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Nursing HomeMedicaid Investigative

Embassy of Saxonburg

On Medicare Special Focus status, a serious quality warning. Visit in person and ask tough questions before deciding.

223 Pittsburgh St, Saxonburg, PA 1605668 bedsLicensed & Active
2/5
Medicare
Inspection
Quality
Staffing
Google rating
3.5/5

based on 24 Google reviews

5
4
3
2
1
Embassy of Saxonburg Nursing Home in Saxonburg, PA — Street View
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6/ 10
high Risk

Quality Concerns Identified

Medicare inspection and quality data reveal areas that families should carefully evaluate before choosing this facility.

  • Abuse citation on record
  • Low overall rating (2/5 stars)
  • Above-median deficiencies (15 vs median 8.0)
  • High staff turnover (54%)

Below average in PA · Meets national RN staffing standard · Below chain average · $4,194 in fines · Abuse citation

Source: Medicare data

What this means for your family

While the facility's rehabilitation and activity teams receive praise, the recurring reports of poor sanitation and clinical neglect are significant red flags. We strongly advise you to visit during off-hours to assess the facility's cleanliness and staffing levels yourself, and to ask specifically about their protocols for wound care and emergency notifications.

Google Reviews

Google Reviews

24 reviews on Google
The Embassy of Saxonburg receives highly polarized reviews, with some families praising the staff's dedication and rehab services while others report severe concerns regarding hygiene and clinical neglect. Recurring complaints highlight a persistent, strong odor of waste throughout the facility and significant issues with wound care and communication during medical emergencies. Prospective families should carefully weigh the positive reports of staff friendliness against the serious allegations of neglect and sanitation failures.

Quality Themes

Tap a score for details
Food5.0Staff6.0Clean2.0Activities8.0Meds2.0MemoryN/AComms3.0Value2.0

Strengths

  • Passionate and dedicated nursing staff
  • Effective rehabilitation and therapy services
  • Active and engaging life enrichment programs
  • Small, personalized care environment

Concerns

  • Persistent, strong odor of urine and feces throughout the facility (mentioned by 4 reviewers)
  • Clinical neglect and failure to manage medical conditions (wounds/infections) (mentioned by 3 reviewers)
  • Understaffing and slow response times (mentioned by 2 reviewers)

Rating Trends

Tap a year to see what changed

2341.02019(2)1.02020(1)1.02022(1)4.32023(8)1.02024(1)3.82025(13)1.02026(2)

Distribution · 28 analyzed

5
14
4
2
3
0
2
0
1
12

How They Respond to Reviews

8%response rate

This facility rarely responds to reviews.

Questions for Your Tour

  • 1With the small, personalized environment here, how do you ensure that each resident's specific daily routine and personal preferences are closely followed?
  • 2What specific protocols are in place to ensure the facility remains fresh and clean, especially in the common areas and resident rooms?
  • 3I've heard wonderful things about your life enrichment programs; could you tell me more about the types of activities residents participate in each week?
  • 4How does the nursing team manage medication administration and monitor for any changes in a resident's medical condition or wound healing?
  • 5In the event of a medical emergency during the night, what is the process for notifying the family and coordinating immediate care?
  • 6How do you ensure that the dedicated nursing staff is able to respond quickly to call lights, even during busier shifts?

Personalized based on this facility's data


Key Review Excerpts

The odor hits you like a wall when you enter. Urine and diarrhea. OMG it takes your breath away.

Visitor · 2025☆☆☆☆

Embassy is smaller, all the aides and nurses interact with the residents. They take time to know names and a little about who they are.

Resident's spouse · 2025★★★★★

The staff never tended to my mum’s open wounds (which became infected) and never identified she had developed a urinary tract infection which landed her in the ER.

