Cadia Rehabilitation Silverside

F-F609. Prior to this survey, the facility identified the seriousness and immediacy of the deficient practice and implemented a Removal Plan on 07/11/24. A review of the facility ' s investigation revealed that the episode of failing to report abuse in a timely manner was brought to QAPI on 07/15/24, and a Performance Improvement Plan (PIP) was developed in response. The PIP was in place and reviewed from 07/15/24 through the end of September. Residents were selected randomly for review regarding abuse. All staff received re-education for abuse and the proper reporting of abuse.

The survey team validated implementation of the Removal Plan on 03/13/25 at 7:56 PM. Based on the facility's implementation of corrective actions, the IJ and Substandard Quality of Care (SQC) were determined to be PNC and the IJ was removed, with substantial compliance achieved on 07/17/24

Findings include:

Review of the facility's policy titled, Abuse, Neglect, Mistreatment, Misappropriation, Exploitation, and Reasonable Suspicions of Crime, dated 01/03/25, revealed, Policy-It is the policy of Cadia Healthcare to protect residents and prevent occurrences of abuse, neglect, mistreatment, misappropriation of resident property, exploitation, and crime. Cadia Healthcare adopts this policy to standardize procedures for employee screening, employee training, prevention, identification, investigation, protection, and reporting of abuse, neglect, mistreatment, misappropriation of resident property, exploitation, and reasonable suspicions of crime. Purpose: To ensure that all residents are protected from abuse, neglect, mistreatment, misappropriation of resident property, exploitation, and crime . Guidelines . Protection: The facility will respond immediately to protect the alleged victim, the integrity of the investigation and provide protection from retaliation. Assessment of the alleged victim will be conducted for signs and symptoms of injury (physical and/ or psychosocial). Increased supervision, room changes, and staffing changes may be provided to the alleged victim and other residents. Psychological support will be offered during and after the investigation. The named person accused of the act will be immediately suspended pending outcome of the investigation.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 27 085056 Department of Health & Human Services Printed: 08/31/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 085056 B. Wing 03/27/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Cadia Rehabilitation Silverside 3322 Silverside Road Wilmington, DE 19810

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 Reporting and Response: Witnessed or suspected incidents of abuse or reasonable suspicions of crime are to be reported immediately . The DON (Director of Nursing) or designee is responsible to conduct the abuse Level of Harm - Immediate investigation. The NHA (Nursing Home Administrator) serves as the abuse coordinator. Allegations of jeopardy to resident health or resident abuse shall be reported to the appropriate state regulatory authority within 2 hours. Incidents safety involving reasonable suspicions of criminal conduct are reported to the applicable state agency and law enforcement within 8 hours or within 2 hours if the conduct causes serious bodily harm . Residents Affected - Few

Review of Resident R80's undated Admission Record, located in Resident R80's electronic medical record (EMR) under the Profile tab, revealed Resident R80 was admitted to the facility on [DATE REDACTED] with diagnoses that include cerebral infarction, unspecified dementia with agitation, major depressive disorder.

Review of the annual Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 05/29/24, located under the MDS tab revealed a Brief Interview for Mental Status (BIMS) score of five out of 15 which indicated Resident R80' was severely cognitively impaired.

Review of the facility investigation revealed the incident occurred on 07/07/24 when Certified Nursing Assistant (CNA) 1 stuck her tongue out at Resident R80 and threw three wipes toward Resident R80's head while in the process of changing the resident. Resident R80 then attempted to throw spit at CNA1. CNA2 witnessed the incident and she and CNA1 left the room. CNA2's undated witness statement revealed that after CNA1 threw the wipes at Resident R80, Resident R80 spit into her hand and threw it at CNA1.

CNA2 reported the incident to Licensed Practical Nurse (LPN)1 on 07/07/24. The incident was not reported to the Abuse Coordinator until 07/11/24. Failing to report the allegation of abuse allowed CNA1 to remain on schedule and she worked 07/08/24, 07/10/24, 07/11/24.

Further review of the Facility Reported Incident revealed a written statement from CNA1, dated 07/11/24, indicating I stuck my tongue out at Resident R80 in response to a comment from her. Resident R80 then called me a B**** and that's when I threw three wipes at her playing around.

Phone interview on 03/13/25 at 12:26 PM CNA2 stated, Resident R80 was aggressive like normal when we went to change her. Then CNA1 threw three individual wipes at Resident R80's face, Resident R80 then spit in her hand and threw it at CNA1. After that we both walked out of the room, and I went to tell the nurse (LPN1) what happened. I went back to check on Resident R80 and she was fine, she didn't say anything about it.

