Inspection Reports for Concordia at Rebecca Residence
3746 CEDAR RIDGE ROAD,, PA, 15101
Back to Facility ProfileDeficiencies (last 5 years)
Deficiencies (over 5 years)
6.4 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
36% worse than Pennsylvania average
Pennsylvania average: 4.7 deficiencies/yearDeficiencies per year
16
12
8
4
0
Census
Latest occupancy rate
91% occupied
Based on a September 2025 inspection.
Census over time
Inspection Report
Renewal
Census: 59
Capacity: 65
Deficiencies: 2
Sep 19, 2025
Visit Reason
The inspection was conducted as a renewal review of the facility's license to ensure continued compliance with regulatory requirements.
Findings
The inspection found deficiencies related to refrigerator/freezer temperature monitoring and incomplete resident medical evaluations. Plans of correction were submitted and fully implemented by the facility.
Deficiencies (2)
| Description |
|---|
| No thermometer in the freezer portion of the first-floor country kitchen’s LG refrigerator and freezer; Traulsen four-door cooler measured 45.6°F exceeding required temperature; no thermometer in the home’s main kitchen Traulsen two-door freezer. |
| Resident annual medical evaluations did not have any of the boxes checked in block #4 designated for 'Special Health or Dietary Needs.' |
Report Facts
License Capacity: 65
Residents Served: 59
Current Residents in Hospice: 13
Residents Age 60 or Older: 59
Residents Diagnosed with Mental Illness: 1
Residents with Mobility Need: 12
Residents with Physical Disability: 1
Total Daily Staff: 71
Waking Staff: 53
Inspection Report
Census: 58
Capacity: 65
Deficiencies: 0
May 20, 2025
Visit Reason
The inspection was conducted as a licensing inspection due to an incident, with an unannounced partial inspection type.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Report Facts
Resident Support Staff: 69
Waking Staff: 52
Residents Served: 58
License Capacity: 65
Current Hospice Residents: 10
Residents Age 60 or Older: 58
Residents Diagnosed with Mental Illness: 1
Residents with Mobility Need: 11
Residents with Physical Disability: 1
Residents Receiving Supplemental Security Income: 0
Residents Diagnosed with Intellectual Disability: 0
Inspection Report
Complaint Investigation
Census: 58
Capacity: 65
Deficiencies: 1
Mar 3, 2025
Visit Reason
The inspection was conducted as a complaint and incident investigation, as indicated by the reason stated in the inspection information section.
Findings
The facility failed to report a suspected abuse incident within the required 24-hour timeframe to the Department’s personal care home regional office or complaint hotline. The administrator concluded the suspicious liquid was salad dressing and did not report it timely, which was a violation of reporting requirements.
Complaint Details
The complaint investigation found that direct care staff discovered a suspicious liquid in a resident's room during a seizure-like event but the incident was not reported to the Department within 24 hours as required. The administrator did not report the incident timely due to the belief the liquid was salad dressing.
Deficiencies (1)
| Description |
|---|
| Failure to report a suspected abuse incident within 24 hours to the Department as required. |
Report Facts
License Capacity: 65
Residents Served: 58
Current Residents in Hospice: 13
Residents Age 60 or Older: 58
Residents Diagnosed with Mental Illness: 1
Residents with Mobility Need: 15
Residents with Physical Disability: 2
Total Daily Staff: 73
Waking Staff: 55
Inspection Report
Renewal
Census: 55
Capacity: 65
Deficiencies: 1
Aug 22, 2024
Visit Reason
The inspection visit on 08/22/2024 was conducted for renewal, complaint, and incident reasons as part of the facility's regulatory oversight.
Findings
The submitted plan of correction related to a medication discrepancy was fully implemented and compliance was maintained. A discontinued medication was found in the medication cart but was promptly removed and staff were re-educated on medication reconciliation policies.
Deficiencies (1)
| Description |
|---|
| A bottle of Atorvastatin 10 mg tablets prescribed for resident #1 was found in the medication cart despite being discontinued. |
Report Facts
License Capacity: 65
Residents Served: 55
Current Hospice Residents: 6
Residents Diagnosed with Mental Illness: 2
Residents with Mobility Need: 16
Residents with Physical Disability: 1
Total Daily Staff: 71
Waking Staff: 53
Inspection Report
Census: 59
Capacity: 65
Deficiencies: 0
Mar 8, 2024
Visit Reason
The inspection was a partial, unannounced visit conducted due to an incident at the facility on 03/08/2024.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Report Facts
License Capacity: 65
Residents Served: 59
Current Hospice Residents: 8
Residents 60 Years or Older: 59
Residents Diagnosed with Mental Illness: 1
Residents with Mobility Need: 13
Residents with Physical Disability: 1
Total Daily Staff: 72
Waking Staff: 54
Inspection Report
Census: 59
Capacity: 65
Deficiencies: 0
Jan 31, 2024
Visit Reason
The inspection was a partial, unannounced licensing inspection conducted due to an incident at the facility.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Report Facts
Total Daily Staff: 74
Waking Staff: 56
Resident Support Staff: 0
Residents Served: 59
License Capacity: 65
Current Hospice Residents: 7
Residents Age 60 or Older: 59
Residents Diagnosed with Mental Illness: 2
Residents with Mobility Need: 15
Inspection Report
Complaint Investigation
Census: 57
Capacity: 65
Deficiencies: 1
Oct 30, 2023
Visit Reason
The inspection was conducted as a complaint investigation to review compliance with resident care requirements.
