Harmony at Hershey

A toilet in a resident room was observed to be soiled on the seat and inside the bowl.

A resident's current medical evaluation did not include their special health or dietary needs.

Resident assessments were not updated to reflect significant changes in dietary needs and physician-ordered diagnoses.

The resident's assessment and support plan failed to document necessary assistance with transferring.

During specific periods in late November, there was insufficient staff trained in first aid and CPR present to meet the requirement of one person per 50 residents.

A resident's bed had an enabler bar installed with an uncovered opening measuring 9" x 10".

Multiple incidents of resident-on-resident physical altercations and reports of staff using rough, degrading, and painful handling techniques during care.

The personal care home failed to post the current license, the current license inspection summary, and a copy of the regulations in a conspicuous and public place.

The home failed to report an incident where a resident eloped from the Secure Care Dementia Unit to the Department within 24 hours.

A resident's bed rail was not securely attached to the bed, presenting a possible entrapment risk.

A large trash can containing soiled briefs, clothing, and bed pads was observed at the entrance of the dining room.

A resident's March 2023 medication administration record did not include the required diagnosis or purpose for a prescribed medication.

Two incidents involving resident injury and hospitalization were not reported to the Department within 24 hours.

Medication bubble packs were found torn and taped, leaving pills exposed.

Expired medication (DT 170 count) was found in the facility with an expiration date of 10/22.

A resident's support plan was not updated to reflect recent falls and a hospital visit.

The facility failed to arrange for required speech therapy and swallow evaluations, resulting in a resident choking and developing aspiration pneumonia.

Two direct care staff members were found to lack a high school diploma, GED, or active status on the Pennsylvania nurse aide registry.

Multiple direct care staff members provided unsupervised ADL services before successfully completing the required Department-approved training and competency test.

A trash receptacle in a resident's shared bathroom was not covered, failing to prevent potential penetration by insects or rodents.