Inspection visit

Health inspectionAugust 9, 2024

KADIMA REHABILITATION & NURSING AT PALMYRACMS #39550620 citations on this visit

20 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 20 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, it was determined that the facility failed to ensure that a dignified environment and services were provided to promote quality of life on the nursing unit. Findings include: Observation on the nursing unit revealed a bulletin board outside of the dining room displaying the menus for breakfast, lunch, and dinner. On Tuesday August 6, 2024, and Wednesday August 7, 2024, the menus posted were labeled Monday and incorrectly identified what was to be served at each meal. Observations on August 6, 2024, from 10:30 a.m. through 12:45 p.m., and on August 7, 2024, from 11:00 a.m., through 12:45 p.m. revealed that the clock in room [ROOM NUMBER] above Resident 8's bed displayed the incorrect time. 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 20 Event ID: 395506 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 0565 Honor the resident's right to organize and participate in resident/family groups in the facility. Level of Harm - Potential for minimal harm Based on a review of facility resident council minutes, and resident and staff interviews, it was determined that the facility failed to address grievances voiced by the resident group. (Residents 1, 4, 8, 10, 22, 23, 27, 29, 30, 32) Residents Affected - Some Findings include: In a group interview conducted on August 7, 2024, at 11:24 a.m., Residents 1, 4, 8, 10, 22, 23, 27, 29, 30, and 32 stated that items were often lost in the laundry, snacks and water were not offered regularly, and call bells were not answered timely. They also stated the facility did not assist with organizing regular resident council meetings. Review of Resident Council minutes dated April 26, 2024, June 13, 2024, and July 9, 2024, revealed that multiple residents had reported issues with lost clothing, a lack of water and snacks, and slow call bell responses. In an interview on August 7, 2024, at 1:30 p.m. the Administrator confirmed that the resident council had met three times in the last eight months and the facility had not followed up on Resident Council grievances. 28 Pa. Code 201.14(a) Responsibility of licensee. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 2 of 20 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 0574 The resident has the right to receive notices in a format and a language he or she understands. Level of Harm - Potential for minimal harm Based on observation and the resident group interview, it was determined that the facility failed to post contact information in the facility for regulatory and advocacy group including (but not limited to) the State Survey Agency and State Long-Term Care Ombudsman. Residents Affected - Many Findings include: During a tour of the facility on August 6, 2024, at 11:00 a.m., there was no information posted in the facility regarding the State Survey Agency and the State Long-Term Care Ombudsman. On August 7, 2024, at 10:30 a.m., ten alert and oriented residents in the group interview stated that they were unaware of how to contact the State Survey Agency and State Long-Term Care Ombudsman. 28 Pa. Code 201.29(c.1) Resident rights. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 3 of 20 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 0577 Allow residents to easily view the nursing home's survey results and communicate with advocate agencies. Level of Harm - Potential for minimal harm Based on observation it was determined that the facility failed to make Department of Health survey results available to all residents. Residents Affected - Many Findings include: Observation on August 7, 2024, at 11:00 a.m., revealed that the binder containing the Department of Health survey results was on the wall near the dining room. The binder did not contain the results of the abbreviated surveys conducted on November 19, 2023, December 10, 2023, December 19, 2023, February 15, 2024, February 25, 2024, March 7, 2024, April 27, 2024, and June 20, 2024. 28 Pa. Code 201.14(a) Responsibility of licensee. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 4 of 20 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Potential for minimal harm Based on observation, it was determined that the facility failed to maintain confidentiality in regards to residents' health information on the nursing unit. Residents Affected - Some Findings include: Observation on August 8, 2024, from 9:20 a.m. through 9:45 a.m., revealed LPN1 passing medications to residents on the nursing unit. Multiple times during this observation LPN1 left the medication cart unattended with the computer opened and unlocked displaying resident names and medications that they received. This information was visible to anyone in the hallway. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 5 of 20 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 observation, it was determined that the facility failed to ensure that a safe, clean, and comfortable environment was maintained on one of one nursing units. Findings include: Observation of the ice machine on August 6, 2024, at 10:09 a.m., revealed an electrical outlet pulled out from the wall, ripped siding on the ice machine and a dirty floor. Observations on August 6, 2024, at various times, revealed a bulletin board in the hallway next to room [ROOM NUMBER] with peeling cork, stained ceiling tiles outside of room [ROOM NUMBER], and a missing cover from the baseboard heater in room [ROOM NUMBER]. Observations on August 8, 2024, at various times, revealed a floor tile missing by the bathroom door in room [ROOM NUMBER], the paint was scratched and marred behind bed 'D' in room [ROOM NUMBER], a tear in the linoleum floor at the foot of bed 'A,' and a white substance on the wall by the soap dispenser in room [ROOM NUMBER]. CFR 483.10(1)(iii) Clean, safe, comfortable environment Previously cited 9/7/2023 FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 6 of 20 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy, personnel file review, and staff interview, it was determined that the facility failed to provide abuse training upon hire as per facililty policy for one of five sampled employees. (Employee 3) Residents Affected - Few Findings include: Review of the facility policy entitled, Abuse Protection, last reviewed August 1, 2024, revealed that residents had the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, involuntary seclusion, neglect, and misappropriation of property. The facility was to have processes in place that included mandated staff training/orientation programs that included topics such as abuse prevention, identification, and reporting of abuse at the time of hire, annually, and as needed. Review of the personnel file for newly hired Employee 3, who was hired July 8, 2024, revealed that there was no documented evidence that the employee had abuse training or orientation upon hire. In an interview on August 9, 2024, at 12:55 p.m., the Administrator confirmed that there was no documented evidence that Employee 3 had received abuse training and orientation as per facility policy. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa Code 201.19 Personnel policies and procedures. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 7 of 20 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 0623 Level of Harm - Potential for minimal harm Residents Affected - Many Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Based on clinical record review and staff interview, it was determined that the facility failed to notify the resident and the resident's representative(s) of transfer(s), including the reasons for the moves, and Ombudsman information, in writing upon transfer from the facility for five of five sampled residents who were transferred to the hospital. (Residents 25, 30, 31, 33, 39) Findings include: Clinical record review revealed that Resident 25 was transferred to the hospital on February 15 and March 16, 2024, after a changes in condition. There was no documentation to support that the resident and/or the resident's responsible party or legal representative was provided written information regarding the transfers to the hospital. Clinical record review revealed that Resident 30 was transferred to the hospital on January 13, 2024, after a change in condition. There was no documentation to support that the resident and/or the resident's responsible party or legal representative was provided written information regarding the transfer to the hospital. Clinical record review revealed that Resident 31 was transferred to the hospital on April 14, 2023, after a change in condition. There was no documentation to support that the resident and/or the resident's responsible party or legal representative was provided written information regarding the transfer to the hospital. Clinical record review revealed that Resident 33 was transferred to the hospital on June 7, 2024, after a change in condition. There was no documentation to support that the resident and/or the resident's responsible party or legal representative was provided written information regarding the transfer to the hospital. Clinical record review revealed that Resident 39 was transferred to the hospital on May 16, 2024, after a change in condition. There was no documentation to support that the resident and/or the resident's responsible party or legal representative was provided written information regarding the transfer to the hospital. In an interview on August 8, 2024, at 10:49 a.m., the Administrator confirmed that notifications of transfers were not sent for these residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 8 of 20 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm Based on observation, policy review, and staff interview, it was determined that the facility failed to ensure that licensed nurses (a licensed practical nurse) maintained professional standards of quality care in the administration of medications set forth in the Pennsylvania Code Title 49, Professional and Vocational Standards for one of two medication carts. (West hall) Residents Affected - Some Findings include: Review of the facility policy entitled, Specific Medication Administration Procedures and eMAR Backup, last reviewed August 1, 2024, revealed that nurses were to use the Medication Administration Record (MAR) to verify medication and document when medications were administered. If the facility's electronic MAR (eMAR) was not functioning, staff was to print a paper MAR to ensure accurate administration and documentation of medications. On August 7, 2024, LPN2 was observed administering medication to the residents in the [NAME] hall. At that time, she stated that the eMAR was not working when she began her medication pass and she administered all the oral medications without using a backup paper MAR. LPN2 failed to demonstrate the provision of care as set forth under Title 49, Professional and Vocational Standards, Department of State, Section 21.145(b) Functions of the LPN of Title 49, Professional and Vocational Standards. 28 Pa. Code 211.10(c) Resident care policies. 28 Pa. Code 211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 9 of 20 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, clinical record review, facility policy review, and staff interview, it was determined that the facility failed to store respiratory equipment appropriately for one of 14 sampled residents. (Resident 12) Residents Affected - Few Findings include: Review of the facility policy entitled, Departmental (Respiratory Therapy) - Prevention of Infection, last reviewed August 1, 2024, revealed that medication nebulizers were to be stored in a plastic bag marked with the resident's name and date between uses. The tubing and medication administration equipment was to be discarded every seven days. Clinical record review revealed that Resident 12 had diagnoses that included asthma. On October 31, 2023, the physician ordered that staff administer an inhalation nebulization solution via a nebulizer two times a day. Observations on August 6, 2024, through August 9, 2024, at various times revealed Resident 12's nebulizer was unbagged in a basin with other items on the floor. In an interview on August 9, 2024, at 11:00 a.m., the Director of Nursing confirmed that nebulizers were to be stored in a plastic bag when not in use. 28 Pa. Code 211.12(d)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 10 of 20 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 clinical record review and staff interview, it was determined that the facility failed to ensure that the pharmacist's