Inspection·December 21, 2023

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning). The resident had physician orders dated February 27, 2023, for the following bowel regimen: - Milk of Magnesia Suspension (MOM) 1200 MG/15 ML (Magnesium Hydroxide) Give 30 ml by mouth as needed for constipation. Give daily at bedtime if no BM x 3 Days PRN - Bisacodyl Rectal Suppository (Bisacodyl). Insert 1 unit rectally as needed for constipation if no BM x 4 days. - Rectal Enema (Sodium Phosphates). Insert 1 unit rectally as needed for constipation if no BM x 5 days. Review of Resident 24 's report of bowel activity from the Documentation Survey Report v2 for the months of February 2023 and March 2023 and the Medication Administration Record (MAR) for March 2023, revealed the that the resident did not have a bowel movement on: February 27, 2023 - day one without a bowel movement February 28, 2023 - day two without a bowel movement March 1, 2023 - day three (72 hours) without a bowel movement, 30 ml of MOM was ordered but no evidence that it was administered to the resident. March 2, 2023 - day four without a bowel movement, Bisacodyl suppository was ordered but no evidence that it was administered. March 3, 2023 - day five without a bowel movement, Rectal enema was ordered but no evidence that it was administered. Bisacodyl suppository was given to the resident and not the Fleet enema as ordered. There was no documented evidence that the staff had notified the physician that the resident went five consecutive days, February 27, 28, 1, 2, and 3, 2023, without a bowel movement. Review of Resident 24's bowel activity from the Documentation Survey Report v2 and the MAR for May 2023, revealed that the resident did not have a bowel movement on: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396095 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 396095 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scranton Health Care Center 2933 McCarthy Street Scranton, PA 18505 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 May 15, 2023 - day one without a BM Level of Harm - Minimal harm or potential for actual harm May 16, 2023 - day two without a BM Residents Affected - Some May 17, 2023 - day three (72 hours) without a BM, 30 ml of MOM was ordered but no evidence that it was administered. May 18, 2023 - day four without a BM, Bisacodyl suppository was ordered but no evidence that it was administered. Review of Resident 24's bowel activity from the Documentation Survey Report v2 and the MAR for June 2023, revealed that the resident did not have a bowel movement on: June 13, 2023 - day one without a BM June 14, 2023 - day two without a BM June 15, 2023 - day three (72 hours) without a BM, 30 ml of MOM was ordered but no evidence that it was administered. June 16, 2023 - day four without a BM, Bisacodyl suppository was ordered but no evidence that it was administered. Review of Resident 24's bowel activity from the Documentation Survey Report v2 and the MAR for August 2023, revealed that the resident did not have a bowel movement on: August 8, 2023 - day one without a BM August 9, 2023 - day two without a BM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396095 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 396095 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scranton Health Care Center 2933 McCarthy Street Scranton, PA 18505 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 - Some August 10, 2023 - day three (72 hours) without a BM, 30 ml of MOM was ordered but no evidence that it was administered. August 11, 2023 - day four without a BM, Bisacodyl suppository was ordered but no evidence that it was administered. August 12, 2023 - day five without a BM, Rectal Enema was ordered but no evidence that it was administered. According to the resident's documented bowel activity on: August 17, 2023 - day one without a BM August 18, 2023 - day two without a BM August 19, 2023 - day three (72 hours) without a BM, 30 ml of MOM was ordered but no evidence that it was administered. August 20, 2023 - day four without a BM, Bisacodyl suppository was ordered but no evidence that it was administered. There was no documented evidence that the physician was notified of the five consecutive days, August 8, 9, 10, 11, and 12, 2023, without a bowel movement. Review of Resident 24's bowel activity from the Documentation Survey Report v2 and the MAR for September 2023, revealed that the resident did not have a bowel movement on: September 13, 2023 - day on without a BM September 14, 2023 - day two without a BM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396095 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 396095 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scranton Health Care Center 2933 McCarthy Street Scranton, PA 18505 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 - Some September 15, 2023 - day three (72 hours) without a BM, 30 ml of MOM was ordered but no evidence that it was administered. September 16, 2023 - day four without a BM, Bisacodyl suppository was ordered but no evidence that it was administered. During an interview with the Director of Nursing (DON) on December 21, 2023, at approximately 12:30 PM, the DON confirmed that staff failed to carry out the physician ordered bowel protocol prescribed for Resident 24 to prevent constipation and promote normal bowel activity and was unable to provide documented evidence that the physician was notified of the five consecutive days without a bowel movement. According to the American Nurses Association Principles for Nursing Documentation, nurses document their work and outcomes and provide an integrated, real-time method of informing the health care team about the patient status. Timely documentation of the