Inspection Reports for
Faithful Living
2015 N Reading Rd, Denver, PA 17517, PA, 17517
Back to Facility Profile29 Reports
Inspection Report — May 14, 2026
Complaint Investigation
Date: May 14, 2026
Visit Reason
The inspection was conducted as a complaint investigation to review compliance with regulatory requirements at the facility.
Complaint Details
The inspection was complaint-driven as indicated by the inspection information section stating 'Reason: Complaint'.
Findings
The inspection identified multiple deficiencies related to medical evaluations, follow prescriber's orders, resident assessments, and medication self-administration. The facility submitted a plan of correction which was accepted and fully implemented.
Citations (6)
141a - Medical Evaluation: The medical evaluation for a resident was not completed within 60 days prior to admission or within 30 days after admission and did not include the resident's diagnoses.
141b1 - Annual Medical Evaluation: A resident's annual medical evaluation did not include cognitive functioning or medical information pertinent to diagnoses and treatment.
187d - Follow Prescriber's Orders: A resident ordered to wear compression stockings daily was found not wearing them at specified times, requiring staff assistance.
225a - Assessment 15 Days: A resident's initial assessment was completed with an incorrect date, not within 15 days of admission.
225c - Additional Assessment: Resident assessments did not reflect changes in oxygen needs, mobility status, or evacuation ability accurately.
227e - Self Administer Medication: A resident's support plan inconsistently documented the ability to self-administer medications, showing conflicting information.
Report Facts
Residents Served: 71
Current Residents in Hospice: 5
Resident Support Staff: 0
Total Daily Staff: 84
Waking Staff: 63
Inspection Report — Apr 14, 2026
Renewal
Date: Apr 14, 2026
Visit Reason
The inspection was conducted as a renewal and incident review of the facility's compliance with licensing requirements.
Findings
The inspection identified multiple deficiencies including issues with carbon monoxide alarm battery labeling, resident abuse involving financial exploitation, privacy concerns with camera placement, equipment safety, sanitary conditions, medication management, and fire drill compliance. Plans of correction were accepted and implemented for all findings.
Citations (14)
According to the Care Facility Carbon Monoxide Alarm Standards Act, CO alarm batteries were not replaced annually as required and had outdated labels.
A staff member financially exploited a resident by requesting money for personal expenses, resulting in staff termination.
Cameras in common areas recorded footage with angles considered too wide, potentially violating resident privacy.
The enabler bar on a resident's bed was not secured and slid out from under the mattress with light pressure.
Sanitary conditions were compromised by use of a glucometer on the wrong resident, feces in a bathroom, and strong odors with gnats in resident rooms.
Trash cans in the library and bathroom were uncovered and overflowing, allowing insect and rodent penetration.
Floors and surfaces in resident rooms were unclean, including food debris on the floor.
A common towel was used in a shared bathroom without sanitary hand drying means, violating hygiene standards.
Food was stored on the floor in the dry food storage closet, violating storage requirements.
Fire drills during sleeping hours were not conducted within the required six-month interval.
A pill was found on the hallway floor outside a resident's room, indicating medication was not properly secured.
A discontinued medication was found in the home's medication cart for a resident.
A resident's medication container label did not include sliding scale orders for insulin administration.
Discrepancies were found in a resident's glucometer blood sugar reading and documented medication administration record; some prescribed medications were unavailable in the home.
Report Facts
Residents Served: 67
Current Residents Hospice: 5
Residents Age 60 or Older: 62
Residents with Mobility Need: 13
Inspection Report — Nov 12, 2025
Complaint Investigation
Date: Nov 12, 2025
Visit Reason
The inspection was conducted as a complaint and incident investigation at the facility.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Report Facts
Residents Served: 65
Current Hospice Residents: 4
Residents Age 60 or Older: 59
Residents Receiving Supplemental Security Income: 6
Residents Diagnosed with Mental Illness: 6
Residents Diagnosed with Intellectual Disability: 3
Residents with Mobility Need: 13
Residents with Physical Disability: 2
Inspection Report — Jul 17, 2025
Plan of Correction
Date: Jul 17, 2025
Visit Reason
The inspection was an unannounced partial inspection conducted as an interim review to verify that the submitted plan of correction was fully implemented.
Findings
Multiple deficiencies were identified related to resident record confidentiality, sanitary conditions, building maintenance, medication storage and administration, and smoking area safety. All deficiencies had accepted plans of correction with completion dates in August 2025 and were reported as implemented by late August.
