Tapestry Senior Living Moon Township.

“Two incidents of suspected abuse were not immediately reported to the Department of Aging. First incident: bruising on resident's arm with allegations of abuse; second incident: resident pushed onto couch by staff member. Both incidents were reported internally but not to the Department of Aging verbally or in writing as required by the Older Adults Protective Services Act.”

“Staff member E, who was alleged to have pushed a resident onto a couch, was not immediately suspended and continued working until approximately 2:30 p.m. on the same day. A plan of supervision was not immediately developed and implemented.”

“Two incidents of alleged abuse were not reported to the Department within 24 hours. First incident involving resident bruising was not reported until 2/13/26 at approximately 2:00 p.m. Second incident involving resident being pushed was not reported to the Department as of the morning of inspection.”

“Direct care staff person B shared multiple photographs on Facebook including photographs of a resident's dentures and catheter bag on the floor of a resident's room, violating resident privacy rights despite facility policy prohibiting camera phone use without consent.”

“Two incidents of suspected abuse were not immediately reported to the Department of Aging. First incident: bruising on resident's arm with allegations of abuse; second incident: resident pushed onto couch by staff member. Both incidents were reported internally but not to the Department of Aging verbally or in writing as required by the Older Adults Protective Services Act.”

“Staff member E, who was alleged to have pushed a resident onto a couch, was not immediately suspended and continued working until approximately 2:30 p.m. on the same day. A plan of supervision was not immediately developed and implemented.”

“Two incidents of alleged abuse were not reported to the Department within 24 hours. First incident involving resident bruising was not reported until 2/13/26 at approximately 2:00 p.m. Second incident involving resident being pushed was not reported to the Department as of the morning of inspection.”

“Direct care staff person B shared multiple photographs on Facebook including photographs of a resident's dentures and catheter bag on the floor of a resident's room, violating resident privacy rights despite facility policy prohibiting camera phone use without consent.”

“Emergency exit steps from stairwells A and B at the front of the facility had approximately one-quarter to one-half inch of slushy snow and ice coating, creating a slipping hazard and fall risk. Additionally, a layer of snow and ice approximately one-half inch thick was present on the patio leading from the dining emergency exit to the north side of the building.”

“A resident's support plan indicated a frequency of 'daily' for assistance with transferring and bowel/bladder management, but the facility maintained a separate list indicating checks every 2 hours, creating a discrepancy between the documented support plan and actual service provision.”

“Poisonous materials were not stored in their original, labeled containers. Spray bottles with handwritten labels indicating bleach and Windex were found on a cleaning cart in the lobby without manufacturer labels.”

“Sanitary conditions were not maintained. Feces was smeared on a toilet seat riser, and multiple bathrooms had brown and yellow stains covering toilets, indicating poor sanitation and cleaning practices.”

“Poisonous materials were not stored in their original, labeled containers. Spray bottles with handwritten labels indicating bleach and Windex were found on a cleaning cart in the lobby without manufacturer labels.”

“Sanitary conditions were not maintained. Feces was smeared on a toilet seat riser, and multiple bathrooms had brown and yellow stains covering toilets, indicating poor sanitation and cleaning practices.”

“Annual assessments were not completed accurately. One resident's assessment indicated no problem with agitation and aggression despite documentation and staff interviews showing the resident is easily agitated and aggressive. Another resident's assessment had not been updated to reflect recent falls and family-provided protective equipment, and inaccurately listed areas where the resident required assistance that they actually did not need.”

“A written cognitive preadmission screening was not completed within 72 hours prior to a resident's admission to the special care unit, as required for residents with Alzheimer's disease or dementia.”

“Six boiler certificates expired on 6/1/2023 and were not reinspected until 6/24/2024, in violation of 34 Pa. Code Chapter 3 (Boilers and Unfired Pressure Vessels regulations) which requires valid certificates of operation.”

“The microwave in the memory care kitchenette had food crumbs, food splatter on the inside of the door, dried spills, and approximately 1 inch crust of food on the floor. Additionally, there were no paper towels or other means to dry hands in the common powder room next to the nurses station.”

“In the first floor common women's restroom near Senior Connections hall, the toilet in the first stall had mold around the caulking at the base with a wet floor indicating a possible leak, and the toilet seat in the second stall had a broken hinge making the seat insecure.”

“There was no soap within reach of the bathroom sink in living unit #303.”

“Resident #2 with orders to check blood glucose levels 3 times daily before meals had a Dexcom G6 continuous glucose monitor that was not set up to store readings, preventing the home's staff, healthcare providers, and Department agents from accessing historical data.”

“A resident requiring total physical assistance with transfers and documented need for 2-person assistance was regularly transferred from recliner to wheelchair by only one direct care staff person, contrary to the resident's support plan requirements.”

“A resident entered another resident's bedroom, pulled them from bed, and dragged them across the floor, resulting in multiple injuries including skin tears to both forearms, facial contusion, and thoracic spine contusion. The injured resident was transported to the hospital for treatment.”