Inspection·October 11, 2024

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, clinical records, and staff interviews, it was determined that the facility failed to make certain call bells were in reach for three of eight residents as required (Resident R30, Resident R35, and Resident R36). Residents Affected - Few Findings include: The facility policy Call Light Response dated 2/22/24, indicated a call bell or alternative device will be placed within the reach of each resident while in their room, toilet, or bathing area. Review of Resident R30's clinical record indicated admission to the facility on 4/25/24. Review of Resident R30's Minimum Data Set (MDS - a periodic assessment of care needs) dated 5/1/24, indicated diagnoses of hypertension (high blood pressure) hyperlipidemia (high fats in the blood) and schizophrenia (a serious mental illness that affects how a person thinks, feels, and behaves). During an interview on 10/8/24, at 10:30 a.m. Resident R30's was laying in his bed, his call light button was on the floor. When Resident R30 was asked what he would do if he needed help, he stated I don't know, I don't know where my call bell is. During an interview on 10/8/24, at 10:45 a.m. Registered Nurse (RN) Employee E1 confirmed the call bell was on the floor and not accessible for Residents R30's use. Review of admission record indicated Resident R35 admitted to the facility on [DATE]. Review of Resident R35's Minimum Data Set (MDS- a periodic assessment of care needs) dated 2/3/24, indicated the diagnoses of hemiplegia of left dominant side (paralysis of left side), following a stroke and depression (mood disorder affecting how one feels, thinks, and handles daily activities). During an interview on 10/8/24, at 10:48 a.m. Resident R35's was laying in her bed, her call light button was on the floor and not accessible. During an interview on 10/8/24, at 11:08 a.m. Graduate Practical Nurse (GPN) Employee E2 confirmed that Resident R35's call bell was not accessible. Review of admission record indicated Resident R36 admitted to the facility on [DATE]. Review of Resident R36's Minimum Data Set (MDS- a periodic assessment of care needs) dated 2/3/24, (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 9 Event ID: 396073 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 396073 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kadima Rehabilitation & Nursing at North Strabane 100 Tandem Village Road Canonsburg, PA 15317 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)