Inspection·November 14, 2024

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 review of facility policy, observations and staff interviews it was determined that the facility failed to provide a clean, safe, comfortable, and homelike environment by maintaining an acceptable temperature range throughout resident areas for 32 resident rooms on three of three units (First, Second, and Third Floor). Findings Include: Review of the facility policy Resident Environment dated 7/1/24, indicated the facility will provide an environment that is safe, clean, comfortable, and homelike. A homelike environment de-emphasizes the institutional character of the setting. Review of the facility policy Temperature Extremes dated 7/1/24, indicated the facility is to provide comfortable and safe temperature levels. The temperature throughout the facility shall be maintained at between 70 degrees and 82 degrees Fahrenheit (F). Review of Title 42 Code of Federal Regulations 483.10(i)(6) Comfortable and safe temperature levels. Facilities initially certified after October 1, 1990, must maintain a temperature range of 71 to 81 degrees F (Fahrenheit). Review of facility provided temperature log dated 11/11/24, indicated 32 resident rooms were below the minimum acceptable temperature of 71 - 81 degrees. First floor five resident rooms: 101, 102, 103, 104, and 110. Second floor eight resident rooms: 204, 208, 209, 214, 215, 218, 219, and 221. Third floor 19 resident rooms: 301, 303, 304, 305, 306, 307, 308, 309, 310, 311, 312, 314, 316, 317, 318, 319, 320, 321, and 326. Interview on 11/14/24, at 8:45 a.m. Maintenance Director Employee E1 indicated the circulatory pump on the main boiler was leaking and ultimately failed on 11/11/24. Facility tour on 11/14/24, at 8:45 a.m. with Maintenance Director Employee E1 indicated the following: Temperature was 67 degrees F in the first-floor dining room. (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 2 Event ID: 395538 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 395538 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Cheswick 3876 Saxonburg Boulevard Cheswick, PA 15024 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)