During an interview on 03/13/25 at 12:52 PM, Unit Clerk (UC) 1 revealed that she initially thought to report

the incident but forgot after taking care of another resident. She learned about the incident on 07/08/24, did not report it at that time, and instead reported it on 07/11/24 after recalling it when the resident returned from

the hospital.

During an interview on 03/13/25 at 12:52 PM, Unit Clerk (UC) 1 revealed that she initially thought to report

the incident but forgot after taking care of another resident. She learned about the incident on 07/08/24, did not report it at that time, and instead reported it on 07/11/24 after recalling it when the resident returned from

the hospital.

During a phone interview on 03/13/25 at 1:20 PM, the former Administrator stated, The CNA was suspended

during the investigation and later terminated. By terminating her we would have confirmed the abuse. The DON performed the investigation.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 27 085056 Department of Health & Human Services Printed: 08/31/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 085056 B. Wing 03/27/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Cadia Rehabilitation Silverside 3322 Silverside Road Wilmington, DE 19810

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 During an interview on 03/13/24 at 2:24 PM LPN1 revealed, I could not get a clear story as to what happened, I was not able to ask Resident R80 due to cognitive status. I finished toileting Resident R80 and made sure she was Level of Harm - Immediate ok. Made sure that the aide did not return to the resident's room. I did not report anything. I thought at the jeopardy to resident health or time that keeping CNA1 away from Resident R80 and keeping Resident R80 safe was enough. Since then, I was retrained on safety the proper reporting of abuse allegations. I received training upon hire and in services after. The incident was at the end of the shift. I have no knowledge of any other concerns with CNA1. Residents Affected - Few

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 16 of 27 085056 Department of Health & Human Services Printed: 08/31/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 085056 B. Wing 03/27/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Cadia Rehabilitation Silverside 3322 Silverside Road Wilmington, DE 19810

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 15406 potential for actual harm Based on observation, interview, record review, and policy review, the facility failed to ensure an injury of Residents Affected - Few unknown origin was investigated for one out of 11 residents reviewed for abuse (Resident (R)2). Resident R2's thumb was noted with a 1.5 centimeter (cm) by 1.5 cm purple area with swelling; once staff to resident abuse was ruled out as a potential cause, the facility failed to investigate further to determine how Resident R2 sustained the injury.

Findings include:

Review of the facility's Abuse, Neglect, Mistreatment, Misappropriation, Exploitation, and Reasonable Suspicions of Crime policy dated 01/03/25 revealed, It is the policy of [facility name] to protect residents and prevent occurrences of abuse, neglect, mistreatment, misappropriation of resident property, exploitation, and crime . Injuries of unknown source are injuries where the source of the injury was not observed by any person; the source of the injury could not be explained by the resident; the injury is suspicious because of

the extent of the injury or the location of the injury . All alleged incidents . including injuries of unknown source, shall be reported to the NHA [Nursing Home Administrator] or designee immediately. The NHA or designee shall investigate allegations .

Review of the undated Admission Record in the electronic medical record (EMR) under the Profile tab revealed Resident R2 was admitted to the facility on [DATE REDACTED] with diagnoses including cerebral palsy, major depressive disorder, and anxiety disorder.

Review of the quarterly Minimum Data Set (MDS) with an assessment reference date (ARD) of 02/19/25 in

the EMR under the MDS tab revealed Resident R2 was intact in cognition with a Brief Interview for Mental Status (BIMS) score of 15 out of 15.

Review of the Incident Report for Web Intake #84519 (Initial Report) dated 03/18/24 and provided by the facility revealed Resident R2 reported on 03/18/24 that on 03/17/24 at 1:30 PM Certified Nursing Assistant (CNA)2 pinched his thumb after he threw a soda can at her, causing an injury to his thumb.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 17 of 27 085056 Department of Health & Human Services Printed: 08/31/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 085056 B. Wing 03/27/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Cadia Rehabilitation Silverside 3322 Silverside Road Wilmington, DE 19810

