Darway Healthcare And Rehabilitation Center
Inspection history, citations, penalties and survey trends for this long-term care facility in Forksville, Pennsylvania.
- Location
- 5865 Route 154, Forksville, Pennsylvania 18616
- CMS Provider Number
- 395909
- Inspections on file
- 20
- Latest survey
- April 25, 2026
- Citations (last 12 mo.)
- 6
Citation history
Health deficiencies cited at Darway Healthcare And Rehabilitation Center during CMS and state inspections, most recent first.
The facility failed to ensure that all staff received required abuse prevention and reporting training after a confirmed abuse incident involving a resident with dementia, bipolar disorder, anxiety disorder, and impulse disorder who was resistant to care and appeared anxious when approached. Following an event in which a nurse aide verbally abused and struck this resident during incontinence care, the facility initiated whole-house education on abuse and staff reporting responsibilities. Review of in-service records and interviews with the NHA and DON showed that one activities aide hired before the incident, and still working with residents, had no documented completion of these abuse-related trainings, contrary to facility policy requiring ongoing abuse education for all staff.
A facility failed to maintain a medication error rate below five percent, resulting in a 9.68 percent error rate. An LPN crushed medications that should not be crushed for a resident with Parkinson's disease, and another LPN allowed a resident to improperly self-administer Flonase nasal spray without documented approval. The Director of Nursing confirmed these findings.
A facility failed to notify a physician in a timely manner about a resident's declining condition after a fall. The resident, who initially had a bruise on her knee, later showed signs of swelling and bruising on her right arm and hand, and experienced significant pain. Despite these changes, the physician was not informed until several days later, delaying necessary medical intervention. An x-ray eventually revealed a fracture, prompting further action.
A facility failed to follow its bowel protocol for a resident diagnosed with constipation. Despite having physician orders to administer specific medications if no bowel movement occurred within a set timeframe, the staff did not offer or document the administration of these medications over several days. This was confirmed by the DON, indicating a lapse in providing the highest practicable care.
The facility failed to develop and implement individualized person-centered care plans for two residents diagnosed with dementia. Despite assessments confirming their diagnoses, no care plans addressing dementia and cognitive loss were created or implemented. The absence of documentation was confirmed by the Nursing Home Administrator and DON.
A facility failed to ensure a consultant pharmacist reported a medication irregularity for a resident prescribed Latuda without a schizophrenia diagnosis. The resident continued receiving the medication for major depressive disorder, despite a recommendation for dose reduction. The physician disagreed, citing the resident's history of aggressive behaviors. The deficiency was confirmed through record review and an interview with the DON.
A registered nurse worked seven shifts without a valid license, providing clinical care and assessments for two residents. Despite being notified of the license expiration, the RN continued to work until the license was renewed. The facility's management confirmed the RN's unlicensed work period.
Failure to Ensure All Staff Received Required Abuse Prevention Training After Confirmed Abuse Incident
Penalty
Summary
The deficiency involves the facility’s failure to fully implement its abuse prevention and reporting policies through required staff training following a substantiated abuse incident. Facility policy on abuse prevention requires training all staff on resolving conflicts, managing stress and emotions, and understanding and managing residents’ verbal or physical aggression, as well as providing information on abuse prevention, intervention, detection, and reporting requirements during orientation and ongoing training. After an incident in which a nurse aide verbally abused a resident and then smacked the resident on the back while attempting incontinence care, the facility initiated whole-house education on abuse and employee reporting responsibilities. However, review of in-service training records for the abuse-related trainings showed no evidence that one activities aide (Employee 2), who was hired before the incident and remained an active employee, completed these trainings. Resident 1, the victim in the original abuse incident, had diagnoses including dementia, bipolar disorder, anxiety disorder, and impulse disorder. Nursing documentation noted that the resident was resistant to care, pulled away, did not want to be touched, and appeared anxious and annoyed when staff approached, requiring two staff for shower care. The abuse incident was reported through the Event Reporting System, and the facility’s investigation confirmed the aide’s abusive behavior. Subsequent review of personnel training records and interviews with the Nursing Home Administrator and DON confirmed that Employee 2’s signature was absent from the abuse-related in-service training sign-in sheets, despite the expectation that all staff receive this education and despite Employee 2 continuing to work with residents after the incident.
