Inspection Reports for Suites at Rouse
615 ROUSE AVENUE,, YOUNGSVILLE, PA, 16371
Back to Facility ProfileDeficiencies (last 4 years)
Deficiencies (over 4 years)
10 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
113% worse than Pennsylvania average
Pennsylvania average: 4.7 deficiencies/yearDeficiencies per year
12
9
6
3
0
Census
Latest occupancy rate
74% occupied
Based on a October 2024 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Monitoring
Census: 89
Capacity: 120
Deficiencies: 6
Date: Oct 22, 2024
Visit Reason
The inspection was a partial, unannounced visit conducted for incident and monitoring purposes at the Suites at Rouse facility on 10/22/2024.
Findings
The inspection identified multiple deficiencies including a fire door gap, unsecured medication cart, medication labeling errors, missing medications, and failure to follow prescriber's orders. Plans of correction were accepted and implemented with ongoing monitoring and education.
Deficiencies (6)
A 1/4 inch gap was found between double fire doors next to a resident room, with the left fire door’s top latch failing to seat correctly.
The B Hall medication cart was left unlocked, granting access to medications of approximately 20 residents.
Resident medication label indicated incorrect dosage instructions differing from the prescribed amount.
A prescribed medication was not present in the home at the time of inspection.
Medication instructions failed to indicate the medication’s proper dose.
Resident self-administered medications not in accordance with prescriber’s orders.
Report Facts
License Capacity: 120
Residents Served: 89
Residents in Secured Dementia Care Unit: 8
Staffing Hours - Total Daily Staff: 115
Staffing Hours - Waking Staff: 86
Residents Diagnosed with Mental Illness: 3
Residents with Mobility Need: 26
Residents Aged 60 or Older: 89
Residents with Physical Disability: 1
Inspection Report
Renewal
Census: 55
Capacity: 120
Deficiencies: 9
Date: Sep 12, 2023
Visit Reason
The inspection was conducted as a renewal and incident review of the facility SUITES AT ROUSE on 09/12/2023 and 09/13/2023.
Findings
The inspection found multiple deficiencies including lack of certified first aid/CPR staff during certain times, uncovered trash dumpster, missing window screen, improper food labeling and storage, evacuation drill times exceeding safety standards, and medication labeling discrepancies. All deficiencies had plans of correction submitted and were implemented by 12/06/2023.
Deficiencies (9)
No staff persons certified in first aid, CPR and obstructed airway techniques were present during certain times despite resident census exceeding 50.
The home's exterior dumpster lid was open at 10:45am on 9/12/23.
Left side kitchen window in the Secure Dementia Care Unit had no screen at 10:40 a.m. on 9/12/23.
An opened, undated container of sour cream was found in the home's bar room kitchen refrigerator at 11:01 a.m. on 9/12/23.
Two dented cans of salmon were observed in the home's food storage area at 10:36 a.m. on 9/12/23.
The home exceeded an evacuation time of 15 minutes during fire drills, including one on 4/21/23 where 10 staff evacuated 60 residents in 15 minutes 26 seconds.
The home routinely holds sleeping hour fire drills at the same approximate time of day.
Resident #1's prescription medication label did not match the prescribed directions for eye drops and topical patches.
Resident #1's support plan did not indicate home health services received; Resident #2's support plan incorrectly indicated inability to self-administer medications.
Report Facts
License Capacity: 120
Residents Served: 55
Staff: 73
Waking Staff: 55
Capacity of Secured Dementia Care Unit: 10
Residents in Secured Dementia Care Unit: 7
Residents Diagnosed with Mental Illness: 10
Residents with Mobility Need: 18
Residents Age 60 or Older: 55
Inspection Report
Complaint Investigation
Census: 61
Capacity: 120
Deficiencies: 0
Date: Apr 25, 2023
Visit Reason
The inspection was conducted as a partial, unannounced visit due to an incident at the facility.
