F 0558
Reasonably accommodate the needs and preferences of each resident.
Level of Harm - Minimal harm
or potential for actual harm
Based on clinical record review, observation, and resident and staff interview, it was determined that the
facility failed to accommodate resident needs regarding the accessibility of a call bell for two of 17 residents
reviewed (Residents 25 and 53).
Residents Affected - Few
Findings include:
Clinical record review for Resident 25 revealed a diagnoses list that included: a need for assistance with
personal care, weakness, and contracture of the muscles.
A current care plan for Resident 25 revealed the resident is at risk for falling related to gait abnormality, a
history of pain, incontinence, and other medical areas. An intervention listed on the care plan included to
keep the call bell in reach.
Observation of Resident 25 on July 31, 2024, at 9:48 AM revealed he was in bed. The call bell was
observed not within reach with the call bell cord tucked between the resident's right side rail and mattress
and the activator hanging down under the bed almost touching the floor.
Observation of Resident 25 on August 1, 2024, at 11:10 AM revealed he was in bed. The call bell was
observed out of his reach with the call bell cord tucked between the resident's right side rail and mattress
and the activator was on the floor. A concurrent interview with Resident 25 revealed the resident replied,
Good question, when asked if he knew where the call bell was. The resident further attempted to access
the call bell and was unable.
Employee 3, registered nurse, was advised of the finding for Resident 25 on August 1, 2024, at 11:13 AM
and further assisted the resident with accessing the call bell.
Clinical record review for Resident 53 revealed a diagnoses list that included: a need for assistance with
personal care, dementia, age-related physical debility, and muscle weakness.
A current care plan for Resident 53 revealed the resident is at risk for falling related to gait abnormality,
cognition deficit, incontinence, attempting to crawl out of bed, and multiple other medical issues. An
intervention listed on the care plan included to keep the call bell in reach.
Observation of Resident 53 on August 1, 2024, at 9:17 AM and 11:14 AM revealed she was in bed. The call
bell was observed out of her immediate reach with the activator hanging down below the bed and almost
touching the floor.
Employee 3, registered nurse, was advised of the finding for Resident 53 on August 1, 2024, at
(continued on next page)
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Facility ID:
If continuation sheet
Page 1 of 9
Event ID:
395533
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
395533
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
08/02/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Heritage Ridge Senior Living at Windy Hill
100 Dogwood Drive
Philipsburg, PA 16866
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0558
11:17 AM.
Level of Harm - Minimal harm
or potential for actual harm
The above information for Residents 25 and 53 were reviewed with the Nursing Home Administrator and
Director of Nursing on August 1, 2024, at 2:05 PM.
Residents Affected - Few
28 Pa. Code 211.12(d)(1)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395533
If continuation sheet
Page 2 of 9
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
395533
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
08/02/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Heritage Ridge Senior Living at Windy Hill
100 Dogwood Drive
Philipsburg, PA 16866
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0623
Level of Harm - Potential for
minimal harm
Residents Affected - Some
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman,
before transfer or discharge, including appeal rights.
Based on clinical record review, observation, and staff interview, it was determined that the facility failed to
provide a written notice of transfer that included all the written components to the resident and/or the
resident's responsible party for two of seven residents reviewed (Resident 8 and 13).
Findings include:
Review of Resident 8's clinical record revealed that the facility transferred her to the hospital on July 23,
2024. Resident 8 was still in the hospital at the time of the full health survey. There was no documented
evidence that that the facility attempted to provide Resident 8's responsible party with a transfer notice that
included all the required contents: State long term care appeal agency or contact and address information
for the Office of the State Long-Term Care Ombudsman including email address.
Observation on August 2, 2024, at 12:15 PM confirmed that Resident 8's transfer forms were still sitting in
an envelope at the facility's front desk. Interview with the Director of Nursing on August 2, 2024, at 12:55
PM confirmed that if a resident's responsible party is unable to be contacted regarding the transfer, then the
notice is sent out via the mail.
Review of Resident 13's clinical record revealed that the facility transferred her to the hospital on May 31,
2024. There was no documented evidence that the facility provided Resident 13's responsible party with a
transfer notice that included all the above components.
Interview with Employee 1, admissions, on August 2, 2024, at 9:18 AM confirmed the above findings for
Resident 13.
28 Pa. Code 201.14(a) Responsibility of license
28 Pa. Code 201.29(a) Resident rights
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395533
If continuation sheet
Page 3 of 9
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
395533
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
08/02/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Heritage Ridge Senior Living at Windy Hill
100 Dogwood Drive
Philipsburg, PA 16866
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0625
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
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.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
clinical record review, observation, and staff interview, it was determined that the facility failed to provide a
written notice of the facility's bed hold policy to the resident or responsible party for two of seven residents
reviewed for hospitalizations (Residents 8 and 13).
