Health inspection·January 16, 2025

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interview, it was determined that the facility failed to exercise reasonable care for the protection of the resident's property from loss or theft for two of three discharged residents reviewed (Residents 105 and 106). Findings include: Review of Resident 105's clinical record revealed she was admitted to the facility on [DATE], and discharged from the facility to the hospital on November 12, 2024. Further review of the closed clinical record revealed no documented inventory of personal effects or accounting for Resident 105's personal effects following discharge. Review of Resident 106's clinical record revealed he was admitted to the facility on [DATE], and passed away at the facility on December 25, 2024. Further review of the closed clinical record revealed no documented inventory of personal effects, or accounting for Resident 106's personal effects following discharge. During an interview with the Director of Nursing on January 16, 2025, at 12:30 PM, she revealed that she was not able to locate a documented inventory of Resident 105's or 106's personal effects, nor confirm the disposition of these personal effects upon discharge. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(2)(e)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 2 of 33 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 01/16/2025 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)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on facility policy review, review of incident investigation documentation, and staff interview, it was determined that the facility failed to report the results of an abuse investigation within the specified timeframes for one of one abuse incidents reviewed. Findings include: Review of facility policy, Abuse Prohibition, revised October 24, 2022, revealed, The Administrator or designee will report findings of all completed investigations within five (5) working days to the Department of Health using the state on-line reporting system or state-approved forms. Review of state form, PB-22 Report Form For Investigation of Alleged Abuse, Neglect, Misappropriation of Property, completed by the facility, revealed that an alleged incident of neglect occurred on September 24, 2024. Further review of the form revealed that the facility became aware of the incident and began an abuse investigation on September 25, 2024. The investigation was concluded on September 26, 2024. Review of the form indicated that it was not completed and submitted to the Department of Health until October 7, 2024 (greater than five working days following the conclusion of the investigation). During an interview with the Nursing Home Administrator on January 16, 2025, at 9:15 AM, she revealed that the PB-22 submission was untimely because the Director of Nursing was not at work due to illness. She also revealed the expectation that the Administrator at the time should have submitted the investigation results (PB-22 form) in her absence. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1)(e)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 3 of 33 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 01/16/2025 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)

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and staff interview, it was determined that the facility failed to ensure that the resident assessment accurately reflected the resident's status for two of 24 residents reviewed (Residents 8 and 36). Residents Affected - Few Findings include: Review of Resident 8's clinical record revealed diagnoses that included congestive heart failure (a chronic condition in which the heart doesn't pump blood as well as it should), chronic kidney disease (a condition characterized by a gradual loss of kidney function), and muscle weakness. Review of Resident 8's Annual MDS (Minimum Data Set- assessment tool utilized to identify residents' physical, mental, and psychosocial needs) with ARD (assessment reference date- last day of the assessment period) of December 4, 2024, revealed under Section N. Medications, Resident 8 was marked yes to indicate he received an anticoagulant. Review of Resident 8's Medicare 5 Day MDS with ARD of December 4, 2024, revealed under Section N, Resident 8 was marked yes to indicate he received an anticoagulant. Review of Resident 8's clinical record failed to reveal he was prescribed or received an anticoagulant medication during the ARD. During an email correspondence with the Director of Nursing (DON) on January 15, 2024, at 9:57 AM, she revealed Resident 8's MDS assessments were revised to reflect that he did not receive an anticoagulant during the ARD for those assessments. Follow-up interview with the DON on January 15, 2024, at 11:27 AM, revealed she would expect Resident 8's MDS assessments to be coded accurately. Review of Resident 36's clinical record revealed diagnoses that included bipolar disorder (a lifelong mood disorder and mental health condition that causes intense shifts in mood, energy levels, thinking patterns, and behaviors) and dementia (a chronic disorder of the mental processes caused by brain disease, and marked by memory disorders, personality changes, and impaired reasoning). Review of Resident 36's current physician orders revealed that the Resident had an order for an antipsychotic medication, dated February 23, 2021. Review of Resident 36's clinical record revealed a psychiatric visit note dated July 11, 2024, that indicated that a gradual dose reduction of their antipsychotic medication was clinically contraindicated. Review of Resident 36's Annual MDS with ARD of August 8, 2024, revealed in Section N. Medications that the date Resident 36's physician documented that a gradual dose reduction was clinically contraindicated was May 30, 2024. Review of Resident 36's clinical record revealed a psychiatric visit note dated November 15, 2024, that indicated that a gradual dose reduction of their antipsychotic medication was clinically contraindicated. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 4 of 33 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 01/16/2025 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)

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident 36's Quarterly MDS with the assessment reference date of December 24, 2024, revealed in Section N. Medications, that the date Resident 36's physician documented that a gradual dose reduction was clinically contraindicated was September 20, 2024. During a staff interview with the Nursing Home Administrator and DON on January 16, 2025, at 12:35 PM, the DON confirmed that Resident 36's MDS's were coded in error and modifications were completed. She further indicated that she would expect a resident's MDS assessment to be coded accurately. 28 Pa Code 211.12 (d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 5 of 33 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 01/16/2025 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)

F 0656 Level of Harm - Minimal harm or potential for actual harm Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on clinical record review and staff interview, it was determined that the facility failed to develop comprehensive care plans for two of 27 resident records reviewed (Residents 29 and 47). Residents Affected - Few Findings Include: Review of Resident 29's clinical record revealed diagnoses that included hypertension (elevated blood pressure) and anxiety disorder (mental health conditions that involve persistent and excessive feelings of fear or worry). Review of Resident 29's current physician orders revealed an order for Buspirone hydrochloride (HCL) tablet 15 milligram (MG) - give one tablet by mouth two times a day for anxiety, with an original active date of July 19, 2024. Review of Resident 29's current physician orders revealed an order for Duloxetine HCL capsule delayed release particles 60 MG -give one capsule by mouth one time a day for depression, with an original active date of July 20, 2024. Review of Resident 29's current physician orders revealed an order for Enoxaparin Sodium Injection Solution Prefilled syringe 40 MG/0.4 milliliter - inject 40 MG intramuscularly every 24 hours for blood thinner, with an active date of December 11, 2024. Review of Resident 29's current care plan failed to reveal a plan of care addressing her antianxiety, antidepressant, and anticoagulant medication use. During an interview with the Director of Nursing (DON) on January 16, 2025, at 9:37 AM, revealed she would have expected Resident 29 to have had a baseline care plan for her antianxiety, antidepressant, and anticoagulant medication use. Review of Resident 47's clinical record revealed diagnoses that included chronic obstructive pulmonary disease (a chronic lung disease that makes it difficult to breathe) and heart failure (when the heart cannot pump enough blood and oxygen to the body). Review of facility policy, titled NSG309 Medications: Self-administration, last reviewed and revised on October 15, 2024, revealed, self-administration and medication self-storage must be care planned. During an interview with Resident 47 on January 13, 2025, at 10:06 AM, she revealed she self-administers her nebulizer medications, and opened her bedside table drawer to show where they are. Review of Resident 47's clinical record revealed a Nursing Progress note written on December 10, 2024, for a self-administration of medication assessment completed on Resident 47 that determined she is fully capable of administering inhalants or inhalers and can keep medications at bedside. Review of Resident 47's current care plan failed to reveal a plan of care addressing her self-administering medications. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 6 of 33 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 01/16/2025 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)