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 Review of the facility's Incident Report for Web Intake #84519 - Follow Up (Five Day Follow up Investigation file) provided by the facility dated 03/21/24 indicated on 03/17/24 at 2:00 PM, CNA2 was sitting at the Level of Harm - Minimal harm or computer on wheels in the long hallway and Resident R2 approached and requested that she make his bed. CNA2 potential for actual harm asked him to give her a minute as she was charting. Resident R2 responded by pushing the computer on wheels into her knees and moving the computer screen side to side. CNA2 stated she was logging off the computer to Residents Affected - Few leave when Resident R2 threw a soda can at her. CNA7 came out of another resident's room and observed CNA2 charting and Resident R2 sitting next to her. CNA7 witnessed Resident R2 throw a can of soda at CNA2. CNA2 alerted 911 to file a police report against Resident R2. Resident R2 was transported to the emergency room [ER] for a psych evaluation on 3/17/24 at 3:00 PM and returned at 9:30 PM. The report indicated that review of the ER records revealed Resident R2 stated he felt like staff was not cleaning him up after an accident or providing him with food so became frustrated and threw food. The investigation revealed on 03/18/24 Resident R2 showed the Speech Therapist his right thumb and stated CNA2 hurt him on 03/17/24. Resident R2's thumb was assessed and a 1.5 cm x 1.5 cm area of purple tone was noted. An X-ray was obtained on 03/18/24 and showed no acute fracture or dislocation but showed soft tissue swelling to the Resident R2's thumb. CNA2 was suspended related to the allegation of abuse made

on 03/18/24. CNA2 stated she did not touch Resident R2. CNA7, who was a witness stated she did not see CNA2 touch Resident R2. Video footage showed Resident R2 pushed the computer into CNA2, shook the computer screen, and threw

a soda at the CNA which hit her. The video footage in the hallway did not show CNA2 making contact with Resident R2. The investigation revealed there was no documentation about the thumb injury in the emergency room documentation on 03/17/24. The allegation of CNA2 abusing Resident R2 was unsubstantiated. There was no additional documentation showing further investigation into the injury of Resident R2's thumb, which became an injury of unknown origin after the allegation of abuse by CNA2 towards Resident R2 was ruled out as the cause.

During an interview on 03/10/25 at 12:03 PM, Resident R2 stated he remembered the incident with a CNA a year ago

in which he was pinched. Resident R2 stated a CNA wanted a soda from him and he stated no and threw the soda at her.

During an interview on 03/13/25 at 02:37 PM, the Assistant Director of Nursing (ADON) stated the abuse incident dated 03/17/24 included an allegation of CNA2 grabbing Resident R2 which was not substantiated. The ADON stated she did not remember an injury to Resident R2's hand when the original investigation was completed; however, the next day he had a scratch on his hand and it would be considered an injury of unknown origin.

The ADON stated any bruising or injury that was new and the staff did not know how it happened, was considered an injury of unknown origin.

During an interview on 03/13/25 at 7:03 PM, the Administrator confirmed the investigation occurred prior to her employment at the facility; however, she would look to see if there was any further information about the injury to Resident R2's hand.

During an interview on 03/14/25 at 12:03 PM, the Director of Nursing (DON) stated the investigation into Resident R2's injury to his hand should be part of the original investigation. The DON stated she would review the file to determine if there was any additional information to show how Resident R2's hand was injured.

During an interview on 03/14/25 at 2:19 PM, the DON stated the facility did not investigate the injury to Resident R2's thumb after it had been ruled out that CNA2 did not abuse Resident R2.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 18 of 27 085056 Department of Health & Human Services Printed: 08/31/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 085056 B. Wing 03/27/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Cadia Rehabilitation Silverside 3322 Silverside Road Wilmington, DE 19810

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 25232 potential for actual harm Based on record review, and interview, the facility failed to ensure that physician's orders were followed for Residents Affected - Few one resident (Resident (R) 208) from a sample of 41 residents reviewed. This failure has the potential to negatively impact Resident R208 and others that have similar orders that currently reside at the facility.

Findings include:

Review of Resident R208's Admission Record, located under the Profile in the Electronic medical record (EMR), indicated, that Resident R208 was readmitted to the facility on [DATE REDACTED] for hypertension.

Review of Resident R208's Order Summary Report, dated 03/22/24, located under the Orders in the EMR, indicated Propranolol HCl Oral Tablet 40 milligrams (mg), give one tablet by mouth (PO) two times (BID) a day for hypertension, hold for heart rate (HR) less than 50.

Review of Medication Administration Record (MAR), dated 03/01/24-03/30/24, under the tab Orders located

in the EMR, indicated, .Propranolol HCL oral tablet 40 mg, give one tablet PO BID .hold for HR less than 50, starting 03/22/24. There is no documented HR taken on the following dates for the morning dose: 03/24/24 and there is no documented HR taken on the following dates for the bedtime dose: 03/22/24, 03/23/24, 03/25/24, and 03/26/24.