following types of information should be made and maintained in a patient's EHR (electronic health record) to support the ability of the health care team to ensure informed decisions and high quality care in the continuity of patient care: · Assessments · Clinical problems · Communications with other health care professionals regarding the patient · Communication with and education of the patient, family, and the patient ' s designated support person and other third parties. Review of the facility Neurological Checks Policy last reviewed by the facility October 17, 2023, indicated that neurological checks are indicated to monitor for potential irregularities in neurological status in the event of known or unknown head trauma as the result of a resident event, change in resident condition, or physician's order. Unless otherwise ordered by the physician, the frequency of neurological assessments will be: every 15 minutes x 4; then every 30 minutes x 4; then every one hour x 4; then every 4 hours x 4; then every 8 hours x 7. Elements to be assessed: level of consciousness, mental state, ability to communicate, movement/coordination, reflexes, change in behavior, vital signs: blood pressure, pulse, respirations. A review of the clinical record revealed that Resident 87 was admitted to the facility on [DATE], with diagnoses, which included diabetes, hypotension, schizophrenia (disorder that affects a person's ability to think, feel, and behave clearly), and depression. A review of a quarterly Minimum Data Set Assessment (MDS - a federally mandated standardized assessment completed at specific times to identify resident care needs) dated September 7, 2023, revealed that the resident was cognitively intact with a BIMS score (brief interview to assess cognitive status) of 14 (13-15 represents cognitively intact), required assistance of one staff for bed mobility, transfers, and toileting, required set-up help for ambulation, was not on a toileting program, was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396095 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 396095 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scranton Health Care Center 2933 McCarthy Street Scranton, PA 18505 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 occasionally incontinent of urine, continent of bowel, and was not on a toileting program. Level of Harm - Minimal harm or potential for actual harm A review of a facility investigation report dated, October 7, 2023, at 4:39 PM revealed that while in the process of obtaining the resident's blood sugar, the resident attempted to sit up in bed and rolled to the floor. Staff witnessed her hitting her head on the mattress. The resident stated I don't know what happened. I hit my head. The resident stated that she hit her head on the floor. Witness employee 3 (LPN) saw the resident hit her head on mattress upon rolling off bed. The incident report noted the registered nurse assessment was completed and no injury was noted. Neuro checks were within normal limits, and the resident denies pain. Residents Affected - Some However, review of the clinical record revealed no documented evidence that additional neuro checks were completed as per facility policy following the incident and the resident's report of hitting her head. A review of a facility investigation report dated, October 16, 2023, at 10:55 AM revealed that the resident fell while going to the bathroom. The resident was found in the bathroom, on the floor, sitting upright. The resident attempted to ambulate without a walker or assist from staff (one assist for transfers). Resident assessment completed with no new injuries noted. The resident was assisted off the floor by staff. The resident was continent. The report noted that the resident does not always ring for assistance and non-compliance was care planned. On assessment no lumps, no lacerations were noted and the resident denied pain. The resident stated that she wanted to use the bathroom, and fell while trying to sit on the toilet. The resident denied injury and hitting her head. Neuro checks were initiated and within normal limits. A nurses note dated October 16, 2023 at 4:34 PM indicated that neuro checks were in progress status post fall. The resident was awake and noted to be in no obvious distress. Vital signs were checked and documented as stable at time of assessment. The resident had a hematoma (injury cause blood to collect and pool under the skin) to right posterior (back) head and complained of a mild headache. A cold compress was provided. Further review of the clinical record revealed no detailed description (size, color) of the hematoma which was found on the right posterior of the resident's head. There was no documented evidence the physician was timely notified of the hematoma to the resident's head and the resident's complaint of mild headache. A review of a facility investigation report dated, October 16, 2023, at 7:22 PM revealed that the resident was found face down on the bathroom floor. The resident stated that she wanted to pee. She denied hitting her head. Staff checked her vital signs and assisted the resident to void. No injuries were observed at the time of the incident. Staff assisted the resident to the chair and then to the nurses station for closer supervision due to unsafe behaviors until she was calm and ready for bed. Review of the results of the resident's Neuro Checks, which were started on October 16, 2023 at 10:55 AM following a fall, revealed that after the resident's fall on October 16, 2023 at 7:22 PM the neuro checks were not restarted at the required frequency based on facility policy. Review of a late entry physician progress note dated October 16, 2023, at 11:00 PM indicated that via telemedicine nursing