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Locust Grove Retirement Village

69 Cottage Road, Mifflin, PA 17058 · Juniata County · (717) 436-8921

104 certified beds, about 66 residents a day · For profit - Limited Liability company · Medicare and Medicaid since 1976

Certified for Medicaid Certified for Medicare
Overall
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
4 of 5

CMS Care Compare ratings, data as of September 1, 2026 · CCN 395350 · See it on Medicare.gov · Compare with other homes

The record in brief

At its most recent standard inspection, on July 10, 2026, inspectors cited 4 health deficiencies (the Pennsylvania average is 10, the national average 9.2).

Of 32 health citations since May 2024, 1 was rated as actual harm or immediate jeopardy to residents.

CMS lists 1 fine totaling $12,831 in the last three years; the largest was $12,831, and the latest is dated May 3, 2024.

Nurses and nurse aides worked 3.91 hours per resident per day, against 3.89 across Pennsylvania and 3.86 nationally. Registered nurses accounted for 0.60 of those hours.

34.3% of nursing staff left within the year CMS measured (Pennsylvania average 44.5%).

CMS links it to Avardis Health, an affiliated group of 38 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 32 health citations on file.

Severity
Isolated
Pattern
Widespread
Immediate jeopardy
0J
0K
0L
Actual harm
1G
0H
0I
Potential for more than minimal harm
24D
7E
0F
Potential for minimal harm
0A
0B
0C
July 10, 2026Standard inspection · 4 citations
  1. 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) August 6, 2026
    Inspectors wroteBased on observation and staff interview, it was determined that the facility failed to store food in accordance with professional standards for food service safety in the facility's main kitchen.
  2. 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 · Corrected (the home has a date of correction) August 6, 2026
    Inspectors wroteBased on observation and staff interview, it was determined that the facility failed to maintain adequate maintenance services to ensure a clean, comfortable, orderly, and homelike environment on one of four nursing units (100 Hall) and in facility's main activity room. Findings Include: Observations on July 8, 2026, at 11:15 AM of the activity room revealed residents were gathered around the tables. Large brown stains were noted scattered on the ceiling at various areas, the largest area was roughly round and measuring two feet in diameter. A dried brown area was also noted in the fluorescent light fixture. Further observation revealed there was water gathering on the ceiling and dripping into a bucket that was located between two tables with residents gathered around them. [...]
  3. D
    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
    F656 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) August 6, 2026
    Inspectors wroteBased on clinical record review and resident and staff interview, it was determined that the facility failed to develop a comprehensive person-centered care plan regarding dementia care for two of two residents reviewed (Residents 8 and 10). Findings Include: Clinical record review for Resident 8 revealed they had an active diagnosis of unspecified dementia (decline in cognitive ability) , unspecified severity, with other behavioral disturbance that was initiated on November 29, 2022. Further review of Resident 8's clinical record revealed a care plan (an outline of an individual's health needs, specific care requirements, and the actions necessary to achieve desired health outcomes) focus area initiated for the resident's impaired cognitive function updated May 15, 2026. [...]
  4. 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) August 6, 2026
    Inspectors wroteBased on clinical record review, observation, and resident and staff interview, it was determined that the facility failed to ensure a medication error rate of less than five percent (Residents 38 and 72).
June 27, 2025Standard inspection, Complaint inspection · 8 citations
  1. 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) August 22, 2025
    Inspectors wroteBased on clinical record review and staff interview, it was determined that the facility failed to provide the highest practicable care regarding physician ordered medication parameters for two of 17 residents reviewed (Residents 32 and 51) and failed to provide comprehensive skin assessments that are consistent with professional standards of practice, to promptly identify skin changes and to promote healing for one of three residents reviewed for skin condition concerns (Resident 1).
  2. E
    Provide safe, appropriate pain management for a resident who requires such services.
    F697 · Quality of Life and Care · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) August 22, 2025
    Inspectors wroteBased on clinical record review and staff interview, it was determined that the facility failed to provide the highest practicable care regarding physician ordered pain medications for one of three residents reviewed (Resident 32)
  3. D
    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
    F656 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) August 22, 2025