Citations (9)
Resident records were unlocked, unattended, and accessible in the office and closet areas, violating confidentiality requirements.
A piece of food with approximately 15 ants was found in the main hallway outside the dining room.
A half-moon shaped crack approximately six inches long was found in the ceiling of a room.
A window in a resident's room was open without a screen present.
Heavy accumulation of air conditioning condensate and dark-colored slime on the exterior dining room wall created a slippery fall hazard.
Multiple boxes of food including ground beef, cookies, and pound cake were stored on the floor of the walk-in freezer.
Heavy accumulation of cigarette ashes was found underneath chairs in the designated smoking area outside the dining room.
Prescription medications and syringes were unlocked and accessible on top of the medication cart in the hallway; a small red pill was found on the floor outside the dining room.
A prescribed medication for constipation was not available in the home, constituting a repeated violation.
Report Facts
Residents Served: 65
Number of ants: 15
Inspection Report — Dec 17, 2024
Complaint Investigation
Date: Dec 17, 2024
Visit Reason
The inspection was conducted as a complaint investigation to review compliance with regulatory requirements and to verify the submitted plan of correction.
Complaint Details
The visit was complaint-related as indicated by the inspection information. The submitted plan of correction was reviewed and determined to be fully implemented. Medication errors were self-reported and investigated with no adverse effects noted.
Findings
The inspection found deficiencies related to incomplete medical evaluations lacking mobility assessments, medication administration errors including missed doses and over-administration, and missing determinations on preadmission screening forms. Plans of correction were accepted and implemented with follow-up dates scheduled.
Citations (3)
Resident initial and annual medical evaluations did not include the mobility needs assessment.
Medication administration errors including missed doses and over-administration of prescribed medications.
Resident preadmission screening form did not include a determination that the needs of the resident can be met by the services provided by the home.
Report Facts
Residents Served: 55
Total Daily Staff: 62
Waking Staff: 47
Resident with Supplemental Security Income: 16
Residents 60 Years or Older: 49
Residents with Mobility Need: 7
Residents with Intellectual Disability: 1
Residents with Physical Disability: 1
Medication Administration Error Doses: 18
Inspection Report — Sep 26, 2023
Complaint Investigation
Date: Sep 26, 2023
Visit Reason
The inspection was conducted as a complaint and incident investigation at Faithful Living facility on 09/26/2023.
Complaint Details
The visit was complaint-related involving allegations of abuse and medication errors. The abuse allegation was investigated, substantiated by suspension and termination of the staff member involved. Other complaints involved medication and smoking policy violations.
Findings
Multiple deficiencies were found including abuse by a staff member, smoking policy violations, medication administration errors, unlabeled and expired medications, and unsecured medications and syringes. Plans of correction were accepted and implemented with ongoing quality assurance measures.
Citations (6)
Staff person A intentionally kicked Resident #1 and made disparaging remarks.
Smoking paraphernalia found near main entrance despite designated smoking areas and posted signs.
Medication administration errors including medications left unattended and residents not properly supervised.
Prescription medications found in unlabeled containers in resident rooms.
Medications and syringes were found unlocked, unattended, and accessible in resident rooms and shared areas.
Expired and unlabeled medications found in unlocked drawer in shared resident room.
Report Facts
Residents Served: 66
Staffing Hours: 67
Waking Staff: 50
Residents Receiving Supplemental Security Income: 11
Residents Age 60 or Older: 61
Residents Diagnosed with Mental Illness: 18
Residents Diagnosed with Intellectual Disability: 10
Residents with Mobility Need: 1
Residents with Physical Disability: 2
Current Hospice Residents: 1
Cigarette Butts Observed: 7
Pills Found in Unattended Medicine Cup: 3
Expired Medication Bottles: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff person A | Named in abuse allegation and terminated following investigation | |
| MW | Employee who received disciplinary action for medication administration errors |
Inspection Report — May 10, 2023
Complaint Investigation
Date: May 10, 2023
Visit Reason
The inspection was conducted as a complaint investigation to review compliance at the facility following a complaint.
Complaint Details
The visit was complaint-related as indicated by the inspection information section stating 'Reason: Complaint'.
Findings
Multiple deficiencies were identified including an inoperable bathroom ventilation fan, safety hazards due to exposed holes and wires, cigarette butts found outside designated smoking areas, unsecured medications accessible to residents, and incomplete medication records. Plans of correction were accepted and implemented by mid-June 2023.
Citations (5)
The ventilation fan located in Resident 1's bathroom was inoperable and there was no window in the bathroom.
