Camp Hill Skilled Nursing And Rehabilitation Ctr

Review of Resident 120's census information revealed the most recent date of Medicare A coverage that began on December 22, 2025, and ended on December 23, 2025.

Review of Resident 120's Skilled Nursing Facility Beneficiary Notification Review form revealed the Resident had not been provided with the required Skilled Nursing Facility-Advance Beneficiary Notice of Non-Coverage form (SNF-ABN) to be informed of the cost of the items and services no longer covered under Medicare A and the cost of those items and services.

Review of Resident 121's clinical record revealed an admission date to the facility on December 17,

• Review of Resident 121's census information revealed the most recent date of Medicare A

coverage that began on January 1, 2026, and ended on January 16, 2026, when the Resident was discharged home from the facility.

Review of Resident 121's Skilled Nursing Facility Beneficiary Notification Review form revealed the Resident had not been provided with the required Notice of Medicare Non- Coverage (NOMNC) form to indicate that her stay was no longer covered under Medicare A.

Review of Resident 122's clinical record revealed an admission date to the facility on August 8, 2025.

Review of Resident 122's census information revealed the most recent date of Medicare A coverage that began on September 21, 2025, and ended on October 26, 2025.

Review of Resident 122's Skilled Nursing Facility Beneficiary Notification Review form revealed the Resident had not been provided with the required SNF-ABN form to be informed of the cost of the items and services no longer covered under Medicare A and the cost of those items and services. An interview with the Nursing Home Administrator on February 24, 2026, at 12:15 PM, confirmed the facility had not provided those residents with the required notices. 28 Pa.

Code 201.14 (a) Responsibility of licensee

395440 02/26/2026

Camp Hill Skilled Nursing and Rehabilitation Ctr 1700 Market Street Camp Hill, PA 17011

Observation in Resident 22's room on February 25, 2026, at 9:51 AM, revealed the wall was damaged in a corner of the room, the baseboard was coming away from the wall, four of the ceiling tiles in her room had brown stains on them, and there were holes in the wall above her bed, consistent as the day before.

Observations in Resident 26's room on February 24, 2026, at 10:30 AM and at 2:11 PM, revealed her tray table was dirty with a spilled liquid, and the floor around her bed was dirty.

Observation in Resident 26's room on February 25, 2026, at 9:50 AM, revealed her tray table was dirty with a spilled liquid, and the floor around her bed was dirty, consistent as the day before.

Observations in Resident 30's room on February 24, 2026, at 10:25 AM and at 2:11 PM, revealed the table on the side of her bed was dirty with several rings from beverage cups, and the floor underneath the table was dirty.

Observation in Resident 30's room on February 25, 2026, at 9:49 AM, revealed the table on the side of her bed was dirty with several rings from beverage cups, and the floor underneath the table was dirty, consistent as the day before.

Observations in Resident 84's room on February 24, 2026, at 12:27 PM and at 2:13 PM, revealed the baseboard was coming away from the wall and the wall was damaged.

Observation in Resident 84's room on February 25, 2026, at 9:52 AM, revealed the baseboard was coming away from the wall and the wall was damaged, consistent as the day before.

During an interview with the Nursing Home Administrator (NHA) on February 25, 2026, at 2:04 PM, the surveyor communicated the environmental concerns in Resident 22's, 26's, 30's, and 84's rooms, the NHA revealed the concerns would be addressed immediately, and he would expect the facility to provide housekeeping and maintenance services necessary to maintain a safe, clean, comfortable and home-like environment.28 Pa.

Code 201.18(e)(2.1) Management 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 TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

395440 02/26/2026

Camp Hill Skilled Nursing and Rehabilitation Ctr 1700 Market Street Camp Hill, PA 17011

Review of Resident 5's clinical record revealed diagnoses that included cirrhosis of the liver (a condition in which the liver is scarred and permanently damaged), chronic kidney disease (a long-term, progressive condition where the kidneys are damaged and gradually lose their ability to filter waste and excess fluid from the blood), and dementia (a loss of thinking, remembering, and reasoning skills).

