Health inspection·May 19, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on review of facility policy, observations, and staff interviews, it was determined that the facility failed to monitor a resident's personal refrigerator for temperatures for one of one residents reviewed with personal refrigerators (Resident R8). Findings include: Review of facility policy entitled, Personal Refrigerators with a policy review date of 3/27/23, revealed Personal refrigerators will be subject to the same monitoring as other facility refrigerators. The food stored in the personal refrigerator must meet the same standards as food stored elsewhere in the facility. The policy also revealed Inform resident that refrigerator must include a thermometer and will be monitored regularly for temperature compliance. Establish a temperature and contents monitoring process. Initiate temperature monitoring and content inspection for food labeling and dating. Observation on 5/16/23, at 1:30 p.m. revealed that Resident R8 had a personal refrigerator in the room that contained food and beverage items. The observation also revealed that there was no thermometer in the refrigerator and no temperature log sheets in order to monitor the resident's personal refrigerator and food/beverage items for proper storage. During an additional observation of Resident R8's personal refrigerator on 5/16/23, at 4:25 p.m. with the Director of Nursing it was confirmed that there was no thermometer in the refrigerator and no temperatures recorded to ensure the safe storage of resident food/beverage items. 28 Pa Code 201.14 (a) Responsibility of Licensee Page 1 of 6 395197 395197 05/19/2023 Kadima Rehabilitation & Nursing at New Wilmington 520 New Castle Street New Wilmington, PA 16142

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy and clinical records and staff interview, it was determined that the facility failed to update and/or individualize a care plan for one of 20 residents reviewed (Resident R42). Findings include: Review of facility policy entitled, Participation in Planning Care and Treatment dated 3/27/23, indicated that the resident care plan shall be reviewed, evaluated and updated, as necessary, by professionals involved in the care of the resident. Resident R42's clinical record revealed an admission date of 2/03/23, with diagnoses including heart disease, kidney disease, and gastrointestinal bleed. Documentation related to Resident R42's weekly weights revealed the following: admission weight documented - 2/03/23 - 227.9 pounds; next weight documented on 2/20/23 - 227.2 pounds 3/01/23 - 236.2 pounds 3/02/23 - 230.1 pounds 3/06/23 - 247.0 pounds - 20 pound weight gain in 14 days 3/20/23 - 247.0 pounds 3/27/23 - 161.4 pounds - 74.8 pound weight loss in 26 days, from 3/01/23 3/29/23- 161.6 pounds 4/02/23 -173.5 pounds 4/10/23- 178.2 pounds 5/15/23-183.2 pounds Review of Resident R42's Discharge Minimum Data Set (MDS-a mandated assessment of a resident's abilities and care needs) assessment, dated March 21, 2023, revealed that the resident had a weight gain of 5% or more in the last month. Review of Resident R42's Quarterly MDS assessment dated [DATE], revealed Resident R42 had a weight loss of 5% or more in the last month. The clinical record revealed a nutritional problem care plan related to dysphagia (difficulty swallowing) dated 2/13/23. As of 5/18/23, there was no evidence that Resident R42's care plan had been updated to reflect Resident R42's weight loss. 395197 Page 2 of 6 395197 05/19/2023 Kadima Rehabilitation & Nursing at New Wilmington 520 New Castle Street New Wilmington, PA 16142

F 0657 During an interview on 5/18/23, at 2:18 p.m. the Director of Nursing confirmed that Resident R42's nutrition care plan was not updated to reflect weight loss and their current status. Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.5(f) Clinical records Residents Affected - Few 28 Pa. Code 211.12(d)(1)(5) Nursing services 395197 Page 3 of 6 395197 05/19/2023 Kadima Rehabilitation & Nursing at New Wilmington 520 New Castle Street New Wilmington, PA 16142

