Orwigsburg, PA

Orwigsburg Nursing And Rehabilitation Center

3-star overall rating with 4-star inspections with $22,128 in total fines with 3 recent health deficiencies with 6 fire-safety deficiencies in the latest cycle

1000 Orwigsburg Manor Dr, Orwigsburg, PA

(570) 366-2999

Compare this facility

Overall

3 / 5

CMS overall stars

Health inspections

4 / 5

Survey and complaint cycles

Staffing

1 / 5

RN + nurse staffing

Quality measures

2 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

130

Certified beds

Average residents

112

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

Imperial Healthcare Group

Operator or chain grouping

Approved since

1992-08-27

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

0.38

Registered nurse staffing · state 0.78 · national 0.68

LPN hours / resident day

0.87

Licensed practical nurse staffing · state 0.91 · national 0.87

Aide hours / resident day

1.84

Nurse aide staffing · state 2.20 · national 2.35

Total nurse hours

3.09

All reported nurse hours · state 3.89 · national 3.89

Licensed hours

1.25

RN + LPN hours · state 1.69 · national 1.54

Weekend hours

2.77

Weekend nurse staffing · state 3.51 · national 3.43

Weekend RN hours

0.27

Weekend registered nurse coverage · state 0.55 · national 0.47

Physical therapist

0.05

Reported PT staffing · state 0.10 · national 0.07

Adjusted RN hours

0.36

CMS adjusted RN staffing hours

Adjusted total hours

2.99

CMS adjusted total nurse staffing hours

Case-mix index

1.41

Higher values indicate more complex resident acuity

RN turnover

46%

Annual RN turnover · state 43% · national 45%

Total nurse turnover

52%

Annual nurse turnover · state 47% · national 46%

SNF VBP

Value-based purchasing

Program rank

12,420

Lower is better among SNFs in the FY 2026 VBP program.

Performance score

12.39

Composite VBP score used to determine payment impact.

Payment multiplier

0.9811

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

3.31

Baseline 18.04% · Performance 19.90% · Measure score 3.31 · Achievement 3.31 · Improvement 0

Healthcare-associated infections

0

Baseline 6.82% · Performance 7.86% · Measure score 0 · Achievement 0 · Improvement 0

Total nurse turnover

1.07

Baseline 56.00% · Performance 59.32% · Measure score 1.07 · Achievement 1.07 · Improvement 0

Adjusted total nurse staffing

0.58

Baseline 3.23 hours · Performance 3.24 hours · Measure score 0.58 · Achievement 0.58 · Improvement 0

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	8.63%	10.72% 2.1 pts better	No Different than the National Rate · Eligible stays 114 · Observed rate 5.26% · Lower 95% interval 6.04%
Discharge to community	37.07%	50.57% 13.5 pts worse	Worse than the National Rate · Eligible stays 126 · Observed rate 28.57% · Lower 95% interval 29.24%
Medicare spending per beneficiary	1.02	1.02 About the same
Drug regimen review with follow-up	100%	95.27% 4.7 pts better	Numerator 80 · Denominator 80
Falls with major injury	1.25%	0.77% 0.5 pts worse	Numerator 1 · Denominator 80
Discharge self-care score	70.91%	53.69% 17.2 pts better	Numerator 39 · Denominator 55
Discharge mobility score	52.73%	50.94% 1.8 pts better	Numerator 29 · Denominator 55
Pressure ulcers or injuries, new or worsened	1.25%	2.29% 1 pts better	Numerator 1 · Denominator 80 · Adjusted rate 1.16%
Healthcare-associated infections requiring hospitalization	7.86%	7.12% 0.7 pts worse	No Different than the National Rate · Eligible stays 86 · Observed rate 10.47% · Lower 95% interval 5.06%
Staff COVID-19 vaccination coverage	2.8%	8.2% 5.4 pts worse	Numerator 4 · Denominator 143
Staff flu vaccination coverage	34.64%	42% 7.4 pts worse	Numerator 62 · Denominator 179
Discharge function score	69.09%	56.45% 12.6 pts better	Numerator 38 · Denominator 55
Transfer of health information to provider	83.33%	95.95% 12.6 pts worse	Numerator 30 · Denominator 36
Transfer of health information to patient	Not Available	96.28%	Numerator Not Available · Denominator 16 · Too few residents or stays to report publicly.
Resident COVID-19 vaccinations up to date	17.02%	25.2% 8.2 pts worse	Numerator 8 · Denominator 47

