Inspection·March 1, 2024

F 0559 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, and resident and staff interviews, it was determined that the facility failed to provide written notice, including the reason for the change, prior to moving a resident to another room, for one of 14 residents reviewed (Resident 19). Findings include: Interview with Resident 19 on February 27, 2024, at 11:57 AM revealed that he moved into his current room in the last few weeks. He stated he was in his old room for a long time. Resident 19 indicated he did not receive a written notice. Resident 19 stated that the staff did not give him a choice about changing rooms, he stated that he was informed that he had to move. Clinical record review revealed the facility admitted Resident 19 on October 18, 2022. Review of Resident 19's census information revealed that on February 14, 2024, the resident was moved from room [ROOM NUMBER] (private) to room [ROOM NUMBER] (three-bedroom). Further review of Resident 19's census information revealed that Resident 19 had resided in room [ROOM NUMBER] since February 28, 2023. Nursing documentation dated February 14, 2024, at 10:00 AM, revealed that Employee 7 (social worker) met with Resident 19 to discuss his room change. She noted per administrative staff and the Department of Health's expectation of having an isolation room, as well as a short-term skilled room for therapy of potential skilled care residents. Employee 7 documented that Resident 19 acknowledged understanding, but stated he liked where he was. Nursing documentation dated February 14, 2024, at 10:21 PM, revealed Resident 19 expressed anger at being moved when he was at activities in the afternoon. Resident 19 stated if my blood pressure is up, you know why. Reviewed findings with the Nursing Home Administrator and Director of Nursing on March 1, 2024, at 10:52 AM. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396093 If continuation sheet Page 2 of 11 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 396093 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Richfield Healthcare and Rehabilitation Center 631 Main Street Richfield, PA 17086 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 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. 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 provide the required Notice of Medicare Provider Non-Coverage timely, in advance of changes for Medicare covered services to one of three residents reviewed whose Medicare coverage was discontinued (Resident 2). Residents Affected - Few Findings include: The form Notice of Medicare Non-Coverage (NOMNC) CMS-10123, is a notice that informs the recipient when care received from the skilled nursing facility is ending; and how to contact a Quality Improvement Organization (QIO) to appeal. The Medicare provider must ensure that the notice is delivered at least two calendar days before covered services end. Review of Resident 2's Notice of Medicare Non-Coverage (NOMNC) CMS-10123 revealed that the Medicare skilled A services will end on January 5, 2024. Review of Resident 2's CMS-10123 form further indicated Resident 2's family was made aware via phone call on January 5, 2024, and verbalized understanding that the coverage of services will end on the effective date indicated on the notice which was also January 5, 2024. Interview with the Nursing Home Administrator on March 1, 2024, at 10:23 AM confirmed the facility failed to ensure that the notice was delivered at least two calendar days before Resident 2's covered services ended. 28 Pa. Code 201.29(a) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396093 If continuation sheet Page 3 of 11 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 396093 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Richfield Healthcare and Rehabilitation Center 631 Main Street Richfield, PA 17086 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 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm Based on observations and staff interview, it was determined that the facility failed to ensure confidentiality of personal health information and a resident's right to privacy for one of two nursing units reviewed (First Floor Nursing Unit; Residents 6 and 188). Residents Affected - Few Findings include: Observation on February 27, 2024, at 11:25 AM of the area outside of the first floor nursing unit near the main entrance to the facility, revealed a medication cart with a computer on top that was clearly visible to anyone passing by. The computer was logged into Resident 6's medical record. There were no staff around at the time of the finding and Resident 6's protected health information (PHI) was clearly visible to anyone passing by. Employee 8, licensed practical nurse, was then observed coming out of a resident's room and started working with the computer. It was unclear how long the resident's chart was left unsecured. Observation on February 28, 2024, at 11:11 AM of the first floor nursing unit near the main entrance to the facility, revealed a laptop computer that was on top of the desk and visible to anyone passing by. The computer was logged into Resident 188's medical record. There