Findings
The submitted plan of correction was found to be fully implemented. A deficiency was identified related to inadequate assistance with activities of daily living, specifically incontinence care for a resident who required total physical assistance.
Complaint Details
The visit was complaint-related as indicated by the inspection reason. The plan of correction was accepted and fully implemented.
Deficiencies (1)
| Description |
|---|
| Resident #1 did not receive incontinence care checks and changes every 2 hours as required, resulting in saturated clothing and bed linens. |
Report Facts
Licensed Capacity: 65
Residents Served: 57
Residents Age 60 or Older: 57
Residents Diagnosed with Mental Illness: 1
Residents with Mobility Need: 16
Residents with Physical Disability: 1
Total Daily Staff: 73
Waking Staff: 55
Inspection Report
Follow-Up
Census: 55
Capacity: 65
Deficiencies: 4
Apr 10, 2023
Visit Reason
The inspection was a partial, unannounced follow-up visit triggered by an incident to verify the implementation of a previously submitted plan of correction related to medication administration violations.
Findings
The facility was found to have fully implemented the plan of correction regarding medication administration violations, including leaving medications unattended and unlocked, and inaccurate documentation of medication administration. Continued compliance must be maintained.
Deficiencies (4)
| Description |
|---|
| Medication administration violation where staff left numerous morning medications unattended on resident #1's nightstand and did not administer them as ordered. |
| Prescription medications and syringes were not kept locked and were accessible on resident #1's nightstand despite resident #1 being unable to self-administer medications. |
| Medication administration times were not recorded accurately; medications were documented as administered though they were left unattended and not given. |
| Failure to follow prescriber's orders by not administering medications as directed and leaving them unattended. |
Report Facts
Resident census: 55
Total licensed capacity: 65
Staffing: 66
Staffing: 50
Residents with mobility need: 11
Residents age 60 or older: 55
Residents diagnosed with mental illness: 1
Inspection Report
Renewal
Census: 55
Capacity: 65
Deficiencies: 6
Dec 14, 2022
Visit Reason
The inspection was conducted as a renewal and complaint investigation of Concordia at Rebecca Residence, including unannounced full inspections on 12/14/2022, 12/15/2022, and 12/16/2022.
Findings
The facility was found to have multiple deficiencies including unqualified direct care staff, unsanitary conditions in the kitchen microwave, damaged ceiling tiles, lack of operable bedside lamps for residents, incomplete fire safety inspection documentation, and outdated annual medical evaluations for residents. Plans of correction were accepted and implemented by January 30, 2023.
Deficiencies (6)
| Description |
|---|
| Direct care staff person provided unsupervised care without a high school diploma, GED, or active registry status on the Pennsylvania nurse aide registry. |
| Unidentifiable yellow substance splattered on every interior surface of the Garden Unit country kitchen microwave and brown residue underneath the rotating glass dish. |
| Drop ceiling tile in the first floor country kitchen was dry but water damaged and stained brownish yellow in an area measuring approximately 5 inches by 2.5 inches. |
| Lamp on the bedside table was out of reach from bedside in resident room belonging to resident #1. |
| Fire safety inspection conducted by a fire safety expert did not designate specific fire safe areas or areas of refuge in writing and only indicated 'Behind fire doors' on the fire safety inspection letter dated 7/12/22. |
| Resident #2's current medical evaluation was dated after the inspection, and the previous medical evaluation was completed on 2/18/21, indicating an outdated annual medical evaluation. |
Report Facts
License Capacity: 65
Residents Served: 55
Current Residents in Hospice: 11
Total Daily Staff: 66
Waking Staff: 50
Inspection Report
Complaint Investigation
Census: 53
Capacity: 65
Deficiencies: 2
May 4, 2022
Visit Reason
The inspection was conducted as a complaint investigation following allegations of abuse and inappropriate behaviors involving residents and staff at Concordia at Rebecca Residence.
Findings
The investigation found an allegation of sexual assault by a staff member which was ultimately unsubstantiated after internal and DHS/APS investigations. Additionally, multiple incidents involving inappropriate behaviors and statements by resident #2 were documented, requiring updated assessments and staff training.
Complaint Details
The complaint involved an allegation of sexual assault by staff person A against resident #1, which was investigated and found unsubstantiated. Multiple staff reported inappropriate behaviors by resident #2, including inappropriate touching and statements. The facility was educated on suspension protocols and updated resident assessments.
