Inspection Report
Census: 88
Capacity: 164
Deficiencies: 0
Sep 4, 2025
Visit Reason
The inspection was conducted as a partial, unannounced visit due to an incident at the facility.
Findings
No regulatory citations or deficiencies were identified during this inspection.
Report Facts
License Capacity: 164
Residents Served: 88
Secured Dementia Care Unit Capacity: 60
Secured Dementia Care Unit Residents Served: 21
Residents Age 60 or Older: 109
Residents with Mobility Need: 25
Residents Diagnosed with Mental Illness: 1
Residents Diagnosed with Intellectual Disability: 1
Inspection Report
Re-Inspection
Census: 86
Capacity: 164
Deficiencies: 20
Mar 27, 2025
Visit Reason
Partial unannounced inspection conducted on 03/27/2025 as a follow-up to verify correction of previous deficiencies and compliance with regulations.
Findings
The inspection identified multiple deficiencies related to safety, abuse, privacy, medication administration, and facility maintenance. Plans of correction were submitted and accepted with ongoing monitoring and retraining scheduled. Some violations were repeat and enforcement actions were initiated.
Deficiencies (20)
| Description |
|---|
| Exit door labeled 1b in memory care unit did not open immediately; panic bar was rusted and sticking. |
| Resident #1 was verbally and physically abused by staff; video evidence showed improper use of Hoyer Lift and inappropriate behavior. |
| Resident #1 was mechanically restrained improperly by staff using a Hoyer Lift sling. |
| Staff recorded inaccurate blood glucose readings on Medication Administration Record (MAR). |
| Medication (Tylenol) not available on hand for Resident #6 as ordered. |
| Staff failed to initial MAR at time of medication administration for Resident #7. |
| Resident #8's heart rate was not measured prior to administration of Metoprolol as ordered. |
| Resident #11's Medical Evaluation form was incomplete and incorrectly dated. |
| Carbon monoxide detector missing near propane gas-fired furnace. |
| Staff did not receive required fire safety training from a certified expert for 2024 training year. |
| Poisonous materials (Windex) stored in unlabeled container. |
| Toothpaste with poison warning accessible to unsafe resident in secure dementia unit. |
| Resident #2's glucometer was used for another resident; contamination risk. |
| Trash can in secured dementia kitchen lacked lid. |
| Residents' bedrooms lacked operable lamps or bedside lighting. |
| No thermometer found in secured dementia kitchen freezer. |
| Fire extinguishers behind locked glass cases lacked accessible keys for staff. |
| Fire drills conducted during sleeping hours when additional staff were present, not meeting regulatory requirements. |
| No code posted near keypad exit doors in secure dementia unit. |
| Outdoor smoking area had cigarette butts mixed with dried leaves, fire hazard. |
Report Facts
Inspection dates: 3
License capacity: 164
Residents served: 86
Secured Dementia Care Unit capacity: 60
Residents served in secure dementia unit: 52
Staffing hours: 138
Waking staff: 104
Deficiency counts: 20
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Linda Palermo | Director of Nursing | Named in relation to retraining staff on abuse, mandatory reporting, and medication administration. |
| Richard Lech | Director of Maintenance | Named in relation to monthly audits for smoking area compliance and fire extinguisher key placement. |
Inspection Report
Follow-Up
Census: 86
Capacity: 164
Deficiencies: 18
Mar 27, 2025
Visit Reason
Partial unannounced inspection conducted on 03/27/2025 as an interim follow-up to previous violations and plan of correction submissions.
Findings
The inspection identified deficiencies related to exit door egress obstructions and malfunctioning locks, medication administration errors, and staff compliance with regulatory requirements. Plans of correction were submitted and accepted with directed completion dates.
