Cycle 1
Health 2025-04-18 · Fire 2025-04-18
4 health deficiencies
Top issue: Quality of Life and Care (3 deficiencies)
1 fire-safety deficiencies
Top issue: Emergency Preparedness (1 deficiency)
Glen Mills, PA
Brinton Manor Nursing And Rehabilitation Center
3-star overall rating with 3-star inspections with 4 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
549 Baltimore Pike, Glen Mills, PA
(610) 358-6005
Overall
3 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
2 / 5
RN + nurse staffing
Quality measures
4 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
92
Certified beds
Average residents
77
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Imperial Healthcare Group
Operator or chain grouping
Approved since
1993-10-28
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
13 facilities
Chain averages 2 overall / 2 health / 2 staffing / 3 quality stars
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
Hours and turnover
RN hours / resident day
0.49
Registered nurse staffing · state 0.78 · national 0.68
LPN hours / resident day
0.97
Licensed practical nurse staffing · state 0.91 · national 0.87
Aide hours / resident day
1.78
Nurse aide staffing · state 2.20 · national 2.35
Total nurse hours
3.25
All reported nurse hours · state 3.89 · national 3.89
Licensed hours
1.47
RN + LPN hours · state 1.69 · national 1.54
Weekend hours
2.98
Weekend nurse staffing · state 3.51 · national 3.43
Weekend RN hours
0.31
Weekend registered nurse coverage · state 0.55 · national 0.47
Physical therapist
0.09
Reported PT staffing · state 0.10 · national 0.07
Adjusted RN hours
0.48
CMS adjusted RN staffing hours
Adjusted total hours
3.13
CMS adjusted total nurse staffing hours
Case-mix index
1.42
Higher values indicate more complex resident acuity
RN turnover
46%
Annual RN turnover · state 43% · national 45%
Total nurse turnover
51%
Annual nurse turnover · state 47% · national 46%
SNF VBP
Value-based purchasing
Program rank
9,892
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
22.13
Composite VBP score used to determine payment impact.
Payment multiplier
0.9828
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
3.37
Baseline 17.39% · Performance 19.87% · Measure score 3.37 · Achievement 3.37 · Improvement 0
Healthcare-associated infections
3.55
Baseline 5.25% · Performance 6.78% · Measure score 3.55 · Achievement 3.55 · Improvement 0
Total nurse turnover
0
Baseline 61.54% · Performance 65.52% · Measure score 0 · Achievement 0 · Improvement 0
Adjusted total nurse staffing
1.93
Baseline 3.48 hours · Performance 3.63 hours · Measure score 1.93 · Achievement 1.93 · Improvement 0.13
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10.89% |
10.72%
0.2 pts worse
|
No Different than the National Rate · Eligible stays 137 · Observed rate 11.68% · Lower 95% interval 7.71% |
| Discharge to community | 49.64% |
50.57%
0.9 pts worse
|
No Different than the National Rate · Eligible stays 110 · Observed rate 43.64% · Lower 95% interval 42.16% |
| Medicare spending per beneficiary | 1.06 |
1.02
About the same
|
|
| Drug regimen review with follow-up | 96.94% |
95.27%
1.7 pts better
|
Numerator 95 · Denominator 98 |
| Falls with major injury | 1.02% |
0.77%
0.2 pts worse
|
Numerator 1 · Denominator 98 |
| Discharge self-care score | 40.74% |
53.69%
12.9 pts worse
|
Numerator 22 · Denominator 54 |
| Discharge mobility score | 62.96% |
50.94%
12 pts better
|
Numerator 34 · Denominator 54 |
| Pressure ulcers or injuries, new or worsened | 1.02% |
2.29%
1.3 pts better
|
Numerator 1 · Denominator 98 · Adjusted rate 0.86% |
| Healthcare-associated infections requiring hospitalization | 6.78% |
7.12%
0.3 pts better
|
No Different than the National Rate · Eligible stays 91 · Observed rate 6.59% · Lower 95% interval 4.23% |
| Staff COVID-19 vaccination coverage | 24.24% |
8.2%
16 pts better
|
Numerator 24 · Denominator 99 |
| Staff flu vaccination coverage | Not Available |
42%
|
Numerator Not Available · Denominator Not Available · No data were submitted for this measure. |
| Discharge function score | 64.81% |
56.45%
8.4 pts better
|
Numerator 35 · Denominator 54 |
| Transfer of health information to provider | 97.78% |
95.95%
1.8 pts better
|
Numerator 44 · Denominator 45 |
| Transfer of health information to patient | 100% |
96.28%
3.7 pts better
|
Numerator 33 · Denominator 33 |
