Inspection visit

Health inspectionFebruary 22, 2024

FOX SUBACUTE AT MECHANICSBURGCMS #39612216 citations on this visit

16 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 16 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0606 Not hire anyone with a finding of abuse, neglect, exploitation, or theft. Level of Harm - Minimal harm or potential for actual harm Based on facility policy review, personnel file review, and staff interview, it was determined that the facility failed to ensure that residents were protected from the potential for abuse by failing to preform criminal history background checks prior to hire for one of five personnel files reviewed (Employee 14); and failed to verify the standing of professional licenses and/or nurse aide registry enrollment prior to hire for five of five personnel files reviewed (Director of Nursing [DON] and Employees 13, 14, 15, and 16). Residents Affected - Some Findings include: Review of facility policy, titled Abuse Reporting, with an update of November 28, 2018, revealed, .criminal history background checks shall be performed on all newly hired employees seeking employment and monthly thereafter. In addition, the Nurse Aid Registry and appropriate state licensing boards shall be contacted for verification of status of every applicant seeking licensed position . Review of the Director of Nursing's (DON) personnel file revealed their nursing license verification was completed February 2, 2024, which was after her date of hire of February 1, 2024. Review of the personnel file for Employee 13 (Registered Nurse) revealed their nursing license verification was completed February 22, 2024, which was after her date of hire of February 12, 2024. Review of the personnel file for Employee 14 (Registered Nurse) revealed their nursing license verification was completed February 2, 2024, which was after his date of hire of February 1, 2024. Further review of Employee 14's personnel file revealed that, at the time of hire, Employee 14 had not been a resident of Pennsylvania for two consecutive years. There was no evidence a Federal Bureau of Investigation (FBI) background check was conducted for Employee 14 prior to hire or starting at the facility. Review of the personnel file for Employee 15 (Registered Nurse) revealed their nursing license verification was completed February 5, 2024, which was after her date of hire of November 9, 2023. Review of the personnel file for Employee 16 (Nurse Aide) revealed their nurse aide registry verification was completed February 22, 2024, which was after his date of hire of February 1, 2024. During a staff interview with the DON and Nursing Home Administrator (NHA) on February 22, 2024, at approximately 1:30 PM, it was confirmed the facility failed to conduct a FBI background check for Employee 14. The NHA stated it is the expectation of the facility that professional licenses and/or nurse aide registry verifications and background checks are completed prior to hire. (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 26 Event ID: 396122 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0606 28 Pa code 201.14(a) Responsibility of licensee Level of Harm - Minimal harm or potential for actual harm 28 Pa. Code 201.18 (b)(1)(e)(1) Management 28 Pa. Code 201.19 (3)(8) Personnel policies and procedures Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 2 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and staff interviews, it was determined that the facility failed to ensure that the resident assessment accurately reflected the resident's status for four of 15 residents reviewed (Residents 10, 12, 18, and 50). Residents Affected - Some Findings include: Review of Resident 10's clinical record on February 20, 2024, at 12:14 PM, revealed diagnoses that included pressure ulcer of right buttock stage four (wound that extends deep into tissues including muscle, tendons, and ligaments) and chronic respiratory failure (lungs ineffectively exchange carbon dioxide and oxygen). Review of Resident 10's quarterly minimum data sets (MDS -mandated assessment tool utilized to identify a resident's physical, mental, and psychosocial needs), with dates of March 29, 2023; August 7, 2023; and November 30, 2023, revealed section I1700 was coded no for MDRO (multi drug resistant organism). During a staff interview on February 22, 2024, at 11:29 AM, with Employee 2 (Infection prevention nurse) it was revealed Resident 10 has a long history of multiple MRDO infections dating back to 2019. During an additional staff interview on February 22, 2024, at 12:10 PM, with the Director of Nursing (DON) in the presence of the Nursing Home Administrator (NHA) it was revealed that Resident 10's quarterly MDSs were coded incorrectly, and it was the expectation of the facility that MDS assessment be accurate. Review of Resident 12's clinical record on February 21, 2024, at 12:38 PM, revealed diagnoses that included pressure ulcer of other site unstageable (an ulcer that has full thickness tissue loss but is either covered by extensive necrotic tissue or by an eschar) and candidiasis (fungal infection caused by a yeast). Review of Resident 12's current physician orders revealed lifetime contact precautions related to MDR candida auris colonization (multi-drug resistant yeast). Review of Resident 12's admission Minimum Data Set, dated [DATE], and quarterly MDS dated [DATE], revealed section I1700 was coded no for MDRO (multi drug resistant organism). During a staff interview on February 22, 2024, at 11:29 AM, with Employee 2 it was revealed candidiasis is considered an MRDO infection. During an additional staff interview on February 22, 2024, at 12:10 PM, with the DON in the presence of the NHA it was revealed that Resident 12's admission MDS and quarterly MDS were coded incorrectly, and it was the expectation of the facility that MDS assessment be accurate. Review of Resident 18's clinical record revealed diagnoses that included end stage renal disease (ESRD-condition in which a person's kidneys cease functioning on a permanent basis) and bipolar disorder (a lifelong mood disorder and mental health condition that causes intense shifts in mood, energy (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 3 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0641 levels, thinking patterns, and behaviors). Level of Harm - Minimal harm or potential for actual harm Review of Resident 18's physician orders revealed the following orders: Dialysis (external filtering of the blood performed by a machine by removing the blood and replacing it) three times a week on Tuesday, Thursday, and Saturday at 5:30 AM at US Renal Care, dated February 9, 2024 (their most recent readmission date); and Quetiapine fumarate (Seroquel) (an antipsychotic medication) 100 milligrams one tablet by mouth twice a day, dated February 9, 2024 (their most recent readmission date). Residents Affected - Some Further review of Resident 18's order history and medication administration records revealed that they had been receiving dialysis for the entire calendar year of 2023, as well as the Quetiapine fumarate (Seroquel). Review of Resident 18's Quarterly MDS with the assessment reference date of September 27, 2023, revealed in Section O. Special Treatments, Procedure, and Programs at question J. Dialysis, Resident 18 was coded as not receiving dialysis. During an interview with Employee 3 (Registered Nurse Assessment Coordinator) on February 22, 2024, at 10:01 AM, Employee 3 confirmed that dialysis should have been coded on the September 27, 2023, Quarterly MDS and that she