Duncannon, PA

Transitions Healthcare Allens Cove

3-star overall rating with 2-star inspections with 10 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle

25 Cove Road, Duncannon, PA

(717) 834-4887

Compare this facility

Overall

3 / 5

CMS overall stars

Health inspections

2 / 5

Survey and complaint cycles

Staffing

3 / 5

RN + nurse staffing

Quality measures

5 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

60

Certified beds

Average residents

54

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

Transitions Healthcare

Operator or chain grouping

Approved since

1993-12-08

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Chain footprint

6 facilities

Chain averages 2 overall / 3 health / 3 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

0.47

Registered nurse staffing · state 0.78 · national 0.68

LPN hours / resident day

1.15

Licensed practical nurse staffing · state 0.91 · national 0.87

Aide hours / resident day

2.26

Nurse aide staffing · state 2.20 · national 2.35

Total nurse hours

3.87

All reported nurse hours · state 3.89 · national 3.89

Licensed hours

1.61

RN + LPN hours · state 1.69 · national 1.54

Weekend hours

3.44

Weekend nurse staffing · state 3.51 · national 3.43

Weekend RN hours

0.30

Weekend registered nurse coverage · state 0.55 · national 0.47

Physical therapist

0.11

Reported PT staffing · state 0.10 · national 0.07

Adjusted RN hours

0.46

CMS adjusted RN staffing hours

Adjusted total hours

3.83

CMS adjusted total nurse staffing hours

Case-mix index

1.38

Higher values indicate more complex resident acuity

RN turnover

38%

Annual RN turnover · state 43% · national 45%

Total nurse turnover

43%

Annual nurse turnover · state 47% · national 46%

SNF VBP

Value-based purchasing

Program rank

2,703

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

Performance score

48.18

Composite VBP score used to determine payment impact.

Payment multiplier

1.0019

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

4.54

Performance 19.33% · Measure score 4.54 · Achievement 4.54 · This facility did not have sufficient data to calculate a baseline period measure result.

Healthcare-associated infections

8.06

Performance 5.43% · Measure score 8.06 · Achievement 8.06 · This facility did not have sufficient data to calculate a baseline period measure result.

Total nurse turnover

3.93

Baseline 57.50% · Performance 47.62% · Measure score 3.93 · Achievement 3.93 · Improvement 2.53

Adjusted total nurse staffing

2.75

Baseline 3.58 hours · Performance 3.86 hours · Measure score 2.75 · Achievement 2.75 · Improvement 0.78

SNF QRP

Medicare quality reporting measures

Measure Facility National Note
Potentially preventable 30-day readmission 11.48%
10.72%
0.8 pts worse
No Different than the National Rate · Eligible stays 88 · Observed rate 12.5% · Lower 95% interval 8.64%
Discharge to community 54.62%
50.57%
4 pts better
No Different than the National Rate · Eligible stays 83 · Observed rate 49.4% · Lower 95% interval 45.3%
Medicare spending per beneficiary 0.79
1.02
0.2 pts better
Drug regimen review with follow-up 100%
95.27%
4.7 pts better
Numerator 64 · Denominator 64
Falls with major injury 0%
0.77%
0.8 pts better
Numerator 0 · Denominator 64
Discharge self-care score 58%
53.69%
4.3 pts better
Numerator 29 · Denominator 50
Discharge mobility score 54%
50.94%
3.1 pts better
Numerator 27 · Denominator 50
Pressure ulcers or injuries, new or worsened 3.13%
2.29%
0.8 pts worse
Numerator 2 · Denominator 64 · Adjusted rate 2.92%
Healthcare-associated infections requiring hospitalization 5.43%
7.12%
1.7 pts better
No Different than the National Rate · Eligible stays 54 · Observed rate 0% · Lower 95% interval 2.82%
Staff COVID-19 vaccination coverage 0%
8.2%
8.2 pts worse
Numerator 0 · Denominator 96
Staff flu vaccination coverage 20.16%
42%
21.8 pts worse
Numerator 26 · Denominator 129
Discharge function score 64%
56.45%
7.5 pts better
Numerator 32 · Denominator 50
Transfer of health information to provider Not Available
95.95%
Numerator Not Available · Denominator 11 · Too few residents or stays to report publicly.
Transfer of health information to patient 100%
96.28%
3.7 pts better
Numerator 36 · Denominator 36
Resident COVID-19 vaccinations up to date 19.35%
25.2%
5.8 pts worse
Numerator 6 · Denominator 31

