Inspection Reports for
Heartful Hands LLC

514 MITCHELL AVENUE,, CLARITON, PA, 15025

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8 Reports

2022–2025

Inspection Report — Jul 17, 2025

Monitoring
Date: Jul 17, 2025

Visit Reason
The inspection was an unannounced partial monitoring visit conducted on 07/17/2025 and 07/18/2025 to review compliance with regulatory requirements and verify the implementation of a previously submitted plan of correction.

Findings
The facility was found to have multiple deficiencies including lack of criminal background checks for staff, inadequate medication administration staffing, incomplete staff orientation and training, improperly stored fire extinguisher, incomplete fire drill records, and medication record errors. The submitted plan of correction was accepted and fully implemented by 09/03/2025.

Citations (8)
Staff person A did not have a criminal history background check completed.
No qualified staff person to administer medications on the 11:00 p.m.-7:00 a.m. shift.
Staff person A did not receive orientation in required fire safety and emergency preparedness topics on the first day of work.
Staff person A did not receive orientation training within 40 scheduled working hours as required.
An unlocked, improperly stored fire extinguisher was accessible to residents, causing a safety hazard.
Fire drill record did not include the amount of time to evacuate.
Resident's medication administration record did not include a prescribed medication for pain or fever.
Resident did not receive prescribed insulin dose despite blood glucose reading indicating need.
Report Facts
Residents Served: 29 Total Daily Staff: 30 Waking Staff: 23 Deficiencies cited: 8

Employees mentioned
NameTitleContext
Kelley MartinConducts file audits for staff compliance
NyhemiaReviews medication administration records and medication cart three times per week
ShannonReviews medication administration records and medication cart three times per week
JUStaff trained explicitly on medication administration

Inspection Report — Mar 13, 2025

Renewal
Date: Mar 13, 2025

Visit Reason
The inspection was conducted as a complaint investigation with multiple visits between March and July 2025, followed by a renewal inspection in April 2025 and a partial incident-related inspection in June 2025.

Complaint Details
The complaint investigation was triggered by multiple issues including sanitary conditions, staff qualifications, medication administration, and resident care concerns. The investigation included unannounced visits on March 13, 20, and 31, 2025, with an exit conference on March 31, 2025.
Findings
The facility was found to have multiple deficiencies including sanitary conditions, staff training and qualifications, medication administration issues, incomplete resident records and assessments, fire safety violations, and failure to post required documents. Several plans of correction were submitted but many were not implemented by the follow-up dates.

Citations (20)
Brownish, sticky substance and grime on container and floor; power strips and extension cords covered in grime and dust.
Latch on resident's bedroom door did not catch; buildup of dirt and grime on floors, baseboards, and furniture.
Bottom drawer of metal filing cabinet rusted and unusable.
Resident medical evaluations and assessments not current or missing.
Resident support plans inaccessible and not updated.
Licensing inspection summaries not posted in a conspicuous place.
Incident of resident altercation not reported timely to Department.
Staff persons without completed criminal background checks employed.
Administrator present less than required 20 hours per week.
No qualified staff to administer medications overnight shift.
Staff list incomplete, missing contact information.
Administrator has not completed required training.
Staff persons without required orientation and annual training.
Emergency procedures not posted; fire drills not conducted monthly or during sleeping hours; fire drill records incomplete; evacuation procedures not fully followed.
Resident prescribed medication (Mounjaro) administered by uncertified staff.
Resident medication (Diphenhydramine) not available in home.
Medication administration records incomplete or not updated.
Staff persons administering insulin injections without current diabetes education.
Preadmission screening forms and resident assessments missing or incomplete.
Resident records missing or incomplete.
Report Facts
Inspection dates: 7 Residents served: 26 Staffing hours: 20 Staffing hours: 27 Total daily staff: 55 Deficiency counts: 20 Follow-up dates: 7

Inspection Report — Apr 4, 2024

Complaint Investigation
Date: Apr 4, 2024

Visit Reason
The inspection was conducted as a complaint investigation during an unannounced partial inspection on 04/04/2024.

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: 32 Total Daily Staff: 33 Waking Staff: 25 Residents Receiving Supplemental Security Income: 32 Residents 60 Years or Older: 21 Residents Diagnosed with Mental Illness: 24 Residents Diagnosed with Intellectual Disability: 4 Residents with Mobility Need: 1 Residents with Physical Disability: 0

Inspection Report — Jul 28, 2023

Renewal
Date: Jul 28, 2023

Visit Reason
The inspection was conducted as part of a renewal, complaint, provisional, and incident review process for Heartful Hands LLC, a personal care home.

Findings
The facility was found to be in compliance with 55 Pa. Code Ch. 2600 after multiple inspections. Several deficiencies were identified related to safety, training, sanitary conditions, equipment, and record keeping, all of which had plans of correction accepted and were implemented by November 13, 2023. A follow-up partial inspection on October 20, 2023 found no deficiencies.

