revealed Dementia (A term used to describe a group of symptoms affecting memory, thinking, and social abilities severely enough to interfere with daily life) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396083 If continuation sheet Page 13 of 18 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 396083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063 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 0758 with behavioral disturbance, anxiety disorder, and Major Depressive Disorder. Level of Harm - Minimal harm or potential for actual harm Review of Resident 107's physician order revealed that on December 2, 2022, an order was made for Lorazepam (A medication to treat anxiety) 1mg every eight hours as needed was anxiety. Residents Affected - Few Review of Resident 107's December 2022, Medication Administration Record (MAR) revealed that from December 2, 2022, until December 22, 2022, as needed Lorazepam was administered to the resident eight times. Clinical record reviews revealed no documented evidence that an alternative behavior intervention was attempted before the medication administration. In addition, as needed Lorazepam was administered to the resident six times with no documented indication. Interview with the director of Nursing on December 30, 2022, at 10:00 a.m., confirmed that there was no documented indication and that non-drug intervention was provided before administering the as-needed Lorazepam to Resident 107. 28 Pa. Code 211.2(a) Physician services 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396083 If continuation sheet Page 14 of 18 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 396083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063 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. Based on observation, review of the medication manufacturer's guidelines, and staff interview, it was determined that the facility failed to ensure medications were properly labeled and stored for one of three medication carts observed (Chateau Medication Cart two). Findings include: Review of the manufacturer's storage guidelines for Insulin Aspart (Novolog-fast-acting insulin), revealed that the medication must be stored at room temperature and must be discarded within 28 days after opening Review of the manufacturer's storage guidelines for Insulin Lispro (Humalog-fast-acting insulin), revealed that the medication must be stored at room temperature and must be discarded within 28 days after opening. Review of the manufacturer's storage guidelines for Humulin R Insulin (fast-acting insulin), revealed that the medication must be stored at room temperature and must be discarded within 28 days after opening. Review of manufacturers' storage guidelines for Insulin Gargline (long-acting insulin) revealed that the medication may be stored at room temperature and must be discarded within 28 days after opening. Review of the manufacturer's guidelines for Latanoprost (used to treat high pressure in the eye), revealed that once a bottle is opened for use it may be stored at room temperature for six weeks. Review of the Lumigan Ophthalmic Solution (A medication to treat high pressure inside the eye) revealed that the medication was to keep the medication only for four weeks once the bottle has been opened. Review of the manufacturer's guidelines revealed Dorzolamide eye drops (medication used in the treatment of glaucoma) should be discarded 28 days after first opening the bottle. Observation of the Chateau unit medication cart two was conducted in the presence of licensed nurse Employee E6 on December 28, 2022, at 10:00 a.m. The observation revealed that the following insulins were opened and undated: One Aspart vial, one Aspart pen, three Lispro vials, one Humulin R vial, one Gargline pen, two Humalog vials, one Novolin R vial, and two Gargline vial. One Gargline vial was observed opened with an open date of November 17, 2022. Further observation of the same medication cart revealed that the following eye drops were opened and undated: Two Latanaprost bottles, two Lumigan bottles, and one Dorzalamide bottle. Interview with Employee E6 was conducted on December 28, 2022, at 10:10 a.m., and confirmed that the above insulin and eye drops should have been dated when opened. The above information was conveyed to the Director of Nursing on December 30, 2022, at 10:00 a.m. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396083 If continuation sheet Page 15 of 18 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 396083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063 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 The facility failed to ensure medications on the Chateau Unit medication cart two were properly labeled and stored. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12 (c)(d)(1)(5) Nursing services Residents Affected - Few Previously cited 11/1/21 FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396083 If continuation sheet Page 16 of 18 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 396083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063 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 resident interviews, observation, and staff interview, it was determined that the facility failed to provide foods that were served at the proper temperature to ensure resident satisfaction on one of four units (1st floor). Residents Affected - Some Findings include: During a group interview with six alert and oriented residents on December 28, 2022, at 10:00 a.m., residents indicated the food is frequently cold and staff will not reheat it. Interview with Resident 8 on December 27, 2022, at 2:30 p.m. revealed that the food is often cold. Interview with Resident 20 on December 28, 2022, at 11:08 a.m. revealed that the food is not always hot. Interview with Resident 26 on December 28, 2022, at 12:56 p.m. revealed that the food is cold. Observation of the lunch meal on December 29, 2022, revealed that the food cart left the kitchen at 12:39 p.m. and arrived on the 1st floor at 12:42 p.m. Staff began passing trays from the cart at 12:42 p.m. The last resident was assisted with their meal at 12:53 p.m., at which time a test tray was evaluated with the Director of Dietary Services, Employee E2. The test tray revealed the following temperatures: Hot dog 121 degrees F, baked beans 149.2 degrees F, and Juice 55 degrees F. Interview with the Director of Dietary Services at that time revealed that these temperatures were not acceptable and should be between 140-145 degrees F at the point of service for hot items and 40-45 degrees F for cold items. 28 Pa. Code: 201.18 (b)(3) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396083 If continuation sheet Page 17 of 18 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 396083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Health Care and Rehab Center 318 South Orange Street Media, PA 19063 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 0887 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. Based on policy and clinical record review and interview, it was determined that the facility failed to provide evidence that education was provided to residents on the risks and benefits of the COVID-19 vaccine for five of five residents reviewed that refused the COVID-19 vaccine (Residents 23, 92, 112, 127, and 147). Findings include: Review of facility policy, COVID-19 Vaccination of Residents and Staff, created May 2021, revealed: Prior to any COVID-19 vaccination clinic, unvaccinated residents (or resident's legal representative) and/or unvaccinated staff members will be provided information and education regarding the benefits and potential side effects of the particular COVID vaccine that will be available .Education will cover the benefits and potential side effects of the vaccine including common reactions, such as aches or fever, and rare reactions such as anaphylaxis. Review of Resident 23's clinical record revealed an admission date of April 29, 2005. Review of Resident 92's clinical record revealed an admission date of March 5, 2022. Review of Resident 112's clinical record revealed an admission date of March 4, 2022. Review of Resident 127's clinical record revealed an admission date of August 9, 2022. Review of Resident 147's clinical record revealed an admission date of September 29, 2022. Review of the clinical records for Residents 23, 92, 112, 127, and 147 revealed the residents did not receive the COVID-19 vaccine. Further review of the clinical records for Residents 23, 92, 112, 127, and 147 failed to reveal documented evidence that each of the residents/representatives were educated regarding the risks and benefits of the COVID-19 vaccination. Interview with the Director of Nursing on December 30, 2022, at 10:08 a.m. confirmed that there was no documentation indicating that education regarding the risks and benefits of the vaccine was provided to the residents/representatives. 28 Pa. Code 201.18(b)(1)Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396083 If continuation sheet Page 18 of 18