Health inspection·March 4, 2025

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, policy review, and staff interviews, it was determined that the facility failed to maintain an infection prevention and control program designed to provide a safe and sanitary environment and to help prevent the transmission of diseases and infections for two of two resident rooms observed (Residents 1 and 2). Residents Affected - Few Findings Include: An entrance interview with the Director of Nursing (DON) and Nursing Home Administrator (NHA) on March 4, 2025, at approximately 8:50 AM, revealed the facility has several residents who tested positive for COVID-19, and the facility is following its COVID-19 infection policy and procedures. Visitors are encouraged to wear surgical masks and screen for signs and symptoms of infection while in the building, and staff providing direct care to those infected residents to wear the required personal protective equipment (PPE). A review of the facility's policy, titled Covid-19 Infection Control Protocols to Minimize Expose, updated February 2024, revealed residents/resident rooms with Covid-19 exposure and positive tests will require staff to don the following PPE: N95 or equivalent respirator, Face shield or goggles, gloves, and gown. An observation of Resident 1's room on March 4, 2025, at approximately 9:00 AM, revealed signage at the door that alerted staff and visitors of droplet precautions (Droplet precautions are used when a patient has an infection that can spread through the air when they cough, sneeze, or talk) and directed anyone entering the room to don the required PPE. The observation revealed the Physical Therapist (Employee 4) providing direct care services to Resident 1 without wearing any of the required PPE. An interview with the Registered Nurse/Infection Preventionist on March 4, 2025, at 9:25 AM, revealed Employee 4 should not be in Resident 1's room without the required PPE. An observation of Resident 2's room on March 4, 2025, at 9:44 AM, revealed signage at the door that alerted staff and visitors of droplet precautions and directed anyone entering the room to don the required PPE. The observation revealed Employee 4 providing direct care services to Resident 2 without wearing any of the required PPE. Interviews with the DON and NHA on March 4, 2025, at 10:02 AM, confirmed Employee 4 had been (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: 395844 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 395844 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elizabethtown Nursing and Rehabilitation 141 Heisey Avenue Elizabethtown, PA 17022 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)