Cycle 1
Health 2025-07-25 · Fire 2025-07-25
8 health deficiencies
Top issue: Quality of Life and Care (3 deficiencies)
2 fire-safety deficiencies
Top issue: Emergency Preparedness (2 deficiencies)
Columbia, PA
Susquehanna Health And Wellness Center
3-star overall rating with 3-star inspections with $132,901 in total fines with 8 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
745 Old Chickies Hill Road, Columbia, PA
(717) 684-7555
Overall
3 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
3 / 5
RN + nurse staffing
Quality measures
3 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
173
Certified beds
Average residents
163
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
1978-01-31
CMS approved date
Coverage
Medicare + Medicaid
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
Staffing
Hours and turnover
RN hours / resident day
0.50
Registered nurse staffing · state 0.78 · national 0.68
LPN hours / resident day
0.74
Licensed practical nurse staffing · state 0.91 · national 0.87
Aide hours / resident day
1.94
Nurse aide staffing · state 2.20 · national 2.35
Total nurse hours
3.17
All reported nurse hours · state 3.89 · national 3.89
Licensed hours
1.24
RN + LPN hours · state 1.69 · national 1.54
Weekend hours
2.91
Weekend nurse staffing · state 3.51 · national 3.43
Weekend RN hours
0.39
Weekend registered nurse coverage · state 0.55 · national 0.47
Physical therapist
0.06
Reported PT staffing · state 0.10 · national 0.07
Adjusted RN hours
0.55
CMS adjusted RN staffing hours
Adjusted total hours
3.50
CMS adjusted total nurse staffing hours
Case-mix index
1.24
Higher values indicate more complex resident acuity
RN turnover
26%
Annual RN turnover · state 43% · national 45%
Total nurse turnover
46%
Annual nurse turnover · state 47% · national 46%
SNF VBP
Value-based purchasing
Program rank
2,812
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
47.57
Composite VBP score used to determine payment impact.
Payment multiplier
1.0011
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
6.80
Baseline 20.86% · Performance 18.28% · Measure score 6.80 · Achievement 6.80 · Improvement 6.23
Healthcare-associated infections
4.27
Baseline 7.43% · Performance 6.56% · Measure score 4.27 · Achievement 4.27 · Improvement 3.09
Total nurse turnover
6.62
Baseline 83.16% · Performance 41.67% · Measure score 6.62 · Achievement 5.39 · Improvement 6.62
Adjusted total nurse staffing
1.34
Baseline 3.58 hours · Performance 3.46 hours · Measure score 1.34 · Achievement 1.34 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10.43% |
10.72%
0.3 pts better
|
No Different than the National Rate · Eligible stays 63 · Observed rate 11.11% · Lower 95% interval 6.7% |
| Discharge to community | 40.84% |
50.57%
9.7 pts worse
|
No Different than the National Rate · Eligible stays 48 · Observed rate 31.25% · Lower 95% interval 28.47% |
| Medicare spending per beneficiary | 1.01 |
1.02
About the same
|
|
| Drug regimen review with follow-up | 100% |
95.27%
4.7 pts better
|
Numerator 88 · Denominator 88 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 88 |
| Discharge self-care score | 44.62% |
53.69%
9.1 pts worse
|
Numerator 29 · Denominator 65 |
| Discharge mobility score | 43.08% |
50.94%
7.9 pts worse
|
Numerator 28 · Denominator 65 |
| Pressure ulcers or injuries, new or worsened | 1.14% |
2.29%
1.2 pts better
|
Numerator 1 · Denominator 88 · Adjusted rate 0.87% |
| Healthcare-associated infections requiring hospitalization | 6.56% |
7.12%
0.6 pts better
|
No Different than the National Rate · Eligible stays 45 · Observed rate 4.44% · Lower 95% interval 3.67% |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 175 |
| Staff flu vaccination coverage | Not Available |
42%
|
Numerator Not Available · Denominator Not Available · No data were submitted for this measure. |
| Discharge function score | 55.38% |
56.45%
1.1 pts worse
|
Numerator 36 · Denominator 65 |
| Transfer of health information to provider | 95% |
95.95%
1 pts worse
|
Numerator 19 · Denominator 20 |
| Transfer of health information to patient | 96.88% |
96.28%
0.6 pts better
|
Numerator 31 · Denominator 32 |
| Resident COVID-19 vaccinations up to date | 23.44% |
25.2%
1.8 pts worse
|
Numerator 15 · Denominator 64 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.4 |
1.7
0.3 pts better
|
1.9
0.5 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.4 · Observed 1.5 · Expected 2.0 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 1.3 |
1.2
0.1 pts worse
|
1.8
0.5 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.3 · Observed 1.2 · Expected 1.6 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 91.9% |
86.9%
5 pts better
|
93.4%
1.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 94.6% · Q2 91.2% · Q3 87.2% · Q4 94.7% · 4Q avg 91.9% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 91.9% |
93.5%
1.6 pts worse
|
95.5%
3.6 pts worse
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 91.9% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 2.7% |
3.2%
0.5 pts better
|
3.3%
0.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.7% · Q2 1.4% · Q3 2.7% · Q4 4.0% · 4Q avg 2.7% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 2.8% |
6.5%
3.7 pts better
