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03-5254
IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON 25 Cove Road Duncannon, PA 17020 Plaintiff V. THE WOODS AT CEDAR RUN 814 Lisbum Road Camp Hill, PA 17011 Defendant No. - ._C&g¥ Civil Action - (x) Law ( ) Equity PRAECIPE FOR WRIT OF SUMMONS TO THE PROTHONOTARY OF SAID COURT: Please issue a Writ of Summons in the above-captioned action. McQUAIDE BLASKO 600 Centerview Drive Hershey, PA 17033 __ Writ of Summons shall be issued and forwarded to ( ) Attorney ( X ) Sheriff Grant H. Fleming, Esquire ~'~~omey Supreme Court ID No. 16212 Date: WRIT OF SUMMONS TO THE ABOVE-NAMED DEFENDANT: YOU ARE NOTIFIED THAT THE ABOVE-NAMED PLAINTIFF HAS COMMENCED AN ACTION AGAINST YOU. Prothonotary Deputy ( ) Check here if reverse is used for additional information SHERIFF' S RETURN - REGULAR CASE NO: 2003-05254 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND CLAUSON LAHOMA S VS WOODS AT CEDAR RUN THE ROBERT BITNER , Cumberland County, Pennsylvania, says, the within WRIT OF SUMMONS WOODS AT CEDAR RUN THE DEFENDANT , at 1523:00 HOURS, on the at 824 LISBURN ROAD CAMP HILL, PA 17011 by handing MARIE THUMMA, OFFICE PERSONNEL ADULT IN CHARGE a true and attested copy of WRIT OF SUMMONS Sheriff or Deputy Sheriff of who being duly sworn according to law, was served upon the 9th day of October , 2003 to together with and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing 18.00 Service 9.66 Affidavit .00 Surcharge 10.00 .00 37.66 Sworn and Subscribed to before me this /~ g day of A.D. ~r~t honor ary So Answers: R. Thomas Kline 10/10/2003 MCQUAIDE BLASKO 1N THE COURT OF COMMON PLEAS CUMBERLAND COUNTY. PENNSYLVANIA LAHOMA S. CLAUSON Plaintiff V. THE WOODS AT CEDAR RUN Defendant No. 2003-05254 P Civil Action - Law AFFIDAVIT OF SERVICE COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF CUMBERLAND Grant H. Fleming, Esquire, attomey for Plaintiff, Lahoma S. Clauson. in the above-captioned matter, after having been duly swom according to law, deposes and says that a true and correct copy of our REQUEST FOR PRODUCTION OF DOCUMENTS on Behalf of Plaintiff was mailed by regular mail at the post office Hershey, Pennsylvania, postage prepaid, this 17th day of November, 2003 to the following: The Woods at Cedar Run 824 Lisbum Road Camp Hill, PA 17011 C. Peter Hitson, Esquire Hitson & Mason 20 Stanwix Street, 4th Floor Pittsburgh, PA 15222 Sworn to and Su.b~ed qt/~Jqd~.~7~6~. 2003. b~t ary Public NOTARIAL SEAL i EUZABETH J. WILSON, NOTAR~ PUBU~ DERR'Y'IWR, DAUPfllN COUNrf M~ COYMI$$1(~N I~XPIRES OCT. 24. 2005 McQUAIDE BLASKO Grant I31[. Fleming, Esquire 1N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON, Plaintiff, V. THE WOODS AT CEDAR RUN, Defendant. CIVIL DIVISION No. 2003-05254 P PRAECIPE FOR ENTRY OF APPEARANCE Filed on Behalf of Defendant The Woods at Cedar Run Counsel of Record for this Party: DONALD H. SMITH, ESQUIRE PA. Id. #41011 HITSON & MASON 20 Stanwix Street, Fourth Floor Pittsburgh, PA 15222 (412) 288-6200 A JURY TRIAL IS DEMANDED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON, Plaimiff, THE WOODS AT CEDAR RUN, Defendant. CIVIL DWISION No. 2003-05254 P PRAECIPE FOR ENTRY OF APPEARANCE TO THE PROTHONOTARY: Please enter my appearance for defendant, The Woods at Cedar Run, in the above-captioned case. A JURY TRIAL IS DEMANDED HITSON & MASON 20 Stanwix Street, Fourth Floor Pittsburgh, PA 15222 (412) 288-6200 DONALD H. SMITH, ESQUIRE Attorney for Defendant The Woods; at Cedar Run CER TIFICA TE OF SER VICE I hereby certify that on October ~.D, 2003, a true and correct copy of the within Praecipe for Entry of Appearance was served by United States mail, ]postage prepaid, to and upon the following: Grant H. Fleming, Esquire McQuaide Blasko 600 Centerview Drive Hershey, PA 17033 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON, Plaintiff, THE WOODS AT CEDAR RUN, Defendant. CWIL DI~rlSION No. 2003-05254 P PRAECIPE FOR RULE TO FILE COMPLAINT PURSUANT TO PA.R. CP. 1037(a) Filed on Behalf of Defendant The Woods at Cedar Run Counsel of Record for this Party: DONALD H. SMITH, ESQUIRE PA. Id. #41011 HITSON & MASON 20 Stanwix Street, Fourth Floor Pittsburgh, PA 15222 (412) 288-6200 A JURY TRIAL IS DEMANDED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON, Plaintiff, THE WOODS AT CEDAR RUN, Defendant. C1VIL DIVISION No. 2003-05254 P DEFENDANT'S PRAECIPE FOR RULE TO FILE COMPLAINT PURSUANT TO PA. R.C.P. 1037(a) TO THE PROTHONOTARY: Please issue a role on plaintiff, Lahoma S. Clauson, to file a complaint within twenty (20) days pursuant to Pa. R.C.P. 1037(a). Dated: October ~ 2003 HITSON & MASON 20 Stanwix S~'eet, Fourth Floor Pittsburgh, PA 15222 (412) 288-6200 Attorney for defendant The Woods at Cedar Run November 6, 2003, Rule to File Ccmplaint Issued. P~>thonotary ~' ~' CER TIFICA TE OF SER VICE ~ (7' I hereby certify that on October Z45,2003, a true and correct copy of the within Praecipe for Rule to File Complaint Pursuant to Pa.R.C.P. 1037(a) was served by United States mail, postage prepaid, to and upon the following: Grant H. Fleming, Esquire McQuaide Blasko 600 Centerview Drive Hershey, PA 17033 D(~ld ~. Smith, Esquire IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON, Plaintiff, THE WOODS AT CEDAR RUN, Defendant. CIVIL DIVISION No. 2003-05254 P NOTICE OF SERVICE OF DEFENDANT'S FIRST SE T OF INTERROGATORIES AND PRODUCTION OF DOCUMENTS DIRECTED TO PLAINTIFF Filed on Behalf of Defendant: The Woods at Cedar Run Counsel of Record for this Party: DONALD H. SMITH, ESQUIRE PA Id. #41011 HITSON & MASON 20 Stanwix Street, Fourth Floor Pittsburgh, PA 15222 (412) 288-6200 JURY TRIAL DEMANDED 1N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON, CIVIL DIVISION Plaintiff, v. No. 2003-05254 P THE WOODS AT CEDAR RUN, Defendant. NOTICE OF SERVICE OF DEFENDANT'S INTERROGATORIES AND REOUEST FOR PRODUCTION OF DOCUMENTS I, Donald H. Smith, Esquire, hereby certify that I served Defendant's Interrogatories and Request for Production of Documents Directed to plaintiff, Lahoma S. Clauson, on the following party, by first class mail, postage prepaid, this I ~d~ay of January, 2004. Grant H. Fleming, Esquire McQuaide Blasko 600 Centerview Drive Hershey, PA 17033 HITSON & MASON 20 Stan)y.~x Street, Fourth Floor [,I~O1NALD H. SMITH, ESQUIRE Attorney for Defendant The Woods at Cedar Run 1N THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON : : Plaintiff : : V. : THE WOODS AT CEDAR RUN : : Defendant : CIVIL DIVISION No. 2003-05254P JURY TRIAL DEMANDED AFFIDAVIT OF SERVICE COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF DAUPHIN ) Grant H. Fleming, Esquire, attorney for Plaintiffin the above-captioned matter, after having been duly sworn according to law, deposes and says that a true and correct copy of Plaintiff's Responses and Objections to Defendant's Request for Production of Documents.was mailed by regular mail at the post office Hershey, Pennsylvania, postage prepaid, thi~iay of February, 2004 to the attorney of record: Donald H. Smith, Esquire HITSON & MASON 20 Stanwix Street, Fourth Floor Pittsburg, PA 15222 Sworn to and Subs.~ed before me this~_.'~day ,,./. ~tary Public McQUAIDE, BLASKO, SCHWARTZ, MYNOTARIAL SEAL ] ELiZABETH J. WILSON, NOTARY PUBUC / DERRY TWR DAUPR N COliN'Pr / COMMIS$ ONEXPIRES OCT. 24, 200!