Inspection Reports for
Greystone Country Estates
424 DELAWARE ROAD,, FREDONIA, PA, 16124
Back to Facility Profile16 Reports
Inspection Report — Apr 10, 2025
Renewal
Date: Apr 10, 2025
Visit Reason
The inspection was conducted as a renewal inspection of the facility's license.
Findings
The submitted plan of correction was determined to be fully implemented. Several deficiencies were noted including missing intended use of rent rebate in resident contract, incomplete criminal background check for a staff member, lack of required qualifications for direct care staff, and improper food storage. All deficiencies had accepted plans of correction with completion dates and were implemented by the time of the report.
Citations (4)
The rent rebate addendum for resident #1 does not include the intended use of the home's portion of the rent rebate.
Staff person A did not have a Pennsylvania background check completed.
Direct care staff person A does not have a high school diploma, GED, or active registry status on the Pennsylvania nurse aide registry.
At 10:36 AM there was a case of wax beans stored on the floor in the pantry.
Report Facts
Residents Served: 35
Current Residents in Hospice: 5
Residents Receiving Supplemental Security Income: 5
Residents 60 Years or Older: 34
Residents Diagnosed with Mental Illness: 5
Residents Diagnosed with Intellectual Disability: 3
Residents with Mobility Need: 2
Residents with Physical Disability: 0
Total Daily Staff: 37
Waking Staff: 28
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff person A | Named in findings related to missing Pennsylvania background check, lack of required qualifications, and high school diploma verification |
Inspection Report — May 2, 2024
Renewal
Date: May 2, 2024
Visit Reason
The inspection was an unannounced full renewal inspection conducted to review the facility's compliance with licensing requirements.
Findings
The inspection identified multiple deficiencies including uncovered trash receptacles, insufficient water pressure in bathroom sinks, unlabeled personal hygiene items, outdated fire safety inspections and drills, incomplete resident preadmission screening forms, and incomplete resident assessments. Plans of correction were submitted and determined to be fully implemented by the follow-up date.
Citations (8)
Partially full, uncovered and unattended trash can in the shared Jack and Jill style bathroom in bedroom #106.
Insufficient water pressure at the 2 bathroom sinks in the shared shower room; one sink was out of order and the other had no hot water.
Seven unlabeled bottles of bodywash and shampoo on the shelf inside shower #1 and four unlabeled bottles plus one container of shaving gel on the shelf inside shower #2 in the shared bathroom.
The last fire drill and fire safety inspection by a fire safety expert was conducted on 9/19/23, with the prior one on 4/19/22, not meeting annual requirements.
During fire drills conducted April to August 2023, the home exceeded the evacuation time of 2 minutes 30 seconds specified by a fire safety expert.
Resident #1 was admitted without a completed preadmission screening form.
Resident #1's initial assessment did not include diagnoses of Vitamin D Deficiency and Degenerative Joint Disease Right Knee as indicated on medical evaluation.
Resident #2's assessment did not include diagnoses of Joint Disorder, Magnesium Deficiency, Hypo-Osmolality and Hyponatremia, Muscle Weakness, Symbolic Dysfunctions, and Dysphagia as indicated on medical evaluation.
Report Facts
Residents Served: 25
Staffing Hours: 27
Waking Staff: 20
Residents Receiving SSI: 9
Residents Age 60 or Older: 23
Residents Diagnosed with Mental Illness: 3
Residents Diagnosed with Intellectual Disability: 3
Residents with Mobility Need: 2
Residents with Physical Disability: 0
Fire Drill Dates: 2
Inspection Report — May 1, 2023
Date: May 1, 2023
Visit Reason
The inspection was a partial, unannounced visit conducted due to an incident at the facility.
Findings
No regulatory citations or deficiencies were identified during this inspection.
Report Facts
Total Daily Staff: 26
Waking Staff: 20
Residents Served: 25
Residents Receiving Supplemental Security Income: 4
Residents Age 60 or Older: 25
Residents with Mobility Need: 1
Inspection Report — Mar 9, 2023
Renewal
Date: Mar 9, 2023
Visit Reason
The inspection was conducted as a renewal inspection of the facility's license to ensure continued compliance with regulatory standards.
Findings
The inspection found multiple deficiencies including lack of window screens, combustible storage near furnace, improper smoking area location, missing posted menus, incomplete preadmission screening forms, and unsigned support plans. The facility submitted plans of correction which were determined to be fully implemented.
Citations (6)
No screen on the functioning window in bedroom #.
Furnace paperwork was stored directly on top of the furnace.
The home's designated smoking area is located directly in front of the rear door.
The home's menu for the week of 3/9/23 was not posted.