discussed with the physician that the resident had a change in level of responsiveness after a fall. A physician order was given to transfer the resident to the emergency room (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396095 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 396095 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scranton Health Care Center 2933 McCarthy Street Scranton, PA 18505 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 for further evaluation to rule out IC (intracranial pressure). Level of Harm - Minimal harm or potential for actual harm A nurses dated October 17, 2023 at 12:07 AM noted that the resident was transferred to the hospital. Residents Affected - Some A nurses note dated October 17, 2023, at 10:39 AM indicated that the resident was admitted to the hospital with a diagnosis of a subarachnoid bleed (bleeding in the space that surrounds the brain). A nurses note dated October 17, 2023, at 2:42 PM noted that the resident representative notified the facility that Resident 87 had passed away at the hospital. Review of hospital documentation dated, October 17, 2023 noted the resident was admitted [DATE] with midline shift of brain due to hematoma, midline shift with brain compression (pressure), brain herniation (swelling from a head injury), and subdural hematoma (pool of blood between the brain and its outermost covering). Interview on December 21, 2023, at approximately 11:30 AM, with the Director of Nursing (DON), failed to provide documented evidence that an adequate assessment of the hematoma to Resident 87's head and required notification to the physician was completed as required. The DON confirmed that the neuro checks in response to the falls noted above were not consistently completed according to facility policy and professional standards of practice. 28 Pa. Code 211.12 (c)(d)(1)(3)(5) Nursing services 28 Pa. Code 211.5(f) Medical records FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396095 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 396095 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scranton Health Care Center 2933 McCarthy Street Scranton, PA 18505 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 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of clinical records, select facility policy, and incident reports, and staff interview it was determined that the facility failed to implement adequate safety measures, including sufficient staff supervision, of a resident identified as at high risk for falls, to prevent a fall with serious head injury to one resident (Resident 87) out of 12 sampled Findings include: Review of the facility Fall Prevention and Management Policy last revised February 3, 2023, indicated that residents will be assess for fall risk(s) on admission, quarterly, after any fall, and as needed. If risks are identified, preventive measures will be put in place and care planned. All falls will be reviewed and investigated. Falls will be reviewed by an interdisciplinary team and any new interventions identified will be implemented and care plan updated as necessary. Such review should include results of the new fall risk assessment, discussion with resident and/or any witnessing parties as to potential causal factors, review of the environment where the fall occurred, and discussion as to any new interventions which may help to prevent further falls. A review of the clinical record revealed that Resident 87 was admitted to the facility on [DATE], with diagnoses, which included diabetes, hypotension, schizophrenia (disorder that affects a person's ability to think, feel, and behave clearly), and depression. A review of a quarterly Minimum Data Set Assessment (MDS - a federally mandated standardized assessment completed at specific times to identify resident care needs) dated September 7, 2023, revealed that the resident was cognitively intact with a BIMS score (brief interview to assess cognitive status) of 14 (13-15 represents cognitively intact), required assistance of one staff for bed mobility, transfers, and toileting, required set-up help for ambulation, was not on a toileting program, was occasionally incontinent of urine, continent of bowel, and was not on a toileting program. An Evaluation for Continence/Retraining/Scheduled Toileting decision dated, September 11, 2023, indicated that the resident was currently continent and no program was recommended. A review of a fall risk evaluation dated September 14, 2023, revealed that the resident was assessed at a high risk for falling. A review of a fall risk evaluation dated, October 7, 2023, revealed the resident was now assessed at a low risk for falling. Interview with the director of nursing on December 21, 2023, at 12:30 PM confirmed that Resident 87 was a high fall risk and that the fall risk assessment dated , October 7, 2023, was inaccurate. The resident's care plan identifed the resident's problem of being at risk for falls related to decreased mobility and weakness initially dated, April 20, 2023, with planned interventions of keeping the resident's call bell within reach and keeping familiar items and most used items within reach. Review of a Physical Therapy Discharge summary dated , September 27, 2023, indicated that the resident had reached the maximum potential with skilled services. The discharge summary noted that the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396095 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 396095 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scranton Health Care Center 2933 McCarthy Street Scranton, PA 18505 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 - Actual harm Residents Affected - Few resident refuses to consistently participate in interventions to