Complaint Details
The visit was incident-related; no deficiencies or substantiation status were noted.
Findings
No regulatory citations or deficiencies were identified as a result of this inspection.
Report Facts
Total Daily Staff: 79
Waking Staff: 59
Residents Served: 61
License Capacity: 120
Secured Dementia Care Unit Capacity: 10
Secured Dementia Care Unit Residents Served: 6
Residents Diagnosed with Mental Illness: 5
Residents Diagnosed with Intellectual Disability: 1
Residents with Mobility Need: 18
Residents 60 Years of Age or Older: 61
Inspection Report
Renewal
Census: 70
Capacity: 120
Deficiencies: 8
Date: Dec 28, 2022
Visit Reason
The inspection was conducted for renewal and incident reasons, including a full unannounced inspection with follow-up on plan of correction submissions.
Findings
The facility was found to have multiple deficiencies including failure to timely report an incident, lack of quality management reviews, missing first aid kits in vehicles, snow and ice obstructions, incomplete fire drill records, incomplete medical evaluations, missing preadmission screening forms, and incomplete resident support plans. Plans of correction were accepted and implemented with specified completion dates.
Deficiencies (8)
Failure to report an incident of possible theft of resident monies within 24 hours.
No quality management reviews completed in the past 12 months.
First aid kits missing or inaccessible in facility vehicles.
Snow and ice not removed from walkways outside Memory Care Unit exit.
No unannounced fire drills conducted for May, June, and August 2022.
Medical evaluations for residents missing required assessments such as temperature, medication regimen, body positioning, cognitive functioning, and health status.
Preadmission screening forms missing or incomplete for certain residents.
Resident support plans missing documentation of enabler use and hospice services.
Report Facts
License Capacity: 120
Residents Served: 70
Secured Dementia Care Unit Capacity: 12
Secured Dementia Care Unit Residents Served: 12
Hospice Current Residents: 1
Residents Age 60 or Older: 70
Residents Diagnosed with Mental Illness: 5
Residents with Mobility Need: 18
Total Daily Staff: 88
Waking Staff: 66
Inspection Report
Follow-Up
Census: 76
Capacity: 120
Deficiencies: 5
Date: May 10, 2022
Visit Reason
The inspection was a follow-up visit to verify the implementation of a previously submitted plan of correction following a complaint investigation.
Complaint Details
The inspection was triggered by a complaint, and the follow-up visit was to verify correction of deficiencies identified during the complaint investigation.
Findings
The facility was found to have fully implemented the submitted plan of correction addressing medication administration delays, incomplete medication records, failure to follow prescriber's orders, and incomplete resident assessments. Continued compliance must be maintained.
Deficiencies (5)
Multiple residents did not receive their 8:00 pm medication administration until after 10:00 pm due to lack of available direct care staffing.
Resident #2's medication administration records did not include the initials of the staff person who administered medication on specific dates.
Resident #1's prescribed medication was not administered on specified dates and times.
Resident #2's prescribed wound care procedure was not provided on specified dates.
Resident #2's assessment did not include specific care needed for legs, frequency, and responsible parties.
Report Facts
License Capacity: 120
Residents Served: 76
Secured Dementia Care Unit Capacity: 12
Secured Dementia Care Unit Residents Served: 6
Hospice Current Residents: 2
Resident Diagnosed with Mental Illness: 3
Resident Diagnosed with Intellectual Disability: 1
Residents with Mobility Need: 15
Residents 60 Years or Older: 76
Inspection Report
Follow-Up
Census: 77
Capacity: 120
Deficiencies: 2
Date: Nov 18, 2021
Visit Reason
The inspection was conducted as a follow-up to a complaint and incident investigation to verify the implementation of a submitted plan of correction.
Complaint Details
The inspection was complaint-related, triggered by a complaint and incident, with a follow-up to verify correction of deficiencies.
Findings
The facility was found to have previously provided insufficient direct care staffing hours for residents with mobility needs, but the submitted plan of correction was fully implemented and compliance was maintained.