~ I IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON Plaintiff V. THE WOODS AT CEDAR RUN Defendant No. 2003-05254 P Civil Action - Law AFFIDAVIT OF SERVICE COMMONWEALTH OF PENNSYLVANIA ) ) SS; COUNTY OF CUMBERLAND ) Britt D. Russell, Esquire, attorney for Plaintiff, Lahoma S. Clauson. in the above-captioned matter, after having been duly sworn according to law, deposes and says that a true and correct copy of Plaintiff's Objection to Defendants' First [SIC] Set of Interrogatories Directed to Plaintiff was mailed by regular mail at the post office Hershey, Pennsylvania, postage prepaid, this 16th day of Febrnary 2004 to the following: C. Peter Hitson, Esquire Hitson & Mason 20 Stanwix Street, 4th Floor Pittsburgh, PA 15222 McQUAIDE BLASKO Sworn to and Subscribed before me this _~day of~fft , 2004. /-'fio~ary Public ~ ~0ISa~A[ sm. BF. ANNAM. HO~ ~1~ ~ffi D~R~ ~R.~PHIN ~U~ W ~MMI~N ~PIRES M~CH 5, Britt D. Russell, Esquire IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON Plaintiff THE WOODS AT CEDAR RUN Defendant CIVIL DIVISION No. 2003-05254P MOTION TO COMPEL DEFENDANT'S RESPONSES TO PLAINTIFF'S REQUEST FOR PRODUCTION OF DOCUMENTS (Set One) AND NOW, comes Plaintiff, Lahoma Clauson, by and through her attorneys, McQuaide, Blasko, Schwartz, Fleming and Faulkner, Inc., and respectfully moves this Honorable Court to issue an appropriate Order compelling Defendant, The Woods at Cedar Run, to fully and completely answer Request for Production of Documents (Set 1). In support of her motion, Plaintiff avers as follows: 1. This action arises out of an incident on March 4, 2003 in which Lahoma S. Clauson, a resident of the Woods at Cedar Run, sustained a broken hip and other injuries during a planned tim drill. 2. On October 3, 2003 Plaintiff instituted suit by filing a Writ of Summons in the Court of Common Pleas of Cumberland County naming the Woods at Cedar Run as a Defendant. 3. On October 28, 2003 Defendant filed a Praecipe for a Rule to File a Complaint, but did not serve the Rule upon Plaintiff. By agreement of the Parties Plaintiff is not required to file a Complaint until 60 days after the Defendant responds to Plaintiff's Request for the Production of Documents (Set 1). 4. On October 17, 2003, Plaintiff initiated pre-Complaint discovery to assist in the preparation of a Complaint. Plaintiff served Request for Production of Documents (Set 1) for Answer by Plaintiff. (True and correct copies of these discovery requests and applicable certificates of service are attached hereto as Exhibit "A"). 5. In accordance with the Pennsylvania Rules of Civil Procedure, Plaintiff was required to respond to the aforementioned discovery requests within thirty (30) days from service thereof. 6. Plaintiff has never responded to these discover)' requests, which were served more than four months ago. 7. Despite the foregoing, as of this date, Defendant still has not received any answers to the Requests for Production, nor have any objections been filed to the discovery requests. 8. Defendant contacted Plaintiff's counsel by correspondence dated December 31, 2003 and February 12, 2004 requesting Plaintiff's counsel to provide discovery responses. (See copy of correspondence attached hereto as Exhibit "B"). After Plaintiff's counsel extended the courtesy of numerous time extensions, Defendant was to provide responses by February 19, 2004 or be subject to a Motion to Compel same. As of this date, Defendant's counsel has not provided any response whatsoever. 9. Pursuant to local rule concurrence was sought and denied on February 19, 2004. See C.C.R.P 206-2(c). 10. Defendant is severely prejudiced in the preparation of this case and in the pursuit of any and all aspects of discovery, including but not limited to, preparation of a Complaint and for the identification of potential witnesses. -4- WHEREFORE, Plaintiff, Lahoma Clauson, respectfully requests that an Order be issued compelling Defendant to fully and completely answer Plaintiff's Request for Production of Documents within ten (10) days of the date of such Order or suffer appropriate sanctions, to include the imposition of attorneys' fees and costs. A proposed Order is attached hereto. McQUAIDE, BLASKO, SCHWARTZ, FLEMING & FAULKNER, INC. BY: Grant H. Fqemine_ F~m.il-e -5- 1N THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON Plaintiff THE WOODS AT CEDAR RUN No. 2003-05254 P Civil Action - Law Defendant AFFIDAVIT OF SERVICE COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF CUMBERLAND ) Britt D. Russell, Esquire, attorney for Plaintiff, Lahoma S. Clauson. in the above-captioned matter, after having been duly sworn according to law, deposes and says that a tree and correct copy of Plaintiff's Motion to Compel D ' efendant s Responses to Plaintiff's Request for Production of Documents (Set One) was mailed by regular mail at the post office Hershey, Pennsylvania, postage prepaid, this 5th day of March 2004 to the following: C. Peter Hitson, Esquire Donald Smith, Esquire Hitson & Mason 20 Stanwix Street, 4th Floor Pittsburgh, PA 15222 McQUAIDE BLASKO Swom to and Su~ribed befgLe me this ~ day DE~ ~, DAUPHIN COUN~ By: Britt D. Russell, Esquire IN THE COURT OF COlVIIVION PLEAS CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON Plaintiff V. THE WOODS AT CEDAR RUN Defendant No. 2003-05254 P Civil Action - Law PLAINTIFF LAHOMA S. CLAUSON'S REQUEST FOR PRODUCTION OF DOCUMENTS FOR ANSWER BY DEFENDANT To: DEFENDANT: THE WOODS AT CEDAR RUN AND NOW, comes the Plaintiff, by and through her counsel, McQuaide, Blasko, Schwartz, Fleming & Faulkner, Inc., and requests that Defendant produce the documents and tangible things described below pursuant to the Pennsylvania Rules of Civil Procedure for inspection and/or photocopying by Plaintiff, her attorneys and agents. The documents and tangible things shall be produced at the offices of McQuaide, Blasko, Schwartz, Fleming & Faulkner, Inc., 600 Centerview Drive, Suite 5103, Hershey, Pennsylvania 17033-2903, thirty (30) days from service of this Request, or at such other time and place that the parties may mutually agree. In responding to this request, you (as hereinafter defined) shall utilize the definitions and follow the instructions hereinafter set forth, each of which shall be deemed to be a material part of each request. McQUAIDE, BLASKO, SCHWARTZ .Grant H. _Fleming ] _At!omey for Plaintiff/ Lahoma S. Clauson / 600 Centerview Drive, Suite 5103 Hershey, PA 17033-2903 (717) 533-1199 INSTRUCTIONS: 1. With respect to each of the following requests, you shall identify and/or produce all documents which are known to you or which can be located or discovered by you through diligent effort on the part of you, your employees, representatives, attorneys or accountants, including but not limited to, all documents which are in the business or personal files of your employees, in the possession of your representatives, attorneys or accountants, or accessible to you, your employees, or your representatives, attorneys or accountants. 2. The following requests shall be deemed to be continuing so as to require further and supplemental production of documents by you in accordance with Rule 4007.4 of the Pennsylvania Rules of Civil Procedure. 3. If any documents requested herein have been lost or destroyed, you shall provide in lieu of a true and correct copy thereof, a list of each document so lost or destroyed, ~ogether with the following information: (1) the date of origin; (2) a brief description of such document; (3) the author of such document; (4) the date upon Which the document was lost or destroyed; and (5) a brief statement of the manner in which the document was lost or destroyed. 