improve abilities and refused to ambulate more than 20 feet. Upon discharge from therapy the resident required contact guard assistance for transfers. Review of an Occupational Therapy Discharge summary dated , September 27, 2023, indicated the resident had reached the maximum potential with skilled services. The discharge summary noted that the resident continued to self-transfer without asking for staff assistance or ringing the call bell and that the resident does not comply with instruction. The resident's care plan revealed no documented evidence that interventions were implemented to address the resident's non-compliance with instruction and self-transfers attempts without asking for staff assistance identified in the OT/PT discharge summaries. A review of a facility investigation report dated, October 7, 2023, at 4:39 PM revealed that while in the process of obtaining the resident's blood sugar, the resident attempted to sit up in bed and rolled to the floor. Staff witnessed the resident hitting her head on the mattress. The new interventions/recommendations noted at that time were that the resident recently completed therapy and to re-screen the resident. Review of a Therapy-To-Nursing Communication Form dated October 9, 2023, indicated that the resident was recently discharged from skilled therapy due to refusing to participate and continued to refuse physical therapy services. A review of a facility investigation report dated, October 16, 2023, at 10:55 AM revealed that the resident fell while going to the bathroom. Staff found the resident sitting upright on the bathroom floor. The resident attempted to ambulate with no walker or assist from staff (required contact guard assistance of one staff for transfers). An assessment was completed with no new injuries noted. Staff assisted the resident off the floor. The report noted that the resident was continent, does not always ring for assistance, and the resident's non-compliance wa care planned. On assessment no lumps, no lacerations, and denies pain. Additional call don't fall signs were hung in the resident's room. Staff educated the resident on the importance of requesting assistance. The resident stated that she does not use her walker or wheelchair because they make her fall. The resident was educated on the importance of the assistive device for safety. The investigation report also indicated that the resident was recently discharged from therapy and a screen was sent for safety, balance transfers, and endurance. The resident stated that she wanted to use the bathroom, and fell while trying to sit on the toilet. The resident denied injury or hitting her head. Neurochecks were initiated and within normal limits. It was noted that staff last saw the resident 55 minutes before the fall, and had been sleeping in bed. The facility failed to provide sufficient staff supervision, at the level and frequency required for this resident identified at high risk for falls and who had displayed unsafe and non-compliant behaviors, which were known to staff, to prevent this fall. Staff last observed the resident approximately one hour (55 minutes) prior to the fall. The facility failed to implement individualized interventions to promote this resident's safety and prevent falls and injuries. A nurses note dated October 16, 2023, at 4:34 PM indicated that the neurochecks were in progress status post fall. Nursing noted that the resident was awake, in no obvious distress, her vital signs were checked and documented as stable at time of assessment. Nursing noted the resident had a hematoma (injury cause blood to collect and pool under the skin) to the right posterior (back) head and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396095 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 396095 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scranton Health Care Center 2933 McCarthy Street Scranton, PA 18505 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 complained of a mild headache. Cold compress were provided and the resident was offered ice water at her request. She remained in bed and was stable according to nursing documentation. Level of Harm - Actual harm Residents Affected - Few A review of a facility investigation report dated, October 16, 2023, at 7:22 PM revealed that the resident was found face down on the bathroom floor. The resident stated that she wanted to pee and denied hitting her head. Vital signs were checked and the resident was assisted to void. No injuries observed at the time of the incident. Predisposing factors to the resident's fall included ambulating without assistance and being non-compliant with the call bell. Staff provided education and reinforced with the resident and encouraged her to utilize the call bell for assistance and educated the resident on the risk versus benefit. Staff assisted the resident to the chair and then to nurse's station for closer supervision due to the resident's unsafe behaviors until she was calm and ready for bed. A late entry physician progress noted dated October 16, 2023, at 11:00 PM, noted that via telemedicine it was discussed with nursing that resident had displayed a change in level of responsiveness after a fall. An order was given to transfer the resident to the emergency room for further evaluation to rule out IC (intracranial pressure). A nurses dated October 17, 2023 at 12:07 AM noted that the resident was transferred to the hospital. A nurses note dated October 17, 2023, at 10:39 AM noted that the resident was admitted to the hospital with a diagnosis of a subarachnoid bleed (bleeding in the space that surrounds the brain). A nurses note dated October 17, 2023, at 2:42 PM noted that the resident's representative notified the facility that Resident 87 had