Inspection visit
Inspection
13 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 13 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0554
Allow residents to self-administer drugs if determined clinically appropriate.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, clinical record review, policy review, and staff interview, it was determined that the
facility failed to ensure residents are assessed for medication self-administration for one of three residents
reviewed for medication administration (Resident 74).
Residents Affected - Few
Findings include:
Review of facility pharmacy policy titled, 2.1 Self Administering Medications, revealed in section, Procedure,
stated, Facility should comply with Facility policy, Applicable Law and the State Operations Manual with
respect to resident Self-Administration of Medications .Facility, in conjunction with the Interdisciplinary Care
Team, should assess and determine, with respect to each resident, whether Self-Administration of
medications is safe and appropriate .
Review of Resident 74's clinical record on October 4, 2023, at approximately 8:50 AM, revealed diagnoses
that included hypertension (elevated/high blood pressure) and osteoarthritis (degenerative joint disease,
which is characterized by the breakdown of soft tissue in the joints).
During medication observations on October 3, 2023, at approximately 8:31 AM, Employee 1 was observed
preparing medications for Resident 74. Employee 1 was observed preparing 10 separate medications for
administration. Shortly after placing the medicines in a medicine cup, Employee 1 was observed leaving the
medicine cup with medicines on the Resident's bedside table and exiting the room.
Review of Resident 74's clinical record revealed no physician order for medication self-administration, no
assessment for medication self-administration, and no care plan for medication self-administration.
During a staff interview on October 5, 2023, at approximately 12:00 PM, Nursing Home Administrator
(NHA) confirmed Resident 74 did not have an assessment for medication self-administration; adding that
the NHA felt Resident 74 was functionally and cognitively safe to self-administer medications.
28 Pa code 211.10(c) Resident care policies
28 Pa code 211.12(d)(1)(5) Nursing services
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 10
Event ID:
396133
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
396133
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/05/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vibra Rehabilitation Center
707 Sheperdstown Rd
Mechanicsburg, PA 17055
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 0582
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a
review of facility documentation, clinical record review, and staff interview, it was determined the facility
failed to timely issue the Skilled Nursing Facility Advanced Beneficiary Notice form (SNF ABN CMS-10055),
and a Notice of Medicare Non-Coverage form published by the Centers for Medicare and Medicaid
Services (NOMNC CMS-10123), for one of three residents reviewed (Resident 77).
Residents Affected - Few
Findings include:
Review of Resident 77's clinical record documented the Resident was admitted to the facility on [DATE].
Review of the Beneficiary Protection Notification Review Form revealed the facility failed to provide the
Resident and/or Resident Representative the required Skilled Nursing Facility Advance Beneficiary Notice
of Non-coverage (SNF-ABN) form that details the cost of care and services no longer covered under
Medicare beginning June 21, 2023.
Review of the Notice of Medicare Non-Coverage form published by the Centers for Medicare and Medicaid
Services (NOMNC CMS-10123), which provides residents/resident representatives an opportunity to
appeal the decision of Medicare Part A non-coverage, indicated Resident 77's last date of coverage was
June 20, 2023.
Review of Resident 77's NOMNC CMS-10123 form indicated the Resident/Resident Representative was
not notified of the last day of Medicare Part A coverage until June 19, 2023.
During an interview on October 4, 2023, at 10:45 AM, the Nursing Home Administrator confirmed the
facility failed to timely issue the Skilled Nursing Facility Advanced Beneficiary Notice form (SNF ABN
CMS-20055) and a Notice of Medicare Non-Coverage form (NOMNC CMS-10123).
28 Pa. Code 201.14 (a) Responsibility of licensee
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396133
If continuation sheet
Page 2 of 10
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
396133
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/05/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vibra Rehabilitation Center
707 Sheperdstown Rd
Mechanicsburg, PA 17055
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 0637
Assess the resident when there is a significant change in condition
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 conduct a
comprehensive assessment after a significant change in health status for one of nine residents reviewed
(Resident 2).
Residents Affected - Few
Findings include:
Review of Resident 2's clinical record on October 2, 2023, at approximately 11:00 AM, revealed diagnoses
that included diabetes mellitus type II (decreased ability of the body to utilize insulin for the transport of
glucose from the blood stream into the cells for nourishment) and hypertension (elevated/high blood
pressure).