Interview on 03/14/25 at 7:45 PM, the Director of Nursing (DON) confirmed that the HR was not taken on the dates listed above and should have been taken as ordered.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 19 of 27 085056 Department of Health & Human Services Printed: 08/31/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 085056 B. Wing 03/27/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Cadia Rehabilitation Silverside 3322 Silverside Road Wilmington, DE 19810

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 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 25232

Residents Affected - Few Based on observations, interviews, and record review, the facility failed to ensure that fall interventions were followed for one resident (Resident (R) 82) out of five residents reviewed for falls, out of a sample of 41 residents. This failure had the potential to negatively impact Resident R82 and other residents residing in the facility by not ensuring that staff consistently implemented fall interventions.

Findings include:

Review of Resident R82's Admission Record, located under the Profile tab in the Electronic Medical Record (EMR), indicated, that Resident R82 was readmitted to the facility on [DATE REDACTED] was a diagnosis of fracture of the right pelvis and

the right shoulder.

Review of a significant change in status Minimum Data Set (MDS) assessment with an Assessment Reference Date (ARD), of 01/27/25, located under the MDS tab in the EMR, indicated, Resident R82 had a Brief

Interview for Mental Status (BIMS) of nine out 15, making Resident R82 moderately impaired cognitively.

Review of facility provided [name of state] Health and Social Services Division of Health Care Quality Incident Report, dated 09/20/24, .resident status post (s/p) fall complaint (c/o) pain .Sent to the hospital for further evaluation.

Review of Resident R82's Order Summary Report, under the Orders, tab dated 03/05/25, located in the EMR, indicated, Fall precautions: low bed, nonskid footwear every shift, no longer needs bolsters.

Review of Resident R82's Care Plan, revised on 10/16/24, located under the ''Care Plan tab in the EMR, indicated, Resident R82 is at high risk for falls related to impaired cognition/confusion, deconditioning, gait/balance problems . history of community falls .actual facility fall. Interventions: .Bilateral fall mats (initiated: 07/10/24). There was no documented evidence that the care plan was revised to include a low bed as ordered by the physician on 03/05/25.

During observation on 03/10/25 at 11:29 AM, Resident R82 was sitting up in her bed with the television on. Resident R82 was observed to be alert and confused. Resident R82's bed was in a standard height with no bilateral floor mats. During

this observation, Resident R82 was attempted to be interviewed, but was confused.

During observation on 03/11/25 at 11:00 AM and 6:00 PM, Resident R82 was observed lying in bed. The bed was observed to be in standard height with no bilateral floor mats.

During observations on 03/12/25 at 9:00 AM, 12:55 PM, and 5:13 PM, Resident R82 was observed lying in bed. The bed was observed to be standard height with no bilateral floor mats.

Interview on 03/13/25 at 3:25 PM, the ADON confirmed that Resident R82 did not have bilateral floor mats, and that bed was in standard height.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 20 of 27 085056 Department of Health & Human Services Printed: 08/31/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 085056 B. Wing 03/27/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Cadia Rehabilitation Silverside 3322 Silverside Road Wilmington, DE 19810

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 25232 potential for actual harm Based on observations, record review, and interviews, the facility failed to ensure a medication error rate of Residents Affected - Some less than five percent. During observation of medication pass, there were three errors observed out of 30 opportunities, resulting in a 10% error rate. This had the potential to place two residents (Residents (R) 36 and Resident R93) at risk of not receiving the full benefit of their medication therapy.

Findings include:

1.Review of Resident R93's facility provided Order Summary Report revealed ritalin oral tablet 20 milligrams (mg) (Methylphenidate HCL), give one tablet by mouth (PO) two times (BID) a day for attention deficit disorder (ADD), starting 01/15/25.

Review of Resident R93's facility provided Order Summary Report revealed omeprazole oral capsule delayed release 40 mg, give one capsule PO one time a day for gastroesophageal reflux disease (GERD), starting 02/04/25.

Review of facility provided Blister Package indicated omeprazole 40 mg capsule, one time a day for GERD . Take on empty stomach, before eating.

Review of facility provided Blister Package indicated Methylphenidate 20 mg tablet twice daily for ADD. Preferably take 30-45 minutes before meals.

Observation on 03/12/25 at 9:00 AM, Registered Nurse (RN) 1 prepared medications for Resident R93, which included ritalin (hyperactivity medication) 20 mg one tablet, and omeprazole 40 mg one capsule, which she popped into a clear cup. After RN1 obtained all the medications needed for Resident R93, she administered the medications.

