14 health deficiencies
Top issue: Quality of Life and Care (6 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
York, PA
1-star overall rating with 1-star inspections with $31,186 in total fines with 14 recent health deficiencies
200 Pauline Drive, York, PA
(717) 741-0824
Overall
1 / 5
CMS overall stars
Health inspections
1 / 5
Survey and complaint cycles
Staffing
2 / 5
RN + nurse staffing
Quality measures
3 / 5
Resident outcomes and process measures
Quick facts
Beds
142
Certified beds
Average residents
137
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Genesis Healthcare
Operator or chain grouping
Approved since
1974-06-19
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
193 facilities
Chain averages 2 overall / 2 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
RN hours / resident day
0.49
Registered nurse staffing · state 0.78 · national 0.68
LPN hours / resident day
1.06
Licensed practical nurse staffing · state 0.91 · national 0.87
Aide hours / resident day
2.05
Nurse aide staffing · state 2.20 · national 2.35
Total nurse hours
3.59
All reported nurse hours · state 3.89 · national 3.89
Licensed hours
1.55
RN + LPN hours · state 1.69 · national 1.54
Weekend hours
3.33
Weekend nurse staffing · state 3.51 · national 3.43
Weekend RN hours
0.38
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
0.44
CMS adjusted RN staffing hours
Adjusted total hours
3.25
CMS adjusted total nurse staffing hours
Case-mix index
1.51
Higher values indicate more complex resident acuity
RN turnover
40%
Annual RN turnover · state 43% · national 45%
Total nurse turnover
42%
Annual nurse turnover · state 47% · national 46%
SNF VBP
Program rank
8,963
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
25.15
Composite VBP score used to determine payment impact.
Payment multiplier
0.9837
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
Readmission
3.81
Baseline 18.76% · Performance 19.67% · Measure score 3.81 · Achievement 3.81 · Improvement 0
Healthcare-associated infections
0
Baseline 5.97% · Performance 9.34% · Measure score 0 · Achievement 0 · Improvement 0
Total nurse turnover
5.46
Baseline 65.84% · Performance 41.41% · Measure score 5.46 · Achievement 5.45 · Improvement 5.46
Adjusted total nurse staffing
0.79
Baseline 3.62 hours · Performance 3.30 hours · Measure score 0.79 · Achievement 0.79 · Improvement 0
SNF QRP
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10.22% |
10.72%
0.5 pts better
|
No Different than the National Rate · Eligible stays 131 · Observed rate 9.92% · Lower 95% interval 7.58% |
| Discharge to community | 56% |
50.57%
5.4 pts better
|
No Different than the National Rate · Eligible stays 138 · Observed rate 48.55% · Lower 95% interval 48.41% |
| Medicare spending per beneficiary | 1.05 |
1.02
About the same
|
|
| Drug regimen review with follow-up | 98.28% |
95.27%
3 pts better
|
Numerator 171 · Denominator 174 |
| Falls with major injury | 2.3% |
0.77%
1.5 pts worse
|
Numerator 4 · Denominator 174 |
| Discharge self-care score | 40.4% |
53.69%
13.3 pts worse
|
Numerator 40 · Denominator 99 |
| Discharge mobility score | 43.43% |
50.94%
7.5 pts worse
|
Numerator 43 · Denominator 99 |
| Pressure ulcers or injuries, new or worsened | 7.47% |
2.29%
5.2 pts worse
|
Numerator 13 · Denominator 174 · Adjusted rate 5.31% |
| Healthcare-associated infections requiring hospitalization | 9.34% |
7.12%
2.2 pts worse
|
No Different than the National Rate · Eligible stays 116 · Observed rate 12.93% · Lower 95% interval 6.36% |
| Staff COVID-19 vaccination coverage | 6.47% |
8.2%
1.7 pts worse
|
Numerator 9 · Denominator 139 |
| Staff flu vaccination coverage | 40.49% |
42%
1.5 pts worse
|
Numerator 66 · Denominator 163 |
| Discharge function score | 42.42% |
56.45%
14 pts worse
|
Numerator 42 · Denominator 99 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 70 · Denominator 70 |
| Transfer of health information to patient | 100% |
96.28%
3.7 pts better
|
Numerator 64 · Denominator 64 |
| Resident COVID-19 vaccinations up to date | 5.88% |
25.2%
19.3 pts worse
|
Numerator 6 · Denominator 102 |
Quality measures
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.6 |
1.7
0.1 pts better