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy and clinical records and staff interviews, it was determined that the facility failed to appropriately monitor a resident identified with a significant weight loss for one of 20 residents reviewed (Resident R42). Residents Affected - Some Findings include: Review of the facility policy related to weight monitoring and weight loss intervention dated 3/27/23, indicated that weight loss intervention will be implemented to prevent further weight loss and to maintain/improve the resident's nutritional status. It also indicated when there is a 5% weight loss in 30 days to follow up with Dietitian recommendations and to keep records of interventions implemented and the progress made. The Registered Dietitian (RD) job description indicated the purpose of the job position is to implement, coordinate and evaluate the medical nutrition therapy for the residents, provide resident and family education, provide nutritional assessment and consultation to assist in planning, organizing and directing the food and nutritional services of the facility. Resident R42's clinical record revealed an admission date of 2/03/23, with diagnoses including heart disease, kidney disease, and gastrointestinal bleed. Documentation related to Resident R42's weekly weights revealed the following: admission weight documented - 2/03/23 - 227.9 pounds; next weight documented on 2/20/23 - 227.2 pounds 3/01/23 - 236.2 pounds 3/02/23 - 230.1 pounds 3/06/23 - 247.0 pounds - 20 pound weight gain in 14 days 3/20/23 - 247.0 pounds 3/27/23 - 161.4 pounds - 74.8 pound weight loss in 26 days, from 3/01/23 3/29/23- 161.6 pounds 4/02/23 -173.5 pounds 4/10/23- 178.2 pounds 5/15/23-183.2 pounds Review of Resident R42's Discharge Minimum Data Set (MDS-a mandated assessment of a resident's abilities and care needs) assessment, dated March 21, 2023, revealed that the resident had a weight gain 395197 Page 4 of 6 395197 05/19/2023 Kadima Rehabilitation & Nursing at New Wilmington 520 New Castle Street New Wilmington, PA 16142

F 0692 Level of Harm - Minimal harm or potential for actual harm of 5% or more in the last month. Review of Resident R42's Quarterly MDS assessment dated [DATE], revealed Resident R42 had a weight loss of 5% or more in the last month. The clinical record revealed no evidence that Resident R42 was reassessed by the RD, since the initial admission Nutrition Data Collection dated 2/16/23, until 5/18/23, a period of three months. Residents Affected - Some During an interview on 5/18/23, at 2:00 p.m. the Director of Nursing confirmed that Resident R42's clinical record lacked evidence of any dietitian notes or recommendations since the initial admission Nutrition Data Collection dated, 2/16/23, until 5/18/23, a period of three months. 28 Pa. Code 211.10(c) Resident care policies 28 Pa. Code 211.12(d)(1)(5) Nursing services 395197 Page 5 of 6 395197 05/19/2023 Kadima Rehabilitation & Nursing at New Wilmington 520 New Castle Street New Wilmington, PA 16142

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on review of facility policy and manufacturer's instructions, observation, and staff interviews it was determined that the facility failed to label pre-filled insulin pens with the date they were opened and discard multi-dose insulin bottle within the use by timeframe for one of two medication carts observed (South Hall) Findings include: Review of facility policy dated 3/27/23, entitled Labeling of Medications indicated that multi-dose medications must be dated when opened for determination of discard date based on manufacturer's instructions. Review of manufacturer's instructions for the Novolog (type of insulin) multi-dose vial directed that once open, they were to be used within 28-days, then discarded. Observation of South Hall medication cart on 5/16/23, at 4:33 p.m. revealed that Resident R15's Basaglar Kwik Pen (type of insulin), R41's Insulin Aspart Flex Pen, and Resident R28's Insulin Glargine and Insulin Lispro Pens were currently in use, but not labeled with an open date. Further observation revealed Resident R23's Novolog multi-dose bottle was open, dated for 4/15/2023, and was currently in use, or 31-days past the open date. During an interview at the time of observation, Licensed Practical Nurse Employee E1 confirmed that Resident R15, R41, and R28's insulin pens were in use and not labeled with an open date and that Resident R23's multi-dose insulin vial was being used past the 28-days. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 211.9(a)(1) Pharmacy services 28 Pa. Code 211.10(c) Resident care policies 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 395197 Page 6 of 6