4. In the event you refuse to produce any document: requested on the grounds of any claimed privilege from discovery, please state each ground for such claimed privilege and describe the document withheld by date, author and recipients (:including all persons who were shown or received a copy). 5. In the event that more than one copy of a document exists, the original shall be produced, as well as every copy on which appears any notation or marking of any sort not appearing on the original. 6. For any documents which are stored or maintained in files in the normal course of business, such documents shall be produced in such files, or in such a manner as to preserve and indicate the file from which such documents were taken. 7. For each request to which defendants reply thai they have previously supplied responsive documents to plaintiff, please state the date the documents were supplied, the number of documents supplied and a brief description of documents supplied. 8. Please label each document you produce with a number corresponding to the particular number of the request to which the produced document(s) pertains. DEFINITIONS: 1. "You" and/or "your" shall mean Defendants, as well as their agents, attorneys, employees, accountants, consultants, independent contractors, and any other individual or entity associated with or affiliated with Defendants or purporting to act on Defendants' behalf with respect to the matter in question, and their respective officers, employees, agents, servants, assigns, representatives, past and present, and each and every attorney, past and present, of each and every such individdal or entity. 2. "Document" shall mean all written or printed matter of any kind in your possession, custody or control, which is either known to you or can be located or discovered by diligent effort, including the originals and all non-identical copies, whether different from the original by reason of any notation made on such copies or otherwise, including without limitation, correspondence, memoranda, notes, speeches, press :releases, diaries, calendars, agenda, statistics, letters, telegrams, minutes, contracts, purchase orders, reports, studies, checks, statements, receipts, returns, summaries, pamphlets, books, inter-office and intra-office communications, email or email electronic attachments, offers, bulletins, printed matter, computer printouts, information maintained by/within your computers which has not yet been reduced/transferred to document form, teletypes, telefax, invoices, work sheets, work papers, records of telephone calls or other communications or conversations, and all drafts, alterations, modifications, changes or amendments of any of the foregoing, ~¥aphic or aural records or representations of any kind, including but not limited to, photographs, charts, graphs, microfiche, microfilm, video tapes, recordings, and motion pictures, and electric or mechanical records or representations of any kind, including but not limited to, tapes, cassettes, discs, and recordings. 3. "Relfiting to" shall include pertaining to, recording, evidencing, containing, setting forth, reflecting, showing, disclosing, describing, explaining, tmmmarizing, concerning, or referring to, whether directly or indirectly. 4. The conjunctions "and" and "or" shall be interpreted to mean "and/or" and shall not be interpreted to exclude any information otherwise withi~ the scope of any request. 5. "Person" shall mean any individual, firm, partnership, corporation, association, business or governmental entity or subdivision, agency, department, and any "person" acting by or through, directly or indirectly, any other "person" as well as any "person" by whom such "person" was controlled with respect to the matter in question. 6. "Occurrence" shall be defined as the injury to Lmhoma S. Clauson on or about March 4, 2003 at the Woods at Cedar Run. 7. "Health care provider" means a person, corporation, facility, institution or other entity licensed or approved by the Commonwealth to provide health care or professional services as a physician, including a medical doctor and a doctor of osteopathy and a doctor of podiatry; a chiropractor; dentist; hospital; nursing home; health maintenance organization; or an officer, employee or agent of any of them acting in the course and scope of his employment. DOCUMENTS TO BE PRODUCED: 1. True and correct copies of any and all medical records in connection with any care and treatment Plaintiff may have received including but not limited to care by any aide, nurse, therapist, social service worker, physician, hospital or medical facility during March 3 and March 4 of 2003. A appropriate release of information is on file at the Woods at Cedar Run for release of the records, as a courtesy a copy of the release is attached. RESPONSE: 2. Any and all photographs and/or videotapes and/or audiotapes in the possession, custody or control of the Defendants, counsel for Defendant, or any other person or entity acting on behalf of the Defendants, including any insurers for the Defendants, showing, representing or purporting to show any person, plaCe, or thing which in any way related to the events which are the subject matter of this litigation, the injury to Plaintiff on or about March 4, 2003. RESPONSE: 3. All statements, signed statements, transcripts of recorded statements or interviews, recorded statements if not transcribed or any statement of recorded statements if not transcribed verbatim taken of any parties, persons, or witnesses as part of an investigation of the happening or cause of the incident in question, conducted by, or in the possession of Defendants, Defendants' attorney, insurers, or anyone else acting on behalf of Defendants, including but not limited to any and all incident reports and/or root cause analysis documentation which in any way reference Lahoma S. Clanson. RESPONSE: 4. True and correct copies of any notes, e-mail, computer entries, memos, diaries, correspondence, memorializations, statements, transcripts of recorded statements or interviews relating to, referring to, or in any way describing the event upon which Plaintiffs base this action, authored by Defendants, or anyone acting on their behalf and/or any person involved. RESPONSE: 5. All documents prepared by Defendants and/or by any insurer(s), insurance company adjusters, representatives, agents or anyone acting on behalf of Defendants; except his attorneys, during an investigation of any aspect of the incident in question or prepared in anticipation of litigation or trial of this matter. Such documents shall include any documents made or prepared up through the present time, with the eXClusion of the mental i:mpressions, conclusions, or opinions respecting the value or merit of a claim or defense or respecting strategy or tactics. (NOTE: As referred to herein, "documents" includes written, printed, typed, recorded, or graphic matter, however produced or reproduced, including correspondence, telegrams, other written communications, data processing storage units, tapes, contracts, agreements, notes, memoranda, analyses, projections, indices, work papers, studies, reports, surveys, diaries, calendars, films, photographs, diagrams, drawings; minutes of meetings or any other writing (including copies of the foregoing, regardless of whether the parties to whom this request is addressed is now in the possession, custody or control of the