Deficiencies (18)
| Description |
|---|
| Exit door labeled 1b in the memory care unit did not open immediately after code entry; panic bar was rusted and sticking. |
| Resident #1 was subjected to abuse including being thrown onto bed and placed in a Hoyer Lift at highest level causing mechanical restraint. |
| Staff recorded inaccurate blood glucose test results on Medication Administration Record (MAR). |
| Staff failed to measure resident's heart rate prior to administering Metoprolol as ordered. |
| Fire extinguishers in memory care unit were locked without accessible keys to staff. |
| Carbon monoxide detector was not present near propane gas-fired furnace. |
| Poisonous materials (Windex) stored in unlabeled container in laundry room. |
| Toothpaste accessible to residents unsafe to use or avoid poisonous materials. |
| Residents in rooms 16 and 20 lacked operable bedside lamps. |
| Resident #1’s glucometer was used for Resident #2, risking cross-contamination. |
| Trash can in secured dementia care kitchen lacked lid. |
| Medical evaluations for residents lacked physician name and license number. |
| No code posted near keypad exits in secured dementia unit. |
| Smoking area had cigarette butts mixed with dried leaves on ground. |
| Resident #6 lacked prescribed Tylenol medication on hand; inaccurate glucometer documentation. |
| Resident #7 medication administered but not initialed on MAR at time of administration. |
| Resident #8’s heart rate was not measured prior to medication administration as ordered. |
| Resident #11’s medical evaluation form was incomplete and incorrectly dated. |
Report Facts
License Capacity: 164
Residents Served: 86
Secured Dementia Care Unit Capacity: 60
Residents Served in Secured Dementia Care Unit: 52
Current Hospice Residents: 6
Total Daily Staff: 138
Waking Staff: 104
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Linda Palermo | Director of Nursing | Conducted retraining on abuse, mandatory reporting, residents rights, and restraints. |
| Richard Lech | Director of Maintenance | Responsible for monthly audits of smoking area and fire extinguisher key placement. |
Inspection Report
Re-Inspection
Census: 86
Capacity: 164
Deficiencies: 16
Mar 27, 2025
Visit Reason
The inspection visit on 03/27/2025 was a partial, unannounced inspection conducted as an interim incident review to assess compliance and investigate violations found during prior inspections.
Findings
The inspection found multiple violations including abuse, privacy breaches, improper medication administration, unsafe storage of poisonous materials, fire safety deficiencies, and maintenance issues such as obstructed egress and inaccessible fire extinguishers. Corrective actions and retraining plans were implemented, with ongoing monitoring and audits directed to ensure compliance.
Deficiencies (16)
| Description |
|---|
| Resident #1 was subjected to physical and verbal abuse by staff, including being thrown onto a bed and restrained improperly in a Hoyer Lift. |
| Staff recorded inaccurate blood glucose readings on the Medication Administration Record (MAR). |
| Carbon monoxide detector was missing near the propane gas-fired furnace in the basement. |
| Fire extinguishers in the memory care unit were locked without accessible keys for staff. |
| Exit door labeled 1b in the memory care unit did not open immediately due to rusted panic bar. |
| Poisonous materials (Windex) were stored in an unlabeled container in the laundry room. |
| Toothpaste accessible to residents unsafe to handle poisonous materials was found unlocked in the dementia unit. |
| Residents in rooms 16 and 20 lacked operable lamps or bedside lighting. |
| Resident #8's heart rate was not measured prior to administration of Metoprolol as ordered. |
| Medical evaluations for residents lacked physician names or license numbers. |
| No code posted near keypad exits in the secure dementia unit. |
| Trash can in the secured dementia kitchen lacked a lid. |
| Resident #1’s glucometer was used to test another resident’s blood sugar, risking cross-contamination. |
| Staff recorded medication administration times inaccurately or failed to initial MAR. |
| Smoking area had cigarette butts mixed with dried leaves, posing fire hazard. |
| Fire drills were routinely held at times when additional staff were present, not meeting regulatory requirements. |
Report Facts
License Capacity: 164
Residents Served: 86
Secured Dementia Care Unit Capacity: 60
Residents Served in Dementia Unit: 52
Current Hospice Residents: 6
Total Daily Staff: 138
Waking Staff: 104
Deficiency Counts: 16
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Linda Palermo | Director of Nursing | Named in relation to retraining staff on abuse, medication administration, and other compliance issues. |
| Richard Lech | Director of Maintenance | Named in relation to maintenance issues and monitoring fire safety compliance. |
| Kristyna Kiefer | Director of Secured Dementia Unit | Named in relation to immediate removal of unsafe poisonous materials. |
Inspection Report
Complaint Investigation
Census: 90
Capacity: 164
Deficiencies: 0
Jan 6, 2025
Visit Reason
The inspection was conducted as a complaint investigation at Fritzingertown Senior Living Community on January 6, 2025.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Complaint Details
The inspection was complaint-driven and no deficiencies or regulatory citations were found, indicating no substantiated issues.
