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Home / Pennsylvania / Camp Hill

Gardens at West Shore, the

770 Poplar Church Road, Camp Hill, PA 17011 · Cumberland County · (717) 763-7070

309 certified beds, about 192 residents a day · For profit - Corporation · Medicare and Medicaid since 1978

CMS abuse icon: cited for abuse in a recent inspection Certified for Medicaid Certified for Medicare
Overall
1 of 5
Health inspections
1 of 5
Staffing
4 of 5
Quality measures
2 of 5

CMS Care Compare ratings, data as of September 1, 2026 · CCN 395223 · See it on Medicare.gov · Compare with other homes

The record in brief

At its most recent standard inspection, on August 7, 2025, inspectors cited 8 health deficiencies (the Pennsylvania average is 10, the national average 9.2).

Of 56 health citations since September 2023, 4 were rated as actual harm or immediate jeopardy to residents (2 immediate jeopardy).

CMS lists 4 fines totaling $58,069 in the last three years; the largest was $23,491, and the latest is dated June 1, 2026.

Nurses and nurse aides worked 3.16 hours per resident per day, against 3.89 across Pennsylvania and 3.86 nationally. Registered nurses accounted for 0.68 of those hours.

36.6% of nursing staff left within the year CMS measured (Pennsylvania average 44.5%).

CMS links it to Priority Healthcare Group, an affiliated group of 12 nursing homes.

Health inspections

Federal rules call for a standard inspection at least every 15 months, plus a visit whenever a complaint is filed. Each mark below is one citation, colored by how serious inspectors rated it. How to read a citation.

Under each citation, the quoted text is the inspector's own summary from the federal statement of deficiencies (CMS form 2567), word for word apart from a privacy scrub; CMS removes residents' and staff names before it publishes the text. The full notes are on Medicare.gov.

Potential for minimal harm Potential for more than minimal harm Actual harm Immediate jeopardy Found on a complaint visit

Where its citations fall on CMS's grid

CMS rates every citation by how much harm it caused (rows) and how many residents it touched (columns). The count in each box is this home's, across all 56 health citations on file.