original) now in the possession, custody or control of Plaintiff, his former or present counsel, agents, employees, officers, insurers, or any other person acting on Plaintiffs behalf.) RESPONSE: 6. True and correct copies of all documents identifying employee, supervisor and management assignment/duties on the date of the incident, including but not limited to fire drill enforcement/supervision schedules, staff rosters and/or schedules of the employees and volunteers who were on duty and/or present at the Woods at Cedar Run. RESPONSE: 7. True and correct copies of any and all maintenance and/or housekeeping reports from January 1, 2003 to present related to the unit of the Woods at Cedar Run in which the injury to Lahoma S. Clauson occurred. RESPONSE: 8. True and correct copies of any and all documents that were given to the ambulance used to transport Lahoma on or about March 4, 2003. RESPONSE: 9. Any and all billing statements, records and documents referring to any such billing statements or records, including but not limited to charges, payments, and adjustments pertaining to or in any way referencing Lahoma S. Clauson for lodging, personal Care, medical care, or dining services furnished to her in 2003. RESPONSE: 10. Any and all documents relating to or in any way referencing the guidelines, policies, regulations, protocols and/or standards of defendant entities related to fire drills and/or safety drills, including but not limited to the guidelines, policies, regulations, protocols and/or standards themselves which were in effect during March of 2003. RESPONSE: 11. Ariy and all documents relating to or in any way referencing notice and/or education provided to residents and/or families of the residents of the Woods at Cedar Run regarding fire drills and/or safety drills. RESPONSE: 12. Any and all documents relating to the guidelines, policies, regulations, protocols and/or standards themselves related to the hiring and/or retention of any and all employees involved with fire drills and/or safety drills. RESPONSE: 13. Any and all documents, including all training materials, provided to employees, servants and/or agents of defendants relating to the selection, preparation, or performance of fire drills and/or safety drills, including but not limited to a complete copy of the orientation material and employee and/or personnel manual. RESPONSE: 14. Any and all documents, including all training materials, provided to employees, servants and/or agents of defendants relating to resident, client or patient falls. RESPONSE: 15. Minutes of any and all meetings at which the subject of this litigation, the fall Lahoma S. Clanson experienced on or about March 4, 2003, was discussed. RESPONSE: 16. Any and all print, radio and/or television advertising published during the period January 1, 2000 until March 4, 2003 which in any way references the services at the Woods at Cedar Run, specifically identifying those provided to I.ahoma S. Clauson and/or Lahoma S. Clauson's family through March 4, 2003. RESPONSE: 17. Any and all corporate organizational charts which in any way relate to the Woods at Cedar Run and/or the Great Commission Care Communities in March of 2003. RESPONSE: 18. Except to the extent produced in response to the preceding requests, any and all documents relating to the chain of command and/or chain of responsibility that was in effect for the defendant entities reflected in the organizational chart(s) in March of 2003, including but not limited to the directors, officers and/or board members of the Woods at Cedar Run and/or The Great Commission Care Communities responsible for patient, resident and/or facility safety. RESPONSE: 19. Any and all documents that refer and/or relate to any complaints or investigations of complaints made to the answering defendant regarding illness or injury caused by slips or falls on the premises of the Woods at Cedar from January 1, 2000 to present. RESPONSE: 20. Except to the extent produced in response to any of the preceding requests, all documents relating to the investigation of the occurrence of Plaintiff's fall on March 4, 2003, by or on behalf of any individual, agency and/or entity other than answering defendant including file memoranda and/or any other documents prepared by employees, agents and/or representatives of such individual, agency and/or entity maintained by, under the control of and/or in possession of answering defendant. RESPONSE: 21. Except to the extent produced in response to any of the preceding requests, all documents whether or not in the nature of an expert report, concerning the explanation for and/or cause of the injury of Lahoma S. Clauson or similar occurrences, including but not limited to any and all documents in any way referencing the manner in which the slips or falls could be avoided. RESPONSE: 22. A list of all documents which are responsive to this Request for Production of documents but which answering defendant no longer maintains. RESPONSE: 23. Any and ail docUments relating to the policy number, Policy limits, insurers and/or insureds on any policy (including excess or umbrella policies) of liability insurance which is or may be applicable to the claim, including but not limited to policies of the Woods at Cedar Run and/or the Great Commission Care Communities and their respective officers, directors and/or board members. RESPONSE: 24. Any and all documents relating to or in any way referencing any amount or source of self-insured funds which are or may be applicable to this claim. RESPONSE: 25. Any and all policies, procedures, guidelines and/or protocols related to requirements for completion of an occurrence report, incident report and/or root cause analysis by Answering Defendant for possible or actuai injury to residents and/or other incidents in effect in March of 2003. RESPONSE: 26. Any and all intemai and extemal policies, procedures, guidelines and/or protocols related to reporting of occurrences and/or incidents where residents of the Woods at Cedar Run may have been injured in effect in March of 2003, including but not: limited to, reports to and from the Pennsylvania Department of Health, and the Area Agency on Aging. RESPONSE: 27. For all "documents" which are responsive to the herein requests, but which defendants have not produced to plaintiff due to defendant's assertion that a privilege its attached thereto, please state: (a) The individual from whom the document originated and the identity of all authors of said documents; (b) All recipients of the document; (c) The number of pages; (d) The date of the document; (e) The privilege asserted and/or the reason the document is being withheld by the answering defendant. RESPONSE: 28. Any and all documents which relate to or in any way reference the assertion that factors outside of, or events other than, Lahoma S. Clauson's March 4, 2003 fall have affected Lahoma S. Clauson's ability to live as independently as she did prior to her fall on or about March 4, 2003 at The Woods at Cedar Run. RESPONSE: 29. Any and ail documents relating to or in any way referencing Answering Defendant's quality assurance program with regard to the selection, preparation, cleaning, waxing and/or service of floors, hallway railing, and/or lighting. RESPONSE: 30. Any and all documents answering defendant referred to and/or relied upon in answering plaintiff's interrogatories addressed to answering defendant. RESPONSE: Respectfully submitted~ By: GrXant ~I. Fleming, l~squire Attorneys for Plain~ff, Lahoma S. Clausor~ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON Plaintiff THE WOODS AT CEDAR RUN Defendant No. 2003-05254 P Civil Action - Law AFFIDAVIT OF SERVICE COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF CUMBERLAND Grant H. Fleming, Esquire, attorney for Plaintiff, Lahoma S. Clauson. in the above-captioned matter, after having been duly sworn according to law, deposes and says that a true and correct copy of our REQUEST FOR PRODUCTION OF DOCUMENTS on Behalf of Plaintiff was mailed by regular mail at the post office Hershey, Pennsylvania, postage prepaid, this 17th day of November, 2003 to the following: The Woods at Cedar Run 824 Lisbum Road Camp Hill, PA 17011 C. Peter Hitson, Esquire Hitson & Mason 20 Stanwix Street, 4th Floor Pittsburgh, PA 15222 McQUAII)E BLASKO Sworn to and Su,bsc, s,s,~ed . ,.l~f~e me t~s /~rdhy I~tary Public ~OT~RI~ ~L I ~ Z WILSON, N~A~ ~BUC [ DE~ ~, D~i~ ~U~W I ~ ~MMISSI0~ ~IRES ~, 24. ~ J By: Grant III, Fleming, E/uire December 31, ~003 Donald H. smith, Esquire I4itson & Mason 20 stanwix Street, 4°~ Floor pittsburgh, PA 15222 CLAUSON v. THE wOODS AT CEDAR RUN RE: LAHOMA S. Dear Mr. Smith: letter is to confirm our agreement for an e~tension of time in which to The purpose of this file a Complaint. As you are aware, we are in receipt of your Praecipe for Rule to File Complaint. I received y°ur message thr°ugh °ur paralegal indicating that in acc°rdance with Grant Fleming's November 13, 2003 request, you agree to give us an additional 60 days after responses to our Requests for Production are served within which to file the discovery requests on or before january 20~. I your complete responses to our _t.,~ to sneak with you directly, .a.s,. Complaint. We anticipate your_ ,~-:~ ,-,atter, but was unam~ ~ .... ~,,din~ please homy ....... telenhone ca[I on tm~ ,~ ~c -,'-u haYe a different una~a~,~ ~ ~ had retumea yu~ _. ~ --*~,ation letter, u j,~ such I am sending tins cu,,, ..... our office as soon as possible. Thank you and please do not hesitate to call if you have any questions or would like to discuss the matter further. Very traly yours, McQU AIDE BLASKO Bdtt D. Russell LAHOMA S. CLAUSON,: Plaintiff : V. : . TIlE WOODS AT : CEDAR RUN, : Defendant : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTy, PENNSYLVANIA CIVIL ACTION - LAW NO. 03-5254 CIVIL TERM ORDER OF COURT AND NOW, this 15t~ day of March, 2004, upon consideration of Plaintiff's Motion To Compel Defendant's Responses to PlaintiWs Request for Production of Documents (Set One), a Rule is hereby issued upon Defendant to show cause why the relief requested should not be granted. RULE RETURNABLE within 20 days of service. BY THE COURT, Grant H. Fleming, Esq. t/~00 Centerview Drive Suite 5103 Hershey, PA 17033 Attorney for Plaintiff ¢/C. Peter Hitson, Esq. Donald Smith, Esq. Hitson & Mason 20 Stanwix Street Fourth Floor Pittsburgh, PA 15222 Attorney for Defendant 03'1.5 :rc IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON Plaintiff No. 2003-05254 P Civil Action - Law V. THE WOODS AT CEDAR RUN Defendant AFFIDAVIT OF SERVICE COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF CUMBERLAND ) Britt D. Russell, Esquire, attomey for Plaintiff, Lahoma S. Clauson in the above-captioned matter, after having been duly sworn according,, to law, deposes and says that a tree and correct copy of Plaintiff's Second Request for Production of Documents for Answer by Defendant was mailed by regular mail at the post office Hershey, Pennsylvania, postage prepaid, this 29th day of April 2004 to the following: C. Peter Hitson, Esquire Donald Smith, Esquire Hitson & Mason 20 Stanwix Street, 4th Floor Pittsburgh, PA 15222 McQUA1DE BLASKO Sworn to and Subsj~ibed before me this~_~_V'clay of/~A4,cd ~ ,2004. By: Britt D. Russell, Esquire 1N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON, Plaintiff, V. THE WOODS AT CEDAR RUN, Defendant. CIVIL DIVISION No. 2003-05254 P DEFEND~4NTS' NOTICE OF SERVICE OF DEFi~;NDANT'S FIRST AMENDED SET OF INTERROGATORIES DIRECTED TO PLAINTIFF Filed on Behalf of Defendant The Woods at Cedar Run Counsel of Record for this Party: DONALD H. SMITH, ESQUIRE PA. Id. #41011 LAW OFFICES OF C. PETER HITSON 20 Stanwix Street, Fourth Floor Pittsburgh,, PA 15222 (412) 288-6200 JURY TRIAL DEMANDED NOTICE OF SERVICE OF DEFENDANT'S FIRST AMENDED SET OF INTERROGATORIES TO PLAINTIFF TO: PROTHONOTARY I hereby certify that on April 30, 2004, the original Defendant's First Amended Set of Interrogatories Directed to Plaintiff was served on the plaintiff by mailing the same to: Grant H. Fleming, Esquire McQuaide Blasko 600 Centerview Drive Hershey, PA 17033 2LoAsWttanOwF~X[CE~SetO_F C. P~EFg~rthTF~cRorHITSON Pittsb~~ By: [// ,,~/ 9' - ALD SMITH, ESQUIRE H. )rney for Defendant CERTIFICATE OF SERVICE I hereby certify that a true and correct copy e,f the within Notice of Service of Defendant's First Amended Set of Interrogatories to Plaintiff was served on April 30, 2004, by U.S. mail, first class postage prepaid, addressed as follows: Grant H. Fleming, Esquire McQuaide Blasko 600 Centerview Drive Hershey, PA 17033 LAW OFFICES OF C. PETER HITSON 20 Stanwix Street - Fourth Floor Pitt sburg/~/~ 52~2 //~ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON Plaintiff THE WOODS AT CEDAR RUN Defendant No. 2003-05254 P Civil Action - Law AFFIDAVIT OF SERVICE COMMONWEALTH OF PENNSYLVANIA ) ) SS~ COUNTY OF CUMBERLAND ) Grant H. Fleming, Esquire, attorney for Plaintiff, Lahoma S. Clauson in the above-captioned matter, after having been duly sworn according to law, deposes and says that a tree and correct copy of Plaintiff s Notices of Depositions of Kay Ebersole, Nedra Marshall, John Beshara and Shane Wilson were mailed by regular mail at the post office Hershey, Pennsylvania, postage prepaid, this I~.4~ day of May 2004 to the following: C. Peter Hitson, Esquire Donald Smith, Esquire Hitson & Mason 20 Stanwix Street, 4th Floor Pittsburgh, PA 15222 McQUAIDE BLASKO Sworn to and Subsc~.bed befo, r~e, me this _!2~_~Xlay of ¥¥[tLOV ,2004. I~otary Public '~ By: Gr~at H. F eming, 7e NOTARIAL SEAL ~ M, HOEY, NOTARY PUBLIC DERRY 1WP., DAUPHIN COUNTY IEf COMMISSION EXPIRES MARCH 5, 2005 MCQUAIDE, BLASKO, SCHWARTZ, FLEMING & FAULKNER, INC. By: Grant H. Fleming, Esquire Identification No. 16212 Britt D. Russell, Esquire Identification No. 91360 Attorneys for Plaintiff 600 Centerview Drive, M.C. A560 Hershey, PA 17033 (717) 531-1199 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON : by and through her Daughter and Power of Attorney: Sandra R. Barends : Plaintiff : V. THE WOODS AT CEDAR RUN/ Gmat Commission Care Communities, Inc. T/A/D/B/A The Woods at Cedar Run Defendants CP~IL DiVISION No. 2003-05254P COMPLAINT Plaintiff, Lahoma S. Clauson, by and through her attorneys, McQuaide, Blasko, Schwartz, Fleming & Faulkner, complains as follows: Venue 1. Venue is proper in this case as to Defendants Woods at Cedar Run and Great Commission Care Communities, Inc. (hereinafter referred to collectively as "Defendants") because their principal place of business is located in Cumberland County and the cause of action arose in Cumberland County. Parties 2. Plaintiff incorporates by reference the allegations set forth within paragraph 1 above, as though set forth herein at length. 3. Lahoma S. Clauson (hereinafter, "Plaintiff") is tm adult individual currently residing at the Kinkora Pythian Home, Duncannon, PA. 4. Sandra R. Barends is Lahoma S. Clauson's adulll daughter and Durable Power of Attorney. (See Durable Power of Attorney attached as Exhibit "A"). 