Health inspection·July 25, 2024

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, observations, clinical record review, staff interviews, and facility documentation review, it was determined that the facility failed to ensure care and services are provided in accordance with professional standards of practice that will meet each resident's physical, mental, and psychosocial needs for four of 12 residents reviewed (Residents 4, 9, 10, and 12). Residents Affected - Some Findings include: Review of facility policy, titled Medication Administration Section 7.1 General Guidelines, dated January 2024, revealed Medications are administered as prescribed in accordance with manufacturers' specifications, good nursing principles and practices; 1. Medications are administered in accordance with written orders of the prescriber .14. medications are administered within 60 minutes of scheduled time. Observation of third floor on July 25, 2024, at 11:30 AM, revealed that Employee 1 (Licensed Practical Nurse [LPN]) and Employee 2 (LPN) were administering medications to residents. During an interview with Employee 1 on July 25, 2024, at 11:31 AM, Employee 1 indicated that the LPN was still administering morning medications and that the they had two more residents (Residents 2 and 3) to administer medications to. Employee 1 further indicated that the they were a new employee at the facility and that the they were not sure of the timeframe in which the they had to pass medications, but thought the they had from 7 AM to 10 AM to pass the residents' morning medications. During an interview with Employee 2 on July 25, 2024, at 11:34 AM, Employee 2 indicated that they had just administered the last Resident their morning medications (Resident 4). Employee 2 indicated that they were not aware of a timeframe in which they had to administer medications, but indicated I try to get them done before lunch. Observation of Arcadia unit on July 25, 2024, at 11:36 AM, revealed that Employee 3 (Licensed Practical Nurse) was administering medications to residents. During an interview with Employee 3 on July 25, 2024, at 11:36 AM, Employee 3 indicated that they were still administering morning medications to residents. Employee 3 indicated that they still needed to administer medications to eight more residents (Residents 5, 6, 7, 8, 9, 10, 11, and 12). Employee 3 further stated that they were running behind. Review of Resident 4's clinical record revealed diagnoses that included right above the knee amputation and diabetes mellitus type II (disease that occurs when your blood glucose, also called blood sugar, is too high, but does not require the use of insulin) with neuropathy (a group of diseases (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 4 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 07/25/2024 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)