Severity
Isolated
Pattern
Widespread
Immediate jeopardy
2J
0K
0L
Actual harm
2G
0H
0I
Potential for more than minimal harm
31D
20E
1F
Potential for minimal harm
0A
0B
0C
July 1, 2026Complaint inspection · 2 citations
  1. J
    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
    F689 · Quality of Life and Care · Immediate jeopardy to resident health or safety, isolated · found on a complaint visit · Past noncompliance: already fixed when inspectors found it
    Inspectors wroteBased on clinical record review, observations, facility document review, staff interviews, and facility policy review, it was determined that the facility displayed past non-compliance by failing to implement interventions, supervision, and effective safety measures to prevent elopement of a resident identified as being at risk for elopement and exhibiting exit seeking behaviors (Resident 1). This failure resulted in an immediate jeopardy situation. Review of facility policy, titled Elopement, revised June 2023, read, in part, It is the policy of this facility to provide a safe and secure environment for our residents and to be proactive in preventing resident elopement. Residents at risk for elopement will be appropriately monitored to reduce the potential for injury. [...]
  2. D
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    F684 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Past noncompliance: already fixed when inspectors found it
    Inspectors wroteBased on review of facility investigation, clinical record review, and staff interviews, it was determined that the facility displayed past noncompliance in its failure to ensure that abnormal test results were acted upon timely and in accordance with professional standards of practice for one of eight residents reviewed (Resident 6).
June 1, 2026Complaint inspection · 2 citations
  1. F
    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.
    F584 · Resident Rights · No actual harm, potential for more than minimal harm, widespread · found on a complaint visit · Corrected (the home has a date of correction) August 7, 2026
    Inspectors wroteBased on observations, facility policy review, and staff interviews, it was determined that the facility failed to maintain a safe, clean, and home-like environment on 5 nursing units, the 2nd floor and the main facility hallway.
  2. D
    Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
    F921 · Environmental · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) July 16, 2026
    Inspectors wroteBased on observations and staff interviews, it was determined that the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents and staff for one out of three floors (2nd floor unit).
February 9, 2026Complaint inspection · 3 citations
  1. J
    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
    F689 · Quality of Life and Care · Immediate jeopardy to resident health or safety, isolated · found on a complaint visit · Past noncompliance: already fixed when inspectors found it
    Inspectors wroteBased on facility policy review, clinical record review, review of facility investigation documentation, and staff interviews, it was determined that the facility displayed past non-compliance by failing to provide adequate supervision to prevent an elopement of a resident identified as being at risk for elopement (Resident 3). Resident 3 was found in the street approximately 0.3 miles away from the facility. This failure placed a total of eight additional residents in an Immediate Jeopardy situation who were identified as at risk for elopement and not on a locked unit (Residents 6, 7, 8, 9, 10, 11, 12 and 13). Findings Include:Review of facility policy, titled Elopement, revised June 2023, revealed, It is the policy of this facility to provide a safe and secure environment for our residents and to be proactive in preventing resident elopement. [...]
  2. G
    Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
    F600 · Freedom from Abuse, Neglect, and Exploitation · Actual harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) February 17, 2026
    Inspectors wroteBased on facility policy review, clinical record review, review of select facility documents, and staff interviews, it was determined that the facility failed to ensure each resident the right to be free from neglect, which resulted in actual harm as evidenced by superficial incontinence associated dermatitis for one out of three residents reviewed (Resident 2).
  3. D
    Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
    F842 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) February 23, 2026
    Inspectors wroteBased on facility policy review, clinical record review, facility document review, and staff interviews, it was determined that the facility failed to maintain complete clinical records for one of 14 residents reviewed (Resident 3). Findings Include:Review of facility policy, titled Elopement, revised June 2023, revealed, Post Elopement/upon return to the facility, the Director of Nursing Services or Charge Nurse shall: complete and file an Incident Report; and Document the event in the resident's medical record. Review of Resident 3's clinical record revealed diagnoses that included alcoholic cirrhosis of the liver (advanced, irreversible scarring of the liver caused by long-term heavy alcohol consumption, often resulting in liver failure), hepatic encephalopathy (a serious condition that occurs when the liver is unable to filter toxins from the blood. [...]
December 26, 2025Complaint inspection · 1 citation
  1. D
    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.
    F584 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) January 22, 2026
    Inspectors wroteBased on facility policy review, observations, and resident and staff interviews, it was determined that the facility failed to maintain a safe, clean, comfortable and home-like environment in one of three shower rooms observed.
August 7, 2025Standard inspection · 8 citations
  1. E
    Ensure each resident receives an accurate assessment.
    F641 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) September 11, 2025
    Inspectors wroteBased on clinical record review and staff interviews, it was determined that the facility failed to ensure the resident assessment accurately reflected the resident status for three of 35 residents reviewed (Residents 5, 51, and 85).
  2. E
    Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
    F657 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) September 11, 2025
    Inspectors wroteBased on facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to review and revise the resident plan of care for one of 35 residents reviewed (Resident 8).
  3. E
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    F684 · Quality of Life and Care · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) September 11, 2025
    Inspectors wroteBased on facility policy review, clinical record reviews, observations, and resident and staff interviews, it was determined that the facility failed to ensure care and services are provided in accordance with professional standards of practice that will meet each resident's physical, mental, and psychosocial needs for four of 35 residents reviewed (Residents 43, 82, 128, and 141).
  4. E
    Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
    F756 · Pharmacy Service · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) September 11, 2025
    Inspectors wroteBased on facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to ensure pharmacy recommendations were acted on appropriately for two of 35 residents reviewed (Residents 25 and 51).
  5. E
    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
    F812 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) September 11, 2025
    Inspectors wroteBased on observations, review of safety data sheet, review of facility temperature logs, and staff interviews, it was determined that the facility failed to utilize kitchen equipment in accordance with professional standards for food service safety in the main kitchen.
  6. D
    Reasonably accommodate the needs and preferences of each resident.
    F558 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) September 11, 2025
    Inspectors wroteBased on observations, record review, and staff interviews, it was determined that the facility failed to ensure the environment meets the individual needs of each resident by ensuring the call system is within reach of the resident for one of 35 residents reviewed (Resident 155).
  7. D
    Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
    F605 · Freedom from Abuse, Neglect, and Exploitation · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) September 11, 2025
    Inspectors wroteBased on facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to ensure that a resident's medication regimen was free from unnecessary psychotropic medications for one of seven residents reviewed for unnecessary medications (Resident 8).
  8. D
    Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
    F688 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) September 11, 2025
    Inspectors wroteBased on clinical record review and resident and staff interviews, it was determined that the facility failed to ensure a resident with limited range of motion and mobility received appropriate services, equipment, and assistance to maintain or improve range of motion or mobility for one of one residents reviewed (Resident 17).
September 26, 2024Standard inspection, Complaint inspection · 14 citations
  1. E
    Ensure each resident receives an accurate assessment.
    F641 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) November 5, 2024
    Inspectors wroteBased on observations, clinical record review, and staff interviews, it was determined that the facility failed to ensure that the resident assessment accurately reflected the resident's status for 11 of 38 residents reviewed (Residents 6, 7, 17, 43, 67, 74, 80, 83, 85, 109, and 142).
  2. E
    Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
    F657 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) November 5, 2024
    Inspectors wroteBased on policy review, resident observations, clinical record review, and resident and staff interviews, it was determined that the facility failed to ensure the care plan was reviewed and revised for seven of 38 residents reviewed (Residents 7, 80, 85, 96, 124, 142, and 171), and failed to give the opportunity to participate in the development, review, and revision of his/her care plan for one of 38 residents reviewed (Resident 61).
  3. E
    Provide safe, appropriate dialysis care/services for a resident who requires such services.
    F698 · Quality of Life and Care · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) November 19, 2024
    Inspectors wroteBased on facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to ensure that residents who require dialysis receive such services consistent with professional standards and failed to maintain complete and accurate records related to dialysis communication for one of two residents reviewed for dialysis (Resident 158).
  4. E
    Observe each nurse aide's job performance and give regular training.
    F730 · Nursing and Physician Services · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) November 5, 2024
    Inspectors wroteBased on review of select facility personnel documentation and staff interview, it was determined that the facility failed to ensure that nurse aide performance evaluations were completed at least annually for four of five nurse aides reviewed (Employees 11, 12, 13, and 15). Findings Include: Review of personnel information revealed that Employee 11's hire date was August 20, 2001; Employee 12's hire date was November 28, 2005; Employee 13's hire date was April 7, 2010; and Employee 15's hire date was January 11, 2022. Further review of personnel information for Employees 11, 12, 13, and 15, failed to reveal that annual performance reviews were completed. During an interview with the Nursing Home Administrator on September 26, 2024, at 12:35 PM, he acknowledged that he had no additional documentation to provide for the selected employees. [...]
  5. E
    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
    F812 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) November 5, 2024
    Inspectors wroteBased on facility policy review, observations, and staff interviews, it was determined that the facility failed to store food and utilize equipment in accordance with professional standards for food service safety in the main kitchen and five of five pantries.
  6. E
    Provide and implement an infection prevention and control program.
    F880 · Infection Control · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) November 5, 2024
    Inspectors wroteBased on observations, clinical record review, policy review, and staff interviews, it was determined that the facility failed to maintain a safe and sanitary environment that supports infection prevention and control for three of 38 residents reviewed (Residents 15, 32, and 171).
  7. E
    Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
    F947 · Nursing and Physician Services · No actual harm, potential for more than minimal harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) November 5, 2024
    Inspectors wroteBased on review of personnel training records and staff interview, it was determined that the facility failed to ensure each nurse aide was provided with the required in-service training consisting of no less than 12 hours per year and included dementia management training and resident abuse prevention training for three of five nurse aide employee records reviewed (Employees 11, 12, and 13). Findings Include: Review of personnel information revealed that Employee 11's hire date was August 20, 2001; Employee 12's hire date was November 28, 2005; and Employee 13's hire date was April 7, 2010. Review of facility training records failed to reveal that the aforementioned Employees completed 12 hours of required annual training in the past 12 months, or that they had completed dementia management training and resident abuse prevention training in the past 12 months. [...]
  8. D
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    F684 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) November 5, 2024
    Inspectors wroteBased on clinical record review and staff interview, it was determined that the facility failed to implement resident-directed care and treatment consistent with the resident's physician orders and plan of care for one of 35 residents reviewed (Resident 142).
  9. D
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.
    F686 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) November 5, 2024
    Inspectors wroteBased on policy review, clinical record review, observations, and staff interviews, it was determined that the facility failed to ensure that residents receive necessary treatment and services, consistent with professional standards of practice, to promote healing and prevent infection for one of four residents reviewed for pressure ulcers (Resident 74).
  10. D
    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
    F689 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) November 5, 2024
    Inspectors wroteBased on clinical record review, review of facility investigation documentation, and staff interviews, it was determined that the facility failed to ensure that each resident received adequate supervision and assistance to prevent accidents for one of 35 residents reviewed (Resident 63). Findings Include: Review of Resident 63's clinical record revealed diagnoses that included schizoaffective disorder, bipolar type (a mental health condition that is marked by a mix of schizophrenia symptoms, such as hallucinations and delusions, and mood disorder symptoms, such as depression, and mania), abnormal posture, and muscle weakness. Review of select facility report detailing the incident that occurred on June 27, 2024, read, in part: Incident Description: Nursing Description: [...]
  11. D
    Provide enough food/fluids to maintain a resident's health.
    F692 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) November 5, 2024
    Inspectors wroteBased on observations, clinical record review, interviews, and facility policy review, it was determined that the facility failed to ensure that one of 38 residents reviewed were monitored for acceptable parameters of weight (Resident 124). Findings Include: Review of facility policy, titled Weight Assessment and Intervention, last reviewed August 21, 2024, revealed: The nursing staff will measure resident weight on admission, and then weekly for four weeks. If no weight concerns are noted at this point, weights will be measured monthly thereafter or as per Dietician or MD. A review of the clinical record for Resident 124 revealed diagnoses that included psychosis (a mental disorder characterized by a disconnection from reality) and dementia (irreversible, progressive degenerative disease of the brain, resulting in loss of reality contact and functioning ability). [...]
