Inspection Reports for
Country Meadows of Forks
175 NEWLINS ROAD WEST,, EASTON, PA, 18040
Back to Facility Profile29 Reports
Notice — Apr 21, 2026
Date: Apr 21, 2026
Visit Reason
The document serves to notify the facility that a waiver request to waive the high school diploma or GED requirement for direct care staff has been granted under Pennsylvania Code 2600.19 due to education obtained outside the United States.
Findings
The waiver is granted with conditions requiring documentation of education and training to be kept on file and available for review. The Department of Human Services will review the waiver annually during inspections to ensure compliance.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Theresa Hartman | Bureau Director, Human Services Licensing | Signed the waiver approval letter. |
Notice — Jan 6, 2026
Date: Jan 6, 2026
Visit Reason
This document serves to notify the facility that a waiver request to 55 Pa.Code § 2600.54(a)(2) regarding direct care staff qualifications has been granted.
Findings
The waiver allows a specific employee to serve as direct care staff despite not meeting the usual high school diploma or nurse aide registry requirements, based on education obtained outside the United States. The waiver is subject to annual review during the facility's annual inspection and requires documentation to be maintained.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Theresa Hartman | Bureau Director, Human Services Licensing | Signed the waiver approval letter. |
Inspection Report — Jul 24, 2025
Renewal
Date: Jul 24, 2025
Visit Reason
The inspection was an unannounced full renewal inspection conducted on 07/24/2025 to review compliance with licensing requirements.
Findings
The facility had multiple deficiencies related to resident equipment safety, unobstructed egress, fire drill scheduling, medication management, resident assessment content, special care unit admission documentation, key-locking device signage, and record-keeping for destroyed resident records. All deficiencies had accepted plans of correction which were fully implemented by 09/18/2025.
Citations (8)
Resident #1’s bedside mobility device was uncovered with an opening posing risk of entrapment and was not firmly attached to the bed.
Blocked egress in the boiler room preventing evacuation.
Fire drills routinely held during sleeping hours at beginning or end of 3rd shift.
Discontinued medication (Rosuvastatin 10 mg) found in resident #2’s medication cart.
Resident #1’s assessment did not include information about use of bedside mobility device.
Resident #3’s record lacked documentation of agreement to admission to special care unit.
Directions for operating key-locking device not posted near exit door by room 17 in special care unit.
Destroyed Record Log did not include resident record number.
Report Facts
Residents Served: 84
Special Care Unit Residents Served: 37
Current Hospice Residents: 6
Residents Age 60 or Older: 84
Residents with Mobility Need: 37
Residents with Physical Disability: 1
Inspection Report — May 21, 2024
Plan of Correction
Date: May 21, 2024
Visit Reason
The document addresses deficiencies found in resident support plans related to documentation of assistance levels and device use, and outlines the facility's plan of correction to ensure regulatory compliance.
Findings
The inspection found that resident support plans lacked specific documentation regarding the level of assistance required for hydration encouragement, social participation, and use of assistive devices such as bed canes.
Citations (3)
Resident #1's support plan does not indicate the level of assistance required for hydration encouragement and agitation management.
Resident #5's support plan does not indicate the level of assistance required for participation in social and leisure activities.
Resident #5's support plan lacks documentation on the specific need, intended use, risks, safe use ability, device specifics, and FDA guideline compliance for a bed cane.
Report Facts
Plan of Correction Completion Date: Jun 12, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Administrator | Responsible for monitoring support plans to ensure regulatory compliance | |
| Director of Nursing | Responsible for monitoring support plans to ensure regulatory compliance |
Inspection Report — May 2, 2024
Complaint Investigation
Date: May 2, 2024
Visit Reason
The inspection was conducted as a complaint and incident investigation during an unannounced partial inspection on 05/02/2024.