Review of Resident 2's clinical record revealed Resident 2 had a Quarterly Minimum Data Set Assessment
(MDS - assessment tool utilized to identify a resident's physical, mental, and psychosocial needs) with an
assessment reference date of September 3, 2023.
Review of the Quarterly MDS revealed section H. Bladder and Bowel was assessed as not having an
indwelling catheter; section M. Skin Conditions was assessed as having one stage II pressure ulcer; section
N. Medications was assessed as no antibiotic use; and section O. Special Treatments and Programs was
assessed as no intravenous (IV) medication use.
Review of Resident 2's clinical record revealed that, after the September 3, 2023, Quarterly MDS, Resident
2's pressure ulcer increased in severity to a stage IV pressure injury, as assessed by the consultant wound
provided on September 12, 2023. Resident 2 also developed an infection of the bone, which resulted in an
order for an IV antibiotic, ordered on September 20, 2023, and to last until October 26, 2023. Finally,
Resident 2 had a foley catheter (internal urinary catheter used to facilitate bladder emptying) inserted on
October 3, 2023.
The aforementioned changes in Resident 2's health status represent significant changes in Resident 2's
health status in four areas assessed in the MDS: section H. Bladder and Bowel, section M. Skin Conditions,
section N. Medications, and section O. Special Treatments.
Review of Resident 2's clinical record on October 3, 2023, at approximately 12:00 PM, revealed that no
Significant Change MDS had been conducted nor started as of October 3, 2023.
During a staff interview on October 5, 2023, at approximately 12:00 PM, Nursing Home Administrator
confirm that Resident 2 had a significant change in health status and that a Significant Change MDS
should have been started as a result.
28 Pa code 211.12(d)(1)(3)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396133
If continuation sheet
Page 3 of 10
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
396133
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/05/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vibra Rehabilitation Center
707 Sheperdstown Rd
Mechanicsburg, PA 17055
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 0641
Ensure each resident receives an accurate assessment.
Level of Harm - Minimal harm
or potential for actual harm
Based on clinical record review and staff interview, it was determined that the faciliy failed to ensure
accuracy of the resident assessment for one of nine residents reviewed (Resident 1).
Residents Affected - Few
Findings include:
Review of Resident 1's clinical record on October 3, 2023, at approximately 10:00 AM, revealed diagnoses
that included senile degeneration of the brain (a decrease in cognitive abilities or mental decline),
unspecified fracture of left femur (a break in the bone connecting the hip and knee), and periprosthetic
fracture around internal prosthetic left knee joint (a broken bone that occurs around the implant of a knee
replacement).
Review of Resident 1's admission Minimum Data Set (MDS - assessment tool utilized to identify a residents
physical, mental, and psychosocial needs) with an Assessment Reference Date of March 7, 2023, revealed
that Section J - Health Conditions, subsection J1700 - Fall History on Admission/Entry or Reentry, section
A was coded No, for Did the resident have a fall any time in the last month prior to admission/entry or
reentry?; section B was coded No, for Did the resident have a fall any time in the last 2-6 months prior to
admission/entry or reentry?; section C was coded No, for Did the resident have any fracture related to a fall
in the 6 months prior to admission/entry or reentry?; and Subsection J2300 - Major Joint Replacement, was
coded No, for Knee Replacement - partial or total.
Review of Resident 1's clinical record revealed Resident 1's medical history included a fall in January 2023,
which resulted in a fracture around the internal prosthetic left knee joint, and a fall in February 2023, which
resulted in a left hip fracture with surgical repair on February 23, 2023.
Review of Resident 1's Significant Change Minimum Data Set MDS with an Assessment Reference Date of
April 3, 2023, revealed that Section I - Active Diagnoses, subsection I2300 - Urinary tract infection
(UTI)(Last 30 Days), was coded No, and section I4800 - Non-Alzheimer's Dementia was coded No.
Review of Resident 1's clinical record revealed Resident 1 was diagnosed with a urinary tract infection on
March 3, 2023, and treated with antibiotics until March 14, 2023. Further review of Resident 1's record
revealed she was admitted to Hospice services on March 22, 2023, with a diagnosis of Terminal Senile
Degeneration of the Brain.