  12. D
    Provide care or services that was trauma informed and/or culturally competent.
    F699 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) November 5, 2024
    Inspectors wroteBased on facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to ensure that residents who are trauma survivors receive culturally competent, trauma-informed care in accordance with professional standards of practice in order to eliminate or mitigate triggers that may cause re-traumatization of the resident for one out of 35 residents reviewed (Resident 43).
  13. D
    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
    F755 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) November 5, 2024
    Inspectors wroteBased on facility documentation review, policy review, clinical record review, and staff interview, it was determined that the facility failed to provide pharmaceutical services to ensure a system of records of receipt and disposition of all controlled drugs in sufficient detail to enable accurate accounting of controlled drugs when acquiring, receiving, dispensing, and or administering to identify possible diversion for one of three residents reviewed (Resident 177).
  14. D
    Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
    F758 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) November 5, 2024
    Inspectors wroteBased on facility policy review, clinical record review, and staff interviews, it was determined that the facility failed to ensure that residents were free of unnecessary psychotropic medications for one of four residents reviewed (Resident 96).
July 10, 2024Complaint inspection · 1 citation
  1. D
    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.
    F584 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) July 30, 2024
    Inspectors wroteBased on observation, policy review, as well as resident and staff interviews, it was determined that the facility failed to ensure a safe, comfortable, homelike interior on one of five nursing units observed (1300 unit).
May 23, 2024Complaint inspection · 2 citations
  1. D
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    F684 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) June 27, 2024
    Inspectors wroteBased on clinical record review and staff interviews, it was determined that the facility failed to ensure care and services are provided in accordance with professional standards of practice that will meet each resident's physical, mental, and psychosocial needs for one of four residents reviewed (Resident 4).
  2. D
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.
    F686 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) June 27, 2024
    Inspectors wroteBased on clinical record review and staff interviews, it was determined that the facility failed to ensure that residents received necessary treatment and services, consistent with professional standards of practice, to promote healing and prevent infection of a pressure ulcer for one of four residents reviewed (Resident 1). Findings Include: Review of Resident 1's clinical record revealed diagnoses that included unstageable pressure ulcer of the sacral region (localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device; [...]
February 22, 2024Complaint inspection · 2 citations
  1. G
    Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
    F690 · Quality of Life and Care · Actual harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) March 19, 2024
    Inspectors wroteBased on clinical record review, document review, observations, resident and staff interviews, and facility policy review, it was determined that the facility failed to provide suprapubic catheter care and monitoring, which resulted in actual harm, as evidenced by an active infection requiring antibiotic treatment. The facility also failed to promptly initiate urology specialist recommendations for treatment of the infection for one of two residents reviewed for catheter use (Resident 2).
  2. D
    Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
    F600 · Freedom from Abuse, Neglect, and Exploitation · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) March 19, 2024
    Inspectors wroteBased on clinical record review, review of facility documentation, policies and procedures, as well as resident and staff interviews, it was determined that the facility failed to ensure residents were free from neglect for one of four residents reviewed (Resident 4).
January 29, 2024Complaint inspection · 1 citation
  1. D
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.
    F686 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) February 20, 2024
    Inspectors wroteBased on review of facility policy, observations, and staff interview, it was determined that the facility failed ensure the resident received care, consistent with professional standards, to prevent pressure ulcers for one of six residents reviewed (Resident 1). Findings Include: Review of facility policy, titled Dressing, Dry/Clean, revised September 2013, revealed, Steps in the Procedure 1. Clean bedside stand. Establish a clean field. 2. Place the clean equipment on the clean field. Arrange the supplies so they can be easily reached. 3. Tape a biohazard or plastic bag on the bedside stand or use a waste basket below clean field. 4. Position resident and adjust clothing to provide access to affected area. 5. Wash and dry your hands thoroughly. 6. Put on clean gloves. Loosen tape and remove soiled dressing. 7. Pull glove over dressing and discard into plastic or biohazard bag. 8. [...]
January 11, 2024Complaint inspection · 1 citation
  1. D
    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.
    F584 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) January 31, 2024
    Inspectors wroteBased on observations and staff interviews, it was determined that the facility failed to maintain a safe, clean, comfortable, and home-like environment in four resident rooms (Residents' 2, 3, 4, and 5 rooms).
November 16, 2023Standard inspection, Complaint inspection · 17 citations
  1. E
    Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
    F578 · Resident Rights · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) December 19, 2023
    Inspectors wroteBased on facility policy review, clinical record reviews, resident rights, and staff interviews, it was determined that the facility failed to offer the option to formulate an advanced directive and provided no documentation pertaining to resident's choices for advanced directives, or documenting how the resident was informed of his/her right to develop a living will or advanced directive, for three of 38 records reviewed; and failed to document the correct code status on the care plan to match the POLST (Pennsylvania Orders for Life-Sustaining Treatment) for one of 38 residents reviewed (Residents 40, 54, 72, and 88).
  2. E
    Ensure each resident receives an accurate assessment.
    F641 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) December 19, 2023
    Inspectors wroteBased on clinical record review and staff interviews, it was determined that the facility failed to ensure that the resident assessment accurately reflected the resident's status for six of 39 residents reviewed (Resident 4, 72, 77, 138, 143, and 151). Findings Include: Review of Resident 4's clinical record revealed diagnoses that included Multiple sclerosis (a disease in which the immune system eats away at the protective covering of nerves) and chronic obstructive pulmonary disease (COPD - a group of lung diseases that block airflow and make it difficult to breathe). Review of Resident 4's MDS (Minimum Data Set is part of the federally mandated process for clinical assessment of all Medicare and Medicaid certified nursing homes) dated August 21, 2023, revealed that section M0150. [...]
  3. E
    Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
    F657 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) December 19, 2023
    Inspectors wroteBased on facility policy review, observations, clinical record review, and resident and staff interviews, it was determined that the facility failed to review and revise the resident plan of care for four of 38 residents reviewed (Residents 22, 59, 69, and 72).
  4. E
    Provide care and assistance to perform activities of daily living for any resident who is unable.
    F677 · Quality of Life and Care · No actual harm, potential for more than minimal harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) December 19, 2023
