13 Reports
Notice — May 14, 2026
Date: May 14, 2026
Visit Reason
This document serves as a waiver approval for Pine Manor Home to allow unlicensed direct care staff to administer subcutaneous injections of GLP-1 agonist medications under specified training and monitoring conditions.
Findings
The waiver is granted with conditions including successful completion of medication administration training, annual training hours, in-person training by licensed professionals, and ongoing monitoring and documentation requirements.
Notice — Jul 29, 2025
Date: Jul 29, 2025
Visit Reason
This document serves to notify the facility that a waiver request to waive the high school diploma or GED requirement for a direct care staff person has been granted due to education obtained outside the United States.
Findings
The waiver is granted under specific conditions including documentation of equivalent education and annual review during inspections to ensure compliance. Failure to comply may result in termination of the waiver or other licensing actions.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Theresa Hartman | Bureau Director, Human Services Licensing | Signed the waiver approval letter. |
Inspection Report — Jun 17, 2025
Renewal
Date: Jun 17, 2025
Visit Reason
The inspection was conducted as a renewal visit to review compliance with licensing requirements and verify the implementation of the submitted plan of correction.
Findings
The inspection found multiple deficiencies including unsigned resident contracts, delayed criminal background checks, unqualified direct care staff, facility maintenance issues such as peeling paint and broken plaster, lint accumulation in dryer vents, medication management errors including discontinued medications kept in the cart, missing medication diagnoses, failure to follow prescriber's orders, and incomplete resident assessments. All deficiencies had plans of correction accepted and were reported as implemented or in progress.
Citations (9)
Resident-home contract for resident #1 was not signed by the resident.
Criminal background check for staff person A was not requested timely.
Staff person A does not have a high school diploma, GED, or active registry status on the Pennsylvania nurse aide registry.
Peeling paint on ceiling above exit door #6 and broken plaster board above bed in resident room #3; missing tile and cracked caulk in lower-level bathroom.
Accumulation of lint in the lint trap of the dryer located in the basement.
Discontinued Clotrimazole cream was found in the home's medication cart.
Medication administration records for residents #3 and #4 did not include diagnosis or purpose for prescribed medications.
Resident #3 was prescribed Eliquis 5mg twice daily but medication was not administered from 6/7/25 through 6/17/25 due to unavailability.
Resident #1’s initial assessment did not include certain diagnoses and safety concerns.
Report Facts
Residents Served: 27
Total Daily Staff: 27
Waking Staff: 20
Residents Receiving Supplemental Security Income: 10
Residents Age 60 or Older: 22
Residents Diagnosed with Mental Illness: 5
Residents Diagnosed with Intellectual Disability: 4
Notice — Sep 5, 2024
Date: Sep 5, 2024
Visit Reason
This document serves as a waiver approval for a direct care staff member at Pine Manor Home to waive the requirement of having a high school diploma, GED, or active registry status due to equivalent education obtained outside the United States.
Findings
The waiver is granted under specific conditions including documentation of educational qualifications and annual review during inspections to ensure compliance. Failure to comply may result in termination of the waiver or other licensing actions.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Theresa Hartman | Bureau Director, Human Services Licensing | Signed the waiver approval letter. |
Inspection Report — Oct 12, 2022
Renewal
Date: Oct 12, 2022
Visit Reason
The inspection was conducted as a renewal, complaint, and incident review to assess compliance and verify the implementation of the submitted plan of correction.
Findings
The facility was found to have fully implemented the submitted plan of correction. Several deficiencies were identified related to incident reporting, privacy, lint removal, fire drills, medication security, resident rights, activity calendar posting, and support plan signatures, all of which had corrective actions accepted and implemented by 10/31/2022.
Citations (8)
The home did not report an incident involving residents 2 and 5 to the Department until 10/03/22.
Video recording cameras were observed in resident areas without posted signs informing residents and visitors about the devices.
There was a thick accumulation of lint in the lint trap of the home's dryer.
Fire drills were held on different days and times with two staff members participating, but not routinely held at low resident attendance times.
A vial of Dicyclomine 10 mg prescribed for Resident 1 was unlocked, unattended, and accessible on the nurses' desk.
Resident 2 was not educated on the right to refuse medication despite the resident's belief of a medication error.
The home did not have a current weekly activity calendar posted in a conspicuous and public place for the month of September.
Resident 3 did not sign the support plan nor was there documentation of refusal or inability to sign.
Report Facts
Residents Served: 27
Resident Supplemental Security Income: 12
Residents Age 60 or Older: 22
Residents Diagnosed with Mental Illness: 4
Residents Diagnosed with Intellectual Disability: 6
Residents with Mobility Need: 0
Residents with Physical Disability: 0
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Mentioned in relation to retraining regarding incident reporting | |
| Administrator | Mentioned multiple times in relation to corrective actions, education, and compliance follow-up |
Inspection Report — Dec 21, 2021
Routine
Date: Dec 21, 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 — Nov 30, 2021
Plan of Correction
Date: Nov 30, 2021
Visit Reason
The document confirms that the Pennsylvania Department of Human Services, Bureau of Human Service Licensing, reviewed the facility's submitted plan of correction on 11/30/2021 and 12/13/2021.
Findings
The submitted plan of correction was determined to be fully implemented, and continued compliance must be maintained.
