Cycle 1
Health 2025-04-16 · Fire 2025-04-16
1 health deficiencies
Top issue: Quality of Life and Care (1 deficiency)
3 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Allentown, PA
Lehigh Valley Hospital Tsu
2-star overall rating with 1-star inspections with 1 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
17th & Chew Sts, Allentown, PA
(610) 969-4225
Overall
2 / 5
CMS overall stars
Health inspections
1 / 5
Survey and complaint cycles
Staffing
5 / 5
RN + nurse staffing
Quality measures
5 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
52
Certified beds
Average residents
31
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
1995-03-23
CMS approved date
Coverage
Medicare
Participation flags
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Hospital-based
Yes
CMS reports the provider resides in a hospital
Staffing
Hours and turnover
RN hours / resident day
3.57
Registered nurse staffing · state 0.78 · national 0.68
LPN hours / resident day
0.34
Licensed practical nurse staffing · state 0.91 · national 0.87
Aide hours / resident day
2.24
Nurse aide staffing · state 2.20 · national 2.35
Total nurse hours
6.15
All reported nurse hours · state 3.89 · national 3.89
Licensed hours
3.91
RN + LPN hours · state 1.69 · national 1.54
Weekend hours
5.30
Weekend nurse staffing · state 3.51 · national 3.43
Weekend RN hours
2.75
Weekend registered nurse coverage · state 0.55 · national 0.47
Physical therapist
0.58
Reported PT staffing · state 0.10 · national 0.07
Adjusted RN hours
3.87
CMS adjusted RN staffing hours
Adjusted total hours
6.67
CMS adjusted total nurse staffing hours
Case-mix index
1.26
Higher values indicate more complex resident acuity
RN turnover
15%
Annual RN turnover · state 43% · national 45%
Total nurse turnover
22%
Annual nurse turnover · state 47% · national 46%
SNF VBP
Value-based purchasing
Program rank
49
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
92.21
Composite VBP score used to determine payment impact.
Payment multiplier
1.0274
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
6.88
Baseline 18.40% · Performance 18.24% · Measure score 6.88 · Achievement 6.88 · Improvement 0.64
Healthcare-associated infections
10
Baseline 3.86% · Performance 4.70% · Measure score 10 · Achievement 10 · Improvement 0
Total nurse turnover
10
Performance 21.28% · Measure score 10 · Achievement 10 · This facility did not have sufficient data to calculate a baseline period measure result.
Adjusted total nurse staffing
10
Baseline 5.81 hours · Performance 6.12 hours · Measure score 10 · Achievement 10 · Improvement 9
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 8.83% |
10.72%
1.9 pts better
|
No Different than the National Rate · Eligible stays 583 · Observed rate 7.2% · Lower 95% interval 7.1% |
| Discharge to community | 80.15% |
50.57%
29.6 pts better
|
Better than the National Rate · Eligible stays 576 · Observed rate 78.3% · Lower 95% interval 76.69% |
| Medicare spending per beneficiary | 0.64 |
1.02
0.4 pts better
|
|
| Drug regimen review with follow-up | 98.83% |
95.27%
3.6 pts better
|
Numerator 337 · Denominator 341 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 341 |
| Discharge self-care score | 60.81% |
53.69%
7.1 pts better
|
Numerator 166 · Denominator 273 |
| Discharge mobility score | 69.6% |
50.94%
18.7 pts better
|
Numerator 190 · Denominator 273 |
| Pressure ulcers or injuries, new or worsened | 3.6% |
2.29%
1.3 pts worse
|
Numerator 12 · Denominator 333 · Adjusted rate 5.41% |
| Healthcare-associated infections requiring hospitalization | 4.7% |
7.12%
2.4 pts better
|
No Different than the National Rate · Eligible stays 352 · Observed rate 2.84% · Lower 95% interval 2.96% |
| Staff COVID-19 vaccination coverage | 1.18% |
8.2%
7 pts worse
|
Numerator 1 · Denominator 85 |
| Staff flu vaccination coverage | 72.93% |
42%
30.9 pts better
|
Numerator 97 · Denominator 133 |
| Discharge function score | 64.84% |
56.45%
8.4 pts better
|
Numerator 177 · Denominator 273 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 264 · Denominator 264 |
| Transfer of health information to patient | 100% |
