Elizabethtown Nursing and Rehabilitation

Name: Elizabethtown Nursing and Rehabilitation
Address: 141 HEISEY AVENUE, Elizabethtown, PA, 17022, US
Telephone: 7173671831

141 Heisey Avenue, Elizabethtown, PA 17022 · Lancaster County · 45 certified beds · avg 41 residents/day · certified since Mar 1, 1991

2/5

Health inspection rating (on-site)

Serious findings on record

Fines, last 3 years

3.44

Nurse hours/resident/day (adjusted)

What health inspectors found (on-site government inspections — the most independent evidence available)

Health inspection rating: ★★☆☆☆2/5 · CMS overall rating: 2/5

The health inspection star above is graded on a curve within each state — a set share of each state's facilities gets each star level — so a facility can have few citations and still rate 2–3 stars if others in its state did even better. The overall rating combines that inspection score with staffing and self-reported quality measures.

All citations in the current public record (44)

CMS publishes roughly the last three inspection cycles plus recent complaint investigations. Older surveys drop out of the record as new ones are completed.

Date	Severity	What the facility was cited for
Jun 18, 2025	E · Potential for harm, repeated	The facility did not provide required paperwork or notices about a resident's needs, their right to appeal a transfer or discharge, or the facility's bed-hold policy (how long a bed is saved during a hospital stay).
Jun 18, 2025	E · Potential for harm, repeated	The facility did not develop a resident's complete plan of care within 7 days of the full assessment, or the plan wasn't prepared, reviewed, and updated by a team of health professionals as required.
Jun 18, 2025	E · Potential for harm, repeated	The facility did not observe each nurse aide's job performance or provide regular training as required.
Jun 18, 2025	D · Potential for harm, one-off	The facility did not accurately assess a resident's health and needs. Assessments are the foundation for all the care a resident receives.
Jun 18, 2025	D · Potential for harm, one-off	The facility did not create and follow a basic care plan covering a new resident's most immediate needs within 48 hours of admission. The first days are when a new resident is most vulnerable.
Jun 18, 2025	D · Potential for harm, one-off	The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Jun 18, 2025	D · Potential for harm, one-off	The facility did not provide enough food and fluids to keep residents healthy, such as preventing unplanned weight loss or dehydration.
Jun 18, 2025	D · Potential for harm, one-off	The facility did not provide care that took into account residents' past trauma or their cultural backgrounds. Care is supposed to be sensitive to what residents have lived through and where they come from.
Jun 18, 2025	D · Potential for harm, one-off	The facility did not label drugs according to professional standards or did not store them in locked compartments, with controlled drugs (medications with a high risk of misuse) kept under a separate lock.
Jun 18, 2025	D · Potential for harm, one-off	The facility did not protect residents' personal information or did not keep complete, accurate medical records that meet professional standards.
Mar 4, 2025	D · Potential for harm, one-off	The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. · from a complaint
Jul 18, 2024	F · Potential for harm, facility-wide	The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide.
Jul 18, 2024	F · Potential for harm, facility-wide	The facility did not designate a qualified infection preventionist — a trained person responsible for running the infection prevention and control program.
Jul 18, 2024	E · Potential for harm, repeated	The facility did not honor residents' rights to request, refuse, or stop treatment, to decline participation in medical research, or to make an advance directive — a written statement of their wishes for future medical care.
Jul 18, 2024	E · Potential for harm, repeated	The facility did not honor residents' right to voice complaints without discrimination or retaliation, or did not have a working complaint process that resolves issues promptly.
Jul 18, 2024	E · Potential for harm, repeated	The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards.
Jul 18, 2024	E · Potential for harm, repeated	The facility did not have a working program to monitor how antibiotics are used. Tracking antibiotic use helps make sure these drugs are given only when needed and remain effective.
Jul 18, 2024	E · Potential for harm, repeated	The facility did not develop and follow policies and procedures for offering residents flu and pneumonia vaccinations.
Jul 18, 2024	E · Potential for harm, repeated	The facility did not educate residents and staff about COVID-19 vaccination, offer the vaccine to those eligible after that education, or properly document everyone's vaccination status.
Jul 18, 2024	D · Potential for harm, one-off	The facility did not post the names, addresses, and phone numbers of state agencies and advocacy groups, along with a notice that residents may file complaints with the state survey agency.
