Garden Spot Village
433 S Kinzer Avenue, New Holland, PA 17557 · Lancaster County · 73 certified beds · avg 67 residents/day · certified since Oct 19, 2001
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★★★★☆4/5 · CMS overall rating: 5/5
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.
Most serious findings (actual harm or immediate jeopardy)
▲ Actual harm, one-off · Nov 13, 2025 · F-0684 · triggered by a complaint
The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals.
Why it matters: Care that strays from doctor's orders or ignores the resident's wishes can lead to declining health and avoidable harm.
Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.
Corrected: Dec 15, 2025 (Deficient, Provider has date of correction)
▲ Actual harm, one-off · Jan 5, 2024 · F-0684
The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals.
Why it matters: Care that strays from doctor's orders or ignores the resident's wishes can lead to declining health and avoidable harm.
Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.
Corrected: Feb 1, 2024 (Deficient, Provider has date of correction)
All citations in the current public record (4)
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 |
|---|---|---|
| Nov 13, 2025 | ▲ G · Actual harm, one-off | The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals. · from a complaint |
| Dec 13, 2024 | 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. |
| Jan 5, 2024 | ▲ G · Actual harm, one-off | The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals. |
| Jan 5, 2024 | 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. |
Inspection trend by year
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2024 | 3 | 1 | G ▲ |
| 2025 | 1 | 1 | G ▲ |
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)
1 fine totaling $8,018.
| Date | Type | Amount / length |
|---|---|---|
| Jan 5, 2024 | Fine | $8,018 |
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) | 5.10 | 3.94 | 3.95 | top 11% in Pennsylvania; top 12% in the U.S. |
| Registered Nurse hours | 0.90 | 0.80 | 0.69 | top 26% in Pennsylvania; top 21% in the U.S. |
| Weekend total nurse staffing | 4.41 | 3.58 | 3.50 | top 15% in Pennsylvania; top 13% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.36 | 0.56 | 0.48 | bottom 37% in Pennsylvania; bottom 45% in the U.S. |
| Total nursing staff turnover (%) | 32.2 | 44.5 | 45.8 | top 20% in Pennsylvania; top 18% in the U.S. |
| RN turnover (%) | 38.1 | 39.9 | 42.9 | top 49% in Pennsylvania; top 44% 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 5.00, RN 0.88, weekend 4.32. Staffing rating: 5/5.
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: 5/5 · long-stay residents: 4/5 · short-stay residents: 5/5
Who owns this facility
Non profit - Corporation
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| Garden Spot Communities | Organization | 5% or Greater Direct Ownership Interest | 100% | 07/01/2016 |
| Aldrich, Donald | Individual | Corporate Director | NOT APPLICABLE | 07/01/2023 |
| Bender, Tim | Individual | Corporate Director | NOT APPLICABLE | 07/01/2023 |
| Edwards, Carl | Individual | Corporate Director | NOT APPLICABLE | 07/01/2023 |
| Garden Spot Communities | Organization | Operational/Managerial Control | NOT APPLICABLE | 07/01/2016 |
| Hess, Philip | Individual | Corporate Director | NOT APPLICABLE | 01/01/2024 |
| Hoover, Joyce | Individual | Corporate Director | NOT APPLICABLE | 07/01/2023 |
| Lindsey, Stephen | Individual | Corporate Officer | NOT APPLICABLE | 07/01/2023 |
| Lindsey, Stephen | Individual | Operational/Managerial Control | NOT APPLICABLE | 07/01/2023 |
| Musser, Karen | Individual | Corporate Director | NOT APPLICABLE | 07/01/2023 |
| Rittersbach, Elma | Individual | Corporate Director | NOT APPLICABLE | 07/01/2023 |
| Rouvre Haeusler, Christina | Individual | W-2 Managing Employee | NOT APPLICABLE | 07/30/2020 |
| Stoltzfus, Alphaus | Individual | Corporate Director | NOT APPLICABLE | 07/01/2023 |
| Vega, David | Individual | Corporate Director | NOT APPLICABLE | 07/01/2023 |
| Weber, Nathaniel | Individual | Corporate Officer | NOT APPLICABLE | 06/11/2022 |
| Weber, Nathaniel | Individual | Operational/Managerial Control | NOT APPLICABLE | 06/11/2022 |
Questions to ask on your visit
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
- "How do you make sure each resident's care follows the doctor's orders, and what changed after this citation?"
- "What specific training do your nurse aides complete in dementia care and abuse prevention, and how often is it refreshed?"
- "Who completes resident assessments here, and how do you check them for accuracy?"
- "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 |
|---|---|---|---|---|---|
| Fairmount Homes | 4.5 mi | Ephrata, PA | ★★★★★ | 5/5 | |
| Ephrata Manor | 6.7 mi | Ephrata, PA | ★★★★☆ | 4/5 | |
| Maple Farm | 7.9 mi | Akron, PA | ★★★★★ | 5/5 | |
| Zerbe Sisters Nursing Center, | 8.2 mi | Narvon, PA | ★★★★★ | 5/5 | |
| Gardens at Stevens, the | 9.3 mi | Stevens, PA | ★★☆☆☆ | 2/5 | |
| Landis Homes | 10.2 mi | Lititz, PA | ★★★★★ | 4/5 | |
| Tel Hai Retirement Community | 10.5 mi | Honey Brook, PA | ★★★★★ | 5/5 | |
| Newport Meadows Health and Rehabilitation Center | 10.8 mi | Christiana, PA | ★★★☆☆ | 3/5 | |
| Hickory House Nursing Home | 11.4 mi | Honey Brook, PA | ★★★★★ | 4/5 | |
| Lancaster Nursing and Rehabilitation Center | 11.8 mi | Lancaster, PA | ★★☆☆☆ | 3/5 |
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Facility data as of CMS processing date 2026-08-01. CCN 396079.