5. Great Commission Care Communities, Inc. is a corporation organized and existing under the laws of the Commonwealth of Pennsylvania with a place of business located at 824 Lisbum Road Camp Hill, PA 17011, Pennsylvania. 6. Defendant, the Great Commission Care Communities, was at all times hereinafter mentioned, and remains, engaged in the business of owning, maintaining, conducting, and operating the Woods at Cedar Run, which is a residential elder care facility that provides assisted living to elderly citizens. 7. The Woods at Cedar Run is a licensed health care, provider as defined by Section 503 of the Medical Care Availability and Reduction of Error (MCare) Act with offices in Cumberland County, Pennsylvania. Plaintiff is asserting a professional liability claim against this defendant. .Facts 8. Plaintiff incorporates by reference the allegations set forth within paragraph 1-7 above, as though set forth herein at length. 2 9. On or about March 4, 2003 Plaintiff Lahoma S. Clauson was a resident in the Woodlands Unit of the Woods at Cedar Run, 824 Lisburn Road, Camp Hill, PA 17011, which facility was owned, controlled and operated by Defendants. 10. The Woodlands unit is an assisted living portion of the Woods at Cedar Run, and is owned and operated by Defendants for people with higher level of need with activities of daily living. 11. At all relevant times herein Defendants and R. Shane Wilson as the Administrator of the Woods at Cedar Run were responsible for the fire prevention, emergency planning, staff supervision and stafftraining of the Woods at Cedar Run, and at all times pertinent to this Complaint Mr. Wilson was an agent, servant and employee of Defendants. 12. Pennsylvania law requires that all personal care Intome administrators be licensed nursing home administrators, and therefore R. Shane Wilson was required to possess and maintain a valid nursing home administrator's license to authorize him to operate and administer the Defendant's assisted living facility known as the Woods at Cedar Run. 62 P.S. § 213 (b)(3). 13. At all times relevant herein, all administrative personnel, nursing personnel, clinical assistants, and/or dietary personnel who were providing care to Plaintiff including R. Shane Wilson, Kay Ebersole, Karen Gadson, Nedra Marshall and Donald Schell, were agents, apparent agents, servants and/or employees of the Defendants, and acting within the scope of same when providing care, assistance, supervision and safety to Lahoma S. Clauson. 14. Lahoma S. Clauson, on March 4, 2003, was a 78 year old woman with dementia, osteoporosis and a history of chronic lower extremity cellulitis and these infirmities were well known to Defendants and their agents and employees. 3 15. On or about March 4, 2003 Defendants knew or should have known that Plaintiff required the assistance of a cane for ambulation, and Defendantts knew or should have known that Lahoma S. Clauson had, available in her room as her personal property a cane which was essential to her safe ambulation to minimize the risk ora fall m~d other injuries. 16. Defendants knew or should have known that Phdntiff required supervision, including and especially during ambulation activities. 17. On March 4, 2003 Defendants executed a planned fire drill. 18. During the fire drill Plaintiff was directed to ambulate without the assistance of her cane or any other device assisting her, and to exit the her room and the adjacent corridor at Woodlands Unit, moving toward the lobby of the Woods at Cedar Run. 19. During the aforementioned fire drill, Plaintiff was escorted towards the lobby without the assistance of her cane by an employee of the Defendants, Kay Ebersole. 20. Defendants had no regulations or policy specifically requiting its residents to be equipped with their customary ambulation assist devices during fire drills. 21. While assisting Lahoma S. Clauson's exit of her room and corridor adjacent to her room at the Woodland's Unit, Kay Ebersole was simultaneously assisting multiple residents of the Woodlands Unit. 22. While being directed by Defendants' agents and employees to walk down the hall without adequate assistance and without the aid of her cane, Plaintiff fell causing her hip to fracture and other fractures to occur. 23. After falling Plaintiff was left unattended for a period of time. 24. Defendants' staffknew or should have known that: Plaintiffwas unable to articulate the severity of injuries due to her dementia, extreme pmn and upset condition. 4 25. Following her fall where severe injuries were itnmediately sustained, Plaintiffwas inappropriately moved by one or more of the employees of the Defendants. 26. All employees of the Defendants, regardless of their level of training, were required by Defendants' policies and protocols to assist with practice evacuation of all residents during fire drills which occurred while they were in the building. 27. The negligent acts of the above stated employees of the Defendants, in moving the injured Plaintiff after the fall without first determining the extent of her injuries, caused additional pain, suffering and injury to the Plaintiff. 28. Defendants at no time prior to March 4, 2003, provided adequate training to its employees regarding the proper methods of assisting injured patients who had fallen, nor did Defendants provide sufficient training to its employees regarding the proper and safe manner of assisting residents such as Plaintiff during planned fire drills. 29. As a result of injuries sustained by the fall, Plaintiff Lahoma S. Clauson was admitted to the Carlisle Hospital where she was diagnosed with a severe femur and hip fracture and under went a painful surgical procedure for a partial hip rep][acement. She also was compelled to undergo painful rehabilitation attempts which were not successful in re-establishing ambulation for the Plaintiff. 30. Lahoma S. Clauson is unable to return to an assis~Ied living facility because of her complete and sudden loss of ambulation, decreased mental status and increased need for skilled nursing care and supervision. 31. Defendants failed to note Lahoma S. Clauson's fall and injuries as an identifiable problem on the fire drill log as required by 55 Pa. Code § 2620.5:5. Instead, the log falsely indicated that there were no problems during the March 4, 20G,3 drill, and the log was submitted to the Department of Welfare without disclosing Plaintiff's fall or injuries. COUNT I - NEGLIGENCE VICARIOUS LIABILITY 32. Plaintiffincorporates by reference the allegations set forth within paragraphs 1-34 above, as though set forth herein at length. 