Garvey Manor

In the surveyor’s words

From the most serious findings on record at Garvey Manor, in the surveyor’s own words.

• Actual harm, isolatedF689Aug 1, 2024

  Based on a review of clinical records, as well as staff interviews, it was determined that the facility failed to assess a resident for safety in a chair after a known history of falls from the chair, resulting in a fall with fracture for one of 39 residents reviewed (Resident 2), and failed to follow fall prevention interventions for one of 39 residents reviewed (Resident 5) who had a history of falls. Findings include: The facility's policy regarding accidents and incidents, dated July 2, 2024, revealed that if a fall is involved the resident must be assessed by the professional (registered) nurse supervisor and additional assessment as appropriate. […]

• Actual harm, isolatedF600Oct 13, 2022

  Based on review of investigative reports and residents' clinical records, as well as staff interviews, it was determined that the facility failed to ensure that residents were free from neglect caused by a failure to follow a resident's care plan for assistance for one of two residents reviewed (Resident 1), resulting in a fall with fracture for the resident. Findings include: A quarterly Minimum Data Set (MDS) assessment (a mandatory assessment of a resident's abilities and care needs) for Resident 1, dated August 23, 2022, revealed diagnoses that included unsteadiness on her feet, gait abnormalities and osteoporosis, was understood and could understand, was cognitively intact, required a one-person physical assist for transfers and ambulation, was not steady without staff assistance, and… […]

• Actual harm, isolatedF689Oct 13, 2022

  Based on review of clinical records and facility investigation documents, as well as staff interviews, it was determined that the facility failed to provide assistance as required to prevent falls for one of two residents reviewed (Resident 1) who was a high risk for falls, resulting in a fall with a fractured pelvis. Findings include: A quarterly Minimum Data Set (MDS) assessment (a mandatory assessment of a resident's abilities and care needs) for Resident 1, dated August 23, 2022, revealed diagnoses that included unsteadiness on her feet, gait abnormalities and osteoporosis, was understood and could understand, was cognitively intact, required a one-person physical assist for transfers and ambulation, was not steady without staff assistance, and used a walker and a wheelchair. […]

• No harm, potential for more than minimal, patternF804Jul 24, 2025

  Based on review of facility policies and information provided by the facility, as well as observations and staff interviews, it was determined that the facility failed to serve food items at appetizing temperatures.Findings include:The facility's policy regarding food temperature records, dated June 20, 2025, revealed that the temperatures of foods shall be taken prior to service. Breakfast temperatures were checked by the cook in the kitchen to assure the food is at proper temperature. […]

• No harm, potential for more than minimal, patternF812Jul 24, 2025

  Based on review of policies, as well as observations and staff interviews, it was determined that the facility failed to store and prepare food in accordance with professional standards for food service safety by failing to ensure hair was properly covered with a hair restraint.Findings include:The facility's policy regarding dietary operations, dated June 20, 2025, revealed that hair and beard restraints would be worn while working in the kitchen.Observations in the facility's kitchen on July 21, 2025, at 9:24 a.m. revealed that Dietary Aide 10 was in the kitchen working and had uncovered facial hair. Interview with Dietary Director at that time confirmed that Dietary Aide 10 should be wearing a beard restraint. 28 Pa. Code 211.6(f) Dietary services