Health inspection·August 1, 2024

F 0561 change between May 30, 2024, and July 30, 2024, since the facility was receiving new male admissions. Level of Harm - Minimal harm or potential for actual harm 28 Pa Code 201.29(a) Resident rights Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 2 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 0565 Honor the resident's right to organize and participate in resident/family groups in the facility. Level of Harm - Minimal harm or potential for actual harm Based on a review of resident council meeting minutes, policy review, and resident and staff interviews, it was determined that the facility failed to have evidence to support that resident council grievances were acted upon. Residents Affected - Some Findings include: Review of the facility's policy, titled Activities/Recreation Administration, revealed that the Activities/Recreation department shall maintain monthly resident council minutes and communicates appropriate information to facility staff. Resident Council meeting minutes for April 2024, May 2024, June 2024, and July 2024 revealed that there were no concerns expressed during the meetings. During an interview on July 30, 2024, at 10:00 AM, with a group of five residents, revealed that the Residents have brought up multiple concerns at the Resident Council meeting and have been given no resolution regarding their concerns. The Residents stated that they go over the same concerns during every Resident Council meeting and do not review old business at the meetings. In the past four months, they have reported complaints about cold food, long waits for call bells to be answered, and staff being rude. The Residents stated that they have received no response from the facility's administration regarding the Council's complaints. During an interview with the Director of Nursing on July 31, 2024, at 10:35 AM, revealed that the Activities Director is responsible for writing down minutes during every Resident Council meeting and that they will work on a better system for documenting resident concerns that are brought up during Resident Council meetings. 28 Pa. Code 211.12(c)(d)(2) Nursing services 28 Pa. Code 201.18(b)(3) Management 28. Pa. Code 201.29(i) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 3 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. Based on observations, facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to provide residents access to grievance forms in a manner that honors the right to file grievances anonymously for one of two resident areas observed (first floor), as well as five of five residents in attendance at the group interview (Residents 3, 17, 46, 71, and 87); and failed to make prompt efforts to resolve a grievance for one of six residents reviewed (Resident 85). Findings include: Review of the facility policy, titled Grievance Policy, with a review date of July 25, 2024, revealed that The facility will make information on how to file a grievance or complaint available to the resident by notifying the resident individually or with prominent postings throughout the facility to include: the right to file a grievance anonymously. Multiple observations from July 29, 2024, to August 1, 2024, in the facility failed to reveal that grievance forms were readily available to residents or resident representatives (first floor). Review of Resident 3's clinical record revealed Resident 3 had a BIMS (Brief Interview for Mental Status - a cognitive assessment) score of 14 (a score of 13-15 indicates a person is cognitively intact). Review of Resident 17's clinical record revealed Resident 17 had a BIMS score of 15 (a score of 13-15 indicates a person is cognitively intact). Review of Resident 46's clinical record revealed Resident 46 had a BIMS score of 15 (a score of 13-15 indicates a person is cognitively intact). Review of Resident 71's clinical record revealed Resident 71 had a BIMS score of 15 (a score of 13-15 indicates a person is cognitively intact). Review of Resident 87's clinical record revealed Resident 87 had a BIMS score of 15 (a score of 13-15 indicates a person is cognitively intact). During Resident Council group interviews on July 30, 2024, at approximately 10:00 AM, Residents 3, 17, 46, 71, and 87 were in attendance. When asked how they would file or submit a grievance or concerns, the Residents said they are located behind the nurses' station on the first floor, and they have to ask staff for them. Resident 71 revealed that when a grievance form is filled out and handed back to the staff at the nurses' station to give to the grievance official, the grievance is read by multiple staff members and not kept confidential. Surveyor accompanied the Nursing Home Administrator (NHA) on August 1, 2024, at approximately 11:00 AM, to the first-floor nurses' station and the NHA asked for a grievance form. A staff member sitting behind the nurses' station opened a filing cabinet behind the nurses' station and handed the NHA a blank form. Interview with the NHA on August 1, 2024, at 11:25 AM, revealed there is a locked grievance box (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 4 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some located on the first floor in the lobby with a grievance form bin above it, however, the bin was empty. NHA revealed that he just made copies of blank grievance forms and placed them in the bin so that the residents are able to file a grievance anonymously. Review of Resident 85's clinical record revealed diagnoses that included cirrhosis of liver (permanent scarring that damages your liver) and hypertension (high blood pressure). Review of a grievance filed by Resident 85's Representative on behalf of Resident 85 on May 16, 2024, revealed multiple concerns including: Resident 85's lunch tray was at the foot of his bed, and he was pointing down at his brief that he was wet. The call bell was rung and no one came. Resident 85's Representative went to the nurses' station with the call bell still on and spoke to the charge nurse who didn't do anything; Resident 85's call bell not being within reach; Resident being taken to the dining area and was left in there all day and never changed; and concerns with Resident 85 not receiving showers. Further review of the grievance form indicated there were no steps taken to investigate the grievance, and no summary of pertinent findings or conclusions regarding the Resident's concerns. The corrective action taken or to be taken by the facility as a result of the grievance filed consisted of the following: Nursing supervisor to check the room two times a shift and make sure resident is fed, checked, and changed per interim Director of Nursing. The grievance form failed to address all of the concerns mentioned. Review of the grievance form had a resolution date of May 18, 2024. During an interview with the NHA on August 1, 2024, at approximately 11:00 AM, he revealed that he would expect grievances to be available for residents to file anonymously, and for grievances to be responded to and resolved appropriately. 