F 0656 During an interview with the DON on January 16, 2025, at 12:21 PM, revealed she would have expected Resident 47 to have a baseline care plan for her self-administration and storage of medications. Level of Harm - Minimal harm or potential for actual harm 42 CFR 483.21(b) Comprehensive Care Plans Residents Affected - Few 28 Pa. Code 211.5(f) Clinical records 28 Pa. Code 211.12(d)(3) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 7 of 33 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 01/16/2025 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)

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. Based on facility policy review, observations, clinical record review, and resident and staff interviews, it was determined that the facility failed to ensure the residents right to participate in the care planning process for one of 24 residents reviewed (Resident 19), and failed to review and revise the resident plan of care for one of 24 residents reviewed (Resident 50). Findings include: Review of facility policy, titled OPS416 Person-Centered Care Plan, dated November 28, 2016, with a revision date of October 24, 2022, and a last review date of October 15, 2024, revealed 7. Care plans will be: 7.2 Reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments, and as needed to reflect the response to care and changing needs and goals; and 9. The Center has the responsibility to assist patients to participate by: 9.3 Facilitating the inclusion of the patient/ resident representative(s) to attend. Review of Resident 19's clinical record revealed diagnoses that included chronic pain, hypertension (persistent high blood pressure), and muscle wasting and atrophy (loss of muscle mass). Interview with Resident 19 on January 13, 2024, at 10:03 AM, revealed she does not remember getting invited to her care plan meetings. Review of Resident 19's clinical record revealed a progress note on January 13, 2024, at 1:48 PM, that stated, Scheduled care plan meeting for January 14, 2024, at 1:30 PM. Further review of Resident 19's clinical record revealed a progress note on January 14, 2024, at 1:38 PM, that stated Called the family for a scheduled care plan meeting. The family did not answer, left a message. Interview with Resident 19 on January 15, 2024, at 9:26 AM, revealed she was unaware she had a care plan meeting yesterday. Interview with Employee 2 (Social Services Director) on January 15, 2024, at 10:38 AM, revealed usually, if the family does not attend, nursing will check and see if the Resident would like to attend. She further revealed the surveyor could check with Employee 7 (Registered Nurse) to see if the Resident was invited and declined, and that she was unable to locate documentation to indicate Resident 19 has had a quarterly care plan meeting scheduled since August 14, 2024. Interview with Employee 7 on January 15, 2024, at 10:42 AM, revealed she was not sure as to why Resident 19 did not attend her care plan meeting yesterday. Interview with the Nursing Home Administrator (NHA) on January 16, 2024, at 9:24 AM, revealed she would expect residents are invited to their quarterly care plan meetings. Review of Resident 50's clinical record revealed diagnoses that included hemiplegia (paralysis of one side of body) and hemiparesis (muscle weakness on one side of the body) following a cerebral infarction (a stroke-damage to the brain from interruption of its blood supply) affecting left non-dominant side, muscle weakness, and other abnormalities of gait and mobility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 8 of 33 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 01/16/2025 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)

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observations of Resident 50 on January 13, 2025, at 9:59 AM, revealed that the Resident was in bed and noted to have foam boots lying on the chair near the foot of their bed. Review of Resident 50's current physician orders revealed an order for Prevalon Boots (heel protectors that help reduce the risk of bedsores by keeping the heel floated, relieving pressure) on when in bed, off when out of bed, entered by the prescriber dated November 26, 2024. Follow-up observations of Resident 50 on January 14, 2025, at 9:26 AM and 1:32 PM; and January 15, 2025, at 9:46 AM, revealed the same observations. Review of Resident 50's care plan revealed a care plan focus for being at risk for loss of range of motion related to physical limitations, last revised on August 14, 2024; and at risk for skin breakdown related to limited mobility and shear and friction risks, last revised on March 22, 2024. The care plan failed to reveal any documentation for the intervention of the Prevalon boots. During an interview with the NHA and Director of Nursing (DON) on January 16, 2025, at 9:35 AM, the DON indicated that she noted that the practitioner put the order in for the boots and it was not put in properly and, therefore, did not trigger for staff to implement. When it was discussed that the boots were present in Resident 50's room January 13-16, 2025, the DON indicated that she was unsure how the boots were present in the room if staff did not know Resident 50 was to have them. The DON confirmed that she would probably expect staff to have asked about them when they saw them in the room. During a final interview with the NHA and DON on January 16, 2025, at 12:20 PM, the DON indicated that she had no additional information to provide regarding Resident 50's Prevalon boots. She confirmed that Resident 50's care plan should have been revised to include the Prevalon boots and that the Prevalon boots should have been implemented. 28 Pa. Code 211.10(c)(d)(a) Resident care policies 28 Pa. Code 211.12(d)(2)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 9 of 33 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 01/16/2025 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)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on facility policy review, observations, clinical record review, and resident and staff interviews, it was determined that the facility failed to ensure a resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal hygiene for three of 24 residents reviewed (Residents 20, 35, and 101). Residents Affected - Some Findings include: Review of facility policy, titled NSG200 Activities of Daily Living (ADLs) [Activities of daily living or ADLs are routine tasks that each of us must perform every day to care for our bodies and ourselves independently] dated June 1, 1996, with a revision date of May 1, 2023, and a last review date of October 15, 2024, revealed 1. Patients are assessed upon admission, quarterly, and with any significant change to identify their status in all areas of ADL's and 4.2 A patient who is unable to carry out ADLs will receive the necessary level of ADL assistance to maintain good nutrition, grooming, and personal and oral hygiene. Review of Resident 20's clinical record revealed diagnoses that included hemiplegia (paralysis of one side of body) and hemiparesis (muscle weakness on one side of the body) following a cerebral infarction (a stroke-damage to the brain from interruption of its blood supply) affecting right dominant side, aphasia (language disorder that affects a person's ability to communicate), and vascular dementia (brain damage caused by multiple strokes which causes memory loss in older adults). Observation during lunch meal service on January 13, 2025, at 12:19 PM, revealed Employee 8 (Nurse Aide) placed Resident 20's tray on her tray table in front of her, left it covered and not set-up, and did not return to provide feeding assistance until 12:39 PM. Review of Resident 20's clinical record revealed she required substantial/maximal assistance with eating. Review of Resident 20's care plan revealed a focus area of ADL Self-care deficit as evidenced by right sided weakness and generalized weakness related to recent and previous strokes, last revised August 26, 2024, with an intervention for Assist with daily hygiene, grooming, dressing, oral care and eating as needed, last revised on January 30, 2024. During an interview with the Nursing Home Administrator (NHA) and Director of Nursing (DON) on January 16, 2025, at 9:25 AM, the surveyor revealed the concern with the process of nursing staff providing a meal tray to a resident 20 minutes prior to being able to provide feeding assistance. The NHA confirmed that staff should not have provided the meal tray to Resident 20 until they were able to provide feeding assistance. Review of Resident 35's clinical record revealed diagnoses that included hemiplegia and hemiparesis following a cerebral infarction affecting right dominant side, aphasia, and vascular dementia (brain damage caused by multiple strokes which causes memory loss in older adults). Observation of Resident 35 on January 13, 2025, at 9:41 AM, revealed the presence of dark facial hair on her upper lip and chin. Review of Resident 35's care plan revealed a focus for ADL self-care deficit related to physical (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 10 of 33 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 01/16/2025 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)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some limitations, with a revised date of November 7, 2024. Interventions included, but were not limited to, assist with bathing/showering, frequently refuses shower, prefers bed bath, will continue to offer shower, daily hygiene, grooming, dressing, oral care and eating as needed, with a revised date of March 19, 2024; and assist of 2 with ADL's, with a revised date of July 10, 2024. Review of Resident 35's Quarterly MDS (Minimum Data Set - an assessment tool to review all care areas specific to the resident such as a resident's physical, mental or psychosocial needs) with the assessment reference date (last day of the assessment period) of November 2, 2024, revealed in Section GG Functional Abilities, in subsection 0310 Self-Care at Question I Personal Hygiene: The ability to maintain personal hygiene, including combing hair, shaving, applying makeup, washing/drying face and hands (excludes baths, showers, and oral hygiene) that she was coded as dependent. During a follow-up observation of Resident 35 on January 14, 2025, at 1:30 PM, revealed the same observation of the presence of moderate dark facial hair on her upper lip and chin. During an immediate interview with Resident 35 when asked if she would like to be shaved, Resident 35 rubbed her chin with her left hand and mouthed the word yes while also nodding her head yes. Review of Resident 35's task documentation for bathing/showering for the past 30 days revealed that she had received a bed bath on December 16, 19, 23, 26, and 30, 2024, and January 2, 6, and 13, 2025. During a staff interview with the NHA and DON on January 15, 2025, at 11:00 AM, the DON indicated that shaving would only be completed if a resident requested it to be done. Observation of Resident 35 on January 16, 2025, at 9:02 AM, revealed that she had been shaved. Resident 35 was observed to rub her chin with her left hand and smile when asked about being shaved. During a final interview with the NHA and DON on January 16, 2025, at 12:21 PM, the DON confirmed that staff should have offered Resident 35 to be shaved as part of her ADL care since the Resident she was dependent for care. Review of Resident 101's clinical record revealed diagnoses that included muscle wasting and atrophy (loss of muscle mass) and Alzheimer's disease (a chronic disorder of the mental processes caused by brain disease, marked by memory disorders, personality changes, and impaired reasoning). Observation of Resident 101 on January 13, 2025, at 12:19 PM, revealed she had three-quarters of an inch facial hair on her chin. Follow-up observations on January 14, 2025, at 9:45 AM, and January 15, 2025, at 9:25 AM, revealed the same observations of three-quarters of an inch facial hair on her chin. Review of Resident 101's task documentation for bathing/showering revealed that she had received a shower on January 13, 2025, at 2:32 PM. Review of Resident 101's care plan revealed a focus area Resident/Patient is at risk for decreased ability to perform ADL(s) in bathing, grooming, personal hygiene, dressing, eating, bed mobility, transfer, locomotion, and toileting related to Delirium (confusion), behavioral symptoms last revised December 11, 2024, with an intervention for ADL: 1 Assist created on December 11, 2024. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 11 of 33 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 01/16/2025 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)

