Health inspection·June 22, 2023

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on facility policy review, clinical record review, and staff interview, it was determined that the facility failed to provide routine assessments of pressure ulcers for two of five residents reviewed (Residents 4 and 5). Residents Affected - Some Findings Include: Review of facility policy, titled NSG236 Skin Integrity and Wound Management with a revision date of February 1, 2023, revealed that the licensed nurse will Complete wound evaluation upon admission/readmission, new in-house acquired, weekly, and with unanticipated decline in wounds .Document daily monitoring of ulcer/wound site with or without dressing. Monitor: status of the dressing (e.g., intact and clean); status of the tissue surrounding the dressing (e.g., free of new redness or swelling); adequate control of wound associated pain; signs of decline in wound status. Review of Resident 4's clinical record revealed diagnoses that included cerebral infarction (stroke), hypertension (elevated blood pressure), and a stage 4 pressure ulcer (localized damage to the skin and/or underlying soft tissue usually over a bony prominence; stage 4 is full-thickness skin and tissue loss) to the coccyx. Review of Resident 4's clinical record on June 22, 2023, revealed that the last wound assessment of the stage 4 pressure ulcer was completed on May 26, 2023. On June 22, 2023, at 12:19 PM, the Director of Nursing (DON) stated that she was unable to locate any additional wound assessments for Resident 4 since May 26, 2023. An additional review of Resident 4's clinical record revealed that a pressure ulcer assessment was completed on June 22, 2023, at 12:28 PM. On June 22, 2023, at 12:33 PM, the DON stated that Resident 4's pressure ulcer is improving. Review of Resident 5's clinical record revealed diagnoses that included encephalopathy (a broad term for any brain disease that alters brain function or structure), hypertension, and an unstageable (obscured full-thickness skin and tissue loss) pressure ulcer to the sacrum. Review of Resident 5's clinical record on June 22, 2023, revealed that the last wound assessment of the unstageable pressure ulcer was completed on May 10, 2023. On June 22, 2023, at 12:19 PM, the DON stated she was unable to locate any additional wound assessments for Resident 5 since May 10, 2023. (continued on next page) 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 2 Event ID: 395440 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 395440 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Camp Hill Skilled Nursing and Rehabilitation Ctr 1700 Market Street 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)