Jul 18, 2024	D · Potential for harm, one-off	The facility did not make its inspection results easy for residents to see, or made it hard for residents to contact advocacy agencies like the ombudsman.
Jul 18, 2024	D · Potential for harm, one-off	The facility did not give residents proper notice about what Medicare or Medicaid covers, or about charges the resident might owe for services that aren't covered.
Jul 18, 2024	D · Potential for harm, one-off	The facility did not give residents (and their representatives and the ombudsman, a state advocate for residents) proper advance notice before a transfer or discharge, including information about their right to appeal.
Jul 18, 2024	D · Potential for harm, one-off	The facility did not give the resident or their representative written notice of how long it would hold the resident's bed during a hospital stay or approved leave.
Jul 18, 2024	D · Potential for harm, one-off	The facility did not develop or follow a complete care plan for each resident — the written roadmap covering all of a resident's needs, with measurable goals and timelines.
Jul 18, 2024	D · Potential for harm, one-off	The facility provided care that did not meet professional standards of quality — the accepted standards that nurses and other clinicians are expected to follow.
Jul 18, 2024	D · Potential for harm, one-off	The facility did not provide safe and appropriate respiratory care — such as oxygen, breathing treatments, or care for residents on breathing equipment — for residents who needed it.
Jul 18, 2024	D · Potential for harm, one-off	The facility did not have a licensed pharmacist review each resident's complete medication regimen and medical chart every month, or did not follow its own rules for reporting medication problems.
Jul 18, 2024	D · Potential for harm, one-off	The facility did not label drugs according to professional standards or did not store them in locked compartments, with controlled drugs (medications with a high risk of misuse) kept under a separate lock.
Jul 18, 2024	D · Potential for harm, one-off	The facility's quality committee — the internal group responsible for finding and fixing care problems — did not have the required members or did not meet at least every three months.
Sep 28, 2023	D · Potential for harm, one-off	The facility did not properly plan a resident's discharge to meet the resident's goals and needs after leaving. · from a complaint
Aug 17, 2023	E · Potential for harm, repeated	The facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors.
Aug 17, 2023	E · Potential for harm, repeated	The facility did not develop or follow a complete care plan for each resident — the written roadmap covering all of a resident's needs, with measurable goals and timelines.
Aug 17, 2023	E · Potential for harm, repeated	The facility did not have enough nursing staff each day to meet every resident's needs, or did not have a licensed nurse in charge on each shift. Adequate staffing is one of the strongest predictors of good care.
Aug 17, 2023	E · Potential for harm, repeated	The facility did not observe each nurse aide's job performance or provide regular training as required.
Aug 17, 2023	E · Potential for harm, repeated	The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards.
Aug 17, 2023	E · Potential for harm, repeated	The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide.
Aug 17, 2023	D · Potential for harm, one-off	The facility did not give residents proper notice about what Medicare or Medicaid covers, or about charges the resident might owe for services that aren't covered.
Aug 17, 2023	D · Potential for harm, one-off	The facility did not reassess a resident after a significant change in their condition, such as a sudden decline in health. A full new assessment is required when a resident's condition changes in a major way.
Aug 17, 2023	D · Potential for harm, one-off	The facility did not provide the help residents need with basic daily activities — like bathing, dressing, eating, and using the bathroom — for residents who cannot do these things on their own.
Aug 17, 2023	D · Potential for harm, one-off	The facility did not provide proper care for pressure ulcers (bedsores) or did not do enough to prevent new ones from forming. Bedsores develop when residents stay in one position too long without help moving.
Aug 17, 2023	D · Potential for harm, one-off	The facility did not provide safe, appropriate care for residents who need dialysis — the treatment that filters the blood when kidneys fail.
Aug 17, 2023	D · Potential for harm, one-off	The facility's medication error rate was 5 percent or higher — meaning too many doses were given incorrectly, such as the wrong drug, dose, or time.
Aug 17, 2023	D · Potential for harm, one-off	The facility did not make sure its nurse aides had the skills needed to care for residents, including training in dementia care and abuse prevention.