F 0677 Level of Harm - Minimal harm or potential for actual harm During a final interview with the NHA and DON on January 16, 2025, at 9:26 AM, the DON revealed that staff offered to shave her on January 15, 2025, and they should have offered it during her shower as part of her ADL care. 28 Pa. Code 211.10(d) Resident care policies Residents Affected - Some 28 Pa. Code 211.12(d)(1)(2)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 12 of 33 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 01/16/2025 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)

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 review of the clinical record and staff interviews, 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 two of 24 residents reviewed (Residents 71 and 88). Residents Affected - Few Findings include: Review of Resident 71's clinical record revealed diagnoses that included peripheral vascular disease (a slow and progressive circulation disorder) and hypertension (elevated blood pressure). Review of Resident 71's December 2024 MAR (Medication Administration Record) revealed a physician's order for Blood Glucose before meals - notify MD (Medical Director) if blood sugar less than 80 or blood sugar greater than 250 before meals for Glucose monitoring, with a start date of December 26, 2024. Review of Resident 71's December 2024 MAR revealed the following: On December 26, 2024, at 4:00 PM, Resident 71's blood sugar was 286. On December 31, 2024, at 6:00 AM, Resident 71's blood sugar was 316. On December 31, 2024, at 11:00 AM, Resident 71's blood sugar was 252. Review of Resident 71's January 2025 MAR revealed a physician's order for Blood Glucose before meals notify MD if blood sugar less than 80 or blood sugar greater than 250 before meals for Glucose monitoring, with a start date of December 26, 2024. Review of Resident 71's January 2025 MAR revealed the following: On January 1, 2025, at 6:00 AM, Resident 71's blood sugar was 268. On January 5, 2025, at 11:00 AM, Resident 71's blood sugar was 308. On January 10, 2025, at 6:00 AM, Resident 71's blood sugar was 266. On January 10, 2025, at 11:00 AM, Resident 71's blood sugar was 283. On January 11, 2025, at 6:00 AM, Resident 71's blood sugar was 255. Review of Resident 71's clinical record failed to reveal the MD was notified of his blood sugar levels being outside of parameters per the physician's order on the dates and times noted above. The facility was unable to provide any evidence of the MD being notified of his blood sugar levels being outside of parameters per the physician's order on the dates and times noted above. During an interview with the Director of Nursing (DON) on January 16, 2025, at 9:31 AM, she revealed she would have expected the MD to have been notified of Resident 71's blood sugar being outside of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 13 of 33 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 01/16/2025 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)

F 0684 parameters per the physician's order on the dates and times noted above. Level of Harm - Minimal harm or potential for actual harm Review of Resident 88's clinical record revealed diagnoses that included chronic obstructive pulmonary disease (a chronic lung disease that makes it difficult to breathe) and heart failure (when the heart cannot pump enough blood and oxygen to the body). Residents Affected - Few Review of Resident 88's clinical record revealed the Resident had a skin and wound evaluation completed on December 9, 2024, for an in-house acquired moisture-associated skin damage (MASD) located on their left gluteus, lateral, and middle, with the wound measuring 68.8 cubic centimeters (cm2) x 7.3 cm x 13.4 cm. Review of Resident 88's clinical record failed to reveal any further skin and wound documentation or assessments monitoring their MASD. During an interview with the DON on January 16, 2025, at 9:42 AM, she revealed she would have expected Resident 88 to have had weekly wound and skin documentation and evaluations completed to monitor the MASD that was identified on December 9, 2024. 28 Pa. Code 211.12(d)(1) Nursing services 28 Pa. Code 211.12(d)(3) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 14 of 33 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 01/16/2025 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)