Quality measures

Resident outcomes and process scores

Measure Facility State National Note
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine 100.0%
86.9%
13.1 pts better
93.4%
6.6 pts better
Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 100.0% · Q4 100.0% · 4Q avg 100.0%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine 95.7%
93.5%
2.2 pts better
95.5%
0.2 pts better
Long Stay · 2024Q3-2025Q2 · 4Q avg 95.7%
Percentage of long-stay residents experiencing one or more falls with major injury 3.0%
3.2%
0.2 pts better
3.3%
0.3 pts better
Long Stay · 2024Q4-2025Q3 · Q1 4.3% · Q2 4.7% · Q3 0.0% · Q4 2.6% · 4Q avg 3.0% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms 0.0%
6.5%
6.5 pts better
11.4%
11.4 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 who lose too much weight 5.2%
6.5%
1.3 pts better
5.4%
0.2 pts better
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 12.5% · Q3 3.1% · Q4 6.1% · 4Q avg 5.2%
Percentage of long-stay residents who received an antianxiety or hypnotic medication 16.5%
19.9%
3.4 pts better
19.6%
3.1 pts better
Long Stay · 2024Q4-2025Q3 · Q1 10.5% · Q2 15.2% · Q3 20.6% · Q4 20.6% · 4Q avg 16.5%
Percentage of long-stay residents who received an antipsychotic medication 24.1%
18.7%
5.4 pts worse
16.7%
7.4 pts worse
Long Stay · 2024Q4-2025Q3 · Q1 23.5% · Q2 16.7% · Q3 25.0% · Q4 30.0% · 4Q avg 24.1% · 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 17.9%
19.6%
1.7 pts better
16.3%
1.6 pts worse
Long Stay · 2024Q4-2025Q3 · 4Q avg 17.9% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased 7.6%
18.3%
10.7 pts better
14.9%
7.3 pts better
Long Stay · 2024Q4-2025Q3 · Q1 2.6% · Q2 9.4% · Q3 9.7% · Q4 9.7% · 4Q avg 7.6% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder 0.6%
0.9%
0.3 pts better
1.0%
0.4 pts better
Long Stay · 2024Q4-2025Q3 · Q1 2.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.6% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection 0.6%
1.7%
1.1 pts better
1.7%
1.1 pts better
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 2.7% · 4Q avg 0.6% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence 20.9%
26.4%
5.5 pts better
19.8%
1.1 pts worse
Long Stay · 2024Q4-2025Q3 · Q1 14.8% · Q2 19.9% · Q3 28.7% · Q4 21.2% · 4Q avg 20.9%
Percentage of long-stay residents with pressure ulcers 3.4%
5.3%
1.9 pts better
5.1%
1.7 pts better
Long Stay · 2024Q4-2025Q3 · Q1 1.4% · Q2 4.7% · Q3 3.2% · Q4 4.8% · 4Q avg 3.4% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine 98.9%
68.9%
30 pts better
81.7%
17.2 pts better
Short Stay · 2024Q4-2025Q3 · Q1 98.7% · Q2 98.3% · Q3 99.2% · Q4 99.2% · 4Q avg 98.9%
Percentage of short-stay residents who had an outpatient emergency department visit 2.3%
9.8%
7.5 pts better
12.0%
9.7 pts better
Short Stay · 20240701-20250630 · Adjusted 2.3% · Observed 2.3% · Expected 11.2% · 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 2.2% · Q2 0.0% · Q3 2.9% · Q4 1.6% · 4Q avg 1.7% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine 90.0%
68.7%
21.3 pts better
79.7%
10.3 pts better
Short Stay · 2024Q3-2025Q2 · 4Q avg 90.0%
Percentage of short-stay residents who were rehospitalized after a nursing home admission 35.9%
23.1%
12.8 pts worse
23.9%
12 pts worse
Short Stay · 20240701-20250630 · Adjusted 35.9% · Observed 34.1% · Expected 22.6% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2025-04-23 · Fire 2025-04-23

10 health deficiencies

Top issue: Quality of Life and Care (3 deficiencies)

2 fire-safety deficiencies

Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)

Cycle 2 Health 2024-05-09 · Fire 2024-05-09

13 health deficiencies

Top issue: Quality of Life and Care (4 deficiencies)

5 fire-safety deficiencies

Top issue: Construction (1 deficiency)

Cycle 3 Health 2023-06-01 · Fire 2023-06-01

17 health deficiencies

Top issue: Resident Rights (7 deficiencies)

6 fire-safety deficiencies

Top issue: Smoke (3 deficiencies)

Fire safety

Fire-safety citations

E · Potential for more than minimal harm 2025-04-23

K511 · Services Deficiencies

Fire Safety

Have properly installed electrical wiring and gas equipment.