Inspection trend by year

Citations from standard inspections decreased between the last two inspection cycles (19 → 10).

Year	Citations	Worst severity that year
2023	14	E
2024	19	F
2025	11	E

Counts reflect the current CMS public record (~3 inspection cycles plus complaint investigations); years with no surveys show no row. Inspection frequency varies, so compare severity as well as counts.

Fines and enforcement (last 3 years)

No fines or payment denials in the published 3-year window.

Nurse staffing (from payroll records, adjusted for how much care residents need)

Measure	This facility	Pennsylvania avg	U.S. avg	Where it stands
Total nurse staffing (hours per resident per day)	3.44	3.94	3.95	bottom 39% in Pennsylvania; bottom 34% in the U.S.
Registered Nurse hours	0.56	0.80	0.69	bottom 38% in Pennsylvania; bottom 47% in the U.S.
Weekend total nurse staffing	3.34	3.58	3.50	bottom 50% in Pennsylvania; bottom 49% in the U.S.
Weekend RN hours (not acuity-adjusted)	0.39	0.56	0.48	bottom 42% in Pennsylvania; top 50% in the U.S.
Total nursing staff turnover (%)	50.0	44.5	45.8	bottom 34% in Pennsylvania; bottom 38% in the U.S.
RN turnover (%)	50.0	39.9	42.9	bottom 31% in Pennsylvania; bottom 39% in the U.S.

Hours are per resident per day, case-mix adjusted by CMS so facilities caring for sicker residents can be compared fairly (same basis as the CMS staffing star). "Top X%" means better than most facilities: more staffing hours, or lower turnover. Raw (unadjusted) reported hours: total 3.63, RN 0.59, weekend 3.53. Staffing rating: 2/5.

Self-reported quality measures

Note: these ratings are based on data the facility reports about itself to CMS. They are not independently verified by inspectors, and can look better than inspection findings. Give more weight to the inspection results above.

Quality measures rating: 4/5 · long-stay residents: 3/5 · short-stay residents: 4/5

Who owns this facility

For profit - Limited Liability company

Owner / manager	Type	Role	Stake	Since
Bornstein, Shlomo	Individual	5% or Greater Indirect Ownership Interest	—	08/30/2023
Elkouby, David	Individual	5% or Greater Indirect Ownership Interest	—	06/01/2023
Et 141 Property LLC	Organization	Indirect Ownership Interest	NOT APPLICABLE	06/01/2023
Ferziger, Benzion	Individual	5% or Greater Indirect Ownership Interest	—	06/01/2023
Fishbane, Benzion	Individual	5% or Greater Indirect Ownership Interest	—	06/01/2023
Mendiowitz, Chaim	Individual	5% or Greater Indirect Ownership Interest	—	06/01/2023
Pa 3 Holdco	Organization	5% or Greater Indirect Ownership Interest	—	06/01/2023
Pa 3 Opco LLC	Organization	5% or Greater Direct Ownership Interest	100%	05/15/2023
Senderovits, Eliezer	Individual	5% or Greater Indirect Ownership Interest	—	08/30/2023
Steinberg, Ephraim	Individual	5% or Greater Indirect Ownership Interest	—	06/01/2023
Tress, Shmuel	Individual	5% or Greater Indirect Ownership Interest	—	06/01/2023
Bornstein, Shlomo	Individual	ADP of the SNF	NOT APPLICABLE	06/01/2023
Dankenbring, Brooke	Individual	Operational/Managerial Control	NOT APPLICABLE	06/06/2023
Dankenbring, Brooke	Individual	ADP of the SNF	NOT APPLICABLE	04/10/2025
Elkouby, David	Individual	ADP of the SNF	NOT APPLICABLE	06/01/2023
Et 141 Property LLC	Organization	Operational/Managerial Control	NOT APPLICABLE	06/01/2023
Et 141 Property LLC	Organization	ADP of the SNF	NOT APPLICABLE	06/01/2023
Ferziger, Benzion	Individual	ADP of the SNF	NOT APPLICABLE	06/01/2023
Fishbane, Benzion	Individual	ADP of the SNF	NOT APPLICABLE	06/01/2023
Ginder, John	Individual	ADP of the SNF	NOT APPLICABLE	08/23/2023

Questions to ask on your visit

Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.