Medication Administration Errors in LTC Facility
Penalty
Summary
The facility failed to maintain a medication error rate below five percent, resulting in a rate of 9.68 percent based on 31 medication opportunities with three errors. One incident involved an LPN who crushed Carbidopa/Levodopa and Effexor XR, both of which are medications that should not be crushed according to the facility's guidelines and the American Society of Consultant Pharmacists. This error occurred during a medication administration pass for a resident with Parkinson's disease symptoms, and the Director of Nursing confirmed the findings. Another incident involved an LPN allowing a resident to self-administer Flonase nasal spray without following proper administration procedures. The resident did not blow her nose or occlude the opposite nostril as recommended in the Flonase package insert. Additionally, there was no documented evidence that the resident was approved for self-administration of the nasal spray, despite a physician's order indicating that nursing staff should administer it. The Director of Nursing confirmed these findings as well.
Failure to Timely Notify Physician of Resident's Condition Change
Penalty
Summary
The facility failed to notify the physician of a resident's change in condition in a timely manner, which is a requirement for ensuring appropriate medical interventions. The deficiency involved a resident who was found on the floor with a bruise on her left knee on December 30, 2024, and the physician was notified at that time. However, subsequent changes in the resident's condition, including swelling and bruising of the right hand and arm, were not communicated to the physician until January 4, 2025, despite the resident experiencing pain and exhibiting signs of injury. The resident's condition continued to decline, with further documentation on January 6, 2025, noting pain, swelling, and bruising, and the resident's inability to use her right hand. An x-ray on January 7, 2025, revealed an acute comminuted fracture of the right humeral head, and the physician was notified again. The Director of Nursing confirmed the lack of documented evidence of timely physician notification regarding the resident's declining condition after the initial fall notification.
Failure to Follow Bowel Protocol for a Resident
Penalty
Summary
The facility failed to adhere to its bowel protocol medication administration for Resident 203, who was diagnosed with constipation. The facility's policy, last reviewed on October 21, 2024, required monitoring and documenting residents' bowel movements per shift and implementing a bowel management protocol if no bowel movement occurred by the ninth shift (72 hours). Despite these guidelines, the clinical records for Resident 203 showed no bowel movements from December 28, 2024, to January 5, 2025, and there was no evidence that the prescribed PRN medications were offered or refused by the resident. The physician orders for Resident 203 included administering Milk of Magnesia if no bowel movement occurred by the third day, followed by a Dulcolax suppository if there was no bowel movement within 24 hours after the Milk of Magnesia, and a Fleet's Enema if there was still no bowel movement by the end of the following shift. However, these orders were not followed, as confirmed by the Director of Nursing on January 9, 2025. This oversight resulted in a failure to provide the highest practicable care for Resident 203, as required by the facility's policies and procedures.
Failure to Implement Person-Centered Care Plans for Dementia
Penalty
Summary
The facility failed to develop and implement individualized person-centered care plans for two residents diagnosed with dementia. Resident 23 was admitted on July 31, 2018, and was diagnosed with dementia on May 23, 2024. Despite the diagnosis, a review of Resident 23's care plan revealed no indication that a person-centered care plan addressing dementia and cognitive loss was developed or implemented. The facility had assessed the resident's needs through the Minimum Data Set Assessment, but did not follow through with the necessary care planning. Similarly, Resident 47, admitted on July 5, 2023, with a diagnosis of Alzheimer's dementia, also lacked a person-centered care plan to address his cognitive loss. The facility's assessment through the MDS confirmed the diagnosis, yet no individualized care plan was created or implemented. The Nursing Home Administrator and Director of Nursing confirmed the absence of documentation for individualized care plans for both residents during a review on January 9, 2025.
Failure to Report Medication Irregularity for Antipsychotic Use
Penalty
Summary
The facility failed to ensure that the consultant pharmacist identified and reported a medication irregularity for a resident who was receiving Latuda, an antipsychotic medication. The resident was admitted without a schizophrenia diagnosis, yet was prescribed Latuda 40 mg daily for schizophrenia. Later, the medication was continued for major depressive disorder. The consultant pharmacist recommended a gradual dose reduction or trial discontinuation of Latuda, but the physician disagreed, citing the resident's history of aggressive behaviors and mood stability. The deficiency was confirmed through a clinical record review and an interview with the Director of Nursing. The review of the resident's behavior tracking showed aggressive behaviors on three days in November, but none in December. Despite these observations, the facility did not ensure that the consultant pharmacist reported the lack of a clinical indication for the continued use of Latuda, as required by their policies and procedures.