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 observations, clinical record review, facility policy review, and staff interviews, it was determined that the facility failed to ensure treatment and services, consistent with professional standards, to promote healing and prevent infection for two of six residents reviewed for pressure ulcers (Residents 16 and 325). Residents Affected - Some Findings include: Review of facility policy, titled NSG236 Skin Integrity and Wound Management, with a last reviewed and revised date of October 15, 2024, revealed 6. The licensed nurse will: 6.5 Complete wound evaluation upon admission/readmission, new in-house acquired, weekly, and with any unanticipated decline in wounds. Review of Resident 16's clinical record revealed diagnoses that included chronic diastolic congestive heart failure (heart failure that occurs when the heart does not relax properly between beats causing the heart to be unable to pump an adequate amount of blood to the body), chronic respiratory failure (long term condition in which the respiratory system is unable to adequately exchange oxygen and carbon dioxide in the body), and chronic kidney disease (longstanding disease of the kidneys leading to renal failure). Review of Resident 16's clinical record revealed that they were transferred to the hospital on January 9, 2025, to be evaluated for mental status change, nausea, vomiting, and not eating. Review of Resident 16's physician orders at time of hospital transfer revealed an order for Wound on sacral area: Cleanse with wound cleanser, pat dry and apply medihoney and foam border dressing. Change every other day or as needed for soilage or dislodgement, dated November 26, 2024. Review of Resident 16's clinical record progress notes revealed a nursing note by a Licensed Practical Nurse dated September 27, 2024, at 12:16 PM, that indicated the Resident was noted to have open area in buttock, and noted blood, saw it small open wound on middle sacrum and that the Registered Nurse Supervisor and was notified and a note was placed on the doctor's book. Review of Resident 16's clinical record progress notes revealed a nursing note by a Registered Nurse dated September 27, 2024, at 1:02 PM, that indicated that a wound care order was obtained. The note further indicated Wound and skin system is down, unable to take new pictures currently will follow up. Review of Resident 16's clinical record revealed a wound specialist consultation note dated October 1, 2024, that indicated that the Resident was consulted for wound prevention. The note further indicated There is no inflammation, rash, wounds, or other lesions of significance. Review of Resident 16's clinical record progress notes revealed a nursing note by a Registered Nurse dated October 10, 2024, at 3:39 PM, indicated the Resident does get small sore area in the sacrum due to [their] incontinence, current treatment with medihoney and covered dressing. Review of Resident 16's Skin and Wound Evaluations revealed that wound evaluations and pictures of their Stage 2 pressure injury were documented on August 23 and 30, 2024; September 5, 2024; October 1 and 8, 2024; November 5 and 29, 2024; and December 10, 2024. All documented evaluations indicated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 15 of 33 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 01/16/2025 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)

F 0686 that the wound was stable or improving. Level of Harm - Minimal harm or potential for actual harm Review of Resident 16's Treatment Administration Records from September 2024 through January 8, 2024, revealed that all ordered treatments were provided except when Resident 16 refused. Resident 16 had refused wound care on January 7 and 8, 2024, and that wound care was not provided prior to their transfer to the hospital for an acute change in condition on January 9, 2024. Residents Affected - Some Review of Resident 16's hospital records dated January 9, 2025, indicated that the Resident had chronic sacral wound(s) buttock avulsion (wound in which skin layers are missing) from being in a moist environment and a pressure ulcer. The wound was described as having approximated edges; being brown, red, yellow in color; with a foam dressing in place that was dry. No measurements or staging of the wound was documented. During a staff interview with the Nursing Home Administrator (NHA) and the Director of Nursing (DON) on January 16, 2025, at 9:42 AM, the DON indicated that she had no additional information to provide regarding Resident 16's pressure ulcer. In addition, she confirmed that weekly wound evaluations to include measurements were not completed as per facility policy and that she would expect them to be completed weekly and documented. Review of Resident 325's clinical record on January 13, 2025, revealed diagnoses that included stage two chronic kidney disease (decreased ability of kidneys to filter toxins from the blood) and diabetes mellitus type II (decrease in the body's ability to utilize insulin for the transport of glucose from the blood stream into the cells for nourishment). Review of Resident 325's clinical record section, titled Wound Evaluation, revealed that an assessment by facility staff on January 8, 2024, revealed Resident 325 had a stage 3 pressure ulcer (wound that extends below the skin to the underlying tissue but does not expose bone or connective tissue) to the sacrum which was present upon admission. Review of facility policy, titled IC308 Enhanced Barrier Precautions, last reviewed October 15, 2024, revealed it stated, Enhanced Barrier Precautions (EBP) are an infection control intervention designed to reduce the transmission of novel or multi-drug resistant organisms. It employs targeted personal protective equipment (PPE) use during high contact patient/resident [sic] activities. Further review of the policy revealed it stated that the facility would implement enhanced barrier precautions when a resident, Has a wound or indwelling medical device without secretions or excretions that are unable to be covered or contained and not known to be infected or colonized with any [multi-drug resistant organism]. During observation directly before wound dressing change observation for Resident 325 on January 15, 2025, at approximately 1:00 PM, it was observed that posted on the wall outside Resident 325's room was a sign which indicated that enhanced barrier precautions were in effect for a resident(s) inside the room (Resident 325). The sign included instructions to utilize personal protective equipment with care (gloves, gown, face mask). Under the sign it was observed that a multi-drawer tote was placed which contained gloves, N-95 masks, and gowns. During wound dressing observations for Resident 325 on January 15, 2025, at approximately 1:10 PM, Employee 9 was observed performing a dressing change on Resident 325's stage three pressure ulcer without wearing a gown as indicated for enhanced barrier precautions. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 16 of 33 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 01/16/2025 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)

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a staff interview on January 16, 2025, at approximately 11:00 AM, DON revealed Employee 9 should have had a gown on, per enhanced barrier precautions, while performing the wound dressing change for Resident 325. During wound dressing observations for Resident 325 on January 15, 2025, at approximately 1:10 PM, Employee 9 was observed performing hand hygiene and then donning gloves prior to the dressing change. After donning gloves, Employee 9 was observed preparing the dressing change area during which Employee 9 was observed using her gloved hand to touch Residents 325 used bed linen (unclean surface), the incontinence brief that Resident 325 was wearing, and used each gloved hand to grab and slightly raise the sleeves of the shirt Employee 9 was wearing (unclean surface). Employee 9 was then observed removing Resident 325's prior dressing without performing hand hygiene and placing new, clean gloves on. After cleansing the wound, Employee 9 was observed preparing a new dressing for Resident 325's pressure ulcer. Employee 9 was observed using her gloved hands to retrieve a marker to write her initials and date on the new dressing. The marker was observed to be retrieved from the top of the medication cart, which was in the hallway, prior to the dressing change. Employee 9 did not cleanse the marker prior to handling it with her gloved hands. After marking the new dressing, Employee 9 put the marker in her pocket. Employee 9 was then observed placing the new dressing over Resident 325's wound. Employee 9 did not perform hand hygiene or change gloves after handling the unclean marker. During a staff interview on January 16, 2025, at approximately 11:00 AM, DON revealed it was the facility's expectation that Employee 9 would have performed hand hygiene and changed gloves after touching unclean surfaces and prior to accessing Resident 325's wound dressing. During the interview, DON confirmed that Employee 9 should have performed hand hygiene and changed gloves after handling the marker that was not cleansed with an anti-microbial agent. 28 Pa Code 201.18(b)(1) Management 28 Pa Code 211.10(c)(d) Resident care policies 28 Pa Code 211.12(d)(1)(2)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 17 of 33 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 01/16/2025 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)