|
11.4%
8.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 6.3% · Q2 3.5% · Q3 1.4% · Q4 0.0% · 4Q avg 2.8% |
| Percentage of long-stay residents who lose too much weight | 5.9% |
6.5%
0.6 pts better
|
5.4%
0.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 5.5% · Q2 8.7% · Q3 5.0% · Q4 4.1% · 4Q avg 5.9% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 15.9% |
19.9%
4 pts better
|
19.6%
3.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 13.7% · Q2 17.4% · Q3 17.3% · Q4 15.2% · 4Q avg 15.9% |
| Percentage of long-stay residents who received an antipsychotic medication | 24.3% |
18.7%
5.6 pts worse
|
16.7%
7.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 19.6% · Q2 24.3% · Q3 24.6% · Q4 28.3% · 4Q avg 24.3% · 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 | 25.3% |
19.6%
5.7 pts worse
|
16.3%
9 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 37.0% · Q2 35.2% · Q3 11.8% · Q4 20.6% · 4Q avg 25.3% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 21.2% |
18.3%
2.9 pts worse
|
14.9%
6.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 28.6% · Q2 29.7% · Q3 14.7% · Q4 12.4% · 4Q avg 21.2% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.7% |
0.9%
0.2 pts better
|
1.0%
0.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.6% · Q2 1.1% · Q3 0.5% · Q4 0.5% · 4Q avg 0.7% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.7% |
1.7%
1 pts better
|
1.7%
1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.4% · Q3 0.7% · Q4 0.7% · 4Q avg 0.7% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 23.5% |
26.4%
2.9 pts better
|
19.8%
3.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 20.6% · Q2 29.0% · Q3 19.6% · Q4 24.6% · 4Q avg 23.5% |
| Percentage of long-stay residents with pressure ulcers | 4.7% |
5.3%
0.6 pts better
|
5.1%
0.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 3.9% · Q2 4.8% · Q3 4.7% · Q4 5.4% · 4Q avg 4.7% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 72.7% |
68.9%
3.8 pts better
|
81.7%
9 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 59.4% · Q2 79.5% · Q3 84.0% · Q4 65.1% · 4Q avg 72.7% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 8.3% |
9.8%
1.5 pts better
|
12.0%
3.7 pts better
|
Short Stay · 20240701-20250630 · Adjusted 8.3% · Observed 8.4% · Expected 11.3% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.8% |
1.5%
0.7 pts better
|
1.6%
0.8 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.5% · Q3 0.0% · Q4 1.9% · 4Q avg 0.8% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 89.0% |
68.7%
20.3 pts better
|
79.7%
9.3 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 89.0% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 22.7% |
23.1%
0.4 pts better
|
23.9%
1.2 pts better
|
Short Stay · 20240701-20250630 · Adjusted 22.7% · Observed 22.4% · Expected 23.6% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-08-22 · Fire 2024-08-22
18 health deficiencies
Top issue: Resident Assessment and Care Planning (5 deficiencies)
1 fire-safety deficiencies
Top issue: Smoke (1 deficiency)
Cycle 3
Health 2024-03-29 · Fire 2024-03-29
9 health deficiencies
Top issue: Quality of Life and Care (3 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2025-07-25
E6 · Emergency Preparedness Deficiencies
Fire Safety
Conduct risk assessment and an All-Hazards approach.
Corrected 2025-09-03
C · Minimal harm
2025-07-25
E4 · Emergency Preparedness Deficiencies
Fire Safety
Develop and maintain an Emergency Preparedness Program (EP).
Corrected 2025-09-03
F · Potential for more than minimal harm
2024-12-17
K345 · Smoke Deficiencies
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2025-02-10
Inspection history
Recent health citations
E · Potential for more than minimal harm
2025-07-25
F730 · Nursing and Physician Services Deficiencies
Health
Observe each nurse aide's job performance and give regular training.
Corrected 2025-09-11
E · Potential for more than minimal harm
2025-07-25
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2025-09-11
D · Potential for more than minimal harm
2025-07-25
F656 · Resident Assessment and Care Planning Deficiencies
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2025-09-11
D · Potential for more than minimal harm
2025-07-25
F692 · Quality of Life and Care Deficiencies
Health
Provide enough food/fluids to maintain a resident's health.
Corrected 2025-09-11
D · Potential for more than minimal harm
2025-07-25
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2025-09-11
D · Potential for more than minimal harm
2025-07-25
F725 · Nursing and Physician Services Deficiencies
Health
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Corrected 2025-09-11
D · Potential for more than minimal harm
2025-07-25
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 2025-09-11
D · Potential for more than minimal harm
2025-03-05
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2025-04-30
E · Potential for more than minimal harm
2024-08-22
F623 · Resident Rights Deficiencies
Health
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Corrected 2024-10-09
E · Potential for more than minimal harm
2024-08-22
F641 · Resident Assessment and Care Planning Deficiencies
Health
Ensure each resident receives an accurate assessment.