Unlicensed RN Worked Shifts and Provided Care
Penalty
Summary
The facility failed to ensure that professional staff were licensed, certified, or registered in accordance with state laws, specifically concerning a registered nurse, referred to as Employee 4. Employee 4's registered nurse license expired and was not renewed for a period during which the employee continued to work. Despite being notified by human resources about the expiration, Employee 4 worked seven shifts without a valid license. During this time, Employee 4 provided clinical care and assessments for two residents, documenting nursing care for one resident and conducting a skilled nursing assessment for another. The Nursing Home Administrator and Director of Nursing confirmed that Employee 4 worked these shifts without a valid license until the renewal was completed.
Latest citations in Pennsylvania
Failure to provide and document respiratory care: A resident with a trach had no documented evidence of respiratory rate, depth, and quality being monitored each shift and as needed, despite oxygen orders and trach care needs. Other residents with CPAP, nebulizer, and oxygen therapy had respiratory equipment left out of required storage, missing CPAP settings and care details in orders and care plans, and MAR entries signed by nursing staff even when respiratory staff reportedly completed the equipment changes.
Failure to Coordinate Hospice Services in Care Plans: The facility failed to coordinate hospice services with facility services for three residents receiving hospice care. One resident’s care plan did not include hospice needs despite hospice enrollment, and two residents’ comprehensive care plans lacked hospice agency contact information and access to the hospice 24-hour on-call system. The RNAC confirmed the omissions during interview; the residents had diagnoses including HTN, heart failure, kidney disease, diabetes, hypokalemia, and vitamin D deficiency.
Cross contamination occurred during a dressing change when an LPN placed a resident’s foot directly on the wheelchair seat without a barrier and did not clean the bedside table after the procedure. The facility also lacked infection surveillance documentation for several months, and its Legionella water management plan was incomplete, with no mapping of high-risk areas, no temperature logs, and no documented preventive measures for unused areas.
Failure to implement an antibiotic stewardship program. The facility’s infection control policy stated that antibiotic use protocols and a system to monitor antibiotic use would be part of the infection control program, but the Infection Control Program lacked documented evidence of antibiotic monitoring or review of appropriate antibiotic use for 3 months. The RN IP stated she had taken over the program, was also supervising the building, and had not been able to complete the program work or review the binders; administration confirmed the lapse.
Failure to Use Resident’s Preferred Name: A resident with HTN, anxiety, and depression had a preferred name documented in the care plan and MDS, but the name tag at the room entrance did not reflect that preference. When staff greeted the resident using the name on the door, the resident stated she did not like being called that and gave her preferred name. Staff interviews confirmed the preferred name was not listed at the door, and the ADON and DON acknowledged the omission.
A resident's confidential medical information was left visible on the East med cart computer screen at the nurses station when the cart was unattended. An RN confirmed the observation and acknowledged that resident personal and clinical information was exposed to anyone passing by.
The facility failed to provide written bed-hold policy notice to two residents or their representatives during hospital transfers. One resident had HTN, kidney disease, and hypokalemia, and another had hyperlipidemia, CHF, and a right femur fracture; records showed hospital transfers, but no documentation that the required bed-hold information was given at the time of transfer.
Failure to monitor weight and individualize nutrition care plans: one resident did not have a required monthly weight recorded, despite facility policy requiring monthly weights by the 7th day of each month, and two residents had care plans that did not reflect their specific nutritional needs. One resident had dx including HTN, PVD, and a thyroid disorder with orders for a renal diet, mechanical soft texture, and Magic Cup BID, while another resident had documented significant wt loss, a regular lactose-free diet, and nutritional juice with meals. Staff confirmed the missing weight and the lack of individualized care plan interventions.
Unlocked treatment cart and improper medication storage were observed in multiple areas. An unlocked, unattended treatment cart was found in a hallway, and the East Medication Room contained personal items mixed with medication supplies. Opened Tubersol vials in two refrigerators and multiple opened meds in the A Hall and C Hall medication carts were not dated, and an LPN confirmed several of the findings.
