Inspection Reports for Country Meadows of Forks
175 NEWLINS ROAD WEST,, PA, 18040
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16
12
8
4
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Census Over Time
Census
Capacity
Inspection Report
Renewal
Census: 84
Capacity: 90
Deficiencies: 8
Jul 24, 2025
Visit Reason
The inspection was an unannounced full renewal inspection conducted on 07/24/2025 to review compliance with licensing requirements.
Findings
The facility had multiple deficiencies related to resident equipment safety, unobstructed egress, fire drill scheduling, medication management, resident assessment content, special care unit admission documentation, key-locking device signage, and record-keeping for destroyed resident records. All deficiencies had accepted plans of correction which were fully implemented by 09/18/2025.
Deficiencies (8)
| Description |
|---|
| Resident #1’s bedside mobility device was uncovered with an opening posing risk of entrapment and was not firmly attached to the bed. |
| Blocked egress in the boiler room preventing evacuation. |
| Fire drills routinely held during sleeping hours at beginning or end of 3rd shift. |
| Discontinued medication (Rosuvastatin 10 mg) found in resident #2’s medication cart. |
| Resident #1’s assessment did not include information about use of bedside mobility device. |
| Resident #3’s record lacked documentation of agreement to admission to special care unit. |
| Directions for operating key-locking device not posted near exit door by room 17 in special care unit. |
| Destroyed Record Log did not include resident record number. |
Report Facts
License Capacity: 90
Residents Served: 84
Special Care Unit Capacity: 45
Special Care Unit Residents Served: 37
Current Hospice Residents: 6
Residents Age 60 or Older: 84
Residents with Mobility Need: 37
Residents with Physical Disability: 1
Inspection Report
Plan of Correction
Deficiencies: 3
May 21, 2024
Visit Reason
The document addresses deficiencies found in resident support plans related to documentation of assistance levels and device use, and outlines the facility's plan of correction to ensure regulatory compliance.
Findings
The inspection found that resident support plans lacked specific documentation regarding the level of assistance required for hydration encouragement, social participation, and use of assistive devices such as bed canes.
Deficiencies (3)
| Description |
|---|
| Resident #1's support plan does not indicate the level of assistance required for hydration encouragement and agitation management. |
| Resident #5's support plan does not indicate the level of assistance required for participation in social and leisure activities. |
| Resident #5's support plan lacks documentation on the specific need, intended use, risks, safe use ability, device specifics, and FDA guideline compliance for a bed cane. |
Report Facts
Plan of Correction Completion Date: Jun 12, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Administrator | Responsible for monitoring support plans to ensure regulatory compliance | |
| Director of Nursing | Responsible for monitoring support plans to ensure regulatory compliance |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 90
Deficiencies: 0
May 2, 2024
Visit Reason
The inspection was conducted as a complaint and incident investigation during an unannounced partial inspection on 05/02/2024.
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 no follow-up was required.
Report Facts
License Capacity: 90
Residents Served: 75
Special Care Unit Capacity: 45
Special Care Unit Residents Served: 40
Hospice Residents: 10
Resident Support Staff: 0
Total Daily Staff: 115
Waking Staff: 86
Residents Age 60 or Older: 75
Residents with Mobility Need: 40
Inspection Report
Renewal
Census: 77
Capacity: 90
Deficiencies: 0
Sep 26, 2023
Visit Reason
The inspection was conducted as a renewal inspection with complaint reason noted, including unannounced full licensing inspections on 09/26/2023 and 09/29/2023.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Report Facts
License Capacity: 90
Residents Served: 77
Special Care Unit Capacity: 45
Special Care Unit Residents Served: 43
Hospice Current Residents: 9
Total Daily Staff: 114
Waking Staff: 86
Residents Age 60 or Older: 77
Residents with Mobility Need: 37
Inspection Report
Follow-Up
Census: 73
Capacity: 90
Deficiencies: 1
Feb 14, 2023
Visit Reason
The inspection visit was conducted as a follow-up to verify the implementation of a submitted plan of correction related to a complaint/incident.
Findings
The submitted plan of correction was determined to be fully implemented. The report details a violation involving staff mistreatment of a resident, with corrective actions including suspension, termination, retraining, and ongoing monitoring.
Complaint Details
The visit was complaint-related, triggered by an incident where a staff member used inappropriate language and behavior towards a resident. The plan of correction was accepted and fully implemented.