Review of Resident 5's census information revealed multiple hospital transfers and included a hospital transfer date of October 26, 2025, with a return and readmission to the facility on November 2, 2025.

Review of the facility's document titled Consultant Pharmacist's Progress Note, dated November 4, 2025, revealed the following documented as Transcription Errors: Hospital d/c [discharge order] Lactulose 10 gm/15 m/-Give 30 ml TID [three times per day].

Current order: Lactulose 10 gm/15ml-Give 30 ml QD [once per day].

Upon review by the Certified Registered Nurse Practitioner (CRNP) (Employee 2), it was revealed that an agreement to change the lactulose order to the recommended dosage made on the hospital discharge summary.

Review of the pharmacist's progress notes also revealed Hospital d/c order-Tamsulosin 0.4 QD.

Current order - Tamsulosin 0.4 mg-Give 2 capsules (0.8mg).

Upon review by Employee 2, an agreement was documented to change to 0.4 mg 1 cap at HS [hour of sleep- bedtime].

Review of the pharmacist's progress notes revealed Hospital d/c order-Bumetanide 1 mg BID [twice per day].

Current order- Bumetanide 0.5 mg BID.

Upon review by Employee 2, an agreement was documented to change the medication order to Bumetanide 1 mg BID.

Continued review of Resident 5's monthly consultant pharmacy recommendation for the Resident's physician to address, dated November 20, 2025, read Per DC [discharge summary] resident was ordered levothyroxine 37.5 mg po [by mouth] ONCE DAILY. On 11/3/2025, it was ordered twice daily; this med [medication] typically dosed once daily.

Upon review of the pharmacy recommendation, Employee 2 agreed with the recommendation and documented Please change to 37.5 mcg ONCE daily. An interview with the Director of Nursing on February 26, 2026, at 10:15 AM, revealed that the Registered Nurse (Employee 1) did not have possession of Resident 5's hospital discharge record and used the prior medication list to review with the physician at Resident 5's readmission to the facility.

The interview revealed that Employee 1 should have used the hospital discharge medication order recommendations to review with the physician and add to Resident 5's clinical record instead of Resident 5's medications listed before the hospitalization. 28 PA.

Code 211.12 (d) (1) (2) (5) Nursing services

395440 02/26/2026

Camp Hill Skilled Nursing and Rehabilitation Ctr 1700 Market Street Camp Hill, PA 17011

Review of Resident 8's clinical record revealed diagnoses that included polyneuropathy (a nerve disease caused by damage to many nerves) and hypertension (high blood pressure).

Observation conducted of Resident 8 on February 24, 2026, at 10:13 AM, revealed the Resident was lying in bed, not wearing a float heel, and did not have any pillows placed under their foot.

Interview conducted with Resident 8 on February 25, 2026, at 11:58 AM, revealed that he hardly ever wears a right heel boot as staff do not place it on him. Resident 8 revealed his heel boot was in his closet.

Observation conducted of Resident 8 on February 25, 2026, at 11:59 AM, revealed the Resident lying in bed, not wearing a float heel, and did not have any pillows placed under their foot.

Observation conducted of Resident 8 on February 25, 2026, at 12:36 PM, revealed the Resident lying in bed, without a float heel on.

Review of Resident 8's care plan revealed a focus area that the Resident is at risk for skin breakdown related to pressure ulcer to right heel, revised on January 23, 2026; with an intervention to wear a prevalon boot to right foot when in bed.

Review of Resident 8's clinical record revealed the Resident had a wound assessment completed on January 15, 2026, for a pressure ulcer on their right heel, with a nutrition recommendation for a dietitian consultation, as well as a recommendation to place heel-float boots to bilateral feet while in bed to offload the heels.

The facility was unable to provide documentation that a dietary consultation has been made or conducted per the wound assessment recommendation above for Resident 8.