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 1.8 · Expected 1.6 · Used in QM five-star
Number of outpatient emergency department visits per 1000 long-stay resident days	1.8	1.2 0.6 pts worse	1.8 About the same	Long Stay · 20240701-20250630 · Adjusted 1.8 · Observed 1.5 · Expected 1.4 · Used in QM five-star
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine	79.6%	86.9% 7.3 pts worse	93.4% 13.8 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 73.5% · Q2 78.1% · Q3 84.4% · Q4 82.8% · 4Q avg 79.6%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine	85.4%	93.5% 8.1 pts worse	95.5% 10.1 pts worse	Long Stay · 2024Q3-2025Q2 · 4Q avg 85.4%
Percentage of long-stay residents experiencing one or more falls with major injury	3.6%	3.2% 0.4 pts worse	3.3% 0.3 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 4.9% · Q2 3.1% · Q3 3.1% · Q4 3.2% · 4Q avg 3.6% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms	5.9%	6.5% 0.6 pts better	11.4% 5.5 pts better	Long Stay · 2024Q4-2025Q3 · Q1 3.3% · Q2 4.5% · Q3 6.7% · Q4 9.4% · 4Q avg 5.9%
Percentage of long-stay residents who lose too much weight	6.1%	6.5% 0.4 pts better	5.4% 0.7 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 5.3% · Q2 5.6% · Q3 2.2% · Q4 11.8% · 4Q avg 6.1%
Percentage of long-stay residents who received an antianxiety or hypnotic medication	22.7%	19.9% 2.8 pts worse	19.6% 3.1 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 24.5% · Q2 23.4% · Q3 23.7% · Q4 19.1% · 4Q avg 22.7%
Percentage of long-stay residents who received an antipsychotic medication	12.4%	18.7% 6.3 pts better	16.7% 4.3 pts better	Long Stay · 2024Q4-2025Q3 · Q1 11.8% · Q2 12.5% · Q3 12.2% · Q4 13.0% · 4Q avg 12.4% · 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	17.6%	19.6% 2 pts better	16.3% 1.3 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 13.4% · Q2 24.0% · Q3 17.2% · Q4 15.5% · 4Q avg 17.6% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	20.5%	18.3% 2.2 pts worse	14.9% 5.6 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 21.9% · Q2 22.2% · Q3 20.7% · Q4 16.5% · 4Q avg 20.5% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder	1.0%	0.9% 0.1 pts worse	1.0% About the same	Long Stay · 2024Q4-2025Q3 · Q1 1.0% · Q2 2.3% · Q3 0.8% · Q4 0.0% · 4Q avg 1.0% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection	2.7%	1.7% 1 pts worse	1.7% 1 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 2.0% · Q2 1.1% · Q3 5.3% · Q4 2.2% · 4Q avg 2.7% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	25.8%	26.4% 0.6 pts better	19.8% 6 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 33.8% · Q2 27.1% · Q3 20.5% · Q4 21.4% · 4Q avg 25.8%
Percentage of long-stay residents with pressure ulcers	7.6%	5.3% 2.3 pts worse	5.1% 2.5 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 11.6% · Q2 7.1% · Q3 6.4% · Q4 5.1% · 4Q avg 7.6% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	74.5%	68.9% 5.6 pts better	81.7% 7.2 pts worse	Short Stay · 2024Q4-2025Q3 · Q1 62.5% · Q2 72.0% · Q3 78.4% · Q4 83.0% · 4Q avg 74.5%
Percentage of short-stay residents who had an outpatient emergency department visit	14.1%	9.8% 4.3 pts worse	12.0% 2.1 pts worse	Short Stay · 20240701-20250630 · Adjusted 14.1% · Observed 13.3% · Expected 10.5% · Used in QM five-star
Percentage of short-stay residents who newly received an antipsychotic medication	1.7%	1.5% 0.2 pts worse	1.6% 0.1 pts worse	Short Stay · 2024Q4-2025Q3 · Q1 7.0% · Q2 0.0% · Q3 0.0% · Q4 1.5% · 4Q avg 1.7% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	58.9%	68.7% 9.8 pts worse	79.7% 20.8 pts worse	Short Stay · 2024Q3-2025Q2 · 4Q avg 58.9%
Percentage of short-stay residents who were rehospitalized after a nursing home admission	24.9%	23.1% 1.8 pts worse	23.9% 1 pts worse	Short Stay · 20240701-20250630 · Adjusted 24.9% · Observed 24.5% · Expected 23.5% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2025-08-07 · Fire 2025-08-07