Findings include:
Review of Resident 8's clinical record revealed that she was admitted to the hospital on [DATE]. Resident 8
was still hospitalized at the time of the full health survey. There was no documented evidence in Resident
8's clinical record to indicate that the facility provided her responsible party written information on the
facility's bed hold policy.
Observation on August 2, 2024, at 12:15 PM confirmed that Resident 8's bed hold forms were still sitting in
an envelope at the facility's front desk. Interview with the Director of Nursing on August 2, 2024, at 12:55
PM confirmed that if a resident's responsible party is unable to be contacted regarding a transfer, then the
notice is sent out via the mail.
Review of Resident 13's clinical record revealed that she was admitted to the hospital on [DATE]. There was
no documented evidence in Resident 13's clinical record to indicate that the facility provided her
responsible party written information on the facility's bed hold policy.
Interview with Employee 1, admissions, on August 2, 2024, at 9:18 AM confirmed the above findings for
Resident 13.
28 Pa. Code 201.14(a) Responsibility of licensee
28 Pa. Code 201.29(f) Resident rights
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395533
If continuation sheet
Page 4 of 9
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
395533
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
08/02/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Heritage Ridge Senior Living at Windy Hill
100 Dogwood Drive
Philipsburg, PA 16866
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0644
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Coordinate assessments with the pre-admission screening and resident review program; and referring for
services as needed.
Based on clinical record review and staff interview, it was determined that the facility failed to identify and
refer a resident with a diagnosed mental disorder for level II review for one of one resident reviewed for
PASRR (Pre-admission Screening and Resident Review) compliance (Resident 10).
Findings include:
The PA-PASRR-ID form (Pennsylvania Pre-admission Screening and Resident Review; PA-PASRR,
federally required form to help ensure that all individuals are evaluated for serious mental disorder and/or
intellectual disability to ensure applicants are not inappropriately placed in nursing homes for long term
care) dated February 2016 and revised in September 2018, lists examples of serious mental illness
including psychotic disorder and schizophrenia.
The revised PA-PASRR-ID bulletin number 01-14-13, 03-14-10, 07-14-01, 55-14-01 dated March 1, 2014,
revealed that nursing facilities are responsible for assuring the accuracy of information reported on the
PA-PASRR-ID form. If the individual has a change in condition that affects target status a PA-PASRR-EV
(Level II) will need to be completed. Nursing facilities will communicate the need to have a PA-PASRR-EV
done by notifying the Department's (Department of Public Welfare, now the Department of Human
Services) Office of Long-Term Living, Bureau of Quality and Provider Management, Division of Nursing
Facility Field Operations via the MA 408 form (a form used to notify the Department of a change in a
resident's target status).
Review of the MA 408 form dated March 2020 indicates that with a change in a resident's condition (any
change in the individual's condition that affects the target status) the nursing facility is to send or fax the
original form within 48 hours to their (Department of Public Welfare's) nursing facility field operations office.
Review of Resident 10's clinical record revealed a PA-PASARR dated November 24, 2004, that
documented no disorders that would trigger a level II review. The assessment indicated that there were no
diagnoses of neurocognitive disorders or serious mental illness, a level II review was not necessary, and to
admit Resident 10 as a regular admission. The form was reviewed by the Department of Human Services
(DHS) on January 5, 2005.
Resident 10's clinical record identified her as having a diagnosis of paranoid schizophrenia (a mental
disorder where a person experiences fear that feeds into their delusions and hallucinations) that was added
to her plan of care on January 20, 2005. There was no evidence that the facility notified the appropriate
agencies related to Resident 10's identified target diagnosis.
Interview with the Director of Nursing on August 2, 2024, at 9:30 AM acknowledged the above findings for
Resident 10.
28 Pa. Code 201.14 (a) Responsibility of Licensee
28 Pa. Code 211.5(f)(iv)(vi) Medical records
28 Pa. Code 211.12 (d)(3)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395533
If continuation sheet
Page 5 of 9
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
395533
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
08/02/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Heritage Ridge Senior Living at Windy Hill
100 Dogwood Drive
Philipsburg, PA 16866
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0699
Provide care or services that was trauma informed and/or culturally competent.
Level of Harm - Minimal harm
or potential for actual harm
Based on clinical record review and staff interview, it was determined that the facility failed to identify
triggers related to a resident's diagnosis of Post-Traumatic Stress Disorder, to provide culturally, competent,
trauma-informed care and eliminate or mitigate re-traumatization for one of one resident reviewed
(Resident 10).