were no staff around at the time of the finding and Resident 188's protected health information was clearly visible to anyone accessing the nurse station. The computer's screen was also visible to anyone coming and going through the front door to the facility. The Director of Nursing confirmed the observation on February 28, 2024, at 11:13 AM and advised the computer belonged to the facility's registered nurse, Employee 9, and proceeded to close the laptop. The above information for the PHI was reviewed with the Nursing Home Administrator and Director of Nursing on February 29, 2024, at 2:00 PM. 28 Pa. Code 211.12(d)(1) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396093 If continuation sheet Page 4 of 11 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 396093 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Richfield Healthcare and Rehabilitation Center 631 Main Street Richfield, PA 17086 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 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. Based on observation, resident and staff interview, and clinical record review, it was determined that the facility failed to provide appropriate treatment and services for a resident with an emotional disorder to attain the highest practicable mental and psychosocial well-being for one of two residents reviewed (Resident 13). Findings include: During an interview with Resident 13 on February 27, 2024, at 12:39 PM, the resident revealed that she was in and out of the hospital for hearing voices. Resident 13 indicated that psychiatric visits are done by computer whenever the woman who helps her is available. Resident 13 voiced that the resident could use someone every day for talking. Clinical record review for Resident 13 revealed that her diagnoses include schizoaffective disorder (a combination of symptoms of hallucinations or a perception of having seen, heard, touched, tasted, or smelled something that his not there, delusions or false beliefs, and mood disorder such as depression or extremely elevated mood). The record included that Resident 13 had two psychiatric hospitalizations from June 2023 to current. Review of a hospital discharge summary for Resident 13 dated August 24, 2023, revealed the resident was hospitalized since June 22, 2023, for schizoaffective disorder. The reason for admission was increasing hallucinations. The resident reported the hallucinations increased her anxiety. The voices told her to hurt herself or do bad things like steal. At the time of discharge from the hospital, the resident was deemed not to be a threat to self or others. The resident was readmitted to the nursing facility. Review of a hospital discharge summary for Resident 13 dated February 2, 2024, revealed that the resident was hospitalized since January 19, 2024, for schizoaffective disorder. The reason for admission was the resident experienced auditory command hallucinations (hearing voices that instruct a person to act in a certain way) for several months that the voice wanted to hurt the resident and for the resident to commit murder. At the time of discharge from the hospital the resident was deemed not a threat to self or others. The resident felt nervous about returning to the nursing facility. The resident was readmitted to the nursing facility. Clinical record review for Resident 13 revealed the resident received psychiatric visits by a nurse practitioner (an advanced practice registered nurse trained to provide mental health services) via telemedicine (using a computer to see and provide care to a person) throughout her stay and most recently on the following dates: October 16, 2023, November 13 and 27, 2023, December 12, 2023, January 2, 16, 2024, and February 4, 13, and 20, 2024. Clinical record review for Resident 13 revealed no person-centered care plan related to the resident's hallucinations, anxiety, and harm to self or others which included an assessment of the level of the resident's distress, providing individualized treatment and services, programs or activities and the supportive care staff can provide to assist the resident in coping with hallucinations and anxiety. In addition, there was no documented routine assessments of the resident's hallucinations or anxiety. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396093 If continuation sheet Page 5 of 11 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 396093 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Richfield Healthcare and Rehabilitation Center 631 Main Street Richfield, PA 17086 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 0742 Level of Harm - Minimal harm or potential for actual harm The facility failed to provide the appropriate treatment and services for Resident 13 to attain the highest practicable mental and psychosocial well-being. During a meeting with the Nursing Home Administrator, Director of Nursing, and Employee 7, social worker, on March 1, 2024, at 10:30 AM, the surveyor reviewed the findings for Resident 13. Residents Affected - Few 28.Pa. Code 201.18(b)(1) Management 28. Pa. Code 201.29(a) Resident rights 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396093 If continuation sheet Page 6 of 11 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 396093 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Richfield Healthcare and Rehabilitation Center 631 Main Street Richfield, PA 17086 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 0744 Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. 