Inspection visit
Health inspection
4 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 4 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited
to receiving treatment and supports for daily living safely.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, it was determined that the facility failed to provide a safe, clean, and comfortable environment
on one of one nursing units.
Findings include:
On April 17, 2025, from 10:00 a.m. to 3:25 p.m., the following was observed:
The right-side swinging glass door of the facility front door is did not open.
In the dining room, the interior entrance door handle and windows were dirty with a white substance. There
was garbage on the floor under the dining room exterior windows.
There was a reddish stain on the door frame of the linen closet across from the nurse station.
In the hallway, there was damage on the wall's wallboard and wallpaper at rooms 1, 3, 8, 24, 27, and 30.
In room [ROOM NUMBER], the floor was sticky with a black residue between the door and A bed. There
was a urine smell.
In room [ROOM NUMBER], the floor was sticky with a black residue between the door and the bed.
In room [ROOM NUMBER], there was a damaged spot on the wall behind the A bed.
In room [ROOM NUMBER], the floor was sticky around the resident's bed. There was dust in the room's
corners.
In room [ROOM NUMBER], there was garbage under the heater.
In room [ROOM NUMBER], the floor was sticky with a black residue around both residents' beds and along
the interior walls.
CFR: 483.10(i) Safe, Clean, Comfortable, and Homelike Environment.
Previously cited 7/18/24 and 8/28/24
(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 5
Event ID:
395846
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
395846
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/17/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Kadima Rehabilitation & Nursing at Campbelltown
2880 Horseshoe Pike
Palmyra, PA 17078
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 0584
28 Pa. Code 201.18(b)(1)(e)(2.1) Management.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395846
If continuation sheet
Page 2 of 5
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
395846
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/17/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Kadima Rehabilitation & Nursing at Campbelltown
2880 Horseshoe Pike
Palmyra, PA 17078
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 0609
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper
authorities.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
facility policy review, facility documentation, clinical record review, resident interview, and staff interview, it
was determined that the facility failed to immediately report an allegation of abuse or injury of unknown
origin to the Administrator/Abuse Prevention Coordinator of the facility and the State Survey Agency for one
of six sampled residents. (Resident 6)
Findings include:
Review of the facility policy, Abuse Reporting and Investigation, last reviewed November 9, 2024, revealed
that all suspected or alleged incidents of abuse, neglect, or exploitation would be reported to the
Administrator immediately. The State Agency would be notified of the alleged or actual event of abuse
within two hours.
Clinical record review revealed that Resident 6 had diagnoses that included Parkinsonism. The Minimum
Data Set assessment dated [DATE], indicated that the resident was not cognitively impaired and needed
substantial/maximal staff assistance with showering or bathing. Resident 6 stated in an interview on April
17, 2025, at 11:10 a.m., that she had reported to nursing staff that on March 28, 2025, two nurse aides
treated her in an abusive and humiliating manner during her shower by forcefully removing her clothing,
shoving her under first cold, then hot water, and roughly scrubbing her while making derogatory remarks
about her skin. Review of facility documentation revealed that Resident 6 reported the incident in writing on
April 1, 2025. There was no documented evidence that facility staff reported the allegation to the
Administrator as required. There was no evidence that the facility reported the incident to the State Survey
Agency.
In an interview on April 17, 2025, at 2:21 p.m., the Administrator confirmed that there was no evidence the
incident alleged by Resident 6 was reported as required.
28 Pa. Code 201.18(e)(1) Management.
28 Pa. Code 211.10(d) Resident care policies.
28 Pa. Code 211.12(d)(1)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395846
If continuation sheet
Page 3 of 5
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
395846
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/17/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Kadima Rehabilitation & Nursing at Campbelltown
2880 Horseshoe Pike
Palmyra, PA 17078
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 0610
Respond appropriately to all alleged violations.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
facility policy review, clinical record review, review of facility documentation, resident interview, and staff
interview, it was determined that the facility failed to thoroughly investigate an allegation of abuse for one of
six sampled residents. (Resident 6)
Residents Affected - Few
Findings include:
Review of the facility policy, Abuse Reporting and Investigation, last reviewed November 9, 2024, revealed
that all suspected or alleged incidents of abuse, neglect, or exploitation would be investigated.