    Inspectors wroteBased on clinical record review, observation, and resident and staff interviews, it was determined that the facility failed to provide assistance with activities of daily living for dependent residents for six of 33 residents reviewed (Resident 15, 17, 55, 69, 88, and 94).
  5. E
    Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
    F756 · Pharmacy Service · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) December 19, 2023
    Inspectors wroteBased on clinical record review, facility policy review, and staff interviews, it was determined that the facility failed to ensure Medication Regimen Reviews were completed by a consultant pharmacist and responded to in a timely manner by the attending physician or prescriber for four of 39 residents reviewed (Residents 72, 77, 88, and 96).
  6. E
    Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
    F758 · Pharmacy Service · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) December 19, 2023
    Inspectors wroteBased on clinical record review and staff interview, it was determined that the facility failed to ensure residents were free from unnecessary antipsychotic medication for one of five residents reviewed for unnecessary medications (Resident 143).
  7. E
    Provide and implement an infection prevention and control program.
    F880 · Infection Control · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) December 19, 2023
    Inspectors wroteBased on resident and staff interviews, policy review, observations, and clinical record review, it was determined that the facility failed to implement infection control practices to prevent the transmission of infectious disease for one of one resident reviewed for transmission based precautions (Resident 105); failed to maintain a data collection system of surveillance for three of 12 months reviewed (December 2022, January 2023, and April 2023); and failed to maintain an effective infection control program related to the preparation and administration of medications to one of three Residents observed (Resident 7).
  8. D
    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.
    F584 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) December 19, 2023
    Inspectors wroteBased on observations and staff interviews, it was determined that the facility failed to maintain a clean, comfortable, and homelike environment for five of 38 residents observed (Residents 14, 114, 137, 138, and 223).
  9. D
    Respond appropriately to all alleged violations.
    F610 · Freedom from Abuse, Neglect, and Exploitation · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) December 19, 2023
    Inspectors wroteBased on review of facility policy, clinical record review, review of facility incident report, and staff interviews, it was determined that the facility failed to conduct a timely and thorough investigation to rule out abuse, neglect, or mistreatment following an unwitnessed fall for one of 12 residents reviewed for falls (Resident 138). Findings Include: Review of facility policy, titled Abuse Policy with last review date of September 23, 2023, revealed, The Facility shall have processes in place to include screening, training, prevention, identification, protection, investigation, reporting and response to allegations of potential or actual abuse and neglect. The policy defined neglect as the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish or emotional distress. [...]
  10. D
    Assess the resident when there is a significant change in condition
    F637 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) December 19, 2023
    Inspectors wroteBased on clinical record review and staff interview, it was determined that the facility failed to ensure a significant change assessment (change to hospice status) was completed for one of 38 residents reviewed (Resident 18).
  11. D
    Ensure services provided by the nursing facility meet professional standards of quality.
    F658 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) December 19, 2023
    Inspectors wroteBased on clinical record review and staff interviews, it was determined that the facility failed to ensure care and services were provided in accordance with professional standards for one of 38 residents reviewed (Resident 88). Findings Include: Review of Resident 88's clinical record revealed diagnoses that included atherosclerotic heart disease (build-up of cholesterol plaques in the walls of the arteries causing obstruction of blood flow) and major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest in things). Review of Resident 88's physician orders revealed an order for Metoprolol Tartrate Tablet 50 MG, Give 1 tablet by mouth one time a day related to essential hypertension, Do not crush; Hold for Systolic Blood Presure <120 Give with food or immediately after meal, with a start date of July 21, 2023. [...]
  12. D
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.
    F686 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) December 19, 2023
    Inspectors wroteBased on observation, clinical record review, and staff interview, it was determined that the facility failed to provide care and services to promote healing and prevent worsening of pressure ulcers for one of four residents reviewed for pressure ulcers (Resident 143).
  13. D
    Provide enough food/fluids to maintain a resident's health.
    F692 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) December 19, 2023
    Inspectors wroteBased on facility policy review, clinical record review, and resident and staff interviews, it was determined that the facility failed to answer a dietary consult in response to weight loss to maintain adequate nutritional status for one of 38 residents reviewed (Resident 88).
  14. D
    Provide safe and appropriate respiratory care for a resident when needed.
    F695 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) December 19, 2023
    Inspectors wroteBased on observations, clinical record review, policy review, and staff interview, it was determined the facility failed to provide respiratory care consistent with professional standards of practice for one of 39 residents reviewed (Resident 8).
  15. D
    Ensure medication error rates are not 5 percent or greater.
    F759 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) December 19, 2023
    Inspectors wroteBased on observations, staff interviews, and clinical record review, it was determined that the facility failed to ensure that it was free from a medication error rate of five percent or greater based on two medication errors out of 31 opportunities.
  16. D
    Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
    F761 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) December 19, 2023
    Inspectors wroteBased on record review, staff interview, and policy review, it was determined that the facility failed to ensure documentation of controlled medication disposition and reason for one of three closed records reviewed (Resident 168).
  17. D
    Provide or obtain dental services for each resident.
    F791 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) December 19, 2023
    Inspectors wroteBased on resident and staff interviews, policy review, and record review, the facility failed to assist residents in obtaining routine and emergency dental services for one of 39 residents (Resident 4).
October 26, 2023Complaint inspection · 1 citation
  1. D
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.
    F686 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) November 7, 2023
    Inspectors wroteBased on observations, clinical record review, facility policy review, and staff interviews, it was determined that the facility failed to provide care and services to heal and prevent infection of pressure ulcers for two of three residents reviewed for pressure ulcers (Residents 1 and 2).
September 8, 2023Complaint inspection · 1 citation
  1. E
    Give residents a notice of rights, rules, services and charges.
    F572 · Resident Rights · No actual harm, potential for more than minimal harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) September 12, 2023
    Inspectors wroteBased on facility policy review, clinical record reviews, and staff interviews, it was determined that the facility failed to ensure that residents were provided a written notice of his or her rights and services provided, as well as all rules and regulations governing resident conduct and responsibilities during their stay in the facility prior to or upon admission for three of six residents reviewed (Residents 1, 4, and 6).