Deficiencies (2)
| Description |
|---|
| Failure to immediately develop and implement a plan of supervision or suspend a staff person involved in an alleged abuse incident. |
| Resident #2's assessment was not initially updated to reflect behavioral needs and incidents of inappropriate sexual behaviors were reported. |
Report Facts
Residents Served: 53
License Capacity: 65
Current Residents in Hospice: 6
Resident Age 60 or Older: 53
Residents with Mobility Need: 8
Inspection Report
Complaint Investigation
Census: 56
Capacity: 65
Deficiencies: 0
Feb 28, 2022
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.
Complaint Details
The inspection was complaint-related, but no deficiencies were found and the follow-up was not required.
Report Facts
License Capacity: 65
Residents Served: 56
Current Hospice Residents: 6
Residents Age 60 or Older: 56
Residents Diagnosed with Mental Illness: 1
Residents with Mobility Need: 15
Residents with Physical Disability: 2
Total Daily Staff: 71
Waking Staff: 53
Inspection Report
Complaint Investigation
Census: 57
Capacity: 65
Deficiencies: 1
Jan 6, 2022
Visit Reason
The inspection was conducted as a complaint investigation to review the facility's compliance with regulatory requirements.
Findings
The facility was found to have a deficiency related to the failure to update a resident's support plan to reflect changes in cognitive behaviors, supervision needs, and incontinence care. The submitted plan of correction was reviewed and determined to be fully implemented.
Complaint Details
The visit was complaint-related. The deficiency involved failure to update a resident's support plan as required. The plan of correction was initially not accepted but later accepted after resident discharge and document submission.
Deficiencies (1)
| Description |
|---|
| Resident #1's support plan had not been updated to include changes in cognitive behaviors, supervision/wandering needs, and increased incontinence care. |
Report Facts
License Capacity: 65
Residents Served: 57
Current Residents in Hospice: 6
Residents Age 60 or Older: 57
Residents with Mobility Need: 15
Residents with Physical Disability: 1
Inspection Report
Renewal
Census: 59
Capacity: 65
Deficiencies: 14
Sep 15, 2021
Visit Reason
The inspection was conducted as a renewal and complaint investigation of Concordia at Rebecca Residence.
Findings
The inspection identified multiple deficiencies including unsigned resident contracts, staff lacking required qualifications, inadequate staffing during certain hours, incomplete or unsigned medical evaluations and support plans, sanitary issues, and medication documentation errors. Plans of correction were submitted and determined to be fully implemented by the follow-up dates.
Deficiencies (14)
| Description |
|---|
| Resident #3's resident-home contract was not signed by the resident until after admission. |
| Direct care staff person C did not have a high school diploma, GED or active registry status on the Pennsylvania nurse aide registry at hire. |
| Inadequate staffing during night shifts on multiple dates, with only one staff present when two were needed for safe evacuation and resident transfers. |
| Direct care staff persons A, B, and C did not complete or pass the Department-approved direct care training and competency test within required timeframes. |
| Multiple areas of dried egg yolk were found on the bottom of the refrigerator in the PC North Pantry. |
| No emergency telephone numbers were posted on or near the telephone in resident #3's bedroom. |
| Two cement slabs of the sidewalk in the PC North courtyard were raised approximately 1.5 inches, posing a tripping hazard. |
| Resident #1, #2, #8, and #10 had medical evaluations not signed by the physician or missing evaluation dates. |
| Incorrect blood glucose readings were documented on residents' medication administration records. |
| Resident #1 received incorrect insulin dosage based on sliding scale; resident #4's blood glucose was not taken as required. |
| Resident #2's preadmission screening form did not include a determination that the home can meet the resident's needs. |
| Resident #6's most recent assessment was not completed timely. |
| Residents #7, #8, #9, and #10's support plans did not indicate need for 2-person assistance with transfers or use of Broda chair. |
| Residents #1, #7, #8, and #10's support plans were not signed by the resident or assessor, and did not indicate if resident was unable or refused to sign. |
Report Facts
License Capacity: 65
Residents Served: 59
Residents with Mobility Needs: 14
Residents Requiring 2 Staff Assistance: 9
Current Hospice Residents: 9
Raised Cement Slabs: 2
Insulin Sliding Scale Units: 14
Notice
Capacity: 65
Deficiencies: 0
Feb 5, 2021
Visit Reason
The document serves as a certificate of compliance and notification of license renewal for Concordia at Rebecca Residence, a Personal Care Home. It also informs the facility administrator about the requirement for an annual onsite inspection within the next twelve months.
Findings
The Department has issued a regular license in response to the renewal application and advises that an annual inspection will be conducted within the next twelve months. No findings or deficiencies are reported in this document.
Report Facts
Total licensed capacity: 65
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Melanie Stewart | Administrator | Facility administrator addressed in the renewal notification letter. |
| Jamie L. Buchenauer | Deputy Secretary, Office of Long-term Living | Signed the renewal notification letter. |
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