28 Pa Code 201.18(b)(2)(3) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 5 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to include a resident in the development of their baseline care plan to establish the initial goals of the resident, and failed to provide the resident or their representative a written summary of their baseline care plan for two of two residents reviewed (Residents 6 and 30). Findings include: Review of facility policy, titled Care Plans- Baseline, with a revised date of December 2016, and a last review date of July 25, 2024, revealed 4. The facility must provide the resident and the representative, if applicable, with a written summary of the baseline care plan by completion of the of the comprehensive care plan. Review of facility policy, titled Care Planning - Interdisciplinary Team, last revised September 2013, read, in part, The resident, the resident's family and/or the resident's legal representative/guardian or surrogate are encouraged to participate in the development of and revisions to the resident's care plan. Every effort will be made to schedule care plan meetings at the best time of the day for the resident and family. Review of facility policy, titled Resident Rights, with a revised date of June 2023, and a last review date of July 25, 2024, revealed be informed of and participate in development, planning and implementation of the resident's person centered plan of care and treatment. Review of Resident 6's clinical record revealed that the Resident was admitted to the facility on [DATE], with diagnoses that included chronic diastolic congestive heart failure (heart failure that occurs when the heart does not relax properly between beats, causing the heart to be unable to pump an adequate amount of blood to the body) and hypertension (high blood pressure). Review of Resident 6's baseline care plan revealed that it was completed on March 7, 2024, and was signed by six facility interdisciplinary team members in the section titled Facility Staff, and that there were no signatures located in the section titled Resident/Family. Review of Resident 6's clinical record failed to reveal any documentation that Resident 6 or their responsible party participated in the development of their baseline care plan, or that Resident 6 or their responsible party were provided a written summary of their baseline care plan. Review of Resident 30's clinical record revealed that the Resident was admitted to the facility on [DATE], with diagnoses that included chronic obstructive pulmonary disease (COPD-a type of progressive lung disease characterized by long term respiratory symptoms and airflow limitations) and post-traumatic stress disorder (PTSD-a disorder in which a person has difficulty recovering after experiencing or witnessing a terrifying event with triggers that can bring back memories of the trauma accompanied by intense emotional and physical reactions). Review of Resident 30's baseline care plan revealed that it was completed on March 12, 2024, and was signed by six facility interdisciplinary team members in the section titled Facility Staff, and that there were no signatures located in the section titled Resident/Family. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 6 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident 30's clinical record failed to reveal any documentation that Resident 30 or their responsible party participated in the development of their baseline care plan, or that Resident 30 or their responsible party were provided a written summary of their baseline care plan. During an interview with the Nursing Home Administrator (NHA), Director of Nursing (DON), and Employee 4 (Regional Director of Clinical Services) on July 31, 2024, at 1:27 PM, the NHA and DON indicated they had no additional information to offer. In addition, they both confirmed that Resident 6 and Resident 30 should have been invited to participate in the development of their baseline care plans and that the Residents should have been provided a summary or copy of their baseline care plan. 28 Pa. Code 201.29(a) Resident rights 28 Pa. Code 211.12(d)(2) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 7 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on policy review, clinical record review, and staff interviews, it was determined that the facility failed to ensure the resident's comprehensive plan of care accurately reflected the needs of the resident for three of 21 residents reviewed (Residents 20, 60, and 72). Findings include: Review of the facility policy, titled Care Plans, Comprehensive Person-Centered, with a review date of July 25, 2024, revealed Policy Statement. A comprehensive, person-centered care plan that includes objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and for each resident . 8. The comprehensive, person-center care plan will: b. Describe services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being . 13. Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change. Review of Resident 20's clinical record revealed diagnoses that included type two diabetes mellitus (condition where the body doesn't produce enough insulin or doesn't use insulin properly), generalized anxiety disorder (severe ongoing anxiety that interferes with daily activities), and paroxysmal atrial fibrillation (type of irregular heartbeat that occurs in brief episodes). Review of Resident 20's physician orders revealed orders apixaban 2.5 milligram (mg) twice daily for paroxysmal atrial fibrillation; novolog Pen 100 unit/milliliter (ml) sliding scale coverage at bedtime for type two diabetes mellitus; insulin glargine solostar 100 unit/ml four units at bedtime for type two diabetes mellitus; and seroquel 25 mg at bedtime for generalized anxiety. Review of Resident 20's comprehensive plan of care failed to reveal Resident 20 had any focus areas or interventions that addressed diabetes mellitus, insulin use, anticoagulant medication use, and psychotropic medication use. During an interview on July 31, 2024, at 10:24 AM, with the Nursing Home Administrator (NHA), Director of Nursing (DON), Employee 3, and Employee 4, it was confirmed that aforementioned areas were not captured on Resident 