Cambridge Rehabilitation And Healthcare Center

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

asked the CNA where the documentation regarding the care required by Resident #2 could be located. The CNA stated that the care was entered on the Plan of care. CNA #3 showed the resident the Kardex and verified that Resident #2 was dependent on staff for care, the resident could not assist with turning/rolling from side to side. CNA #3 informed the surveyor that she had been taking care of the resident for the last three years. The CNA stated that Resident #2 was a FULL complete. When asked to elaborate she stated, Resident #2 was bedridden, she required 2 persons assist with care. Resident #2 could not turn on their own as they were immobile. She cared for the resident with her hallway partner daily. The CNA further stated that the day of the fall she was about to leave the unit when she observed the resident on the floor bleeding and both CNA #1 and CNA #2 were in the room. She went to the nursing station and informed the nurse.The facility did not provide any statement from CNA #3.On 11/6/25 at 2:00 PM, the surveyor interviewed the DON regarding the plan of care implemented for Resident #2. The DON stated again that

she did not look at the MDS coding yet and could not comment on the plan of care.On 11/6/25 at 2:05 PM,

the surveyor reviewed the MDS coding with the DON and asked if the CNA should have followed the plan of care. In the presence of the survey team, the DON stated, yes. The CNAs should have followed the plan of care.The facility concluded that CNA #1 performed tasks properly per protocols. Resident #2 moved their arm which shifted their weight and they loss trunk balance, landing on the floor. Root Cause: Resident rolled out of bed, which caused a fall during incontinent and linen change while in bed. On 11/6/25 at 2:18 PM, during a telephone interview with CNA #1 who cared for Resident #2 on 9/5/25, she stated that Resident #2 did not have siderails in use. CNA #1 stated that she did not check the plan of care prior to provide care to Resident #2. She was not aware that Resident #2 required two-persons physical assist with care. CNA #1 further stated that she did not get report from the 7:00 AM-3:00 PM shift regarding Resident #2's plan of care. However, the investigation was completed and closed on 9/18/25. 62 days had elapsed, and the facility could not comment on the plan of care required by Resident #2. Based on the assessment provide and dated 7/21/25, Resident #2 required 2 persons physical assist with care. On 11/6/25 at 2:45 PM, the DON did not provide the in-service education that was done following the incident. The DON provided an in-service education dated 8/22/25 regarding ADL. The CNA involved with the fall of 9/5/25 was not in attendance.NJAC 8:39-9.4(f)

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If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/06/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Cambridge Rehabilitation and Healthcare Center

255 East Main St Moorestown, NJ 08057

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 Level of Harm - Actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

administrator. Policy Interpretation and implementation- The nurse supervisor/charge nurse and/or the department director or supervisor shall promptly initiate and document investigation of the accident or incident. The following data, as applicable, shall be included on the Report of Incident/ Accident. The data and time. The nature of the injury/illness (e.g., bruise, fall) .The circumstances surrounding the accident or incident. Follow up information, other pertinent data as necessary or required. The administrator and /or director of nursing will determine the need for further action and follow-up, as deemed appropriate based

on the results of the investigation.The Care Plans Comprehensive Person-Centered policy, last revised 2/2022, revealed the following:Policy Statement- A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident.Policy Interpretation and Implementation-The care plan interventions are derived from a thorough analysis of the information gathered as part of the comprehensive assessment. NJAC 8:39-27.1(a), NJAC 8:39-11.2(e) 1 .

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/06/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Cambridge Rehabilitation and Healthcare Center

255 East Main St Moorestown, NJ 08057

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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

of pain, location and description of the pain. The DON stated that the nurse would also be responsible to call the provider to obtain an order for pain medications. The DON continued to explain that nurses were expected to follow-up with the provider for further interventions to manage the pain and to document the effectiveness of the interventions.The facility policy titled, Pain Assessment and Management dated April 2025 indicated that the purpose of this procedure were to help staff identify pain in the resident, development of interventions and address the underlying cause of pain. General guidelines indicated that staff were to identify underlying causes, intensity, duration, type and characteristics of pain and to address

the underlying cause of pain. The policy reflected that non-pharmacological interventions may be appropriate alone or in conjunction with medications. The medication regimen is implemented as ordered and results of the interventions are documented and communicated to the provided when appropriate.NJAC 8:39-27.1(a)

Event ID:

Facility ID:

If continuation sheet