4 health deficiencies

Top issue: Quality of Life and Care (2 deficiencies)

6 fire-safety deficiencies

Top issue: Smoke (3 deficiencies)

Cycle 2 Health 2024-07-26 · Fire 2024-07-26

6 health deficiencies

Top issue: Nutrition and Dietary (2 deficiencies)

4 fire-safety deficiencies

Top issue: Smoke (3 deficiencies)

Cycle 3 Health 2023-08-04 · Fire 2023-08-04

2 health deficiencies

Top issue: Quality of Life and Care (2 deficiencies)

3 fire-safety deficiencies

Top issue: Smoke (2 deficiencies)

Fire safety

Fire-safety citations

E · Potential for more than minimal harm 2025-08-07

K161 · Construction Deficiencies

Fire Safety

Use approved construction type or materials.

Corrected 2025-09-30

E · Potential for more than minimal harm 2025-08-07

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 2025-12-02

E · Potential for more than minimal harm 2025-08-07

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2025-09-30

C · Minimal harm 2025-08-07

K100 · Construction Deficiencies

Fire Safety

Meet other general requirements.

Corrected 2025-09-30

C · Minimal harm 2025-08-07

K211 · Egress Deficiencies

Fire Safety

Keep aisles, corridors, and exits free of obstruction in case of emergency.

Corrected 2025-09-30

C · Minimal harm 2025-08-07

K345 · Smoke Deficiencies

Fire Safety

Have approved installation, maintenance and testing program for fire alarm systems.

Corrected 2025-09-30

E · Potential for more than minimal harm 2024-07-26

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 2024-08-06

E · Potential for more than minimal harm 2024-07-26

K362 · Smoke Deficiencies

Fire Safety

Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.

Corrected 2024-08-06

C · Minimal harm 2024-07-26

K918 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have generator or other power source capable of supplying service within 10 seconds.

Corrected 2024-08-06

B · Minimal harm 2024-07-26

K324 · Smoke Deficiencies

Fire Safety

Provide properly protected cooking facilities.

Corrected 2024-08-06

E · Potential for more than minimal harm 2023-08-04

K211 · Egress Deficiencies

Fire Safety

Keep aisles, corridors, and exits free of obstruction in case of emergency.

Corrected 2023-10-13

E · Potential for more than minimal harm 2023-08-04

K355 · Smoke Deficiencies

Fire Safety

Properly select, install, inspect, or maintain portable fire extinguishes.

Corrected 2023-10-13

C · Minimal harm 2023-08-04

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2023-10-13

Inspection history

Recent health citations

D · Potential for more than minimal harm 2025-11-12

F583 · Resident Rights Deficiencies

Health

Keep residents' personal and medical records private and confidential.

Corrected 2025-12-09

E · Potential for more than minimal harm 2025-08-07

F684 · Quality of Life and Care Deficiencies

Health

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

Corrected 2025-09-02

D · Potential for more than minimal harm 2025-08-07

F641 · Resident Assessment and Care Planning Deficiencies

Health

Ensure each resident receives an accurate assessment.

Corrected 2025-09-02

K · Immediate jeopardy 2025-04-11

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 2025-04-26