Pennsylvania Department of Health
ROUSE- WARREN COUNTY HOME
Patient Care Inspection Results

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ROUSE- WARREN COUNTY HOME
Inspection Results For:

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ROUSE- WARREN COUNTY HOME - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:
Based on a State Licensure Monitoring survey on February 2, 2024, it was determined that Rouse-Warren County Home 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 there was no visual representation of the ownership structure 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

This Plan of correction constitutes our written allegation of compliance for the deficiencies cited. However, submission of the Plan of Correction is not an admission that a deficiency exists or that one was cited correctly. This Plan of correction is submitted to meet requirements established by state and federal law.
The original application submitted contained an organizational chart, however after further clarification from a Department of Health representative, a new visual representation of the ownership structure was created, and submitted to the instructed recipient via email.
Update:
The person responsible was educated on the new requirements, and a new diagram was created which showed a visual representation of the organizations ownership structure.

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