Report Facts
Plan of correction review dates: Plan of correction was reviewed on 11/30/2021 and 12/13/2021
Notice — Apr 16, 2021
Date: Apr 16, 2021
Visit Reason
The document serves as a certificate of compliance and notification of license renewal for Pine Manor Home, a Personal Care Home. It informs the facility that the Department will conduct an onsite inspection within the next twelve months as required by regulation.
Findings
No inspection findings are reported in this document. It confirms issuance of a regular license in response to the renewal application and advises that future inspections will be conducted to ensure compliance.
Report Facts
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jamie J. Buchenauer | Deputy Secretary, Office of Long-term Living | Signed the renewal notification letter. |
Inspection Report — Jun 9, 2020
Routine
Date: Jun 9, 2020
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 — Jan 13, 2020
Renewal
Date: Jan 13, 2020
Visit Reason
The inspection was an unannounced renewal inspection of Pine Manor Home conducted by the Pennsylvania Department of Human Services on January 13, 2020.
Findings
The facility was found to have multiple violations including staff qualifications, environmental hazards, hot water temperature issues, medical evaluation documentation, medication administration, and support plan documentation. The submitted plan of correction was fully implemented as of the follow-up review on February 26, 2020.
Citations (12)
54a - Direct Care Staff: Direct Care Staff Person A did not have a high school diploma, GED, or active registry status on the Pennsylvania nurse aide registry.
88a - Surfaces: The top left window in the entry way/sun porch was cracked and contained three holes.
89b - Hot Water Temperature: Hot water temperatures in resident-accessible areas exceeded 120°F, measuring 127°F, 132°F, and 126°F in various bathrooms.
121a - Unobstructed Egress: Three filled trash bags, an empty detergent bottle, and a cardboard box blocked egress at Exit #3 off the dining area.
141a - Medical Evaluation Information: Resident 1's medical evaluation form lacked the date of evaluation and a list of medications.
185a - Implement Storage Procedures: Resident 2's medication administration record lacked staff initials and did not store blood sugar measurement in the glucometer memory.
187b - Date/Time of Medication Admin.: Resident 2's medication record did not include staff initials for medications administered on 1/9/2020 at 8pm.
187d - Follow Prescriber's Orders: Resident 2's blood glucose was not tested on 1/9/2020 at 7am as prescribed.
190a - Completion Medication Course: Staff Person B had not completed required medication administration training since 9/7/2016 and administered medication on 1/4/2020.
190b - Insulin Injections: Staff Person B had not completed required diabetes education since 12/11/2018 but administered diabetic care and insulin injections.
227d - Support Plan Medical/Dental: Resident 3's medical evaluation and support plan were outdated and did not document the need for leg elevation as required.
227g - Support Plan Signatures: Resident 4's support plan was not signed by the resident and lacked documentation of refusal or inability to sign.
Report Facts
Residents Served: 27
Resident Support Staff: 0
Total Daily Staff: 27
Waking Staff: 20
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Gladys Chepkoit | Administrator | Named as administrator responsible for plan of correction and signature on multiple findings |
Notice — Dec 18, 2019
Date: Dec 18, 2019
Visit Reason
This document serves as a renewal notification and license issuance for Pine Manor Home to operate as a Personal Care Home. It informs the facility of the requirement for an annual onsite inspection within the next twelve months.
Findings
No inspection findings are reported in this document. It confirms the issuance of a regular license and outlines the Department's intent to conduct an annual inspection.
Inspection Report — Jul 31, 2019
Complaint Investigation
Date: Jul 31, 2019
Visit Reason
The inspection was conducted as a complaint and incident investigation at Pine Manor Home.
Complaint Details
The inspection was complaint-related, investigating allegations of verbal abuse and mistreatment by Direct Care Staff Member A. The complaint was substantiated as violations were found.
Findings
The inspection found violations related to abuse, neglect, and mistreatment of residents by direct care staff. A plan of correction was required to address these issues and prevent recurrence.
Citations (3)
42b. A resident may not be neglected, intimidated, physically or verbally abused, mistreated, subjected to corporal punishment or disciplined in any way. Direct Care Staff Member A was reported by residents as verbally abusive and rude. Resident #1 reported that Direct Care Staff Member A called her fat and said that the resident wouldn’t have health problems if she wasn’t fat.
Resident #2 reported that Direct Care Staff Member A also told Resident #1, who is incontinent, that she 'stank' and threatened to kick the resident out of the home. Resident #2 stated that Direct Care Staff Member A is known 'to fly off the handle,' yells at residents, and threatens to throw them out of the home.
On 7/30/2019, Resident #3 was told by Direct Care Staff Member A to 'hurry up and eat your damn chicken,' and was also told to 'sit up straight' while eating by Direct Care Staff Member A. Residents #1, #2, and #3 stated that they were fearful of retaliation from Direct Care Staff Member A.
Report Facts
Residents Served: 24
Inspection Report — Mar 21, 2019
Original Licensing
Date: Mar 21, 2019
Visit Reason
The inspection was conducted as part of the licensing process for a new legal entity operating the facility.
Findings
The facility was found to be in substantial compliance with applicable regulations, but the licensing inspector was unable to complete a full inspection due to the new legal entity status.
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