passed away at the hospital. Review of hospital documentation dated, October 17, 2023 noted the resident was admitted on [DATE] with midline shift of brain due to hematoma, midline shift with brain compression (pressure), brain herniation (swelling from a head injury), and subdural hematoma (pool of blood between the brain and its outermost covering). The facility failed to demonstrate that this resident was adequately supervised and provided effective safety measures to prevent unassisted transfers and toileting attempts and this fall resulting in a serious head injury. An interview with the director of nursing on December 21, 2023, at approximately 10:00 AM confirmed that the facility failed to provide effective safety interventions and sufficient and timely staff supervision to Resident 87 to prevent repeated falls and injuries. This deficiency is cited as past non-compliance. The facility's corrective action plan included the following: This deficiency is cited as past non-compliance. The facility's corrective action plan included the following: 1. The facility failed to ensure appropriate interventions were in place due to multiple falls and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396095 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 396095 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scranton Health Care Center 2933 McCarthy Street Scranton, PA 18505 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 resident being non-compliant. Level of Harm - Actual harm 2. Residents Affected - Few To identify like residents that have the potential to be affected, the director of nursing (DON)/designee will review incidents and accidents going back 14 days to ensure interventions are care planned. To identify like residents that have the potential to be affected the DON/designee will audit the last 14 days of falls to ensure fall huddle is completed entirely and accurately. To identify like residents that have the potential to be affected the DON/designee reviewed capable and incapable residents who are non-compliant to ensure safety measures are care planned and appropriate. Therapy screen residents that are non-compliant to see if additional safety interventions are needed. Capable residents were educated on the importance of safety devices. 3. To prevent reoccurrence the DON/designee will educate licensed staff on ensuring appropriate interventions are in place after an incident or accident. The DON/designee will educate licensed staff on ensuring new interventions related to incident and accidents are care planned. The RDCS (regional director of clinical services) will educate the nursing home administrator/DON on the falls program. Once educated the DON will educate the licensed staff. The DON/designee will educate nursing staff on recognizing unsafe independent behaviors and placing these residents on close observation while attempting to meet the resident's need. If capable educate on the risks versus benefits. 4. To monitor and maintain ongoing compliance the DON/designee will audit incidents and accidents weekly times four then monthly times two to ensure interventions are care planned. The DON/designee will audit falls weekly times four then monthly times two to ensure the falls huddle is completed entirely and accurately. The DON/designee will review progress notes five days per week times five weeks then monthly times two to monitor for unsafe behaviors and ensure close observation, care plan updated, and physician and family aware. The facility's compliance date was October 23, 2023, and completion of corrective action plan noted above was confirmed during the survey ending December 21, 2023. 28 Pa. Code 211.12 (c)(d)(1)(3)(5) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396095 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 396095 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scranton Health Care Center 2933 McCarthy Street Scranton, PA 18505 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 review of clinical records, observation, and staff interview, it was determined that the facility failed to maintain oxygen equipment in a functional and sanitary manner for one resident out of 12 sampled (Residents 187). Residents Affected - Few Findings include: Review of Resident 187's clinical record revealed that the resident was admitted the facility on December 15, 2023, with diagnoses to include respiratory failure (not enough oxygen passes from the lungs to the blood, making it difficult to breath) and obstructive sleep apnea (intermittent airflow blockage during sleep). The resident had a current physician's order, initially dated December 15, 2023, for Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML (medication inhaled into the lungs using a nebulizer machine (a small machine that turns liquid medicine into a mist that can be inhaled into the lungs) - 3 ml inhale orally two times a day for SOB for 14 Days. Resident 187 also had a physician's order dated December 15, 2023, to apply CPAP (Continuous positive airway pressure-a machine that uses mild air pressure to keep breathing airways open while you sleep) during hours of sleep. An observation conducted on December 19, 2023, at 10:30 AM revealed that Resident 187 was awake and lying in bed. The resident's nebulizer and CPAP machine, including the tubing, mouthpiece and masks, were placed on the bedside nightstand. Also present on the bedside nightstand were opened beverage containers and toiletries. The nebulizer mouthpiece and CPAP mask were both uncovered and not bagged. An additional observation made on December 20, 2023, at 10:50 AM revealed that the nebulizer mouthpiece and CPAP mask remained uncovered and unbagged on top of the bedside nightstand. Interview with the Director of Nursing (DON) at the time of the observation on December 20, 2023, at 11:00 AM confirmed that residents' respiratory equipment and supplies should be bagged when not in use to prevent contamination. 