Complaint Details
The inspection was complaint-related, but no deficiencies were found and no follow-up was required.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Report Facts
Residents Served: 75
Special Care Unit Residents Served: 40
Hospice Residents: 10
Resident Support Staff: 0
Total Daily Staff: 115
Waking Staff: 86
Residents Age 60 or Older: 75
Residents with Mobility Need: 40
Inspection Report — Sep 26, 2023
Renewal
Date: Sep 26, 2023
Visit Reason
The inspection was conducted as a renewal inspection with complaint reason noted, including unannounced full licensing inspections on 09/26/2023 and 09/29/2023.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Report Facts
Residents Served: 77
Special Care Unit Residents Served: 43
Hospice Current Residents: 9
Total Daily Staff: 114
Waking Staff: 86
Residents Age 60 or Older: 77
Residents with Mobility Need: 37
Inspection Report — Feb 14, 2023
Follow-Up
Date: Feb 14, 2023
Visit Reason
The inspection visit was conducted as a follow-up to verify the implementation of a submitted plan of correction related to a complaint/incident.
Complaint Details
The visit was complaint-related, triggered by an incident where a staff member used inappropriate language and behavior towards a resident. The plan of correction was accepted and fully implemented.
Findings
The submitted plan of correction was determined to be fully implemented. The report details a violation involving staff mistreatment of a resident, with corrective actions including suspension, termination, retraining, and ongoing monitoring.
Citations (1)
Staff person A yelled at and used foul language during an interaction with resident #1, witnessed by others and reported to the administrator.
Report Facts
Residents Served: 73
Special Care Unit Residents Served: 32
Hospice Current Residents: 7
Residents Age 60 or Older: 73
Residents with Mobility Need: 32
Inspection Report — Dec 28, 2022
Complaint Investigation
Date: Dec 28, 2022
Visit Reason
The inspection was conducted as a complaint and incident investigation at the facility on 12/28/2022.
Complaint Details
The visit was complaint-related and incident-driven, with a follow-up type of Plan of Correction submission and document submission. The complaint was investigated on-site on 12/28/2022.
Findings
Two deficiencies were identified: one involving unsafe access to poisonous materials by a resident, and another involving incomplete documentation of a resident's behavior in the support plan. Both deficiencies had plans of correction accepted and were implemented by 03/08/2023.
Citations (2)
Poisonous materials were not kept locked and inaccessible to a resident who cannot safely use or avoid them, as evidenced by a resident having a bottle of hand sanitizer with the pump in their mouth.
The support plan for a resident in the special care unit was not updated to reflect the resident's behavior of self-propelling a wheelchair and collecting items.
Report Facts
Residents Served: 74
Special Care Unit Residents Served: 33
Hospice Residents: 8
Resident Mobility Need: 35
Total Daily Staff: 109
Waking Staff: 82
Inspection Report — Oct 13, 2022
Follow-Up
Date: Oct 13, 2022
Visit Reason
The inspection was a partial, unannounced follow-up visit triggered by an incident to verify the implementation of a previously submitted plan of correction.
Findings
The submitted plan of correction was determined to be fully implemented. The report details multiple resident abuse violations involving staff members and residents, including delayed reporting of abuse, physical abuse resulting in injury, and verbal abuse. Appropriate corrective actions, including staff coaching, retraining, suspension, and termination, were completed and verified.
Citations (3)
Failure to immediately report suspected abuse of a resident, with delayed notification to the administrator.
Resident 2 fractured their hip after being hit multiple times by Resident 3 with a shoe, indicating physical abuse.
Staff Member C was observed cursing at and antagonizing Resident 1 by waving a t-shirt in their face, constituting verbal abuse.