Residents Affected - Few
Findings include:
Clinical record review for Resident 10 revealed a current care plan entitled Behavioral Symptoms that
identified her as having PTSD (Post Traumatic Stress Syndrome, a mental and behavioral disorder that
develops from experiencing a traumatic event). The care plan goal was that Resident 10 would remain
stable with interventions and medications as ordered. Further review of her care plan revealed that the
facility failed to identify triggers that may retraumatize her related to her diagnosis of PTSD.
A physician's progress note provided to the surveyor on August 2, 2024, at 9:30 AM dated November 24,
2004, indicated that Resident 10 was admitted from a personal care home after an alleged rape by another
resident. The note also indicated that Resident 10 was in a motor vehicle accident in 1987 and suffered
head trauma. Neither of the two events were identified in her plan of care as the cause of her PTSD but
were provided to the surveyor as the identified cause of Resident 10's PTSD.
Interview with the Director of Nursing on August 2, 2024, at 9:45 AM confirmed the above noted findings
related to Resident 10's diagnosis of PTSD.
The facility failed to identify care plan triggers that may retraumatize Resident 10 related to her diagnosis of
PTSD.
28 Pa Code 211.12 (d)(3)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395533
If continuation sheet
Page 6 of 9
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
395533
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
08/02/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Heritage Ridge Senior Living at Windy Hill
100 Dogwood Drive
Philipsburg, PA 16866
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0812
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on observation and staff interview, it was determined the facility failed to store food and maintain
food service equipment in a safe and sanitary manner and prevent the potential for food contamination in
the facility's main kitchen.
Findings include:
An observation of the facility's main kitchen on July 30, 2024, at 9:37 AM revealed the following:
A speed rack located beside the ovens was observed with trays of potatoes, as well as another tray at the
bottom of the rack holding a container with a variety of equipment such as spatulas, spoons, labels, and
pens. The tray contained dried spills and food splatter.
A drawer unit under a preparation table across from the ovens was dusty, contained dried food debris, and
food splatter.
Lower shelves of preparation and storage tables throughout the kitchen where food preparation equipment
was stored were observed with dust, crumbs, and dried spills.
Flooring throughout the kitchen under preparation tables, steam tables, oven, coolers, and along wall
edges, was observed with dirt and debris buildup, dried food, wrappers, soiled plastic spoon, and dried
spills.
A three-tier black cart beside the dishwashing area was observed with clean plate bases and lids. The cart
handles and edges of the shelves were soiled with debris and dried food.
A table where open boxes of sugar packets and hot chocolate packets were stored contained significant
dust and debris behind and around the containers.
The floor of the walk-in cooler contained a buildup of dirt and debris.
The flooring in the dry storage area was significantly worn with multiple cracked tiles.
Employee 3, production manager, was observed walking in and out of the kitchen multiple times during the
above observations. Employee 3 had a full beard without any covering.
A follow up observation in the main kitchen on August 1, 2024, at 12:04 PM revealed Employee 4 and
Employee 5, dietary aides, working in the kitchen production area preparing lunch service trays. Employee
4 and Employee 5 both had visible facial hair without any protective covering.
The above information was reviewed with the Nursing Home Administrator and Director of Nursing on
August 1, 2024, at 2:02 PM.
483.60 (i)(2) Food store, distribute, maintain, sanitary
Previously cited 8/25/23
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395533
If continuation sheet
Page 7 of 9
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
395533
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
08/02/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Heritage Ridge Senior Living at Windy Hill
100 Dogwood Drive
Philipsburg, PA 16866
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0812
28 Pa. Code 201.14 (a) Responsibility of licensee
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395533
If continuation sheet
Page 8 of 9
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
395533
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
08/02/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Heritage Ridge Senior Living at Windy Hill
100 Dogwood Drive
Philipsburg, PA 16866
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0883
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Level of Harm - Minimal harm
or potential for actual harm
Based on clinical record review and staff interview, it was determined that the facility failed to ensure a
resident received or was offered pneumococcal conjugate vaccines for two of five residents reviewed for
immunization concerns (Residents 7 and 168).
Residents Affected - Few
Findings include:
Clinical record review for Resident 7 revealed that the facility admitted her on March 12, 2024. Review of
her immunizations in her clinical record revealed that there was no documentation related to the
pneumococcal conjugate vaccines (vaccines administered to prevent pneumonia).
Clinical record review for Resident 168 revealed that the facility admitted her on July 17, 2024. Review of
her immunizations in her clinical record revealed that there was no documentation related to the
pneumococcal conjugate vaccines.
The Director of Nursing was made aware of concerns with Resident 7 and 168's pneumococcal
vaccinations on August 2, 2024, at 1:01 PM.
The facility failed to ensure the Residents 7 and 168 received the appropriate vaccinations as
recommended.
28 Pa. Code 201.14(a) Responsibility of licensee
28 Pa. Code 201.18(b)(1) Management
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
395533
If continuation sheet
Page 9 of 9