completed a modification to the assessment. Review of Resident 18's Annual MDS with an assessment reference date of December 28, 2023, revealed that in Section N. Medications, Subsection N0450. Antipsychotic Medication Review, question D. Physician documented GDR (gradual dose reduction) as clinically contraindicated was coded No. Review of Resident 18's clinical record revealed a pharmacy recommendation dated August 18, 2023, for the physician to review their antipsychotic for a dose reduction. The physician documented that Resident with good response, maintain the current dose and was signed and dated for August 23, 2023. During the interview with Employee 3 on February 22, 2024, at 10:01 AM, the aforementioned coding concern was discussed. She indicated that she would look into it because she thought, since the physician documentation of a clinical contraindication on August 23, 2023, was coded on Resident 18's Quarterly MDS with an assessment reference date of September 27, 2023, that the annual clock restarts. During a follow-up interview with the Employee 3 on February 22, 2024, at 10:47 AM, she indicated that she had contacted her corporate support person and confirmed that Resident 18's Annual MDS should have included the last date that the physician documented a GDR was contraindicated. She further indicated that she would be completing a modification to the assessment. During an interview with the NHA on February 22, 2024, at 12:03 PM, he stated that MDS assessments should be coded correctly. Review of Resident 50's clinical record revealed diagnoses that included chronic respiratory failure, hypertension (elevated blood pressure), and hypothyroidism. Further review of Resident 50's clinical record revealed that Resident 50 was discharged from the facility on February 5, 2024. Review of Resident 50's progress notes revealed that discharge planning was occuring since at least December 7, 2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 4 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0641 Level of Harm - Minimal harm or potential for actual harm Review of Resident 50's discharge return not anticipated MDS dated [DATE], revealed that Section A0310, Type of Discharge, was coded as being unplanned. During an interview with Employee 3 on February 22, 2024, at 9:59 AM, she stated that Resident 50's discharge was planned and the MDS was coded incorrectly. Residents Affected - Some During an interview with the NHA on February 22, 2024, at 12:03 PM, he stated that MDS assessments should be coded correctly. 28 Pa. Code 211.12(d)(1)(3) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 5 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0657 Level of Harm - Minimal harm or potential for actual harm Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on clinical record review, policy review, and staff interviews, it was determined that the facility failed to review and revise the resident plan of care for two of 15 residents reviewed (Residents 18 and 20). Residents Affected - Few Findings include: Review of facility policy, titled Care Plan and Conference, last revised November 30, 2018, revealed, in part, Purpose: To facilitate communication of all disciplines of pertinent patient information to formulate a useful care plan that will drive patient care and improve outcomes .The care plan process will be monitored by all disciplines as necessary based on the resident's assessment of problems and needs. Review of Resident 18's clinical record revealed diagnoses that included bipolar disorder (a lifelong mood disorder and mental health condition that causes intense shifts in mood, energy levels, thinking patterns, and behaviors) and major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest in things). Review of Resident 18's physician orders revealed an order for Venlafaxine Hydrochloride oral tablet (an antidepressant medication) 112.5 milligrams give one tablet by mouth, dated February 9, 2024. Review of Resident 18's care plan revealed a care plan focus for potential for adverse reaction to prescribed psychotropic medications: Anti-depressant medications: Trazodone, Mirtazapine, Venlafaxine. Resident has diagnosis of depression, with a date initiated of November 28, 2023, and a last revision date of December 29, 2023. Further review of Resident 18's physician order history revealed that their Trazodone and Mirtazapine (both antidepressant medications) were discontinued on January 19, 2024. During an interview with the Nursing Home Administrator (NHA) and Director of Nursing (DON) on February 21, 2024, at 1:50 PM, the aforementioned care plan concern was shared, and they indicated they would look into the concern. During a follow-up interview with the NHA and DON on February 22, 2024, at 10:31 AM, the NHA indicated that he had spoken to the Social Worker and that she said that she continued the care plan because she was on antidepressants. It was shared again that there were specific medications listed on the care plan that Resident 18 was no longer taking. During a final interview with the NHA and DON on February 22, 2024, at 1:29 PM, the NHA indicated that the social worker thought that she was being proactive in leaving the discontinued medications on the care plan should Resident 18 be placed back on those medications. He further indicated that, moving forward, the facility would not be including specific medications on resident care plans. Review of facility policy, titled Weights, last revised November 30, 2020, revealed, in part, The Registered Dietitian will update/revise the resident's care plan to reflect the significant weight change, goals, and approaches. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 6 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident 20's clinical record revealed diagnoses that included protein calorie malnutrition (an imbalance between the nutrients your body needs to function and the nutrients it gets), dysphagia (difficulty swallowing), and type 2 diabetes mellitus (a form of diabetes that is characterized by high blood sugar, insulin resistance, and relative lack of insulin). Review of Resident 20's medical record revealed a significant weight gain of 12 pounds from November 4, 2023, to December 3, 2023, and then a significant weight loss of 21.4 pounds from January 2, 2024, to January 6, 2024, confirmed by a re-weigh measure on January 7, 2024. Review of Resident 20's care plan revealed a focus area of, Feeding tube as a result of swallowing problems/dysphagia .and is at risk of .imbalanced nutrition. Physician documented malnutrition, last revised May 25, 2023. Further review of Resident 20's care plan failed to mention Resident 20's significant weight changes. During an interview with the NHA on February 22, 2024, at 12:05 PM, revealed he would expect Resident 20's care plan to be updated to include the significant weight changes. 42 CFR 483.21(b) Comprehensive Care Plans 28 Pa. Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 7 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on observations, facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to maintain adequate personal grooming of residents dependent on staff for assistance with these activities of daily living (ADLs) for two of 15 residents reviewed (Residents 31 and 37). Residents Affected - Few Findings Include: Review of facility policy, titled Quality of Life, dated November 28, 2018, revealed 1. The facility will promote, maintain and enhance each resident's dignity and respect his or her individuality. a. Grooming residents as they wish to be groomed. Review of Resident 31's clinical record revealed diagnoses that included acute and chronic respiratory failure, paroxysmal atrial fibrillation (occurs when a rapid, erratic heart rate begins suddenly and then stops on its own within seven days), and chronic kidney disease stage 4 (kidneys are moderately or severely damaged and are not working as well as they should to filter waste from the blood). Review of Resident 31's current care plan revealed an intervention with a revision date of October 13, 2023, Resident is dependent on ADLs: toileting, transfers, hygiene, dressing, bed mobility, showers/bathing. Further review of Resident 31's care plan failed to reveal any preference for facial hair or refusals of care. Observation of Resident 31 on February 20, 2024, at 11:41 AM, and February 21, 2024, at 9:52 AM, revealed Resident 31 with what appeared to be several days of facial hair growth. On February 21, 2024, at 1:35 PM, the Nursing Home Administrator (NHA) and Director of Nusing (DON) were made aware of the observations of Resident 31's facial hair and questioned if this was Resident 31's preference. They stated they would look into it. Review of Resident 31's nursing progress note dated February 21, 2024, at 4:25 PM, revealed that facility staff spoke with Resident 31's daughter who stated that she prefers resident to be shaved if/when he is agreeable to it. She expressed understanding that her father is sometimes behavioral and resistive to care and is ok if he is not shaved under those circumstances. Observation of Resident 31 on February 22, 2024, at 9:31 AM, revealed Resident 31 continued with several days of facial hair growth. During an interview with the NHA, DON, and Assistant Director of Nursing (ADON) on February 22, 2024, at 11:57 AM, the ADON stated that Resident 31 sometimes has behaviors and refuses to be shaved. Review of Resident 31's task sheet for the past 30 days for hygiene, which included shaving, revealed no documentation of any refusals. Review of Resident 31's task sheet for rejection of care over the past 30 days revealed no refusals documented. On February 22, 2024, at 1:26 PM, during an interview with the NHA, DON, and ADON, the ADON (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 8 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0677 confirmed that there was no evidence of Resident 31 refusing to be shaved. Level of Harm - Minimal harm or potential for actual harm Review of Resident 37's clinical record revealed diagnoses that included acute and chronic respiratory failure and functional quadriplegia (complete immobility due to severe disability or frailty from another medical condition without injury to the brain or spinal cord). Residents Affected - Few Review of Resident 37's current care plan revealed an intervention dated January 18, 2023, Resident is dependent with ADLs: transfers, toileting, hygiene, dressing, bathing/showers, bed mobility. Further review of Resident 37's care plan failed to reveal any preference for facial hair or refusals of care. Observation of Resident 37 on February 20, 2024, at 10:21 AM, and February 21, 2024, at 9:53 AM, revealed revealed Resident 37 with what appeared to be several days of facial hair growth. On February 21, 2024, at 1:30 PM, the NHA and DON were made aware of the observations of Resident 37's facial hair and questioned if this was Resident 37's preference. They stated they would look into it. Observation of Resident 37 on February 22, 2024, at 9:31 AM, revealed Resident 37 continued with several days of facial hair growth. During an interview with the NHA, DON, and ADON on February 22, 2024, at 11:56 AM, the ADON stated that residents should be shaved on their scheduled shower days. 28 Pa code 211.12(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 9 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on observation, facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to ensure that residents receive necessary treatment and services, consistent with professional standards of practice, to promote healing and prevent infection of a pressure ulcer for one of two residents reviewed for pressure ulcers (Resident 12). Residents Affected - Few Finding include: Review of facility policy, titled wound care and pressure ulcer care, with an update date of November 30, 2018, failed to reveal guidance for hand hygiene during wound care. Review of facility policy, titled hand hygiene, with a revision date of November 30, 2022, revealed procedure section B read, in part, hand hygiene is performed using hand washing or ABHR (alcohol based hand rub) before and after the following scenarios: before and after direct contact with residents, before performing any non-surgical invasive procedures, before handling clean or soiled dressing, gauze pads, etc., after removing gloves or an entire set of PPE (personal protective equipment), before performing an aseptic task; and section H, which read the use of gloves does not replace hand washing/hand hygiene. Integration of glove use along with routine hand hygiene is recognized as best practice for preventing healthcare-associated infections. Review of Resident 12's clinical record revealed diagnoses that included pressure ulcer of other site, unstageable (an ulcer that has full thickness tissue loss but is either covered by extensive necrotic tissue or by an eschar) and candidiasis (fungal infection caused by a yeast). Review of Resident 12's current physician orders revealed a treatment order dated February 12, 2024, to cleanse the left lateral foot with normal sterile saline (NSS), apply medihoney (ointment with anti-inflammatory effects) to the wound bed, and cover with foam adhesive dressing daily and as needed (PRN). Observation of Resident 12's wound care on February 21, 2024, at 12:04 PM, revealed Employee 5 (Licensed Practical Nurse) preformed ABHR prior to donning a gown and gloves. During the wound treatment and dressing change, it was observed that Employee 5 failed to preform hand hygiene after removing the soiled dressing and donning clean gloves. It was also observed that Employee 5 failed to perform hand hygiene and change of gloves between cleansing the wound and applying a new dressing. During the observation, Employee 5 failed to provide a barrier between Resident 12's wound and bed linens. After removal of the old dressing, Employee 5 placed Resident 12's left foot on the bed with the wound bed directly touching the bed linens. It was also observed that when Employee 5 cleansed the wound with NSS, liquid drained onto the bed linen causing a wet spot. Employee 5 failed to provide clean and dry linens, and placed Resident 12's left foot over the wet/soiled linen prior to covering Resident 12's foot with the top blankets. During a staff interview on February 21, 2024, at 1:48 PM, with the Director of Nursing (DON) in the presence of the Nursing Home Administrator, the DON stated it is the expectation of the facility that hand hygiene policies would be followed. 