Health inspection·February 18, 2026

F 0678 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Note: The nursing home is disputing this citation. and low for exhalation (EPAP). Inspiratory pressure 14, Expiratory pressure 5 at bedtime. Review of Resident CL1's nursing progress notes documented by licensed nurse Employee E4 dated February 12, 2026, at 5:10 a.m., revealed Resident noted at 0510 without signs of life. Evidence of irreversible signs of death are pulseless, no viable vital signs, and skin cool, skin color pale and grayish, pupils dilated and fixed, no chest rise or lung sound heard. Resident pronounced by this RN (registered Nurse), family notified. Review of statements obtained from the staff by the Director of Nursing the night of the incident revealed a statement by unlicensed Employee E5, I [employee's name] changed [Resident CL1] at 2:30 (a.m.) [they] rolled over for me and drank some water when I went back to change [them] at 4:45 (a.m.), that's when I realized [they were] gone and I called the nurse. Interview conducted on February 17, 2026, at 6:30 a.m. with licensed nurse Employee E4, revealed Employee E4 reported being a new nurse and employee in the facility. Employee E4 confirmed being the nurse of Resident CL1 on February 11-12, 2026, on the 11-7 shift. Employee E4 revealed that Resident CL1 was first observed at 12 midnight sleeping with BIPAP on, the resident was next observed at around 3:30 a.m., sleeping without a BIPAP mask but with a nasal cannula (flexible tube with two prongs that deliver supplemental oxygen at a low flow rate). Employee E4 reported, the resident had a habit of taking off the BIPAP mask at night. Employee E4 further revealed that before 5:00 a.m., non-licensed nursing Employee E5 called them to check the resident. Employee E4 stated, [Resident] was lying supine, normal pale color, [resident] normally pale. I checked the pulse on the wrist and neck using my two fingers, and I did not feel a pulse. I checked the code status, but it was not listed on my sheet. Then, I saw the Nursing Supervisor, Employee E3, coming, so I called her and both of us looked for the code status, which took approximately 10 minutes. Employee E4 revealed an aide was left with Resident CL1 while checking for the resident's code status, but the code status was not on the computer. Employee E4 asked Employee E3 (nursing supervisor) what to do, and Employee E3 responded to go and get the vitals. Employee E4 reported Resident's blood pressure, pulse rate and respirations were all 0, the temperature was 97.9 F (Fahrenheit) with the use of a thermometer machine on the forehead, resident was still kinda warm, fingertips were just turning blue, arms were both movable because I was able to put the blood pressure cuff. Employee E4 reported the above information was communicated with Employee E3 and the response was the DON (Director of Nursing) had been called. Employee E4 stated, I was never told to do CPR or call 911. Interview conducted with licensed nurse Employee E3 on February 17, 2026, at 7:10 a.m. revealed Employee E3 reported that on February 12, 2026, at around 5:00 a.m., Employee E4 flagged them down to come to the unit and check the resident. Employee E3 revealed Resident CL1 was gray, cheek was cool, no breath sounds, no carotid pulse (located on either side of the neck, in the soft groove between the windpipe and the large neck muscle), no radial pulse (located on the thumb side of the inner wrist, is a primary site to measure the heart rate). Employee E3 further stated that during the assessment I did not feel any warmth, eyes were closed, mouth was open, when I checked the wrist, I was still able to roll the arm, there was mottling (discoloration caused by reduced blood flow to the skin's surface) on the legs, they were off color but I'm not sure since I'm not familiar with the resident. Employee E3 reported that upon checking the computer, the resident's code status was full code, as indicated on the resident's preadmission report located under the miscellaneous section of the resident's EMR- Electronic Medical Record) dated [DATE], the DON was called. When asked by the surveyor why CPR was not initiated, Employee E3 responded, I do not do CPR to somebody that I assessed was already dead, no viable signs of life. Review of Resident CL1's physician's orders revealed no order for a code status. Interview was conducted with the DON on February 17, 2026, at 10:30 a.m. The Director of Nursing (DON) revealed the residents' code status (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396144 If continuation sheet Page 2 of 7 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 396144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/18/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Exton Post Acute 501 Thomas Jones Way Exton, PA 19341 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 0678 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Note: The nursing home is disputing this citation. should be reflected on the EMR (electronic medical records) in PCC (Point Click Care- electronic documentation program) below their name and on physician's orders. The DON was unable to provide an answer as to why Resident CL1's code status was not reflected in both places. The DON reported getting a call around 5:15-5:30 a.m., from Employee E3 reporting that Resident CL1 was unresponsive, was cold and ashen (color), starting to mottle, with no vitals and was last seen by the aide at 2:30 a.m. The DON reported asking for Resident CL1's code status, and Employee E3 responded, I don't know, I'm looking for the advance directive (legal documents, primarily