C72

Millcreek Manor

Grade C 72/100 composite score

Non profit - Corporation

CMS Star Ratings

Overall
4/5
Health Insp.
3/5
Quality
3/5
Staffing
5/5
RN Staffing
Not rated

Certified Beds

144

Ownership

Non profit - Corporation

Total Fines

$100,240

Last Survey

N/A

5535 PEACH STREET, ERIE, PA 16509
8148687395

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Staffing Hours & Turnover

Hours per Resident per Day (PBJ)

RN
1.10h
LPN
1.04h
CNA
2.70h
Total
4.84h
Facility
State Average

Turnover Rates

RN Turnover
N/A
Total Nurse Turnover
N/A
Admin Turnover
N/A

Ownership

MILLCREEK HEALTH SYSTEM

Organization5% OR GREATER DIRECT OWNERSHIP INTERESTSince Nov 2003

100%

BABIAK, JAIME

IndividualOPERATIONAL/MANAGERIAL CONTROLSince Nov 2022

BEERBOWER, JOSHUA

IndividualOPERATIONAL/MANAGERIAL CONTROLSince Nov 2023

INMAN, STEVEN

IndividualCORPORATE DIRECTORSince Sep 2023

LIN, JAMES

IndividualCORPORATE DIRECTORSince Jul 2024

Penalties & Fines (2)

$100,240total fines
DateTypeDescriptionAmount
Feb 2, 2024Fine$100,240
Feb 6, 2023Payment Denial

Health Inspection Deficiencies (32)

November 18, 2025Health1 deficiency
0760DMinimal harm, Isolated

Ensure that residents are free from significant medication errors.

Pharmacy Service Deficiencies

July 30, 2025Health2 deficiencies
0684DMinimal harm, Isolated

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Quality of Life and Care Deficiencies

Corrected Aug 25, 2025
0842BNo harm, Pattern

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Resident Assessment and Care Planning Deficiencies

Corrected Aug 25, 2025
March 27, 2025Health1 deficiency
0760DMinimal harm, Isolated

Ensure that residents are free from significant medication errors.

Pharmacy Service Deficiencies

Corrected Apr 22, 2025
January 24, 2025Health3 deficiencies
0578DMinimal harm, Isolated

Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

Resident Rights Deficiencies

Corrected Feb 21, 2025
0758DMinimal harm, Isolated

Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

Pharmacy Service Deficiencies

Corrected Feb 21, 2025
0761DMinimal harm, Isolated

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Pharmacy Service Deficiencies

Corrected Feb 21, 2025
September 5, 2024Health1 deficiency
0760DMinimal harm, Isolated

Ensure that residents are free from significant medication errors.

Pharmacy Service Deficiencies

Corrected Oct 7, 2024
July 24, 2024Health1 deficiency
0607DMinimal harm, Isolated

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Aug 16, 2024
February 23, 2024Health9 deficiencies1 severe
0554EMinimal harm, Pattern

Allow residents to self-administer drugs if determined clinically appropriate.

Resident Rights Deficiencies

Corrected Apr 1, 2024
0637DMinimal harm, Isolated

Assess the resident when there is a significant change in condition

Resident Assessment and Care Planning Deficiencies

Corrected Apr 1, 2024
0641DMinimal harm, Isolated

Ensure each resident receives an accurate assessment.

Resident Assessment and Care Planning Deficiencies

Corrected Apr 1, 2024
0655EMinimal harm, Pattern

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

Resident Assessment and Care Planning Deficiencies

Corrected Apr 1, 2024
0656DMinimal harm, Isolated

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Resident Assessment and Care Planning Deficiencies

Corrected Apr 1, 2024
0689JImmediate jeopardy, Isolated

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Quality of Life and Care Deficiencies

Corrected Apr 1, 2024
0758DMinimal harm, Isolated

Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

Pharmacy Service Deficiencies

Corrected Apr 1, 2024
0835DMinimal harm, Isolated

Administer the facility in a manner that enables it to use its resources effectively and efficiently.

Administration Deficiencies

Corrected Apr 1, 2024
0842EMinimal harm, Pattern

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Resident Assessment and Care Planning Deficiencies

Corrected Apr 1, 2024
February 2, 2024Health3 deficiencies
0760DMinimal harm, Isolated

Ensure that residents are free from significant medication errors.

Pharmacy Service Deficiencies

Corrected Mar 4, 2024
0684DMinimal harm, Isolated

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Quality of Life and Care Deficiencies

Corrected Mar 4, 2024
0842DMinimal harm, Isolated

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Resident Assessment and Care Planning Deficiencies

Corrected Mar 4, 2024
October 16, 2023Health4 deficiencies
0580DMinimal harm, Isolated

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Resident Rights Deficiencies

Corrected Nov 17, 2023
0584EMinimal harm, Pattern

Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

Resident Rights Deficiencies

Corrected Nov 17, 2023
0684DMinimal harm, Isolated

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Quality of Life and Care Deficiencies

Corrected Nov 17, 2023
0842EMinimal harm, Pattern

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Resident Assessment and Care Planning Deficiencies

Corrected Nov 17, 2023
March 24, 2023Health6 deficiencies
0625CNo harm, Widespread

Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.

Resident Rights Deficiencies

Corrected May 14, 2023
0656DMinimal harm, Isolated

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Resident Assessment and Care Planning Deficiencies

Corrected May 14, 2023
0684DMinimal harm, Isolated

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Quality of Life and Care Deficiencies

Corrected May 14, 2023
0695DMinimal harm, Isolated

Provide safe and appropriate respiratory care for a resident when needed.

Quality of Life and Care Deficiencies

Corrected May 14, 2023
0758DMinimal harm, Isolated

Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

Pharmacy Service Deficiencies

Corrected May 14, 2023
0849DMinimal harm, Isolated

Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.

Administration Deficiencies

Corrected May 14, 2023
February 6, 2023Health1 deficiency
0725EMinimal harm, Pattern

Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

Nursing and Physician Services Deficiencies

Corrected Mar 18, 2023

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Frequently Asked Questions

What is the CareGrader rating for Millcreek Manor?

Millcreek Manor in ERIE, Pennsylvania has a CareGrader grade of C (Average), with a composite score of 71.8 out of 100. This grade is based on health inspections, staffing levels, quality measures, and penalty history from official CMS government data.

What is the CMS star rating for Millcreek Manor?

Millcreek Manor has an overall CMS star rating of 4 out of 5, a health inspection rating of 3/5, and a staffing rating of 5/5. CareGrader combines this with additional data to calculate an A-F grade.

How many health deficiencies does Millcreek Manor have?

Millcreek Manor has 32 health deficiencies on record from CMS health inspection surveys. Deficiencies are rated from A (minimal harm potential) to L (immediate jeopardy, widespread). View the full inspection timeline above for details on each deficiency.

Has Millcreek Manor been fined?

Yes. Millcreek Manor has $100,240 in total fines from CMS enforcement actions across 2 penalties.

How many beds does Millcreek Manor have?

Millcreek Manor has 144 certified beds with approximately 137 current residents (95% occupancy). The facility is located at 5535 PEACH STREET, ERIE, Pennsylvania 16509. It is a non profit - corporation facility.

Data Disclaimer

Inspection data, staffing levels, and star ratings are sourced from CMS Medicare Nursing Home Compare and are largely self-reported by facilities. A 2019 GAO study found that 43% of facilities under-reported falls. CareGrader provides this data for informational purposes only and is not affiliated with CMS or Medicare. Always visit facilities in person before making a decision.