Clinical record review revealed that Resident 6 had diagnoses that included Parkinsonism. The Minimum
Data Set assessment dated [DATE], indicated that the resident was not cognitively impaired and needed
substantial/maximal staff assistance with showering or bathing. In an interview on April 17, 2025, at 11:10
a.m Resident 6 reported that on March 28, 2025, two aides treated her in an abusive and humiliating
manner during her shower by forcefully removing her clothing, shoving her under first cold, then hot water,
and roughly scrubbing her while making derogatory remarks about her skin. Resident 6 stated she reported
the incident verbally on March 28th to facility staff. Review of facility documentation revealed that Resident
6 also reported the incident in writing on April 1, 2025.
There was no documented evidence that the facility completed an investigation of Resident 6's allegation of
abuse. In an interview on April 17, 2025, at 2:21 p.m., the Administrator confirmed that there was no
evidence of an investigation.
28 Pa. Code 211.10(d) Resident care policies.
28 Pa. Code 211.12(d)(1)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395846
If continuation sheet
Page 4 of 5
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
395846
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/17/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Kadima Rehabilitation & Nursing at Campbelltown
2880 Horseshoe Pike
Palmyra, PA 17078
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 0740
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure each resident must receive and the facility must provide necessary behavioral health care and
services.
Based on clinical record review, resident interview, and staff interview, it was determined that the facility
failed to provide behavioral health services for one of three sampled residents with mood and behavior
concerns. (Resident 6)
Findings include:
Clinical record review revealed that Resident 6 had diagnoses that included schizoaffective disorder,
borderline personality disorder, intermittent explosive disorder, and anxiety disorder. Review of the care
plan dated January 21, 2025, revealed the resident had a history of mood problems and used anti-anxiety
and anti-depressant medications. The interventions included notification of the resident's physician of mood
changes and behavioral problems and referral to behavioral health services as needed. On March 25,
2025, the psychiatric nurse practitioner recommended referral to outpatient mental health therapy for
increased anxiety. On April 3, 2025, notes indicated the resident had requested referral to outpatient
therapy for increased anxiety. There was no evidence that staff notified the resident's physician of the
alteration in the resident's mood or of the referral recommendation.
In an interview on April 17, 2025 at 11:10 a.m., the resident stated that her anxiety had been increasing
and she had requested a referral to outpatient therapy.
In an interview on April 17, 2025, at 2:55 p.m., the Director of Nursing confirmed that there had been no
referral to outpatient mental health therapy as requested by Resident 6 and the psychiatric nurse
practitioner.
28 Pa. Code 201.14(a) Responsibility of licensee.
28 Pa. Code 211.12(d)(1)(5) Nursing services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395846
If continuation sheet
Page 5 of 5
Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.
Back to topCitations
4 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F584 - Safe Environment
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
F609 - The facility must develop and implement written policies and procedures that:
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
F610 - In response to allegations of abuse, neglect, exploitation, or mistreatment, the
Respond appropriately to all alleged violations.
F740 - Behavioral health services
Ensure each resident must receive and the facility must provide necessary behavioral health care and services.
FAQ · About this visit
Common questions about this visit
What happened during the April 17, 2025 survey of KADIMA REHABILITATION & NURSING AT CAMPBELLTOWN?
This was a inspection survey of KADIMA REHABILITATION & NURSING AT CAMPBELLTOWN on April 17, 2025. The surveyor cited 4 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at KADIMA REHABILITATION & NURSING AT CAMPBELLTOWN on April 17, 2025?
Yes, 4 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receivin..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.