28 Pa. Code 211.12(d)(1)(2)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 10 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on observations, clinical record review, and staff interviews, it was determined that the facility failed to ensure residents with limited mobility received appropriate services, equipment, and assistance to maintain or improve mobility for one of two residents reviewed (Resident 84). Findings include: Review of Resident 84's clinical record revealed diagnoses that included cerebral infarction (a stroke-damage to the brain from interruption of its blood supply), anoxic brain damage (injury to the brain that occurs when the oxygen supply to the brain is compromised or interrupted), and muscle weakness. Review of Resident 84's physician orders revealed an order for Resident to wear bilateral resting hand splints during the day to prevent contracture of wrist and fingers. Approach: Bilateral resting hand splints to be worn four hours a day, three times a week. Off for self-care, ROM (range of motion), skin checks, monitor for skin breakdown, dated January 31, 2024. Observation of Resident 84 on February 20, 2024, at 10:38 AM, revealed that they had both of their hands closed and both of their hands were bent inwards toward the inner arm with no resting hand splints noted to be present on Resident 84, nor were they noted to be visible in Resident 84's room. Subsequent observations on February 20, 2024, at 2:07 PM; February 21, 2024, at 9:55 AM; and February 21, 2024, at 12:15 PM, all revealed the same findings as above. During an interview with the Director of Nursing (DON) on February 21, 2024, at 12:20 PM, the aforementioned observations were shared and splint documentation was requested. During a follow-up interview with the DON on February 21, 2024, at 12:36 PM, she indicated that the splints had been removed for care earlier and that they had now been reapplied. All additional observations above were again shared with the DON, and she said she would follow back up with nursing staff for additional information. During an interview with the Nursing Home Administrator (NHA) and DON on February 21, 2024, at 2:00 PM, all aforementioned observations were shared and splint documentation was again requested. Observation of Resident 84 on February 22, 2024, at 9:15 AM, again revealed that they had both of their hands closed and both of their hands were bent inwards toward the inner arm with no resting hand splints noted to be present on Resident 84, nor were they noted to be visible in Resident 84's room. During an interview with the NHA and DON on February 22, 2024, at 10:21 AM, the observation of Resident 84 at 9:15 AM was shared and splint documentation was requested. During an interview with the NHA and DON on February 22, 2024, at 12:12 PM, the NHA indicated that they had put a sheet in the restorative book yesterday for staff to track specific times that the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 11 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few splints were applied. When asked if they had documentation prior to yesterday in regard to Resident 84's splint program, the NHA indicated that this information was documented on paper and was located in a binder on the unit. He further indicated that Resident 84 did not have their splints on today because it was their rest day. Splint documentation was again requested for review. Review of Resident 84's Restorative Nursing form, undated but appeared to be February 2024's documentation, provided by the facility indicated that Resident 84's program was established on January 24, 2024, and that Resident 84's goals were: 1) PROM (passive range of motion)/AAROM (active assistive active range of motion) BUE's[bilateral upper extremities] and BLE's [bilateral lower extremities] and 2) will wear bilateral resting hand splints 4 hours during the day to prevent contractures of the wrist and fingers. The form also indicated that the frequency of the program was 2-3 times a week. Further review of this documentation revealed that Resident 84 was only documented as having their bilateral resting hand splints applied on February 2, 5, 9, 12, 13, and 20, 2024; that there were no documented refusals noted on the form; that their splints were not provided at a minimum of twice a week as ordered for the week of February 12-16, 2024; and as of February 22, 2024, at 1:00 PM, Resident 84 had only been provided their splints one time during the week of February 19-23, 2024. In addition, the form did not include the time applied or removed to ensure the ordered wearing schedule was followed. During a final interview with the NHA and DON on February 22, 2024, at 1:25 PM, the NHA confirmed that he would expect Resident 84's ordered splint wearing schedule to be followed and that he thought the information was in place to show documentation of the splint wearing times. He again shared that, as of yesterday, they made changes to show a time on and time off to ensure Resident 84's wearing schedule would be followed. 28 Pa. Code 211.12(d)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 12 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to ensure proper monitoring for acceptable parameters of nutritional status for one of 15 residents reviewed (Resident 20). Residents Affected - Few Findings include: Review of facility policy, titled Weights, last revised November 30, 2020, revealed, in part, Notify Medical Provider, RNAC (Registered Nurse Assessment Coordinator), and Registered Dietitian within 24 hours, if the re-weight verifies a significant weight change for the resident. The Registered Dietitian will update/revise the resident's Care Plan to reflect the significant weight change, goals, and approached. Review of Resident 20's clinical record revealed diagnoses that included protein calorie malnutrition (an imbalance between the nutrients your body needs to function and the nutrients it gets), dysphagia (difficulty swallowing), and type 2 diabetes mellitus (a form of diabetes that is characterized by high blood sugar, insulin resistance, and relative lack of insulin). Review of Resident 20's care plan revealed a focus area of: Feeding tube as a result of swallowing problems/dysphagia .and is at risk of .imbalanced nutrition. Physician documented malnutrition, last revised May 25, 2023, with an intervention for Dietitian to assess per policy and make recommendations as indicated, last revised June 22, 2018. Review of Resident 20's medical record revealed a significant weight gain of 12 pounds from November 4, 2023, to December 3, 2023, and then a significant weight loss of 21.4 pounds from January 2, 2024, to January 6, 2024, confirmed by a re-weigh measure on January 7, 2024. Review of Resident 20's clinical record failed to reveal any nutrition assessments in response to the aforementioned significant weight changes, and that no nutritional assessments were conducted on Resident 20 between the dates of November 17, 2023, and February 15, 2024; the significant weight changes were not mentioned in the nutritional assessment on February 15, 2024. During an interview with Employee 6 (Registered Dietitian) on February 22, 2024, at 10:14 AM, the surveyor revealed the concern with the lack of nutritional assessments completed in response to significant weight changes, and Employee 6 replied, I see where you are coming from. Interview with the Nursing Home Administrator (NHA) on February 22, 2024, at 12:15 PM, revealed he would expect comprehensive nutritional assessments to be completed in response to significant weight changes. 