living will and durable power of attorney for healthcare that outline your preferences for medical treatments if you become unable to communicate or make decisions). The DON reported coming to the facility around 5:50 a.m. Resident CL1's pupils were fixed and dilated. The resident was hard, ashen in color, with no vitals, the medical director was notified. The DON revealed that Employee E3 pronounced the resident dead at 5:15 a.m. Review of Resident CL1's death certificate dated February 12, 2026, revealed the following cause of death: Cardiac Arrest (abrupt, often fatal cessation of heart function, causing immediate loss of consciousness, pulse, and breathing, requiring instant CPR and defibrillation to survive), A-fib, and Respiratory Failure. Interview with Director of Nursing (DON) on February 17, 2026, at 10:30 a.m., revealed the facility did not initiate CPR despite information indicating the resident was a full code due to irreversible signs of death as mentioned in their interviews. The assessments mentioned in the interviews were not signs of irreversible death as indicated by the AHA guidelines and facility policy. On February 17, 2026, at 12:12 p.m., the Nursing Home Administrator (NHA) and Director of Nursing were informed the health and safety of facility residents were in Immediate Jeopardy due to licensed nurse staff failing to provide CPR in accordance with a resident's physician encounter note and hospital documents indicating resident was a full code. The Immediate Jeopardy template was presented to the NHA and DON at this time. The facility submitted an acceptable action plan on February 17, 2026, at 2:47 p.m. that included the following actions: A full house audit of all residents was completed to determine presence of code status and presence of a physician order; Monthly CPR drills were reviewed; Licensed staff education in CPR policy and procedures including general guidelines with focus on assessment of unresponsive residents, when to initiate CPR and identification of irreversible signs of death; Licensed staff have been taught that code status will be in PCC on the code status banner; Licensed staff have been educated in Emergency Code documentation form including the narrative of details during the code; Licensed staff have been educated in the compliance with physician orders related to the provision of CPR when indicated; Licensed staff orientation has been updated to include CPR and procedures, Emergency Code Documentation and compliance with physician order; Audit of order listing report and admission/readmission for presence of code status and corresponding order in PCC daily for seven days, three times a week for two weeks, weekly for two weeks, biweekly for two weeks then monthly for two month; Audit of effectiveness of licensed staff training will be conducted via questionnaires and on the spot interviews daily for seven days, three times a week for two weeks, weekly for two weeks, biweekly for two weeks then monthly for two months; and All ongoing compliance audits will be presented and reviewed at the QAPI meeting monthly for the next 6 months. The Immediate Jeopardy was lifted on February 18, 2026, at 11:32 a.m., when it was confirmed the facility provided licensed nursing staff with education regarding providing CPR in accordance with residents' advanced directives, physician's orders and facility's policy, location of code status, and completed a Code drill to ensure that licensed nurses were prepared to respond to situations that required CPR. Any remaining staff were scheduled to receive the education prior to the start of their next shift. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1)(3)(e)(1) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396144 If continuation sheet Page 3 of 7 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 396144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/18/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Exton Post Acute 501 Thomas Jones Way Exton, PA 19341 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 0678 Management 28 Pa. Code 201.18(e)(3) Management 28 Pa. Code 211.12(c)(d)(1)(3)(5) Nursing services Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Note: The nursing home is disputing this citation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396144 If continuation sheet Page 4 of 7 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 396144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/18/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Exton Post Acute 501 Thomas Jones Way Exton, PA 19341 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 review and staff interview, it was determined that the facility failed to follow a physician's recommendations for one of five residents reviewed (Resident CL2).Findings: A review of Resident CL2's admission notes dated February 3, 2026, at 7:53 p.m., revealed the resident was admitted with a diagnosis of COVID (Coronavirus disease- A contagious disease caused by the coronavirus SARS-CoV-2), shingles (A painful, blistering skin eruption caused by the reactivation of the chickenpox virus). The resident had a fall and required rehab. The same notes revealed the resident was incontinent of bowel and bladder. A review of Resident CL2's Physical Medicine and Rehab notes dated February 5, 2026, at 9:18 p.m., revealed resident was admitted with altered mental status, COVID, Shingles, Encephalopathy (A reversible, non-structural brain dysfunction caused by systemic metabolic issues such as organ failure or infection) and BPH (Benign prostatic hyperplasia- A non-cancerous enlargement of the prostate gland caused by