An interview with the Nursing Home Administrator on October 4, 2023 at 2:00 PM, revealed it was the
facility's expectation that the Resident's assessment would be coded correctly.
28 Pa code 211.12(d)(1)(3)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396133
If continuation sheet
Page 4 of 10
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
396133
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/05/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vibra Rehabilitation Center
707 Sheperdstown Rd
Mechanicsburg, PA 17055
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 0655
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being
admitted
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
clinical record review and staff interview, it was determined that the facility failed to ensure a baseline care
plan was developed and implemented for one of nine residents reviewed (Resident 121).
Findings include:
Review of Resident 121's clinical record on October 2, 2023, at approximately 11:50 AM, revealed
diagnoses that included hypothyroidism (condition in which the body does not produce adequate hormones
via the thyroid gland) and depression (prolonged feelings of sadness and depressed mood that is
characterized by changes in appetite, decrease enjoyment of activities, and possible difficulties performing
day to day tasks).
Review of Resident 121's clinical record revealed that Resident 121 was admitted to the facility on [DATE].
Review of Resident 121's comprehensive plan of care revealed that areas designated for staff to specify
individualized information for Resident 121 were not completed by staff. Areas left incomplete included
Resident 121's assistance needs and number of staff required for assistance with Activities of Daily Living,
ambulation status and assistive devices; Resident 121's risk level for falls; areas at risk for skin breakdown;
psychotropic medication including anti-depressants, anti-psychotic, and anti-anxiety medications.
During a staff interview on October 5, 2023, at approximately 12:15 PM, Nursing Home Administrator
revealed the facility had no further information to provide regarding the completion of the comprehensive
plan of care for Resident 121.
28 Pa code 211.12(d)(1)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396133
If continuation sheet
Page 5 of 10
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
396133
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/05/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vibra Rehabilitation Center
707 Sheperdstown Rd
Mechanicsburg, PA 17055
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 0656
Level of Harm - Minimal harm
or potential for actual harm
Develop and implement a complete care plan that meets all the resident's needs, with timetables and
actions that can be measured.
Based on observation, staff interviews, and record review, the facility failed to develop a person-centered
care plan for two of 14 residents reviewed (Residents 1 and 71).
Residents Affected - Some
Findings include:
Review of Resident 1's clinical record on October 3, 2023, at approximately 1:20 PM, revealed diagnoses
that included senile degeneration of the brain (a decrease in cognitive abilities or mental decline) and
chronic kidney disease (CKD - gradual loss of kidney function over time).
Review of Resident 1's physician orders revealed an order for insertion of a foley catheter due to urine
retention, written on May 8, 2023.
Review of Resident 1's comprehensive plan of care revealed Resident 1 did not have a care plan developed
or implemented that addressed the foley catheter.
During an interview with the Director of Nursing (DON) and Nursing Home Administrator on October 4,
2023, at approximately 1:50 PM, it was revealed that it was the facility's expectation that Resident 1's
comprehensive plan of care would include the foley catheter.
A review of the clinical record on October 3, 2023, for Resident 71 revealed diagnoses that included right
fractured ankle (broken ankle bone) and cerebral vascular accident (stroke).
Observation of Resident 71 on October 2, 2023, revealed the Resident sitting in her wheelchair in her
room.
A review of Resident 71's physician orders dated September 16, 2023, revealed the Resident wa
non-weight bearing right lower extremity ankle, meaning she may not stand on her right leg.
A review of the Resident 71's care plan and interventions on October 3, 2023, failed to reveal a care plan
for the non-weight bearing status of her right ankle.
During an interview with the DON on October 4, 2023, at approximately 11:00 AM, the DON stated the
Resident is care planned for mechanical lift transfers.
On October 4, 2023, the facility revised Resident 71's care plan to include the non-weight bearing status of
the right ankle, and agreed that it should have been on the care plan when the orders were written.
28 Pa. Code 211.12(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396133
If continuation sheet
Page 6 of 10
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
396133
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/05/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vibra Rehabilitation Center
707 Sheperdstown Rd
Mechanicsburg, PA 17055
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 0690
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate
catheter care, and appropriate care to prevent urinary tract infections.