    Inspectors wroteBased on clinical record review and staff interview, it was determined that the facility failed to implement a comprehensive person-centered care plan regarding behaviors for one out of three residents reviewed for behaviors (Resident 54). Findings Include: Review of Resident 54's clinical record revealed that the facility admitted her on March 14, 2023. A Minimum Data Set Assessment (MDS, an assessment completed at specific intervals to determine care needs) dated March 20, 2023, indicated that the facility assessed her as having behaviors, such as refusal of care and agitation. The facility implemented a plan of care to address Resident 54's behaviors on March 17, 2023. There was no documented evidence in Resident 54's plan of care regarding interventions for staff to utilize if Resident 54 exhibits those behaviors during care. [...]
  4. 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) August 22, 2025
    Inspectors wroteBased on clinical record review, observations, and staff interview, it was determined that the facility failed to implement preventative measures to prevent pressure ulcers for one of three residents reviewed for pressure ulcer concerns (Resident 67).
  5. 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) August 22, 2025
    Inspectors wroteBased on observation, clinical record review, and staff and resident interview, it was determined that the facility failed to implement a physician ordered device utilized to prevent further decline in range of motion for one of five residents reviewed (Residents 5).
  6. 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) August 22, 2025
    Inspectors wroteBased on clinical record review, review of facility documentation, and staff interview, it was determined that the facility failed to thoroughly investigation a resident's accident in an attempt to prevent future incidents and implement interventions to prevent falls injuries for one of five residents reviewed for falls (Resident 3).
  7. D
    Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder.
    F742 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) August 22, 2025
    Inspectors wroteBased on review of select facility policies, clinical record review, observation, and staff interview, it was determined that the facility failed to implement physician ordered interventions for a resident's suicidal ideations for one of one resident reviewed (Resident 31).
  8. D
    Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.
    F744 · 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) August 22, 2025
    Inspectors wroteBased on clinical record review and staff interview, it was determined that the facility failed to develop and implement an individualized person-centered care plan to address dementia and cognitive loss displayed by one of 3 residents reviewed (Resident 67).
October 9, 2024Complaint inspection · 1 citation
  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) November 15, 2024
    Inspectors wroteBased on clinical record review, observation, and resident and staff interview, it was determined that the facility failed to provide the highest practicable care regarding physician ordered medications for five of five residents (Residents 1, 2, 3, 4, and 5) and provide incontinence care for one of five residents reviewed (Resident 1).
June 18, 2024Complaint inspection · 1 citation
  1. D
    Provide routine and 24-hour emergency dental care for each resident.
    F790 · 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) July 5, 2024
    Inspectors wroteBased on clinical record review and staff interview it was determined that the facility failed to obtain dental care for one of six residents reviewed for dental concerns (Resident 1).
May 3, 2024Standard inspection, Complaint inspection · 18 citations
  1. 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 · Past noncompliance: already fixed when inspectors found it
    Inspectors wroteBased on observation, clinical record review, review of facility documents, and resident and staff interview, it was determined that the facility failed to protect the rights of a resident to be free from neglect by not providing the services necessary to avoid physical harm related to a sustained fracture on one of two nursing units, (Unit 100-300, Resident 33). This deficiency is cited as past noncompliance
  2. 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) June 14, 2024
    Inspectors wroteBased on clinical record review and resident and staff interview, it was determined that the facility failed to provide bathing assistance for a resident dependent on staff assistance for five of seven residents reviewed for activities of daily living (Residents 33, 39, 47, 52, and 63).
  3. E
    Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
    F725 · 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) June 14, 2024
    Inspectors wroteBased on clinical record review, review of facility documents, and resident, family member, and staff interview, it was determined that the facility failed to have sufficient nursing staff to meet resident's needs for four of 24 residents reviewed (Resident 28, 33, 52, and 64).
  4. E
    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, pattern · Corrected (the home has a date of correction) June 14, 2024
    Inspectors wroteBased on observation, review of select policies and procedures, and staff interview, it was determined that the facility failed to secure medications and biologicals on one of two nursing units (One, Two, Three Hall nursing unit).
  5. 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) June 14, 2024
    Inspectors wroteBased on review of select facility policies and procedures, observation, clinical record review, and resident and staff interview, it was determined that the facility failed to implement appropriate enhanced barrier transmission-based precautions on two of two nursing units (400, and 100/200/300 nursing unit; Residents 65, 74, 231, and 232).