Exposed hole in cement slab and exposed wires, hosing, and copper pipes in the rear of the home posing safety and tripping hazards.
Cigarette butts found outside designated smoking areas near the main entrance.
Unsecured medications found in Resident 2 and Resident 3's bedrooms despite orders that residents cannot self-administer medications.
Medication found behind Resident 3's television was not listed on the Medication Administration Record.
Report Facts
Residents Served: 69
Resident with Mobility Need: 1
Residents 60 Years or Older: 64
Residents Diagnosed with Mental Illness: 18
Residents Diagnosed with Intellectual Disability: 5
Residents with Physical Disability: 1
Residents Receiving Supplemental Security Income: 12
Total Daily Staff: 70
Waking Staff: 53
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Regional Director of Operations | Removed unsecured medications from Resident 2 and Resident 3's apartments upon notification. | |
| Administrator | Notified maintenance of deficiencies, re-educated residents and staff on medication storage and administration, and responsible for daily room checks and staff education. | |
| Maintenance Director | Performed repairs and maintenance related to ventilation fan, exposed wires, and cement slab hazards. |
Inspection Report — Apr 13, 2023
Follow-Up
Date: Apr 13, 2023
Visit Reason
The inspection was conducted as a partial, unannounced incident review to verify the submitted plan of correction for the facility.
Findings
The facility was found to have discrepancies in medication storage and documentation, specifically regarding Resident #1's glucometer readings and medication administration records. The submitted plan of correction was accepted and determined to be fully implemented.
Citations (2)
Failure to develop and implement procedures for safe storage, access, security, distribution, and use of medications and medical equipment by trained staff, evidenced by undocumented glucometer readings and discrepancies in recorded times.
Medication administration record deficiencies where the number of units administered to Resident #1 was not entered on the medication administration record.
Report Facts
Residents Served: 70
Resident Age 60 or Older: 64
Residents Diagnosed with Mental Illness: 18
Residents Diagnosed with Intellectual Disability: 5
Residents Receiving Supplemental Security Income: 12
Residents with Mobility Need: 1
Residents with Physical Disability: 1
Total Daily Staff: 71
Waking Staff: 53
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Wellness | Director of Wellness | Responsible for calibrating glucometers, re-educating clinical staff, and auditing glucometer usage and medication administration records as part of the plan of correction. |
| Regional Director of Operation | Regional Director of Operation | Identified missing information in the medication administration record and initiated pharmacy changes. |
| Regional Director of Nursing | Regional Director of Nursing | Identified missing information in the medication administration record and initiated pharmacy changes. |
Notice — Mar 31, 2023
Date: Mar 31, 2023
Visit Reason
This document serves to grant a waiver to an employee of Faithful Living to allow additional time to complete the required personal care home administrator training course.
Findings
The waiver is granted with conditions including enrollment in a 100-hour training course, passing a competency-based test, attending an orientation session, and supervision by a qualified administrator. The Department will review compliance with these conditions during the annual inspection.
Report Facts
Waiver duration: 66
Code reference: 2600.64
Inspection Report — Jan 11, 2023
Renewal
Date: Jan 11, 2023
Visit Reason
The inspection was conducted as a renewal and complaint investigation of the Faithful Living facility to assess compliance with applicable regulations and verify correction of previous deficiencies.
Complaint Details
The inspection included a complaint investigation component as indicated by the inspection reason 'Renewal, Complaint'. Specific complaint details or substantiation status were not explicitly stated.
Findings
The inspection identified multiple deficiencies including lack of carbon monoxide detectors, unsigned resident contracts, trash management issues, excessive hot water temperatures, missing emergency telephone numbers, window repairs needed, unlabeled soap bars, insufficient emergency water supply, combustible storage violations, incomplete medical evaluations, smoking policy violations, medication storage issues, and incomplete support plans. Plans of correction were accepted and implemented for all deficiencies.
Citations (16)
No carbon monoxide detector near gas furnaces and gas-fired dryer in basement and laundry room.
Resident-home contracts for two residents were not signed by the residents.
Dumpster sliding door was open showing trash visible from parking lot.
Hot water temperature exceeded 120°F in multiple resident-accessible locations.
Emergency telephone numbers not posted by telephones in some resident rooms.
Windows in resident rooms were in poor repair with missing or cracked panes.
Unlabeled used bars of soap found in shared resident bathrooms.
Emergency drinking water supply was below the required 3-day amount.
Combustible and flammable materials stored unlocked near heat sources and in resident rooms.