|
1.9
0.3 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.6 · Observed 1.6 · Expected 1.9 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 1.0 |
1.2
0.2 pts better
|
1.8
0.8 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.0 · Observed 1.0 · Expected 1.6 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 83.7% |
86.9%
3.2 pts worse
|
93.4%
9.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 83.5% · Q2 83.2% · Q3 85.2% · Q4 83.0% · 4Q avg 83.7% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 96.7% |
93.5%
3.2 pts better
|
95.5%
1.2 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 96.7% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 7.6% |
3.2%
4.4 pts worse
|
3.3%
4.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 6.4% · Q2 8.8% · Q3 9.6% · Q4 5.4% · 4Q avg 7.6% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 7.1% |
6.5%
0.6 pts worse
|
11.4%
4.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 3.8% · Q2 4.5% · Q3 10.8% · Q4 9.3% · 4Q avg 7.1% |
| Percentage of long-stay residents who lose too much weight | 10.8% |
6.5%
4.3 pts worse
|
5.4%
5.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 8.5% · Q2 13.6% · Q3 11.3% · Q4 9.4% · 4Q avg 10.8% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 25.0% |
19.9%
5.1 pts worse
|
19.6%
5.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 24.2% · Q2 24.3% · Q3 25.0% · Q4 26.4% · 4Q avg 25.0% |
| Percentage of long-stay residents who received an antipsychotic medication | 19.3% |
18.7%
0.6 pts worse
|
16.7%
2.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 18.6% · Q2 19.1% · Q3 18.4% · Q4 21.1% · 4Q avg 19.3% · 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 | 22.7% |
19.6%
3.1 pts worse
|
16.3%
6.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 23.0% · Q2 18.0% · Q3 28.8% · Q4 20.7% · 4Q avg 22.7% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 25.6% |
18.3%
7.3 pts worse
|
14.9%
10.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 28.3% · Q2 26.3% · Q3 27.5% · Q4 20.8% · 4Q avg 25.6% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.3% |
0.9%
0.6 pts better
|
1.0%
0.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.1% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.3% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 2.6% |
1.7%
0.9 pts worse
|
1.7%
0.9 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 2.9% · Q2 3.7% · Q3 1.8% · Q4 1.9% · 4Q avg 2.6% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 32.5% |
26.4%
6.1 pts worse
|
19.8%
12.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 30.6% · Q2 27.4% · Q3 29.8% · Q4 42.4% · 4Q avg 32.5% |
| Percentage of long-stay residents with pressure ulcers | 4.1% |
5.3%
1.2 pts better
|
5.1%
1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 3.6% · Q2 4.4% · Q3 3.2% · Q4 5.0% · 4Q avg 4.1% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 61.9% |
68.9%
7 pts worse
|
81.7%
19.8 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 63.5% · Q2 62.0% · Q3 60.6% · Q4 61.6% · 4Q avg 61.9% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 10.0% |
9.8%
0.2 pts worse
|
12.0%
2 pts better
|
Short Stay · 20240701-20250630 · Adjusted 10.0% · Observed 9.6% · Expected 10.7% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 1.5% |
1.5%
About the same
|
1.6%
0.1 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 1.1% · Q2 1.0% · Q3 1.8% · Q4 1.9% · 4Q avg 1.5% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 50.9% |
68.7%
17.8 pts worse
|
79.7%
28.8 pts worse
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 50.9% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 20.2% |
23.1%
2.9 pts better
|
23.9%
3.7 pts better
|
Short Stay · 20240701-20250630 · Adjusted 20.2% · Observed 22.5% · Expected 26.5% · Used in QM five-star |
Survey summary
Top issue: Quality of Life and Care (6 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Top issue: Quality of Life and Care (6 deficiencies)
4 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Top issue: Quality of Life and Care (10 deficiencies)
6 fire-safety deficiencies
Top issue: Egress (2 deficiencies)
Fire safety
Fire Safety
Meet other general requirements.