Failure to Maintain a Qualified Infection Preventionist: The facility did not maintain a consistent qualified onsite IP responsible for infection prevention and control for one month after the former IP resigned. An RN assumed the role while also supervising the building, reported limited time to perform the duties, and could not produce a certificate for completion of the Nursing Home Infection Preventionist Training Course.
Failure to Provide and Document Respiratory Care
Penalty
Summary
The facility failed to ensure appropriate respiratory care was provided and documented for residents with tracheostomy, oxygen, CPAP, and nebulizer needs. Facility policy required respiratory treatments and equipment care to be based on physician orders, care plans, and diagnoses, and required documentation of services provided, including date, time, and the name and title of the person providing care. The respiratory therapy job description stated respiratory staff assumed primary responsibility for respiratory care modalities, conducted therapeutic procedures, maintained resident records, and documented patient care services. Resident R3 had diagnoses including traumatic brain injury and respiratory failure and had a physician order for oxygen at 10 liters per minute continuously, titrated to maintain oxygen saturation above 90%. The resident’s MDS indicated tracheostomy care was required. During observation, R3 was receiving oxygen via face mask to the trach and pulse and oxygen saturation were being monitored. However, review of the clinical record failed to show evidence that the resident’s respiratory rate, depth, and quality were monitored and documented each shift and as needed. Staff interviews confirmed that nurses were responsible for reviewing care plans, monitoring respiratory status, and documenting changes, and that the facility failed to document and monitor R3’s respiratory rate, depth, and quality each shift and as needed. Resident R67 had obstructive sleep apnea, heart failure, and diabetes, with an order for CPAP at hour of sleep at home settings. The order did not include the setting or any care for the CPAP machine, and the care plan also did not include the CPAP settings or care needed for the machine. During observation, the resident’s CPAP mask was sitting on top of the bedside stand and was not stored in a bag as required. Resident R69 had emphysema and was ordered albuterol nebulizer treatments four times a day, but during observation the handheld nebulizer was sitting on top of the machine and not stored in a bag as required. Resident R11 and Resident R32 both had oxygen therapy orders requiring nasal cannula changes every two weeks, but the MAR showed changes documented by nursing staff while interviews confirmed respiratory staff actually performed the changes and that staff signed off even when they had not personally completed the task. The interviews also reflected confusion about who was responsible for the equipment changes and documentation.
Failure to Coordinate Hospice Services in Care Plans
Penalty
Summary
The facility failed to ensure coordination of hospice services with facility services to meet the end-of-life care needs of three residents. Review of the facility’s hospice policy showed that coordinated care plans for residents receiving hospice services were to include the most recent hospice plan of care and the care and services provided by the facility. For Resident R9, the record showed admission to hospice with a diagnosis of hypertensive heart disease, and the MDS indicated hospice care was received while a resident; however, the current care plan did not include a hospice care plan. During interview, the RNAC confirmed the facility failed to implement a care plan for Resident R9’s hospice needs. For Resident R24 and Resident R78, the records showed physician orders to admit each resident to hospice services. Their current comprehensive care plans did not include coordination details for hospice services, including contact information for the hospice agency or how to access the hospice’s 24-hour on-call system. During interview, the RNAC confirmed the facility failed to include this information in the plan of care and failed to ensure coordination of hospice services with facility services for these residents. Resident R24’s diagnoses included high blood pressure, kidney disease, and hypokalemia, and Resident R78’s diagnoses included high blood pressure, kidney disease, and vitamin D deficiency.