Report Facts
Residents Served: 70
Special Care Unit Residents Served: 34
Hospice Residents: 10
Residents Age 60 or Older: 70
Residents with Mobility Need: 36
Total Daily Staff: 106
Waking Staff: 80
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff Member C | Named in verbal and physical abuse findings; was suspended and subsequently terminated. | |
| Staff Member A | Involved in delayed reporting of abuse. | |
| Staff Member B | Aware of abuse but did not report immediately. | |
| Staff Member D | Supervisor who delayed notifying the administrator about abuse. | |
| Administrator | Administrator | Responsible for retraining staff and monitoring resident behaviors. |
| Director of Nursing | Director of Nursing | Responsible for monitoring resident behaviors as needed. |
Inspection Report — Aug 30, 2022
Complaint Investigation
Date: Aug 30, 2022
Visit Reason
The inspection was conducted as a complaint investigation with an unannounced partial inspection on 08/30/2022.
Complaint Details
The inspection was complaint-related, but no deficiencies or citations were substantiated.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Report Facts
Residents Served: 70
Special Care Unit Residents Served: 32
Hospice Current Residents: 10
Total Daily Staff: 105
Waking Staff: 79
Residents 60 Years or Older: 70
Residents with Mobility Need: 35
Residents with Physical Disability: 1
Inspection Report — Jul 14, 2022
Renewal
Date: Jul 14, 2022
Visit Reason
The inspection was conducted as a licensing inspection by the Pennsylvania Department of Human Services, Bureau of Human Service Licensing.
Findings
No regulatory citations were identified as a result of this inspection.
Inspection Report — Jun 28, 2022
Renewal
Date: Jun 28, 2022
Visit Reason
The inspection was an unannounced full renewal inspection conducted over three days from 06/28/2022 to 06/30/2022 to review compliance with licensing requirements.
Findings
The facility had multiple deficiencies including issues with contract signatures, outdated food, fire extinguisher inspections, medication administration and labeling, storage procedures, support plans, key-locking device postings, and staff training. All deficiencies had accepted plans of correction which were fully implemented by the time of the report.
Citations (13)
The resident-home contract for Resident #1 was signed by the resident's power of attorney but not by the resident, with no indication the resident was offered to sign.
There was a dented can of Dole pineapple tidbits in the home's kitchen pantry.
The fire extinguisher in the mechanical room had not been inspected since June 2020, exceeding the required annual inspection timeframe.
Resident #2 had medications in their bathroom despite medical evaluation indicating they cannot self-administer medications.
A container of Clomitrozole Cream 1% prescribed to Resident #3 was in the medication cart but not listed as a current order in the medication record.
The pharmacy label for Resident #5's Pain Reliever Plus tab did not include the medication dosage.
The glucometer for Resident #4 was not calibrated for the current date and time; several PRN medications were missing from the medication cart at inspection.
Resident #5's medication record did not list the dosage for Pain Reliever Plus tabs.
Resident #6 was administered Metoprolol despite systolic blood pressure being below the hold parameter.
Resident #7's assessment and support plan did not document the need for a bed cane used for transfers.
Directions for operating locked exit doors in the special care unit were not conspicuously posted; the keypad code posted was incorrect.
Direct care staff person A in the special care unit completed only 6.5 hours of required initial dementia training instead of 8 hours.
Direct care staff person A did not complete required training on managing challenging behaviors.
Report Facts
Inspection dates: 3
Residents served: 74
Special care unit residents served: 34
Hospice residents: 5
Total daily staff: 109
Waking staff: 82
Residents with mobility need: 35
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Direct care staff person A | Named in findings related to incomplete dementia care training and missing training on managing challenging behaviors | |
| Director of Nursing | Director of Nursing | Responsible person for multiple medication-related deficiencies and training compliance |
| Administrator | Administrator | Responsible person for contract signature deficiency and support plan documentation |
| Director of Maintenance | Director of Maintenance | Responsible for fire extinguisher inspections and audits |
| Dining director | Dining director | Responsible for food inspection and canned goods audits |
Inspection Report — Nov 2, 2021
Renewal
Date: Nov 2, 2021
Visit Reason
The inspection was conducted as a licensing inspection by the Pennsylvania Department of Human Services, Bureau of Human Service Licensing.