28 Pa. Code 211.12 (d)(1)(3)(5) Nursing services 28 Pa. Code 211.10 (a)(c) Resident Care Policies FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396095 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 396095 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scranton Health Care Center 2933 McCarthy Street Scranton, PA 18505 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 clinical record, resident and staff interviews, it was determined that the facility failed to provide person-centered and coordinated care for one resident out of one sampled receiving dialysis (Resident 19) Residents Affected - Few Findings include: A review of the clinical record revealed that Resident 19 was most recently admitted to the facility on [DATE], with diagnoses that included diabetes, chronic kidney disease (CKD), respiratory failure, and acquired absence of kidney. A quarterly Minimum Data Set (MDS) assessment dated [DATE], indicated that the resident was cognitively intact with a BIMS (brief interview for mental status - a tool to assess cognitive status) of 15. A physician order dated January 5, 2023, was noted for dialysis (a process of purifying the blood of a person whose kidneys are not working normally) Tuesdays, Thursdays, and Saturdays, transport by wheelchair. The resident also had a physician orders dated April 12, 2023, for a Total Daily Fluid Restriction of 1,500 milliliters (ml). The fluid distribution was noted as Days - 7 AM to 3 PM shift 900 ccs, evenings 3 PM to 11 PM shift 420 cc, and nights 11 PM to 7 AM shift 180 cc (a total of 1500 ccs). Dietary would provide 960 cc for meals breakfast 360 cc, lunch 360 cc, and dinner 240 cc (a total of 1560 ccs) and an additional 180 ccs was allotted for nursing each shift (540 ccs). The resident's care plan, dated October 16, 2022 and revised January 4, 2023, indicated that the resident received dialysis treatment 3 times weekly for End Stage Renal Disease (ESRD), Tuesday, Thursdays, and Saturdays and to provide a fluid restriction as ordered (the 1500 cc physician prescribed fluid restriction was not specifically noted). The care planned interventions also noted that if bleeding occurs from dialysis site, apply pressure and call 911 if needed, monitor shunt/vascular catheter site for bleeding or signs, symptoms (s/s) of infection, and no labs/blood pressure (BP) etc on shunt arm, date-initiated October 16, 2022. The resident's care plan failed to identify the type, and location of the dialysis access site, shunt/vascular catheter site, (right chest, central venous catheter), and which arm was not to be used during labs/blood pressure (BP). The resident's care plan dated October 17, 2022, and revised November 1, 2023, indicated that the resident was at increased nutrition/hydration risk and had the potential for weight fluctuations secondary to diuretic use, initiated July 15, 2022, revised on October 18, 2023. The intervention/tasks planned were to provide fluids per ordered restriction: 1,500 ml. Days, 7-3 900 ml, evening 3-11 420 ml, nights 11-7 180 ml. (Dietary 960 ml for meals - breakfast 360 ml, lunch 360 ml, and dinner 240 ml) Nursing 180 ml every shift date-initiated October 17, 2022, revised on November 1, 2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396095 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 396095 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scranton Health Care Center 2933 McCarthy Street Scranton, PA 18505 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A dietary note dated May 31, 2023, at 11:09 AM, indicated that the resident weighed 216.2 lbs, was on a therapeutic low concentrated sweets renal diet with a 1,500 ml fluid restriction diet and that he was complaint. A review of Resident 19's Medication Administration Record (MAR) for the months of May 2023, through the time of the survey ending December 21, 2023, revealed that the resident almost consistently consumed less than 1500 ccs of fluid daily with weekly daily average fluid intakes ranging from 584 ccs to 1251 ccs. A Dietary Medical Nutrition Therapy Assessment note dated July 19, 2023, at 9:25 AM, indicated that the resident weighed 208.9 lbs, BMI 33.7, and was prescribed a renal low concentrated sweet 1,500 ml fluid restriction, and his estimated fluid needs ranged from 1,600 - 2,000 ccs. A nursing note dated August 7, 2023, at 1:07 PM, indicated that the resident was not currently not meeting his fluid needs, but was without signs or symptoms of dehydration. MD aware, no new orders. Resident aware and encouraged to consume/meet fluid needs, verbally expressed understanding. A review of a dietary note dated August 8, 2023, at 9:48 AM, indicated that the resident was on a fluid restriction in which he was compliant, but drinking under the restriction. He has been educated on drinking to the restriction. A dietary note dated November 30, 2023, at 1:34 PM, indicated that the resident was on a fluid restriction and the resident's average intake 7 days was 1050 ml. No signs/symptoms of dehydration were noted. A review of a nursing note dated December 4, 2023, at 10:22 AM, revealed that a hydration assessment was completed as the resident was not meeting current fluid goals. No signs and symptoms of dehydration were noted. It was noted that the MD was aware and there were no other concerns noted at this time. During an interview on December 19, 2023, at approximately 12:15 PM Resident 19 stated that he was aware of his fluid restriction and that he manages it (the fluid restriction) himself. During an interview with Employee 