Corrected 2025-04-28

E · Potential for more than minimal harm 2025-04-23

K920 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure proper usage of power strips and extension cords.

Corrected 2025-04-28

F · Potential for more than minimal harm 2024-05-09

K100 · Construction Deficiencies

Fire Safety

Meet other general requirements.

Corrected 2024-07-29

E · Potential for more than minimal harm 2024-05-09

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2024-06-28

E · Potential for more than minimal harm 2024-05-09

K741 · Miscellaneous Deficiencies

Fire Safety

Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.

Corrected 2024-06-28

E · Potential for more than minimal harm 2024-05-09

K912 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have power receptacles that are properly grounded.

Corrected 2024-06-28

C · Minimal harm 2024-05-09

K521 · Services Deficiencies

Fire Safety

Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.

Corrected 2024-06-28

D · Potential for more than minimal harm 2023-06-01

K225 · Egress Deficiencies

Fire Safety

Have stairways and smokeproof enclosures used as exits that meet safety requirements.

Corrected 2023-07-05

D · Potential for more than minimal harm 2023-06-01

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 2023-07-05

D · Potential for more than minimal harm 2023-06-01

K324 · Smoke Deficiencies

Fire Safety

Provide properly protected cooking facilities.

Corrected 2023-07-05

D · Potential for more than minimal harm 2023-06-01

K363 · Smoke Deficiencies

Fire Safety

Install corridor and hallway doors that block smoke.

Corrected 2023-07-05

C · Minimal harm 2023-06-01

K100 · Construction Deficiencies

Fire Safety

Meet other general requirements.

Corrected 2023-07-05

C · Minimal harm 2023-06-01

K291 · Egress Deficiencies

Fire Safety

Install emergency lighting that can last at least 1 1/2 hours.

Corrected 2023-07-05

Inspection history

Recent health citations

E · Potential for more than minimal harm 2025-04-23

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 2025-06-03

E · Potential for more than minimal harm 2025-04-23

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 2025-06-03

D · Potential for more than minimal harm 2025-04-23

F625 · Resident Rights Deficiencies

Health

Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.

Corrected 2025-06-03

D · Potential for more than minimal harm 2025-04-23

F641 · Resident Assessment and Care Planning Deficiencies

Health

Ensure each resident receives an accurate assessment.

Corrected 2025-06-03

D · Potential for more than minimal harm 2025-04-23

F677 · Quality of Life and Care Deficiencies

Health

Provide care and assistance to perform activities of daily living for any resident who is unable.

Corrected 2025-06-03

D · Potential for more than minimal harm 2025-04-23

F684 · Quality of Life and Care Deficiencies

Health

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

Corrected 2025-06-03

D · Potential for more than minimal harm 2025-04-23

F688 · Quality of Life and Care Deficiencies

Health

Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.

Corrected 2025-06-03

D · Potential for more than minimal harm 2025-04-23

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2025-06-03

E · Potential for more than minimal harm 2025-03-31

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 2025-04-14

E · Potential for more than minimal harm 2025-03-31

F730 · Nursing and Physician Services Deficiencies

Health

Observe each nurse aide's job performance and give regular training.

Corrected 2025-04-14

E · Potential for more than minimal harm 2024-09-04

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 2024-11-07

E · Potential for more than minimal harm 2024-05-09

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 2024-06-21

E · Potential for more than minimal harm 2024-05-09

F676 · Quality of Life and Care Deficiencies

Health

Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.

Corrected 2024-06-21

E · Potential for more than minimal harm 2024-05-09

F679 · Quality of Life and Care Deficiencies

Health

Provide activities to meet all resident's needs.

Corrected 2024-06-21

E · Potential for more than minimal harm 2024-05-09

F692 · Quality of Life and Care Deficiencies

Health

Provide enough food/fluids to maintain a resident's health.

Corrected 2024-06-21

E · Potential for more than minimal harm 2024-05-09

F695 · Quality of Life and Care Deficiencies

Health

Provide safe and appropriate respiratory care for a resident when needed.