Findings
No regulatory citations were identified as a result of this inspection.
Inspection Report — Aug 24, 2021
Renewal
Date: Aug 24, 2021
Visit Reason
The inspection was conducted as a renewal and complaint investigation for the facility.
Findings
The submitted plan of correction was found to be fully implemented following the inspection. One deficiency was noted involving outdated food in the kitchen freezer, specifically an undated package of pizza sausage weighing approximately 5 pounds.
Citations (1)
The freezer located in the kitchen had 1 package of pizza sausage that was approximately 5 pounds that was not dated.
Report Facts
Residents Served: 69
Special Care Unit Residents Served: 32
Hospice Residents: 1
Notice — Jun 9, 2021
Date: Jun 9, 2021
Visit Reason
The document serves as a certificate of compliance and license renewal for Country Meadows of Forks Assisted Living-Special Care facility, confirming the renewal application was received and a regular license issued. It also notifies that an annual onsite inspection will be conducted within the next twelve months as required by state regulations.
Findings
No inspection findings are reported in this document. It confirms the issuance of a regular license following the renewal application and outlines the requirement for a future annual inspection to ensure compliance.
Report Facts
Inspection Report — May 10, 2021
Follow-Up
Date: May 10, 2021
Visit Reason
The inspection was a follow-up review to verify that the submitted plan of correction was fully implemented following prior deficiencies.
Findings
The submitted plan of correction was determined to be fully implemented, with continued compliance required. A specific deficiency related to dignity and respect was addressed by staff suspension, resignation, and retraining.
Citations (1)
Direct care staff member pushed a resident's forehead back after the resident pushed the staff member's stomach, failing to treat the resident with dignity and respect.
Report Facts
Residents Served: 66
Special Care Unit Residents Served: 32
Hospice Residents: 1
Resident Mobility Need: 33
Total Daily Staff: 99
Waking Staff: 74
Inspection Report — Dec 15, 2020
Renewal
Date: Dec 15, 2020
Visit Reason
The inspection was conducted as part of the Pennsylvania Department of Human Services licensing inspections on 12/15/2020 and 12/17/2020 for the facility COUNTRY MEADOWS OF FORKS.
Findings
No regulatory citations were identified as a result of this inspection.
Notice — May 15, 2020
Date: May 15, 2020
Visit Reason
The document serves as a renewal notification for the assisted living home license and informs that the Department will conduct an onsite annual inspection within the next twelve months as required by regulation.
Findings
No inspection findings are reported in this document. It is a license renewal notice and certificate of compliance.
Report Facts
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kevin Hancock | Deputy Secretary | Signed the renewal notification letter |
Inspection Report — Dec 12, 2019
Renewal
Date: Dec 12, 2019
Visit Reason
The inspection was an unannounced renewal visit to assess compliance with licensing requirements at Country Meadows of Forks.
Findings
The facility had three violations related to posting of influenza posters, fire drill evacuation times exceeding limits, and a late quarterly review of a resident's final support plan. All plans of correction were approved and fully implemented as of January 30, 2020.
Citations (3)
The influenza poster was not posted in a public conspicuous area as required by the Influenza Awareness Act. The facility corrected this by posting the DHS website poster instead of the CDC poster.
Fire drills exceeded the maximum evacuation time designated by the fire safety expert, with drills taking 17 minutes 24 seconds and 15 minutes 6 seconds. The facility modified procedures and retrained staff to complete drills within the required time.
A resident's quarterly final support plan review was late due to an error in transcription of the review month. The director of wellness conducted audits to ensure timely quarterly reviews going forward.
Report Facts
Residents Served: 68
Special Care Unit Residents Served: 30
Hospice Current Residents: 2
Residents Age 60 or Older: 68
Residents with Mobility Need: 30
Residents with Physical Disability: 1
Inspection Report — Dec 3, 2019
Complaint Investigation
Date: Dec 3, 2019
Visit Reason
The inspection was conducted as a complaint investigation following allegations related to incident reporting and medical care.