2, Licensed Practical Nurse (LPN), on December 21, 2023, at approximately 11:05 AM, along with a review of the facility and dialysis communication log of the communications between the providers during the time period from July 2023 to present survey of December 21, 2023, revealed no documentation that the facility had informed the dialysis provider that the resident was consistently not meeting his estimated fluid needs and consuming fluids often well below the 1500 cc restriction, which was confirmed by Employee 2. During an interview with the Director of Nursing (DON) on December 21, 2023, at approximately 1:05 PM, confirmed that the facility's documentation of the resident's actual fluid intake was not accurate and did not reflect the total daily amount of fluid intake the resident had actually consumed each day from all sources. The DON also verified that the resident's care plan did not identify the type, and location of the shunt/vascular catheter site, and which arm that was not to be used during labs/blood pressure (BP). 28 Pa. Code 211.12 (d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396095 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 396095 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scranton Health Care Center 2933 McCarthy Street Scranton, PA 18505 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on review of select facility policy and controlled drug count records, observations and staff interview, it was determined that the facility failed implement procedures for reconciliation of controlled drugs on two of two medication carts (Vent Long/Short, Vent/Private). Finding include: A review of the facility policy Inventory Control of Controlled Substances last reviewed by the facility October 17, 2023, indicated the facility should maintain separate individual controlled substance records on all Schedule II medications and any medication with a potential for abuse or diversion in the form of a declining inventory sheet using the Controlled Substance Declining Inventory Record. Facility should ensure that the incoming and outgoing nurses count all Schedule II controlled substances and other medications with a risk of abuse or diversion at the change of each shift or at least daily and document the results on a Controlled Substance Count Verification/Shift Count Sheet. A review of the Shift change controlled substance inventory count sheet for November 2023 and December 2023, for the Vent Long/Short medication cart conducted on December 19, 2023, at approximately 8:25 AM, revealed that the on-coming nurse and/or off-going nurse failed to sign the count sheets during shift change on the following date to verify that they had completed the procedure of counting the controlled drugs in the respective medication carts on December 14, 16, and 19, 2023. A review of the Shift change controlled substance inventory count sheet for November and December 2023, for the Vent/Private medication cart on December 19, 2023, at approximately 8:48 AM, revealed that the on-coming nurse and/or off-going nurse failed to sign the sheets during shift change on the following date to verify that the staff had completed the counts of controlled drugs in the respective medication cart on November 4, 2023. Interview with the Director of Nursing (DON) on December 20, 2023, at approximately 1:10 PM, confirmed that it is her expectation that nursing staff counts the controlled drugs and signs the Control Substance logs, Shift change controlled substance inventory count sheet at change of shift to demonstrate that the task was completed. The DON confirmed that the facility failed to implement established pharmacy procedures for maintaining records of all controlled drugs in sufficient detail to enable an accurate reconciliation. 28 Pa. Code 211.19(a)(1)(k) Pharmacy services 28 Pa. Code 211.12 (d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396095 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 396095 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scranton Health Care Center 2933 McCarthy Street Scranton, PA 18505 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, a review of select facility policy, and staff interview, it was determined that the facility failed to adhere to acceptable storage and use by dates for multi-dose medication on one of two medication carts observed and failed to secure the medication room to prevent unauthorized access (Vent/Maple hall Resident 17) Findings include: A review of facility policy entitled Accessing a Multi-Dose Vial last reviewed by the facility October 17, 2023, indicated that the licensed nurses according to state law and facility policy. Single -use systems including single-dose vials and pre-filled syringes are the preferred choices for flushing and locking. If multi-dose vials must be used (e.g. insulin, folic acid), each vial is dedicated to a single patient. Multi - dose vials will be labeled after opening with patients name, date and time, and nurses initials. Observation of medication administration pass was conducted on December 19, 2023, at approximately 8:20 AM, of Employee 1, Licensed Practical Nurse (LPN), on the Vent/Maple Hall medication cart, administering medications to residents. Continued observation of the Vent/Maple hall medication cart on December 19, 2023, at approximately 8:20 AM, revealed one (1) Insulin Aspart vial (medication used for diabetes) belonging to Resident 17, opened and available for use that was not dated when initially opened. Employee 1, licensed practical nurse (LPN), confirmed the medication belonged to Resident 17, and that the vial of insulin was not dated when first opened for resident use to determine acceptable storage time. An observation of the medication room on December 19, 2023, at approximately 8:15 A.M. and again at 8:55 A.M revealed that the door to the medication room was propped wide open. An oxygen tank in a wheeled holder was observed inside the unsecured medication room. A third observation on December 19, 2023, at approximately 9:20 AM conducted in the presence of the Director of Nursing (DON) confirmed the observation of the medication room door propped open. Interview with the DON on December 20, 2023, at approximately 1:10 PM, confirmed the that the facility failed to date multi-dose medications when opened to assure acceptable storage times and failed to secure the medication room and its content. 