Kingston Court Skilled Nursing And Rehabilitation
Inspection Findings
F-Tag F0550
Federal health inspectors cited KINGSTON COURT SKILLED NURSING AND REHABILITATION in YORK, PA for a deficiency under regulatory tag F-F0550 during a standard health inspection conducted on 2025-09-11.
Category: Resident Rights Deficiencies
The facility was found deficient in the following area: Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 7 deficiencies cited during this inspection of KINGSTON COURT SKILLED NURSING AND REHABILITATION.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-21.
F-Tag F0584
Federal health inspectors cited KINGSTON COURT SKILLED NURSING AND REHABILITATION in YORK, PA for a deficiency under regulatory tag F-F0584 during a standard health inspection conducted on 2025-09-11.
Category: Resident Rights Deficiencies
The facility was found deficient in the following area: Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 7 deficiencies cited during this inspection of KINGSTON COURT SKILLED NURSING AND REHABILITATION.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-21.
F-Tag F0657
Federal health inspectors cited KINGSTON COURT SKILLED NURSING AND REHABILITATION in YORK, PA for a deficiency under regulatory tag F-F0657 during a standard health inspection conducted on 2025-09-11.
Category: Resident Assessment and Care Planning Deficiencies
The facility was found deficient in the following area: Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 7 deficiencies cited during this inspection of KINGSTON COURT SKILLED NURSING AND REHABILITATION.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-21.
F-Tag F0684
Federal health inspectors cited KINGSTON COURT SKILLED NURSING AND REHABILITATION in YORK, PA for a deficiency under regulatory tag F-F0684 during a standard health inspection conducted on 2025-09-11.
Category: Quality of Life and Care Deficiencies
The facility was found deficient in the following area: Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 7 deficiencies cited during this inspection of KINGSTON COURT SKILLED NURSING AND REHABILITATION.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-21.
F-Tag F0697
F 0697
Provide safe, appropriate pain management for a resident who requires such services.
Level of Harm - Minimal harm or potential for actual harm
Based on review of the clinical record, policy review, and resident and staff interviews, it was determined that the facility failed to ensure pain management is provided in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for one of 30 residents reviewed (Resident 143).Findings include:Review of facility policy, administration of medications and treatments, last revised August 1, 2016, failed to reveal any expectation for a timeframe when meds are to be given around the time that they are ordered.Review of Resident 143's clinical record revealed diagnoses that included displaced fracture of lateral malleolus of right fibula (fracture of the ankle) and unspecified fracture of the upper end of the right tibia (fracture of the shin bone).Review of Resident 143's physician orders revealed an order for Gabapentin (medication used to treat nerve pain) 800 mg four times daily at 8:00 AM, 12:00 PM, 4:00 PM, and 8:00 PM for neuropathy (pain caused by nerve damage).Review of Resident 143's care plan revealed a focus area of, Resident exhibits or is at risk for alterations in comfort related to multiple fractures and a history or migraines, with an intervention of, medicate Resident as ordered for pain and monitor for effectiveness and monitor of side effects.Review of Resident 143's electronic medical record revealed that on September 6, 2025, her 8:00 AM dose of Gabapentin 800 mg was given at 10:50 AM, and the 12:00 PM dose of Gabapentin was given at 2:28 PM.
Further review revealed that on September 7, 2025, her 8:00 AM dose of Gabapentin 800 mg was given at 10:32 AM, and the 12:00 PM dose of Gabapentin was given at 2:26 PM.Interview with Resident 143 on September 8, 2025, at 9:45 AM, revealed that over the weekend on September 6 and 7, 2025, she had received her morning pain medication over 2 hours late even though she was ringing her call bell to notify staff that she was in pain and needed her medication and that it was late.Interview with the Director of Nursing on September 11, 2025, at 11:30 AM, revealed that they don't have a policy regarding what timeframe that meds should be given, but she would expect them to be given in the timeframe an hour
before until an hour after they are ordered to be given.28 Pa. Code 211.12(d)(1) Nursing services.28 Pa.
Code 211.12(d)(3) Nursing services.28 Pa. Code 211.12(d)(5) Nursing services.
Residents Affected - Few
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 REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
F-Tag F0804
Federal health inspectors cited KINGSTON COURT SKILLED NURSING AND REHABILITATION in YORK, PA for a deficiency under regulatory tag F-F0804 during a standard health inspection conducted on 2025-09-11.
Category: Nutrition and Dietary Deficiencies
The facility was found deficient in the following area: Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 7 deficiencies cited during this inspection of KINGSTON COURT SKILLED NURSING AND REHABILITATION.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-21.
F-Tag F0812
Federal health inspectors cited KINGSTON COURT SKILLED NURSING AND REHABILITATION in YORK, PA for a deficiency under regulatory tag F-F0812 during a standard health inspection conducted on 2025-09-11.
Category: Nutrition and Dietary Deficiencies
The facility was found deficient in the following area: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 7 deficiencies cited during this inspection of KINGSTON COURT SKILLED NURSING AND REHABILITATION.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-21.
KINGSTON COURT SKILLED NURSING AND REHABILITATION in YORK, PA inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
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 YORK, 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 KINGSTON COURT SKILLED NURSING AND REHABILITATION or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.