Corrected 2024-10-09
E · Potential for more than minimal harm
2024-08-22
F656 · Resident Assessment and Care Planning Deficiencies
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2024-10-09
E · Potential for more than minimal harm
2024-08-22
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2024-10-09
E · Potential for more than minimal harm
2024-08-22
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 2024-10-09
E · Potential for more than minimal harm
2024-08-22
F760 · Pharmacy Service Deficiencies
Health
Ensure that residents are free from significant medication errors.
Corrected 2024-10-09
E · Potential for more than minimal harm
2024-08-22
F804 · Nutrition and Dietary Deficiencies
Health
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected 2024-10-09
E · Potential for more than minimal harm
2024-08-22
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-10-09
E · Potential for more than minimal harm
2024-08-22
F842 · Resident Assessment and Care Planning Deficiencies
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2024-10-09
D · Potential for more than minimal harm
2024-08-22
F550 · Resident Rights Deficiencies
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2024-10-09
D · Potential for more than minimal harm
2024-08-22
F558 · Resident Rights Deficiencies
Health
Reasonably accommodate the needs and preferences of each resident.
Corrected 2024-10-09
D · Potential for more than minimal harm
2024-08-22
F559 · Resident Rights Deficiencies
Health
Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made.
Corrected 2024-10-09
D · Potential for more than minimal harm
2024-08-22
F636 · Resident Assessment and Care Planning Deficiencies
Health
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
Corrected 2024-10-09
D · Potential for more than minimal harm
2024-08-22
F638 · Resident Assessment and Care Planning Deficiencies
Health
Assure that each resident’s assessment is updated at least once every 3 months.
Corrected 2024-10-09
D · Potential for more than minimal harm
2024-08-22
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2024-10-09
D · Potential for more than minimal harm
2024-08-22
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 2024-10-09
D · Potential for more than minimal harm
2024-08-22
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 2024-10-09
D · Potential for more than minimal harm
2024-08-22
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2024-10-09
G · Actual harm
2024-03-29
F656 · Resident Assessment and Care Planning Deficiencies
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2024-05-07
G · Actual harm
2024-03-29
F693 · Quality of Life and Care Deficiencies
Health
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.
Corrected 2024-05-07
F · Potential for more than minimal harm
2024-03-29
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-05-07
E · Potential for more than minimal harm
2024-03-29
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 2024-05-07
D · Potential for more than minimal harm
2024-03-29
F550 · Resident Rights Deficiencies
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2024-05-07
D · Potential for more than minimal harm
2024-03-29
F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Respond appropriately to all alleged violations.
Corrected 2024-05-07
D · Potential for more than minimal harm
2024-03-29
F686 · Quality of Life and Care Deficiencies
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2024-05-07
D · Potential for more than minimal harm
2024-03-29
F740 · Quality of Life and Care Deficiencies
Health
Ensure each resident must receive and the facility must provide necessary behavioral health care and services.
Corrected 2024-05-07
D · Potential for more than minimal harm
2023-08-23
F656 · Resident Assessment and Care Planning Deficiencies
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2023-10-02
Penalties and ownership
What sits behind the stars
$48,731
2024-03-29
Fine
Fine · fine $48,731
Fine
$4,893
2024-02-20
Fine
Fine · fine $4,893
Fine
$14,679
2024-01-30
Fine
Fine · fine $14,679
Fine
$4,893
2024-01-08
Fine
Fine · fine $4,893
Fine
$4,545
2024-01-02
Fine
Fine · fine $4,545
Fine
$4,892
2023-12-11
Fine
Fine · fine $4,892
Fine
$4,634
2023-11-20
Fine
Fine · fine $4,634
Fine
$4,643
2023-11-13
Fine
Fine · fine $4,643
Fine
$13,778
2023-10-23
Fine
Fine · fine $13,778
Fine
$11,620
2023-08-07
Fine
Fine · fine $11,620
Fine
$4,413
2023-05-10
Fine
Fine · fine $4,413
Fine
$11,180
2023-05-10
Fine
Fine · fine $11,180
Fine
Ownership
Snhhc LLC
5% Or Greater Direct Ownership Interest · Organization
Atwood, Mark
Operational/Managerial Control · Individual
Mandel, Avital
5% Or Greater Indirect Ownership Interest · Individual
Mandel, Avital
Operational/Managerial Control · Individual
Sar Ft Family Tr
5% Or Greater Indirect Ownership Interest · Organization
Nearby options
Other facilities in reach
#1
St Anne's Retirement Community
Columbia, PA
4-star overall rating with 4-star inspections with 3 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
#2
Elizabethtown Nursing And Rehabilitation
Elizabethtown, PA
1-star overall rating with 1-star inspections with $88,614 in total fines with 11 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
#3
Homestead Village, Inc
Lancaster, PA
5-star overall rating with 4-star inspections with 2 recent health deficiencies
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