Interview on 03/12/25 at 9:05 AM, Resident R93 said that she already had eaten breakfast. Resident R93 said that she ate cereal this morning.

Interview on 03/13/25 at 10:41 AM, RN1 confirmed that she was aware that these medications were to be given before meals; however, RN1 stated that she does her best to give them to the resident before breakfast but has other things to do prior to giving these medications.

2. Review of Resident R36's facility provided Order Summary Report revealed glipizide 2.5 mg, give one tablet PO one time a day every Monday, Wednesday, Friday for diabetes. Give 30 minutes before meals, starting 12/03/24.

Review of the facility provided Blister Package indicated, glipizide 2.5 mg one tablet PO one time a day every Monday, Wednesday, Friday for diabetes. Give 30 minutes before meals.

Observation on 03/10/25 at 10:00 AM, Licensed Practical Nurse (LPN) 2 prepared medications for Resident R36, which included glipizide (diabetes medication) 2.5 mg one tablet, which she popped into a clear cup. After LPN2 obtained all the medications needed for Resident R36, she administered the medications.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 21 of 27 085056 Department of Health & Human Services Printed: 08/31/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 085056 B. Wing 03/27/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Cadia Rehabilitation Silverside 3322 Silverside Road Wilmington, DE 19810

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 Interview on 03/10/25 at 10:15 AM, LPN2 confirmed that Resident R36 already had her breakfast tray.

Level of Harm - Minimal harm or Follow up interview on 03/13/25 at 12:05 PM, LPN2 said that Resident R36's medication was held due to her blood potential for actual harm sugar being low (blood sugar documented at 112) and said that she gave Resident R36's medication around 9:00 AM; however, when the correct time for administration was discussed, LPN2 had nothing to say. Residents Affected - Some

Interview on 03/13/25 at 11:30 AM, the Director of Nursing (DON) said that she expects medications to be given as ordered, and according to blister package instructions.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 22 of 27 085056 Department of Health & Human Services Printed: 08/31/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 085056 B. Wing 03/27/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Cadia Rehabilitation Silverside 3322 Silverside Road Wilmington, DE 19810

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 15406 potential for actual harm 25232 Residents Affected - Many 36190

Based on observation, interview and policy review, the facility failed to follow Transmission Based Precautions, use proper hand hygiene, and change gloves during incontinent care. These breaches in infection control could cause a spread in disease and affect all the residents.

Findings include:

Review of the facility policy titled Infection Prevention and Control Program Policy, revised 04/14/21, provided by the facility revealed individuals with suspected or diagnosed communicable disease are placed

on the appropriate precaution for that disease, as recommended by the Centers for Disease Control and Prevention (CDC) . Employees will follow hand hygiene practices consistent with standards of care .

Review of facility provided poster titled, Stop: Enhanced Barrier Precautions Everyone Must: Clean their hands, including before entering and when leaving the room. Providers and Staff Must Also: Wear gloves and a gown for the following high-contact resident care activities: .changing linen .changing briefs or assisting with toileting, device care or use: .feeding tube.

Review of facility provided policy titled, Standard and Transmission Based Precautions, revised 01/02/25, indicated, .Policy: [name of the facility] institutes the following precautionary measures to help prevent the spread of Multi-Drug-Resistant Organisms (MDRO) and highly contagious infections/outbreaks. Our goal is to use these infection prevention principles to protect our residents and staff from spread of infections related to MDRO.

The types of precautions and when to implement are defined below.

Type of Precautions:

1. Standard Precautions-Applies to all residents. No room restrictions. Clean, non-sterile gloves when touching or coming into contact with blood, body fluids, secretions, or excretions. Remove gloves after use. Discard before touching non-contaminated items or environmental surfaces and before providing care to another resident. Hand Hygiene/alcohol-based hand gel/hand washing

2. Enhanced Barrier Precautions-Applies to all residents with wounds and/or indwelling medical devices (central line, urinary catheter, feeding tube, tracheostomy/ventilator) regardless of MDRO colonization as well as for residents with MDRO infection or colonization, when contact precautions do not otherwise apply. No room restrictions.