20's comprehensive plan of care. The DON stated it was the expectation of the facility that comprehensive care plans be completed accurately. Review of Resident 60's clinical record revealed diagnoses that included stage three chronic kidney disease (CKD - decrease in the kidney's ability to filter toxins from the blood) and type two diabetes mellitus. Review of Resident 60's clinical record revealed that on May 25, 2024, Resident 60 had a foley catheter placed (tube inserted into the bladder to drain urine from the body). Review of Resident 60's comprehensive plan of care revealed that Resident 60 had a care plan with a focus of, The resident has urinary incontinence [related to] diuretic use, muscle weakness, and decreased mobility, which was initiated and last revised on May 8, 2024. Review of Resident 60's comprehensive plan of care revealed that the use of a foley catheter was not included in Resident 60's comprehensive plan of care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 8 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a staff interview on August 1, 2024, at approximately 12:05 PM, the DON revealed it was the facility's expectation that Resident 60's care plan would have been updated to include the use of a foley catheter. Review of Resident 72's clinical record revealed diagnoses that included hypertension and stage three chronic kidney disease (decrease in the kidney's ability to filter toxins from the blood). Review of Resident 72's clinical record revealed that on June 15, 2024, Resident 72 had a foley catheter placed. Review of Resident 72's comprehensive plan of care revealed that Resident 72 had a care plan with a focus of, The resident is incontinent of urine, which was initiated on March 9, 2023; and an intervention of, Assist to toilet as needed and Provide incontinence care as needed, with an initiation and revision date of June 13, 2024. Review of Resident 72's comprehensive plan of care revealed that the use of a foley catheter was not included. During a staff interview on August 1, 2024, at approximately 10:15 AM, the DON revealed it was the facility's expectation that Resident 72's care plan would have been updated to include the use of a foley catheter. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 9 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on facility policy review, record review, and resident and staff interviews, it was determined that the facility failed to review and revise the resident plan of care and ensure the residents right to participate in the care planning process for seven of 27 residents reviewed (Resident 3, 34, 56, 58, 71, 73, and 81). Findings include: Review of facility policy, titled Care Planning - Interdisciplinary Team, last revised September 2013, read, in part, The resident, the resident's family and/or the resident's legal representative/guardian or surrogate are encouraged to participate in the development of and revisions to the resident's care plan. Every effort will be made to schedule care plan meetings at the best time of the day for the resident and family. Review of Resident 3's clinical record revealed diagnoses that included hypertension (high blood pressure) and dementia (loss of memory, language, problem-solving, and other thinking abilities that are severe enough to interfere with daily life). During an interview with Resident 3 on July 30, 2024, at approximately 10:30 AM, revealed she does not get invited to her care plan meetings. Review of Resident 3's clinical record revealed the last comprehensive Minimum Data Set (MDS standardized assessment tool utilized to identify a resident's physical, mental, and psychosocial needs) was an Annual MDS with an assessment reference date of May 6, 2024. Review of Resident 3's clinical record revealed no evidence that a care plan meeting was conducted in response to the comprehensive assessment. During an interview with Employee 2 (Social Services Director) on July 31, 2024, at approximately 12:30 PM, revealed that Resident 3 did not have a care plan meeting after their Annual MDS on May 6, 2024, and could not provide any evidence so show they were invited to their most recent care plan meeting. Review of Resident 34's clinical record revealed diagnoses that included end stage renal disease (severe decrease in the kidneys ability to filter toxins from the blood resulting) and dementia (progressive, irreversible degenerative brain disease that results in decreased contact with reality and decreased ability to perform activities of daily living). Review of Resident 34's clinical record revealed the last comprehensive MDS was a Significant Change MDS with an assessment reference date of November 10, 2023. Review of Resident 34's clinical record revealed no evidence that a care plan meeting was conducted in response to the comprehensive assessment. Review of Resident 56's clinical record revealed diagnoses that included hyperlipidemia (high cholesterol), diabetes (a metabolic disorder in which the body has high sugar levels for prolonged periods of time), and major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest in things). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 10 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 0657 Level of Harm - Minimal harm or potential for actual harm Interview with Resident 56 on July 29, 2024, at 11:27 AM, revealed he does not get invited to his care plan meetings. Review of Resident 56's clinical record failed to indicate he was invited to his quarterly care plan meetings, or that quarterly care plan meetings had been held. Residents Affected - Some Review of Resident 58's clinical record revealed diagnoses that included epilepsy (disorder of nerve cell activity within the brain that can cause muscle contractions and/or spasms, amnesia, loss of consciousness, and/or abnormal behavior) and hypertension. Review of Resident 58's clinical record revealed the most recent comprehensive MDS was an Annual MDS with an assessment reference date of September 23, 2024. Review of Resident 58's clinical record revealed no evidence that a care plan meeting was conducted in response to the comprehensive assessment. Review of Resident 71's clinical record revealed diagnoses that included chronic obstructive pulmonary disease (COPD - a common lung disease causing restricted airflow and breathing problems) and chronic respiratory failure (when the lungs cannot get enough oxygen into the blood or eliminate enough carbon dioxide from the body). During an interview with Resident 71 on July 30, 2024, at approximately 10:30 AM, revealed he does not get invited to his care plan meetings. Review