Emerald Nursing And Rehabilitation

agencies.

minimal harm Based on observations and interviews with residents and staff, it was determined that the facility failed to post the results of the most recent Department of Health survey in a place readily accessible

the survey revealed a posting that the state survey results were available in the lobby.Interview with residents during a group meeting on April 21, 2026, at 1:00 p.m. revealed that they were not aware of the location of the state survey results.

The residents also revealed that they do not have access to the lobby and the elevator to the lobby requires a code.Interview with the Nursing Home Administrator on April 23, 2026, at 12:50 p.m. confirmed that the survey results were only located in the lobby which is not readily accessible to the residents.28 Pa.

Code: 201.14(a) Responsibility of licensee.Previously cited 12/22/25, 8/4/25, 5/22/25

Review of Resident 2's progress note of January 7, 2026, revealed that the resident was seen by the wound nurse practitioner (NP) and was noted to have a painful, red lump to the incision line. NP recommended to reach out to wound center and or surgeon. An additional note on January 7, 2026, revealed that a representative from the surgical group suggested that the resident be sent to the emergency department.

Resident was admitted for left above the knee amputation cellulitis (bacterial infection of the deep skin layers).

Review of facility documentation failed to reveal evidence that the State Ombudsman's office was notified of Resident 2's transfer and admission to the hospital.

Review of Resident 5's progress note of January 9, 2026, revealed that 911 was activated to take Resident 5 to the hospital for treatment and evaluation of crushing chest pain. An additional note on January 11, 2026, revealed that Resident 5 was admitted to the hospital for congestive heart failure exacerbation.

Review of facility documentation failed to reveal evidence that the State Ombudsman's office was notified of Resident 5's transfer and admission to the hospital.

Review of Resident 8's progress note of February 16, 2026, revealed that Resident 8 was admitted to the hospital with a diagnosis of osteomyelitis.

Review of facility documentation failed to reveal evidence that the State Ombudsman's office was notified of Resident 8's transfer and admission to the hospital.

Review of Resident 9's progress note of December 27, 2025, revealed that the resident was experiencing respiratory distress, hypoxia (low oxygen levels), productive cough, and was using abdominal muscles to breath.

Resident appeared cyanotic (bluish or purplish discoloration of the skin, lips, or mucous membranes caused by low oxygen saturation in the blood.

Resident was transferred to the hospital.

Progress note of December 29, 2026, revealed that the resident was admitted to the hospital for respiratory failure with hypoxia.

Interview with Employee E5 on April 23, 2026, at 1:00 p.m. confirmed that the above residents were not on the list provided to the State Ombudsman's office. 483.15 Admission, Transfer, and Discharge Previously cited 5/22/25 28 Pa.

Code 201.14(a) Responsibility of licensee Previously cited 12/22/25, 8/4/25, 5/22/25

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Emerald Nursing and Rehabilitation 320 South Market Street Elizabethtown, PA 17022

reviewed (Resident 2).Findings include:Review of Resident 2's quarterly MDS (Minimum Data Set -

resident was receiving insulin on one day in the last seven days Further review of the physician's orders and Medication Administration Record revealed no evidence that the resident received insulin during the assessment lookback period.Interview with licensed staff, E4, on April 23, 2026, at 1:35 p.m. confirmed that the assessment was coded inaccurately.28 Pa.

Code 211.5(f) Clinical records

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Emerald Nursing and Rehabilitation 320 South Market Street Elizabethtown, PA 17022

catheter care as directed by facility policy. 28 Pa.

Code 211.12(c)(d)(1)(5) Nursing Services

3/27/2026

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Emerald Nursing and Rehabilitation 320 South Market Street Elizabethtown, PA 17022

Review of Resident 31's weights revealed a weight of 131.0 pounds on December 2, 2025, and 111.0 pounds on January 8, 2026 indicating a loss of 20 pounds or 15.3%.

Further review of the clinical record revealed that no reweight was obtained. Resident 31's weight was recorded as 113.0 pounds on January 15, 2026, and 125.0 pounds on January 20, 2026, indicating a gain of 14 pounds or 12.6% with no reweight obtained.

Next weight of 116.0 pounds was obtained on February 3, 2026, indicating a loss of 9 pounds or 7.2% with no reweight obtained.

Interview with Employee E4 on April 23, 2026, at 1:00 p.m. confirmed that Resident 31's weights were not being verified for accuracy. 483.25 Nutrition/Hydration Status MaintenancePreviously cited 5/22/25 28 Pa.

Code 211.12(d)(1)(3)(5) Nursing servicesPreviously cited 5/22/25

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Emerald Nursing and Rehabilitation 320 South Market Street Elizabethtown, PA 17022

serve food in accordance with professional standards.

sanitization monitoring and documentation was completed for daily dishwasher sanitization for one of

the kitchen on April 20, 2026, at 10:00 a.m. revealed the dishwashing machine to be running.Interview with Employee E6 on April 20, 2026, at 10:00 a.m. revealed the dishwasher water temperature to be 125 degrees.

Review of the dishwasher log on April 20, 2026, at 10:00 a.m. revealed the log to be completed.Observation during a second visit to the kitchen on April 22, 2026, at 10:15 a.m. revealed the dishwasher to be running.Interview with Employee E6 on April 22, 2026, at 10:15 a.m. revealed that no test strips were immediately available to test the sanitization of the water coming out of the dishwasher.Upon locating test strips, the water was tested and revealed to be greater than 100 PPM (parts per million).

Review of the dishwasher sanitization log on April 22, 2026, at 10:15 a.m. revealed that the sanitization was tested during the cleaning of breakfast dishes.Interview with Employee E6 on April 22, 2026, at 10:15 a.m. revealed Employee E6 had completed the log for the breakfast dishes.Observation of the dishwasher sanitization log revealed that the entire day was completed on April 22, 2026, at 10:15 a.m.Interview with Food Service Director Employee E7 confirmed that employees are to test the sanitization of the dishwasher during each meal and to complete the log after the completion of the testing of the sanitization of the water.This interview further confirmed that the log was inappropriately completed ahead of the meals on April 22, 2026, and therefore no adequate sanitization was tested during each meal. 28 Pa.

Code 211.6(f) Dietary ServicesPreviously cited 5/22/2025

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Emerald Nursing and Rehabilitation 320 South Market Street Elizabethtown, PA 17022

of two residents observed (Resident 1).Findings include:Review of facility policy and procedure titled

(e.g. handwashing, antiseptic technique, gloves, isolation preventions, etc.) for the administration of medications, as applicable.Observation of medication administration on April 22, 2026, at 9:00 a.m. revealed Licensed Employee E3 cut open medication pill packets and spill the medications onto the top of the medication cart.

Licensed Employee E3 picked up the medications off of the top of the medication cart and placed them in a medication cup and administered them to Resident 1.The above information was conveyed to Licensed Employee E4 and the Nursing Home Administrator on April 23, 2026, at 1:00 p.m. 28 Pa.

Code 211.12(c)(d)(1)(5) Nursing ServicesPreviously cited 5/22/2025, 7/16/2025, 8/4/225, 12/22/2025, 2/4/2026, 3/27/2026

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Emerald Nursing and Rehabilitation 320 South Market Street Elizabethtown, PA 17022