28 Pa. Code 211.10(c) Resident care policies 28 Pa. Code 211.12(d)(1)(3) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 13 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. Based on observation, clinical record review, and staff interview, it was determined that the facility failed to follow physician orders for residents receiving tube feedings for one of seven residents reviewed for tube feedings (Resident 31). Findings Include: Review of Resident 31's clinical record revealed diagnoses that included acute and chronic respiratory failure, paroxysmal atrial fibrillation (occurs when a rapid, erratic heart rate begins suddenly and then stops on its own within seven days), and chronic kidney disease stage 4 (kidneys are moderately or severely damaged and are not working as well as they should to filter waste from the blood). Review of Resident 31's current physician orders revealed an order dated October 27, 2023, for enteral feed (also known as tube feeding, is a way of sending nutrition right to the stomach or small intestine), Nepro at 50 mL/hour with free water flush of 40 mL every hour. Observation of Resident 31's feeding tube on February 20, 2024, at 11:29 AM, and February 21, 2024, at 9:49 AM, revealed Resident 31's feeding pump was set to give a free water flush of 50 mL every hour. During an interview with the Nursing Home Administrator and Director of Nursing on February 22, 2024, at 1:25 PM, they stated that water flushes should be administered per physician's order. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 14 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based on facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to maintain complete and accurate records related to dialysis communication for one of one residents reviewed for diapysis services (Resident 18). Residents Affected - Some Findings Include: Review of facility policy, titled Hemodialysis, with a last revision date of November 30, 2018, and a last review date of December 27, 2023, indicated under section titled Documentation that 1. The dialysis unit doing the dialysis will supply copy of their completed record for the patient chart; and 3. All patient observations, interventions, etc. will be recorded in the patient record. Review of Resident 18's clinical record revealed diagnoses that included end stage renal disease (ESRD-condition in which a person's kidneys cease functioning on a permanent basis) and bipolar disorder (a lifelong mood disorder and mental health condition that causes intense shifts in mood, energy levels, thinking patterns, and behaviors). Review of Resident 18's physician orders revealed the following orders: Dialysis (external filtering of the blood performed by a machine by removing the blood and replacing it) three times a week on Tuesday, Thursday, and Saturday, at 5:30 AM, at US Renal Care, dated February 9, 2024 (their most recent readmission date). Further review of Resident 18's order history and medication administration records revealed that they had been receiving dialysis for the entire calendar year of 2023. Review of Resident 18's clinical record on February 21, 2024, at 12:15 PM, failed to reveal any dialysis communication notes/forms. During an interview with the Director of Nursing (DON) on February 21, 2024, at 12:20 PM, she indicated that communication sheets are completed to accompany the Resident to dialysis, but that these forms are kept in the dialysis center. She further indicated that a staff member accompanies Resident 18 to dialysis, so that is how they would know if there were any concerns with Resident 18 during their dialysis treatment. During a follow-up interview with the Nursing Home Administrator (NHA) and DON on February 21, 2024, at 1:50 PM, the concern of no documentation to support facility communication or coordination of care with dialysis was shared. Additional information was requested. Email communication from the NHA on February 22, 2024, at 1:38 AM, included facility dialysis communication sheets dated February 13, 15, 17, and 20, 2024. No other documentation was provided. Review of Resident 18's nutritional assessments revealed that they had been assessed by the dietician on the following dates April 5, 2023; July 5, 2023; September 27, 2023; November 20 and 27, 2023; December 28, 2023; January 18 and 25, 2024; and February 5 and 14, 2024 (a total of ten assessments). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 15 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0698 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Further review of these ten completed nutritional assessments revealed that the seven assessments completed on July 5, 2023; November 20, 2023; December 28, 2023; January 18 and 25, 2024; and February 5 and 14, 2024, failed to include any documentation of Resident 18 receiving dialysis or communication with the dialysis dietician. Review of Resident 18's clinical record progress notes failed to reveal any nutritional notes addressing dialysis or communication with the dialysis dietician since March 20, 2023, which was in the previous survey year. During an interview with the NHA and DON on February 22, 2024, at 10:27 AM, the concern of the lack of documentation to show communication between the dietician here and the dialysis dietician was shared to include the aforementioned nutritional assessments and nutrition notes. It was also shared at that time that only four dialysis communications sheets had been provided and that more would be needed for review. He indicated that they have a binder of them, which was requested for review. The DON indicated that she would get the binder for review. During an interview with the Employee 6 (Registered Dietician) on February 22, 2024, at 11:04 AM, she indicated that she maintains contact with the dialysis dietician, but confirmed that she could not provide any documentation to support this. She also confirmed that her nutritional assessments did not all indicate that Resident 18 was receiving dialysis, and that there were no dietary progress notes outside of her assessments that referenced any documentation regarding communication with the dialysis dietician since March 20, 2023. During a follow-up interview with the NHA on February 22, 2024 at 11:45 AM, he confirmed that he had no binder or dialysis communication sheets to provide. He provided copies of Resident 18's clinical progress notes that were documented under Note Type: Dialysis that showed nurses' notes that the Resident went to dialysis. It was discussed that all these notes had been reviewed, but that these notes did not indicate any communication with the dialysis center and were sporadic. The concern that there was no evidence of ongoing communication between the facility and the dialysis center each day that Resident 18 was emphasized again. The NHA indicated that the dialysis center used to send a report over after every dialysis treatment, but that when a new person took over at dialysis, that person determined that they [dialysis center] did not need to be sending those documents and stopped doing so. During a final interview with the NHA and DON on February 22, 2024, at 12:10 PM, the NHA confirmed that he had no additional documentation to provide to show collaboration or communication with the dialysis center and the facility nursing staff or facility dietician. He confirmed that he would expect this communication to occur and that documentation should be present to support the ongoing coordination of nursing and nutritional care. 