Report Facts
License Capacity: 164
Residents Served: 90
Secured Dementia Care Unit Capacity: 64
Secured Dementia Care Unit Residents Served: 23
Hospice Current Residents: 9
Residents Age 60 or Older: 89
Residents with Mobility Need: 28
Residents Diagnosed with Intellectual Disability: 1
Residents Receiving Supplemental Security Income: 2
Inspection Report
Complaint Investigation
Census: 90
Capacity: 164
Deficiencies: 0
Dec 31, 2024
Visit Reason
The inspection was conducted as a complaint investigation at Fritzingertown Senior Living Community on December 31, 2024.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Complaint Details
The inspection was complaint-driven, but no deficiencies or regulatory citations were found, indicating no substantiated issues.
Report Facts
License Capacity: 164
Residents Served: 90
Secured Dementia Care Unit Capacity: 64
Secured Dementia Care Unit Residents Served: 23
Hospice Current Residents: 9
Residents Receiving Supplemental Security Income: 2
Residents Age 60 or Older: 89
Residents Diagnosed with Intellectual Disability: 1
Residents with Mobility Need: 28
Inspection Report
Complaint Investigation
Census: 90
Capacity: 164
Deficiencies: 1
Dec 4, 2024
Visit Reason
The inspection was conducted as a complaint and incident investigation at the Fritzingertown Senior Living Community.
Findings
The investigation found that a resident punched another resident resulting in an injury requiring emergency room treatment. The facility responded with immediate medical assessment, updated care plans, increased monitoring, staff re-training, and ongoing behavioral monitoring.
Complaint Details
The complaint involved an incident where one resident punched another resident in the secured dementia unit, causing injury. The incident was substantiated with medical treatment required and corrective actions implemented.
Deficiencies (1)
| Description |
|---|
| A resident punched another resident causing injury requiring sutures and emergency room treatment. |
Report Facts
Residents Served: 90
License Capacity: 164
Secured Dementia Care Unit Capacity: 64
Secured Dementia Care Unit Residents Served: 23
Current Hospice Residents: 9
Residents Age 60 or Older: 89
Residents with Mobility Need: 28
Residents Diagnosed with Intellectual Disability: 1
Residents Receiving Supplemental Security Income: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Director of Nursing | Named in monitoring and oversight of resident behaviors and corrective actions |
| Administrator | Administrator | Named in monitoring and oversight of resident behaviors and corrective actions |
Inspection Report
Plan of Correction
Census: 84
Capacity: 164
Deficiencies: 3
Nov 25, 2024
Visit Reason
The inspection was a partial, unannounced visit conducted due to an incident at the facility on 11/25/2024.
Findings
The facility was found to be out of compliance with fire safety regulations, including lack of documentation for an annual fire safety inspection and fire drill, failure to meet evacuation time requirements, and failure to alternate exit routes during fire drills. The facility submitted a plan of correction which was accepted and fully implemented by 12/17/2024.
Deficiencies (3)
| Description |
|---|
| No documentation that a fire safety inspection and fire drill was conducted by a fire safety expert within the past 12 months. |
| Evacuation times during fire drills exceeded the required 2 minutes and 30 seconds, with recorded times of 7 minutes 25 seconds and 10 minutes 40 seconds. |
| Fire drill records indicate the home is not alternating exit routes during monthly fire drills. |
Report Facts
License Capacity: 164
Residents Served: 84
Secured Dementia Care Unit Capacity: 64
Secured Dementia Care Unit Residents Served: 24
Hospice Current Residents: 6
Residents Age 60 or Older: 83
Residents with Mobility Need: 29
Residents with Mental Illness: 1
Residents with Intellectual Disability: 1
Residents with Physical Disability: 0
Residents Receiving Supplemental Security Income: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Valley Regional Fire Department Chief | Named as the individual who will perform the fire safety inspection on December 12, 2024 |
Inspection Report
Complaint Investigation
Census: 91
Capacity: 164
Deficiencies: 0
Jul 23, 2024
Visit Reason
The inspection was conducted as a complaint investigation at the facility on 07/23/2024.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Complaint Details
The inspection was complaint-related, but no deficiencies or citations were found, indicating no substantiated issues.
