Lutheran Home at Hollidaysburg

916 Hickory Street · Hollidaysburg, PA · 16648 · 8146964527

89 certified beds Non profit - Church related Part of a CCRC

  • Staffing hours comfortably above national benchmarks.
  • Inspection results have improved across recent cycles.

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Red flags

2 abuse-related citations at the actual-harm level

Inspectors cited failures in the abuse-prevention rules (F600–F610) that resulted in actual harm to a resident.

Score breakdown

Inspection record 30% of score 50
Serious harm & abuse 20% 68
Staffing 20% 80
Federal penalties 15% 47
Trend 10% 77
Context 5% 100

Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.

CMS ratings & staffing

Overall: 2 of 5 Inspections: 2 of 5 Staffing: 4 of 5 Quality measures: 4 of 5

Total nurse hours / resident-day4.033.48 min · 4.1 strong
RN hours / resident-day0.890.55–0.75
Weekend hours / resident-day3.71≈ weekday level
Nursing turnover / year48%median 45%
Fines (3-yr window)2 · $101,905

Inspection citations (39 in the current record)

  • Potential for harm · D December 10, 2025

    Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

    Corrected December 18, 2025 · Resident Assessment and Care Planning

  • Potential for harm · D December 10, 2025

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

    Corrected December 18, 2025 · Quality of Life and Care

  • Potential for harm · D December 10, 2025

    Provide appropriate pressure ulcer care and prevent new ulcers from developing.

    Corrected December 18, 2025 · Quality of Life and Care

  • Potential for harm · D December 10, 2025

    Observe each nurse aide's job performance and give regular training.

    Corrected December 18, 2025 · Nursing and Physician Services

  • Potential for harm · D December 10, 2025

    Ensure that residents are free from significant medication errors.

    Corrected December 18, 2025 · Pharmacy Service

  • Potential for harm · D December 10, 2025

    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

    Corrected December 18, 2025 · Nutrition and Dietary

  • Potential for harm · D December 10, 2025

    Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members.

    Corrected December 18, 2025 · Administration

  • Potential for harm · D December 10, 2025

    Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents.

    Corrected December 18, 2025 · Resident Rights

  • Potential for harm · D December 10, 2025

    Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.

    Corrected December 18, 2025 · Freedom from Abuse, Neglect, and Exploitation

  • Potential for harm · D December 10, 2025

    Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.

    Corrected December 18, 2025 · Administration

  • Potential for harm · D December 10, 2025

    Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program.

    Corrected December 18, 2025 · Infection Control

  • Potential for harm · D December 10, 2025

    Provide training in compliance and ethics.

    Corrected December 18, 2025 · Administration

  • Potential for harm · D December 10, 2025

    Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.

    Corrected December 18, 2025 · Nursing and Physician Services

  • Potential for harm · D December 10, 2025

    Provide behavior health training consistent with the requirements and as determined by a facility assessment.

    Corrected December 18, 2025 · Administration

  • Potential for harm · D September 12, 2024

    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.

    Corrected November 1, 2024 · Resident Rights

  • Potential for harm · E September 12, 2024

    Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.

    Corrected November 1, 2024 · Resident Rights

  • Potential for harm · D September 12, 2024

    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

    Corrected November 1, 2024 · Resident Assessment and Care Planning

  • Potential for harm · E September 12, 2024

    Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

    Corrected November 1, 2024 · Resident Assessment and Care Planning

  • Potential for harm · D September 12, 2024

    Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.

    Corrected November 1, 2024 · Quality of Life and Care

  • Potential for harm · D September 12, 2024

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

    Corrected November 1, 2024 · Quality of Life and Care

  • Potential for harm · D September 12, 2024

    Provide appropriate pressure ulcer care and prevent new ulcers from developing.

    Corrected November 1, 2024 · Quality of Life and Care

  • Potential for harm · E September 12, 2024

    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

    Corrected November 1, 2024 · Quality of Life and Care

  • Potential for harm · D September 12, 2024

    Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

    Corrected November 1, 2024 · Quality of Life and Care

  • Potential for harm · D September 12, 2024

    Provide enough food/fluids to maintain a resident's health.

    Corrected November 1, 2024 · Quality of Life and Care

  • Potential for harm · D September 12, 2024

    Verify that a nurse aide has been trained; and if they haven't worked as a nurse aide for 2 years, receive retraining.

    Corrected April 5, 2024 · Nursing and Physician Services

Showing the 25 most recent. The Safety Report includes every citation with full findings.

Federal penalties

DateTypeAmount / length
June 25, 2024Fine$11,132
October 12, 2023Fine$90,773

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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 395427 · certified since June 1, 1979. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.