Health inspection·April 27, 2024

F 0620 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Not require residents to give up Medicare or Medicaid benefits, or pay privately as a condition of admission; and must tell residents what care they do not provide. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, facility policy review, and staff interview, it was determined that the facility failed to provide necessary equipment to a resident on admission for one of five sampled residents. (Resident CL1) Findings include: Review of the the facility policy entitled, Pre-admission Process Procedure, last reviewed July 1, 2023, revealed that when a referral was received the Clinical Director of Admissions and Marketing would pre-screen the referral. The Director of Nursing would review the referral clinically for staff education needs and to ensure all necessary equipment was ordered. If there were additional needs identified, they would be communicated to the Clinical Director of Admissions and Marketing so they could be addressed before admission. Clinical record review revealed that Resident CL1 was admitted to the facility on [DATE], with diagnoses that included chronic obstructive pulmonary disease, dependence on supplemental oxygen, and morbid obesity. Review of pre-admission documentation received by the facility from the hospital revealed that the resident was dependent on four liters of continuous oxygen and used an average volume-assured pressure support (AVAPS) machine (a machine that facilitates non-invasive ventilation to support people with respiratory failure) daily prior to admission and during her hospitalization. Review of Resident CL1's admission assessment and nurse's notes revealed that the resident was admitted to the facility on [DATE], and the facility did not have an AVAPS machine for the resident to use through April 22, 2024, when the resident was transferred to the hospital. In an interview on April 27, 2024, at 2:00 p.m., the Nursing Home Administrator, confirmed that the facility did not have the needed equipment to support Resident CL1 and that the Pre-admission Process Policy had not been followed. 28 Pa Code 201.24 (c) admission policy. Page 1 of 3 395506 395506 04/27/2024 Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078

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 clinical record review and staff interview, it was determined that the facility failed to ensure that physician's orders were implemented for one of five sampled residents. (Resident CL1 ) Residents Affected - Few Findings include: Clinical record review revealed that Resident CL1 had diagnoses that included chronic obstructive pulmonary disease, congestive heart failure, and morbid obesity. A physician's order dated April 21, 2024, directed staff to administer an inhaler (Symbicort) two times a day to treat the resident's wheezing. A review of the April 2024 Medication Administration Records revealed that there was no evidence that staff administered the inhaler as ordered on April 21 and 22, 2024. In an interview on April 27, 2024, at 2:05 p.m., the Nursing Home Administrator confirmed that there was no documented evidence that Resident CL1 received the inhaler as ordered by the physician. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 395506 Page 2 of 3 395506 04/27/2024 Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and resident interview, it was determined that the facility failed to provide a safe, sanitary, and comfortable environment in nine of 16 resident rooms on the nursing unit. (Rooms 104, 106, 107, 108, 114, 115, 116, 117, 118) Findings include: Observation on the nursing unit on April 27, 2024, at 1:30 p.m. revealed the following: In room [ROOM NUMBER] the paint was chipped and peeling on the radiator cover. In room [ROOM NUMBER] there was an area of mismatched floor tiles and large ruts in the floor in the area of the D bed. Resident 2 stated that her wheelchair frequently gets stuck in the ruts in the floor. The call light notification outside of room [ROOM NUMBER] did not light up when the residents in the room rang their call bell. The door of room [ROOM NUMBER] had peeling paint. In room [ROOM NUMBER] there were stained ceiling tiles. Outside of room [ROOM NUMBER] on the wall underneath the hand sanitizer was an area missing paint. In room [ROOM NUMBER] the paint was peeling on the radiator cover and a part of the cover was missing with a pipe exposed. The corner of the wall near the bathroom door had chipped paint with a jagged edge. In room [ROOM NUMBER] the closet doors and drawers contained mismatched paint and the wall above the sink had an area where old wallpaper was exposed. In room [ROOM NUMBER] the wall by the sink contained areas of mismatched paint and areas with unfinished exposed spackle. In room [ROOM NUMBER] the radiator cover was heavily marred. The window blinds in room [ROOM NUMBER] had multiple broken blinds. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(1) Management. 395506 Page 3 of 3