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 Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 6 Event ID: 395197 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 395197 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at New Wilmington 520 New Castle Street New Wilmington, PA 16142 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)