Incomplete medical evaluations missing key information such as weight, temperature, immunization history, and cognitive functioning.
Smoking observed in resident room and cigarette butts found near main entrance despite no smoking signs.
Medications and syringes not stored in locked containers in resident rooms.
Glucometers not calibrated to correct date and time; inaccurate documentation in Medication Administration Records.
Medications prescribed were not discontinued or available as required.
Resident support plans lacked documentation of medical/dental needs and ability to self-administer medications.
Support plan for a resident lacked required signatures.
Report Facts
Residents Served: 73
Current Residents in Hospice: 1
Residents Receiving Supplemental Security Income: 14
Residents Age 60 or Older: 66
Residents Diagnosed with Mental Illness: 19
Residents Diagnosed with Intellectual Disability: 5
Residents with Mobility Need: 1
Residents with Physical Disability: 1
Total Daily Staff: 74
Waking Staff: 56
Emergency Drinking Water Required (gallons): 216
Emergency Drinking Water On Site (gallons): 199
Inspection Report — Aug 18, 2021
Renewal
Date: Aug 18, 2021
Visit Reason
The inspection was conducted as a renewal and complaint investigation to assess compliance with licensing requirements and address specific complaints.
Complaint Details
The complaint involved an allegation of abuse regarding Resident 1, which was investigated and found to be unsubstantiated under the previous administrator.
Findings
The facility was found to have multiple violations including failure to report an incident, lack of carbon monoxide detector, elevated hot water temperatures, unsafe furniture equipment, smoking area violations, medication storage and labeling issues, and incomplete support plans. Plans of correction were accepted and implemented for all deficiencies.
Citations (8)
Failure to report an incident of alleged abuse regarding Resident 1 to the Department as required.
No carbon monoxide detector placed in the kitchen area as required by the Care Facility Carbon Monoxide Standards Act.
Hot water temperature in bathroom sinks exceeded 120°F, measuring 126.5°F and 131.1°F.
An enabler bar attached to beds of Residents 2 and 3 had openings presenting potential safety hazards.
Smoking permitted in two designated areas with fire safety violations including unlabeled fire retardant chairs and cushions.
Inhaler prescribed to Resident 4 was not labeled with the date it was opened.
Medication box for Resident 5 contained a trainer pen but no pens with medication.
Resident 6's support plan was not updated to include new diagnoses and medication prescriptions.
Report Facts
Residents Served: 74
Current Residents in Hospice: 1
Residents 60 Years or Older: 74
Residents Diagnosed with Mental Illness: 22
Residents Diagnosed with Intellectual Disability: 4
Residents with Mobility Need: 1
Residents with Physical Disability: 2
Inspection Date: Aug 18, 2021
Completion Dates for Corrections: 2021-08-19 to 2021-08-27
Inspection Report — Mar 19, 2021
Renewal
Date: Mar 19, 2021
Visit Reason
The document is a renewal application response and license issuance for the Personal Care Home 'Faithful Living'. It informs that an onsite inspection will be conducted within the next twelve months as required by regulation.
Findings
No inspection findings are reported in this document. It is a license renewal notification with no mention of deficiencies or compliance issues.
Report Facts
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jamie L. Buchenauer | Deputy Secretary, Office of Long-term Living | Signed the renewal license letter |
Inspection Report — Apr 29, 2020
Routine
Date: Apr 29, 2020
Visit Reason
The Department’s Bureau of Human Services Licensing Representative conducted an inspection of the facility on April 29, 2020 and May 1, 2020.
Findings
No regulatory citations with 55 Pa. Code Ch. 2600 (relating to Personal Care Homes) were identified as a result of this inspection.
Inspection Report — Mar 5, 2020
Routine
Date: Mar 5, 2020
Visit Reason
The Department’s Bureau of Human Services Licensing conducted an inspection of the Personal Care Home facility to assess regulatory compliance with 55 Pa. Code Ch. 2600.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Inspection Report — Dec 16, 2019
Renewal
Date: Dec 16, 2019
Visit Reason
The inspection was conducted as a renewal and complaint investigation visit to assess compliance with licensing regulations.
Complaint Details
The inspection included a complaint investigation component, but the substantiation status is not explicitly stated in the report.
Findings
The facility was found to have multiple deficiencies including outdated home rules restricting resident communication, incomplete medical evaluations, improper medication administration, failure to follow prescriber's orders, and incomplete documentation in support plans. Plans of correction were submitted and approved with full implementation verified.