Hand Hygiene/alcohol-based hand gel/hand washing Personal protective equipment (PPE)-gloves and gown and/or face protection during high- contact resident care activities: i.e.changing linens, changing briefs or assisting with toileting, device care or use.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 23 of 27 085056 Department of Health & Human Services Printed: 08/31/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 085056 B. Wing 03/27/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Cadia Rehabilitation Silverside 3322 Silverside Road Wilmington, DE 19810

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 3. Contact Precautions - Applies to all residents infected or colonized with a MDRO [multidrug-resistant bacteria] in the following situations: presence of acute diarrhea, draining wounds, or other sites of secretions Level of Harm - Minimal harm or or excretions that are unable to be covered or contained, . potential for actual harm 1. Observation on 03/10/25 at 12:09 PM, Licensed Practical Nurse (LPN) 2 entered Resident R68's enhanced barrier Residents Affected - Many precaution (EBP) room with any person protective equipment (PPE) on and hung Resident R68's tube feeding, removed the cap from the tube. LPN2 primed the line, dropped the tubbing on the floor, and picked the tubbing up off the floor. At the time of picking the tubbing off the floor, there was no observed cap at the end of the tubbing, and LPN2 flung it over the tube feed (TF) pole. LPN2 sat the two cups of liquid medications

on the overbed table, then gave the medications. After incontinent care was completed, LPN2 went over to

the TF pole, obtained the tubbing that was hung over the pole, and placed the tip of the tube into the g-tube without wiping it off.

Observation on 03/10/25 at 12:24 PM, Certified Nursing Assistant (CNA) 12, entered Resident R68's EBP room with PPE on. CNA12 had a gown, gloves, and mask. CNA12 brought another gown which she placed on Resident R68's bed toward LPN2. LPN2 was on the right side of the bed that was closest to the window. CNA12 removed Resident R68's wedges, and pillows. With the same gloves, CNA12 went to the bathroom got a gray basin, filled it with water, came back out and placed it onto the overbed table, and got Resident R68's soap out of the top drawer of the nightstand. CNA12 removed Resident R68's soiled brief tucking it under Resident R68's bottom, then washing Resident R68's perineal area. With the same gloves, CNA12 rinses and dries Resident R68. CNA12 assists Resident R68 in turning over to LPN2, and then CNA12 changed her. CNA12 removed fitted sheet, and bunched up brief which was soiled with bowel movement (BM) and washed, rinsed, and dried Resident R68 all with the same gloves. CNA12 then placed a new brief

on Resident R68, and turned Resident R68 towards her, while LPN2 removed linen, without LPN2 wearing PPE. After LPN2 removed the linen, LPN2 did not change gloves, but finished fixing Resident R68's brief. CNA12 placed new linen on Resident R68's bed with the same gloves.

Review of Order Summary Report, dated 12/18/24, under the Orders tab, located in the Electronic Medical

Record (EMR), indicated, EBP related to peg tube and history of extended-spectrum beta-lactamase (ESBL)

in urine.

Interview on 03/13/25 at 12:05 PM, LPN2 was unaware of EBP for tube feeding residents, stating that she has never worn a gown before giving tube feed. Indicated that the tube had a cap on it and that cap was present prior to her inserting the tip into the g-tube.

Interview on 03/13/25 at 1:00 PM, CNA12 confirmed that she did not change her gloves when going from a dirty area to a clean area and indicated that she should have.

2. During observation on 03/11/25 at 10:06 AM, the Assistant Director of Nursing (ADON) went into Resident R53's room without washing and/or sanitizing her hands prior to entering the room. Resident R53 is on enhanced barrier precautions (EBP) and there was a sign on the door to let staff know what to do and a clear bin next to Resident R53's door for personal protective equipment (PPE).

Review of Order Summary Report, dated 12/02/24, under the Orders tab, located in the EMR, indicated, EBP related to gastrojejunostomy (GJ) tube.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 24 of 27 085056 Department of Health & Human Services Printed: 08/31/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 085056 B. Wing 03/27/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Cadia Rehabilitation Silverside 3322 Silverside Road Wilmington, DE 19810

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 3. During the medication observation pass on 03/11/25 at 10:39 AM, Registered Nurse (RN) 3 observed popping Resident R74's seven medications into his left hand from the medication blister package followed by placing Level of Harm - Minimal harm or them into a clear medication cup on top of the medication cart. RN3 then gave Resident R74 his medication. potential for actual harm

Interview on 03/13/25 at 10:53 AM, RN3 confirmed that he popped the medication into his hand; however, Residents Affected - Many RN3 said that he sanitized his hands first and it was better than dropping the medication.

Interview on 03/13/25 at 11:30 AM, the Director of Nursing (DON), she said that she expects nurses to pop medications directly into the medication cup, not into their hands.