Complaint Details
The complaint was substantiated based on failure to timely report an incident and delay in securing medical care for a resident with a fractured ankle.
Findings
The facility failed to report a resident's fractured ankle incident timely and did not secure medical care promptly after the resident's fall. The submitted plan of correction was fully implemented and approved.
Citations (2)
2600.16c The home failed to report a resident's fractured ankle incident to the Department's regional office within 24 hours as required. The incident was reported several days late after the resident complained of pain and difficulty ambulating.
2600.142a The home did not secure medical care promptly when a resident reported pain and difficulty ambulating after a fall. An x-ray was delayed until requested by a family member, revealing a fracture.
Report Facts
Residents Served: 64
Residents Served in Dementia Unit: 31
Current Hospice Residents: 2
Total Daily Staff: 95
Waking Staff: 71
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Susan Parker | Administrator | Named as facility administrator in violation report |
| Amy Deluca | Department Representative | On-site inspector for the complaint investigation |
| Diana Ponterio | Sr. VP of Ops/Regulatory Compliance | Signed plan of correction documents |
| Michele Moskalczyk | Human Services Licensing Supervisor | Approved plan of correction and signed cover letter |
Inspection Report — May 17, 2019
Renewal
Date: May 17, 2019
Visit Reason
This document is a renewal license issued in response to a May 10, 2019 renewal application to operate an Assisted Living Home. The Department advises that an onsite annual inspection will be conducted within the next twelve months as required by regulation.
Findings
No inspection findings are reported in this document. It serves as a license renewal certificate and notification letter.
Report Facts
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jacqueline L. Rowe | Director | Signed the renewal notification letter |
Inspection Report — Aug 16, 2018
Renewal
Date: Aug 16, 2018
Visit Reason
The inspection was conducted as a renewal of the facility license for Country Meadows of Forks, an assisted living residence, to assess compliance with 55 Pa. Code Ch. 2800.
Findings
The inspection identified multiple violations including food storage issues, fire hazard risks, resident evacuation noncompliance during fire drills, and medication labeling errors. Plans of correction were submitted addressing each violation with monitoring and retraining measures.
Citations (6)
Regulation 103a: A bag of mini pancakes was found unsealed in the memory care kitchenette freezer. All improperly wrapped food was discarded and staff retrained on proper food handling.
Regulation 105g-1: The lint basket of the commercial dryer contained lint, a tissue, and a straw posing a possible fire hazard. Lint was removed and cleaning protocols established.
Regulation 132h: Resident #1 and Resident #2 refused to evacuate during fire drills on 7/2/18 and 10/19/17 respectively. Counseling was provided and fire drills were successfully rerun.
Regulation 184b: Resident #3's stool softener and prevagen medications were not labeled with the resident's name. All medications were labeled and staff retrained on medication storage.
Regulation 227h: Resident #4's ASP dated 6/16/18 was unsigned and lacked documentation of refusal or inability to sign. The ASP was re-reviewed and signed; future signatures will be obtained.
Regulation 252: Resident #4 and #5's records did not include identifying marks. Identifying marks were added and procedures established for future admissions.
Report Facts
Number of Residents Served: 67
Number of Residents Served in Secured Dementia Care Unit: 32
Number of Current Hospice Residents: 4
Number of Hospice Residents in Past Year: 10
Notice — Feb 22, 2018
Date: Feb 22, 2018
Visit Reason
This letter responds to a waiver request related to qualifications for direct care staff persons at Country Meadows of Forks.
Findings
The Department determined that a diploma from Holy Child School of Davao, Philippines is equivalent to a U.S. high school diploma and that a waiver is not needed for the specified individual.
Report Facts
Waiver request: 55
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jill Kachmar | Regulatory Licensing Manager | Signed the waiver determination letter. |
Inspection Report — Aug 3, 2017
Renewal
Date: Aug 3, 2017
Visit Reason
The inspection was a renewal inspection combined with an incident inspection conducted on August 3, 2017, at Country Meadows of Forks Assisted Living Residence.