Cross Contamination During Dressing Change and Infection Control Program Deficiencies
Penalty
Summary
Cross contamination occurred during a dressing change for Resident R24. The resident was admitted to the facility and had diagnoses including peripheral vascular disease and diabetes. A physician order dated 4/27/26 directed the right lateral foot to be cleansed with normal saline, patted dry, treated with Santyl ointment, and covered with a dry dressing daily and as needed. During observation of the dressing change on 5/5/26, the LPN prepared a clean area on the resident’s over-bed table with a barrier and supplies, cleansed the foot, then placed the resident’s right foot directly on the wheelchair seat without placing a barrier before applying the ointment and dressing. After the dressing was completed, the LPN gathered and discarded supplies, removed the barrier from the over-bed table, and exited the room. During interview, the LPN confirmed that a clean barrier had not been placed on the wheelchair seat before the resident’s foot was placed there and confirmed that the bedside table was not cleaned after the supplies and barrier were removed. The LPN also confirmed the failure to prevent cross contamination during the dressing change. The facility also failed to maintain infection control surveillance for three months, as the infection control documentation did not show tracking of resident infections for February 2026, March 2026, and April 2026. When asked about the surveillance system, the RN who had taken over the program stated she had not done anything since taking over on 4/4/26 and had not looked at the infection control binders. The NHA confirmed the facility failed to implement an infection control program that included a system of surveillance to identify possible communicable diseases or infections for those months. In addition, the facility’s Legionella water management plan lacked mapping of high-opportunity areas, water temperature logs, and evidence of preventive measures for areas not in use, and staff could not provide logs or explain required temperatures during interviews.
Failure to Implement Antibiotic Stewardship Program
Penalty
Summary
The facility failed to implement an antibiotic stewardship program for 3 of 10 months, specifically February 2026, March 2026, and April 2026. The facility’s Infection Control Plan, Program and Committee policy, last reviewed on 1/6/26, stated that an antibiotic stewardship program would be part of the overall infection control program and that antibiotic use protocols and a system to monitor antibiotic use would be implemented. However, review of the Infection Control Program for February 2026, March 2026, and April 2026 found no documented evidence that antibiotic monitoring or review of appropriate antibiotic use was completed. During a telephonic interview on 5/6/26, the RN infection preventionist stated she took over the Infection Control program on 4/4/26, was also supervising the building, had only been looking at records for reportable issues, had not been able to do the program since starting, and had not seen the binders. Nursing home administration confirmed during an interview on 5/6/26 that the facility failed to implement an antibiotic stewardship program for those 3 months.
Failure to Use Resident’s Preferred Name
Penalty
Summary
The facility failed to treat a resident with respect by not addressing the resident by the preferred name. Review of the resident’s care plan showed the name the resident preferred to be called, and the MDS also documented that preferred name. The resident had diagnoses of high blood pressure, anxiety, and depression. During an observation and interview, the resident’s name tag at the entrance of the room did not show the preferred name, and when the resident was greeted using the name listed on the door, the resident stated she did not like being called that and stated the preferred name. Staff interviews confirmed that residents are asked about name preferences on admission and that preferred nicknames are included in the care plan, but the Activities Director was unsure who was responsible for ensuring the preferred name was listed at the door. A nurse aide stated nurses are usually responsible for placing the name tag at the entrance of the door, though aides sometimes do it. Subsequent observations confirmed the preferred name was still not listed on the door, and the ADON and DON both confirmed that the resident’s preferred name choice was not listed at the entrance of the door.
Failure to Protect Confidential Resident Information
Penalty
Summary
The facility failed to maintain the confidentiality of a resident's medical information on the East Medication Cart. Facility policy titled Quality of Life - Dignity, dated 1/6/26, stated that staff shall maintain an environment in which confidential clinical information is protected. During an observation on 5/4/26 at 11:38 a.m., the East Medication Cart at the nurses station was left unattended with the computer screen open, and identifiable resident personal and confidential information was visible to anyone passing by. During an interview at the same time, RN Employee E9 confirmed the observation and acknowledged that the facility failed to maintain the confidentiality of residents' medical information.
Failure to Notify Residents of Bed-Hold Policy During Hospital Transfers
Penalty
Summary
The facility failed to notify the resident or the resident’s representative of its bed-hold policy for two hospital transfers. Facility policy stated that at the time of transfer for hospitalization or therapeutic leave, the facility would provide written notice explaining the duration of the bed-hold policy and information about the resident’s return to the next available bed, and that in an emergency transfer the notice would be provided within 24 hours. For Resident R24, who had diagnoses including high blood pressure, kidney disease, and hypokalemia, the record showed a hospital transfer on 3/31/26 and return on 4/5/26, but there was no documented evidence that written bed-hold information was provided at the time of transfer. For Closed Resident Record CR87, the record showed diagnoses including hyperlipidemia, congestive heart failure, and a right femur fracture. On 2/6/26, staff received venous doppler results indicating a nonocclusive thrombus in the right common femoral vein, relayed the results to the CRNP, and obtained orders to increase Eliquis temporarily and repeat an ultrasound. After the resident’s daughter called and staff reported the situation to the CRNP, the resident was sent to the hospital around 5:50 p.m. The emergency room transfer form and the clinical record did not include documented evidence that CR87 or the representative were provided written information about the facility’s bed-hold policy at the time of transfer.