4. Observation on 03/12/25 at 9:40 AM, the ADON entered Resident R11's EBP room without washing her hands and/or sanitizing her hands; however, placed a gown on. Along with the ADON, Licensed Practical Nurse Supervisor (LPNS)2, entered the room at the same time, without putting on a gown, and did not wash hands and/or sanitize hands before entering the room but put on gloves. LPNS2 picked up linen off the floor near bed B and ADON left the room at 9:43 AM, removing her gown without sanitizing her hands or washing her hands, going down the hallway to get a hamper, and returned to the room. At 9:46 AM, ADON went back inside the room without washing hands and/or sanitizing hands and delivered hamper to LPNS2. LPNS2 finished gathering linen up off the floor and gathered linen off bed B, placing all linen in the hamper.

Interview on 03/12/25 at 9:52 AM, the LPNS2 confirmed that she did not wear any PPE and should have. Confirmed that linen should not have been on the floor.

5. Observation on 03/13/25 at 3:25 PM, the ADON entered and exited Resident R82's EBP room without washing and/or sanitizing her hands.

Review of Resident R82's Order Summary Report, dated 12/11/24, located under Orders tab in the EMR, documented, Enhanced Barrier Precautions related to history of Methicillin-resistant Staphylococcus aureus (MRSA).

Interview on 03/14/25 at 2:00 PM, the ADON confirmed that she did not sanitize hands and/or wash her hands prior to and/or exiting EBP rooms as she should.

Interview on 03/13/25 at 10:01 AM, the Infection Preventionist (IP) confirmed that medications should be popped directly into a medication cup, not into a nurse's hand. Said that when providing peri-care, gloves are to be changed when going from a dirty area to a clean area. She said that when giving medications through

a gastrotomy tube (g-tube), if the tubing falls on the floor, that tubing is not to be used. If a resident is on EBP donning (putting on) is to occur prior to entering the room along with washing and/or sanitizing hands, and doffing (taking off) PPE prior to exiting the room, placing PPE in the bins provided in the room. After staff exit

an EBP room, staff are to wash their hands and/or sanitize their hands.

6. Review of Resident R15's admission Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 02/05/25 and located in the electronic medical record (EMR) under the MDS tab, revealed Resident R15 had an admitted [DATE REDACTED] and a Brief Interview for Mental Status (BIMS) score of 15 out of 15, which indicated Resident R15's cognition was intact. The MDS assessment indicated Resident R15 had diagnoses of aftercare following joint replacement surgery, cancer, and disorder involving the immune mechanism, unspecified.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 25 of 27 085056 Department of Health & Human Services Printed: 08/31/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 085056 B. Wing 03/27/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Cadia Rehabilitation Silverside 3322 Silverside Road Wilmington, DE 19810

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 Review of Resident R15's nurses notes, dated 03/08/25, located in the EMR under the Progress Note tab revealed Received Urinalysis culture report. Urine positive for ESBL [extended-spectrum beta-lactamase (a bacteria Level of Harm - Minimal harm or resistant to many antibiotics)]. Notified on call nurse [name] and obtained order for 1gm [gram] of Ertapenem potential for actual harm [antibiotic] daily x 7 days. Notified Infection Control Nurse. Awit [sic] further recommendations. Called Mr. [name] and informed of UA [urine analysis] Culture report and the start of the antibiotics. Residents Affected - Many

Review of Resident R15's orders, dated 03/08/25, located in the EMR under the Order tab revealed Contact Precautions r/t [related to] ESBL in urine with ABT [antibiotic] tx [treatment] every shift for ESBL UTI [urinary tract infection] for 10 Days.

On 03/10/25 at 2:12 PM, Resident R15's room was noted to have a sign that read Stop, Contact Precautions everyone must: clean their hands, including before entering and when leaving the room. Providers and staff must also: put on gloves before room entry. Discard gloves before room exit. Put on gown before room entry. Discard gown before room exit . Use dedicated or disposable equipment. Clean and disinfect reusable equipment

before use on another person. A supply of protective personnel equipment (PPE) that included gowns and gloves were hanging on the outside of the door.

On 03/10/25 at 2:13 PM, Heavy Housekeeping (HH)1 was observed to knock on Resident R15's closed door, enter

the room without donning a gown and gloves and started sweeping the floor. Resident R15 was sitting in the room dressed and groomed and talking on her phone as HH1 swept the floor around her.

On 03/10/25 at 2:15 PM, HH1 came out of Resident R15's room and briefly went across the hall to another room to sweep with the same broom and then back to his cart. HH1 was asked if he was supposed to wear a gown and gloves when cleaning Resident R15's room. The contact precaution sign and the supply of PPE supplies were pointed to on the door. HH1 stated he wouldn't have known if he should use the gowns as no one told him. HH1 confirmed he didn't wear a gown and gloves into Resident R15's room.