Fire safety inspections

1 fire safety citation on file: 1 on May 28, 2026.

Every fire safety citation1 citation
  1. E
    Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
    K 321 · May 28, 2026 · Corrected (the home has a date of correction)

Fines and payment denials

DatePenaltyAmount or length
June 1, 2026Fine $16,355
February 9, 2026Fine $9,110
February 9, 2026Fine $9,113
February 22, 2024Fine $23,491

A payment denial means Medicare and Medicaid stopped paying for new admissions for that period.

Staffing

Hours of care per resident per day, from the payroll records every home sends CMS. Higher means more staff time with each resident.

MeasureThis homePennsylvaniaUnited States
All nursing staff (RN, LPN and aides)3.163.893.86
Registered nurses0.680.790.69
All nursing staff on weekends2.873.533.42
Nurse aides1.94
Licensed practical nurses0.54
Nursing staff turnover (share who left in a year)36.6%44.5%45.8%
Registered nurse turnover34.6%39.9%42.9%
Administrators who left0

CMS expects 3.24 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.

Staffing by quarter, from daily payroll records

Every nursing home sends CMS its staff hours for each day (the Payroll Based Journal). Here they are added up by quarter. The latest quarter is the one behind the figures above. In January to March 2026, nursing staff hours per resident were 3.28 on weekdays and 2.87 on weekends, 12% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 5.3% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 3.29 in April to June 2025 to 3.16 in January to March 2026.

QuarterAll nursing staffRegistered nursesWeekdaysWeekendsContract staff shareDays with no RN hoursResidents a day
Jan to Mar 20263.160.683.282.87 5.3%0 of 90192
Oct to Dec 20253.220.693.303.00 1.0%0 of 92183
Jul to Sep 20253.120.633.252.79 3.5%0 of 92184
Apr to Jun 20253.290.633.413.01 4.5%0 of 91182
United States, Jan to Mar 20263.750.623.923.335.3%0.5% of days
Pennsylvania, Jan to Mar 20263.690.653.823.3411.3%0.1% of days

Hours per resident per day: staff hours in the quarter divided by resident days (the daily census CMS derives from resident assessments). Registered nurses include the director of nursing and RNs with administrative duties; aides include nurse aides in training and medication aides, as in CMS's own staffing measure. How these are calculated.