Deficiencies (1)
| Description |
|---|
| Staff person A yelled at and used foul language during an interaction with resident #1, witnessed by others and reported to the administrator. |
Report Facts
License Capacity: 90
Residents Served: 73
Special Care Unit Capacity: 45
Special Care Unit Residents Served: 32
Hospice Current Residents: 7
Residents Age 60 or Older: 73
Residents with Mobility Need: 32
Inspection Report
Complaint Investigation
Census: 74
Capacity: 90
Deficiencies: 2
Dec 28, 2022
Visit Reason
The inspection was conducted as a complaint and incident investigation at the facility on 12/28/2022.
Findings
Two deficiencies were identified: one involving unsafe access to poisonous materials by a resident, and another involving incomplete documentation of a resident's behavior in the support plan. Both deficiencies had plans of correction accepted and were implemented by 03/08/2023.
Complaint Details
The visit was complaint-related and incident-driven, with a follow-up type of Plan of Correction submission and document submission. The complaint was investigated on-site on 12/28/2022.
Deficiencies (2)
| Description |
|---|
| Poisonous materials were not kept locked and inaccessible to a resident who cannot safely use or avoid them, as evidenced by a resident having a bottle of hand sanitizer with the pump in their mouth. |
| The support plan for a resident in the special care unit was not updated to reflect the resident's behavior of self-propelling a wheelchair and collecting items. |
Report Facts
License Capacity: 90
Residents Served: 74
Special Care Unit Capacity: 35
Special Care Unit Residents Served: 33
Hospice Residents: 8
Resident Mobility Need: 35
Total Daily Staff: 109
Waking Staff: 82
Inspection Report
Follow-Up
Census: 70
Capacity: 90
Deficiencies: 3
Oct 13, 2022
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.
Findings
The submitted plan of correction was determined to be fully implemented. The report details multiple resident abuse violations involving staff members and residents, including delayed reporting of abuse, physical abuse resulting in injury, and verbal abuse. Appropriate corrective actions, including staff coaching, retraining, suspension, and termination, were completed and verified.
Deficiencies (3)
| Description |
|---|
| Failure to immediately report suspected abuse of a resident, with delayed notification to the administrator. |
| Resident 2 fractured their hip after being hit multiple times by Resident 3 with a shoe, indicating physical abuse. |
| Staff Member C was observed cursing at and antagonizing Resident 1 by waving a t-shirt in their face, constituting verbal abuse. |
Report Facts
License Capacity: 90
Residents Served: 70
Special Care Unit Capacity: 45
Special Care Unit Residents Served: 34
Hospice Residents: 10
Residents Age 60 or Older: 70
Residents with Mobility Need: 36
Total Daily Staff: 106
Waking Staff: 80
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Staff Member C | Named in verbal and physical abuse findings; was suspended and subsequently terminated. | |
| Staff Member A | Involved in delayed reporting of abuse. | |
| Staff Member B | Aware of abuse but did not report immediately. | |
| Staff Member D | Supervisor who delayed notifying the administrator about abuse. | |
| Administrator | Administrator | Responsible for retraining staff and monitoring resident behaviors. |
| Director of Nursing | Director of Nursing | Responsible for monitoring resident behaviors as needed. |
Inspection Report
Complaint Investigation
Census: 70
Capacity: 90
Deficiencies: 0
Aug 30, 2022
Visit Reason
The inspection was conducted as a complaint investigation with an unannounced partial inspection on 08/30/2022.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Complaint Details
The inspection was complaint-related, but no deficiencies or citations were substantiated.
Report Facts
License Capacity: 90
Residents Served: 70
Special Care Unit Capacity: 45
Special Care Unit Residents Served: 32
Hospice Current Residents: 10
Total Daily Staff: 105
Waking Staff: 79
Residents 60 Years or Older: 70
Residents with Mobility Need: 35
Residents with Physical Disability: 1
Inspection Report
Renewal
Deficiencies: 0
Jul 14, 2022
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
Renewal
Census: 74
Capacity: 90
Deficiencies: 13
Jun 28, 2022
Visit Reason
The inspection was an unannounced full renewal inspection conducted over three days from 06/28/2022 to 06/30/2022 to review compliance with licensing requirements.
Findings
The facility had multiple deficiencies including issues with contract signatures, outdated food, fire extinguisher inspections, medication administration and labeling, storage procedures, support plans, key-locking device postings, and staff training. All deficiencies had accepted plans of correction which were fully implemented by the time of the report.