33. Plaintiff's injuries were directly and proximately caused by the negligence, carelessness and/or recklessness of Defendants through the above-referenced agents, servants, employees, or workmen in: a. Failing to properly oversee and supervise Lahoma S. Clauson's participation in the March 4, 2003 fire drill and failing to request assistance from other employees to prevent injury, knowing that she was at increased risk for falling; b. Allowing and or encouraging Lahoma S. Clauson to participate in a fire drill without the use of her cane for ambulation, or aitematively failing to request that residents such as Plaintiff to he provided and equipped with ambulation a2~sistance devices during fire drills; c. Failing to provide proper supervision of Lahoma S. Clauson during the fire drill by assisting multiple residents simultaneously; d. Failing to promptly secure, assist and supervise Lahoma S. Clauson following her fall, so as to minimize the risk of increased pain and further injury; e. Moving Lahoma S. Clauson before she was assessed by appropriate medical personnel; 6 f. Falling to clinically examine or completely and properly evaluate Lahoma S. Clauson promptly after her fall, or alternatively prevent movement pending a competent medical evaluation of her injuries; g. Falling to promptly notify Lahoma S. Clauson's attending physician of the fall; h. Placing Lahoma S. Clauson in a wheelchair when Defendants knew or should have known Lahoma S. Clauson had sustained a fracture hip or other serious injury; i. Allowing Lahoma S. Clanson to remain seated in a wheelchair with a fractured hip until she was transported to the hospital; j. Failure of the administrator of the Woods at Cedar Run to properly supervise the staff that provided care to Lahoma S. Clauson and/or provide adequate staffing during periods of pre-determined fire drills; k. Failure of the administrator of Corporate Defendants to properly train the staff that provided care to Lahoma S. Clanson; 34. As a result of the aforementioned acts and/or omissions of Corporate Defendants and/or their agents, servants and/or employees, acting within the course and scope of their agency and/or employment, Plaintiff was permitted and/or encouraged to exit her residential Woodland Unit and to ambulate without the assistance of her cane, or providing a similar cane, and without adequate personal assistance, and without proper positioning, sec:mW and safe stability. 35. As a further result of the aforementioned acts and/or omissions of Defendants and/or their agents, servants and/or employees acting within the course and scope of their agency and/or employment, Plaintiff sustained a broken hip, fractured ribs, decreased mobility, increased 7 risk of infection, malalignment of hip, increased risk of death, decreased mental capacity and great physical pain and mental anguish. 36. As a further result of the aforementioned acts and/or omissions of Defendants agents, servants and/or employees who were acting within the course and scope of their agency and/or employment, Plalntiffunderwent extensive medical treatment and care and incurred various expenses for that treatment, and may be obligated to continue such medical care and incur such expenses for an indefinite time in the future. 37. As a further result of the aforementioned acts and/or omissions of Defendants and/or their agents, servants and/or employees acting within the, course and scope of their agency and/or employment, Plaintiffis, and will remain, unable to live the life-style she enjoyed prior to the March 4, 2003 fall and hip fracture. 38. As a further result of the aforementioned acts and/or omissions of Defendants and/or their agents, servants and/or employees acting within the course and scope of their agency and/or employment, Plaintiff does now and will continue, for the rest of her life, to incur additional living expenses related to the increased level of care She now requires as a result of her fractured hip. WHEREFORE, Plaintiff demands judgment against Defendants in an amount in excess of $50,000, which is beyond the jurisdiction's limit for compulsory arbitration, together with punitive damages, costs and any other relief the court deems appropriate. COUNT I - CORPORATE NEGLIGENCE 39. Plaintiffincorporates by reference the allegations set forth within paragraphs 1-41 above, as though set forth herein at length. 40. Plaintiffs injuries were directly and proximately caused by the negligence, carelessness and/or recklessness of Corporate Defendants in: a. Failing to supervise, train and adequately staff the facility operated by Defendants to ensure the safe exit of all residents during fire drills; b. Failing to adopt and/or enforce adequate rules and policies requiring that residents who are known to ambulate with assistive devices be iprovided with an assistive device or wheelchair for use during fire drills; c. Failing to adopt and enforce adequate rules and policies to prevent resident falls; d. Failing to adopt and enforce adequate rules and policies to ensure quality care for residents who fall on premises to prevent further injury; e. Failing to select and retain a properly trained administrator; f. Failing to properly train all of its employees in the safe assistance of residents who were undergoing practice evacuation during pre-determined fire drills; g. Failing to properly staff and equip its employees during times of planned evacuation during pre-determined fire drills; h. Failing to properly train staff to report events or "unusual incidents" to the Department of Public Welfare as required by the Pennsylvania Code; 41. Corporate Defendants had actual or constructive knowledge of the above defects or procedures which created the harm to Lahoma S. Clauson. 42. As a result of the aforementioned acts and/or omissions of Defendants and/or their agents, servants and/or employees, acting within the course and scope of their agency and/or employment, Plaintiff fractured her ribs and her hip causing injuries as set forth above, and necessitating hip replacement surgery, permanent loss of ambulation, and admission to a skilled nursing facility. 43. As a further result of the aforementioned acts as~d/or omissions of Defendants and/or their agents, servants and/or employees acting within the course and scope of their agency and/or employment, Plaintiff developed a fractured hip, permanent loss of ambulation and mobility, increased risk of infection, malalignment of hip, increased risk of death, decreased mental capacity and great physical pain and mental anguish. 44. As a further result of the aforementioned acts and/or omissions of Defendants agents, servants and/or employees who were acting within the course and scope of their agency and/or employment, Plaintiff underwent extensive medical treal~nent and care and incurred various expenses for that treatment, and may be obligated to continue such medical care and incur such expenses for an indefinite time in the future. 45. As a further result of the aforementioned acts and/or omissions of Defendants and/or their agents, servants and/or employees acting within the course and scope of their agency and/or employment, Plalntiffhas permanently lost life's pleasures associated with ambulation, including a life-style diminution, pain and suffering, other diseases and infirm conditions such as decubitus ulcers and risk of deep venous thrombosis associated ~adth loss of ambulation and mobility and other grievous injuries. 46. As a further result of the aforementioned acts and/or omissions of Defendants and/or their agents, servants and/or employees acting within the course and scope of their agency and/or employment, Plaintiff does now and will continue, for the rest of her life, to incur additional living expenses related to the increased level of care she now requires as a result of her fall and fractured hip. 10 WHEREFORE, Plaintiff demands judgment against Defendants in an amount in excess of $50,000, which is beyond the jurisdiction's limit for compulsory arbitration, together with punitive damages, costs and any other relief the court deems appropriate. COUNT W - BREACH OF CONTRACT 47. Plaintiff incorporates the allegations set forth in paragraphs 1-47 above, as though fully set forth herein. 