Citations (5)
42o. The facility's home rules required written permission for residents to transport others in personal vehicles, which was removed in the plan of correction.
141a. Resident 1's medical evaluation did not document the need for a bedside enabler bar used for mobility assistance.
182c. Staff Person A administered medications to six residents without proper documentation at the time of administration.
187d. Resident 2 was prescribed Ted Hose treatment which was not administered from 12/12/19 to 12/17/19 due to unavailability of the equipment.
227d. Resident 1's support plan did not document the need for an assistive device and Resident 3's support plan lacked documentation of behavioral health case management.
Report Facts
Residents Served: 71
Current Hospice Residents: 2
Residents with Supplemental Security Income: 10
Residents 60 Years or Older: 63
Residents Diagnosed with Mental Illness: 26
Residents Diagnosed with Intellectual Disability: 4
Residents with Mobility Need: 3
Residents with Physical Disability: 1
Total Daily Staff: 74
Waking Staff: 56
Notice — Nov 27, 2019
Date: Nov 27, 2019
Visit Reason
The document serves as a renewal approval for the Personal Care Home license for Faithful Living, confirming the facility's renewal application and informing about the requirement for annual onsite inspections.
Findings
No inspection findings are reported in this document. It is an administrative renewal notice confirming the issuance of a regular license.
Inspection Report — Apr 29, 2019
Complaint Investigation
Date: Apr 29, 2019
Visit Reason
The inspection was conducted as a partial, unannounced visit due to an incident at the facility.
Complaint Details
The inspection was triggered by an incident complaint. Specific medication errors and resident behavior concerns were investigated. The report does not state substantiation status.
Findings
Violations of 55 Pa.Code Ch. 2600 related to Personal Care Homes were found during the inspection. The facility submitted plans of correction addressing issues such as window coverings, medication administration, and resident assessments.
Citations (6)
The horizontal mini-blinds in Resident 1's bedroom had damaged louvers allowing people outside the home to see into the room.
Resident 1's medication administration record was not marked as given for Gabapentin on 4/20/19 at 0800 and 1200 despite administration.
Resident 1 was not administered prescribed medications on 4/17/19 at 0800 and on 3/12/19 at 0800 and 1200 due to medication unavailability.
The facility failed to report medication administration errors to the prescriber as required.
Resident 1's most recent assessment did not reflect updated aggressive behaviors documented by the home.
The administrator and Director of Resident Services must audit all resident assessments and support plans to ensure accuracy and completeness within 30 days.
Report Facts
Residents Served: 67
Residents Receiving Supplemental Security Income: 11
Residents 60 Years or Older: 55
Residents Diagnosed with Mental Illness: 29
Residents Diagnosed with Intellectual Disability: 6
Residents with Mobility Need: 3
Residents with Physical Disability: 1
Hospice Residents: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Harry Yoder | Administrator | Named in multiple plans of correction and responsible for oversight of corrective actions |
Inspection Report — Feb 22, 2019
Complaint Investigation
Date: Feb 22, 2019
Visit Reason
The inspection was conducted as a complaint investigation triggered by an incident.
Complaint Details
The visit was complaint-related due to an incident. Specific substantiation status is not stated.
Findings
Violations of 55 Pa.Code Chapter 2600 related to Personal Care Homes were found, specifically concerning the resident support plan and documentation of services. A plan of correction was developed to update assessments and include necessary diagnoses.
Citations (1)
55 Pa.Code §2600 requires each home to document in the resident's support plan the medical, dental, vision, hearing, mental health, or other behavioral care services available or referred. The facility failed to document formal support services and diagnosis of chest pain for Resident 1.
Report Facts
Number of Residents Served: 68
Number of Current Hospice Residents: 1
Number of Residents who Receive Supplemental Security Income: 7
Number of Residents who Are 60 Years of Age or Older: 59
Number of Residents who Have Mental Illness: 31
Number of Residents who Have an Intellectual Disability: 6
Number of Residents who Have a Mobility Need: 4
Number of Residents who Have a Physical Disability: 0
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Harry Yoder | Administrator | Named as Administrator on the violation report |
| Laura Heemer | Department representative on-site during inspection |
Inspection Report — Jan 30, 2019
Annual Inspection
Date: Jan 30, 2019
Visit Reason
The inspection was an annual inspection conducted on January 30 and 31, 2019 and March 8, 2019, triggered by renewal, complaint, and incident reasons.
Findings
Violations of 55 Pa.Code Ch. 2600 related to Personal Care Homes were found during the inspection. Deficiencies included failure to provide required personal hygiene assistance and medication order issues.
