Inspection Report
Renewal
Census: 39
Capacity: 40
Deficiencies: 4
May 6, 2025
Visit Reason
The inspection was conducted as a renewal inspection of the Plymouth Manor Personal Care Center to verify compliance with licensing requirements.
Findings
The submitted plan of correction was found to be fully implemented. Deficiencies were identified related to bedside lighting placement, lint removal from dryer vents, medication storage, and following prescriber's orders, all of which were corrected promptly with training and monitoring measures put in place.
Deficiencies (4)
| Description |
|---|
| Room 101 bedside lamp was over 4 feet from the side of the bed; Room 109 bedside light source was an overhead light switch 3.5 feet from the side of the bed. |
| A thick layer of lint was observed behind the dryer and on the dryer vent to the outside of the building, causing a fire hazard. |
| Novolog 100 unit/ml Injectable Flexpen in the medication cart had no documentation of opening date, violating storage requirements. |
| Resident #3 was administered incorrect insulin doses on 4/26/25 and 4/27/25, not following prescriber's orders. |
Report Facts
License Capacity: 40
Residents Served: 39
Total Daily Staff: 39
Waking Staff: 29
Residents Receiving Supplemental Security Income: 5
Residents Age 60 or Older: 36
Residents Diagnosed with Mental Illness: 12
Residents Diagnosed with Intellectual Disability: 1
Residents with Physical Disability: 1
Hospice Residents: 1
Inspection Report
Renewal
Census: 38
Capacity: 40
Deficiencies: 1
Apr 9, 2024
Visit Reason
The inspection was conducted as a renewal review of the Plymouth Manor Personal Care Center to verify compliance and the implementation of the submitted plan of correction.
Findings
The submitted plan of correction was fully implemented, including correction of a deficiency related to the absence of a thermometer in the chest freezer. Continued compliance must be maintained.
Deficiencies (1)
| Description |
|---|
| No thermometer in the chest freezer in the home's kitchen. |
Report Facts
License Capacity: 40
Residents Served: 38
Total Daily Staff: 38
Waking Staff: 29
Residents Receiving Supplemental Security Income: 6
Residents Age 60 or Older: 36
Residents Diagnosed with Mental Illness: 8
Residents Diagnosed with Intellectual Disability: 2
Inspection Report
Complaint Investigation
Census: 37
Capacity: 40
Deficiencies: 0
Mar 12, 2024
Visit Reason
The inspection was conducted as a complaint investigation during an unannounced partial licensing inspection.
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 type was noted as not required.
Report Facts
License Capacity: 40
Residents Served: 37
Total Daily Staff: 37
Waking Staff: 28
Residents Receiving Supplemental Security Income: 8
Residents Age 60 or Older: 35
Residents Diagnosed with Mental Illness: 9
Residents Diagnosed with Intellectual Disability: 2
Residents with Physical Disability: 2
Inspection Report
Follow-Up
Census: 34
Capacity: 40
Deficiencies: 2
Dec 27, 2023
Visit Reason
The inspection was a partial, unannounced follow-up visit conducted due to an incident involving resident-to-resident abuse.
Findings
The inspection found that a resident pushed another resident causing a hip fracture requiring surgery. The facility had not updated the resident's support plan to reflect the incident and subsequent care. The plan of correction was accepted and fully implemented by the follow-up date.
Deficiencies (2)
| Description |
|---|
| A resident was pushed by another resident resulting in a hip fracture and surgery, constituting resident-to-resident abuse. |
| Resident assessment and support plan (RASP) was not updated to document the incident and subsequent care changes. |
Report Facts
License Capacity: 40
Residents Served: 34
Resident Age 60 or Older: 31
Residents Diagnosed with Mental Illness: 12
Residents Diagnosed with Intellectual Disability: 4
Residents with Physical Disability: 3
Residents Receiving Supplemental Security Income: 10
Inspection Report
Complaint Investigation
Census: 39
Capacity: 40
Deficiencies: 1
Sep 19, 2023
Visit Reason
The inspection was conducted as a complaint investigation at Plymouth Manor Personal Care Center to review compliance with regulations and verify the submitted plan of correction.
Findings
The inspection found a violation related to resident record confidentiality where medication administration records (MAR) were left unlocked and unattended, exposing confidential resident information. The facility implemented corrective actions including securing the MAR and staff training on confidentiality.
Complaint Details
The visit was complaint-related and the submitted plan of correction was determined to be fully implemented.
Deficiencies (1)
| Description |
|---|
| Medication administration record (MAR) left unlocked and unattended on top of the medication cart, exposing confidential resident information. |
Report Facts
License Capacity: 40
Residents Served: 39
Resident Support Staff: 0
Total Daily Staff: 39
Waking Staff: 29
Residents Receiving Supplemental Security Income: 9
Residents Aged 60 or Older: 35
Residents Diagnosed with Mental Illness: 14
Residents Diagnosed with Intellectual Disability: 3
Residents with Physical Disability: 2
Inspection Report
Renewal
Census: 40
Capacity: 40
Deficiencies: 8
Apr 4, 2023
Visit Reason
The inspection was conducted as a renewal visit to review compliance with licensing requirements at Plymouth Manor Personal Care Center.
Findings
The facility was found to have multiple deficiencies including issues with posting the current license, staff training topics, hot water temperature, lighting at bedside, combustible storage, medication cart security, and medication record keeping. All deficiencies had plans of correction accepted and were implemented by the end of May 2023.
