February DOH survey found ‘Immediate Jeopardy’ situation at Cedar Haven

The Pennsylvania Department of Health surveyed Cedar Haven Healthcare Center on Feb. 2 in response to a complaint and identified an “Immediate Jeopardy” situation with how the facility was handling drugs.

The survey says that the facility, at 590 S. 5th Ave. in South Lebanon Township, failed to properly store and label medications on six of 10 nursing units and in the central supply room and also failed to ensure correct and safe administration of medications for 34 of 43 sampled residents.

“This failure put residents at risk for medication administration errors and resulted in an Immediate Jeopardy situation,” says the survey.

According to the Pennsylvania Department of Health (DOH), this level of severity indicates that the resident is in immediate jeopardy of a situation that has caused, or is likely to cause, serious injury, harm, impairment, or death as a result of the nursing home’s noncompliance with one or more regulations.

LebTown had received a tip about the survey in February, but the Department of Health declined to comment.

Survey results are made public at least 41 days after they take place. The Feb. 2 survey became available on the state’s website Friday.

“This timeframe allows the report to include not only the inspection findings, but also a Corrective Action Plan,” said DOH spokesperson Eli Steiker-Ginzberg. “Skilled nursing facilities in Pennsylvania work collaboratively with the Pennsylvania Department of Health throughout this process and are often already implementing corrective measures by the time the survey is officially published.”

According to the survey, the facility’s administrator was informed at 5:15 p.m. on Feb 2 of the Immediate Jeopardy situation, with a corrective action plan detailed. The survey says that the surveyor “validated that the Immediate Jeopardy was removed on February 2, 2026, at 8:55 p.m., through observation, interviews, review of the facility training, and review of facility policies and procedures following the facility’s implementation of the corrective action plan for the Immediate Jeopardy.”

The survey also found that the facility had failed to meet state-mandated nurse aide-to-resident ratios for six of 21 days reviewed. Facilities are required to have a minimum of one nurse aide per 10 residents during the day, one nurse aide per 11 residents during the evening, and one nurse aide per 15 residents overnight. The survey says that for the 21 days reviewed, the facility failed to meet the minimums for four days during the day shift, one day for the evening shift, and three days during the night shift. The survey does not say what ratio was in effect for the periods mentioned.

The survey also found that the total number of hours of general nursing care provided in each 24-hour period, when totaled for the entire facility, fell below a minimum of 3.2 hours of direct resident care for each resident on four of 10 days reviewed.

In January, Cedar Haven Acquisition LLC, operator of the 430-bed facility, filed for Chapter 11 bankruptcy.

Cedar Haven Acquisition LLC is seeking court approval for the facility to be sold in a $27 million deal that values the real estate at $27 million and allocates $100,000 towards the business and other assets. The Pennsylvania Attorney General’s office on behalf of the Department of Human Service has objected to this proposed sale.

A phone call to Cedar Haven on Monday requesting comment had not received a response as of publication.