Citations (2)
The assessment and support plan for Resident #1 indicates minimal assistance with personal hygiene was required, but the resident was found with unclean, matted hair and fecal matter on her legs, indicating lack of required assistance.
Resident #1 had a prescription for Ativan 0.5 mg prescribed every six hours as needed for agitation, and Resident #2 had a prescription for Lorazepam 1.0 mg with topical application every four hours as needed, but medication orders were not properly addressed.
Report Facts
Number of Residents Served: 66
Number of Current Hospice Residents: 1
Number of Hospice Residents in Past Year: 3
Number of Residents Age 60 or Older: 56
Number of Residents with Mental Illness: 31
Number of Residents with Intellectual Disability: 5
Number of Residents with Mobility Need: 4
Number of Residents with Physical Disability: 1
Number of Residents Receiving Supplemental Security Income: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Harry Yoder | Administrator | Signed the plan of correction related to medication order deficiencies. |
Inspection Report — Nov 27, 2018
Renewal
Date: Nov 27, 2018
Visit Reason
This document is a renewal application and license issuance for Colonial Lodge Retirement Community to operate as a Personal Care Home. The Department advises that an onsite 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 notification and confirmation of the facility's authorized capacity.
Inspection Report — Jan 29, 2018
Renewal
Date: Jan 29, 2018
Visit Reason
The inspection was conducted as an annual licensing inspection for renewal of the facility license.
Findings
Violations of 55 Pa.Code Ch. 2600 related to Personal Care Homes were found and specified in the enclosed License Inspection Summary. Plans of correction were submitted to address the violations.
Citations (4)
Direct care Staff Person A began providing unsupervised ADL services on 10-27-2017 without completing the required Department-approved direct care training course and competency test by 12-6-2017.
Resident #7 stored medications in an unlocked, accessible location in their bedroom, including Vicks Vapo Rub and nasal spray, which were not secured in a locked container.
The upholstered chair, rocking chair, and electric keyboard were blocking the emergency exit in Room 18, obstructing egress.
Resident records for Residents 1, 2, 3, 4, and 5 did not include information on whether these residents have identifying marks.
Report Facts
Number of Residents Served: 63
Number of Current Hospice Residents: 1
Number of Hospice Residents in past year: 2
Residents 60 Years or Older: 54
Residents with Mental Illness: 20
Residents with Intellectual Disability: 5
Residents with Mobility Need: 1
Residents Receiving Supplemental Security Income: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Harry Yoder | Administrator | Named as legal entity representative and responsible for plan of correction. |
Inspection Report — Dec 1, 2017
Renewal
Date: Dec 1, 2017
Visit Reason
The document is a renewal license issued to Colonial Lodge Retirement Community to operate as a Personal Care Home. The Department will conduct an onsite inspection within the next twelve months as part of the annual inspection requirement.
Findings
No inspection findings are reported in this document. It is a license renewal notice confirming the issuance of a regular license and outlining future inspection requirements.
Inspection Report — Oct 19, 2017
Complaint Investigation
Date: Oct 19, 2017
Visit Reason
The inspection was conducted as a complaint investigation at Colonial Lodge Retirement Community on October 19, 2017.
Complaint Details
The visit was complaint-triggered and the violations were related to medication administration records and adherence to prescriber directions.
Findings
Two medication administration violations were found related to missing diagnosis or purpose for medication and failure to follow prescriber directions. Plans of correction were partially implemented with adequate progress noted.
Citations (2)
55 Pa.Code §2600 2600.187(a) - Medication records lacked diagnosis or purpose for Benzotropine, 0.5 mg, for Resident #1 in October 2017.
55 Pa.Code §2600 2600.187(d) - The home failed to follow prescriber directions for Resident #2, as Hydrocodone, 5-325 mg, was not administered on 10/6/17 at 8:00 am.
Report Facts
Number of Residents Served: 61
Total Daily Staff: 62
Waking Staff: 47
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Harry Yoder | Administrator | Named in relation to plan of correction signatures and medication administration findings |
Inspection Report — May 19, 2017
Complaint Investigation
Date: May 19, 2017
Visit Reason
The inspection was conducted due to complaints and incidents reported at the Colonial Lodge Retirement Community. The visit was an unannounced partial inspection to investigate these complaints.
Complaint Details
The inspection was complaint-driven and incident-related. Specific complaints included inadequate meal portions, failure to complete psychiatric assessments, unsanitary conditions, pest infestation, facility damage, and missing safety equipment in bathrooms. No repeat violations were noted.