age related hormones changes). Plan and assessment for BPH revealed as follows: recommend monitoring urine output and PVRs (post-void residual- the amount of urine remaining in the bladder immediately after urination). A review of Resident CL2's physician orders failed to reveal an order of urine output and PVR monitoring. An interview with the Director of Nursing on February 17, 2026, at 1:00 p.m., revealed that nursing was not aware of the physiatrist's (A medical doctor who specializes in helping people regain function after surgery, a stroke, or an injury) recommendations; therefore, they were not communicated with the primary physician. The DON confirmed that the physiatrist's recommendations for urine output monitoring and PVR were not followed. The facility failed to ensure Resident CL2's Physician's recommendations for urine and PVR monitoring were followed. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 28 Pa Code 211.5(f) Clinical Records Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396144 If continuation sheet Page 5 of 7 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 396144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/18/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Exton Post Acute 501 Thomas Jones Way Exton, PA 19341 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 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. Level of Harm - Minimal harm or potential for actual harm Based on clinical records review and staff interview, it was determined that the facility failed to follow a blood work order in a timely manner for one of five residents reviewed (Resident CL2)Findings include: A review of Resident CL2's Nurse Practitioner's (NP) notes dated February 4, 2026, at 9:36 a.m., revealed a resident with a diagnosis of Metabolic Encephalopathy (A reversible, non-structural brain dysfunction caused by systemic metabolic issues such as organ failure or infection), and behavioral disturbances. A review of Resident CL2's physician order dated February 4, 2026, revealed an order for CBC (Complete blood count- A blood test that measures amounts and sizes of your red blood cells, hemoglobin, white blood cells and platelets) and CMP ( Comprehensive Metabolic Panel- A routine blood test measuring 14 different substances to evaluate kidney/liver function, blood sugar, and electrolyte imbalance) on February 5, 2026. A review of Resident CL2's February 2026 Treatment Administration Record (TAR) revealed that the order for CBC and CMP was done on February 4, 2026. A review of Resident CL2's Laboratory Results revealed that Resident CL2's CBC and CMP ordered for February 5, 2026, were not done until February 11, 2026. February 11, 2026, blood works revealed the following: WBC (white blood cell) was 16.8 (normal range 3.5-11), Creatinine was 2.86 (normal range 0.60 -1.5), and BUN (blood urea nitrogen) was 79 (normal range 8-23). A review of Resident CL2's physician's order dated February 11, 2026, revealed an order for Sodium Chloride 0.45%. Use 2 liters intravenously (administer through a vein) one time only for hydration for 1 day at 80ml/hr. x 2 liters. An interview with the Director of Nursing was conducted on February 17, 2026, at 1:00 p.m. The DON reported that the blood work order for February 5, 2026, was not put into the laboratory system and therefore was not done. The missed blood work was not identified until February 10, 2026, during an audit. The DON confirmed that the laboratory ordered for February 5, 2026, was not followed timely manner. The facility failed to ensure Resident CL2's orders for CBC and CMP were timely followed. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 28 Pa Code 211.5(f) Clinical Records Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396144 If continuation sheet Page 6 of 7 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 396144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/18/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Exton Post Acute 501 Thomas Jones Way Exton, PA 19341 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 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. Level of Harm - Minimal harm or potential for actual harm Based on a review of their job descriptions it was determined that the Nursing Home Administrator (NHA) and the Director of Nursing (DON) did not effectively manage the facility to ensure that Cardiopulmonary Resuscitation was provided in accordance with the facility policy and procedures to residents that are a full code. Findings include: Review of the job description for the NHA revealed the administrative authority, responsibility and accountability of directing the activities and programs in the center. Review of the job description for the DON revealed planning, develop, organize, evaluate, and direct the nursing service department, as well as its programs and activities, in accordance with current rules, regulations, and guidelines that govern the nursing care facilities. The findings in this report identified that the facility failed to ensure that CPR was provided in accordance with the facility policy and procedures as a resident was a FULL CODE. The NHA and DON failed to fulfill their essential job duties that the federal and state guidelines and regulations were followed. Refer to F678 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 201.18(b)(3) Management 28 Pa. Code 201.18(e)(1) Management 28 Pa. Code 207.2(a) Administrator's Responsibility 28 Pa. Code 211.12(d)(1)(5) Nursing Services 28 Pa. Code 211.12(d)(2)(3) Nursing Services Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396144 If continuation sheet Page 7 of 7