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.10(a)(c) Resident care policies 28 Pa. Code 211.12(d)(1)(2)(3)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 16 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. Based on observations, clinical record review, and staff interviews, it was determined that the facility failed to ensure each resident was evaluated appropriately for the use of side rails for one of three residents reviewed for side rails(Resident 31). Findings Include: Review of Resident 31's clinical record revealed diagnoses that included acute and chronic respiratory failure, paroxysmal atrial fibrillation (occurs when a rapid, erratic heart rate begins suddenly and then stops on its own within seven days), and chronic kidney disease stage 4 (kidneys are moderately or severely damaged and are not working as well as they should to filter waste from the blood). Observation on February 20, 2024, at 11:32 AM, revealed Resident 31 in bed, with bilateral side rails attached to the top of the bed. Review of Resident 31's physician orders revealed an order dated October 30, 2023, for 1/4 side rails to assist with bed mobility and repositioning. Further review revealed that order was discontinued on February 16, 2024, and a new order was placed on February 16, 2024, for 1/4 rails for bed mobility and repositioning. Review of Resident 31's current care plan revealed a care plan initiated October 7, 2023, with a revision date February 16, 2024, stating The resident uses 1/4 rails to assist with bed mobility and repositioning. Review of Resident 31's clinical record revealed bed rail consent was signed by Resident 31's Responsible Party on October 5, 2023. Review of Resident 31's facility assessment form, titled Bed Rail Assessment, dated October 5, 2023, revealed Does the resident need bed rails for: with the options to choose from being 1. Bed Mobility; 2. Repositioning; 3. Turning; or 4. No- none of the above. Further review of the assessment form revealed that 4. No-none of the above was checked. Review of Resident 31's facility assessment form, titled Bed Rail Assessment, dated October 6, 2023, revealed options 1. Bed Mobility, 2. Repositioning, and 3. Turning, were all checked. Review of Resident 31's facility assessment form, titled Bed Rail Assessment, dated October 27, 2023, and February 5, 2024, revealed on both assessments, 4. No-none of the above, was checked. Review of Resident 31's facility form, titled Fox Subacute Safe Measurement of Rails/Gaps, revealed that measurements of Resident 31's side rails were taken on January 17, 2024, and February 16, 2024. Review of Resident 31's rehabilitation screening dated February 15, 2024, revealed that the Resident was assessed and is appropriate for bed rails for mobility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 17 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On February 22, 2024, at 12:04 PM, the Nursing Home Administrator (NHA), Director of Nursing (DON), and Assistant Director of Nusing (ADON) were questioned about Resident 31's assessments for side rails, with the assessments on October 5 and 27, 2023, and February 5, 2024, stating that Resident 31 did not need side rails although the Resident had an active care plan in place for the use of side rails and the physician placed an order for them on October 30, 2023. Resident also had measurements of the side rails taken in January 2024, between the October 27, 2023, and February 5, 2024, assessments that stated Resident 31 did not have or need side rails. The NHA, DON, and ADON stated they would look into the contradictory information. On February 22, 2024, at 1:26 PM, during an interview with the NHA, DON, and ADON, the ADON stated that the Resident had lethargy and was maybe not appropriate for the rails at the assessment times, and that is maybe why nursing documented it that way. The surveyor questioned if the side rails were removed during those times. The NHA and ADON stated that the rails can be put into the down position, but they were unable to state if that occurred. 28 Pa Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 211.12(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 18 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0730 Observe each nurse aide's job performance and give regular training. Level of Harm - Minimal harm or potential for actual harm Based on review of select facility personnel documentation and staff interview, it was determined that the facility failed to ensure that nurse aide performance evaluations were completed at least annually for three of five nurse aides reviewed (Employees 9, 10, and 11) and failed to ensure that in-service education was provided based on the outcome of these reviews for five of five nurse aides reviewed (Employees 8, 9, 10, 11, and 12). Residents Affected - Some Findings Include: Review of personnel information revealed Employee 8's hire date was November 28, 2014, and that they had an annual performance review completed on May 22, 2023, but failed to reveal that in-service education was provided based on the outcome of this review. Review of personnel information revealed Employee 9's hire date was July 8, 2022; Employee 10's hire date was November 24, 2020; and Employee 11's hire date was August 15, 2021. Further review of personnel information for Employees 9, 10, and 11, failed to reveal that annual performance reviews were completed and that in-service education was provided based on the outcome of these reviews. Review of personnel information revealed Employee 12's hire date was March 28, 2019, and that they had an annual performance review on May 12, 2023, but failed to reveal that in-service education was provided based on the outcome of this review. During an interview with the Nursing Home Administrator on February 22, 2024, at 2:25 PM, he acknowledged that he had no additional documentation to provide. He confirmed that he would expect annual performance reviews to be completed and subsequent education based on the performance review be completed and documented. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management 28 Pa. Code 201.19(2)(7)Personnel policies and procedures 28 Pa. Code 201.20(a)(d) Staff development FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 19 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on facility policy review, product manufacturer label, observations, and clinical record review, and staff interview, it was determined that the facility failed to ensure a medication error rate of less than five percent (17 errors in 32 observations, 53.13%). Residents Affected - Some Findings include: Review of the clinical record for Resident 7 revealed the resident has a gastric tube (tube inserted through the abdomen that delivers nutrition directly to the stomach). Review of Resident 7's current physician orders revealed medication orders for the following medications: Valium (medication for seizures) 5 mg, Metoclopramide (medication to treat stomach) 10 mg, Lamotrigine (medication for seizures) 25 mg, Lamotrigine 200 mg, Lasix (diuretic medication) 40 mg, Baclofen (medication for muscle spasms) 10mg, and Metoprolol (blood pressure medicine) 25mg. Observation on February 21, 2024, at 8:56 AM, revealed Employee 1 (Licensed Practical Nurse [LPN]) was observed administering the above listed medications to Resident 7. Employee 1 crushed all of the above listed medications together and administered the medications together, and did not flush the tube with water between medications. Review of the clinical record for Resident 7 revealed the Resident has a gastric tube (tube inserted through the abdomen that delivers nutrition directly to the stomach). Review of the current physician orders for Resident 24 revealed medication orders for the following medications: Adderall (amphetamine medication) 5 mg, Sodium Chloride 2 mg, Senna (constipation medication) 8.6 mg, Magnesium Oxide (magnesium supplement) 800 mg, Losartan Potassium (blood pressure medication) 100 mg, Lasix 20 mg, Aspirin 81 mg, Amlodipine (blood pressure medication) 5 mg, and Esomeprazole Magnesium (heart burn medication) 40 mg. Observation on February 21, 2024, at 9:15 AM, revealed Employee 1 was observed administering the above listed medications to Resident 24. Employee 1 crushed all of the above listed medications together and administered the medications together, and did not flush the tube with water between medications. Further observation of Employee 1 at that time revealed her preparing to inject Resident 24 with Lantus (insulin) 25 units subcutaneously. Observation of the insulin bottle revealed that it was opened on January 20, 2024, and should not be used after February 16, 2024. Review of product information for Lantus insulin revealed that it is to be discarded 28 days after opened or removed from refrigeration. During an interview with the Director of Nursing on February 22, at 12:15 PM, she revealed that she would have expected Employee 1 to give the medications according to the standard of practice, and also not give insulin beyond its expiration date. Based on 17 medication errors observed out of a possible 32 opportunities, the facility medication error rate was a calculated 53.13 percent. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 20 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0759 28 Pa. Code 211.12(d)(1) Nursing services 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: 396122 If continuation sheet Page 21 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on facility policy reviews, observations, and staff interviews, it was determined that the facility failed to store food and utilize equipment in accordance with professional standards for food service safety in the main kitchen, receiving area, and three of three nourishment areas. Findings include: Review of facility policy, titled Storage- Food, not dated, read, in part, Food should be stored in a manner which maximizes food quality and safety. Review of facility policy, titled Labeling and Dating of Food, not dated, read, in part, Condiments in pantry areas will be discarded and replaced monthly. Any foods found that are not labeled and dated need to be discarded immediately. Observation of the dish machine in the main kitchen on February 20, 2024, at 9:49 AM, revealed the sanitizing final rinse cycle reached a maximum temperature of 178 degrees Fahrenheit (F). Review of the dish machine temperature log for February 2024, revealed all sanitizing final rinse temperatures recorded in the month of February were below the minimum temperature for food service safety of 180 degrees F. Interview with Employee 6 (Registered Dietitian) on February 20, 2024, at 9:51 AM, revealed they are getting a new dish machine in April 2024 due to issues with reaching the appropriate final rinse cycle temperatures. Observation of trash receptacle and recycling bin on February 20, 2024, at 9:53 AM, revealed the dumpster lids were open and the recycling door was open. Interview with Employee 7 (Food Service Employee) on February 20, 2024, at 9:54 AM, revealed the lids to the dumpster and door to the recycling bin should be closed when not in use. Observation during initial tour of the west nourishment area on February 20, 2024, at 9:55 AM, revealed: five Nutra grain bars not dated; a container of condiments not dated, and some of the condiments had broken open and spilled in the container. Observation of the west nourishment area refrigerator on February 20, 2024, at 9:57 AM, revealed: four individual orange juices not dated; and one individual container of cranberry juice not dated. Observation during initial tour of the first-floor nourishment area refrigerator on February 20, 2024, at 10:01 AM, revealed: a shelf containing individual butter packets not dated; and two individual orange juice containers not dated. Observation during initial tour of the first-floor nourishment area on February 20, 2024, at 10:03 AM, revealed one bin of condiments not dated. Observation during initial tour of the second-floor nourishment area on February 20, 2024, at 10:06 AM, revealed two bins of condiments in the refrigerator not dated, and one can of thickening powder (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 22 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0812 in a cabinet with a scoop stored inside. Level of Harm - Minimal harm or potential for actual harm Observation in the main kitchen on February 21, 2024, at 11:38 AM, revealed one container of parsley flakes, one container of chives, and one container of garlic powder all open and not labeled with an open date, and the garlic powder had a scoop stored inside. Residents Affected - Some Interview with the Nursing Home Administrator on February 21, 2024, at 1:44 PM, revealed it is the facility's expectation that food and beverages are labeled and dated, the dumpster lids are closed when not in use, and food items and kitchen equipment are stored, cleaned, and utilized in accordance with professional standards. 28 Pa. Code 211.6(f) Dietary services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 23 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 observation, clinical record review, facility policy review, and staff interview, it was determined that the facility failed to maintain infection control practices to prevent the spread of infection for one of 13 residents reviewed (Resident 12). Residents Affected - Few Findings include: Review of facility policy, titled wound care and pressure ulcer care, with an update date of November 30, 2018, revealed section titled procedure B 4, Discard the dressing and gloves in the waterproof red trash bag. Review of Resident 12's clinical record revealed diagnoses that included pressure ulcer of other site, unstageable (an ulcer that has full thickness tissue loss but is either covered by extensive necrotic tissue or by an eschar) and candidiasis (fungal infection caused by a yeast). Review of Resident 12's current physician orders revealed a treatment order dated February 12, 2024, to cleanse the left lateral foot with normal sterile saline (NSS), apply medihoney (ointment with anti-inflammatory effects) to the wound bed, and cover with foam adhesive dressing daily and as needed (PRN) and lifetime contact precautions related to MDR candida auris colonization (multi-drug resistant yeast). Review of Resident 12's plan of care revealed the resident is at risk for infection related to positive candida auris PCR (polymerase chain reaction) and is to have lifetime contact precautions related to MDR candida auris colonization with an intervention for all disposables to be placed in a red trash bag. Observation of Resident 12's left lateral foot pressure ulcer dressing change on February 21, 2024, at 12:04 PM, revealed Employee 5 removed the dressing that was covering Resident 12's pressure ulcer and placed it in a clear, plastic trash bag. Employee 5 then proceeded to perform the rest of Resident 12's dressing change. Upon completion of the dressing change, Employee 5 was observed tying the trash bag closed and discarding it in the trash bin in Resident 12's room, which did not contain a red biohazard bag (a container for materials that have been exposed to blood or other biological fluids). During a staff interview on February 21, 2024, at 1:48 PM, with the Director of Nursing (DON) and in the presence of the Nursing Home Administrator, the DON revealed it was the expectation of the facility that Employee 5 would have followed facility policy and disposed of Resident 12's trash in a red bag and trash receptacle. 