| Resident COVID-19 vaccinations up to date | 19.57% |
25.2%
5.6 pts worse
|
Numerator 9 · Denominator 46 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 2.1 |
1.7
0.4 pts worse
|
1.9
0.2 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 2.1 · Observed 2.2 · Expected 1.9 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 1.5 |
1.2
0.3 pts worse
|
1.8
0.3 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.5 · Observed 1.4 · Expected 1.5 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 92.4% |
86.9%
5.5 pts better
|
93.4%
1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 89.1% · Q2 96.9% · Q3 90.2% · Q4 93.3% · 4Q avg 92.4% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 98.5% |
93.5%
5 pts better
|
95.5%
3 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 98.5% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 4.0% |
3.2%
0.8 pts worse
|
3.3%
0.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 6.2% · Q2 7.8% · Q3 1.6% · Q4 0.0% · 4Q avg 4.0% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 16.0% |
6.5%
9.5 pts worse
|
11.4%
4.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 12.5% · Q2 13.7% · Q3 16.3% · Q4 22.0% · 4Q avg 16.0% |
| Percentage of long-stay residents who lose too much weight | 3.7% |
6.5%
2.8 pts better
|
5.4%
1.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 3.5% · Q2 5.5% · Q3 3.9% · Q4 1.8% · 4Q avg 3.7% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 24.8% |
19.9%
4.9 pts worse
|
19.6%
5.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 23.3% · Q2 26.2% · Q3 26.8% · Q4 22.8% · 4Q avg 24.8% |
| Percentage of long-stay residents who received an antipsychotic medication | 19.7% |
18.7%
1 pts worse
|
16.7%
3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 23.8% · Q2 30.8% · Q3 18.9% · Q4 9.5% · 4Q avg 19.7% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.2%
0.2 pts better
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 7.7% |
19.6%
11.9 pts better
|
16.3%
8.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 9.5% · Q2 14.6% · 4Q avg 7.7% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 10.5% |
18.3%
7.8 pts better
|
14.9%
4.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 5.1% · Q2 26.7% · Q3 3.7% · Q4 5.5% · 4Q avg 10.5% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.0% |
0.9%
0.9 pts better
|
1.0%
1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.4% |
1.7%
1.3 pts better
|
1.7%
1.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.8% · Q3 0.0% · Q4 0.0% · 4Q avg 0.4% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 32.2% |
26.4%
5.8 pts worse
|
19.8%
12.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 31.4% · Q2 30.6% · Q3 21.1% · Q4 46.1% · 4Q avg 32.2% |
| Percentage of long-stay residents with pressure ulcers | 3.2% |
5.3%
2.1 pts better
|
5.1%
1.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 6.4% · Q3 1.9% · Q4 4.9% · 4Q avg 3.2% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 76.0% |
68.9%
7.1 pts better
|
81.7%
5.7 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 56.1% · Q2 72.7% · Q3 88.0% · Q4 89.6% · 4Q avg 76.0% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 11.4% |
9.8%
1.6 pts worse
|
12.0%
0.6 pts better
|
Short Stay · 20240701-20250630 · Adjusted 11.4% · Observed 10.8% · Expected 10.5% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.6% |
1.5%
0.9 pts better
|
1.6%
1 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.1% · Q3 1.1% · Q4 0.0% · 4Q avg 0.6% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 70.6% |
68.7%
1.9 pts better
|
79.7%
9.1 pts worse
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 70.6% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 27.6% |
23.1%
4.5 pts worse
|
23.9%
3.7 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 27.6% · Observed 28.0% · Expected 24.2% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-05-10 · Fire 2024-05-10
6 health deficiencies
Top issue: Quality of Life and Care (3 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Cycle 3
Health 2023-07-13 · Fire 2023-07-13
7 health deficiencies
Top issue: Quality of Life and Care (4 deficiencies)
2 fire-safety deficiencies
Top issue: Emergency Preparedness (2 deficiencies)
Fire safety
Fire-safety citations
B · Minimal harm
2025-04-18
E39 · Emergency Preparedness Deficiencies
Fire Safety
Conduct testing and exercise requirements.