Staff pay reports

Staff pay at this home

No staff pay figure for this home has passed review yet. A figure appears only after at least 5 reports from at least 3 different people, sent over at least 60 days, have passed review.

Official wage estimates for Pennsylvania

JobMedianMiddle halfEmployed
Pennsylvania, all employers
CNAs (nursing assistants)$21.44$18.88 to $22.5267,740
LPNs and LVNs$30.74$29.02 to $35.0138,260
Registered nurses$46.36$38.75 to $50.35146,520
United States, nursing care facilities
CNAs (nursing assistants)$20.67$17.91 to $22.55534,270
LPNs and LVNs$33.86$30.05 to $37.40188,210
Registered nurses$41.11$37.85 to $47.68142,270

Hourly wages; the middle half runs from the 25th to the 75th percentile. Source: U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2025. BLS has no separate estimate for medication aides. These are survey estimates for whole occupations, not figures for any one home.

How staff pay reports work · CNA pay by state

Quality measures

The measures CMS uses for the quality star. Lower is better for every one of them.

MeasureThis homePennsylvaniaUS
Percentage of long-stay residents whose need for help with daily activities has increased
Long Stay residents, 2025Q2-2026Q1
5.116.813.9
Percentage of long-stay residents with a catheter inserted and left in their bladder
Long Stay residents, 2025Q2-2026Q1
0.70.70.8
Percentage of long-stay residents with a urinary tract infection
Long Stay residents, 2025Q2-2026Q1
2.21.41.6
Percentage of long-stay residents experiencing one or more falls with major injury
Long Stay residents, 2025Q2-2026Q1
2.03.13.2
Percentage of short-stay residents who newly received an antipsychotic medication
Short Stay residents, 2025Q2-2026Q1
0.61.41.6
Percentage of long-stay residents whose ability to walk independently worsened
Long Stay residents, 2025Q2-2026Q1
2.817.014.1
Percentage of long-stay residents with pressure ulcers
Long Stay residents, 2025Q2-2026Q1
4.14.84.6
Percentage of long-stay residents who received an antipsychotic medication
Long Stay residents, 2025Q2-2026Q1
20.717.715.4
Percentage of short-stay residents who were rehospitalized after a nursing home admission
Short Stay residents, 20250101-20251231
25.522.523.8
Percentage of short-stay residents who had an outpatient emergency department visit
Short Stay residents, 20250101-20251231
9.99.512.0

Short-term rehab results

For a stay to recover after a hospital visit, these are the results CMS publishes for Gardens at West Shore, the's Medicare short-stay residents. On returning residents home or to the community, CMS rates it worse than the national rate (37.2% of residents, after adjusting for how sick they were). How to read these, and what Medicare pays for.

Went home or back to the community

37.2% this home

Worse than the national rate

US median of homes 51.5% · Pennsylvania: 100 better, 108 worse

Rate of successful return to home or community from a SNF (risk-standardized discharge to community rate). Higher is better. October 2022 to September 2024. 75 eligible stays.

Potentially preventable readmissions

12.4% this home

No different from the national rate

US median of homes 10.7% · Pennsylvania: 3 better, 9 worse

Rate of potentially preventable hospital readmissions 30 days after discharge from a SNF (risk-standardized rate). Lower is better. October 2022 to September 2024. 85 eligible stays.

Infections that led to a hospital stay

6.3% this home

No different from the national rate

US median of homes 7.1% · Pennsylvania: 7 better, 5 worse

Percentage of infections residents got during their SNF stay that resulted in hospitalization (risk-standardized rate). Lower is better. October 2023 to September 2024. 36 eligible stays.

Self-care and mobility at discharge

36.4% this home

Median of homes: Pennsylvania54.4% · US 56.6%

Percentage of residents who are at or above an expected ability to care for themselves and move around at discharge. Higher is better. October 2024 to September 2025. 33 residents counted.

Falls with major injury

2.3% this home

Median of homes: Pennsylvania0.0% · US 0.0%

Percentage of SNF residents who experience one or more falls with major injury during their SNF stay. Lower is better. October 2024 to September 2025. 43 residents counted.

New or worsened pressure ulcers

2.7% this home

Median of homes: Pennsylvania2.0% · US 1.7%

Percentage of residents with pressure ulcers or pressure injuries that are new or worsened (adjusted rate). Lower is better. October 2024 to September 2025. 43 residents counted.

Medication list given at discharge

Not reported

CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.