Report Facts
License Capacity: 164
Residents Served: 91
Secured Dementia Care Unit Capacity: 64
Secured Dementia Care Unit Residents Served: 25
Hospice Current Residents: 7
Residents Age 60 or Older: 91
Residents Diagnosed with Mental Illness: 1
Residents Diagnosed with Intellectual Disability: 1
Residents with Mobility Need: 28
Residents with Physical Disability: 1
Inspection Report
Complaint Investigation
Census: 104
Capacity: 164
Deficiencies: 0
Jun 10, 2024
Visit Reason
The inspection was conducted as a complaint investigation during an unannounced partial inspection on 06/10/2024.
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 the follow-up was not required.
Report Facts
License Capacity: 164
Residents Served: 104
Secured Dementia Care Unit Capacity: 60
Secured Dementia Care Unit Residents Served: 20
Hospice Residents: 8
Residents 60 Years or Older: 104
Residents Diagnosed with Mental Illness: 1
Residents Diagnosed with Intellectual Disability: 1
Residents with Mobility Need: 24
Residents with Physical Disability: 0
Total Daily Staff: 128
Waking Staff: 96
Inspection Report
Renewal
Census: 84
Capacity: 164
Deficiencies: 6
Feb 21, 2024
Visit Reason
The inspection was conducted as a renewal and incident review of the Fritzingertown Senior Living Community on 02/21/2024.
Findings
The inspection identified multiple deficiencies including unsecured poisonous materials, lack of bedside lighting in resident rooms, delayed annual fire safety inspection, medication storage and administration issues, and incomplete or untimely updates to resident support plans. Plans of correction were accepted and implemented with ongoing monitoring.
Deficiencies (6)
| Description |
|---|
| Activities room door in the secured dementia unit was left open with poisonous materials accessible to residents. |
| Resident rooms 17 and 20 did not have a bedside light within reach from the bed. |
| The most recent fire safety inspection was delayed beyond one year due to COVID-19 related restrictions. |
| Resident #1's medication was not available in the medication cart at the time of inspection. |
| Resident #3's support plan was not updated within 5 days after a fall requiring hospitalization and hospice placement. |
| Resident #2's support plan lacked documentation of a pureed diet. |
Report Facts
Residents Served: 84
License Capacity: 164
Residents Served in Secured Dementia Care Unit: 24
Capacity of Secured Dementia Care Unit: 64
Current Residents in Hospice: 7
Residents Age 60 or Older: 84
Residents with Mobility Need: 29
Residents Diagnosed with Intellectual Disability: 1
Inspection Report
Census: 80
Capacity: 164
Deficiencies: 0
Apr 14, 2023
Visit Reason
The inspection was conducted as a licensing inspection with a partial, unannounced visit due to an incident.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Report Facts
License Capacity: 164
Residents Served: 80
Secured Dementia Care Unit Capacity: 64
Secured Dementia Care Unit Residents Served: 19
Hospice Current Residents: 6
Residents Age 60 or Older: 80
Residents Diagnosed with Mental Illness: 1
Residents Diagnosed with Intellectual Disability: 1
Residents with Mobility Need: 24
Inspection Report
Renewal
Census: 80
Capacity: 164
Deficiencies: 6
Jan 24, 2023
Visit Reason
The inspection was a full, unannounced review conducted on 01/24/2023 and 01/26/2023 for renewal, complaint, and incident reasons.
Findings
The facility was found to have multiple deficiencies including failure to report incidents timely, incomplete final incident reports, expired medications in first aid kits, unlabeled medications, incorrect medication administration records, and failure to update resident support plans. Plans of correction were accepted and implemented by 02/24/2023.
Complaint Details
The complaint involved an allegation of physical abuse of Resident #5 by a staff person. The internal investigation and assessment by the resident's PCP found no evidence of abuse. The case was closed and considered unfounded by the Area Agency on Aging.
Deficiencies (6)
| Description |
|---|
| Failure to submit an incident report to the Department regarding Resident #4's fall and fractured ribs. |
| Failure to submit a final report to the Department immediately following the conclusion of an investigation regarding an allegation of physical abuse of Resident #5. |
| Expired bacitracin zinc ointment found in the first aid kit. |
| Resident #2's medication did not have a pharmacy label attached. |
| Medication Administration Records (MAR) for Residents #1, #2, and #3 contained incorrect dosage information. |
| Resident #4's Resident Assessment Support Plan (RASP) was not updated to reflect current care needs after a fall and hospitalization. |
Report Facts
License Capacity: 164
Residents Served: 80
Secured Dementia Care Unit Capacity: 64
Secured Dementia Care Unit Residents Served: 24
Current Hospice Residents: 7
Residents with Mobility Need: 29
Residents 60 Years or Older: 80
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Allsion Kline | Resident Care Coordinator, LPN | Interviewed resident and alleged perpetrator during abuse allegation investigation |
| Unnamed Executive Director | Executive Director | Responsible for submitting incident reports and conducting internal investigations; delayed final report submission in abuse allegation case |
| Unnamed Director of Nursing | Director of Nursing | Provided verbal re-education to staff regarding incident reporting and medication regulations; audited medication carts |
Inspection Report
Renewal
Census: 83
Capacity: 164
Deficiencies: 11
Feb 1, 2022
Visit Reason
The inspection was conducted as a renewal inspection with an incident exit conference on 02/04/2022.
