Gracedale Nursing Home has had its provisional license downgraded once again following two inspections by the Pennsylvania Department of Health in September that found operational issues in the facility.
The department rescinded Gracedale’s provisional II license and reissued a six-month provisional III license, according to a news release from Gracedale. The two reports were discussed at an oversight committee meeting last month. This announcement by the county-operated facility follows the recent announcement that Gracedale administrator Michelle Morton was resigning effective Thursday.
The Department of Health does not provide comment outside of what is already in reports.
One inspection that occurred Sept. 24 involved a resident with osteoarthritis, an amputation of the right leg above the knee and phantom limb syndrome.
A physician ordered that the resident needed two staff members to assist her anytime she was transferring and toileting. However, on Sept. 19, a nurse aide tried to move the resident by herself from the toilet to her wheelchair and “let her slide down,” which resulted in the patient fracturing one of her metatarsals.
As a result of the incident, Gracedale reeducated the nurse aide, all resident transfer orders were reviewed, the facility began providing additional training to all aides, auditing was conducted and signs were placed around the facility.
Another inspection that occurred Sept. 10 found that the facility allowed a resident with documented swallowing issues to choke on food.
As an intervention, the resident was supposed to have direct supervision with all meals to ensure they ate slowly and to chew each bite thoroughly. The resident was also on a modified, physician-ordered diet where his food was mechanically altered to be soft, tender, moist and in small, bite-sized pieces.
However, on July 25, another resident, unbeknownst to staff, handed the man a piece of their sandwich, and at 6:07 p.m. the patient started to choke on the sandwich. A nurse spotted the choking resident, whose face was turning pale grey and rescue interventions were attempted. The patient coughed up the sandwich and was transferred to a hospital. There, the resident was diagnosed with acute respiratory failure with hypoxia, meaning body tissue had been deprived of oxygen. The resident returned to the facility Sept. 2.
In response, Gracedale updated the patient’s supervision order during meals to one-to-one supervision and reevaluated the patient’s diet order. Gracedale also forbade the resident who shared their sandwich from sitting near the resident who choked and told him not to share his food anymore.
The facility also reviewed whether other residents may require one-to-one supervision during meals and began auditing compliance of meal supervision.
“Correcting individual findings is not enough,” Northampton County Executive Tara Zrinski said. “We must also examine the systems that allowed additional problems to occur and intend to hire a consultant to review policies, procedures and resident care plans, strengthen our corrective actions, and help demonstrate lasting compliance. Our priority remains the safety and well-being of every resident.”
The state uses a tiered licensing system for nursing care facilities with all licenses either regular or some form of provisional, numbered I through IV. The state issues provisional licenses to facilities if there are numerous deficiencies or a serious, specific deficiency and the facility is not in substantial compliance. The tiers of provisional licenses determine the fee amounts owed by the facility to the state, with regular license holders paying the least and provisional license holders paying more with each ascending tier. These provisional licenses only last six months, at which point the state decides whether to issue a new license.
Gracedale was initially placed on a provisional I license in 2025 after it was cited by the state seven times over the course of the year, including for an incident where a nurse assaulted a patient. In May, it was moved to a provisional II license after there were two incidents involving patients who left the facility.
The move from a provisional II license to a provisional III comes with an increase in fees from $600 for the license and $6 per bed to $800 for the license and $8 per bed.