On 03/12/25 at 12:22 PM, Licensed Practical Nurse (LPN)2 was observed entering Resident R15's room without donning a gown to give Resident R15's medications and stayed in the room for a few minutes talking with Resident R15. LPN2 came out of Resident R15's room and back to the medication cart. LPN2 was asked if Resident R15 was still under contact precautions and LPN2 stated, No. LPN was asked if she should have used PPE to give medications and the supply of PPE and the contact precaution sign were pointed to on the door. LPN2 stated, No, only if she came in contact with Resident R15's urine.

During an interview on 03/13/25 at 10:30 AM, the Infection Preventionist (IP) was asked about Resident R15. The IP stated Resident R15 was currently taking an antibiotic for a urinary tract infection with ESBL. The IP stated Resident R15 was complaining of burning upon urination and that's when a urinary analysis was conducted. The laboratory results came back with ESBL. The IP went on to say Resident R15 was receiving treatment and contact precautions were started. The IP was asked if housekeeping should use PPE when cleaning Resident R15's room since she has ESBL. The IP stated, Yes, housekeeping should use PPE. The IP was informed that HH1 didn't use PPE on 03/10/25. The DON was present and stated housekeeping were contract and they are responsible for their own training. The IP stated she will assist with additional training with housekeeping if she identifies a need.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 26 of 27 085056 Department of Health & Human Services Printed: 08/31/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 085056 B. Wing 03/27/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Cadia Rehabilitation Silverside 3322 Silverside Road Wilmington, DE 19810

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 During an interview on 03/13/25 at 10:35 AM, the IP asked if LPN2 should wear PPE while passing medications to Resident R15 while in her room. The IP stated, Yes. The IP was informed that LPN2 entered Resident R15's Level of Harm - Minimal harm or room without donning PPE to give medications on 03/12/25. The IP was informed that LPN2 stated Resident R15 potential for actual harm wasn't under contact precautions and that she should only wear PPE if she encountered Resident R15's urine.

Residents Affected - Many 7. Review of the COVID-19 policy dated 01/03/25 and provided by the facility revealed it was the policy of the facility, to prevent the spread of COVID-19 (Coronavirus) . When a resident meets the criteria to be a Person Under investigation (PUl) for symptoms identified or confirmed COVID, staff must contact the Provider and

the Director of Nursing (DON). The resident will immediately be placed in isolation with contact/droplet precautions using Personal Protective Equipment (PPE) as described below . Personnel entering the room should use PPE, including gown, gloves, N95 respirator (or equivalent or higher level respirator), and eye protection. Facemasks can be used if N95 respirator (or equivalent or higher level respirator) is not available. For residents with suspected or confirmed COVID-19, an N95 (or equivalent or higher level respirator) mask, eye protection, gloves, and gown must be worn while performing any of the above procedures.

Review of the undated Admission Record in the electronic medical record (EMR) under the Profile tab revealed Resident R158 was admitted to the facility on [DATE REDACTED] and was discharged on [DATE REDACTED]. Resident R158's closed record was reviewed.

Review of a Physician's Order dated 10/13/24 and provided by the facility revealed the Physician ordered droplet and contact precautions for Resident R158 from 10/13/24 through 10/21/24.

During an interview on 03/11/25 at 3:47 PM, Family Member (FM)1 stated Resident R158 was quarantined during her stay due to being exposed to someone in the facility with COVID in October 2024.

During an interview on 03/13/25 at 10:12 AM with the IP and the DON, they stated if a resident was exposed to COVID, they were placed on quarantine with both contact and droplet precautions in place for eight days. All staff were required to don a gown, wear gloves, an N95 mask, eye protection, and a face shield to go into

a COVID quarantine room. The IP and DON stated that the door to the room should remain closed.

During an interview on 03/13/25 at 10:49 AM, LPN4 stated she remembered Resident R158 being quarantined due to exposure to staff that tested positive for COVID. LPN4 stated Resident R158 was under quarantine for seven days and there should have been a sign regarding isolation and PPE requirements posted outside the door. LPN4 stated contact isolation would have been in effect and nursing staff would have been required to wear full PPE if providing resident care: however, she did not think other staff such as housekeepers would have been required to wear PPE. LPN4 did not indicate that droplet precautions should also be in effect.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 27 of 27 085056