Emerald Nursing and Rehabilitation: Catheter Care Failures - PA
The inspection, completed May 1, 2026, cited the facility under a deficiency category covering appropriate care for residents who are continent or incontinent of bowel and bladder, proper catheter management, and prevention of urinary tract infections. The severity level assigned was H, meaning inspectors found not an isolated incident but a pattern, and not a theoretical risk but harm that had already occurred.
The facility has filed no plan of correction.
That last detail is not a formality. When a nursing home receives a deficiency citation, it is expected to submit a written plan describing what went wrong, what it will do differently, and when those changes will be in place. The plan is the facility's formal acknowledgment that something failed and a commitment to the people living there that it will not fail again. Emerald Nursing and Rehabilitation has not submitted one.
The deficiency was one of eight cited during the same inspection.
Catheter care is among the most consequential and measurable responsibilities a nursing home carries. Residents who require urinary catheters, whether short-term or long-term, are dependent on staff to manage those devices correctly. A catheter that is not maintained properly becomes a direct pathway for bacteria to enter the bladder. The infections that result, urinary tract infections, can progress rapidly in elderly residents, moving from discomfort and confusion to sepsis and death. In a population already weakened by age, chronic illness, and limited mobility, a UTI is not a minor inconvenience. It can be the event that ends a life or permanently diminishes what remains of it.
Incontinence care, the other component of this deficiency, carries its own weight. Residents who are incontinent depend entirely on staff to keep them clean, dry, and free from the skin breakdown that follows prolonged exposure to moisture and waste. When that care is inconsistent or delayed, residents develop pressure injuries, infections, and the particular humiliation of lying in their own waste while waiting for someone to come.
Inspectors assigned a scope and severity level of H to what they found at Emerald. The CMS severity scale runs from A through L. Level H sits in the middle tier, above the levels that indicate no actual harm and below the levels that indicate immediate jeopardy to life. What it means, precisely, is that inspectors observed the same problem happening more than once, across more than one resident, and that those residents were actually hurt.
Not potentially hurt. Not at risk of being hurt. Hurt.
The inspection record does not specify how many residents were affected, what form the harm took in each case, or what the facility's staff said when confronted with the findings. Those details, when they exist, appear in the full statement of deficiencies, the document inspectors compile during their survey. What the available record confirms is the category of care, the scope, the severity, and the absence of any corrective response from the facility.
Emerald Nursing and Rehabilitation operates in Elizabethtown, a borough in Lancaster County. Lancaster County has a substantial elderly population, and its nursing facilities serve residents from across the region, many of them transferred from hospitals following surgeries, strokes, or other acute events that leave them temporarily or permanently dependent on skilled nursing care. For those residents and their families, the assumption when entering a facility is that the staff know how to manage a catheter. That assumption, at Emerald, was not warranted.
The eight deficiencies cited during the May inspection cover the full Quality of Life and Care category. The catheter and incontinence care finding is the one that rose to the level of documented, patterned, actual harm. The others are not described in the available record beyond their count.
What is described, and what matters, is the combination of factors that makes this finding particularly stark. A severity level of H requires inspectors to conclude that the problem was not confined to a single staff member on a single shift, that it was not a one-time lapse corrected before anyone was hurt. It requires a finding of pattern. In CMS survey methodology, a pattern means the problem was identified in multiple residents or occurred repeatedly with the same resident or residents over time. Coupled with actual harm, it means the facility's approach to this category of care was producing injury on a recurring basis.
The facility's decision not to file a plan of correction compounds the picture. It is possible that a plan is forthcoming, that the deadline has not yet passed or that paperwork is in process. It is also possible that the facility is contesting the findings. Neither of those possibilities changes what the inspection record currently shows, which is a facility cited for causing patterned, documented harm to vulnerable residents, with no written commitment to change.
For the residents at Emerald who depend on catheter care or require assistance with incontinence, the inspection record offers no resolution. It does not say whether the staff responsible for the failures are still on the floor. It does not say whether the residents who were harmed have recovered, deteriorated, or left the facility. It does not say what the harm looked like in practice, whether it was a UTI that sent someone to the emergency room, a skin breakdown that opened into a wound, or something else entirely.
What it says is that inspectors came, looked at what was happening to the people living there, and concluded that a pattern of care failures had already hurt them.
Families who have a loved one at Emerald Nursing and Rehabilitation can request the full statement of deficiencies from the facility or from the Pennsylvania Department of Health. That document, when available, will contain the specific findings inspectors recorded, including which residents were affected, what staff said during interviews, and what the medical records showed. It is a public document. Facilities are required to make it available.
The question that the inspection record leaves open is the one that matters most to the people living at 100 North Mount Joy Street in Elizabethtown, the actual address of their days and nights and medical care. The question is whether anything has changed since the inspectors left.
The facility has not yet said.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Emerald Nursing and Rehabilitation from 2026-05-01 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: August 4, 2026 · Our methodology
EMERALD NURSING AND REHABILITATION in ELIZABETHTOWN, PA was cited for violations during a health inspection on May 1, 2026.
The facility has filed no plan of correction.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.