Health inspection·August 17, 2023

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few were reported to facility in the afternoon on August 8, 2023, which showed a final impression to be an acute displaced/angulated fracture of the left hip, left femur with an acute intertrochanteric fracture of the proximal femur with varus angulation deformity at the fracture site, and there was no other fracture seen in the remaining shaft of the femur distally to the knee. Based on the results of the x-ray, the facility began an internal investigation to determine how Resident 1 sustained the injury. Employee 1 (Nurse Aide) was interviewed by the facility on August 8, 2023, at 1:00 PM. Employee 2 was assigned to Resident 1 on the evening shift of August 6, 2023. Employee 1 stated that she entered the room around 4:00 PM (Nursing Home Administrator [NHA] informed this writer that facility video reveals that it was closer to 5:00 PM) and Resident 1 was sleeping. Employee 1 stated he attempted to raise the head of the bed and Resident 1 responded, my hip is killing me. Employee 1 also stated that the last time he was assigned to Resident 1, the Resident did not have any hip pain. The facility interview with Employee 2 (Licensed Practical Nurse) on August 8, 2023, at 1:00 PM, revealed she had provided Resident 1 with medications and wound care on August 5, 2023, and August 6, 2023, on day shift. Employee 2 documented that she did not assist with any other direct care or any transfers for Resident 1. Employee 2 documented that the Hospice nurse pushed Resident 1 back to her room after lunch, and informed Employee 2 that Resident 1 was sitting in her room and doing good, then the Hospice nurse left. The facility interview with Employee 3 (Licensed Practical Nurse) on August 8, 2023, at 1:30 PM, revealed that she worked 6:00 PM until 6:00 AM, and began her shift on August 6, 2023. Employee 3 stated that Employee 4 informed her that Resident 1 was having pain and, after being informed the second time, she contacted the Registered Nurse to assess the Resident. There was no trauma observed. Employee 3 added that Resident 1 usually yells with any movement. The facility interview with Employee 4 (Registered Nurse) on August 8, 2023, at 1:00 PM, revealed Employee 4 worked the night shift August 6, 2023, into August 7, 2023. Documentation revealed she was called to Resident 1's room by Employee 3 due to the Resident having pain. Resident 1 told Employee 4 that she was having back pain, but Employee 3 said no, she's having left hip pain. Resident 1 informed Employee 4 that she broke my back a couple weeks ago. Employee 4 said no trauma was observed, but Resident 1 wouldn't let me do much with ROM [range of motion)]. During the facility interview with Employee 5 (Nurse Aide) on August 8, 2023, at 1:00 PM, Employee 5 revealed that she provided PM care and every 2-hour checks/changes and position changes On Saturday evening August 5, 2023. Employee 5 documented that Resident 1 was transferred to bed during the shift with 2 Employee persons and use of the walker. Resident 1 had no complaints of pain. The facility interview with Employee 6 (Registered Nurse) on August 8, 2023, he stated that staff made him aware that Resident 1 had a lump on her left hip. Employee 6 assessed Resident 1, who stated he was resting comfortable at the time. The assessment revealed there did appear to be an abnormality of the left hip and Employee 6 notified the PA-C (Physician Assistant-Contracted), when she arrived shortly after the assessment. It was determined that the hospice nurse would be in the building, and she would also assess the Resident. Hospice assessed Resident 1 and it was decided the staff would monitor the Resident for the next 24-hours. The family of the Resident was notified, and they decided to have an x-ray performed for the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395375 If continuation sheet Page 2 of 6 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 395375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Swaim Health Center 210 Big Spring Road Newville, PA 17241 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 0600 purpose of re-evaluating the Resident's pain medication. The x-ray was scheduled for August 8, 2023. Level of Harm - Minimal harm or potential for actual harm A review of the documentation by the PA-C on August 8, 2023, stated the following assessment and plan: Resident 1 was seen this AM at the request of nursing staff for left hip discomfort. Resident is usually bedbound and does not usually bear weight and there has been no reported falls or injuries. Resident is confused per baseline, unable to give much info at the time of visit. Resident does appear to have pain when touching the left hip area. Musculoskeletal Assessment: limited range of motion, rotated in bed, leaning to right side, left hip exam reveals no ecchymosis; tender upon palpation; no range of motion of either lower extremity; knee without swelling and no range of motion. Plan: left hip pain; Questionable left hip pain without reported injury, consider arthritic flare versus acute bony injury but without reports of fall/injury, this is less likely; it was discussed with staff that id hospice\family approves we can obtain x-ray versus treating with pain meds that she already has and re-assess later afternoon/tomorrow depending on how things go. Will monitor closely. Residents Affected - Few During the facility interview with Employee 7 (Nurse Aide) on August 8, 2023, Employee 7 revealed that she was assigned to Resident 1 on August 6, 2023, during day shift. Employee 7 stated that she provided AM care/hygiene and transferred Resident 1 from the bed to the wheelchair using a gait belt. Employee 7 revealed that she transferred Resident 1 from the wheelchair to the bed after lunch using a gait belt. Employee 7 stated that when she was trained, she was informed Resident 1 was a one-person assist transfer. When ask if Resident 1 had pain or anything out of the ordinary happen during transfer, Employee 7 replied, no, she gave me no indication of anything out of the ordinary. During a telephone interview with Employee 7 on August 16, 2023, at 12:30 PM, it was verified that Employee 7 was assigned to Resident 1 on August 6, 2023, during the day shift. Employee 7 was asked how Resident 1 was transferred, she replied, I'm aware now that she is a 2 assist for transfers but wasn't aware at that time, I believe I mistakenly looked at the roommates transfer status. Employee 7 was ask to describe the transfer technique for Resident 1 on August 6, 2023, she replied, the wheelchair was placed beside the bed and locked, the footrest was moved, a gait belt was applied, I told resident on the count of 3 you are going to stand, then resident pivoted until she sat on the edge of the bed, I placed my hand on the resident's back