Deficiencies (13)
| Description |
|---|
| The resident-home contract for Resident #1 was signed by the resident's power of attorney but not by the resident, with no indication the resident was offered to sign. |
| There was a dented can of Dole pineapple tidbits in the home's kitchen pantry. |
| The fire extinguisher in the mechanical room had not been inspected since June 2020, exceeding the required annual inspection timeframe. |
| Resident #2 had medications in their bathroom despite medical evaluation indicating they cannot self-administer medications. |
| A container of Clomitrozole Cream 1% prescribed to Resident #3 was in the medication cart but not listed as a current order in the medication record. |
| The pharmacy label for Resident #5's Pain Reliever Plus tab did not include the medication dosage. |
| The glucometer for Resident #4 was not calibrated for the current date and time; several PRN medications were missing from the medication cart at inspection. |
| Resident #5's medication record did not list the dosage for Pain Reliever Plus tabs. |
| Resident #6 was administered Metoprolol despite systolic blood pressure being below the hold parameter. |
| Resident #7's assessment and support plan did not document the need for a bed cane used for transfers. |
| Directions for operating locked exit doors in the special care unit were not conspicuously posted; the keypad code posted was incorrect. |
| Direct care staff person A in the special care unit completed only 6.5 hours of required initial dementia training instead of 8 hours. |
| Direct care staff person A did not complete required training on managing challenging behaviors. |
Report Facts
Inspection dates: 3
License capacity: 90
Residents served: 74
Special care unit capacity: 36
Special care unit residents served: 34
Hospice residents: 5
Total daily staff: 109
Waking staff: 82
Residents with mobility need: 35
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Direct care staff person A | Named in findings related to incomplete dementia care training and missing training on managing challenging behaviors | |
| Director of Nursing | Director of Nursing | Responsible person for multiple medication-related deficiencies and training compliance |
| Administrator | Administrator | Responsible person for contract signature deficiency and support plan documentation |
| Director of Maintenance | Director of Maintenance | Responsible for fire extinguisher inspections and audits |
| Dining director | Dining director | Responsible for food inspection and canned goods audits |
Inspection Report
Renewal
Deficiencies: 0
Nov 2, 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
Renewal
Census: 69
Capacity: 90
Deficiencies: 1
Aug 24, 2021
Visit Reason
The inspection was conducted as a renewal and complaint investigation for the facility.
Findings
The submitted plan of correction was found to be fully implemented following the inspection. One deficiency was noted involving outdated food in the kitchen freezer, specifically an undated package of pizza sausage weighing approximately 5 pounds.
Deficiencies (1)
| Description |
|---|
| The freezer located in the kitchen had 1 package of pizza sausage that was approximately 5 pounds that was not dated. |
Report Facts
License Capacity: 90
Residents Served: 69
Special Care Unit Capacity: 45
Special Care Unit Residents Served: 32
Hospice Residents: 1
Notice
Capacity: 90
Deficiencies: 0
Jun 9, 2021
Visit Reason
The document serves as a certificate of compliance and license renewal for Country Meadows of Forks Assisted Living-Special Care facility, confirming the renewal application was received and a regular license issued. It also notifies that an annual onsite inspection will be conducted within the next twelve months as required by state regulations.
Findings
No inspection findings are reported in this document. It confirms the issuance of a regular license following the renewal application and outlines the requirement for a future annual inspection to ensure compliance.
Report Facts
Total licensed capacity: 90
Special Care Unit capacity: 45
Inspection Report
Follow-Up
Census: 66
Capacity: 90
Deficiencies: 1
May 10, 2021
Visit Reason
The inspection was a follow-up review to verify that the submitted plan of correction was fully implemented following prior deficiencies.
Findings
The submitted plan of correction was determined to be fully implemented, with continued compliance required. A specific deficiency related to dignity and respect was addressed by staff suspension, resignation, and retraining.
Deficiencies (1)
| Description |
|---|
| Direct care staff member pushed a resident's forehead back after the resident pushed the staff member's stomach, failing to treat the resident with dignity and respect. |
Report Facts
License Capacity: 90
Residents Served: 66
Special Care Unit Capacity: 36
Special Care Unit Residents Served: 32
Hospice Residents: 1
Resident Mobility Need: 33
Total Daily Staff: 99
Waking Staff: 74
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