recommendations were acknowledged by the physician for one of 14 sampled residents. (Residents 12) Findings include: Clinical record review revealed that Resident 12 had diagnoses that included depression and insomnia. On November 1, 2023, the physician ordered that staff administer sertraline (an antidepressant) twice a day. On April 9, 2024, the pharmacist noted that Resident 12's sertraline was due for an assessment to see if the dose could be gradually reduced and if not a rationale was to be provided. There was no documented evidence that the physician responded to the pharmacist's recommendation. In an interview on August 9, 2024, at 11:15 a.m. the Director of Nursing confirmed that there was no documented evidence that the physician acknowledged the pharmacist's recommendation. CFR 483.45(c)(iii) Drug Regimen Review. Previously cited 9/7/23 28 Pa. Code 211.12(d)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 11 of 20 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 - Some 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 facility policy review and observation, it was determined that the facility failed to ensure that medications/biologicals were securely stored in one of two medication carts on the nursing unit. (East cart) Findings include: Review of the facility policy entitled, Storage of Medication, last reviewed August 1, 2024, revealed that the medications were to be stored securely and accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. Medication rooms, carts, and medication supplies were to be locked or attended by persons with authorized access. Observations on August 8, 2024, from 9:20 a.m. through 9:45 a.m. revealed the licensed nurse (LPN1) passing medications on the nursing unit. At various times throughout the observation LPN1 left the medication cart unlocked, unattended, and accessible to anyone in the vicinity. 28 Pa. Code 211.12(d)(1)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 12 of 20 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, and resident and staff interviews, it was determined that the facility failed to offer routine annual dental services and emergency dental care for one of 14 sampled residents. (Resident 25) Residents Affected - Few Findings include: Clinical record review revealed that Resident 25 was admitted to the facility on [DATE], with diagnoses that included diabetes mellitus, dysphagia (difficulty swallowing), and aphasia (difficulty communicating) following a stroke. Review of the Minimum Data Set assessment, dated May 3, 2024, revealed the resident was mildly cognitively impaired. On March 19, 2024, the physician ordered a dental evaluation and treatment for the resident. In an interview on August 6, 2024, at 11:14 a.m., Resident 25 stated that he had not been seen by a dentist while at the facility and would like a dental appointment. There was a lack of documentation to support that the resident received dental services as ordered. In an interview on August 8, 2024, at 11:35 a.m., the Administrator confirmed that no dental care had been provided for Resident 25. 28 Pa. Code 211.12(d)(3)(5) Nursing services. 28 Pa. Code 211.15 Dental services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 13 of 20 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 0801 Level of Harm - Minimal harm or potential for actual harm Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Based on staff interview, it was determined that the facility failed to employ a full-time qualified dietary services manager in the absence of a full-time qualified dietitian. Residents Affected - Many Findings include: During an interview on August 6, 2024, at 10:50 a.m., the Administrator stated that the facility did not employ a certified dietary manager. The Administrator also stated that there was not a full-time registered dietitian at the facility. There was no evidence that the facility employed a certified dietary manager in the absence of a full-time qualified dietitian. 28 Pa Code 201.18(e)(1)(6) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 14 of 20 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 0807 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration. Based on clinical record review, observations, and resident interview, it was determined that the facility failed to provide sufficient and fresh fluids consistent with resident needs and preferences for four of 14 sampled residents. (Residents 1, 8, 10, 12) Findings include: Clinical record review revealed that Resident 1 had diagnoses that included Alzheimer's disease and depression. Review of Resident 1's current care plan revealed that she was nutritionally at risk and that staff was to monitor for signs and symptoms of dehydration. On August 8, 2024, at 12:30 p.m., Resident 1 was observed in her room with a cup containing warm water dated 8/7 in front of her on her bedside table. Clinical record review revealed that Resident 8 had diagnoses that included dehydration and urine retention. Review of Resident 8's current care plan revealed that she was at risk for dehydration and urinary tract infections. An intervention was for staff to promote and encourage fluid consumption. On August 8, 2024, at 12:35 p.m., Resident 8 was observed in her room with a cup containing warm water dated 8/7 in front of her on her bedside table. Clinical record review revealed that Resident 10 had diagnoses that included heart failure and anxiety. Review of Resident 10's current care plan revealed that she had the potential for fluid deficit and an intervention was to have ice water at her bedside. On August 8, 2024, at 12:25 p.m., Resident 10 was observed in her room with a cup containing warm water dated 8/7 in front of her on her bedside table. In a interview at that time, Resident 10 stated that she had not received any fresh water for the day and that she frequently did not receive fresh water. Clinical record review revealed that Resident 12 had diagnoses that included hypertension and depression. Review of Resident 12's current care plan revealed that she was at risk for constipation and an intervention was to increase her fluid intake. On August 8, 2024, at 12:15 p.m., Resident 12 stated that she had not received fresh water for the day and that she frequently did not receive fresh water. Resident 12 had a cup on her nightstand that contained warm water. 