  6. D
    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, isolated · Corrected (the home has a date of correction) June 14, 2024
    Inspectors wroteBased on clinical record review and staff interview, it was determined that the facility failed to establish clear and consistent resident's wishes regarding advance directives (written instruction, such as a living will or durable power of attorney, relating to the provision of healthcare, for a time when a resident may be incapacitated and not able to make decisions) for one of one resident reviewed (Resident 16).
  7. 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 · Corrected (the home has a date of correction) June 14, 2024
    Inspectors wroteBased on review of select facility policies and procedures, clinical record review, and family and staff interview, it was determined that the facility failed to ensure reasonable care for the protection of the resident's property for one of 18 residents reviewed (Resident 228).
  8. D
    Develop and implement policies and procedures to prevent abuse, neglect, and theft.
    F607 · Freedom from Abuse, Neglect, and Exploitation · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) June 14, 2024
    Inspectors wroteBased on a review of select facility policies and procedures, employee personnel record review, and staff interview, it was determined that the facility failed to obtain attestation of Pennsylvania residency as required for one of five personnel records reviewed (Employee 3).
  9. D
    Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
    F655 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) June 14, 2024
    Inspectors wroteBased on clinical record review and staff, resident, and family interview, it was determined that the facility failed to provide the resident and their representative a summary of the baseline care plan for two of 24 residents reviewed (Residents 228 and 231).
  10. 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) June 14, 2024
    Inspectors wroteBased on clinical record review and resident and staff interview, it was determined that the facility failed to provide the highest practicable care related to intravenous access and medication administration for one of two residents reviewed for intravenous access concerns (Resident 74); implementation of interventions for one of four residents reviewed for skin conditions (Resident 231); and bowel protocol medications for one of one resident reviewed for constipation concerns (Resident 231).
  11. 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) June 14, 2024
    Inspectors wroteBased on clinical record review, observation, and staff interview, it was determined that the facility failed to assess a blister for one of three residents reviewed (Resident 10).
  12. 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) June 14, 2024
    Inspectors wroteBased on clinical record review and staff interview, it was determined that the facility failed to provide services to maintain a resident's range of motion for one of three residents reviewed (Residents 39).
  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) June 14, 2024
    Inspectors wroteBased on clinical record review and staff interview, it was determined that the facility failed to implement interventions to maintain acceptable parameters of nutritional status for one of six residents reviewed for nutritional concerns (Resident 233).
  14. 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) June 14, 2024
    Inspectors wroteBased on clinical record review and staff and resident interview, it was determined that the facility failed to identify triggers related to a resident's diagnosis of Post-Traumatic Stress Disorder, to provide culturally, competent, trauma-informed care, and to eliminate or mitigate re-traumatization for one of five residents reviewed for mood/behavior (Resident 3).
  15. D
    Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
    F726 · Nursing and Physician Services · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) June 14, 2024
    Inspectors wroteBased on review of select facility policies and procedures, observation, and review of personnel records, it was determined that the facility failed to ensure specific competencies necessary to care for resident needs for one of two residents reviewed for intravenous access concerns (400 hall nursing unit, Resident 74, Employee 7).
  16. D
    Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.
    F744 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) June 14, 2024
    Inspectors wroteBased on clinical record review and staff interview, it was determined that the facility failed to develop and implement individualized person-centered care plans to address dementia and cognitive loss displayed by one of two residents reviewed (Resident 3).
  17. 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) June 14, 2024
    Inspectors wroteBased on clinical record review and staff interview, it was determined that the facility failed to ensure a resident's medication regime was free from potentially unnecessary medications for one of five residents reviewed for medication regime review (Resident 3).
  18. 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) June 14, 2024
    Inspectors wroteBased on review of select facility policies and procedures, observation, and staff interview, it was determined that the facility failed to ensure a medication error rate below five percent (100/200/300 hall nursing unit, Residents 62 and 15).

