Pennsylvania Department of Health
FOXDALE VILLAGE
Patient Care Inspection Results

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FOXDALE VILLAGE
Inspection Results For:

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FOXDALE VILLAGE - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:
Based on a State Licensure Monitoring survey on February 5, 2024, it was determined that Foxdale Village was not in compliance with the following requirements of the 28 PA Code, Commonwealth of Pennsylvania Long Term Care Licensure Regulations.


 Plan of Correction:


§ 201.13c (b) LICENSURE License renewal:State only Deficiency.
(b) In addition to the application form and fee under subsection (a), a facility shall submit an updated annual financial report that meets the requirements set forth in § 201.12(b)(8) (relating to application for license of a new facility or change in ownership).
Observations:
Based on review of the facility submitted application for renewal of the license, it was determined that the facility failed to submit an annual financial report which shall include the following:

(i) Audited financial statements prepared in accordance with generally accepted accounting principles (GAAP). If GAAP requires consolidated financial statements, then consolidated statements shall be provided. (The GAAP indicates that the following is included in and audited financial statement: Balance Sheet, Cash Flow Statement, Income Statement, Statement of Shareholder Equity Changes and an auditor opinion)
(ii) A visual representation of the current ownership structure, which shall include parent companies, shareholders, and any related parties of the persons identified in paragraphs (1) through (6). (this would be an organizational chart rather than a list)
(iii) A supplemental schedule of annual gross revenues, prepared in accordance with GAAP. The supplemental schedule shall be broken out by payor type.

Findings:
Review of the submitted application revealed that the visual representation of organization structure and supplemental schedule of annual gross revenues by payer type was not contained in the application.

The facility failed to meet the requirements as set forth in 28 Pa Code 201.13c.



 Plan of Correction - To be completed: 02/12/2024

1)Foxdale will update the check list with newly required documents for the annual licensure renewal together for the organization to utilize prior to annual submission. Foxdale will review all documents prior to submission with the Nursing Home Administrator and Chief Financial Officer. All individuals involved in the annual renewal process will be re-education on the new Pennsylvania Long Term Care annual licensure renewal required documents.

2)Moving forward Foxdale will maintain all prior licensure renewal documents as examples of acceptable required documents in the Administrators office for future licensure renewals. NHA or designee will report on annual compliance during QAPI.

3)Foxdale will re-submit the required visual representation of organizational structure and submit additional documentation that supports the requirement of the supplemental schedule of annual gross revenues by payer type. All information will be sent via email to the Department by 2/12/24.


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