28 Pa. Code 211.12 (d)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 15 of 20 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. Based on clinical record review, observation, and resident and staff interview, it was determined that the facility failed to provide therapeutic diets as ordered by the physician for two of 14 sampled residents. (Residents 8, 12) Findings include: Clinical record review revealed that Resident 8 had diagnoses that included dysphagia and hypertension. A physician's order dated March 11, 2023, directed staff to provide a mechanical soft diet. Review of the care plan revealed that the resident received a mechanically altered diet. Review of a speech therapy evaluation dated July 1, 2024, revealed that the resident received a mechanical soft chopped meat and ground texture diet. Observation on August 8, 2024, at 12:20 p.m., revealed that the resident was served Salisbury steak, mashed potatoes, and California blend vegetables. The Salisbury steak was in a whole patty form. Review of the Resident 12's meal ticket revealed that she was to receive ground Salisbury steak. In an interview on August 8, 2024, at 12:40 p.m. the speech therapist stated that Resident 12 should have received the Salisbury steak ground into small pieces. Clinical record review revealed that Resident 12 had diagnoses that included celiac disease. A physician's order dated April 10, 2024, directed staff to provide a regular diet with an allergy to wheat. On August 6, 2024, at 12:25 p.m., Resident 6 was served pork with gravy covering the pork. Review of the resident's meal ticket revealed that she had a wheat allergy, and that a substitution was needed for the main entree. In an interview at that time, Resident 12 stated that she frequently received foods that contain wheat with her meals. In an interview on August 6, 2024, at 12:45 p.m. Employee 3 stated that he had only made one type of gravy for the lunch meal. Observation of the gravy packet used at that time revealed that it contained wheat. 28 Pa Code: 201.14(a) Responsibility of licensee. 28 Pa Code: 211.12(d)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 16 of 20 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review and observation, it was determined that the facility failed to provide adaptive equipment to assist with eating meals for one of 14 sampled residents. (Resident 12) Residents Affected - Few Findings include: Clinical record review revealed that Resident 12 had diagnoses that included tremors and depression. On April 10, 2024, the physician ordered for staff to provide a plate guard with all meals. The care plan indicated that the resident was at nutrition risk and staff was to provide a plate guard with all meals. On August 6, 2024, August 7, 2024, and August 8, 2024, from 12:15 p.m. through 12:30 p.m. Resident 12 was observed eating her lunch in her room. She did not have a plate guard. In an interview on August 6, 2024, at 12:20 p.m. Resident 12 stated that the plate guard helped her with self-feeding and that she rarely received it. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 17 of 20 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and review of facility policy, it was determined that the facility failed to store food under sanitary conditions in the kitchen. Residents Affected - Many Findings include: Review of the facility policy entitled, Food Storage, last reviewed August 1, 2024, revealed that food storage areas should be maintained in a clean, safe, and sanitary manner. Observation of the kitchen during a tour on August 6, 2024, at 9:30 a.m., revealed a container of sugar with a plastic cup stored inside the container, directly touching the sugar in the dry storage area. In refrigerator 1 there were four heads of lettuce in a bag dated July 17, 2024, that were turning brown and an opened, undated container of ice cream with a soiled spoon next to it. The walk-in freezer contained a large accumulation of ice buildup that was covering food items and there was trash on the floor. CFR 483.60 Food Procurement Store/Prepare/Serve-Sanitary. Previously cited 9/3/23 28 Pa. Code 201.18(b)(3) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 18 of 20 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 0868 Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Level of Harm - Potential for minimal harm Based on facility documentation review and staff interview, it was determined that the facility Quality Assurance and Performance Improvement (QAPI) committee failed to meet at least quarterly. Additionally, the facility failed to ensure that all required staff persons were in attendance at quarterly QAPI committee meetings for four of four quarters reviewed. Residents Affected - Many Findings include: A review of QAPI committee meeting minutes revealed that the committee met only twice between July 2023, and August 2024, and did not meet quarterly. According to the QAPI committee minutes, the Infection Preventionist was not present for any meetings. In an interview on August 9, 2024, at 9:30 a.m., the Administrator confirmed there were only two QAPI meetings in the previous calendar year and that there no Infection Preventionist was present. 28 Pa. Code 201.18(e)(1)(2)(3) Management. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 19 of 20 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 395506 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Palmyra 341 North Railroad St Palmyra, PA 17078 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 0882 Level of Harm - Minimal harm or potential for actual harm Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. Based on policy review and staff interview, it was determined that the facility did not have a credentialed Infection Preventionist (IP). Residents Affected - Many Findings include: Review of the facility policy entitled, Infection Control, last reviewed August 1, 2024, revealed that the facility staff was to report all infections to the IP, who would then conduct routine surveillance. In an interview on August 6, 2024, at 9:47 a.m., the Director of Nursing stated that the facility had no staff that were credentialed infection preventionists. 28 Pa. Code 211.10(d) Resident care policies. 28 Pa. Code 211.12 (d)(1)(3)(5) Nursing services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395506 If continuation sheet Page 20 of 20

