Deficiencies per Year
12
9
6
3
0
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Renewal
Census: 27
Capacity: 29
Deficiencies: 9
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.
Deficiencies (9)
| Description |
|---|
| 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
License Capacity: 29
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
Inspection Report
Renewal
Census: 27
Capacity: 29
Deficiencies: 8
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.
Deficiencies (8)
| Description |
|---|
| 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
License Capacity: 29
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
Routine
Deficiencies: 0
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
Plan of Correction
Deficiencies: 0
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
Capacity: 29
Deficiencies: 0
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
Maximum capacity: 29
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jamie J. Buchenauer | Deputy Secretary, Office of Long-term Living | Signed the renewal notification letter. |
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