Findings
The inspection identified multiple deficiencies including failure to obtain written receipts for cash disbursements, snow and ice removal issues, outdated food usage, evacuation procedure non-compliance, smoking policy violations, medication storage and administration issues, support plan signature omissions, and missing directions for key-locking devices. Plans of correction were accepted and verified as implemented.
Deficiencies (11)
| Description |
|---|
| Failure to obtain resident signatures for cash disbursements on multiple dates. |
| Snow and ice were present on outside walkways, ramps, and emergency exits. |
| Four large containers of plain Yoplait yogurt in the walk-in fridge were past the 'Best By' date. |
| Residents did not fully evacuate to designated fire-safe areas during inclement weather. |
| Employees permitted to smoke in non-designated areas; cigarette butts found outside emergency exit. |
| Resident #3 did not store medications in a locked area and did not lock bedroom door. |
| Resident #4's prescribed medication was not available at time of inspection. |
| Resident #5's daily heart rate was not recorded as required for medication administration. |
| Resident #6's medication administration record did not match prescription bottle directions. |
| Residents #1 and #7 did not sign their support plans without documentation of refusal or inability. |
| Directions for operating key-locking devices were not conspicuously posted near locked exit. |
Report Facts
License Capacity: 164
Residents Served: 83
Secured Dementia Care Unit Capacity: 60
Residents Served in Dementia Unit: 23
Hospice Residents: 7
Staffing Hours: 110
Waking Staff: 83
Notice
Capacity: 164
Deficiencies: 0
Sep 14, 2021
Visit Reason
The document serves as a renewal notification and license issuance for the Fritzingertown Senior Living Community Personal Care Home, confirming receipt of the renewal application and advising of an upcoming annual inspection within the next twelve months.
Findings
No inspection findings are reported in this document; it is an administrative notice confirming license renewal and outlining the requirement for an annual inspection.
Report Facts
Maximum licensed capacity: 164
Secure Dementia Care Unit capacity: 60
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jamie L. Buchenauer | Deputy Secretary, Office of Long-term Living | Signed the renewal notification letter |
| Paula Sagan-Hahn | Executive Director | Legal entity representative who signed the renewal application |
Inspection Report
Renewal
Deficiencies: 0
Aug 5, 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.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michele Moskalczyk | Human Services Licensing Supervisor | Signed the inspection report letter. |
Inspection Report
Complaint Investigation
Census: 85
Capacity: 164
Deficiencies: 3
Mar 9, 2021
Visit Reason
The inspection was conducted as a complaint investigation following reports of resident abuse by staff person B witnessed by staff person A on 02/19/2021.
Findings
The investigation substantiated that staff person B physically abused three residents by bending their fingers painfully, pushing them forcefully using a blanket, and roughly handling clothing. The abuse was not reported immediately by staff person A or the facility to the Department and Area Agency on Aging, resulting in delayed reporting. The accused employee was terminated following the investigation.
Complaint Details
The complaint was substantiated. Staff person A witnessed staff person B physically abusing residents on 02/19/2021. The home delayed reporting the abuse to the Department until 02/22/2021. The accused employee was terminated after investigation.
Deficiencies (3)
| Description |
|---|
| Failure to immediately report suspected resident abuse as required by regulations. |
| Resident abuse involving physical mistreatment of three residents by staff person B. |
| Use of manual restraint by staff person B, restraining residents in bed for approximately 7 to 10 seconds. |
Report Facts
Residents served: 85
License capacity: 164
Current hospice residents: 6
Capacity of secured dementia care unit: 60
Residents served in secured dementia care unit: 18
Staff total daily: 105
Waking staff: 79
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