Inspection·November 25, 2024

F 0600 confirmed it was the facility's expectation that residents are free of abuse. Level of Harm - Minimal harm or potential for actual harm 28 Pa code 201.18(b)(1)(2)(3) Management Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395784 If continuation sheet Page 2 of 6 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 11/25/2024 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)

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 on clinical record review, staff interviews, and facility document review, it was determined that the facility failed to provide care and services in accordance with professional standards of practice for one of 18 residents reviewed for skin issues (Resident 18). Residents Affected - Few Findings include: Review of Resident 18's clinical record revealed diagnoses that included dementia (irreversible, progressive degenerative brain disease that results in decreased contact with reality and decreased ability to perform activities of daily living) and hypertension (elevated/high blood pressure). Further, review of Resident 18's clinical record revealed that on October 15, 2024, a physician communication form stated, Resident [18's] family [complaint of] rash like areas on [right] arm. The physician responded with an order for hydrocortisone cream 1% twice a day as needed. At 4:00 PM, a interdisciplinary note was entered which stated, POA [Power of Attorney] (son) made aware of new order for hydrocortisone cream [due to] [bilateral upper extremity] rash. POA voiced concern for possible need bath soap change. Resident may benefit from dove soap. Review of Resident 18's clinical record revealed no assessment of the rash to Resident 18's right arm which provided possible characteristics of the rash (size, presentation, area). During interview on November 19, 2024, at approximately 1:15 PM, Director of Nursing confirmed that there was no assessment of Resident 18's rash. During a staff interview on November 19, 2024, at approximately 3:10 PM, Nursing Home Administrator revealed it was the facility's expectation that Resident 18's rash would have been assessed when identified. 28 Pa code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395784 If continuation sheet Page 3 of 6 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 11/25/2024 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)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, review of Centers for Disease Control and Prevention guidance, facility documentation review, and staff interviews, it was determined that the facility failed to implement infection control practices to prevent or limit the spread of infectious disease for 13 of 17 residents reviewed for skin conditions (Residents 2, 4, 5, 7, 8, 9, 10, 11, 13, 14, 15, 16, and 17). Residents Affected - Some Findings include: Review of the Centers for Disease Control and Prevention (CDC) guidance, titled Public Health Strategies for Scabies Outbreaks in Institutional Settings, dated December 18, 2023, revealed the guidance stated: Prevention: Early detection, treatment, and implementation of appropriate isolation and infection control practices are essential in preventing scabies outbreaks. Institutions should maintain a high index of suspicion that undiagnosed skin rashes and conditions may be scabies, even if characteristic signs or symptoms of scabies are absent (e.g. no itching). New patients/residents and employees should be screened carefully and evaluated for any skin conditions that could be compatible with scabies. The onset of scabies in a staff person who has had scabies before can be an early warning sign of undetected scabies in a patient/resident. When there is concern for scabies in a person, skin scrapings should be obtained and examined carefully by a person who is trained and experienced in identifying scabies mites. Appropriate isolation and infection control practices (e.g., gloves, gowns, avoidance of direct skin-to-skin contact, etc.) should be used when providing hands-on care to patients/residents who might have scabies. Epidemiologic and clinical information about patients/residents with confirmed and suspected scabies should be collected and used for systematic review in order to facilitate early identification of and response to potential outbreaks. Surveillance: Establish surveillance. Have an active program for early detection of infested patients/residents and staff. Maintain a high index of suspicion that scabies may be the cause of undiagnosed skin rash; evaluate and confirm suspected cases by obtaining skin scrapings . Diagnostic Services: Ensure that adequate diagnostic services are available. Consult with an experienced dermatologist for assistance in differentiating between skin rashes and scabies. During a staff interview on November 19, 2024, at approximately 12:30 PM, Director of Nursing (DON) revealed the facility did not have a specific policy or procedure for scabies and that the facility would follow the CDC guidance for a scabies outbreak. Review of available facility documentation revealed that the facility had identified an increase in skin rashes in the facility population since approximately December 2023. Review of the documentation revealed 23 residents were monitored for skin rashes. Of those 23 residents that were included in the facility monitoring, 16 were still living in the facility with continued rashes at the time of the onsite survey on November 18, 2024, and confirmed by the DON via an electronic communication on November 19, 2024, at 2:14 PM. Review of the documentation for the 16 residents still residing in the facility, revealed rashes were identified on the following dates: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395784 If continuation sheet Page 4 of 6 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 11/25/2024 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)

F 0880 Resident 2, July 21, 2023 Level of Harm - Minimal harm or potential for actual harm Resident 3, May 7, 2024 Resident 4, October 11, 2024 Residents Affected - Some Resident 5, September 4, 2024 Resident 6, December 24, 2023 Resident 7, May 26, 2024 Resident 8, August 14, 2024 Resident 9, October 24, 2024 Resident 10, November 2, 2024 Resident 11, October 21, 2024 Resident 13, September 28, 2024 Resident 14, March 26, 2024 Resident 15, August 5, 2024 Resident 16, March 23, 2024 Resident 17, June 26, 2024 Based on review of clinical records, Resident 18 was identified as having complaints of a rash that was communicated to the physician, but no assessment or tracking of the skin condition was implemented. Resident 3 had developed a rash on May 7, 2024. Review of the facility documentation revealed that between May 7, 2024, and November 7, 2024, Resident 3 had been treated multiple times for the rash and had multiple medications, oral and topical (on skin) ordered to treat the rash and itching. However, Resident 3's rash persisted and results of a skin scrape (scraping of the skin observed under a microscope in an attempt to confirm scabies infection) conducted by consultant dermatologist on November 7, 2024, confirmed the presence of scabies (contagious skin condition caused by parasites that borrow into the skin) eggs and mites. During an interview with DON on November 18, 2024, at approximately 1:20 PM, DON confirmed that the only residents who was on contact precautions for scabies was Resident 3 and Resident 6, who shared the room with Resident 3. Resident 6 was being monitored for a rash that was first identified December 24, 2023. During the interview, DON confirmed that no skin scrapes had been conducted for any other residents that presented with rashes and, at that time, the facility did not have the means to collect skin (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395784 If continuation sheet Page 5 of 6 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 11/25/2024 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)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some scrapes of rashes. DON also revealed that no skin scrapes had been conducted on residents with rashes prior to Resident 3's skin scrape on November 7, 2024. As of November 18, 2024, the facility failed to implement isolation and infection control practices for Residents 2, 4, 5, 7, 8, 9, 10, 11, 13, 14, 15, 16, and 17 for undiagnosed rashes after a confirmed case of scabies in the facility. Further, at that time the facility had not secured testing via skin scrapes for residents who present with a rash. During a staff interview on November 19, 2024, at approximately 3:10 PM, Nursing Home Administrator revealed it was the facility's expectation that the facility follow the CDC's guidelines after scabies have been identified in the building. 28 Pa code 201.18(b)(1)(3) Management 28 Pa code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 395784 If continuation sheet Page 6 of 6