of Resident 71's clinical record revealed the last comprehensive MDS was a Quarterly MDS with an assessment reference date of May 2, 2024. Review of Resident 71's clinical record revealed no evidence that a care plan meeting was conducted in response to the comprehensive assessment. During an interview with Employee 2 on July 31, 2024, at approximately 12:30 PM, revealed that Resident 71 did not have a care plan meeting after their Quarterly MDS on May 2, 2024, and could not provide any evidence so show the Resident was invited to their most recent care plan meeting. Review of Resident 73's clinical record revealed diagnoses that included congestive heart failure (CHF disease of the heart muscle that results in decreased ability of the heart to circulate blood efficiently through the body) and hypertension. Review of Resident 73's clinical record revealed the most recent comprehensive MDS was an Annual MDS with an assessment reference date of February 1, 2024. Review of Resident 73's clinical record revealed no evidence that a care plan meeting was conducted in response to the comprehensive assessment. Interview with Employee 2 on July 31, 2024, at 12:39 PM, revealed she has been trying to get care plan meetings back on track since she started working at the facility in March 2024, but she has not gotten to schedule a care plan meeting for Resident 56, and, looking back, she can't find the last time he had one. Further, review of Resident 73's interdisciplinary progress notes entered by Employee 2 on July 5, 2024, revealed Resident 73 had requested a Nursing Home Transition (NHT) Program (Pennsylvania State initiative that works towards Residents' receiving care in the community setting rather than in a Long Term Care facility). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 11 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On July 9, 2024, Employee 2 entered a progress note that stated an NHT referral for Resident 73 had been completed. Review of Resident 73's comprehensive plan of care revealed it contained a care plan with a focus of Resident is [Long Term Care] and will remain in [the facility], with the sole intervention of, Staff to assist with tasks that resident is unable to complete independently, both with an initiation date of May 6, 2024. Resident 73's care plan did not include Resident 73's discharge planning for returning to the community. During a staff interview on August 1, 2024, at approximately 12:05 PM, Director of Nursing (DON) revealed it was the facility's expectation that Resident 73's care plan would include the plan for discharge for Resident 73. Review of Resident 81's clinical record revealed diagnoses that included major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest) and hyperlipidemia (when there are high levels of fat particles in the blood). Review of Resident 81's clinical record revealed the last comprehensive MDS was a Quarterly MDS with an assessment reference date of May 6, 2024. Review of Resident 81's clinical record revealed no evidence that a care plan meeting was conducted in response to the comprehensive assessment. During an interview with Employee 2 on July 31, 2024, at approximately 12:30 PM, revealed that Resident 81 was admitted in January 2024 and has never had a care plan meeting. During an interview with the Nursing Home Administrator on July 31, 2024, at 12:39 PM, he revealed he would expect quarterly care plan meetings to be held and residents and/or their representatives to be invited. During a staff interview on August 1, 2024, at approximately 12:05 PM, the DON revealed it was the facility's expectation that care plan meetings are conducted at least after a residents' comprehensive assessment. 28 Pa. Code 211.10(d)(a) Resident care policies 28 Pa. Code 211.11(d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 12 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on facility policy, observation, clinical record review, and resident and staff interviews, it was determined that the facility failed to provide services necessary to maintain adequate personal grooming of residents' dependent on staff for assistance with these activities of daily living for two of three residents reviewed (Residents 36 and 53). Residents Affected - Few Findings Include: Review of facility policy, titled Activities of Daily Living (ADLs), Supporting, with a review date of July 25, 2024, revealed Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with: hygiene (bathing, dressing, grooming, and oral care). Review of Resident 36's clinical record revealed diagnoses that included hypertension (high blood pressure) and chronic obstructive pulmonary disease (COPD-a common lung disease causing restricted airflow and breathing problems). During an interview with Resident 36 on July 29, 2024, at 10:15 AM, revealed that Resident 36 has not had a shower in a long time, and stated that she needed her hair shampooed. Resident 36 revealed that she prefers to receive a shower over a bed bath. Review of Resident 36's comprehensive plan of care revealed a care plan focus area of, The resident has an ADL Self Care Performance Deficit related to weakness, with an initiation date of October 1, 2020, and a revision date of October 9, 2020; as well as an intervention area of, resident prefers a shower. Review of Resident 36's clinical record revealed that she received a bed bath on the following days: July 3, 6, 13, and 27, 2024. Review of Resident 36's clinical record revealed she did not receive a shower in the past 30 days reviewed. During an interview with the Director of Nursing (DON) on August 1, 2024, at 10:20 AM, revealed that Resident 36 should not be getting bed baths regularly. Review of Resident 53's clinical record revealed diagnoses that included major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest) and fibromyalgia (a long-term condition that involves widespread body pain and tiredness). Observation on July 29, 2024, at 2:00 PM, revealed Resident 53 lying in bed, with facial hair noted to on her chin and upper lip. During an interview with Resident 53 on July 29, 2024, at 2:00 PM, Resident 53 revealed her facial hair was getting so long she can put beads in it soon. Resident 53 revealed she prefers her facial hair to be shaved, but staff do not offer to shave her every time she receives a shower. Observation on July 30, 2024, at 12:42 PM, and July 31, 2024, at 11:45 AM, revealed Resident 53 lying in bed, with facial hair noted to on her chin and upper lip. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 13 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident 53's comprehensive plan of care revealed a care plan focus area of, The resident has an ADL Self Care Performance Deficit related to weakness, history of fibromyalgia, depression, malnutrition, with an initiation date of July 18, 2020, and a revision date of December 1, 2021; as well as an intervention area of: ensure the resident is well groomed and appropriately dressed and personal hygiene/oral care: the resident requires 1 or 2 staff participation with personal hygiene and oral care, both with an initiation date of July 27, 2020. During an interview with the DON on August 1, 2024, at 10:21 AM, revealed that Resident 53 has been offered to have her facial hair removed. 28 Pa Code 211.12(a)(c)(d)(1)(3)(5) Nursing services 28 Pa. Code 201.29(j) Resident rights FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 14 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 facility policy review, clinical record review, and resident representative and staff interviews, it was determined that the facility failed to ensure each resident received treatment in accordance with professional standards of practice for two of 21 residents reviewed (Residents 25 and 85). Residents Affected - Some Findings Include: Facility policy, titled Pacemaker, Care of a Resident, with a last reviewed July 25, 2024, read, in part, Monitoring. 3. The pacemaker battery will be monitored remotely through the telephone or an internet connection. 4. The resident will have an EKG (electrocardiogram) annually, or as ordered, to monitor for changes in the heart's electrical activity. 5. Make sure the resident has a medical identification card that indicates he or she has a pacemaker. The medical record must contain this information as well. Documentation. 1. For each resident with a pacemaker, document the following in the medical record and on a pacemaker identification card upon admission: a. The name, address, and telephone number of the cardiologist; b.Type of pacemaker; c. Type of leads; d. Manufacturer and model; e. Serial number; f. Date of implant; and g. Paced rate. Further review of Resident 25's clinical record revealed diagnoses that included schizophrenia (serious mental illness that affects a person's thoughts, feelings, and behaviors) and right bundle branch block (delay or blockage on the right side of the heart that prevents the heart's electrical signals to move at the same speed as the left side of the heart, creating an irregular heartbeat). Further review of Resident 25's clinical records revealed Resident 25 was admitted to the facility May 8, 2024, from the hospital. Review of Resident 25's comprehensive plan of care revealed a focus area for resident is at risk for complications related to pacemaker, with interventions that included EKG as ordered. Review of Resident 25's physician progress notes revealed a note dated May 10, 2024, that read, in part, H&P (history and physical) past medical history of . high grade AV (atrioventricular) block status post pacemaker March 2024. Review of Resident 25's physician orders failed to reveal orders for monitoring Resident 25's pacemaker. Review of Resident 25's hospital records from admission revealed past surgical history: leadless pacemaker implant March 7, 2024. Further review of Resident 25's clinical record failed to reveal an EKG had been completed. Review of a chest Xray dated May 11, 2024, read, in part, impression . loop recorder over the heart. During an interview on July 31, 2024 at 11:48 AM, with Employee 3, she stated she had spoken with staff and Resident 25 does not have a pacemaker. At that time, the surveyor requested additional information regarding Resident 25's physician's note, hospital records, and chest Xray indicating Resident 25 had a pacemaker. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 15 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 During an additional staff interview on August 1, 2024 at 10:18 AM, with the Nursing Home Administrator, Director of Nursing (DON), Employee 3, and Employee 4, the DON confirmed Resident 25 did not have an EKG done and stated she would have expected the hospital to include Resident 25's pacemaker orders in the discharge orders. The DON also stated that a call had been placed to the cardiology office listed in Resident 25's hospital paperwork, and that it was the expectation of the facility that residents with pacemakers have orders for pacemaker care and monitoring. Review of Resident 85's clinical record revealed diagnoses that included cirrhosis of liver (permanent scarring that damages your liver) and hypertension (high blood pressure). During an interview with Resident 85's Representative on July 30, 2024, at 2:30 PM, revealed Resident 85 missed his oncology appointment that was scheduled for July 24, 2024, due to staff forgetting to schedule transportation. The Representative revealed Resident 85 was to start chemotherapy for a brain tumor that day and now it has been delayed. Review of Resident 85's July 2024 MAR (Medication Administration Record) revealed an appointment scheduled for July 24, 2024, at 9:00 AM. Further review of Resident 85's July 2024 MAR revealed that the order for his appointment on July 24, 2024, was marked 16, which is code for hold/see nurse notes. Review of Resident 85's clinical record revealed a nursing progress note on July 24, 2024, at 11:30 AM, with the following note text: This nurse spoke with resident's representative and resident has been rescheduled for August 6, 2024, at 10:00 AM, transportation has been faxed with confirmation. During an interview with the DON on July 31, 2024, at 10:30 AM, she revealed the nurse forgot to schedule transportation for Resident 85's appointment that was initially scheduled on July 24, 2024, and that it has been rescheduled for August 6, 2024. