Inspection·July 30, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to timely notify hospice of a change in condition for one of six residents reviewed (Resident 1). Residents Affected - Few Findings Include: Review of facility policy, titled Notification of Changes, revised August 29, 2023, revealed, The facility must inform the resident, consult with the resident's physician and/or notify the resident's family member or legal representative when there is a change requiring such notification. Circumstances requiring notification include: .Significant change in the resident's physical, mental or psychosocial condition such as deterioration in health, mental or psychosocial status. Review of the facility's hospice contract with Resident 1's hospice provider, most recently dated August 26, 2013, revealed Facility shall immediately notify Hospice when: a. A significant change in a patient's physical, mental, social or emotional status occurs. b. Clinical complications appear that suggest the need to alter the plan of care. The contract also stated, in part, to ensure that the needs of the patient are addressed and met 24 hours per day. Review of Resident 1's clinical record revealed diagnoses that included acute respiratory failure with hypoxia (when the lungs can't get enough oxygen into the blood) and diffuse large B-cell lymphoma (a type of cancer). Further review of Resident 1's clinical record revealed that she was admitted to hospice on July 11, 2024, with a primary diagnosis of interstitial pulmonary disease (an umbrella term used for a large group of diseases that cause scarring of the lungs. The scarring causes stiffness in the lungs which makes it difficult to breathe and get oxygen to the bloodstream). Review of Resident 1's physician orders revealed an order dated June 27, 2024, for oxygen at 5 L (liters) via nasal cannula. Review of Resident 1's nursing progress note dated July 21, 2024, at 11:43 PM, revealed that at around 9:00 PM, Resident 1's oxygen saturation was 86% on 5 L of oxygen via nasal cannula. RN (registered nurse) assessment revealed the Resident was laying in her bed with her eyes closed, with oxygen saturation 48% on 5 L of oxygen. Resident 1 denied shortness of breath, pain, or discomfort. Resident 1 received as needed morphine for comfort. Review of Resident 1's Medication Administration Record (MAR) dated July 2024, revealed that (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: 395784 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 395784 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Letort Spring Nursing and Rehab LLC 801 N. Hanover Street Carlisle, PA 17013 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)