Corrected 2024-08-07
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2024-08-07
Fire Safety
Properly select, install, inspect, or maintain portable fire extinguishes.
Corrected 2024-08-07
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2024-08-07
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2023-09-29
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2023-09-29
Fire Safety
Meet other general requirements.
Corrected 2023-10-20
Fire Safety
Have stairways and smokeproof enclosures used as exits that meet safety requirements.
Corrected 2023-09-29
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2023-09-29
Fire Safety
Have elevators that firefighters can control in the event of a fire.
Corrected 2023-09-29
Inspection history
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2025-06-24
Health
Ensure each resident receives an accurate assessment.
Corrected 2025-06-24
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 2025-06-24
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2025-06-24
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2025-06-24
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2025-06-24
Health
Reasonably accommodate the needs and preferences of each resident.
Corrected 2025-06-24
Health
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Corrected 2025-06-24
Health
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Corrected 2025-06-24
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 2025-06-24
Health
Provide enough food/fluids to maintain a resident's health.
Corrected 2025-06-24
Health
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected 2025-06-24
Health
Provide and implement an infection prevention and control program.
Corrected 2025-06-24
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 2025-04-15
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2024-10-30
Health
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected 2024-10-30
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2024-09-10
Health
Provide care by qualified persons according to each resident's written plan of care.
Corrected 2024-08-21
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 2024-08-21
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2024-08-21
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2024-09-10
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-09-10
Health
Provide and implement an infection prevention and control program.
Corrected 2024-08-21
Health
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Corrected 2024-08-21
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 2024-08-21
Health
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Corrected 2024-08-21
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2024-08-21
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 2024-08-21
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2024-08-21
Health
Observe each nurse aide's job performance and give regular training.
Corrected 2024-08-21
Health
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Corrected 2024-08-21
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2024-04-02
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2023-09-21
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 2023-09-21
Health
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Corrected 2023-09-21
Health
Observe each nurse aide's job performance and give regular training.
Corrected 2023-09-21
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 2023-09-21
Health
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected 2023-09-21
Health
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
Corrected 2023-09-21
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2023-09-21
Health
Provide and implement an infection prevention and control program.
Corrected 2023-09-21
Health
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
Corrected 2023-09-21
Health
Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.
Corrected 2023-09-21
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 2023-09-21
Health
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Corrected 2023-09-21
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 2023-09-21
Health
Ensure each resident receives an accurate assessment.
Corrected 2023-10-24
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2023-09-21
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 2023-09-21
Health
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Corrected 2023-09-21
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2023-09-21
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2023-09-21
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2023-09-21
Health
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected 2023-09-21
Health
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
Corrected 2023-09-21
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2023-06-28
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 2023-04-25
Health
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
Corrected 2023-04-25
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 2023-04-25
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2023-04-10
Health
Provide and implement an infection prevention and control program.
Corrected 2023-04-10
Penalties and ownership
Fine · fine $15,593
Fine
Fine · fine $7,403
Fine
Fine · fine $8,190
Fine
5% Or Greater Direct Ownership Interest · Organization
Corporate Officer · Individual
Corporate Officer · Individual
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Individual
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
Operational/Managerial Control · Individual
Corporate Officer · Individual
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Individual
5% Or Greater Indirect Ownership Interest · Organization
Nearby options
York, PA
5-star overall rating with 5-star inspections with 2 recent health deficiencies
York, PA
2-star overall rating with 3-star inspections with 9 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
York, PA
2-star overall rating with 2-star inspections with $59,314 in total fines with 7 recent health deficiencies with 7 fire-safety deficiencies in the latest cycle
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