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 16 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on facility policy review, clinical record review, and staff interview, it was determined that the facility failed to act upon the licensed pharmacist's report of a medication irregularity for one of five residents reviewed for unnecessary medications (Resident 29). Findings include: Review of facility policy, titled Medication Regimen Review, last reviewed July 25, 2024, read, in part The consultant pharmacist performs a comprehensive medication regimen review (MRR) at least monthly. Recommendations are acted upon and documented by the facility staff and or the prescriber. The director of nursing of designated licensed nurse address and document recommendations that do not require a physician intervention, e.g., monitor blood pressure. Review of Resident 29's clinical record revealed diagnoses that included hypotension (low blood pressure), dysphagia (difficulty swallowing), and atrial fibrillation (abnormal heart rhythm characterized by rapid and irregular beating). Review of Resident 29's physician orders revealed the following orders: Midodrine HCl Tablet 5 MG (milligram-unit of measure), Give one tablet by mouth two times a day, hold if systolic blood pressure (SBP) is greater 120 related to hypotension, with a start date of August 4, 2023, and an end date of January 22, 2024. Midodrine HCl Tablet 5 MG Give one tablet by mouth three times a day, hold if systolic BP >120 related to hypotension, with a start date of February 2, 2024, and an end date of February 11, 2024. Midodrine HCl Tablet 5 MG Give one tablet by mouth three times a day, hold if systolic BP >120 related to hypotension, with a start date of February 13, 2024, and an end date of February 21, 2024. Review of Resident 29's MRR from December 4, 2023, revealed a recommendation from the pharmacist, Please be aware of the hold parameters noted in the Midodrine order. Hold for SBP > 120. Administered outside the order, the report was not signed by facility staff or the provider. Review of Resident 29's December 2023 MAR (Medication Administration Record- documentation for medication/treatment administered or monitored), revealed the Midodrine medication continued to be administered outside of parameters on December 9, 14, 16, 17, 18, 23, 25, 28, 30, and 31, 2024. Review of Resident 29's January 2024 MAR, revealed the Midodrine medication continued to be administered outside of parameters on January 3, 6, 7, 10, 13, 14, 16, 17, and 19-21, 2024. Review of Resident 29's February 2024 MAR, revealed the Midodrine medication continued to be administered outside of parameters on February 4, 8, 9, 14, 16, and 17, 2024. Interview with the Director of Nursing on August 1, 2024, at 12:04 PM, revealed she was not able to locate documentation to indicate the facility responded to the pharmacy recommendation, or that interventions or staff education were implemented in response to that recommendation. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 17 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0756 28 Pa Code 211.9(a)(1) Pharmacy Services Level of Harm - Minimal harm or potential for actual harm 28 Pa Code 211.12(d)(3)(5) Nursing Services Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 18 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on facility policy review, observations, and staff interviews, it was determined that the facility failed to store food and utilize equipment in accordance with professional standards for food service safety in the main kitchen. Findings include: Review of facility policy, titled Chapter 3 Food, not dated, read, in part, Packaged food shall be labeled as specified in law including food labeling, labeling marking devices, and containers. Food shall be protected from cross contamination. During preparation, unpackaged food shall be protected from environmental sources of contamination. A test kit or other device that accurately measures the concentration of sanitizing solutions shall be provided. Observation of the walk-in freezer on July 29, 2024, at 9:38 AM, revealed a bag of mixed vegetables not dated; one bag of corn not dated; one bag of peas not dated; two angel food cakes not dated; and one frozen beverage cup as well as one frozen shake from an outside source. During an interview with Employee 5 (Dietary Manager) on July 29, 2024, at 9:39 AM, he revealed the aforementioned outside sourced items belong to dietary staff and should not be in facility food storage areas. Observation of reach-in refrigerator 1 on July 29, 2024, at 9:41 AM, revealed 20 containers of mixed beverages not dated; two containers of mixed beverage dated prepared on July 23, 2024; and one to-go box container of food. Interview with Employee 5 on July 29, 2024, at 9:42 AM, revealed the juices should be labeled and discarded once expired, and the to-go box belongs to staff and should not be in the reach-in refrigerator. Observation of the walk-in refrigerator on July 29, 2024, at 9:44 AM, revealed a container of chicken salad labeled use by July 27; a container of ham labeled use by July 23; an open container of shredded cheese without an open date; and a plastic container of food from an outside source belonging to staff. Observation of reach in refrigerator 2 on July 29, 2024, at 9:48 AM, revealed one container of hamburger buns not dated and open to air; and four containers of mixed beverage not dated. Observation of the ice machine in the main kitchen on July 29, 2024, at 9:50 AM, failed to reveal an air gap between the floor drain and the drain of the ice machine. Observation in the main kitchen on July 29, 2024, at 9:52 AM, revealed a shelf with a container of toasted-O cereal labeled use by July 28; one container of puffed rice cereal labeled use by July 17. Further observation in the main kitchen on July 29, 2024, at 9:54 AM, revealed an open package of grits not dated with an open date; two containers of dry rub spice not dated; one bin of thickener not dated; and a bin of potatoes with many potatoes appearing to be rotten. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 19 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 - Some During an observation of the three-compartment sink in the main kitchen on July 29, 2024, at 9:56 AM, the surveyor requested Employee 5 to test the concentration of the sanitizer water. Employee 5 tested the water with test strips that were not in an original container to indicate when they expire. Surveyor review of the second bottle of test strips on the shelf on July 29, 2024, at 9:57 AM, revealed they were the incorrect test strips based on the sanitizer being used and had an expiration date of March 1, 2024. Interview with Employee 5 on July 29, 2024, at 9:58 AM, revealed he does not have a recorded log for the three-compartment sink sanitizer concentration. He further revealed he has to decide how he wants staff to record activity, as they utilize the sink for both food preparation and sanitizing kitchen equipment. Observation of the dry storage area on July 29, 2024, at 10:01 AM, revealed an open bag of penne pasta without an open date; an open bag of thickener without an open date; and a bag of orzo not dated. Interview with the Nursing Home Administrator on July 31, 2024, at 11:11 AM, he revealed it is the facility's expectation that food items and kitchen equipment are stored and utilized in accordance with professional standards. 