"What written notices do we get before any transfer or discharge, and what is your bed-hold policy?"
"Who is on the team that builds each resident's care plan, and how quickly is it in place after admission?"
"How often do you evaluate your nurse aides and what ongoing training do they receive?"
"Who completes resident assessments here, and how do you check them for accuracy?"
"What does the care plan for a brand-new resident cover in the first 48 hours, and who writes it?"
"What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
"How do you monitor residents' weight and eating, and what happens when someone starts losing weight?"
"How do you learn about each resident's background and history, and how does that shape their care?"
"What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
"Can I see the results and plan of correction from your most recent state inspection?"

Nearby facilities (within 20 miles)

Facility	Distance	City	Overall	Inspection	Flags
Masonic Village at Elizabethtown	1.9 mi	Elizabethtown, PA	★★★★★	5/5
Emerald Nursing and Rehabilitation	2.0 mi	Elizabethtown, PA	★★☆☆☆	2/5
Susquehanna Health and Wellness Center	6.8 mi	Columbia, PA	★★★☆☆	3/5
Mt Hope Nazarene Retirement Community	7.7 mi	Manheim, PA	★★★★★	4/5
St Anne's Retirement Community	9.2 mi	Columbia, PA	★★★★★	4/5
Oak Hill Center for Rehabilitation and Nursing	10.1 mi	Middletown, PA	★★☆☆☆	1/5
Kadima Rehabilitation & Nursing at Campbelltown	10.2 mi	Palmyra, PA	★☆☆☆☆	1/5	SFF
Courtyard Gardens Nursing and Rehab Ctr	10.5 mi	Middletown, PA	★★★★☆	4/5
Pleasant View Communities	11.0 mi	Manheim, PA	★★★★★	4/5
Lebanon Valley Brethren Home	11.9 mi	Palmyra, PA	★★★★★	5/5
Pleasant Acres Rehabilitation and Nursing Center	12.1 mi	York, PA	★★☆☆☆	2/5	abuse
Kingston Court Skilled Nursing and Rehabilitation	12.3 mi	York, PA	★☆☆☆☆	1/5

Compare this facility with the 3 closest →

All facilities in Elizabethtown →

Facility data as of CMS processing date 2026-08-01. CCN 395844.

The Care File

Visit checklist — Elizabethtown Nursing and Rehabilitation

141 Heisey Avenue, Elizabethtown, PA 17022 · 7173671831

Health inspection rating 2/5 · CMS overall 2/5· Fines (3y): $0

Questions for the administrator:

☐ "What written notices do we get before any transfer or discharge, and what is your bed-hold policy?"
☐ "Who is on the team that builds each resident's care plan, and how quickly is it in place after admission?"
☐ "How often do you evaluate your nurse aides and what ongoing training do they receive?"
☐ "Who completes resident assessments here, and how do you check them for accuracy?"
☐ "What does the care plan for a brand-new resident cover in the first 48 hours, and who writes it?"
☐ "What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
☐ "How do you monitor residents' weight and eating, and what happens when someone starts losing weight?"
☐ "How do you learn about each resident's background and history, and how does that shape their care?"
☐ "What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
☐ "Can I see the results and plan of correction from your most recent state inspection?"

While you're there, notice:

☐ Smell and cleanliness in hallways, not just the lobby
☐ How staff speak to residents; call lights answered promptly
☐ Residents up, dressed, and engaged (visit mealtimes and a weekend if you can)

Data: CMS Provider Data Catalog, version 2026-08-01 · CCN 395844 · Verify at medicare.gov/care-compare · Printed from The Care File (thecarefile.com)