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Complaint Investigation

Complete Care At Harston Hall Llc

September 17, 2025 · Flourtown, PA · 350 Haws Lane
Citations 2
CMS Rating 1/5
Beds 120
Provider ID 395791
Healthcare Facility
Complete Care At Harston Hall Llc
Flourtown, PA  ·  View full profile →
Source Document
Official CMS Inspection Report (Medicare.gov)
Downloaded from CMS/Medicare.gov. Reflects what state inspectors documented and does not include the facility's plan of correction, which is submitted separately. Facilities may have taken corrective actions since this report was released.
Inspection Summary

COMPLETE CARE AT HARSTON HALL LLC in FLOURTOWN, PA — inspection on September 17, 2025.

Found 2 citations. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

Inspection Findings

FF0557
Resident Rights Deficiencies

Review of Resident R1's clinical record revealed resident was admitted to facility on August 13, 2025, with the diagnosis of Sepsis (infection in the blood stream), Paraplegia (paralysis on the lower half of the body), and Pressure Ulcer of Left Buttocks.

Review of Resident R1's Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) dated September 11, 2025, revealed that the resident has a BIMS (Brief interview for Mental Status) score of 15 indicating that resident cognitively intact.

Observation of Resident R1's wound care with Employee E4, Licensed Practical Nurse on September 17, 2025, at 12:30pm revealed resident left with exposed buttocks after perineal care, for approximately 2 minutes, while staff prepared for dressing change.

Observed multiple unnamed staff members entering and exiting room without introduction or providing the resident with privacy.Interview with Resident R1 on September 17, 2025 at 12:45pm, revealed that this experience happens often when care is being provided and it makes him feel very uncomfortable.

People come and go while I am getting care, I don't know who they are, they do not introduce themselves, sometimes it someone dropping off a tray, other times it is housekeeping. It's uncomfortable when I am exposed and have no privacy and it doesn't seem like anyone cares. 28 Pa.

Code: 201.18(b)(2) Management.28 Pa.

Code: 201.29(j) Resident's rights.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

395791 09/17/2025

Complete Care at Harston Hall LLC 350 Haws Lane Flourtown, PA 19031

Investigation of alleged Abuse, Neglect and Exploitation, An immediate investigation is warranted when suspicion of abuse, neglect or exploitation, or reports of abuse, neglect or exploitation occur.

Written procedures for investigation include: Identifying staff responsible for the investigation; Exercising caution in handling evidence that could be used in a criminal investigation (e.g., not tampering or destroying evidence); Investigating different typers of alleged violations; Identifying and Interviewing all involved persons, including the alleged victims, alleged perpetrator, witnesses, and others who might have knowledge of the allegations; Focusing the investigation on determining if abuse, neglect, exploitation, and/or mistreatment has occurred, the extent and cause; and providing complete and thorough documentation of the investigation.

Review of Resident R2's clinical record revealed that resident was admitted to the facility on [DATE], with the diagnosis of End Stage Renal Disease.

Review of Resident R2's Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) dated August 20, 2025, revealed that the resident has a BIMS (Brief interview for Mental Status) score of 15 indicating that resident was cognitively intact.

Review of facility grievance revealed concern form dated August 26, 2025 with letter attached signed by Resident R2's family.

Letter revealed At approximately 8:50pm, I received a call from my mother, [Resident R2].

She was very upset.

She told me that an aide/orderly had treated her poorly and she was very hurt.

She asked the aide to help her get in the chair so that she could use the bathroom.

The aide told her no and that she had to get in the bed.

She asked again and was told the same thing.

Shortly after being put in the bed, my mom had an accident.

When the aide returned and found that she had soiled herself, her tone was demeaning and she said, This is just a mess! (In a mean tone). My mom also said that she was very forceful while changing her.

This is unacceptable. My Mom said that she felt hurt and embarrassed.

She should not be made to feel this way and my family would like to know what the consequence will be for this behavior. We need to know that she is safe and cared for while in this facility, we are officially requesting an apology from this worker and assurance that this will not happen again.

Sincerely, The family of [Resident R2] Request for incident investigation on September 17, 2025 at 1:30pm revealed no documented evidence of investigation completed.

Further review of grievance form dated August 26, 2025, revealed that Employee E5 Nurse Aide (CNA) was identified.

Employee E5 was provided education on customer service and perineal care on August 28, 2025.

Interview with Employee E2, Director of Nursing confirmed no documented evidence of investigation completed regarding the concern of abuse and neglect. 28 Pa.

Code 201.14(a) Responsibility of licensee28 Pa.

Code 201.29 (a) Resident rights

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in FLOURTOWN, PA, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from COMPLETE CARE AT HARSTON HALL LLC or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


More Reports

About This Inspection Report

Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.

Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.

Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.