Median of homes: Pennsylvania100.0% · US 98.7%

Percentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge. Higher is better. October 2024 to September 2025. 9 residents counted.

Source: CMS Skilled Nursing Facility Quality Reporting Program - Provider Data, released 2026-09-30. Better, no different and worse are CMS's own comparisons with the national rate, after adjusting for how sick residents were. Medians of homes and the state counts are worked out by us from the same file.

Owners and operators

Legal business name: THE MEADOWS AT WEST SHORE FOR NURSING AND REHABILITATION LLC. CMS links this home to Priority Healthcare Group, a group of 12 nursing homes averaging 2.9 stars overall.

NameRoleTypeShareSince
Hashtag Holdings LLC5% or greater direct ownership interestOrganization100%02/01/2017
Blglpa LLC5% or greater indirect ownership interestOrganization14%10/27/2017
Fair Oaks Family Holdings LLC5% or greater indirect ownership interestOrganization14%01/28/2020
Hashtag-El-Holdings LLC5% or greater indirect ownership interestOrganization17%10/27/2017
Samara Holdings Company LLC5% or greater indirect ownership interestOrganization17%01/28/2020
Strawberry Hill Holdings LLC5% or greater indirect ownership interestOrganization17%01/28/2020
Sebbag, Gabriel5% or greater indirect ownership interestIndividual5%10/27/2017
Schiowitz, MarcCorporate officerIndividual01/01/2019
Clinical Consulting Services LLCOperational/managerial controlOrganization01/01/2019
Priority Care Group LLCOperational/managerial controlOrganization01/01/2019
Summation Financial Services LLCOperational/managerial controlOrganization01/01/2019
Baughman, KevinOperational/managerial controlIndividual04/13/2024
Schiowitz, MarcOperational/managerial controlIndividual01/01/2019
Tarique, AhmedOperational/managerial controlIndividual06/01/2020
Gamzeh, DavidIndividual is an owner, partner or trustee of any ADP of the SNFIndividual06/04/2025
Glatzer, AkivaIndividual is an owner, partner or trustee of any ADP of the SNFIndividual06/17/2025
Greatorex, TinaIndividual is an owner, partner or trustee of any ADP of the SNFIndividual06/04/2025
Clinical Consulting Services LLCAdp of the SNFOrganization06/04/2025
Gph Camp Hill West Shore LPAdp of the SNFOrganization02/01/2017
Priority Care Group LLCAdp of the SNFOrganization06/17/2025
Summation Financial Services LLCAdp of the SNFOrganization06/04/2025
Baughman, KevinAdp of the SNFIndividual04/13/2024
Schiowitz, MarcAdp of the SNFIndividual01/01/2019
Tarique, AhmedAdp of the SNFIndividual06/01/2020

As listed in the CMS ownership file, which names owners with a 5% or greater stake and the people and companies with operational or managerial control.

Questions to ask on a visit

Chosen from this home's own inspection record.

  1. How do you prevent falls and pressure injuries, and how are families told when one happens?Inspectors cited 21 problems in this area, most recently on July 1, 2026: "Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents."
  2. When is the care plan meeting, and can family attend it?Inspectors cited 9 problems in this area, most recently on February 9, 2026: "Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards."
  3. How do residents and families raise a complaint or grievance, and how fast is it answered?Inspectors cited 8 problems in this area, most recently on June 1, 2026: "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."
  4. How are medications reviewed, and how often are antipsychotic or sedating drugs used?Inspectors cited 7 problems in this area, most recently on August 7, 2025: "Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures."
  5. Who is on the floor on Saturday and Sunday, and how many residents does each aide care for?Weekend nurse staffing here was 2.87 hours per resident per day, below the Pennsylvania average of 3.53.

Other nursing homes nearby

Pennsylvania contacts for a concern about a nursing home

These are the official offices in Pennsylvania. NursingHomeClear cannot take or act on complaints.

Common questions

What is Gardens at West Shore, the's Medicare star rating?
CMS rates Gardens at West Shore, the 1 out of 5 stars overall, with 1 for health inspections, 4 for staffing and 2 for quality measures (CMS data as of September 1, 2026).
How many deficiencies did Gardens at West Shore, the get at its last inspection?
8 health deficiencies at the standard inspection on August 7, 2025. The Pennsylvania average is 10.
Has Gardens at West Shore, the been fined?
Yes. CMS lists 4 fines totaling $58,069 in the last three years.
Does Gardens at West Shore, the accept Medicaid?
It is certified to take Medicaid (CMS lists it as "Medicare and Medicaid"). Certification does not mean a Medicaid bed is open: ask the admissions office.
Who owns Gardens at West Shore, the?
CMS lists 24 owners and managers, and links the home to Priority Healthcare Group. Legal business name: THE MEADOWS AT WEST SHORE FOR NURSING AND REHABILITATION LLC.

Sources

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