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on facility policy review, observations, clinical record review, and staff interviews, it was determined that the facility failed to ensure residents with limited mobility received appropriate services, equipment, and assistance to maintain or improve mobility for three of five residents reviewed for limited range of motion (Residents 35, 40, and 50). Findings include: Review of facility policy, titled Restorative Nursing Guidelines, dated April 1, 2024, read, in part, Restorative nursing services (RNP) refer to interventions that promote the patient's ability to adapt & adjust to living as independently & safety as possible. It includes interventions that promote the resident's ability to attain & maintain their maximum functional potential. RNP's include, but are not limited to: Active Range of Motion (AROM) & Passive Range of Motion (PROM). Developing a RNP includes patient need identification, program design, documentation & monitoring outcomes. The program must include documentation of the number of minutes spent per restorative session. Document daily restorative nursing 'tasks' include interventions provided, time in minutes that restorative nursing care was provided, and patient tolerance of nursing interventions. Review of Resident 35's clinical record revealed diagnoses that included hemiplegia (paralysis of one side of body) and hemiparesis (muscle weakness on one side of the body) following a cerebral infarction (a stroke-damage to the brain from interruption of its blood supply) affecting right dominant side, aphasia (language disorder that affects a person's ability to communicate), and vascular dementia (brain damage caused by multiple strokes which causes memory loss in older adults). Review of Resident 35's current physician orders revealed an order for right palm guard on at all times except for hygiene. Check skin daily every shift, dated July 17, 2024. Observations of Resident 35 on January 13, 2025, at 11:47 AM and 12:14 PM; on January 14, 2024, at 9:24 AM and 1:31 PM; and January 15, at 9:44 AM, all revealed that Resident 35 did not have a palm guard in place in their right hand. Review of Resident 35's Treatment Administration Records from July 1, 2024, through December 31, 2024, revealed that Resident 35's palm guard was documented as being applied; however, review of Resident 35's January 2025 Treatment Administration Record failed to include the palm guard as an ordered treatment to be provided. Review of Resident 35's care plan revealed a focus for ADL [Activities of daily living or ADLs are routine tasks that each of us must perform every day to care for our bodies and ourselves independently] self-care deficit related to physical limitations with a revised date of November 7, 2024. Interventions included, but were not limited to, Passive Range of Motion to right upper extremity during ADLs dated August 13, 2024; and Restorative Dressing/Grooming: Resident will raise her arms, as tolerated, to assist with putting arms into clothing/gown, during AM and PM care moderate assist, with a revised date of March 20, 2024. Review of Resident 35's Restorative Nursing Program documentation from November 1, 2024, through January 15, 2025, revealed the following: Restorative Dressing/Grooming and Restorative Range of Motion were blank for day shift on November 7, 15, and 21, 2024; were blank for evening shift on November (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 18 of 33 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 01/16/2025 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)

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 19, 2024; were blank for day shift on December 4 and 31, 2024; were blank for evening shift on December 9 and 30, 2024; and were blank on day shift on January 9, 10, and 11, 2025; and were blank for evening shift on January 6 and 12, 2025. During a staff interview with the Nursing Home Administrator (NHA) and the Director of Nursing (DON) on January 16, 2025, at 12:21 PM, the DON indicated that she had no additional information to provide regarding Resident 35's palm guard not being applied as ordered. The DON confirmed that there were multiple occasions where there was no documentation to support that Resident 35's received their established Restorative Nursing Programs. In addition, the DON confirmed that she would expect staff to have provided Resident 35 their programs and to have applied that their palm guard as ordered. Review of Resident 40's clinical record revealed diagnoses that included muscle weakness and contracture (when muscles or joints tighten or shorten reducing your range of motion). Review of Resident 40's occupational therapy discharge summary on November 3, 2023, revealed he was discharged from therapy services on that date and referred to a RNP program. Review of Resident 40's care plan revealed a focus area of At risk for loss of range of motion related to physical limitations, created on October 14, 2020, with an intervention for Restorative Passive ROM: to bilateral hands (5 reps, twice a day) as tolerated, during care, last revised November 18, 2024. Review of Resident 40's clinical record failed to reveal documentation noting Resident 40's RNP program minutes or tolerance. During an email correspondence with the DON on January 15, 2025, at 9:27 AM, she revealed Resident 40's RNP program was 'corrected.' Interview with Employee 11 (Licensed Practical Nurse) on January 16, 2025, at 10:51 AM, revealed the facility had a change in electronic systems, which caused Resident 40's RNP program to not automatically carry over to documentation, so his RNP program documentation was not captured for the duration of the program. During an interview with the DON on January 16, 2025, at 12:20 PM, she revealed she would expect RNP program minutes and tolerance to be documented per facility policy. Review of Resident 50's clinical record revealed diagnoses that included hemiplegia (paralysis of one side of body) and hemiparesis (muscle weakness on one side of the body) following a cerebral infarction (a stroke-damage to the brain from interruption of its blood supply) affecting left non-dominant side, muscle weakness, and other abnormalities of gait and mobility. Review of Resident 50's care plan revealed a care plan focus for being at risk for loss of range of motion related to physical limitations last revised on August 14, 2024, with interventions that included Restorative Active Range of Motion to right upper extremity before every meal 2 sets of 5 repetitions revised November 5, 2024; Restorative Passive Range of Motion to left upper extremity with ADL's/Care 2 sets of 5 repetitions, revised November 5, 2024. Review of Resident 50's care plan also revealed a care plan focus for ADL self-care deficit evidenced by weakness related to physical limitations revised August 14, 2024, with interventions that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 19 of 33 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 01/16/2025 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)

F 0688 Level of Harm - Minimal harm or potential for actual harm included Restorative Bed Mobility: Moderate assist with moving to and from lying position, Moves side to side, while in bed revised May 22, 2024; Restorative Active-Assisted Range of Motion to lower extremities 2 sets of 5 repetitions with moderate assist, dated September 24, 2024; and Restorative Transfer: Transfer from bed to chair, Transfer from w/c [wheelchair]to standard chair, Transfer from chair to bed, Transfer to/from shower chair extensive assist of 2 dated September 24, 2024. Residents Affected - Some Review of Resident 50's Restorative Nursing Program documentation from November 1, 2024, through January 15, 2025, revealed the following: Restorative Bed Mobility, both Restorative Range of Motion programs, and Restorative Transfers were blank on day shift on December 4, 9, 13, 18, 24, and 26, 2024; were blank on evening shift December 30, 2024; were blank on day shift on January 3 and 6, 2025; and were blank on evening shift on January 12, 2025. During a staff interview with the NHA and DON on January 16, 2025, at 12:21 PM, the DON confirmed that there were multiple occasions where there was no documentation to support that Resident 50 received their established Restorative Nursing Programs and that she would expect staff to have provided Resident 50 their programs. 28 Pa. Code 211.10(c)(d) Resident care policies 28 Pa. Code 211.12(d)(1)(2)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 20 of 33 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 01/16/2025 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)