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Citations

20 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0565GeneralS&S Bno actual harm
F565 - The resident has a right to organize and participate in resident groups in the
Honor the resident's right to organize and participate in resident/family groups in the facility.
0550GeneralS&S Epotential for harm
F550 - Resident Rights
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
0574GeneralS&S Cno actual harm
F574 - The resident has the right to receive notices orally (meaning spoken) and in
The resident has the right to receive notices in a format and a language he or she understands.
0577GeneralS&S Cno actual harm
F577 - The resident has the right to-
Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.
0583GeneralS&S Bno actual harm
F583 - Privacy and Confidentiality
Keep residents' personal and medical records private and confidential.
0584GeneralS&S Epotential for harm
F584 - Safe Environment
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.
0607GeneralS&S Dpotential for harm
F607 - The facility must develop and implement written policies and procedures that:
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
0623GeneralS&S Cno actual harm
F623 - Transfer and discharge-
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
0658GeneralS&S Epotential for harm
F658 - Comprehensive Care Plans
Ensure services provided by the nursing facility meet professional standards of quality.
0695GeneralS&S Dpotential for harm
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
0756GeneralS&S Dpotential for harm
F756 - Drug Regimen Review
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
0761GeneralS&S Epotential for harm
F761 - Labeling of Drugs and Biologicals
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.
0791GeneralS&S Dpotential for harm
F791 - Dental Services
Provide or obtain dental services for each resident.
0801GeneralS&S Fpotential for harm
F801 - Staffing
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
0807GeneralS&S Dpotential for harm
F807 - Food and drink
Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration.
0808GeneralS&S Dpotential for harm
F808 - Therapeutic Diets
Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.
0810GeneralS&S Dpotential for harm
F810 - Assistive devices
Provide special eating equipment and utensils for residents who need them and appropriate assistance.
0812GeneralS&S Fpotential for harm
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
0868GeneralS&S Cno actual harm
F868 - Quality assessment and assurance
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
0882GeneralS&S Fpotential for harm
F882 - Infection preventionist
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.

FAQ · About this visit

Common questions about this visit

What happened during the August 9, 2024 survey of KADIMA REHABILITATION & NURSING AT PALMYRA?

This was a inspection survey of KADIMA REHABILITATION & NURSING AT PALMYRA on August 9, 2024. The surveyor cited 20 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at KADIMA REHABILITATION & NURSING AT PALMYRA on August 9, 2024?

Yes, 20 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to organize and participate in resident/family groups in the facility."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.

Data from CMS Care Compare public records. Dataset last refreshed June 22, 2026. If you believe any information is inaccurate, report it here.

Health inspection·August 9, 2024