Resident's family member · 2026☆☆☆☆
Source: 24 Google reviews

Staffing

Staffing Hours

per resident/day · Medicare 2026
RN Hours
0.79hrs
OK
Registered nurses for medical care
Total Nursing
3.53hrs
86%
All nurses + aides combined
Staff Turnover
51%
Lower is better (< 30% = good)
RN Turnover
25%
Lower is better (< 30% = good)

Total nursing hours are below minimum, though RN coverage is adequate. This may mean fewer aides for daily tasks like bathing and mobility.

Quality Measures

Quality Measures

Resident outcomes compared with national, state, and local averages · 17 measures

Medicare Rating
5/ 5
Better Than Avg

8

measures

Worse Than Avg

6

measures

Mixed Results

3

measures

Long-Stay Residents
😔

Residents with depression symptoms

↓ Lower is better
This Facility2.7%
Better than Avg
Here
2.7%
US
12.1%
PA
8.3%
Butler
17.9%

Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.

🚿

Residents whose bladder or bowel control got worse

↓ Lower is better
This Facility32.9%
Worse than Avg
Here
32.9%
US
19.4%
PA
26.0%
Butler
23.3%
💉

Residents vaccinated for pneumonia

↑ Higher is better
This Facility80.1%
Worse than Avg
Here
80.1%
US
93.4%
PA
87.1%
Butler
91.4%
🛏️

Residents needing more daily help over time

↓ Lower is better
This Facility11.7%
Better than Avg
Here
11.7%
US
14.4%
PA
17.5%
Butler
13.9%
💊

Residents on anti-anxiety or sleep medication

↓ Lower is better
This Facility19.7%
Mixed vs Avgs
Here
19.7%
US
19.5%
PA
19.9%
Butler
25.2%
🩹

Residents with pressure sores (bedsores)

↓ Lower is better
This Facility9.7%
Worse than Avg
Here
9.7%
US
4.9%
PA
5.1%
Butler
4.3%
Short-Stay Residents (Rehab / Post-Acute)
💉

Short-stay residents vaccinated for pneumonia

↑ Higher is better
This Facility45.2%
Worse than Avg
Here
45.2%
US
81.8%
PA
69.2%
Butler
81.2%
💉

Short-stay residents vaccinated for the flu

↑ Higher is better
This Facility78.8%
Mixed vs Avgs
Here
78.8%
US
79.8%
PA
68.7%
Butler
77.4%
💊

Short-stay residents newly given antipsychotics

↓ Lower is better
This Facility0.0%
Better than Avg
Here
0.0%
US
1.6%
PA
1.4%
Butler
1.9%
Source: Medicare quality measures

US average from Medicare published data

Inspection History

Medicare Inspection History

3-year lookback · Medicare 2026

43deficiencies
2penalties
Well above state avg (10.1)
34 complaint-triggered
$4,194 in fines

This facility has a concerning pattern of deficiencies with families filing 16 complaints that triggered inspections, including a serious November 2025 abuse protection violation. The most recurring issues involve resident rights violations, abuse prevention failures, and care planning problems. While all deficiencies show correction dates, the persistent complaints about fundamental protections and dignified treatment suggest ongoing care quality concerns that families should carefully consider.

Apr 23, 2026Routine
18
0812Potential for harm · WidespreadCorrected

Nutrition and Dietary Deficiencies

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

0353Potential for harm · WidespreadCorrected

Smoke Deficiencies

Inspect, test, and maintain automatic sprinkler systems.

0911Potential for harm · PatternCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Meet requirements for the installation and maintenance of electrical systems.

0578Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

0580Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

0627Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.

0628Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.

0658Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Ensure services provided by the nursing facility meet professional standards of quality.

0689Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

0693Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.

0695Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide safe and appropriate respiratory care for a resident when needed.

0697Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide safe, appropriate pain management for a resident who requires such services.

0699Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide care or services that was trauma informed and/or culturally competent.

0740Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Ensure each resident must receive and the facility must provide necessary behavioral health care and services.

0756Potential for harm · IsolatedCorrected

Pharmacy Service Deficiencies

Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

0761Potential for harm · IsolatedCorrected

Pharmacy Service Deficiencies

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

0880Potential for harm · IsolatedCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

0908Potential for harm · IsolatedCorrected

Environmental Deficiencies

Keep all essential equipment working safely.