F 0710 Obtain a doctor's order to admit a resident and ensure the resident is under a doctor's care. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based clinical record review, hospital record review, and staff interview, it was determined that the facility failed to ensure the physician provided orders for the resident's immediate care and needs for one of 24 residents reviewed (Resident 325). Residents Affected - Few Findings include: Review of Resident 325's clinical record on January 13, 2025, revealed diagnoses that included stage two chronic kidney disease (decreased ability of kidneys to filter toxins from the blood), diabetes mellitus type II (decrease in the body's ability to utilize insulin for the transport of glucose from the blood stream into the cells for nourishment), and a stage three pressure ulcer to the sacrum (wound of the skin that can extend to the deeper layers of the skin caused by pressure over a bony prominence). Review of Resident 325's clinical record revealed that Resident 325 was admitted to the facility from the hospital on January 7, 2025. Review of hospital documentation revealed that while Resident 325 was in the hospital, Resident 325 had a foley catheter inserted (tube inserted into the bladder to drain urine from the bladder) and Resident 325 was assessed as having a stage II pressure ulcer to the sacrum which required treatment. Review of Resident 325's clinical record revealed a facility document titled, Transition of Care, which was dated January 7, 2025, that indicated Resident 325 was being admitted from the hospital. Review of the document revealed staff had documented, stage 2 sacral [wound], and foley under the section titled, Reason for Hospitalization. Further, under section titled, Devices/Special Treatment the box labeled, Foley Catheter was marked. Review of Resident 325's interdisciplinary progress notes revealed an initial assessment documented on January 7, 2025, at 4:48. The initial assessment conducted by Employee 10 (Registered Nurse), confirmed that Resident 325 was admitted with a foley catheter in place and a wound to the sacrum. Review of Resident 325's clinical record section titled Wound Evaluation, revealed that an assessment by facility staff on January 8, 2024, revealed Resident 325 had a stage 3 pressure ulcer (wound that extends below the skin to the underlying tissue but does not expose bone or connective tissue) to the sacrum which was present upon admission. Review of Resident 325's physician orders revealed that Resident 325 did not have orders for treatment to the sacral pressure ulcer upon admission. Review of the order for treatment to Resident 325's sacral pressure ulcer revealed it was ordered on January 11, 2025, with a start date of January 12, 2025, five days after admission. Review of Resident 325's physician orders also revealed Resident 325 did not have orders for care and/or treatment of Resident 325's foley catheter upon admission. Review of the orders for the foley catheter, including care and treatment, revealed they were dated and started on January 13, 2025, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 21 of 33 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 01/16/2025 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)

F 0710 six days after admission. Level of Harm - Minimal harm or potential for actual harm During a staff interview on January 16, 2025, at approximately 12:25 PM, Director of Nursing revealed it was the facility's expectation that the physician would have provided orders for foley catheter care and wound treatment for Resident 325 upon admission on [DATE]. Residents Affected - Few 28 Pa code 201.18(b)(1) Management 28 Pa code 211.2(d)(3) Medical director 28 Pa code 211.12(d)(1)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 22 of 33 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 01/16/2025 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)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to maintain an accurate accounting of the final disposition of medications upon discharge for two of three closed records reviewed (Residents 105 and 107). Findings Include: Review of facility policy, Disposal of Medication Waste, revised July 1, 2024, revealed, Medications that cannot be returned to the pharmacy, discharged with the patient, or donated will be placed in medication disposal bins labeled .controlled substance waste. Review of facility policy, Collection Receptacles for Disposal of Medications, undated, revealed, When disposing of such controlled substances by transferring those substances into a collection receptacle, such disposal shall occur immediately, but no longer than three business days after the discontinuation of use by the resident/ultimate user. Discontinuation of use includes a permanent discontinuation of use as directed by the prescriber, as a result of the resident's transfer from the long-term care facility, or as a result of death. Disposition of Controlled Medication into the receptacle should only be completed by two staff as authorized by the state. Upon discontinuation of a patient's controlled substance medication, two authorized staff must document the removal of the patient's dangerous drugs from the medication cart or storage area and record the transfer of the drugs to the medication receptacle .The record of the controlled substance removed from the medication cart, or other area for storage, for disposal shall be made on a controlled substance proof-of-use sheet. Review of Resident 105's clinical record revealed that she was discharged from the facility to the hospital on November 12, 2024. Review of Resident 105's closed record revealed four Controlled Drug Record forms that indicated that Resident 105 had a total of 98 (26 on one form, 12 on another, 30 on another, and 30 on another) Oxycodone tablets (opioid used to treat severe pain) remaining at discharge. On each form, disposition of remaining doses was signed off by one staff person on December 31, 2024. During an interview with the Director of Nursing (DON) on January 16, 2025, at 12:30 PM, she revealed the expectation that two staff members should have signed off on the disposal of Resident 105's medication. Review of Resident 107's clinical record revealed that he was discharged to home on December 8, 2024. Review of Resident 107's physician orders revealed that at the time of discharge, he was prescribed oxycodone 5 mg every six hours as needed for pain. Review of Resident 107's closed record revealed no evidence of final disposition of the aforementioned medication. During an interview with the DON on January 16, 2025, at 12:30 PM, she revealed that she had no additional information to provide regarding final disposition of Resident 107's medications. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 23 of 33 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 01/16/2025 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)

F 0755 28 Pa. Code 211.9(j.1)(3)(4) Pharmacy services Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 24 of 33 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 01/16/2025 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)

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to ensure that the licensed pharmacist's report of a medication irregularity was reviewed and acted upon timely for two of five residents reviewed for unnecessary medications (Residents 29 and 74). Findings include: Review of facility policy, titled Medication Regimen Review, last reviewed October 15, 2024, read, in part, Medication Regimen Review (MRR) is a thorough evaluation of the medication regimen of a resident, with the goal of promoting positive outcomes and minimizing adverse consequences and potential risks associated with medication. The MRR includes review of the medical record in order to prevent, identify, report and resolve medication-related problems, medication errors, or other irregularities. The findings are communicated to the Director of Nursing (DON) or designee and the medical director. These findings are documented and filed with other consultant pharmacist recommendations in the resident's chart. Resident-specific MRR recommendations and findings are documented and acted upon by the nursing care center and/or physician. Review of Resident 29's clinical record revealed diagnoses that included hypertension (elevated blood pressure) and anxiety disorder (mental health conditions that involve persistent and excessive feelings of fear or worry). Review of Resident 29's physician orders revealed an order for Quetiapine Fumarate Oral Tablet 150 MG (Quetiapine Fumarate), give one tablet by mouth at bedtime for anxiety, depression, insomnia, with an original start date of July 19, 2024. Review of select facility documentation provided revealed a MRR from August 11, 2024, that read, in part, Patient on Seroquel suggest a trial dose reduction. Further review of the aforementioned document revealed it was signed by the physician on October 31, 2024, that they were in agreement with the recommendation. Review of Resident 29's clinical record on January 14, 2025, failed to reveal the recommendation from August 11, 2024, was ever implemented. During an interview with the Director of Nursing (DON) on January 16, 2025, at 12:21 PM, revealed she would have expected Resident 29's MRR to have been responded to timely by the physician and for the recommendation to have been implemented. Review of Resident 74's clinical record revealed diagnoses that included major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest in things), anxiety disorder (a persistent feeling of worry, nervousness, or unease), and dementia (a chronic disorder of the mental processes caused by brain disease, marked by memory disorders, personality changes, and impaired reasoning). Review of Resident 74's physician orders revealed an order for Quetiapine Fumarate Oral Tablet 200 MG (Seroquel- Antipsychotic Medication), Give 200 mg orally at bedtime for depression, with a start (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 25 of 33 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 01/16/2025 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)