Failure to Monitor Weight and Individualize Nutrition Care Plans
Penalty
Summary
The facility failed to properly monitor weight and nutrition status for two residents. For one resident, no monthly weight was recorded for April 2026, even though the facility policy required monthly weights to be obtained by the 7th day of each month and documented in the electronic medical record. That resident’s record showed diagnoses of high blood pressure, PVD, and a thyroid disorder, and the physician had ordered a renal diet, mechanical soft ground meat texture with a low fat diet for low protein, and Magic Cup twice daily for additional nutrition. A nurse aide confirmed that the monthly weight was not obtained. The facility also failed to individualize care plans to address resident-specific nutritional concerns for two residents. For one resident, the care plan identified potential nutritional problems related to dysphagia and the need for a mechanically altered and therapeutic diet, but it did not include resident-specific interventions for the ordered renal diet, mechanical soft diet, or supplements. For the second resident, the MDS indicated a 5% or greater weight loss in the last month or 10% or greater in 6 months, and the resident was not on a physician-prescribed weight loss regimen. That resident had orders for a regular lactose-free diet and nutritional juice with meals, but the care plan only included a general intervention to serve the diet as ordered and did not address the weight loss or the ordered diet and supplement needs. An RNAC confirmed the care plans were not individualized for these nutritional concerns.
Unlocked Treatment Cart and Improper Medication Storage
Penalty
Summary
The facility failed to properly secure a treatment cart while it was not in use and failed to properly store medications in the East Medication Room, the A Hall Medication Cart, and the C Hall Medication Cart. Facility policies reviewed indicated medication carts are to be kept closed and locked when out of sight of the medication nurse, and compartments containing drugs and biologicals are to be locked when not in use. The policy also stated that when opening a multi-dose container, the date opened shall be recorded on the container. During an observation on the East side, the treatment cart was found in the hallway near a room, unlocked and unattended. An LPN confirmed the cart had been left unlocked and unattended. In the East Medication Room, surveyors observed personal items and clothing stored with medication-related supplies, including cups, a tote bag, sweaters, pants, blankets, wheelchair cushions, and leg rest bags. The East first hall and second hall refrigerators each contained two opened vials of Tubersol solution that were not labeled with a date. In the A Hall Medication Cart, surveyors observed opened Nystatin liquid, Latanoprost eye drops, and a Trelegy Ellipta inhaler that were not dated, along with a coffee cup, pastry, sliced red peppers, and a personal cell phone in the cart compartment; an LPN confirmed the items belonged to her. In the C Hall Medication Cart, surveyors observed opened Robitussin cough suppressant, Milk of Magnesia, Miralax powder, and lactulose liquid that were not labeled with a date, and an LPN confirmed the findings.
Failure to Maintain a Qualified Infection Preventionist
Penalty
Summary
The facility failed to designate a consistent qualified individual onsite who was responsible for implementing programs and activities to prevent and control infections for one of 10 months, identified as April 2026. The facility’s Infection Control Plan, Program and Committee policy, last reviewed on 1/6/26, stated that the designated Infection Preventionist is responsible for oversight of the infection control program and serves as a consultant to staff on infectious diseases, resident room placement, isolation precautions, staff and resident exposures, and surveillance and epidemiological investigations. During interviews, Human Resource staff stated that the former Infection Preventionist resigned, with the last day of employment on 4/4/26. A Registered Nurse who took over the infection control program stated she assumed the role on 4/4/26, was also supervising the building, looked at records to see if any were reportable, and had not been able to fully do the work since starting, estimating about 12 hours per week. She also stated that her infection control training and certification had been completed long ago and she would need to find it. Review of the facility-provided certification courses showed training completed in 2022, but there was no certificate for completion of the Nursing Home Infection Preventionist Training Course. Nursing Home Administration confirmed the facility failed to designate a consistent qualified individual onsite responsible for infection prevention and control during that month.
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