Fire safety inspections

11 fire safety citations on file: 2 on June 27, 2025, 6 on May 3, 2024, 3 on August 4, 2023.

Every fire safety citation11 citations
  1. F
    Install corridor and hallway doors that block smoke.
    K 363 · June 27, 2025 · Corrected (the home has a date of correction)
  2. 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 · June 27, 2025 · Corrected (the home has a date of correction)
  3. F
    Inspect, test, and maintain automatic sprinkler systems.
    K 353 · May 3, 2024 · Corrected (the home has a date of correction)
  4. 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 3, 2024 · Corrected (the home has a date of correction)
  5. E
    Have power receptacles that are properly grounded.
    K 912 · May 3, 2024 · Corrected (the home has a date of correction)
  6. C
    Conduct risk assessment and an All-Hazards approach.
    E 6 · May 3, 2024 · Corrected (the home has a date of correction)
  7. C
    Meet other general requirements.
    K 100 · May 3, 2024 · Corrected (the home has a date of correction)
  8. C
    Provide properly protected cooking facilities.
    K 324 · May 3, 2024 · Corrected (the home has a date of correction)
  9. 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 · August 4, 2023 · Corrected (the home has a date of correction)
  10. E
    Ensure proper usage of power strips and extension cords.
    K 920 · August 4, 2023 · Corrected (the home has a date of correction)
  11. C
    Have generator or other power source capable of supplying service within 10 seconds.
    K 918 · August 4, 2023 · Corrected (the home has a date of correction)

Fines and payment denials

DatePenaltyAmount or length
May 3, 2024Fine $12,831

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)3.913.893.86
Registered nurses0.600.790.69
All nursing staff on weekends3.243.533.42
Nurse aides2.15
Licensed practical nurses1.16
Nursing staff turnover (share who left in a year)34.3%44.5%45.8%
Registered nurse turnover25.0%39.9%42.9%
Administrators who left1

CMS expects 3.52 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 4.18 on weekdays and 3.24 on weekends, 22% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 18.9% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 3.38 in April to June 2025 to 3.91 in January to March 2026.

QuarterAll nursing staffRegistered nursesWeekdaysWeekendsContract staff shareDays with no RN hoursResidents a day
Jan to Mar 20263.910.604.183.24 18.9%0 of 9066
Oct to Dec 20253.960.554.253.25 23.2%0 of 9270
Jul to Sep 20253.850.604.143.11 24.6%0 of 9267
Apr to Jun 20253.380.613.632.78 20.7%0 of 9167
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
12.716.813.9
Percentage of long-stay residents with a catheter inserted and left in their bladder
Long Stay residents, 2025Q2-2026Q1
0.00.70.8
Percentage of long-stay residents with a urinary tract infection
Long Stay residents, 2025Q2-2026Q1
1.21.41.6
Percentage of long-stay residents experiencing one or more falls with major injury
Long Stay residents, 2025Q2-2026Q1
4.03.13.2
Percentage of short-stay residents who newly received an antipsychotic medication
Short Stay residents, 2025Q2-2026Q1
0.01.41.6
Percentage of long-stay residents whose ability to walk independently worsened
Long Stay residents, 2025Q2-2026Q1
10.917.014.1
Percentage of long-stay residents with pressure ulcers
Long Stay residents, 2025Q2-2026Q1
2.34.84.6
Percentage of long-stay residents who received an antipsychotic medication
Long Stay residents, 2025Q2-2026Q1
25.517.715.4
Percentage of short-stay residents who were rehospitalized after a nursing home admission
Short Stay residents, 20250101-20251231
24.122.523.8
Percentage of short-stay residents who had an outpatient emergency department visit
Short Stay residents, 20250101-20251231
9.49.512.0
Number of hospitalizations per 1000 long-stay resident days
Long Stay residents, 20250101-20251231
1.21.61.9
Number of outpatient emergency department visits per 1000 long-stay resident days
Long Stay residents, 20250101-20251231
1.01.21.8