28 Pa. Code 211.6(f) Dietary services 28 Pa. Code 201.18(b)(3)(e)(2.1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 20 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observations and staff interviews, it was determined that the facility failed to ensure that garbage and refuse was disposed of properly, and sanitary conditions were maintained in the garbage storage area for one of one dumpster observed. Residents Affected - Few Findings include: Observation of the receiving area dumpster on July 29, 2024, at 9:25 AM, revealed there were two bags of garbage on the ground in front of the dumpster; one was open and garbage was spilled out onto the ground, and there were five bags of garbage piled up on the ground to the left of the dumpster. Employee 5 (Dietary Manager) opened the sliding door to the garbage receptacle and it was empty. Interview with Employee 5 on July 29, 2024, at 9:29 AM, revealed the trash was left there by housekeeping staff and it should not be on the ground. Observation on July 30, 2024, at 8:39 AM, 11:40 AM, and 1:52 PM, revealed the sliding door to the dumpster was open while not in use. Interview with the Nursing Home Administrator on July 31, 2024, at 11:09 AM, revealed it is his expectation that the dumpster sliding door should be kept closed and areas around the dumpster should be clean and free of waste. 28 Pa. Code: 201.18 (b)(3) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 21 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 0868 Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Level of Harm - Minimal harm or potential for actual harm Based on review of the sign-in sheets for the facility's Quality Assurance (QA) Committee and staff interview, it was determined that the required members failed to attend a meeting at least quarterly for two of three quarters over the past year. Residents Affected - Some Findings include: Review of all available documentation submitted by the facility revealed no evidence that the Nursing Home Administrator (NHA) and the facility Infection Control Preventionist attended a meeting during the quarter of October 2023, November 2023, and December 2023. Review of all available documentation submitted by the facility revealed no evidence that the facility Infection Control Preventionist attended a meeting during the quarter of April 2024, May 2024, and June 2024. During an interview with the NHA and the Director of Nursing (DON) on August 1, 2024, at approximately 9:28 AM, the NHA indicated that the facility QA committee meets monthly. He confirmed that the aforementioned members did not attend at least one meeting in the last quarter of 2023 or the second quarter of 2024. He further indicated that he would expect all required members to attend a QA meeting at a minimum of quarterly. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1)(3) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 22 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy, clinical record review, observations, and staff interviews, it was determined that the facility failed to maintain a system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases, and failed to ensure staff follow professional standards of infection control practices during medication administration for two of five residents observed for medication administration (Residents 34 and 78). Residents Affected - Many Findings include: Facility policy, titled Infection Control Prevention, Control and Antibiotic Stewardship, last reviewed July 25, 2024, read, in part, E. Measures for the Detection, Control and Prevention of HealthCare Acquired Infections. Detection of HealthCare Acquired Infections (HCAI) is accomplished through a facility based ongoing system of surveillance. All infections are identified and reported to the facility Infection Control Preventionist of designee . A Line Listing of residents with infections is maintained and tracked for trending and outbreak potential. Follow up review of lab data is compared. A monthly IC review is completed to identify trends. An interview on July 31, 2024 at 11:11 AM, with the Director of Nursing (DON) revealed the facility has been without an Infection Preventionist (IP) since April 2024. The DON stated that infection tracking was not being done since the IP left. The DON provided a binder titled, Infection Prevention. Review of the aforementioned binder revealed no infection control surveillance and data analysis had been done for April 2024, May 2024, June 2024, and July 2024. Review of Resident 34's clinical record revealed diagnoses that included end stage renal disease (severe decrease in the kidneys ability to filter toxins from the blood resulting) and dementia (progressive, irreversible degenerative brain disease that results in decreased contact with reality and decreased ability to perform activities of daily living). During medication administration observation on July 31, 2024, at approximately 9:00 AM, Employee 1 was observed preparing medications for Resident 34. During the preparation of medication, Employee 1 was observed dispensing multiple docusate sodium 100 milligram (mg - metric unit of measure) tablets into the lid of the medications multidose container. Employee 1 was observed placing an ungloved finger onto an extra tablet to prevent it from being poured into Resident 34's medication cup. After pouring the prescribed number of tablets into a medicine cup, Employee 1 was observed pouring the unused tablet back into the multidose container. Employee 1 then stored the multidose container of docusate sodium 100 mg back in the medication cart. Review of Resident 78's clinical record revealed diagnoses that included epilepsy (disorder of nerve cell activity within the brain that can cause muscle contractions and/or spasms, amnesia, loss of consciousness, and/or abnormal behavior) and congestive heart failure (CHF-disease of the heart muscle that results in decreased ability of the heart to circulate blood efficiently through the body). During medication administration observation on July 31, 2024, at approximately 8:45 AM, Employee 1 was observed preparing medications for Resident 78. During the medication preparation, Employee 1 was observed to pick up one tablet of potassium chloride 20 milliequivalent (mEq - metric unit of measure) with Employee 1's bare hand to break the tablet in half. Employee 1 was also observed preparing vitamin C 500 milligrams (mg - metric unit of measure) and aspirin 81 mg by dispensing tablets (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 23 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many into the lid of the multidose container for each medicine. Employee 1 was observed placing an ungloved finger onto an extra tablet of both the vitamin C 500 mg and aspirin 81 mg, holding it while pouring the ordered amount into a medicine cup; after which Employee 1 returned the unused tablet back to the multidose container. Employee 1 was observed returning the vitamin C 500 mg multidose container and aspirin 81 mg multidose container to the medication cart for storage. After preparation, Employee 1 was observed administering the medications to Resident 78. During a staff interview on August 1, 2024, at approximately 10:10 AM, the DON revealed it was the facility's expectation that staff do not touch medications with their bare hands. 