Resident #1’s preadmission screening form does not include a determination that the needs of the resident can be met by the services provided by the home.
Resident #2’s current support plan was not signed by the resident nor does it indicate inability or refusal to sign.
Report Facts
Residents Served: 32
Total Daily Staff: 33
Waking Staff: 25
Residents Receiving Supplemental Security Income: 4
Residents 60 Years or Older: 32
Residents Diagnosed with Mental Illness: 3
Residents Diagnosed with Intellectual Disability: 3
Residents with Mobility Need: 1
Residents with Physical Disability: 0
Inspection Report — Mar 17, 2022
Renewal
Date: Mar 17, 2022
Visit Reason
The inspection was conducted as a renewal inspection of the facility's license.
Findings
The inspection identified several deficiencies including lack of carbon monoxide alarms near fossil fuel devices, inadequate overnight staffing, missing emergency telephone numbers, outdated fire safety inspection and drill, medication storage and administration issues, and incomplete resident assessments. Plans of correction were accepted and implemented for all deficiencies.
Citations (7)
No carbon monoxide alarms near the gas furnace on the 3rd floor and gas dryers in laundry rooms.
Only one staff person regularly works overnight, which is inadequate to meet resident needs in an emergency.
No emergency telephone numbers posted on or near the cordless phone in resident #4's bedroom.
Last fire safety inspection and fire drill conducted by a fire safety expert was on 6/4/2019, overdue for annual requirement.
Medication storage and administration errors found for residents #4 and #5.
Staff person administering medications had not completed required Department-approved medication administration annual practicum course.
Resident #3 and #7 had incomplete or untimely additional assessments.
Report Facts
Residents Served: 31
Total Daily Staff: 32
Waking Staff: 24
Completion Date: May 5, 2022
Completion Date: May 18, 2022
Fire Drill Completion Date: Apr 19, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| General Manager | Registered to take Medication Train the Trainer course and responsible for staff medication training. | |
| Administrator | Responsible for oversight of plans of correction, documentation, and monitoring compliance. |
Notice — Apr 30, 2021
Date: Apr 30, 2021
Visit Reason
The document serves as a notification of receipt and approval of the renewal application to operate the Personal Care Home, Greystone Country Estates, and 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 notice confirming issuance of a regular license and advising of future inspections.
Report Facts
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jamie L. Buchenauer | Deputy Secretary | Signed the renewal notification letter and Certificate of Compliance. |
| Monica Shoup | Administrator | Recipient of the renewal notification letter. |
Inspection Report — Feb 3, 2021
Renewal
Date: Feb 3, 2021
Visit Reason
The inspection was a full, unannounced renewal inspection conducted on 02/03/2021 through 02/05/2021 to assess compliance with licensing requirements.
Findings
Several deficiencies were identified including improper glucometer use, unfinished wall surfaces with lint accumulation, snow and ice obstructions on emergency exits, blocked egress routes, incomplete emergency evacuation diagrams, and inaccurate blood glucose documentation. Plans of correction were directed or accepted with completion dates ranging from 02/05/2021 to 04/30/2021. Weekly and monthly monitoring and staff reeducation were implemented.
Citations (6)
Resident #1’s glucometer was used to measure resident #2’s blood glucose levels on 1/26/21 and 2/1/21.
The lower wall behind 2 dryers in the 100 hall laundry is unfinished, exposing pink wall insulation covered with dryer lint.
Outside landing and steps leading from the side driveway emergency exit doors were covered with 2" of snow and ice from 2/3/21 to 2/4/21.
Emergency exit double doors off the lounge had a handwritten sign taped stating 'This is not an exit' and egress was blocked by a chair and other items on 2/3/21 and 2/4/21.
Emergency evacuation diagram posted in the 200 hallway did not include the line of travel to the exit doors off of the lounge.
Blood glucose readings documented on Resident #1 and Resident #2's medication administration records were not found on the glucometer.
Report Facts
Residents Served: 30
Current Residents in Hospice: 5
Staffing Hours - Total Daily Staff: 30
Staffing Hours - Waking Staff: 23
Snow/Ice Obstruction Duration: 1.5
Inspection Report — Jan 13, 2020
Renewal
Date: Jan 13, 2020
Visit Reason
The document is a renewal application and license issuance for Greystone Country Estates Personal Care Home. The Department notifies the facility that an annual 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 confirmation and notification of future inspection requirements.
Report Facts
Inspection Report — Dec 12, 2019
Renewal
Date: Dec 12, 2019
Visit Reason
The inspection was a licensing renewal inspection conducted by the Pennsylvania Department of Human Services, Bureau of Human Services Licensing on December 12, 2019.
