Pennsylvania Department of Health
HIGHLANDS REHABILITATION AND HEALTHCARE
Patient Care Inspection Results

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Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

HIGHLANDS REHABILITATION AND HEALTHCARE
Inspection Results For:

There are 142 surveys for this facility. Please select a date to view the survey results.

Surveys don't appear on this website until at least 41 days have elapsed since the exit date of the survey.


HIGHLANDS REHABILITATION AND HEALTHCARE - Inspection Results	Scope of Citation Number of Residents Affected By Deficient Practice

Initial comments:Findings of an Abbreviated Survey to review three Complaints, completed on July 13, 2026, at Highlands Rehabilitation and Healthcare, it was determined that there were no federal deficiencies, related to the reported complaint allegations under the requirements of 42 CFR Part 483, Subpart B, Requirements for Long Term Care as they relate to the Health portion of the survey process; however, the facility was not in compliance with 28 PA Code, Commonwealth of Pennsylvania Long Term Care Licensure Regulations.

Plan of Correction:

§ 211.12(f.1)(3) LICENSURE Nursing services. :

(3) Effective July 1, 2024, a minimum of 1 nurse aide per 10 residents during the day, 1 nurse aide per 11 residents during the evening, and 1 nurse aide per 15 residents overnight.

Plan of Correction - To be completed: 08/24/2026

1. Facility cannot retroactively correct nurse aide staffing ratio.

2. NHA/Designee will conduct an initial audit of the past two weeks' schedule to determine if nurse aide ratio is in compliance.

3. NHA/Designee will re-educate the scheduler on the proper nurse aide staffing ratios. The facility will hold labor meetings Monday-Friday to verify ratios are made.

4. NHA/Designee will conduct random audits of nurse aide staffing weekly for four weeks, then monthly for two months thereafter to verify proper nurse aide ratios. Results of audits will be reviewed by the Quality Assurance Performance Improvement Committee and changes will be made as necessary.

§ 211.12(f.1)(4) LICENSURE Nursing services. :

(4) Effective July 1, 2023, a minimum of 1 LPN per 25 residents during the day, 1 LPN per 30 residents during the evening, and 1 LPN per 40 residents overnight.

Plan of Correction - To be completed: 08/24/2026

1. Facility cannot retroactively correct LPN staffing ratio.

2. NHA/Designee will conduct an initial audit of the past two weeks schedule to determine if LPN ratio is in compliance.

3. NHA/Designee will re-educate the scheduler on the proper LPN staffing ratios. The facility will hold labor meetings Monday-Friday to verify ratios are made.

4. NHA/Designee will conduct random audits of LPN staffing weekly for four weeks, then monthly for two months thereafter to verify proper LPN ratios. Results of audits will be reviewed by the Quality Assurance Performance Improvement Committee and changes will be made as necessary.

§ 211.12(i)(2) LICENSURE Nursing services.:

(2) Effective July 1, 2024, the total number of hours of general nursing care provided in each 24-hour period shall, when totaled for the entire facility, be a minimum of 3.2 hours of direct resident care for each resident.

Observations: Based on a review of nursing staffing hours and staff interview, it was determined that the facility failed to ensure that the total of nursing care hours provided in each 24-hour period was a minimum of 3.2 hours per patient per day (PPD), effective July 1, 2024, for 16 of 21 days reviewed. Findings include: A review of nursing care hours provided by the facility dated March 21 through 27, 2026; May 23 through 29, 2026; and July 6 through 12, 2026; revealed that the facility failed to meet the minimum hours PPD for the following days: March 21, 2026, hours PPD 2.89 March 22, 2026, hours PPD 2.88 March 24, 2026, hours PPD 3.08 March 26, 2026, hours PPD 3.12 March 27, 2026, hours PPD 3.10 May 23, 2026, hours PPD 2.70 May 24, 2026, hours PPD 2.90 May 25, 2026, hours PPD 3.05 May 28, 2026, hours PPD 3.18 July 6, 2026, hours PPD 2.71 July 7, 2026, hours PPD 2.86 July 8, 2026, hours PPD 2.73 July 9, 2026, hours PPD 2.44 July 10, 2026, hours PPD 2.85 July 11, 2026, hours PPD 2.59 July 12, 2026, hours PPD 2.69 The surveyor confirmed the above staffing concerns during an interview with the Director of Nursing on July 13, 2026, at 4:00 PM.

Plan of Correction - To be completed: 08/24/2026

1. Facility cannot retroactively correct staffing PPD.

2. NHA/Designee will conduct an initial audit of the past two weeks' schedule to determine if PPD is in compliance.

3. NHA/Designee will re-educate the scheduler on the proper PPD. The facility will hold labor meetings Monday-Friday to verify PPD is made.

4. NHA/Designee will conduct random audits of facility PPD weekly for four weeks, then monthly for two months thereafter to verify proper PPD hours. Results of audits will be reviewed by the Quality Assurance Performance Improvement Committee and changes will be made as necessary.

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