Health inspection·January 7, 2025

F 0570 Assure the security of all personal funds of residents deposited with the facility. Level of Harm - Minimal harm or potential for actual harm Based on a review of facility policies, documents and staff interviews it was determined that the facility failed to secure a surety bond on behalf of the residents of the facility that assured the security of all personal funds of residents deposited with the facility for three months 11/24, 12/24, and 1/25 as required. (11/24, 12/24, and 1/25) Residents Affected - Many Finding include: A review of facility Surety Bond policy dated 7/1/24, indicated that a surety bond is purchased on behalf of the residents by the facility to protect the financial security of resident's funds deposited in a resident trust account. The facility evaluates the value of the bond annually to make certain that sufficient coverage is maintained. A review of the facility's Resident Trust Surety Bond effective 11/1/24, revealed that the bond's value at $193,915.84, A review of the Facillity Trial Balance (a document providing evidence of each resident's current balance held by the facility) date 1/7/25, indicated the value of funds held by the facility at $252,107.96 During an interview on 1/7/25, at 1:00 pm the Nursing Home Administrator confirmed that the amount of the facility's surety bond failed to protect all resident financial funds deposited in the facility Reisdent Trust Fund as required. PA Code: 201.18(e)(1) Management 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 01/07/2025 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)