28 Pa. Code 211.9 (a)(1)(k) Pharmacy Services 28 Pa. Code 211.12 (c)(d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396095 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 396095 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scranton Health Care Center 2933 McCarthy Street Scranton, PA 18505 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 review of clinical records and staff interview, it was determined that the facility failed to maintain complete clinical records, according to professional standards of nursing practice, by failing to document active monitoring of a newly admitted resident's current clinical status and progression for one of 12 sampled residents (Resident 36). Findings include: According to the American Nurses Association Principles for Nursing Documentation, nurses document their work and outcomes and provide an integrated, real-time method of informing the health care team about the patient status. Timely documentation of the following types of information should be made and maintained in a patient record to support the ability of the health care team to ensure informed decisions and high-quality care in the continuity of patient care: Assessments, Clinical problems, Communications with other health care professionals regarding the patient, Communication with and education of the patient, family, and the patient's designated support person and other third parties. A review of the clinical record of Resident 36 revealed that the resident was admitted to the facility on [DATE], with diagnoses to include diabetes, congestive heart failure (CHF), acute kidney failure, and acute respiratory failure. A review of an admission note dated [DATE], at 3:01 PM indicated the resident arrived at 1:30 PM, from the hospital for rehabilitation, code status DNR (do not resuscitate), and that the residents discharge goal was to return to the community. A nursing note dated [DATE], at 12:15 AM, indicated the resident was continually yelling out take me home, I'm not supposed to be here. Where's (her daughter's name). Nursing noted that the resident would not calm down until she was put in my bed. The resident stated take me home. A call was placed to the resident's daughter to assist in calming the resident. The resident had been on the phone with her daughter for approximately 15 minutes and was noted to be calmer after talking with her daughter. Nursing placed the call bell within the resident's reach. A nursing note dated [DATE], at 6:11 AM, revealed that at 6:01 AM, indicated resident absence of pulse, respirations, lung sounds and pupil response noted. MD notified, order received for Registered Nurse (RN) to pronounce and transfer to funeral home of family's choice. Daughter, contacted by primary nurse, message left to please return call to facility. A review of a nursing note dated [DATE], at 6:21 AM, indicated that the resident's daughter was notified. There was no nursing documentation from [DATE], at 12:15 AM when the resident was assisted to bed and spoke with her daughter, until 6:11 AM when staff noted that the resident was with pulse, respirations, lung sounds and pupil response. A review of a discharge summary note dated [DATE], at 8:57 AM, noted that resident was discharged to a funeral home, belongings were sent with resident's representative. The resident expired in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396095 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 396095 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scranton Health Care Center 2933 McCarthy Street Scranton, PA 18505 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 facility. She was admitted to long term care and was on hospice services. Level of Harm - Minimal harm or potential for actual harm However, during a clinical record review conducted at the time of the survey ending [DATE], there was no physician order or care plan noting that the resident had been evaluated and admitted to hospice care during the resident's stay at the facility. Residents Affected - Few The resident's clinical record contained no documentation that nursing staff had checked the resident's status and behavior following the resident's display of behavioral symptoms on [DATE], at 12:15 AM. Nursing noted that the resident had been continually yelling out, as documented on [DATE], but there was no follow-up nursing documentation to demonstrate that nursing staff had monitored the resident's status, condition or behaviors, until staff found the resident had expired at 6:01 AM on [DATE]. Interview with the Director of Nursing on [DATE], at approximately 1:05 PM, confirmed that the facility's nursing staff failed to document an accurate representation of the actual experiences of the resident and include enough information to provide a picture of the resident's progress, including her response to treatments and services, and changes in her condition during that shift leading up to the resident's death. 28 Pa. Code 211.5 (f) Medical records. 28 Pa. Code 211.12 (c)(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396095 If continuation sheet Page 18 of 18