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 develop and implement an individualized person-centered care plan to address dementia and cognitive loss displayed by one of one resident reviewed (Resident 32). Residents Affected - Few Findings include: Clinical record review for Resident 32 revealed the facility admitted her on November 2, 2023, with diagnosis including Dementia (loss of memory, language, problem-solving, and other thinking abilities that interfere with daily life). A review of Resident 32's admission Minimum Data Set Assessment (MDS, a form completed at specific intervals to determine care needs) dated November 2, 2023, indicated that the facility assessed Resident 32 as having a diagnosis of dementia. The facility determined that a care plan for dementia and cognitive loss would be developed. A review of Resident 32's care plan revealed that there was no indication that the facility had developed and implemented a person-centered care plan to address the resident's dementia and cognitive loss. The findings were reviewed with Employee 6 (RNAC, registered nurse assessment coordinator) on February 29. 2024, at 2:37 PM. Employee 6 confirmed the facility had no further documentation that the facility developed and implemented an individualized person-centered care plan to address Resident 32's dementia and cognitive loss. 28 Pa Code 211.12 (d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396093 If continuation sheet Page 7 of 11 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 396093 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Richfield Healthcare and Rehabilitation Center 631 Main Street Richfield, PA 17086 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 - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, it was determined the facility failed to store food and maintain food service equipment in accordance with professional standards for food service safety in the facility's main kitchen, dining area, and food storeroom. Findings include: Observation of the facility's main kitchen on February 27, 2024, at 9:20 AM with Employee 1, cook, revealed the following: A large garbage can in the food preparation area across from the dishwasher was observed with visible dried food and dried liquid runs on the exterior of the can and the lid was not present. The lid was on top of the garbage can next to the handwashing sink. The cook's refrigerator contained a plastic bag of sliced onions, that were not dated. Employee 1 indicated that nursing staff had leftovers and gave them to the kitchen in case they were needed but they were not used. Also in the refrigerator were the following food items that were not dated with a use-by date or expiration date: six slices of bread, two plastic squeeze bottles of Italian dressing, two sticky plastic squeeze bottles of sauce that was identified as barbeque sauce and two plastic squeeze bottles that was identified as liquid butter by Employee 1, two containers of mustard, two cartons of orange juice, and a partial pack of hamburger rolls. Employee 1 indicated that the items in the squeeze bottles were taken from the original containers to make it easier for resident use at the tables. In addition, in the refrigerator was an open container of beef broth that was not dated with the open date and the label indicated to use within 14 days of opening, a container of tomato sauce with a use-by date of February 25, 2024, a container of tapioca pudding with use-by date of February 26, 2024, a partial tray of yellow cake with chocolate icing that was dated as made on February 23, 2024, and a container of cheesy broccoli soup with use-by date of February 24, 2024. Employee 1 indicated that cooked food is good for three days after making. The plastic shelving unit contained an open container of drink thickener with the expiration date of February 25, 2024, and a spray bottle labeled as a sanitizer that was stored with the food items. The shelving unit near the coffee machine contained three bags of homemade cookies with no use-by date, a container of individual coffee creamers without a use-by date or expiration date, bins of single serve condiments (ketchup, mustard, honey, jelly, barbeque sauce, salad dressing, mayonnaise, and syrup) without expiration dates, and a bottle of coconut syrup that was labeled for staff use with a best-by date of December 14, 2023. The cupboard on the bottom of the steam table housed single serve condiments without expirations dates. The corner shelf next to the cook's refrigerator contained an open jar of peanut butter with the expiration date of November 6, 2023, a 22-pound container of chocolate icing with a use-by date of January 16, 2024, and a container of flour, two bags of cake mix, and a bag of rice pilaf that were not dated with expiration dates. