Health inspection·August 21, 2025

F 0579 Provide information about how to apply for and use Medicare and Medicaid benefits. Level of Harm - Minimal harm or potential for actual harm Based on observations and staff interview, it was determined that the facility failed to display (for residents and/or their responsible person) written information on applying for Medicare and Medicaid benefits and receiving refunds for previous payments covered by Medicare and Medicaid as required, in the facility. Based on observations and staff interview, it was determined that the facility failed to display (for residents and/or their responsible person) written information on applying for Medicare and Medicaid benefits and receiving refunds for previous payments covered by Medicare and Medicaid as required, in the facility. Findings include: During observations completed on 821/25, of the first-floor lobby and the second-floor nursing unit posting locations, failed to include information on how to apply for Medicare and Medicaid benefits and receiving refunds for previous payments covered by Medicare and Medicaid. During an interview and rounds, on 8/21/25, at 8:30 a.m., the Director of Nursing confirmed the facility failed to display (for residents and/or their responsible person) written information on applying for Medicare and Medicaid benefits and receiving refunds for previous payments covered by Medicare and Medicaid as required, in the facility. 28 Pa. Code: 201.14(a)Responsibility of licensee. 28 Pa. Code: 201.18(e) Management. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396085 If continuation sheet Page 2 of 3 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 396085 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mon Valley Care Center 200 Stoops Drive Monongahela, PA 15063 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. 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, clinical records, and staff interviews it was determined that the facility failed to make certain consistent dialysis communication was maintained for three of six residents (Residents R27, R41 and R46).Findings include: Review of the facility policy Hemodialysis dated 3/31/25, indicates the ongoing assessment of the resident's condition and monitoring for complications before and after dialysis treatments received at a certified dialysis facility. Ongoing communication and collaboration with the dialysis facility regarding dialysis care and services. The Licensed nurse will communicate to the dialysis facility via telephonic communication or written format, such as a dialysis communication form or other form, that will include, but not limit itself to: medication administration, treatment orders, laboratory values, vital signs, advanced directives, nutrition/fluid management, treatment provided, adverse reactions, changes in condition, injury and transportation concerns. The dialysis communication form has sections for both the skilled nursing facility and dialysis center documentation to be completed. Review of the admission record indicated Resident R27 was admitted to the facility on [DATE].Review of Resident R27's Minimum Data Set (MDS - periodic assessment of resident care needs) dated 6/18/25, indicated diagnoses of end stage renal disease, hypertension, and type 2 diabetes.Review of Resident R27's physician orders dated 8/3/25, indicated dialysis: at [dialysis center] on Monday, Wednesday, and Friday. Pick up time 9:15 am-10:15 am.Review of Resident R27's current care plan indicated dialysis: at [dialysis center] on Monday, Wednesday, and Friday. Pick up time 9:15 am-10:15 am.Review of Resident R27's dialysis communication forms indicated the following:8/6, 8/11, 8/13, and 8/15/25 dialysis communication forms were incomplete Review of the admission record indicated Resident R41 was originally admitted to the facility on [DATE]. Review of Resident R41's MDS dated [DATE], indicated diagnoses of end stage renal disease (condition where kidneys lose the ability to remove waste and balance fluids), diabetes mellitus (impaired ability to produce or respond to insulin), and hypertension (high blood pressure). Review of Resident R41's physician orders dated 5/13/25, indicated dialysis: Monday, Wednesday, and Friday at [dialysis center]. Chair time scheduled at 7:30 a.m., pick up time 6-6:30 a.m., and return time 10:30-11:00 a.m. Review of Resident R41's current care plan indicated dialysis three times a week, treatments as scheduled: Monday, Wednesday, and Friday at [dialysis center]. Chair time scheduled at 7:30 a.m., pick up time 6-6:30 a.m., and return time 10:30-11:00 a.m. Monitor for side effects and notify physician accordingly. Review of Resident R41's dialysis communication forms indicated the following:5/2/25, 5/5/25, 5/7/25, 5/9/25, 5/12/25, 5/19/25, 5/28/25, 5/30/25, 6/2/25, 6/4/25, 6/23/25, 6/25/25, 7/4/25, 7/9/25, and 8/1/25 dialysis communication forms were incomplete. Review of the admission record indicated Resident R46 was re-admitted to the facility on [DATE]. Review of Resident R46's MDS dated [DATE], indicated diagnoses of end stage renal disease, heart disease, and bladder cancer. Review of Resident R46's physician orders dated 6/16/25, indicated dialysis: at [dialysis center]. Chair time scheduled at 5:50 a.m., pick up time 5:00 am-5:30 am a.m. Review of Resident R46's current care plan indicated dialysis: at [dialysis center]. Chair time scheduled at 5:50 a.m., pick up time 5:00 am-5:30 am a.m. Review of Resident R46's dialysis communication forms indicated the following: 6/24, 7/14, 7/19, 7/29, and 7/31/25 dialysis communication forms were incomplete. During an interview on 8/19/25, at 10:00 a.m. the Director of Nursing confirmed the facility failed to make certain consistent dialysis communication was maintained for three of six residents (Residents R27, R41 and R46). 28 Pa. Code: 211.5(f) Clinical records 28 Pa. Code: 211.12(d)(2)(3) Nursing services Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396085 If continuation sheet Page 3 of 3