Inspection Reports for
Celebration Villa of Shippensburg

No regulatory citations or deficiencies were identified as a result of this inspection.

The visit was complaint-related, investigating incidents of verbal and physical abuse involving staff and residents. The investigation substantiated the abuse allegations and other regulatory violations.

The inspection found multiple violations including failure to report an incident timely, verbal and physical abuse among residents, incomplete medical evaluations within required timeframes, unsecured medications, and incomplete preadmission screening forms. Corrective actions and staff education were implemented with ongoing monitoring.

The waiver outlines the required training and monitoring procedures for direct care staff administering GLP-1 agonist injections, including initial and annual training, policy development, and availability of a clinical contact.

The Department reviewed the submitted information and determined that the informed consent process includes voluntary participation, the right to discontinue use, and notification of residents' rights, satisfying regulatory privacy requirements. The letter does not endorse the device but reminds the facility to maintain compliance with all regulations.

The submitted plan of correction was determined to be fully implemented. However, deficiencies were found related to fire drill records and evacuation times exceeding the safe evacuation time specified by a fire safety expert.

The facility was found to have deficiencies related to missing resident contract signatures, improper medication storage with loose pills found, and incomplete documentation of mobility needs for a resident. Plans of correction were accepted and implemented with follow-up monitoring scheduled.

The Department issued a regular license in response to the renewal application and advised that an onsite inspection will be conducted within the next twelve months to ensure compliance with applicable regulations.

The complaint was substantiated based on the staff member's verbal threat to a resident. The staff member was suspended immediately and terminated on 6/12/2020. An internal investigation and reporting to the Cumberland County Office of Aging and the Department of Human Services occurred.

A staff member was found to have verbally abused a resident during assistance in the bathroom. The staff member was suspended and subsequently terminated. A plan of correction including re-education and resident interviews was accepted.

No inspection findings are reported in this document. It serves as a license renewal notification and states that inspections will be conducted annually to ensure compliance.

The submitted plan of correction was found to be fully implemented. Two violations were noted: missing emergency telephone numbers posted near the pool table and inadequate use of alternate exit routes during fire drills in 2019.

No inspection findings are reported in this document. It is a license renewal notice with no deficiencies or compliance issues mentioned.

The inspection was complaint-related due to an incident on 6/28/2018 involving Resident 1 being combative during incontinence care. The staff member involved was suspended and terminated after an internal investigation. The staff member was placed on a performance improvement plan for failure to report the incident immediately.

Violations of 55 Pa.Code Chapter 2600 related to Personal Care Homes were found, including a resident being treated without dignity and respect during incontinence care. A staff member was suspended and placed on a performance improvement plan due to failure to report the incident.

The facility was found to be in substantial but not complete compliance with 55 Pa. Code Chapter 2600. Two violations were identified related to annual medical evaluations and support plan development.