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396093 If continuation sheet Page 8 of 11 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 396093 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Richfield Healthcare and Rehabilitation Center 631 Main Street Richfield, PA 17086 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 - Many The drink refrigerator contained a pitcher of honey-thick lemonade with a use-by date of February 24, 2024, and an open container of Thick and Easy drink without a use-by date. The Thick and Easy label indicated to use the product within 10 days of opening. Tour of the facility's food storage area was done after the tour of the main kitchen with Employee 2, dietary aide, and revealed the following: The shelving unit contained the following food items without expiration dates: a bin of flour, a box of graham crackers, three boxes of cookies, and two boxes of oatmeal pies. In addition, a box of cookies was on the shelf with an expiration date of October 24, 2023. Another shelving unit contained the following food items without expiration dates: brownie and cake mixes, chicken and beef bases, packs of rice pilaf, packs of potato pearls, and #10 cans of food. The walk-in freezer contained bags of chicken and hamburger without any expiration dates. The stand-up refrigerator contained the following items without expiration dates: 12 cartons of orange juice and seven packs of luncheon meat. A bag of lettuce that had browning and wilting had a use-by date of February 24, 2024. The emergency food section contained numerous cans of evaporated milk with an expiration date of January 20, 2024. The canned goods were labeled with [NAME] dates (dates according to the [NAME] calendar, that represents the date the food as manufactured or packaged). Employee 2 did not know how to read the [NAME] dates and determine the use-by dates of the emergency canned food. The surveyor reviewed the findings for the kitchen and storage area with Employee 3, dietary manager, on February 27, 2024, at 1:45 PM. The surveyor reviewed the above findings with the Nursing Home Administrator on February 27, 2024, at 2:15 PM. Observation on February 29, 2024, at 12:10 PM of the facility's ice machine that is in a room in the main dining room revealed there was no visible air gap from the ice machine between the indirect waste pipe and the flood level rim of the waste receptor as indicted in International Plumbing Code 802.3.1 and 802.3.2 of 2018. The above findings were reviewed with the Nursing Home Administrator on February 29, 2024, at 12:15 PM. 28 Pa. Code 201.14 (a) Responsibility of Licensee FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396093 If continuation sheet Page 9 of 11 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 396093 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Richfield Healthcare and Rehabilitation Center 631 Main Street Richfield, PA 17086 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to ensure accurate clinical documentation for one of 14 residents reviewed (Resident 20). Findings include: Review of Resident 20's medical record revealed a section of the electronic health record (EHR) where various documents are uploaded to the medical record. Further review of this section for Resident 20 revealed that multiple scans for another resident, Resident 191, were uploaded on April 6, 2023, to Resident 20's medical record. The following documents were erroneously uploaded to Resident 20's medical record: An updated POLST (Physician Orders for Life-Sustaining Treatment form X-ray results Status Report Referral to Rehabilitation Service Psychological Evaluation and Consult [DATE] Psychological Evaluation and Consult [DATE] Psychological Evaluation and Consult March 23 Psychological Evaluation and Consult [DATE] Physician Orders March 23 Physician Orders [DATE] Physician Orders [DATE] Physician Orders [DATE] Physician Orders [DATE] Physician Orders [DATE] Physician Notes March 23 Physician Notes [DATE] Physician Note (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396093 If continuation sheet Page 10 of 11 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 396093 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Richfield Healthcare and Rehabilitation Center 631 Main Street Richfield, PA 17086 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 Order Summary March 23 Level of Harm - Minimal harm or potential for actual harm Multidisciplinary Therapy Screen Nursing to Therapy Communication Residents Affected - Few Labs [DATE] Labs [DATE] Interdisciplinary Rehabilitation Data Gathering and Screening Form Hospital Documents Hospital to PAC Facility Form Hospital Documents Hospital Documents Endoprosthesis Identification Card Family Practice Documents Controlled Substance Record Consults AIMS (Abnormal Involuntary Movement Score) March 23 Consent for Psychotropic Therapy After Visit Summary [DATE] After Visit Summary [DATE] Diabetic Foot Care Summary Report [DATE] The Nursing Home Administrator and Director of Nursing were informed of the findings on March 1, 2024, at 1:42 PM. 28 Pa. Code 211.5(i) Medical records 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396093 If continuation sheet Page 11 of 11