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Complaint Investigation

Hamilton Arms Center

February 25, 2026 · Lancaster, PA · 336 South West End Avenue
Citations 2
CMS Rating 3/5
Beds 94
Provider ID 395224
Healthcare Facility
Hamilton Arms Center
Lancaster, PA  ·  View full profile →
Inspection Summary

HAMILTON ARMS CENTER in LANCASTER, PA — inspection on February 25, 2026.

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.

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Inspection Findings

FF0550
Resident Rights Deficiencies

Review of Resident 1's diagnosis list includes: Alzheimer's disease (an irreversible, progressive degenerative disease of the brain, resulting in loss of reality contact and functioning ability), and Dementia (A term used to describe a group of symptoms affecting memory, thinking, and social abilities severely enough to interfere with daily life.

Review of Resident 1's Profile Page, revealed that the resident's son [name of the son] was their financial and healthcare POA (A Power of Attorney is a legal document granting an agent authority to act on a principal's behalf regarding financial or medical matters).

Review of Resident 1's POA documents signed on March 29. In 2022, confirmed that the residents' son [name] was their financial and care POA.

Review of Resident 1's health insurance document, dated October 2025, revealed that the resident's insurance company sent the facility a notification indicating that the resident's current insurance plan is no longer offered.

Interview with the Business Manager, Employee E3, was conducted on February 25, 2026, at 11:00 a.m.

Employee E3 confirmed that the facility enrolled Resident 1 to new health insurance after a notification from the original insurance indicating that the plan the resident was enrolled in was no longer offered.

Employee E3 was not certain of the date the change was made but the new insurance coverage for Resident 1 started on January 26, 2026.

Employee E3 further reported that the residents' son, the POA, was notified by the insurance company of the change and questioned the facility why they were not notified.

Employee E3 reported that the change was made to ensure that the residents will have coverage (insurance) but did not realize the mistake of not informing the POA first until after the residents' POA called their attention.

The POA re-enrolled the residents back to their original insurance with a different plan. An interview with the Nursing Home Administrator on February 25, 2026, at 1:00 p.m., confirmed that the facility enrolled Resident 1 on a different health insurance plan without notifying their POA.

The facility failed to ensure residents' appointed representatives were notified of insurance coverage changes. 28 Pa.

Code 201.14(a) Responsibility of licensee 28 Pa.

Code 201.18(b)(1)(3)(e)(1) Management 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

395224 02/25/2026

Hamilton Arms Center 336 South West End Avenue Lancaster, PA 17603

Review of Resident CL1's physician's order dated November 6, 2025, revealed an order for Cardiology follow-up.

There was no documented evidence indicating that the Cardiology consultation ordered on November 16, 2026, was followed.

Review of Resident CL1's nursing progress notes dated December 8, 2025, at 2:04 p.m., revealed: New order per NP (nurse practitioner) f/u Cardiology Dx (diagnosis) CHF.

Review of Resident CL1's physician's order dated December 8, 2025, revealed an order for Cardiology follow-up.

Review of Resident CL1's physician's progress notes dated December 10, 2025, revealed that the resident continues to complain of shortness of breath, using supplemental O2 (oxygen), and a new medication was ordered.

Plan and assessment revealed: CHF.

Ordered updated labs for monitoring, will repeat CXR (chest x-ray), last CXR was negative for fluid or acute process.

Continue Lasix (Furosemide).

Needs f/u with cardiology, discussed this with the facility, which will coordinate scheduling.

Review of Resident CL1's nursing progress notes dated December 11, 2025, at 2:48 p.m., revealed that Cardiology has been called twice and messages were left for return call to schedule an appointment, awaiting return call at this time.

There was no documented evidence indicating that the Cardiology consult ordered on December 11, 2025, was followed. An interview with the Director of Nursing was conducted on February 25, 2026, at 1:00 p.m.

The DON reported that a cardiology consult was scheduled, but the residents could not go due to residents being sick.

The DON was unable to provide documented evidence of the above incident.

The facility failed to ensure Resident CL1's orders for a cardiology follow-up ordered on November 6, 2025, and December 8, 2025, were followed. 28 Pa.

Code 211.12(d)(1)(3)(5) Nursing services 28 Pa Code 211.5(f) Clinical Records

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 LANCASTER, 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 HAMILTON ARMS CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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