Citations (17)
Carbon monoxide alarms were installed too close to gas furnaces and batteries were not labeled with installation dates.
Staff persons present were not certified in first aid or CPR during certain evening hours.
Orientation training documentation for a staff person was not dated, making timely completion unverifiable.
Staff person did not receive required resident rights training during the 2022 training year.
Unsanitary conditions observed including tobacco on resident's sheets, dusty bathroom fan, soiled incontinence pad on bathroom floor, and grime on staircase banister.
Overhead light in bedroom #12 was inoperable.
Resident #2's bedside table was damaged with exposed sharp staples.
Concrete landing at front steps was deteriorated presenting a trip hazard.
Resident #3's mattress was torn and springs were visible.
Bedroom #12 had only 2 chairs for 3 residents.
Residents #1, #5, and #6 had no operable bedside lamps.
Lint trap in clothes dryer was caked with lint, creating a fire hazard.
The home did not have the emergency preparedness plan for the local municipality posted.
During a fire drill, one resident refused to evacuate due to fear, requiring reassessment and wheelchair use.
Fire drill during sleeping hours was overdue, with the last conducted in May 2023.
Resident #7's record did not include a photograph no more than 2 years old.
Resident #1 and #4 had beds without pillow cases.
Report Facts
Residents present during inspection: 33 Total daily staff: 34 Waking staff: 26 Residents receiving Supplemental Security Income: 32 Residents 60 years or older: 22 Residents diagnosed with mental illness: 18 Residents diagnosed with intellectual disability: 4 Residents with mobility need: 1

Inspection Report — May 19, 2023

Follow-Up
Date: May 19, 2023

Visit Reason
The inspection was an unannounced partial review conducted for provisional, incident, and fine reasons, including a follow-up on a previously submitted plan of correction.

Findings
The report found a substantiated incident of inappropriate touching between residents, deficiencies in fire drill record documentation, and the need for updated resident assessments. The submitted plan of correction was accepted and fully implemented by the follow-up date.

Citations (3)
Resident #1 intentionally touched resident #2's buttocks inappropriately multiple times, constituting abuse.
Fire drill records lacked required details such as the date of the drill and contained inaccurate time descriptions.
Resident #1's additional assessment was outdated and did not reflect recent behavioral issues.
Report Facts
Total Daily Staff: 35 Waking Staff: 26 Residents Receiving Supplemental Security Income: 31 Residents Aged 60 or Older: 25 Residents Diagnosed with Mental Illness: 19 Residents Diagnosed with Intellectual Disability: 3 Residents with Physical Disability: 2 Two Hour Checks for Resident #1: Resident #1 was placed on two-hour checks from 05/20/2023 to 06/15/2023.

Inspection Report — Mar 21, 2023

Complaint Investigation
Date: Mar 21, 2023

Visit Reason
The inspection was conducted as a complaint investigation with an unannounced partial inspection to review compliance at Heartful Hands LLC.

Complaint Details
The inspection was triggered by a complaint. The plan of correction was reviewed and determined to be fully implemented as of June 20, 2023.
Findings
The facility was found to be non-compliant with administrator staffing requirements, as no qualified administrator was present an average of 20 hours per week. A plan of correction was submitted and fully implemented by June 20, 2023.

Citations (1)
No current, qualified administrator present in the home an average of 20 hours per week.
Report Facts
Residents Served: 35 Total Daily Staff: 38 Waking Staff: 29 Supplemental Security Income recipients: 30 Residents 60 Years or Older: 35 Residents Diagnosed with Mental Illness: 30 Residents Diagnosed with Intellectual Disability: 1 Residents with Mobility Need: 3 Residents with Physical Disability: 0

Inspection Report — Dec 28, 2022

Complaint Investigation
Date: Dec 28, 2022

Visit Reason
The inspection was a complaint investigation conducted on December 28, 2022, as part of a licensing inspection of Heartful Hands LLC.

Complaint Details
The inspection was complaint-related as explicitly stated. No substantiation status was provided.
Findings
The inspection found violations related to hot water temperatures exceeding the allowed maximum of 120°F in multiple bathrooms. A second provisional license was issued based on an acceptable plan of correction. The facility was required to correct violations by specified dates to avoid fines.

Citations (1)
Hot water temperature in areas accessible to residents exceeded 120°F, with measurements ranging from 146.2°F to 152.4°F in multiple bathrooms.
Report Facts
Fine per day: 5 Calculated Fine per day: 175 Mandated Correction Date: 5

Inspection Report — Jul 12, 2022

Original Licensing
Date: Jul 12, 2022

Visit Reason
The inspection was conducted due to a change in legal entity for the personal care home, Heartful Hands, LLC, and was a partial licensing inspection as this is a new legal entity operating the home.

Findings
The facility was found to be in substantial compliance with applicable regulations, but the licensing inspector was unable to complete a full inspection. Citations were found related to lighting at bedside and monthly fire drills, which required correction.

Citations (2)
Resident #1 does not have a source of lighting that can be turned on/off at bedside.
Unannounced fire drills were not conducted during the months of March and April 2022.
Report Facts
Residents Served: 33 Total Daily Staff: 33 Waking Staff: 25 Residents Receiving Supplemental Security Income: 33 Residents Age 60 or Older: 24 Residents Diagnosed with Mental Illness: 18 Residents Diagnosed with Intellectual Disability: 3 Residents with Mobility Need: 0 Residents with Physical Disability: 0 Current Hospice Residents: 0

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