28 Pa. Code 211.12 (c)(d)(3)(5) Nursing services 28 Pa. Code 211.10 (d) Resident care policies FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 24 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm Based on a review of the facility's infection prevention and control policy and staff interview, it was determined that the facility failed to maintain an antibiotic stewardship program that includes a system to effectively monitor antibiotic usage. Residents Affected - Some Findings include: Facility policy, titled Infection Control Prevention, Control and Antibiotic Stewardship, last reviewed July 25, 2024, read, in part, A. Mission and Goals. The infection Prevention and Control Plan is a comprehensive process that addresses preventing, identifying, reporting, investigating, and controlling infections and communicable diseases and monitoring judicious use of antibiotic to individuals .the goals of the program are to: 3. Optimize the use of antibiotics to meet resident and community specific needs .6. Facilitate compliance with state and federal regulations relating to infection control and antibiotic stewardship. B. Scope 6. Core Elements of Antibiotic Stewardship Action: Formal review procedure for the appropriateness of any antibiotics prescribed by the Infection Preventionist on a regular basis when antibiotic orders are prescribed. Tracking: Monitoring antibiotic prescribing and resistance patterns. Reporting: Regular reporting information on antibiotic use and resistance to doctors, nurses, and relevant staff. An interview on July 31, 2024 at 11:11 AM, with the Director of Nursing (DON), revealed the facility has been without an Infection Preventionist since April 2024. The DON stated she was unsure of when antibiotic tracking was last completed. The DON provided a binder titled, Infection Prevention. Review of the aforementioned binder revealed no antibiotic tracking had been done for April 2024, May 2024, June 2024, and July 2024. 28 Pa. Code 211.12 (d)(1)(2) Nursing services 28 Pa. Code 211.10 (a) Resident Care Policies FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 25 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 0882 Level of Harm - Minimal harm or potential for actual harm Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. Based on review of regulations, facility policy review, and staff interviews, it was determined that the facility failed to have an Infection Preventionist (IP) that worked at least part time at the facility. Residents Affected - Some Findings Include: The Centers for Medicare and Medicaid Services regulation §483.80(b)(3) stated, The facility must designate one or more individual(s) as the infection Preventionist(s) (IP)(s) who are responsible for the facility ' s IPCP. The IP must: Work at least part-time at the facility. The IP must physically work onsite in the facility. He/she cannot be an off-site consultant or perform the IP work at a separate location such as a corporate office or affiliated short term acute care facility. Review of facility policy, titled Infection Control Prevention, Control and Antibiotic Stewardship, last reviewed July 25, 2024, revealed The facility designates one or more individual(s) as the infection Preventionist(s)(IPs) who are responsible for the facility IPCP. The IP works at least part-time at the facility. During an interview with the Director of Nursing, it was revealed that the prior IP left the role in April 2024 and that the facility does not currently have an IP. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 26 of 27 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 395123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gardens at Camp Hill, The 46 Erford Road Camp Hill, PA 17011 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 0947 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. Based on review of personnel training records and staff interviews, it was determined that the facility failed to ensure each nurse aide was provided with the required in-service training consisting of no less than 12 hours per year for five of five nurse aide employee records reviewed (Employees 6, 7, 8, 9, and 10), and failed to provide annual training that included resident abuse prevention for one of five nurse aide employee records reviewed (Employee 6). Findings Include: Review of personnel information revealed Employee 6's hire date was November 18, 1992; Employee 7's hire date was October 16, 2000; Employee 8's hire date was November 15, 2004; Employee 9's hire date was October 15, 2007; and Employee 10's hire date was December 19, 2022. Review of facility training records failed to reveal that the aforementioned Employees completed 12 hours of required annual training in the past 12 months. Further review of facility training records failed to reveal evidence that abuse prevention training was completed by Employee 6 within the past 12 months. During an interview with the Nursing Home Administrator (NHA), Director of Nursing (DON), and Employee 4 (Regional Director of Clinical Services) on August 1, 2024, at 10:30 AM, Employee 4 confirmed that they could not provide documentation to show that Employees 6, 7, 8, 9, and 10 received the required 12 hours of education for the past year. The NHA and DON both confirmed that they would expect nurse aides to receive the required 12 hours of education on an annual basis. During a follow-up interview with the NHA, DON, and Employee 4, on August 1, 2024, at 12:10 PM, the DON confirmed she could not provide any documentation that Employee 6 had received abuse prevention training in the past year, and confirmed that all staff should receive this training at least annually. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1)(3) Management 28 Pa. Code 201.19(7) Personnel policies and procedures 28 Pa. Code 201.20(a)(d) Staff development FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395123 If continuation sheet Page 27 of 27