Findings
Several violations were cited related to resident contract signatures, training records, first aid kit contents, lighting, food storage, and fire extinguisher inspection. The facility submitted an acceptable plan of correction for all citations.
Citations (10)
Regulation 2600 25.b. Resident #1 and Resident #2's resident-home contracts were not signed by the residents.
Regulation 2600 65.i. The record for fire safety training held on 7/18/18 did not include the length of the course.
Regulation 2600 96.a. The first aid kit located in the closet by the front desk did not include eye coverings.
Regulation 2600 101.j. Resident #1's bedside lamp was unplugged and no other lighting source was available at bedside.
Regulation 2600 103.d. Foods including water bottles, macaroni noodles, and bags of onions were stored on the floor in the dry food storage area and hallway.
Regulation 2600 103.e. Refrigerated foods were not properly dated or labeled with use-by dates in Ziploc bags.
Regulation 2600 103.g. Unsealed foods such as peanut butter wafers and crackers were stored on the shelf without proper sealing or labeling.
Regulation 2600 103.i. Dented cans of sliced beets and fruit cocktail were stored on the shelf in the dry foods pantry.
Regulation 2600 131.f. The fire extinguisher in the smoking lounge had not been inspected by a fire safety expert since May 2018.
Regulation 2600 251.b. Correction fluid was used on the date of resident #2's contract dated 10/2/19.
Report Facts
Residents Served: 36
Resident Support Staff: 0
Total Daily Staff: 37
Waking Staff: 28
Residents with Supplemental Security Income: 3
Residents 60 Years or Older: 36
Residents Diagnosed with Intellectual Disability: 5
Residents with Mobility Need: 7
Residents with Physical Disability: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Monica Shoup | Administrator | Named in multiple findings and plan of correction signatures |
Notice — Jan 11, 2019
Date: Jan 11, 2019
Visit Reason
The document serves as a renewal certificate and notification for the operation of Greystone Country Estates as a Personal Care Home. It informs the facility that an onsite inspection will be conducted within the next twelve months as part of the annual inspection requirement.
Findings
No inspection findings are reported in this document. It is a licensing renewal notice confirming the issuance of a regular license and outlining future inspection requirements.
Inspection Report — Dec 18, 2018
Renewal
Date: Dec 18, 2018
Visit Reason
The inspection was a renewal visit conducted by the Department of Human Services Bureau of Human Services Licensing to assess compliance with 55 Pa. Code Chapter 2600 for the Personal Care Home Greystone Country Estates.
Findings
Multiple violations were found including lack of carbon monoxide alarms, broken window panes posing safety hazards, improper refrigeration temperatures, inadequate fire evacuation procedures, incomplete medical evaluations, fire hazards in smoking areas, and medication administration record errors. Plans of correction were submitted and partially or fully implemented by the facility.
Citations (7)
55 Pa.Code 2600.18 requires carbon monoxide alarms to be installed near fossil-fuel burning devices. The home had no carbon monoxide detectors and a gas stove was present in the kitchen.
55 Pa.Code 2600.92 requires windows to be in good repair and securely screened. Eight window panes were broken and jagged glass posed a skin tear hazard.
55 Pa.Code 2600.103(f) requires food requiring refrigeration to be stored at or below 40°F. Temperatures of 44°F were recorded in refrigerators and produce storage areas.
55 Pa.Code 2600.132(d) requires residents to evacuate to a fire-safe area during drills. During inclement weather, residents stayed inside and the home lacked an interior fire safe area.
55 Pa.Code 2600.141(b)(1) requires residents to have annual medical evaluations. Resident #1's medical evaluation was blank in the cognitive functioning area.
55 Pa.Code 2600.144(c)(1) requires safeguards to prevent fire hazards including proper furnishings and ventilation. Smoking area had wrought iron chairs with fabric cushions and a metal can with cigarette butts near chairs.
55 Pa.Code 2600.187(b) requires medication administration to be recorded at the time of administration. Staff initialed the December 2018 medication administration record as the injection having been administered on 12/10/18, but the injection was ordered for the 13th.
Report Facts
Number of Residents Served: 36
Temperature readings: 44
Broken window panes: 8
Cigarette butts: 16
Wrought iron chairs: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Monica Shoup | Administrator | Named in multiple findings and plan of correction responses throughout the report |
| Lisa Flinner-Alman | Inspector | On-site inspector for the inspection visit |
| Lori Gillette | Inspector | On-site inspector for the inspection visit |
| Kimberly Taylor | Med Tech | Spoke with General Manager regarding medication administration record issue |
Notice — Jan 8, 2018
Date: Jan 8, 2018
Visit Reason
The document serves as a renewal notification for the operation of Greystone Country Estates as a Personal Care Home and includes the license certificate and information about the requirement for annual inspections.