Based on observation, staff interviews, and record review, it was determined that the facility failed to
provide appropriate urinary catheter (tubing inserted into the bladder to drain urine into a bag) care for one
of 11 residents reviewed (Resident 75).
Findings include:
Review of Resident 75's clinical record on October 3, 2023, revealed Resident 75 had diagnoses that
included urinary retention (unable to empty bladder completely during urination) and benign prostate
hyperplasia (BPH -age-associated prostate gland enlargement that can cause urinary difficulty).
Review of physician orders dated October 2023, identified that Resident 75 had an indwelling urinary
catheter in place per physician orders
Observation of Resident 75 on October 2, 2023, at 12:23 PM, revealed Resident 75's catheter bag and
tubing dragging on the floor as he was mobile in his wheelchair, both in his room and in the hall.
During an interview with the Employee 2 (Assistant Director of Nursing) on October 2, 2023, at 12:25 PM,
she observed Resident 75's foley catheter bag and tubing dragging on the floor, and agreed it should never
touch the floor.
During an interview with the Director of Nursing (DON) on October 4, 2023, at 10:45 AM, the DON
confirmed the catheter bag and tubing should never be touching the floor.
28 Pa. Code 211.12(d)(1)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396133
If continuation sheet
Page 7 of 10
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
396133
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/05/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vibra Rehabilitation Center
707 Sheperdstown Rd
Mechanicsburg, PA 17055
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 0697
Provide safe, appropriate pain management for a resident who requires such services.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, clinical record review, and staff interviews, it was determined that the facility failed to
ensure pain management was provided per order for one of nine residents reviewed (Resident 2).
Residents Affected - Few
Findings include:
Review of Resident 2's clinical record on October 2, 2023, at approximately 11:00 AM, revealed diagnoses
that included diabetes mellitus type II (decreased ability of the body to utilize insulin for the transport of
glucose from the blood stream into the cells for nourishment) and hypertension (elevated/high blood
pressure).
Review of Resident 2's physician's orders revealed an order for hydrocodone-acetaminophen (combination
narcotic medication used to treat pain) 5-325 milligrams (mg - metric unit of measure) give one tablet by
mouth every 24 hours as needed for pain, give one half hour prior to dressing change, which was dated
September 29, 2023; and Hydrocodone-acetaminophen 5-325 mg give one tablet by mouth two times a day
for severe pain, which was dated September 26, 2023.
Review of Resident 2's hydrocodone-acetaminophen narcotic controlled substance count sheets (required
documentation tool utilized to track the administration amount and time of controlled substances) revealed
that on October 3, 2023, no evening dose was provided to Resident 2.
Observation of Resident 2's wound dressing change on October 5, 2023, completed by Employee 2, at
approximately 11:40 AM, revealed Resident 2 was experiencing signs of pain during the dressing change
as evidenced by facial grimacing and moaning with movement and dressing removal and placement.
Directly after the wound dressing change, a staff interview with Employee 2 revealed that Employee 2
assumed the medication nurse had provided the pain medication prior to the dressing change.
Review of Resident 2's narcotic controlled substance count sheets and Resident 2's October Medication
Administration Record on October 5, 2023, at approximately 11:50 AM, revealed staff did not document
providing the as needed pain medication prior to the dressing change, nor was the medication provided
prior to dressing changes on October 1 through 4, 2023.
During a staff interview with the Nursing Home Administrator and Director of Nursing on October 5, 2023,
at approximately 12:30 PM, it was revealed that Resident 2 was not provided pain medications as
prescribed.
28 Pa code 211.12(d)(1)(5) Nursing Services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396133
If continuation sheet
Page 8 of 10
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
396133
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/05/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vibra Rehabilitation Center
707 Sheperdstown Rd
Mechanicsburg, PA 17055
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 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, facility policy review, and staff interviews, it was determined that the facility failed to
ensure infection prevention strategies were implemented for one of two medication carts observed (300 hall
medication cart).
