Inspection visit
Health inspection
3 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 3 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
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.
Based on observation and resident and staff interview, it was determined that the facility failed to provide
adequate housekeeping and maintenance services to ensure a clean, safe, and orderly environment on two
of four nursing units (Unit 1 and Unit 4, Residents 5 and 10).Findings included: An interview with Resident 5
on November 19, 2025, at 11:20 AM revealed that she was very unhappy with the cleanliness of her
bathroom, stating she keeps her own broom and a Swiffer mop, so she can clean the area herself, but she
is unable to remove the dirt. Observation of the bathroom revealed there was a lot of brown and gray debris
on the floor along all of the baseboards that appeared to be stuck to the floor. The threshold was noted to
have a gray strip running the width of the doorway and along this strip on both sides was a layer of dust and
debris that appeared to be stuck to the floor. These findings were reviewed during an interview with the
Nursing Home Administrator and the Director of Nursing on November 19, 2025, at 3:35 PM. An interview
with Resident 10 on November 19, 2025, at 1:23 PM revealed concerns with the cleanliness of the
bathroom floor. Concurrent observation of Resident 10's bathroom revealed a gap the resident pointed out
between areas of the wall and bathroom floor. Observation revealed a small gap, most noticeably between
the floor and wall located behind the commode. Some areas of this gap contained unidentified debris. The
above information for Resident 10 was reviewed in a meeting with the Nursing Home Administrator and
Director of Nursing on November 19, 2025, at 3:30 PM. 483.10(i)(1)-(7) Safe/clean/comfortable/homelike
EnvironmentPreviously cited deficiency 9/19/25 28 Pa. Code 201.18(b)(3)(e)(2.1) Management
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 3
Event ID:
395616
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
395616
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/19/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Lock Haven Rehabilitation and Senior Living
22 Cree Drive
Lock Haven, PA 17745
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 0802
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition
service.
Based on observation, review of facility documents, and resident and staff interview, it was determined that
the facility failed to provide sufficient staff to carry out the functions of the food and nutrition services in the
main kitchen and on two of four nursing units (Unit 4, Residents 5).Findings include: An Interview with
Resident 5 revealed that using plastic utensils to cut food on Styrofoam is awful, and this happens often,
especially on the weekends. A review of the resident council meeting summary for October 2025, revealed
that concerns regarding tray tickets and actual items on the tray are mismatched, and the Fall/Winter
menus had not yet been updated or distributed, despite a launch date of October 1, 2025, as indicated on
the September resident council meeting. During an interview with Employee 1, Food Services Director, on
November 19, 2025, at 10:20 AM it was confirmed paper products (foam containers and plastic ware) were
used to serve resident meals for dinner on Wednesday, November 12, due to not having enough food
service staff to operate the dish machine to wash dishes and silverware and complete other duties.
Employee 1 stated that this is done any time there is not enough staff to wash the dishes and prepare
meals. Review of the food service staff schedule for November 2 to 11, 2025, with Employee 1, on
November 19, 2025, at 10:20 AM revealed the following open positions for food service workers on the
schedule required to meet the needs of the department: Sunday, November 2, 2025, two morning shifts
Monday, November 3, 2025, three morning shifts Tuesday, November 4, 2025, one morning shift, one
evening shift Wednesday, November 5, 2025, two morning shifts Thursday, November 6, 2025, three
morning shifts Friday, November 7, 2025, one morning shift, one evening shift Saturday, November 8, 2025,
three morning shifts and one evening shift Sunday, November 9, 2025, two morning shifts Monday,
November 10, two morning shifts Tuesday, November 11, 2025, two morning shifts, and two evening shifts
Wednesday, November 12, 2025, two morning shifts, and two evening shifts Thursday, November 13, 2025,
two morning shifts, and one evening shift Friday, November 14, 2025, one morning shift, one evening shift
Saturday, November 15, 2025, two morning shifts The above concerns regarding the timing of meals, and
utilization of paper products due to staffing was reviewed with the Nursing Home Administrator on
November 19, 2025, at 3:30 PM. 483.60 (a) Sufficient Dietary Support PersonnelPreviously cited 9/19/25
28 Pa. Code 201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(3) Management
Event ID:
Facility ID:
395616
If continuation sheet
Page 2 of 3
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
395616
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/19/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Lock Haven Rehabilitation and Senior Living
22 Cree Drive
Lock Haven, PA 17745
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 0803
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
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.
Based on observation, facility document review, and resident and staff interview, it was determined that the
facility failed to serve all meal ticket items for three of five residents observed (Residents 5, 6, and
7).Findings include: During an interview with Resident 5 on November 19, 2025, at 11:20 AM she stated
that she often does not receive the items on her tray that she is supposed to. A review of the resident
council meeting summary for October 2025, revealed that concerns regarding tray tickets and actual items
on the tray are mismatched. Observation of the lunch meal service for unit 4 on November 19, 2025, at
12:15 PM revealed the following: Employee 2 NA (nurse aide), delivered meal trays to the residents and
assisted Residents 6 and 7 in preparing their trays by removing the lids and placing them in front of the
resident on a tray table. Review of Resident 5's lunch meal ticket (paper slip provided with tray that
indicates diet, items to be received, as well as resident allergies and preferences) revealed that the resident
had both bread and margarine listed on her ticket. No bread or margarine was observed on the resident's
tray. Concurrent reviews and observations of Resident 6 and 7's lunch meal tickets revealed that Resident 6
should have received cottage cheese on her tray, and Resident 7 should have received a grilled cheese
sandwich. These items were not present on either resident's tray. Partway through meal service at 12:30
PM, the surveyor notified Employee 2 of the residents missing lunch service items. At this time Employee 2
called down to the kitchen and requested these items be sent for these individuals. The surveyor discussed
the above findings with the Nursing Home Administrator on November 20, 2025, at 3:35 PM. 28 Pa. Code
201.14(a) Responsibility of licensee 28 Pa. Code 201.18(b)(3) Management
Event ID:
Facility ID:
395616
If continuation sheet
Page 3 of 3
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Back to topCitations
3 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F584 - Safe Environment
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.
F802 - Staffing
Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
F803 - Menus and nutritional adequacy
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.
FAQ · About this visit
Common questions about this visit
What happened during the November 19, 2025 survey of LOCK HAVEN REHABILITATION AND SENIOR LIVING?
This was a inspection survey of LOCK HAVEN REHABILITATION AND SENIOR LIVING on November 19, 2025. The surveyor cited 3 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at LOCK HAVEN REHABILITATION AND SENIOR LIVING on November 19, 2025?
Yes, 3 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receivin..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.