to lower her into bed and raised her legs onto the bed. Employee 7 stated the Resident gave her no indication of pain. Employee 7 added that Resident 1 made her usual comment, what did you do that for? and Employee 7 stated that she reminded the Resident, remember you're going to lie down and take a nap. Employee 7 said she removed the Resident's socks and then her pants, at which time the Resident said she was cold. Employee 7 said she performed incontinence care and covered the Resident. Employee 7 said, she never yelled or screamed, there was indication of pain even during incontinence care. The facility did report to the appropriate authorities and followed their policy pertaining to abuse and neglect. During an interview on August 17, 2023, at 12:30 PM, the Assistant Director of Nursing (DON) and NHA confirmed that the facility failed to ensure that Resident 1 was free from neglect, because Employee 7 failed to provide two-person transfer assistance with a walker, which may have caused harm. 28. Pa Code 201.14(a) Responsibility of licensee 28. Pa Code 201.18(b)(1)(3) Management (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395375 If continuation sheet Page 3 of 6 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 395375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Swaim Health Center 210 Big Spring Road Newville, PA 17241 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 0600 28. Pa. Code 211.12(d)(1)(5) Nursing services Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395375 If continuation sheet Page 4 of 6 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 395375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Swaim Health Center 210 Big Spring Road Newville, PA 17241 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of clinical records, review of facility investigation reports, and staff interviews, it was determined that the facility failed to provide an environment that was free of accident hazards for residents who were at risk for falls by failing to follow care-planned interventions for one of three residents reviewed (Resident 1). Findings include: A review of Resident 1's clinical record revealed diagnoses that included osteoporosis (decreased bone density and softening of the bone), dementia (irreversible, progressive degenerative disease of the brain, resulting in loss of reality contact and functioning ability), and was hospice status (end of life). Further review of Resident 1's admission record indicated she was admitted on [DATE]. Review of Resident 1's Quarterly MDS assessment (Minimum Data Set assessment: MDS - a periodic assessment of resident care needs) dated May 17, 2023, indicated a BIMS (brief interview of mental status) scored a 3, indicating severely impaired cognitive status. Review of section G0110-B (functional mobility describing how a resident move between surfaces including to or from a bed, chair, or wheelchair) of the MDS assessment indicated a performance level of 3-Extensive assistance and a support level of 2-two-person assistance, meaning that Resident 1 receives two-person assistance when transferring between surfaces. A review of Resident 1's Fall Risk Evaluation, with a date of July 5, 2023, revealed a score of 14, which indicates the Resident is at high risk for falls. A review of Resident 1's care plan, effective August 6, 2023, revealed a triggered focus area for risk of falls related to impaired vision and ambulatory dysfunction. Review of Resident 1's incident report dated August 8, 2023, at approximately 8:00 AM, for an injury of unknown origin, indicated Resident 1 had a x-ray completed August 8, 2023, of her left hip due to complaints of pain to left hip and swelling that began on August 6, 2023, between 4:00 PM and 5:00 PM. Final x-ray results were reported to the facility in the afternoon on August 8, 2023, which showed a final impression to be an acute displaced/angulated fracture of the left hip, left femur with an acute intertrochanteric fracture of the proximal femur with varus angulation deformity at the fracture site, and there was no other fracture seen in the remaining shaft of the femur distally to the knee. During the facility interview with Employee 7 (Nurse Aide) on August 8, 2023, Employee 7 revealed that she was assigned to Resident 1 on August 6, 2023, during day shift. Employee 7 stated that she provided AM care/hygiene and transferred Resident 1 from the bed to the wheelchair using a gait belt. Employee 7 revealed that she transferred Resident 1 from the wheelchair to the bed after lunch using a gait belt. Employee 7 stated that when she was trained, she was informed Resident 1 was a one-person assist transfer. When asked if Resident 1 had pain or anything out of the ordinary happen during transfer, Employee 7 replied, no, she gave me no indication of anything out of the ordinary. During a telephone interview with Employee 7 on August 16, 2023, at 12:30 PM, it was verified that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395375 If continuation sheet Page 5 of 6 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 395375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Swaim Health Center 210 Big Spring Road Newville, PA 17241 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Employee 7 was assigned to Resident 1 on August 6, 2023, during the day shift. Employee 7 was asked how Resident 1 was transferred, she replied, I'm aware now that she is a 2 assist for transfers but wasn't aware at that time, I believe I mistakenly looked at the roommates transfer status. Employee 7 was ask to describe the transfer technique for Resident 1 on August 6, 2023, she replied, the wheelchair was placed beside the bed and locked, the footrest was moved, a gait belt was applied, I told resident on the count of 3 you are going to stand, then resident pivoted until she sat on the edge of the bed, I placed my hand on the resident's back to lower her into bed and raised her legs onto the bed. Employee 7 stated the Resident gave her no indication of pain. Employee 7 added that Resident 1 made her usual comment, what did you do that for?, and Employee 7 stated that she reminded the Resident, remember you're going to lie down and take a nap. Employee 7 said she removed the Resident's socks and then her pants, at which time the Resident said she was cold. Employee 7 said she performed incontinence care and covered the Resident. Employee 7 said, she never yelled or screamed, there was indication of pain even during incontinence care. During an interview with the Assistant Director of Nursing and Nursing Home Administrator on August 17, 2023, both agreed that the care plan should be followed. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management 28 Pa Code: 211.10 (c)(d) Resident care policies FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395375 If continuation sheet Page 6 of 6