Findings
Multiple violations of 55 Pa.Code Chapter 2600 were found, including failure to provide additional meal portions, incomplete psychiatric assessments, unsanitary conditions, pest infestation, damaged facilities, and missing grab bars in bathrooms. Plans of correction were submitted and approved with varying implementation statuses.
Citations (6)
2600.161(c) - No additional portions of meals and beverages were provided to residents at breakfast and evening meals.
2600.225(c) - Resident #1 was not assessed for psychiatric services after expressing suicidal ideation and refusing to eat or drink, and an updated assessment was not completed.
2600.85(a) - Mildew was found on the bottom of shower curtains in resident bathrooms of Rooms #104, #119, #146, and #154.
2600.85(b) - One live bed bug and bed bug eggs were found on the bed nearest the door in Room #112.
2600.88(a) - The drywall on the lower portion of the wall between the door and bathroom in Room #150 was smashed and broken, and the linoleum in Room #107 was separated from the floor with water damage underneath.
2600.102(d)(1) - The toilets in Rooms #127 and #133 did not have grab bars, hand rails, or assist bars, and none were present by the toilet and bathtub/shower of Room #207.
Report Facts
Number of Residents Served: 62
Number of Residents Served: 63
Total Daily Staff: 63
Waking Staff: 47
Total Daily Staff: 64
Waking Staff: 48
Number of Residents Who Are 60 Years or Older: 52
Number of Residents Who Are 60 Years or Older: 55
Number of Residents Who Have Mental Illness: 18
Number of Residents Who Have Mental Illness: 19
Number of Residents Who Have an Intellectual Disability: 6
Number of Residents Who Have a Mobility Need: 1
Number of Residents Who Have a Mobility Need: 1
Number of Residents Who Have a Physical Disability: 0
Number of Residents Who Have a Physical Disability: 1
Number of Current Hospice Residents: 0
Number of Current Hospice Residents: 1
Number of Hospice Residents in Past Year: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Harry Yoder | Administrator | Named in multiple plans of correction and violation reports |
Inspection Report — Feb 22, 2017
Renewal
Date: Feb 22, 2017
Visit Reason
The inspection was conducted as part of the annual licensing renewal for Colonial Lodge Retirement Community on February 22 and 23, 2017.
Findings
Multiple violations of 55 Pa.Code Chapter 2600 related to personal care homes were identified, including issues with resident funds, sanitary conditions, grab bars, fire drills, medical evaluations, and first aid kits. Plans of correction were submitted and partially or fully implemented by June 30, 2017.
Citations (6)
55 Pa.Code §2600.20(b)(6) - The home failed to offer assistance in establishing interest-bearing accounts for resident funds exceeding $200 for Residents #2 and #5.
55 Pa.Code §2600.85(a) - Resident #4's blood sugar readings were not properly recorded; the morning reading on 2/21/17 was missing from the medication administration record.
55 Pa.Code §2600.102(d)(1) - Grab bars were missing next to the toilet in Bedroom #130 and the shower of Bedroom #203.
55 Pa.Code §2600.132(g) - Fire drills were not held on different days and times as required; drills on 4/20/16 and 10/18/16 had only two staff persons present on duty.
55 Pa.Code §2600.141(a)(1) - Resident #1's medical evaluation was completed more than 60 days prior to admission, violating timing requirements.
55 Pa.Code §2600.171(b)(5) - The first aid kit in the 2006 Kia Sedona used for resident transport lacked protective eye coverings and a breathing shield.
Report Facts
Number of Residents Served: 62
Total Daily Staff: 63
Waking Staff: 47
Number of Residents 60 Years or Older: 53
Number of Residents with Mental Illness: 17
Number of Residents with Intellectual Disability: 6
Number of Residents with Mobility Need: 1
Number of Residents with Physical Disability: 1
Number of Hospice Residents in Past Year: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Harry Yoder | Administrator | Named in relation to plan of correction signatures and legal entity representative. |
| Kelly Comstock | Department representative conducting the inspection. | |
| Cybil Bomberger | Department representative conducting the inspection. |
Inspection Report — Dec 6, 2016
Complaint Investigation
Date: Dec 6, 2016
Visit Reason
The inspection was conducted as a complaint investigation at Colonial Lodge Retirement Community on December 6, 2016.
Complaint Details
The visit was complaint-related, triggered by concerns about mail handling and medication administration. The complaint was substantiated based on the violations found.
