Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record

LUTHERAN HOME AT HOLLIDAYSBURG

HOLLIDAYSBURG, PA · 89 certified beds · Last Life Safety survey December 10, 2025

CMS Certification Number 395427 · first certified June 1979

Ownership

Independently operated (no chain recorded by CMS) · Non profit - Church related

No change of ownership on CMS record since January 1, 2016, when the records begin.

7
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
0
Tags cited more than once
Across separate surveys
3
Inspection & testing records
Of the citations on file

Position within PA

7 citations — more than 35% of the 656 certified nursing homes in PA. Compared within PA rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated

Slippingmore citations at the latest survey than at its earlier surveys in the window.

The latest survey found 0 citations; the earlier surveys in the window averaged 3.5. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

The window opens October 2026 — about 1 month from now. This facility’s last Life Safety survey was December 2025. Facilities in PA are typically surveyed 10–12 months after the last one (median 11), measured over 1,113 consecutive surveys in the last two years of CMS records.

A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured

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Which alerts

Emergency preparedness

1 of the 7 citations on file is Emergency Preparedness E-tags. E-tags are cited under 42 CFR §483.73 and concern the emergency plan, training, drills, communications and supplies. Nationally about half of certified facilities have at least one. The Emergency Preparedness Index

Physical environment (health survey)

4 physical-environment citations on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 7 Life Safety citations above. The Physical Environment Index

  • F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  • F-0880 Provide and implement an infection prevention and control program.

How that compares

Citations on file over three years

Compared with the median facility in PA, and nationally. Surveyors differ markedly between states, so the PA figure is the meaningful one.

This facility7PA median10National median11
Citations on file over three years, compared
MeasureCitations
This facility7
Median facility in PA10
Median facility nationally11

Survey history

Citations at each Life Safety survey
22023-1052024-0902025-12
Citations at each Life Safety survey
Survey dateCitations
October 12, 20232
September 12, 20245
December 10, 20250

Most-cited tags

Most-cited tags at this facility
K-03721K-02111K-03531K-03211E-00391K-09201K-09231
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.12023-10-12
K-0211Keep aisles, corridors, and exits free of obstruction in case of emergency.12024-09-12
K-0353Inspect, test, and maintain automatic sprinkler systems.12024-09-12
K-0321Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.12024-09-12
E-0039Conduct testing and exercise requirements.12024-09-12
K-0920Ensure proper usage of power strips and extension cords.12024-09-12
K-0923Have proper medical gas storage and administration areas.12023-10-12

What the citations cover

Citations by CMS category
  • Smoke Deficiencies 3
  • Gas, Vacuum, and Electrical Systems Deficiencies 2
  • Emergency Preparedness Deficiencies 1
  • Egress Deficiencies 1
Citations by CMS category
CategoryCitations
Smoke Deficiencies3
Gas, Vacuum, and Electrical Systems Deficiencies2
Emergency Preparedness Deficiencies1
Egress Deficiencies1

Every citation on file

As published by CMS, newest survey first. Descriptions are CMS’s own wording.

September 12, 2024 — 5 citations

Citations issued on September 12, 2024
TagWhat the surveyor checksStatus
E-0039Conduct testing and exercise requirements.Deficient, Provider has date of correction (November 2, 2024)
K-0211Keep aisles, corridors, and exits free of obstruction in case of emergency.Deficient, Provider has date of correction (November 2, 2024)
K-0321Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.Deficient, Provider has date of correction (November 2, 2024)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (November 2, 2024)
K-0920Ensure proper usage of power strips and extension cords.Deficient, Provider has date of correction (November 2, 2024)

October 12, 2023 — 2 citations

Citations issued on October 12, 2023
TagWhat the surveyor checksStatus
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.Deficient, Provider has date of correction (November 15, 2023)
K-0923Have proper medical gas storage and administration areas.Deficient, Provider has date of correction (November 15, 2023)

Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.