Review of Resident 8's clinical record revealed their most recent dietary consult was conducted on September 29, 2025.

Review of Resident 8's clinical record revealed the Resident had a wound assessment completed on January 22, 2026, with the following treatment recommendations: primary dressing: 1.

Santyl ointment; secondary dressing:

• Vashe moistened gauze 2.

Foam; this treatment will be done daily and as needed until discontinued. Review of Resident 8's January 2026 TAR (Treatment administration record) revealed an order for: Santyl External Ointment 250 unit/gram (Collagenase); apply to right heel topically every day shift for pressure ulcer, with a start date of January 23, 2026, and a discontinue date of January 31, 2026.

The order failed to include the secondary dressing in the recommendation from the wound assessment above on January 22, 2026.

Review of Resident 8's February 2026 TAR revealed an order for: Right heel boots on all the time except for care every shift for pressure ulcer prevention, with a start date of October 23, 2025.

Further review of the TAR revealed that on February 24 and 25, 2026, during every shift, it was documented that Resident 8 was wearing a right heel boot.

During an interview with the Nursing Home Administrator and Director of Nursing on February 26, 2026, at 10:05 AM, revealed they would expect Resident 8 to be wearing their heel boot as ordered and documented, would expect wound assessment recommendations to be completed, and for wound orders to be put in correctly. 28 Pa.

Code 211.12(d)(1) Nursing services.28 Pa.

Code 211.12(d)(3) Nursing services.28 Pa.

Code 211.12(d)(5) Nursing services.

395440 02/26/2026

Camp Hill Skilled Nursing and Rehabilitation Ctr 1700 Market Street Camp Hill, PA 17011

Review of Resident 97's clinical record revealed diagnoses that included chronic obstructive pulmonary disease (COPD - a progressive, incurable, but treatable lung disease) and obstructive sleep apnea (serious, common sleep disorder where throat muscles relax excessively, causing repeated airway collapse and breathing pauses [apnea] during sleep).

Observation of Resident 97 on February 24, 2026, at 10:24 AM, revealed Resident 97 lying in bed. Resident 97 was wearing a nasal canula (oxygen delivery device) and receiving supplemental oxygen at 2 liters per minute.

Review of Resident 97's care plan revealed a care plan of: Resident exhibits or is at risk for respiratory complications related to recent hospitalization, COPD, created on October 23, 2025.

Review of current physician orders for Resident 97 failed to reveal a physician's order for supplemental oxygen.

Interview with the Director of Nursing on February 26, 2026, at 10:15 AM, revealed that Resident 97 had an order for supplemental oxygen previously, but the order had not been renewed. 28 Pa.

Code 211.12(d)(1) Nursing services.28 Pa.

Code 211.12(d)(3) Nursing services.28 Pa.

Code 211.12(d)(5) Nursing services.

395440 02/26/2026

Camp Hill Skilled Nursing and Rehabilitation Ctr 1700 Market Street Camp Hill, PA 17011

86's lidocaine patch to have been added to the order and for it to have been administered as ordered

395440 02/26/2026

Camp Hill Skilled Nursing and Rehabilitation Ctr 1700 Market Street Camp Hill, PA 17011

Review of Resident 7's clinical record revealed diagnoses that included post-traumatic stress disorder (PTSD - a disorder in which a person has difficulty recovering after experiencing or witnessing a terrifying event.

The condition may last months or years, with triggers that can bring back memories of the trauma, accompanied by intense emotional and physical reactions) and major depressive disorder (ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life).

Review of Resident 7's clinical record revealed the Resident was seen by a psychiatry on December 31, 2025, and January 20, 2026, with documentation of the visit to include the Resident had trauma history with being abused as a child by stepfathers and prefers not to have male caregivers.

Review of Resident 7's care plan on February 24 and 25, 2026, revealed a care plan for Resident 7 being at risk for distressed/fluctuating mood symptoms related to anxiety and PTSD, initiated and created on December 1, 2025.