Corrected 2025-06-03
F · Potential for more than minimal harm
2023-07-13
E36 · Emergency Preparedness Deficiencies
Fire Safety
Establish emergency prep training and testing.
Corrected 2023-09-14
C · Minimal harm
2023-07-13
E35 · Emergency Preparedness Deficiencies
Fire Safety
Provide family notifications of emergency plan.
Corrected 2023-09-14
Inspection history
Recent health citations
E · Potential for more than minimal harm
2025-04-18
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2025-05-20
D · Potential for more than minimal harm
2025-04-18
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2025-05-20
D · Potential for more than minimal harm
2025-04-18
F686 · Quality of Life and Care Deficiencies
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2025-05-20
D · Potential for more than minimal harm
2025-03-19
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2025-04-08
D · Potential for more than minimal harm
2024-10-08
F584 · Resident Rights Deficiencies
Health
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.
Corrected 2024-11-25
D · Potential for more than minimal harm
2024-10-08
F761 · Pharmacy Service Deficiencies
Health
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.
Corrected 2024-11-25
D · Potential for more than minimal harm
2024-05-10
F606 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Not hire anyone with a finding of abuse, neglect, exploitation, or theft.
Corrected 2024-06-19
D · Potential for more than minimal harm
2024-05-10
F690 · Quality of Life and Care Deficiencies
Health
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected 2024-06-19
D · Potential for more than minimal harm
2024-05-10
F692 · Quality of Life and Care Deficiencies
Health
Provide enough food/fluids to maintain a resident's health.
Corrected 2024-06-19
D · Potential for more than minimal harm
2024-05-10
F697 · Quality of Life and Care Deficiencies
Health
Provide safe, appropriate pain management for a resident who requires such services.
Corrected 2024-06-19
D · Potential for more than minimal harm
2024-01-24
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2024-02-16
D · Potential for more than minimal harm
2023-07-13
F698 · Quality of Life and Care Deficiencies
Health
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Corrected 2023-08-15
D · Potential for more than minimal harm
2023-07-13
F755 · Pharmacy Service Deficiencies
Health
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected 2023-08-15
D · Potential for more than minimal harm
2023-07-13
F756 · Pharmacy Service Deficiencies
Health
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Corrected 2023-08-15
D · Potential for more than minimal harm
2023-07-13
F758 · Pharmacy Service Deficiencies
Health
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Corrected 2023-08-15
E · Potential for more than minimal harm
2023-03-08
F686 · Quality of Life and Care Deficiencies
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2023-04-12
D · Potential for more than minimal harm
2023-03-08
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2023-04-12
Penalties and ownership
What sits behind the stars
Ownership
Bh Opco Holdco LLC
5% Or Greater Direct Ownership Interest · Organization
Chiles, Machere
W-2 Managing Employee · Individual
Chrh Equities LLC
5% Or Greater Indirect Ownership Interest · Organization
Ens Holdings, LLC
5% Or Greater Indirect Ownership Interest · Organization
Gottesman, Daniel
5% Or Greater Indirect Ownership Interest · Individual
Herzka, Yisroel
5% Or Greater Indirect Ownership Interest · Individual
Herzka, Yisroel
Corporate Officer · Individual
Kopelowitz, Shaul
5% Or Greater Indirect Ownership Interest · Individual
The Ens Family Trust
5% Or Greater Indirect Ownership Interest · Organization
Ymcs Equities LLC
5% Or Greater Indirect Ownership Interest · Organization
Nearby options
Other facilities in reach
#1
Continuing Care At Maris Grove
Glen Mills, PA
5-star overall rating with 3-star inspections with $22,737 in total fines with 6 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
#2
Willowbrooke Court-Granite
Media, PA
5-star overall rating with 5-star inspections with 9 fire-safety deficiencies in the latest cycle
#3
Fair Acres Geriatric Center
Lima, PA
5-star overall rating with 5-star inspections with 2 recent health deficiencies with 7 fire-safety deficiencies in the latest cycle
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