Apr 23, 2026Complaint
4
0727Potential for harm · WidespreadCorrected

Nursing and Physician Services Deficiencies

Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.

0730Potential for harm · PatternCorrected

Nursing and Physician Services Deficiencies

Observe each nurse aide's job performance and give regular training.

0550Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

0679Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide activities to meet all resident's needs.

Mar 14, 2026Complaint
11
0600Immediate jeopardy · IsolatedCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

0607Immediate jeopardy · IsolatedCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

0725Potential for harm · WidespreadCorrected

Nursing and Physician Services Deficiencies

Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

0801Potential for harm · WidespreadCorrected

Nutrition and Dietary Deficiencies

Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.

0835Potential for harm · WidespreadCorrected

Administration Deficiencies

Administer the facility in a manner that enables it to use its resources effectively and efficiently.

0838Potential for harm · WidespreadCorrected

Administration Deficiencies

Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.

0865Potential for harm · WidespreadCorrected

Administration Deficiencies

Have a plan that describes the process for conducting QAPI and QAA activities.

0712Potential for harm · PatternCorrected

Nursing and Physician Services Deficiencies

Ensure that the resident and his/her doctor meet face-to-face at all required visits.

0842Potential for harm · PatternCorrected

Resident Assessment and Care Planning Deficiencies

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

0941Potential for harm · PatternCorrected

Administration Deficiencies

Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members.

0686Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Feb 19, 2026Complaint
3
0865Potential for harm · WidespreadCorrected

Administration Deficiencies

Have a plan that describes the process for conducting QAPI and QAA activities.

0725Potential for harm · PatternCorrected

Nursing and Physician Services Deficiencies

Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

0684Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Nov 13, 2025Complaint
8
0600Actual harm · IsolatedCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

0550Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

0551Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Give the resident's representative the ability to exercise the resident's rights.

0609Potential for harm · IsolatedCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

0610Potential for harm · IsolatedCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Respond appropriately to all alleged violations.

0680Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Ensure the activities program is directed by a qualified professional.

0865Potential for harm · IsolatedCorrected

Administration Deficiencies

Have a plan that describes the process for conducting QAPI and QAA activities.

0575Minimal · WidespreadCorrected

Resident Rights Deficiencies

Post a list of names, addresses, and telephone numbers of all pertinent State agencies and advocacy groups and a statement that the resident may file a complaint with the State Survey Agency.

Aug 12, 2025Complaint
1
0584Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

Federal Penalties

Fine

Nov 13, 2025

$63,990

Fine

Oct 17, 2023

$4,194

Ownership & Operations

Who Operates This Facility

Owner / Operator

Embassy of Saxonburg

Organization Type

for profit

Chain Affiliation

Chain Name

Embassy Healthcare

Chain Size

35 facilities nationwide

Chain avg rating: 2.5/5 · Rank 16 of 37

Ownership & Management

Owners

Aaron Handler Family Dynasty Trust

Owner (parent company) · Organization

George S. Repchick 2020 Family Dynasty Trust

Owner (parent company) · Organization

Repchick, George

Owner (parent company)

Key personnel

Embassy Healthcare Management INCManagerHeritage Employment Services, LLCManagerGodinez, DanielleManagerHandler, AaronManagerRepchick, GeorgeManager
Source: Medicare provider data

Contact

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Contact this facility directly and verify the details that matter most to your family.

References & Resources

EveryPlace is a research directory. Facility information is compiled from public sources — Medicare.gov, state licensing portals, Google Places, and publicly available street-level imagery. Listings do not constitute endorsement, recommendation, or advertisement, and we do not accept payment for placement. Families should verify all details directly with the facility and the original sources linked above before making any care decisions. See our Research Policy for our editorial standards, correction process, and image-removal policy.

Safer Alternatives Nearby

Based on current clinical data, we identified 6 nearby facilities within 10 miles that may offer a stronger care environment. We encourage families to compare options carefully.

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