Health inspection·October 26, 2023

F 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm Based on review of grievances lodged with the facility, the schedule of the facility's activities staff and activities programming and interviews with staff, it was determined that the facility failed to provide an ongoing program of activities designed to meet the needs, interests, and preferences of two out of 8 sampled residents (Residents 18 and 21) Residents Affected - Some Findings include: Review of grievance submitted by Resident 18 dated October 7, 2023, revealed that the resident was very upset that the Activity Director was not present in activities. The grievance further indicated that the resident was weepy at times and that she was bored. Resident 18 questioned if it was something the resident did wrong. Comfort and emotional support were provided at the time the resident's concern was expressed. Review of grievance submitted by Resident 21 dated October 8, 2023, revealed that the resident was very upset, there are no activities in the morning. The resident stated I don't even want to get out of bed anymore. I have nothing to look forward to. The resident stated that she was going to tell her family member what was going on in the facility. The facility's resolution to the above grievances was that the Activity Director was being reinstated. Review of October 2023 Activity Staff Schedule revealed that both the facility's Activity Director and the Activity Aide were laid off beginning October 3, 2023, through October 10, 2023. Review of facility Midnight Census report dated October 3, 2023, revealed that the facility had 28 occupied beds out of 37 available. On October 10, 2023, when Activity staff were reinstated, the facility had 32 occupied beds out of 37 available. Interview with NHA on October 26, 2023, at approximately 11 AM revealed that during the time period from October 4, 2023, to October 10, 2023, while the activity department staff were laid off at the direction of the facility's administration due to decreased resident census, the facility's limited activities were conducted, as able, by nursing staff or the administrative assistant. The facility was not able to provide evidence at time of survey ending October 26, 2023, that activities scheduled from October 4, 2023, to October 10, 2023 were provided to the residents as planned in the absence of the activity staff. The facility failed to consistently provide an on-going program of activities that supported the (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 5 Event ID: 395484 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 395484 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Luzerne 463 North Hunter Hwy Drums, PA 18222 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)