Findings
Multiple violations were found related to resident agreements, fire hazards, medication management, prescription labeling, medication storage, and support plan documentation. Plans of correction were partially implemented with adequate progress noted.
Citations (7)
Regulation 2800.25(b): Resident #1's home contract was not signed by the resident. The resident was unable to sign due to dementia and has since been discharged.
Regulation 2800.125(a): A combustible microfiber cloth was found on top of the dryer ductwork in the laundry area, posing a fire hazard.
Regulation 2800.183(d): Acetaminophen medication in the medication cart for resident #2 was not a current order from the resident's physician.
Regulation 2800.184(c): Resident #1's prescribed Pentasa medication lacked written instructions from the prescriber.
Regulation 2800.185(a): The glucometer for resident #3 was not calibrated to the current time, and medication for resident #4 was not on hand when requested.
Regulation 2800.227(c): Resident #4's Assessment and Support Plan was not completed within the required timeframe; a quarterly update was missing.
Regulation 2800.227(d): Resident #1's Assessment and Support Plan did not address a recent incident involving a stabbing and related care needs.
Report Facts
Number of Residents Served: 53
Number of Residents in Secured Dementia Care Unit: 17
Number of Current Hospice Residents: 4
Number of Hospice Residents in Past Year: 8
Residents Age 60 or Older: 53
Residents with Mobility Need: 18
Notice — May 30, 2017
Date: May 30, 2017
Visit Reason
The document serves as a renewal notification and license issuance for the assisted living facility Country Meadows of Forks, confirming the facility's authorized capacity and informing about the requirement for annual onsite inspections.
Findings
No inspection findings are reported in this document. It is a license renewal approval letter and certificate of occupancy.
Report Facts
Notice — Aug 29, 2016
Date: Aug 29, 2016
Visit Reason
This document serves as a waiver approval for Country Meadows of Forks regarding specific assisted living residence regulations under 55 Pa.Code Ch. 2800, specifically for resident living units in the licensed special care unit.
Findings
The waiver allows the facility to omit cooking appliances such as microwaves in resident living units within the special care unit, while requiring provision of a cabinet, bar-type sink with running water, and a small refrigerator. The waiver is subject to annual review during the facility's annual inspection and may be terminated if conditions are not met.
Report Facts
Waiver reference: 55
License number: 226550
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jacqueline L. Rowe | Director | Signed the waiver approval letter |
Inspection Report — Aug 23, 2016
Original Licensing
Date: Aug 23, 2016
Visit Reason
The inspection was conducted as a licensing inspection for the newly licensed assisted living facility Country Meadows of Forks. The visit was unable to complete a full inspection because the home was new and not yet serving four or more residents.
Findings
The facility was found to be in substantial compliance with applicable regulations. Three deficiencies were cited related to fire extinguisher placement, exit signage, and key-locking device directions, all of which had corrective plans implemented by the time of the report.
Citations (3)
131c - A fire extinguisher was not located in the "Reflections" kitchen as required. An appropriate fire extinguisher was installed on the day of the survey and will be monitored monthly.
133a1 - Exit signs for the exit door in the Lafayette Room and the lobby door leading to the front patio were not placed in the residence. Exit signs were placed at these exits on the day of the survey and will be monitored for compliance.
233c - The gate in the "Reflections" courtyard was secured by a magnetic key-locking device without posted directions. A key pad with directions was installed on the courtyard gate and will be monitored for ongoing compliance.
Report Facts
Number of Residents Served: 0
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jacqueline L. Rowe | Director | Signed licensing inspection letter |
| Michelle Hamilton | Chief of Senior Living Operations | Signed plan of correction approval |
Report — May 29, 2018
May 29, 2018
Report — March 31, 2017
March 31, 2017
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