28 Pa. Code 211.12(d)(1)(3)(5) Nursing services 28 Pa. Code 201.18(e)(1) Management 28 Pa. Code 211.12(d)(1)(5) Nursing services FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 24 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0882 Level of Harm - Minimal harm or potential for actual harm Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. Based on review of regulations, facility policy review, and staff interviews, it was determined that the facility failed to have an Infection Preventionist (IP) that worked at least part time at the facility. Residents Affected - Few Findings Include: The Centers for Medicare and Medicaid Services regulation §483.80(b)(3) states, The facility must designate one or more individual(s) as the infection preventionist(s) (IP)(s) who are responsible for the facility ' s IPCP. The IP must: Work at least part-time at the facility. The IP must physically work onsite in the facility. He/she cannot be an off-site consultant or perform the IP work at a separate location such as a corporate office or affiliated short term acute care facility. Review of facility policy, titled Infection Preventionist, with a review date of November 30, 2023, revealed The IP works at least part-time at the facility. During an interview with the Nursing Home Administrator (NHA) on February 21, 2024, at 11:41 AM, he stated that the prior IP left the role in December 2023 and Employee 2 has been the designated IP since then. He further stated that they have hired a new IP, but she has not yet completed the required IP training. He stated that Employee 2 comes to the facility about two or more times per month. At that time, the NHA was made aware that the IP needed to work at least part-time at the facility and be physically present at the facility. The NHA acknowledged understanding. During an interview with Employee 2 on February 22, 2024, at 10:16 AM, she stated that she took over the IP role in January 2024 and confirmed that she is only physically in the building a few times a month. Employee 2 stated that will change going forward. On February 22, 2024, at approximately 11:30 AM, Employee 2 provided an updated Infection Preventionist policy, with an updated date of February 22, 2024. The updated policy now stated that the IP Must work physically onsite at the facility- the infection preventionist cannot be an offsite consultant or perform the infection preventionist's work at a separate location. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1) Management FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 25 of 26 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 396122 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Subacute at Mechanicsburg 120 South Filbert St Mechanicsburg, PA 17055 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 0947 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. Based on review of personnel training records and staff interview, it was determined that the facility failed to ensure each nurse aide was provided with the required in-service training consisting of no less than 12 hours per year for five of five nurse aide employee records reviewed (Employees 8, 9, 10, 11 and 12); failed to provide annual training that included dementia management and resident abuse prevention for four of five nurse aide employee records reviewed (Employees 8, 9, 10, and 11); and failed to provide annual training that included dementia management for one of five nurse aide employee records reviewed (Employee 12). Findings Include: Review of personnel information revealed Employee 8's hire date was November 28, 2014; Employee 9's hire date was July 8, 2022; Employee 10's hire date was November 24, 2020; Employee 11's hire date was August 15, 2021; and Employee 12's hire date was March 28, 2019. Review of facility training records failed to reveal that the aforementioned Employees completed 12 hours of required annual training in the past 12 months. Further review of facility training records failed to reveal evidence that dementia management or abuse prevention training was completed by Employees 8, 9, 10, and 11 within the past 12 months. Further review of facility training records failed to reveal evidence that dementia management training was completed by Employee 12 within the past 12 months. During an interview with the Nursing Home Administrator on February 22, 2024, at 2:25 PM, he acknowledged that he had no documentation of actual training hours or additional training information to provide. He confirmed that he would expect required training be completed. 28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(1)(3)(e)(1) Management 28 Pa. Code 201.19 (2) (7) Personnel policies and procedures 28 Pa. Code 201.20(a)(d) Staff development FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 396122 If continuation sheet Page 26 of 26

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Citations

16 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.

0686GeneralS&S Dpotential for harm
F686 - Skin Integrity
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
0688GeneralS&S Dpotential for harm
F688 - Mobility
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
0692GeneralS&S Dpotential for harm
F692 - Assisted nutrition and hydration
Provide enough food/fluids to maintain a resident's health.
0693GeneralS&S Dpotential for harm
F693 - Assisted nutrition and hydration
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
0698GeneralS&S Epotential for harm
F698 - Dialysis
Provide safe, appropriate dialysis care/services for a resident who requires such services.
0700GeneralS&S Dpotential for harm
F700 - Bed Rails
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
0759GeneralS&S Epotential for harm
F759 - Medication Errors
Ensure medication error rates are not 5 percent or greater.
0812GeneralS&S Epotential for harm
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
0880GeneralS&S Dpotential for harm
F880 - Infection Control
Provide and implement an infection prevention and control program.
0882GeneralS&S Dpotential for harm
F882 - Infection preventionist
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
0947GeneralS&S Epotential for harm
F947 - Training Requirements
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
0606GeneralS&S Epotential for harm
F606 - The facility must—
Not hire anyone with a finding of abuse, neglect, exploitation, or theft.
0641GeneralS&S Epotential for harm
F641 - Accuracy of Assessments
Ensure each resident receives an accurate assessment.
0657GeneralS&S Dpotential for harm
F657 - Comprehensive Care Plans
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
0677GeneralS&S Dpotential for harm
F677 - A resident who is unable to carry out activities of daily living receives
Provide care and assistance to perform activities of daily living for any resident who is unable.
0730GeneralS&S Epotential for harm
F730 - Regular in-service education
Observe each nurse aide's job performance and give regular training.

FAQ · About this visit

Common questions about this visit

What happened during the February 22, 2024 survey of FOX SUBACUTE AT MECHANICSBURG?

This was a inspection survey of FOX SUBACUTE AT MECHANICSBURG on February 22, 2024. The surveyor cited 16 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at FOX SUBACUTE AT MECHANICSBURG on February 22, 2024?

Yes, 16 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide appropriate pressure ulcer care and prevent new ulcers from developing."

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.

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Data from CMS Care Compare public records. Dataset last refreshed June 22, 2026. If you believe any information is inaccurate, report it here.

Health inspection·February 22, 2024