Findings
Violations were found related to the handling of residents' mail and medication administration for Resident #1. The facility opened incoming mail without consent and failed to administer prescribed medications as ordered.
Citations (2)
55 Pa.Code §2600.42(f): A mailed package of nutritional supplements for Resident #1 was opened by staff without the resident's consent and contents were not provided to the resident.
55 Pa.Code §2600.187(d): The home did not administer Resident #1's prescribed Isosorbide MN 60 mg tablet and Abartvastatin 80 mg tablet as ordered; medications were not available in the home for administration.
Report Facts
Number of Residents Served: 67
Total Daily Staff: 68
Visiting Staff: 51
Residents 80 Years or Older: 56
Residents with Mental Illness: 19
Residents with Intellectual Disability: 6
Residents with Mobility Need: 1
Residents Receiving Supplemental Security Income: 5
Number of Hospice Residents in Past Year: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Harry Yoder | Administrator | Named in relation to plan of correction signatures and oversight |
| Laura Heemer | Department of Human Services inspector conducting the inspection |
Inspection Report — Feb 9, 2016
Renewal
Date: Feb 9, 2016
Visit Reason
The inspection was conducted as part of the Department of Human Services' annual licensing inspections on February 9 and 10, 2016, for renewal of the facility license.
Findings
Multiple violations of 55 Pa.Code Chapter 2600 related to facility maintenance, safety, and medication administration were found. The facility submitted plans of correction for each violation, with most corrections fully implemented by early May 2016.
Citations (9)
55 Pa.Code §2600.86(a) - Floors, walls, ceilings, windows, doors and other surfaces must be clean, in good repair and free of hazards. The ceiling in the hallway between bedrooms 136 and 138 has loose, crumbling plaster which feels damp and a plaster repair material panel is attached to the ceiling with a straight edge that moves up and down about 1/4 inch.
55 Pa.Code §2600.89(b) - Hot water temperature in areas accessible to the resident may not exceed 120°F. Bathroom sinks in bedrooms 117, 118, and 127 recorded hot water temperatures of 131°F, 130°F, and 123°F respectively.
55 Pa.Code §2600.94(b) - Interior stairs, exterior steps and ramps must have nonskid surfaces. The wood exterior porch and steps leading from bedrooms 203 and 207 lack non-skid surfaces.
55 Pa.Code §2600.100(a) - The exterior of the building and the building grounds or yard must be in good repair and free of hazards. The bottom step of the wood stairs leading from bedroom 207 is cracked and poses a tripping and falling hazard.
55 Pa.Code §2600.103(f) - Food requiring refrigeration shall be stored at or below 40°F. The household refrigerator in the west lounge did not have thermometers in the refrigerator or freezer.
55 Pa.Code §2600.105(g)(1) - To reduce fire hazards, lint shall be removed from the lint trap and drum of clothes dryers after each use. A heavy accumulation of lint was found in the lint trap of the commercial dryer on the right side of the laundry room.
55 Pa.Code §2600.1016(7) - Each resident shall have an operable lamp or other source of lighting that can be turned on at bedside. Beds in rooms 117 and 118 do not have a source of light that can be turned on/off from the bedside.
55 Pa.Code §2600.132(h) - Residents shall evacuate to a designated meeting place away from the building or within the fire-safe area during each fire drill. During fire drills on 5-23, 5-29, and 10-30, not all residents evacuated to designated safe areas; some residents present were not evacuated.
55 Pa.Code §2600.187(a) - A medication record shall be kept to include diagnosis or purpose for the medication. Medication administration records for two residents did not include the diagnosis or purpose for Prednisone and Symbicort medications.
Report Facts
Number of Residents Served: 65
Number of Current Hospice Residents: 2
Number of Hospice Residents in past year: 4
Residents receiving Supplemental Security Income: 7
Residents age 60 or older: 55
Residents with Mental Illness: 16
Residents with Intellectual Disability: 8
Residents with Mobility Need: 3
Residents with Physical Disability: 0
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Harry Yoder | Administrator | Named in multiple plans of correction and as legal entity representative |
Notice — Jan 7, 2016
Date: Jan 7, 2016
Visit Reason
The document serves as a renewal notice and certificate of compliance for Colonial Lodge Retirement Community to operate as a Personal Care Home, confirming the renewal application received on January 7, 2016.
Findings
The Department advises that an onsite inspection will be conducted within the next twelve months as required by regulation. No findings or deficiencies are reported in this document.
Report — November 23, 2016
November 23, 2016
Viewing
Loading inspection reports...