F 0756 date of August 3, 2024. Level of Harm - Minimal harm or potential for actual harm Review of select facility documentation provided revealed a MRR from August 8, 2024, that read, in part, Recommendation: Routine antipsychotic use must be evaluated by MD on admission for potential dose reduction or discontinuation. Please provide rationale for use with diagnosis of depression. Residents Affected - Few Further review of the aforementioned document failed to reveal the recommendations were reviewed by the physician or acted upon. Review of select facility documentation provided revealed a MRR from August 11, 2024, that read, in part, Patient on Seroquel suggest a trial dose reduction. Further review of the aforementioned document revealed it was signed by the physician on October 29, 2024, that they were in agreement with the recommendation. Review of Resident 74's clinical record on January 14, 2025, failed to reveal the recommendation from August 11, 2024, was ever implemented. Interview with the DON on January 16, 2025, at 12:17 PM, revealed she would expect MRRs to be reviewed by nursing and/or physician and implemented timely, if applicable. 28 Pa. Code 211.2(d)(3) Medical Director 28 Pa Code 211.9(a)(1) Pharmacy Services 28 Pa. Code 211.12(d)(3)(5) Nursing Services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 26 of 33 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 01/16/2025 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)

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 observations, facility policy review, review of medication data sheets, and staff interviews, it was determined that the facility failed to discard expired medications in one of three medication carts (Arcadia); and failed to properly label drugs and biologics in one of three medication carts (3rd floor short hall cart). Findings include: Review of facility policy, titled Storage of Medications, with a last review date of October 15, 2024, revealed, 12. [in part] Note the date on the label for insulin vials and pens when first used; and 14. [in part] Outdated .medications are immediately removed from stock, disposed of according to procedures. Review of insulin degludec (a long-acting insulin used to manage diabetes) medication data sheet from Drugs.com revealed that this brand of insulin should be used or discarded within 56 days of opening. Review of insulin aspart (a fast-acting insulin used to lower blood sugar levels) medication data sheet from Drugs.com revealed that this brand of insulin should be used or discarded within 28 days of opening. Review of Medline Liquid Active Protein data sheet on Medline.com revealed that the supplement should be used or discarded within three months of opening. Observation of the Arcadia unit medication cart with Employee 2 (Licensed Practical Nurse) on January 14, 2025, at 10:16 AM, revealed an unopened box of OHC COVID tests (two) with an expiration date December 30, 2023. Employee 2 confirmed the tests were expired and indicated that they would discard them. Observation of the 3rd floor short hall medication cart with Employee 3 (Graduate Practical Nurse) on January 14, 2025, at 10:27 AM, revealed two insulin degludec pens, one insulin aspart pen, and a bottle of Medline Liquid Active Protein supplement without open dates indicated. Employee 3 confirmed the items were not dated when opened. During a staff interview with the Nursing Home Administrator (NHA) and the Director of Nursing (DON) on January 15, 2025, at 11:19 AM, the DON confirmed that the COVID tests should have been discarded and that the insulin pens should have been dated when they were opened. She indicated that she would need to check on the liquid protein as she believed it to be good to the manufacturer expiration date. During a follow-up staff interview with the NHA and DON on January 16, 2025, at 9:42 AM, the DON confirmed that the bottle of liquid protein should have been dated when opened. The NHA and DON both confirmed that medications that have a shortened shelf life after opening should be dated. 28 Pa. Code 201.18(b)(1) Management (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 27 of 33 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 01/16/2025 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)

F 0761 28 Pa. Code 211.9(a)(1) Pharmacy 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: 395440 If continuation sheet Page 28 of 33 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 01/16/2025 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)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on facility policy reviews, observations, and staff interviews, it was determined that the facility failed to store food and utilize kitchen equipment in accordance with professional standards for food service safety in the main kitchen and one of three nourishment areas. Findings include: Based on facility policy, titled Food and Nutrition Services 'Use By' Dating Guidelines, last reviewed October 15, 2024, read, in part, Guidelines apply regardless of storage location (e.g. kitchen, pantries, etc.). Thickened liquids- 'use by' date seven days after opening. Frozen shakes 'use by' date of fourteen days once thawed- use labels for individual items when removed from the carton. Based on facility policy, titled Food Brought in for Patients/Residents, last reviewed October 15, 2024, read, in part, Food brought to residents by family or visitors will be handled and stored in a safe and sanitary manner. Food items that require refrigeration must be labeled with a resident's name and date the food was brought in. Food will be held in refrigerator for up to three days following date on label and will be discarded by staff upon notification to resident. Observation of the three-compartment sink in the main kitchen on January 13, 2025, at 9:15 AM, failed to reveal a log for the concentration of the sanitizer solution. Interview with Employee 1 (Food Service Director) on January 13, 2025, at 9:16 AM, revealed they are not logging the concentration of the sanitizer solution in the three-compartment sink when in use. Observation of the dish machine in the main kitchen on January 13, 2025, at 9:17 AM, revealed the wash temperature was 130 degrees F (Fahrenheit- unit of measure), which is below the minimum safe temperature of 160 degrees F. Interview with Employee 1 on January 13, 2025, at 9:18 AM, revealed they are not logging the temperature of the dish machine when in use. Observation in the Med Bridge pantry area refrigerator on January 13, 2025, at 9:26 AM, revealed the following from an outside source: one container of food without a date; one grocery bag of food without a date; one paper bag of food without a date; one black lunch bag of food without a name or date; one paper bag of food dated December 16, 2024, with rotten food inside; one container of rotten fruit without a name or date; one container of food dated December 31, 2024; and one open container of potato salad dated January 5, 2025. Further observation in the Med Bridge pantry area refrigerator on January 13, 2025, at 9:28 AM, revealed: two thickened cranberry juices with an open date of January 5, 2025; one container of thickened orange juice not dated with an open date; one container of thickened lemon water not dated with an open date; and one thawed frozen shake not labeled with a thawed date. Follow-up observation of the dish machine on January 13, 2025, at 1:16 PM, revealed the wash temperature was 122 degrees F. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 29 of 33 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 01/16/2025 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)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview with Employee 1 on January 13, 2025, at 1:18 AM, revealed he contacted maintenance, but they are unable to fix the machine, and the servicer has been contacted to come out as soon as possible. He then instructed the employee washing the dishes to pause and rerun the dishes through the machine after he hooks up a sanitizing solution for low temperature use. Interview with the Nursing Home Administrator on January 15, 2025, at 11:26 AM, revealed it was the facility's expectation that expired items are discarded, foods items are labeled and dated per facility policy, and kitchen equipment is utilized in accordance with professional standards. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.6(f) Dietary services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 30 of 33 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 01/16/2025 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)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, observations, facility policy review, and staff interview, it was determined that the facility failed to implement infection control practices to help prevent the development and transmission of infectious diseases for one of one treatment cart observed (Third floor treatment cart). Residents Affected - Few Findings include: Review of facility policy, titled Infection Prevention and Control Program Description, last reviewed October 15, 2024, revealed it stated, .Implementation of Control Measures and Precautions includes basics such as hand hygiene, Standard and Transmission Based Precautions, cleaning/disinfecting equipment and measures to protect persons [sic] from communicable diseases or infections. Review of Resident 325's clinical record on January 13, 2025, revealed diagnoses that included stage two chronic kidney disease (decreased ability of kidneys to filter toxins from the blood), diabetes mellitus type II (decrease in the body's ability to utilize insulin for the transport of glucose from the blood stream into the cells for nourishment), and a stage three pressure ulcer to the sacrum (wound of the skin that can extend to the deeper layers of the skin caused by pressure over a bony prominence). Prior to wound dressing observations for Resident 325 on January 15, 2025, at approximately 1:10 PM, Employee 9 was observed retrieving a box of medical grade honey (used to promote healing and prevent infection) from the unit treatment cart. During Resident 325's dressing change observation, Employee 9 was observed placing the box of medical grade honey on Resident 325's bed-side table (an unclean surface), then opening the box, removing the seal of the tube of medical grade honey, and applying the medical grade honey on swabs to be placed on Resident 325's wound. Employee 9 replaced the tube of medical grade honey in the manufacturer's box. Upon completion of the dressing change, Employee 9 was observed exiting Resident 325's room holding the box of medical grade honey with the right hand and a bag containing soiled dressing supplies in the left hand. Employee 9 then went to the soiled utility room, partially entered the soiled utility room, and discarded the bag of soiled dressing supplies into a trashcan after making contact with the lid of the soiled utility room trash can. Employee 9 was then observed returning the box of medical grade honey to the treatment cart drawer without cleansing the box or tube. Employee 9 did not place the box of medical grade honey in a clean container prior to storing it in the treatment cart drawer, nor did Employee 9 mark the box or tube of the medical grade honey with any indication that the treatment supply was utilized for Resident 325. During a staff interview on January 16, 2025, at approximately 11:00 AM, Director of Nursing revealed it was the facility's expectation that Employee 9 would have labeled the medical grade honey with Resident 325's name to ensure it would not be used on a separate resident. 28 Pa code 211.12(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 31 of 33 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 01/16/2025 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)