Residents Affected - Few
Findings include:
Review of facility policy, titled Glucometer Disinfection, last reviewed April 21, 2023, revealed the policy
stated, VibraLife shall provide guidelines for the disinfection of capillary-blood sampling devices to prevent
transmission of blood borne disease to residents and employees .The glucometers should be disinfected
with a wipe pre-saturated with an EPA registered healthcare disinfectant that is effective against HIV,
Hepatitis C and Hepatitis B virus .Glucometers should be cleaned and disinfected after each use and
according to manufacturer's instructions regardless of whether they are intended for single resident or
multiple resident use .
During general observations on October 3, 2023, at approximately 8:20 AM, Employee 11 was observed
exiting a resident room with a glucometer (hand held device used to test a small amount of blood for the
amount of glucose in the blood stream) in hand. Employee 11 was observed placing the glucometer on the
300 hall medication cart, at which time it was observed that a test strip (strip used to collect small amount
of blood) was still inserted into the glucometer.
At approximately 8:22 AM, Employee 11 was observed removing and discarding the test strip from the
glucometer, and then placing the glucometer in the medication cart drawer directly on top of unused lancet
devices (devices used to puncture the finger tip to produce blood for a glucose blood test). Employee 11 did
not cleanse the glucometer prior to storage in the 300 hall medication cart.
During a staff interview on October 5, 2023, at approximately 12:00 PM, Nursing Home Administrator
revealed that the glucometer should be cleansed appropriate after use and prior to storage.
28 Pa code 211.12(d)(1)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396133
If continuation sheet
Page 9 of 10
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
396133
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/05/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Vibra Rehabilitation Center
707 Sheperdstown Rd
Mechanicsburg, PA 17055
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 0947
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in
dementia care and abuse prevention.
Based on review of personnel records and staff interview, it was determined that the facility failed to
complete annual training on dementia management, behavioral health, and abuse for one of five nurse aide
personnel records reviewed (Employee 9), and the facility failed to complete annual training on abuse for
one of five nurse aide personnel records reviewed (Employee 10).
Findings include:
Review of Employee 9's (Nurse Aide) personnel record indicated a date of hire on August 10, 2021, and
that Employee 9 received the annual performance evaluation covering the period of July 31, 2022, through
August 10, 2023.
Review of the annual in-service documentation and personnel records did not include a training on
dementia management, behavioral management, or abuse for Employee 9.
Review of Employee 10's (Nurse Aide) personnel record indicated a date of hire on January 31, 2017, and
that Employee 10 received the annual performance evaluation covering the period of March 1, 2022,
through March 1, 2023.
Review of the annual in-service documentation and personnel records did not include a training on abuse
for Employee 10.
During an interview on October 4, 2023, at 10:40 AM, the Nursing Home Administrator confirmed the
facility failed to complete annual training on dementia management, behavioral health, and abuse for
Employee 9, and failed to complete abuse training for Employee 10, as required.
28 Pa Code 201.14(a) Responsibility of licensee
28 Pa. Code 201.18(1) Management
28 Pa. Code 201.20(a)Staff development
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396133
If continuation sheet
Page 10 of 10
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13 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.
F582 - The facility must—
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
F637 - Within 14 days after the facility determines, or should have determined,
Assess the resident when there is a significant change in condition
F641 - Accuracy of Assessments
Ensure each resident receives an accurate assessment.
F655 - Comprehensive Person-Centered Care Planning
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
F690 - Incontinence
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
F697 - Pain Management
Provide safe, appropriate pain management for a resident who requires such services.
F880 - Infection Control
Provide and implement an infection prevention and control program.
F947 - Training Requirements
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
F554 - The right to self-administer medications if the interdisciplinary team, as
Allow residents to self-administer drugs if determined clinically appropriate.
- 0161GeneralS&S Epotential for harm
Use approved construction type or materials.
- 0321GeneralS&S Epotential for harm
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
F923 - Have adequate outside ventilation by means of windows, or mechanical
Have proper medical gas storage and administration areas.
FAQ · About this visit
Common questions about this visit
What happened during the October 5, 2023 survey of Vibra Rehabilitation Center?
This was a inspection survey of Vibra Rehabilitation Center on October 5, 2023. The surveyor cited 13 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at Vibra Rehabilitation Center on October 5, 2023?
Yes, 13 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered."
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
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.