Deficiencies (8)
| Description |
|---|
| The last Licensing Inspection Summary was kept behind the reception desk and was not accessible without staff assistance. |
| Staff Member A was not trained in the mandatory topic of care for residents with mental health or intellectual disabilities for the 2022 training year. |
| The water temperature taken from the bathroom of room 111 was 130.1 degrees, exceeding the maximum allowed 120°F. |
| There was no lamp or light accessible at bedside for Resident 1 or Resident 2. |
| There was a washcloth observed on the exhaust vent of the dryer in the laundry room, a combustible storage hazard. |
| The medication cart was observed unlocked and unattended. |
| The medication administration record (MAR) for Resident 3 listed a medication to be given once daily that was discontinued but still administered. |
| The MAR for Resident 3 was initialed by staff member B indicating administration of a discontinued medication that was not available on the medication cart. |
Report Facts
License Capacity: 40
Residents Served: 40
Resident Age 60 or Older: 38
Residents Receiving Supplemental Security Income: 8
Residents Diagnosed with Mental Illness: 6
Residents with Physical Disability: 1
Inspection Report
Complaint Investigation
Census: 34
Capacity: 40
Deficiencies: 0
Jul 21, 2022
Visit Reason
The inspection was conducted as a complaint investigation at Plymouth Manor Personal Care Center.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Complaint Details
The inspection was complaint-related; however, no deficiencies or citations were found, and no follow-up was required.
Report Facts
License Capacity: 40
Residents Served: 34
Total Daily Staff: 34
Waking Staff: 26
Residents Receiving Supplemental Security Income: 10
Residents 60 Years of Age or Older: 31
Residents Diagnosed with Mental Illness: 12
Residents Diagnosed with Intellectual Disability: 4
Residents with Physical Disability: 3
Residents with Mobility Need: 0
Inspection Report
Renewal
Census: 36
Capacity: 40
Deficiencies: 4
Feb 24, 2022
Visit Reason
The inspection was conducted as a renewal inspection of Plymouth Manor Personal Care Center to review compliance with licensing requirements.
Findings
The inspection found several deficiencies related to resident contracts, medical evaluations, medication records, and following prescriber's orders. All deficiencies were addressed with plans of correction and subsequent document submissions were implemented and approved.
Deficiencies (4)
| Description |
|---|
| The resident-home contract for resident #1 does not include the charges for holding a bed during an absence. |
| Resident #2's medical evaluation did not include weight. |
| Resident #2 and Resident #3 medication administration records do not indicate the diagnosis. Resident #1's medication administration record indicates a different medication amount than the doctor's order. |
| Resident #3 did not receive prescribed blood glucose readings on 2/23/2022 as ordered. |
Report Facts
License Capacity: 40
Residents Served: 36
Total Daily Staff: 36
Waking Staff: 27
Residents Receiving Supplemental Security Income: 9
Residents 60 Years or Older: 34
Residents Diagnosed with Mental Illness: 14
Residents Diagnosed with Intellectual Disability: 2
Residents with Physical Disability: 1
Inspection Report
Renewal
Deficiencies: 0
Feb 9, 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: 34
Capacity: 40
Deficiencies: 4
Feb 10, 2021
Visit Reason
The inspection was conducted as a renewal review of the Plymouth Manor Personal Care Center to verify compliance with licensing requirements.
Findings
The inspection identified several deficiencies including snow removal from emergency exit walkways, bedside lamp accessibility, food labeling, and medication storage procedures. All deficiencies were addressed with plans of correction implemented and verified.
Deficiencies (4)
| Description |
|---|
| Sidewalk leading from the home's emergency exit door was not cleared of approximately 2 inches of snow. |
| A bedside lamp in a resident's room was not within reach of the resident. |
| One rewrapped turkey was found in the walk-in freezer not labeled or dated. |
| Resident #1's glucometer did not include documented numbers as found in the medication administration record, indicating a repeat violation. |
Report Facts
Residents Served: 34
License Capacity: 40
Staffing: 34
Waking Staff: 26
Supplemental Security Income Recipients: 10
Residents Age 60 or Older: 31
Residents Diagnosed with Mental Illness: 12
Residents Diagnosed with Intellectual Disability: 4
Residents with Physical Disability: 3
Inspection Report
Plan of Correction
Census: 37
Capacity: 40
Deficiencies: 1
Feb 5, 2021
Visit Reason
The inspection was conducted as a follow-up to verify the implementation of a previously submitted plan of correction related to resident record confidentiality.
Findings
The facility was found to have unattended medication administration records (MAR) accessible to unauthorized persons, violating resident confidentiality. The plan of correction was fully implemented with staff training and securing MARs in locked med carts or rooms.
Deficiencies (1)
| Description |
|---|
| Residents' medication administration records (MAR) were left unattended on medication carts in a public area, exposing private information to unauthorized persons. |
Report Facts
Resident Census: 37
Total Licensed Capacity: 40
Staffing Hours: 37
Staffing Hours: 28
Residents Receiving Supplemental Security Income: 12
Residents Diagnosed with Mental Illness: 12
Residents Age 60 or Older: 34
Residents Diagnosed with Intellectual Disability: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michele Moskalczyk | Human Services Licensing Supervisor | Signed the letter confirming plan of correction implementation |
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