Pa. DOH - Gracedale Had Yet Another Elopement, a Dishonest LPN and a Resident Who Probably Does Not Belong There

Although NorCo Exec Tara Zrinski should be commended for an ambitious if expensive plan to save Gracedale, the fact remains that the beleaguered home in serios trouble. It was downgraded from a regular to a Provisional I license late last year, and that has recently been downgraded to a Provisional II. Gracedale is the only nursing home in the state with a Provisional II license, and as Council member Dave Holland has warned, this could result in serious repercussions. The state could bar the home from accepting new residents, could stop Medicaid and Medicare reimbursement or take over the facility with more competent management than it has had. 

This downgrade is undoubtedly due to a DOH inspection on May 16, which you can read for yourself here. It is a damning indictment of the home's management. For the fourth time, a resident just walked out of the facility and was gone for five hours before a police officer called at 1 am. An agency LPN falsified her reports. And another resident who for some reason is allowed to come and go as he pleases as per his doctor, appears to be bringing in booze and drugs and is getting loaded, high or both. 

In a recent report to NorCo Council, Exec Tara Zrinski claimed that the root cause of all these issues occurred because the county was too lax about who it admitted. She said all that changed when Michelle Morton came aboard as Administrator. 

Zrinski is wrong. The resident who took a powder (he's called Resident 1) was first admitted to Gracedale in December 2025. At that time, Michelle Morton had already been administrator for nine months. 

On May 13, Resident 1 decided to wander off  at around 5 pm. Though two CNAs noticed that Resident 1 was missing and reported this to an agency LPN responsible for this resident. She did nothing to alert anyone that he was missing. She instead documented that she had given him prescribed medications, even though he was not there. She also reported bogus blood glucose levels and then scratched them out, falsely claiming that he had declined the test. 

In the meantime, Resident 1 had somehow made it from Gracedale to outside of Nazareth's police station, about 1.5 miles away. A police officer noticed him milling about around 10 pm and called facility to see if anyone was missing. 

Once again, Gracedale allowed a resident to just walk off. What's worse, an agency LPN falsely documented that he had received prescribed medications and falsely reported blood glucose levels. 

Resident 2 was admitted to Gracedale before Michelle Morton's time, and I have to wonder why on earth he was admitted. He had a history of drug and alcohol abuse."I am a biker," he told one nurse. That's what we do; we drink, smoke, play pool, and party." He also had a habit of pocketing narcotics provided to him for "pain." For reasons that mystify me, his doctor allowed him to go on "independent leaves of absence," during which he could have been selling those pocketed meds, which include oxycodone. He would return to the facility smelling of booze and would be belligerent and exhibit violent behavior. 

After one of these episodes, a nurse cleaning his room found the following items in a wrapped up blanket: " 12 to 15 marijuana vape cartridges, one bottle of Smirnoff vodka, two 12 ounce (oz) empty bottles of Fireball, one 12 oz empty bottle of Southern Comfort whiskey, a large hunting knife, a wallet with $43.00 and cards, and a container of Resident 2's untaken prescribed medications, which were identified by the pharmacist as six allopurinol 100 mg tablets (prevents and lowers uric acid levels), one atorvastatin 20 mg tablet (used to lower cholesterol), two duloxetine 60 mg capsules (antidepressant), eight gabapentin 400 mg capsules (pain medication), two loratadine 10 mg tablets (allergy medication), 36 melatonin 5 mg tablets (natural sleep aid), one multivitamin tablet, 27 oxycodone 10 mg tablets (opioid), 11 of which were partially dissolved, two ropinirole 1 mg tablets (used to treat restless leg syndrome) , tablet of trazadone 150 mg (antidepressant), two vitamin D3 capsules, one Tylenol 325 mg tablet, and two Tessalon Perles (cough medication). The police confiscated the vape, cartridges, and knife."

This guy is a walking pharmacy! 

He was also caught on one occasion snorting what he said was antifungal powder. 

The DOH concluded that Gracedale failed to prevent Resident 2 from pocketing medications that were administered, returning to the facility intoxicated more than once, and having narcotic medications, illegal marijuana vape cartridges, alcohol, and a weapon in a room shared with other residents. This is an  Immediate Jeopardy situation, meaning that residents are at risk of serious injury, harm, impairment, or death, requiring immediate corrective action.

DOH was responding to one complaint and two reported incidents, which tell me that Gracedale, to its credit, turned itself in.