F 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, laboratory result review, facility policy review, and resident and staff interviews, it was determined that the facility failed to ensure the facility's Antibiotic Stewardship Program was implemented for one of two residents reviewed for antibiotic use (Resident 98). Residents Affected - Few Findings include: Review of facility policy, titled IC402 Antibiotic Stewardship, last revision date of December 16, 2024, revealed the facility policy stated, Centers will implement an Antibiotic Stewardship Program (ASP) as part of the facility's overall infection and control program . The policy's included purpose stated, To reduce inappropriate antibiotic use and prevent the development of antibiotic-resistant organisms. Review of the policy's Process section revealed the program included the following: 1. The Medical Director, [Director of Nursing], and Consultant Pharmacist serve as the leaders of the ASP and receive support from the Administrator and other governing officials of the Center. 1.1 The Medical director .Sets the standards for antibiotic prescribing practices for all healthcare providers prescribing antibiotics .Oversees adherence to antibiotic prescribing practices, and .Reviews antibiotic use data and ensures best practices are followed. 1.3 The Consultant Pharmacist .Reviews microbiology culture results and provides feedback to prescribers on initial antibiotic selection to let them know if it is the right drug to treat the infection or if the bacteria may be resistant to the antibiotic. 4.2 Monitoring Patients' Antibiotic Use .Monitor response to antibiotics, and laboratory results when available, to determine if the antibiotic is still indicated or adjustments should be made . Review of Resident 98's clinical record on January 14, 2025, revealed diagnoses that included congestive heart failure (decreased ability of the heart to effectively pump blood throughout the body) and urinary tract infection (infection that affects any part of the urinary system). During a Resident interview on January 14, 2025, at approximately 10:45 AM, Resident 98 revealed that he was recently diagnosed with an urinary tract infection. Resident 98 stated that he did not experience any symptoms prior to or after being diagnosed with an urinary tract infection. Resident 98 revealed that, at the time of the interview, he was receiving antibiotics for the urinary tract infection. Review of Resident 98's clinical record revealed that on January 8, 2025, Resident 98 was ordered an urinary analysis (laboratory examination of the urine to identify substances that may indicate health issues), along with an urinary culture (laboratory test to determine the presence, type, and amount of bacteria) and sensitivity test (laboratory test to determine which antibiotic(s) the identified bacteria is susceptible to or resistant to) due to urinary retention after the removal of a urinary catheter (tube inserted into the bladder to facilitate the draining of urine). Review of the urinalysis completed on January 8, 2025, for Resident 98 revealed that Resident 98 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 32 of 33 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 01/16/2025 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)

F 0881 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few had indication of a possible urinary tract infection. Written on the urinary analysis laboratory results was, Sent to [attending physician]. Cipro 500 mg [twice a day for seven days]. Review of Resident 98's physician orders revealed that on January 8, 2025, Resident 98 had an order for Cipro (generic name - ciprofloxacin; an antibiotic used to treat infection) 500 milligrams (mg - metric unit of measure) twice a day for seven days, initially dated January 8, 2025, and revised on January 9, 2025. Review of Resident 98's medication administration record revealed Resident 98 started the antibiotic on the morning of January 9, 2025. Review of the laboratory's urine culture, which was verified by the laboratory on January 9, 2025, revealed it stated, 50,000 to 100,000 cfu/ml [cfu - colony-forming unit; ml - milliliters, combined to indicate the number of bacteria that can grow from a sample] Presumptive [methicillin-resistant Staphylococcus aureus - bacteria that is resistant to some antibiotics that can cause serious illness] .Please refer to final report for confirmatory susceptibility to Oxacilliin [antibiotic] .Susceptibility to follow. Review of the urine culture report revealed it was signed and dated on January 10, 2025, and included a written statement of, On Cipro [follow-up] final results. Review of Resident 98's urine culture and sensitivity report, which had a laboratory verification date of January 10, 2025, revealed that the bacteria identified in Resident 98's urine was listed as resistant to ciprofloxacin, oxacillin, and other antibiotics. The report identified the bacteria was susceptible to nitrofurantoin, rifampin, tetracycline, tigecycline, and vancomycin (antibiotics used to treat infections). Review of the laboratory result sheet revealed it was not initialed, indicating it had not been reviewed. Review of Resident 98's clinical record revealed there was no change in Resident 98's medication as a result of the sensitivity report, which indicated that the bacteria was resistant to the prescribed antibiotic. As of January 16, 2025, at 12:00 PM, review of available documentation revealed no documented clinical rationale for the continued use of cipro to treat Resident 98's urinary tract infection. During a staff interview on January 16, 2025, at approximately 12:25 PM, Director of Nursing stated it was the facility's expectation that antibiotic use is monitored and adjusted with the use of sensitivity test, per the facility's Antibiotic Stewardship Program. 28 Pa code 201.18(b)(1)(3) Management 28 Pa code 211.2(d)(3)(5) Medical director 28 Pa code 211.12(d)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395440 If continuation sheet Page 33 of 33