96.28%
3.7 pts better
|
Numerator 77 · Denominator 77 |
| Resident COVID-19 vaccinations up to date | 26.47% |
25.2%
1.3 pts better
|
Numerator 45 · Denominator 170 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 98.2% |
68.9%
29.3 pts better
|
81.7%
16.5 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 99.0% · Q2 99.0% · Q3 97.8% · Q4 97.2% · 4Q avg 98.2% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 6.4% |
9.8%
3.4 pts better
|
12.0%
5.6 pts better
|
Short Stay · 20240701-20250630 · Adjusted 6.4% · Observed 6.1% · Expected 10.7% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.0% |
1.5%
1.5 pts better
|
1.6%
1.6 pts better
|
Short 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 short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 96.0% |
68.7%
27.3 pts better
|
79.7%
16.3 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 96.0% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 21.7% |
23.1%
1.4 pts better
|
23.9%
2.2 pts better
|
Short Stay · 20240701-20250630 · Adjusted 21.7% · Observed 18.5% · Expected 20.4% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-05-03 · Fire 2024-05-03
0 health deficiencies
No concentrated health issue counts in this cycle.
1 fire-safety deficiencies
Top issue: Smoke (1 deficiency)
Cycle 3
Health 2023-06-08 · Fire 2023-06-08
0 health deficiencies
No concentrated health issue counts in this cycle.
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Fire safety
Fire-safety citations
E · Potential for more than minimal harm
2025-04-16
K223 · Egress Deficiencies
Fire Safety
Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
Corrected 2025-05-20
E · Potential for more than minimal harm
2025-04-16
K321 · Smoke Deficiencies
Fire Safety
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Corrected 2025-05-20
E · Potential for more than minimal harm
2025-04-16
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2025-05-20
E · Potential for more than minimal harm
2024-05-03
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2024-06-18
Inspection history
Recent health citations
L · Immediate jeopardy
2025-04-16
F689 · Quality of Life and Care Deficiencies
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2025-05-05
Penalties and ownership
What sits behind the stars
Ownership
Jefferson Health Corporation
5% Or Greater Direct Ownership Interest · Organization
Thomas Jefferson University
5% Or Greater Direct Ownership Interest · Organization
Abia Buenache, Jose
Corporate Officer · Individual
Anthony, Kirsten
Corporate Director · Individual
Begliomini, Robert
Corporate Officer · Individual
Brooke, Beth
Corporate Director · Individual
Friel, Timothy
Corporate Officer · Individual
Green, Linda
Corporate Director · Individual
Gupta, Ranju
Corporate Director · Individual
Hoffman, Joel
Corporate Director · Individual
Kane, Bryan
Corporate Director · Individual
Macomb, Julie
Corporate Officer · Individual
Miller, Allison
Corporate Director · Individual
Miller, James
Corporate Director · Individual
Molitoris, Stephen
Operational/Managerial Control · Individual
Murphy, Robert
Corporate Officer · Individual
O'brien, Kathy
Corporate Director · Individual
Rossi, Michael
Corporate Director · Individual
Sandhu, Rovinder
Corporate Officer · Individual
Shedlock, Caroline
Operational/Managerial Control · Individual
Stanley, John
Corporate Officer · Individual
Thomas, Robert
Corporate Officer · Individual
Worthington, William
Corporate Director · Individual
Yee, Susan
Corporate Director · Individual
Nearby options
Other facilities in reach
#1
Cedarbrook Senior Care And Rehabilitation
Allentown, PA
5-star overall rating with 4-star inspections with 5 recent health deficiencies
#2
Cedar Crest Post Acute
Allentown, PA
3-star overall rating with 3-star inspections with 10 recent health deficiencies with 4 fire-safety deficiencies in the latest cycle
#3
Luther Crest Nursing Facility
Allentown, PA
5-star overall rating with 5-star inspections with 2 recent health deficiencies with 12 fire-safety deficiencies in the latest cycle
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