Inspection Reports for
The Addison of Clen-Moore Place

No regulatory citations or deficiencies were identified during the inspection.

The submitted plan of correction was fully implemented and compliance was maintained. Several deficiencies were identified related to heat sources, furniture and equipment, combustible storage, and smoking area distance, all of which had corrective actions planned and implemented.

The facility was found to be in substantial compliance with the regulations at the time of inspection. A temperature violation was cited for the reach-in freezer measuring 45°F, which was corrected immediately and a plan of correction was implemented.

The submitted plan of correction regarding a refrigerator/freezer temperature violation was found to be fully implemented. The freezer temperature issue was corrected promptly, and ongoing monitoring and staff education measures were established.

The facility was found to have deficiencies related to criminal background checks and staff training topics. Plans of correction were accepted and implemented by 06/28/2023, with ongoing audits and quality improvement meetings planned to maintain compliance.

The facility was found to have fully implemented the submitted plan of correction related to multiple deficiencies including failure to immediately report suspected resident abuse, failure to report incidents timely, lack of first day orientation for a staff member, and incomplete resident assessments. Continued compliance must be maintained.

The complaint investigation substantiated that staff person A violated resident dignity and respect by speaking inappropriately to residents with dementia. Protective Services and the Area Agency on Aging were notified, and staff person A was placed on administrative leave pending investigation.

The investigation found that staff person A spoke to multiple residents with dementia in a loud, demanding, and abrasive tone, violating resident dignity and respect. Additionally, a resident's assessment did not include the use of a wander guard system as ordered.

The inspection identified multiple deficiencies including failure to provide required assistance with activities of daily living, inadequate quality management plan content, mistreatment of a resident by staff, incomplete criminal background checks, insufficient staff orientation and training, and medication labeling discrepancies. Plans of correction were submitted and accepted with completion dates mostly by 05/02/2022.

The Department issued a regular license in response to the renewal application and stated that an onsite inspection will be conducted within the next twelve months to ensure compliance with applicable regulations.

The facility was found to have inadequate staffing during the night shift to safely evacuate all residents in an emergency, particularly for residents requiring assistance with mobility. A plan of correction was submitted and fully implemented.

No inspection findings are reported in this document. It confirms the issuance of a regular license following the renewal application.

The inspection identified violations related to staff training on medication self-administration, labeling of prescription medications, and medication record keeping. Plans of correction were submitted and approved to address these deficiencies.

The visit was complaint-related due to an incident involving Resident #1 not receiving proper toileting and bladder management assistance. The complaint was substantiated by the findings.

The inspection found a violation of 55 Pa. Code Ch. 2600 regarding assistance with activities of daily living. Resident #1 was found soaked with urine and did not receive required toileting and bladder management assistance during the specified time.

No regulatory citations or deficiencies were identified as a result of this inspection.

No inspection findings are reported in this document as it is a license renewal notice.

The inspection included a complaint investigation; however, no substantiation status is explicitly stated in the report.

The inspection found violations related to resident privacy and confidentiality, missing resident acknowledgments of rights and complaint procedures, and incomplete preadmission screening documentation.

No inspection findings are reported in this document. It states that an onsite inspection will be conducted within the next twelve months as required by regulation.

No regulatory violations were identified as a result of this inspection.

The inspection was complaint-driven as stated on page 2. The complaint involved concerns about resident rights and care, including unauthorized restriction of a resident's movement and inadequate medical and dietary care.

The inspection found multiple violations including improper restriction of a resident's right to leave the home, incomplete medical evaluations, failure to meet special dietary needs, inadequate resident assessments, and missing documentation in the resident's support plan.

Multiple violations of 55 Pa.Code Chapter 2600 related to resident contracts, sanitation, food storage, refrigeration, medication storage, and record keeping were found. Plans of correction were submitted and partially implemented as of early 2018.

No inspection findings are reported in this document. It states that the Department will conduct an onsite inspection within the next twelve months as required by regulation.

The complaint was substantiated based on the incident where staff person A said, "Here's your coffee, goober?" to resident #1 on 2/12/2017. The resident's family member reported the incident to the administrator who reported it to the Department.

One violation was found regarding staff treating a resident without dignity and respect during dinner. The incident involved a staff member making an inappropriate comment to a resident, which was witnessed and reported by a family member.

The facility was found to be in compliance with 55 Pa.Code Chapter 2600 relating to Personal Care Homes after corrections were made. One violation was noted regarding a delayed criminal background check for a staff member, which was subsequently corrected.

The investigation was substantiated with findings of abuse and neglect by staff person A, who was suspended and terminated. Other violations related to staff background checks and resident support plan documentation were also identified.

Multiple violations of 55 Pa.Code Chapter 2600 were found, including resident abuse, failure to treat residents with dignity and respect, incomplete criminal background checks for staff, and inadequate documentation of psychiatric services in resident support plans.

No inspection findings are reported in this document. It serves as a license renewal confirmation and notification of future inspection requirements.

The complaint investigation was substantiated based on findings that staff person A abused a resident by grabbing the resident's cheeks and calling the resident a derogatory name. The home failed to immediately act by developing a supervision plan or suspending the staff. Additional deficiencies related to training and resident support plans were also identified.

The investigation found that a staff person grabbed a resident's cheeks and called the resident a derogatory name. The home failed to immediately develop and implement a plan of supervision or suspend the involved staff. Additional violations included failure to provide required training and incomplete resident support plans.

The inspection was complaint-driven and incident-related. Specific substantiation status is not stated.

The inspection found violations related to wheelchair maintenance, resident dietary assessments, and documentation of hospice services in resident support plans. Plans of correction were submitted addressing these issues with partial implementation noted.