Health inspection·June 7, 2024

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 upon review of the clinical record and facility documentation, it was determined the facility failed to follow physician orders for one of twelve residents reviewed (Resident 28). Residents Affected - Few Findings include: Review of Resident 28's physician orders revealed an order dated February 29, 2024, for Dermal sleeves [worn to protect skin] to bilateral lower extremities for protection. Remove to assess skin. May remove for care/showers then reapply. Review of Resident 28's active plan of care revealed tubigrips [sleeves worn to protect skin] to bilateral legs at all times. Review of documentation dated March 1, 2024, revealed Resident acquired a skin tear to right lower leg measuring 9 cm [centimeters] x 4 cm with adipose tissue exposed. Sanguineous drainage was noted. Resident c/o [complained of] pain upon dressing change but denied pain after. The resident did not have tubigrips during transfers. Resident has an order for dermal sleeves to BLE [bilateral lower extremities] to be worn for protection. Review of [community wound specialist] wound evaluation dated March 6, 2024, revealed 9.4 cm x 3.9 cm x 0.1 cm right lower lateral leg skin tear. Interview with the Director of Nursing and Nursing Home Administrator on June 7, 2024, at 11:00 a.m. confirmed Resident 28 was not wearing tubigrips as ordered by the physician on the lower extremities during the transfer. 28 Pa. Code 211.12(d)(1)(3) Nursing Services Previously cited 8/31/2023 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 4 Event ID: 395590 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 395590 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at Lititz 125 South Broad Street Lititz, PA 17543 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)