Further review of Resident 7's care plan failed to reveal an intervention that the Resident prefers not to have male caregivers, or any triggers identified.

Review of Resident 7's clinical record revealed the Resident had a trauma assessment completed on February 25, 2026, at 12:52 PM, and scored a 4, which indicated a positive screen for trauma.

Interview conducted with the Nursing Home Administrator on February 26, 2026, at 10:04 AM, revealed he would have expected Resident 7's trigger of male caregivers to have been added to her care plan prior to this date and have been in place. 28 Pa.

Code: 201.14(a) Responsibility of licensee.28 Pa.

Code: 201.18(b)(1) Management28 Pa.

Code 211.12(d)(3)(5) Nursing Services.

395440 02/26/2026

Camp Hill Skilled Nursing and Rehabilitation Ctr 1700 Market Street Camp Hill, PA 17011

Review of Resident 4's clinical record revealed diagnoses that included major depressive disorder (a serious, common mood disorder characterized by persistent sadness, loss of interest, and fatigue, lasting at least two weeks and impairing daily life) and dementia (a general term for severe mental function loss).

Review of Resident 's medical record revealed a recommendation made on September 9, 2025, by the consultant pharmacist to add an parameters for Resident 4's PRN (as needed) pain medication.

Further review of the record failed to reveal that the physician had reviewed or taken action to address the irregularity.

Review of Resident 's medical record revealed a recommendation made on December 29, 2025, by the consultant pharmacist, to add an appropriate dose for Resident 4's pain medication.

Further review of the record failed to reveal that the physician had reviewed or taken action to address the irregularity.

Interview with the Director of Nursing on February 26, 2026, at 10:45 AM, revealed that they would expect the regulation to be followed and that the physician would review the irregularities, document what, if any, action has been taken to address it, and document his or her rationale in the resident's medical record. 28 Pa.

Code 211.10(c) Resident care policies.

Review of facility diet extension sheet for the lunch meal on February 25, 2026, revealed the regular/liberalized diet should be served a slice of angel food cake, and the consistent carbohydrate diet should be provided a slice of diet angel food cake.

Observations during tray line meal service on February 25, 2026, between 12:07 PM and 12:41 PM, revealed Residents 5, 8, 15, 52, 68, and 106 were served a piece of angel food cake on their trays.

Review of physician orders for Resident 5, 8, 15, 52, 68, and 106 revealed they were ordered a consistent carbohydrate diet for diabetes.

Review of physician orders for Resident 4, 6, 7, 9, 10, 16, 20, 24, 31, 35, 49, 50, 59, 64, 67, 69, 75, 77, 78, 85, 87, 88, 89, 96, 99, 104, 109, 110, 123, 124, and 126, revealed they were also ordered a consistent carbohydrate diet for diabetes.

During an interview with Employee 4 (Dietary Manager) on February 25, 2026, at 12:46 PM, he revealed the angel food cake served at lunch today was the same angel food cake served across all diet orders.

Review of the nutrition facts and ingredients label for Angel Food [NAME] Cake served at the lunch meal on February 25, 2026, revealed the cake contained 28 grams of total carbohydrates and 20 grams of sugar.

Further review of the ingredients revealed the number one ingredient of the cake was sugar, and there were no sugar substitutes present in the ingredients.

Interview with the Nursing Home Administrator on February 25, 2026, at 2:06 PM, revealed he would expect therapeutic diets to be provided as ordered and extension sheets to be followed for therapeutic diet alterations. 28 Pa Code 201.18(b)(1) Management

395440 02/26/2026

Camp Hill Skilled Nursing and Rehabilitation Ctr 1700 Market Street Camp Hill, PA 17011

December 2025.

The NHA revealed his expectation that expired items are discarded, foods items are

Pa.

Code 211.6(f) Dietary services

395440 02/26/2026

Camp Hill Skilled Nursing and Rehabilitation Ctr 1700 Market Street Camp Hill, PA 17011