Findings
No inspection findings are reported in this document. It confirms the issuance of a regular license following the renewal application.
Report Facts
Inspection Report — Dec 15, 2017
Renewal
Date: Dec 15, 2017
Visit Reason
The inspection was a renewal visit conducted as part of the Bureau of Human Services Licensing annual inspection process for Greystone Country Estates.
Findings
Multiple violations of 55 Pa.Code Chapter 2600 were found, including issues with resident privacy, staff background checks, medication self-administration training, sanitary conditions related to blood glucose monitoring, emergency telephone posting, bed safety, and food storage temperatures. Plans of correction were submitted and partially implemented.
Citations (8)
55 Pa.Code 2600.42(s): There was no lock on shared bathrooms and shower stalls, and video cameras recorded and stored images for 30 days, compromising resident privacy.
55 Pa.Code 2600.51: A direct care staff person hired in 2016 did not have a completed criminal background check until the inspection date.
55 Pa.Code 2600.65(f): A direct care staff person did not receive required training in medication self-administration during the 2016 training year.
55 Pa.Code 2600.85(a): The home used an Accucheck glucometer not labeled with resident names, and blood glucose readings were incorrectly recorded.
55 Pa.Code 2600.91: Emergency service telephone numbers were not posted in the main shower room.
55 Pa.Code 2600.101(j)(1): The headboard of a resident's bed was unstable, causing the bed to move approximately 3 inches back and forth.
55 Pa.Code 2600.103(f): The freezer temperature in the main kitchen pantry was 19 degrees Fahrenheit, above the required 0°F.
55 Pa.Code 2600.185(a): Multiple residents' blood glucose readings did not match the home's documentation in the medication administration record.
Report Facts
Staff Count: 36
Staff Count: 37
Deficiency Count: 8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Monica Shoup | Administrator | Named in multiple findings and plans of correction throughout the report. |
Notice — Jan 6, 2017
Date: Jan 6, 2017
Visit Reason
The document serves as a renewal notification and license issuance for Greystone Country Estates Personal Care Home. It informs the facility of the requirement for an annual onsite inspection within the next twelve months as mandated by state regulations.
Findings
No inspection findings are reported in this document. It is an administrative letter confirming license renewal and outlining inspection requirements.
Report Facts
Inspection Report — Dec 13, 2016
Renewal
Date: Dec 13, 2016
Visit Reason
The inspection was a renewal licensing inspection conducted by the Department of Human Services on December 13, 2016.
Findings
A violation was found related to the home's fire drill record not containing the exit route used for drills conducted on specified dates. A plan of correction was submitted and partially implemented to address this issue.
Citations (1)
Regulation 55 Pa.Code §2600.132(c): The home's fire drill record did not contain the exit route used for drills conducted on multiple dates in 2016.
Report Facts
Number of Residents Served: 39
Total Daily Staff: 40
Waking Staff: 30
Number of Current Hospice Residents: 1
Number of Residents Age 60 or Older: 39
Number of Residents with Mental Illness: 1
Number of Residents with Intellectual Disability: 4
Number of Residents with Mobility Need: 1
Number of Residents with Physical Disability: 0
Number of Residents Receiving Supplemental Security Income: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Monica Shoup | Administrator | Named in relation to the fire drill record violation and plan of correction |
| Monica Powell | General Manager | Named as verifying and initialing fire drill records for six months as part of plan of correction |
Inspection Report — Feb 3, 2016
Renewal
Date: Feb 3, 2016
Visit Reason
The inspection was conducted as part of the Department of Human Services' licensing inspections for renewal and provisional licensing of Greystone Country Estates.
Findings
The inspection identified several violations related to emergency telephone postings, operable lighting in resident bedrooms, refrigeration temperature, and fire drill procedures. Plans of correction were submitted and partially implemented with adequate progress noted.
Citations (4)
55 Pa.Code 2600.91 requires posting emergency telephone numbers by each telephone. No emergency telephone numbers were posted near resident #1's telephone.
55 Pa.Code 2600.101(j)(7) requires an operable lamp or other source of lighting at bedside. Residents #2 and #3 did not have operable lighting that could be turned on/off from bedside.
55 Pa.Code 2600.103(f) requires food requiring refrigeration to be stored at or below 40°F. The freezer temperature was measured at 20°F, above the required 0°F for frozen food.
55 Pa.Code 2600.132(g) requires fire drills on different days and times with minimum staff participation. Fire drills during sleeping hours were not routinely held with minimum staff participation in 2015.
Report Facts
Number of Residents Served: 41
Staffing: 42
Staffing: 32
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Monica Shoup | Administrator | Named in relation to plan of correction and signature on violation reports |
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