Deficiencies (2)
On 11/14/21, the facility provided only 81 hours of direct care staffing for 15 residents with mobility needs, requiring 86 hours minimum.
On 11/14/21, only 60.75 hours of direct care staffing were provided during waking hours, below the required 64.5 hours.
Report Facts
Residents served: 77
License capacity: 120
Residents with mobility needs: 15
Direct care hours required: 86
Direct care hours provided: 81
Direct care hours required during waking hours: 64.5
Direct care hours provided during waking hours: 60.75
Notice
Capacity: 120
Deficiencies: 0
Date: Sep 14, 2021
Visit Reason
The document serves as a certificate of compliance and a license renewal notification for Suites at Rouse, a Personal Care Home, confirming the facility's authorized capacity and informing that an annual inspection will be conducted within the next twelve months.
Findings
The Department has issued a regular license in response to the renewal application and advises that an onsite inspection will be conducted within the next twelve months to ensure compliance with applicable regulations.
Report Facts
Maximum capacity: 120
Secure Dementia Care Unit capacity: 12
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jamie L. Buchenauer | Deputy Secretary, Office of Long-term Living | Signed the renewal notification letter. |
Inspection Report
Renewal
Census: 76
Capacity: 120
Deficiencies: 7
Date: Aug 18, 2021
Visit Reason
The inspection was conducted as a renewal inspection with an incident review, including unannounced full inspections on 08/18/2021, 08/19/2021, and an off-site review on 08/20/2021.
Findings
The inspection identified multiple deficiencies including unsigned resident contracts, inoperable equipment, lack of bedside lighting for some residents, insufficient supply of linens for one resident, medication record discrepancies, missing medication, and unsigned support plans. Plans of correction were accepted for all deficiencies with completion dates set for 11/24/2021.
Deficiencies (7)
The resident-home contract for resident #1 was not signed by the resident.
The PTAC unit in bedroom #3 of the secured dementia care unit was not operable because it was not plugged in.
Residents #1, #2, and #3 did not have access to a source of light that can be turned on/off at bedside.
Resident #2 has only one set of bed linens; the home does not maintain a common bed linen supply.
Resident #2's medication administration record did not match the prescribed medication dose.
Resident #1 was prescribed a patch for pain, but the medication was not available in the home on the day of inspection.
Resident #4’s support plan was not signed by the resident nor indicated if the resident was unable or refused to sign.
Report Facts
License Capacity: 120
Residents Served: 76
Secured Dementia Care Unit Capacity: 12
Secured Dementia Care Unit Residents Served: 7
Total Daily Staff: 94
Waking Staff: 71
Inspection Report
Complaint Investigation
Census: 80
Capacity: 120
Deficiencies: 3
Date: Jul 20, 2021
Visit Reason
The inspection was conducted as a complaint investigation with unannounced partial inspections on 07/20/2021, 07/27/2021, and 07/28/2021 to review compliance and follow up on submitted plans of correction.
Complaint Details
The inspection was complaint-driven, with a partial unannounced inspection and exit conference on 07/28/2021. The complaint involved concerns about resident care and supervision.
Findings
The facility was found deficient in securing timely medical care for a resident with a serious injury, incomplete resident assessments reflecting significant condition changes, and inadequate documentation of supervision and support plans. The submitted plans of correction were accepted and fully implemented.
Deficiencies (3)
Failure to document resident's condition and secure medical care promptly after swelling, bruising, and pain in resident's right forearm and elbow, resulting in delayed emergency room visit and surgery.
Resident assessment did not address the need for assistance in transferring, ambulating, emergency mobility, and judgment issues despite history of falls and fractures.
Resident support plan did not document the required supervision checks approximately every 30 minutes.
Report Facts
License Capacity: 120
Residents Served: 80
Secured Dementia Care Unit Capacity: 12
Secured Dementia Care Unit Residents Served: 9
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