Corrected 2024-06-21

E · Potential for more than minimal harm 2024-05-09

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 2024-06-21

D · Potential for more than minimal harm 2024-05-09

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 2024-06-21

D · Potential for more than minimal harm 2024-05-09

F625 · Resident Rights Deficiencies

Health

Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.

Corrected 2024-06-21

D · Potential for more than minimal harm 2024-05-09

F641 · Resident Assessment and Care Planning Deficiencies

Health

Ensure each resident receives an accurate assessment.

Corrected 2024-06-21

D · Potential for more than minimal harm 2024-05-09

F655 · Resident Assessment and Care Planning Deficiencies

Health

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

Corrected 2024-06-21

D · Potential for more than minimal harm 2024-05-09

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 2024-06-21

D · Potential for more than minimal harm 2024-05-09

F804 · Nutrition and Dietary Deficiencies

Health

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Corrected 2024-06-21

D · Potential for more than minimal harm 2023-11-13

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 2023-12-08

E · Potential for more than minimal harm 2023-08-11

F804 · Nutrition and Dietary Deficiencies

Health

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Corrected 2023-09-26

D · Potential for more than minimal harm 2023-08-11

F803 · Nutrition and Dietary Deficiencies

Health

Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

Corrected 2023-09-26

E · Potential for more than minimal harm 2023-06-01

F565 · Resident Rights Deficiencies

Health

Honor the resident's right to organize and participate in resident/family groups in the facility.

Corrected 2023-07-11

E · Potential for more than minimal harm 2023-06-01

F580 · Resident Rights Deficiencies

Health

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Corrected 2023-07-11

E · Potential for more than minimal harm 2023-06-01

F600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Corrected 2023-07-11

E · Potential for more than minimal harm 2023-06-01

F657 · Resident Assessment and Care Planning Deficiencies

Health

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

Corrected 2023-07-11

E · Potential for more than minimal harm 2023-06-01

F809 · Nutrition and Dietary Deficiencies

Health

Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.

Corrected 2023-07-11

E · Potential for more than minimal harm 2023-06-01

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 2023-07-11

D · Potential for more than minimal harm 2023-06-01

F558 · Resident Rights Deficiencies

Health

Reasonably accommodate the needs and preferences of each resident.

Corrected 2023-07-11

D · Potential for more than minimal harm 2023-06-01

F578 · Resident Rights Deficiencies

Health

Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

Corrected 2023-07-11

D · Potential for more than minimal harm 2023-06-01

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 2023-07-11

D · Potential for more than minimal harm 2023-06-01

F585 · Resident Rights Deficiencies

Health

Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.

Corrected 2023-07-11

D · Potential for more than minimal harm 2023-06-01

F677 · Quality of Life and Care Deficiencies

Health

Provide care and assistance to perform activities of daily living for any resident who is unable.

Corrected 2023-07-11

D · Potential for more than minimal harm 2023-06-01

F730 · Nursing and Physician Services Deficiencies

Health

Observe each nurse aide's job performance and give regular training.

Corrected 2023-07-11

D · Potential for more than minimal harm 2023-06-01

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 2023-07-11

D · Potential for more than minimal harm 2023-06-01

F808 · Nutrition and Dietary Deficiencies

Health

Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.

Corrected 2023-07-11

Penalties and ownership

What sits behind the stars

Ownership

Feldman, Marc

5% Or Greater Direct Ownership Interest · Individual

33% 6 facilities 2023-01-01
Maurano, Matthew

5% Or Greater Indirect Ownership Interest · Individual

33% 6 facilities 2023-01-01
Williams, Kevin

5% Or Greater Direct Ownership Interest · Individual

33% 8 facilities 2023-01-01
Feldman, Marc

Operational/Managerial Control · Individual

0% 6 facilities 2023-01-01
Jones, Carl

Operational/Managerial Control · Individual

0% 1 facilities 2023-01-01
Maurano, Matthew

Operational/Managerial Control · Individual

0% 6 facilities 2023-01-01
Members First Federal Credit Unions

5% Or Greater Mortgage Interest · Organization

0% 2 facilities 2023-01-01
Menon, Madhu

Operational/Managerial Control · Individual

0% 1 facilities 2023-01-01
Transitions Healthcare LLC

Operational/Managerial Control · Organization

0% 5 facilities 2023-01-01
Williams, Kevin

Operational/Managerial Control · Individual

0% 8 facilities 2023-01-01

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