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25Feb

Chapel Pointe Qualifies for CMS Risk-Based Survey and Earns Deficiency-Free (Perfect) Results

In long-term care, excellence isn’t measured by a single day. Instead, it’s revealed in consistently providing meaningful person-centered care every day.

Chapel Pointe’s steady commitment recently led to two exciting milestones:

  • Because Chapel Pointe ranks among the top 10% of skilled nursing facilities in Pennsylvania, we were the first regional community selected to participate in a new survey process being tested by the Centers for Medicare & Medicaid Services (CMS).
  • During that survey, our skilled nursing households received the best possible result: a deficiency-free survey!

These are two related but distinct accomplishments, and together they tell an important story about consistent, high-quality care in Chapel Pointe’s skilled nursing households.

“Please join me in congratulating the Chapel Pointe Team for a deficiency-free survey! The greater accomplishment is that Chapel Pointe has ranked in the top 10% of all Pennsylvania Skilled Nursing Facilities and allowed us to qualify for an abbreviated survey because of our high standards and the efforts we make every day, all year long.” - Tawnya Walter, Administrator


Qualification for the Risk-Based Survey Pilot

CMS is currently testing a Risk-Based Survey (RBS) model in Pennsylvania and planning to expand this pilot to 20 states. Up to the top 10 percent of nursing facilities within each state can qualify for this pilot program featuring a shorter and more focused survey than the traditional recertification survey. The RBS still ensures full compliance with federal health and safety standards, and if any concerns arise during the review, the survey immediately expands.

Communities that qualify for the RBS demonstrate strong quality trends, including:

  • A history of fewer citations for noncompliance
  • High staffing levels
  • Fewer hospitalizations
  • No citations related to resident harm or abuse
  • Compliance with staffing and data submissions

Because of Chapel Pointe’s sustained performance across these measures, we are qualified to participate, becoming the first community in our area to undergo the new survey.


What is a Deficiency-Free Survey?

A deficiency-free survey means that inspectors found Chapel Pointe’s households fully meeting every federal and state standard for resident care, safety, and environment, with zero citations. Fewer than 10% of nursing facilities earn this distinction in a given year, making it a meaningful mark of excellence.

“Congratulations, Household team! This is an amazing accomplishment and a testament to the excellent care and service you provide to our residents!” – Kent Peachey, CEO

Receiving a deficiency-free survey is more than a regulatory milestone, it reflects a culture of accountability, compassionate caregiving, strong staffing, and a daily commitment to helping residents live safely, comfortably, and with dignity.


Why This Matters

Survey language can feel technical, but what it means for residents and families is simple:

  • Chapel Pointe has a proven history of consistent, high-quality care.
  • Our staffing, systems, and outcomes consistently meet rigorous federal standards.
  • Even under a focused pilot survey model, our team demonstrated full compliance.

We are grateful for our entire team and for the residents and families who trust us. Excellence at Chapel Pointe is not an event; it is our standard.

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Chapel Pointe

Senior Living Community in Carlisle, PA

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