Owners and operators

Legal business name: 69 COTTAGE ROAD OPCO LLC. CMS links this home to Avardis Health, a group of 38 nursing homes averaging 2 stars overall.

NameRoleTypeShareSince
Mifflin Parentco LLC5% or greater direct ownership interestOrganization100%05/01/2025
Juniata Holdco LLC5% or greater indirect ownership interestOrganization05/01/2025
Paop Holdco LLC5% or greater indirect ownership interestOrganization05/01/2025
Mifflin Re Owner, LLC5% or greater security interestOrganization05/01/2025
Clark, AlyssaManaging control - governing bodyIndividual05/01/2025
Hoback, TiffanyManaging control - governing bodyIndividual05/01/2025
SNF Mgr LLCOperational/managerial controlOrganization05/01/2025
Clark, AlyssaOperational/managerial controlIndividual05/01/2025
Criag, MicheleOperational/managerial controlIndividual05/01/2025
Hoback, TiffanyOperational/managerial controlIndividual05/01/2025
Jones, TequillaOperational/managerial controlIndividual05/01/2025
Roscoe, BrandonOperational/managerial controlIndividual05/01/2025
Simpson, LouannOperational/managerial controlIndividual05/01/2025
Mifflin Re Owner, LLCAdp of the SNFOrganization05/01/2025
SNF Mgr LLCAdp of the SNFOrganization04/11/2025
Clark, AlyssaAdp of the SNFIndividual05/01/2025
Criag, MicheleAdp of the SNFIndividual05/01/2025
Hoback, TiffanyAdp of the SNFIndividual05/01/2025
Jones, TequillaAdp of the SNFIndividual05/01/2025
Roscoe, BrandonAdp of the SNFIndividual05/01/2025
Simpson, LouannAdp of the SNFIndividual05/01/2025

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 16 problems in this area, most recently on June 27, 2025: "Provide appropriate treatment and care according to orders, resident’s preferences and goals."
  2. How are medications reviewed, and how often are antipsychotic or sedating drugs used?Inspectors cited 4 problems in this area, most recently on July 10, 2026: "Ensure medication error rates are not 5 percent or greater."
  3. How do residents and families raise a complaint or grievance, and how fast is it answered?Inspectors cited 3 problems in this area, most recently on July 10, 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. When is the care plan meeting, and can family attend it?Inspectors cited 3 problems in this area, most recently on July 10, 2026: "Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured."
  5. Who is on the floor on Saturday and Sunday, and how many residents does each aide care for?Weekend nurse staffing here was 3.24 hours per resident per day, below the Pennsylvania average of 3.53.
  6. How long has the current administrator been here?CMS counts 1 administrator who left in the period it measured.

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Common questions

What is Locust Grove Retirement Village's Medicare star rating?
CMS rates Locust Grove Retirement Village 3 out of 5 stars overall, with 3 for health inspections, 4 for staffing and 4 for quality measures (CMS data as of September 1, 2026).
How many deficiencies did Locust Grove Retirement Village get at its last inspection?
4 health deficiencies at the standard inspection on July 10, 2026. The Pennsylvania average is 10.
Has Locust Grove Retirement Village been fined?
Yes. CMS lists 1 fine totaling $12,831 in the last three years.
Does Locust Grove Retirement Village 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 Locust Grove Retirement Village?
CMS lists 21 owners and managers, and links the home to Avardis Health. Legal business name: 69 COTTAGE ROAD OPCO LLC.

Sources

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