48. Plaintiffpurchased supervision, assistance in arnbulation and other care, which included personal care services, ancillary to her rental of an apartment at Woods at Cedar Run. (See Personal Care Admission Agreement, Attached as Exhibit "B" and Confidential Application for Occupancy attached as Exhibit "C"). 49. The Personal Care Admission Agreement specifically provides that Corporate Defendants will provide Plaintiffwith daily personal care assistance as needed, including ambulation. (See Exhibit A Lessor's Services and Resident's Rights, Section II(A)(v)(i)). 50. That the assistance with ambulation will be sufficient to meet the safety needs of Lahoma S. Clauson is an implied term of the contract. 51. In addition, the Personal Care Admission Agreement provides that the resident's records shall remain confidential and unless prior written consent is obtained, the Woods at Cedar Run shall disclose the records to "no one (other that by Court order or to the Pennsylvania Department of Public Welfare)". (See Exhibit A Lessor's Services and Resident's Rights, Section II(A)(vi)). 52. Plaintiff substantially performed under the contract by paying the Monthly Fee, along with complying with each and every other provision of the contract. 11 53. Defendants breached the contract by: a. Failing to provide dally personal care assistance by adequate assistance with ambulation during the March 4, 2003 fire drill. b. Releasing resident's records without prior written consent to third parties, including the Hartford Insurance Company on or about May 30, 2003. 54. As a direct and proximate result of the Defendants' actions regarding the duty to provide safe assistance and ambulation, Plaintiff fell fracturing her hip, as detailed herein, and because of her life-threatening condition caused by defendant's aforementioned breach, was forced to leave her apartment at the Woods at Cedar Run and reside at Carlisle Hospital for and now lives in skilled nursing unit at Kinkora Pythian Home. 55. As a direct and proximate result of the Defendants' actions Plaintiff's records were released to a third party without written authorization, causing a violation of her privacy interests and expectation of privacy. 56. As a direct and proximate result of the Defendants' breach of contractual obligation to provide safe ambulation and care, Plaintiff sustained permanent loss of ambulation, permanent cognitive and short-term memory loss, resulting in Plaintiff loss of life's pleasures in no longer being able to live in a home-like environment, ambulate in public, and consequently, Plaintiff was compelled to move out of the apartment she had orig/nally rented from the Woods at Cedar Run. 57. As a direct and proximate result of the Defendants' breach of contract, Plaintiff's altered physical condition and disabilities brought on by the Defendants' breach, Plaintiff is compelled her to reside in an environment where she must be pro,tided with the increased level 12 of care she now and for the rest of her life will require, thus depriving her of the use and enjoyment of the apartment she had originally rented from the Woods at Cedar Run. 58. As a direct and proximate result of the Defendants' breach of contract, Plaintiff was no longer obligated to perform her duties under the contract with the Woods at Cedar, and she was required to reside in a facility that would provide her with a safe environment and the increased level of care she then needed and will continue to need for the rest of her life. 59. As a direct and proximate result of the Defendmat's breach of contract, Plaintiff has incurred substantial costs in hospital expenses and, for the :rest of her life, will incur increased living expenses as a result of her need for an increased level of care, which would not have been necessary had the Woods at Cedar Run not breached the contract to provide daily personal care assistance. WHEREFORE, Plaintiff demands judgment against Defendants in an amount in excess of $50,000, which is beyond the jurisdiction's limit for compulsory arbitration, together with costs and any other relief the court deems appropriate. Dated: McQUAIDE BLASKO By: IB~ ~N ~!I'R61F! sl?il~g~ s~i~i r e ID No. 913,60 Attorneys ~r Plaintiff 600 Centerview Drive Hershey, PA 17033 (717) 531-1199 13 VERIFICATIOI~[ I, SANDRA R. BARENDS verify that I am authorized to make this verification as Power-of-Attorney for my mother, LAHOMA S. CLAUSON, Plalntiffin the within action; and that the statements made in the foregoing Complaint are true artd correct to the best of my knowledge, information and belief. I understand that false statements herein are subject to the penalties of 18 Pa. C.S.A. § 4904, related to unswom falsification to authority. Dated: SANDtLA R. BARENDS, Power-of- Attorney for LAHOMA S. CLAUSON, Plaintiff Swom to and subs~ibed before me this /~t~' day o f )'),qo~] ,2004 I 1N THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON Plaintiff No. 2003-05254 P Civil Action - Law THE WOODS AT CEDAR RUN Defendant AFFIDAVIT OF SERVICE COMMONWEALTH OF PENNSYLVANIA ) ) SS: cOUNTY OF CUMBERLAND ) Britt D. Russell, Esquire, attorney for Plaintiff, Lahoma S. Clauson in the above-captioned matter, after having been duly sworn according; to law, deposes and says that a true and correct copy of Plaintiff's Complaint was mailed by regmlar mail at the post office Hershey, Pennsylvania, postage prepaid, this \'~f day ofMay 2004 to the following: C. Peter Hitson, Esquire Donald Smith, Esquire Hitson & Mason 20 Stanwix Street, 4th Floor Pittsburgh, PA 15222 McQUA1DE BLASKO Sworn to and Subs,c~bed before me this _C~_r~lay of }n/l~r/ ,2004. NOTARIAL D~..ANNA M. HO~ NOTARY PIJBI.IO DERRY 'P, AtI~, DAUPHIN COUNIY MYCOMMISStON E~PIRES MARCH Britt D. Russell, Esquire 1N THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON Plaintiff V. THE WOODS AT CEDAR RUN No. 2003-05254 P Civil Action - Law Defendant : AFFIDAVIT OF SERVICE COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF CUMBERLAND ) Grant H. Fleming, Esquire, attorney for Plaintiff, Lahoma S. Clauson in the above-captioned matter, after having been duly sworn according to law, deposes and says that a true and correct copy of Plaintiff' s Praecipe to Attach Exhibits to Plaintiff's Complaint e r aid this V'~da mailed by regular mail at the post office Hershey, Pennsylvania, postag pep , ~ y of May 2004 to the following: C. Peter Hitson, Esquire Donald Smith, Esquire Hitson & Mason 20 Stanwix Street, 4th Floor Pittsburgh, PA 15222 Sworn to and S?s,~ribed before me this/7,__~ day of J"Jq~ ,2004. ~l~6tary Pul~lic ~ McQUAIDE BLASKO By: MCQUAIDE, BLASKO, SCHWARTZ, FLEMING & FAULKNER, INC. By: Grant H. Fleming, Esquire Identification No. 16212 Britt D. Russell, Esquire Identification No. 91360 Attorneys for Plaintiff 600 Centerview Drive, M.C. A560 Hershey, PA 17033 (717) 531-1199 IN THE COURT OF COMMON PiLEAS CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON by and through her Daughter and Power of Attorney Sandra R. Barends Plaintiff CB/IL D1VISION THE WOODS AT CEDAR RUN/ Great Commission Care Communities, Inc. T/A/D/B/A The Woods at Cedar Run Defendants No. 2003-05254P PLAINTIFF'S PRAECIPE TO ATTACH EXHIBITS TO PLAINTIFF'S COMPLAINT To the Prothonotary: Kindly attach the enclosed Exhibits to Plaintiff's Complaint which was filed on May 18, 2004. They were inadvertently omitted from the original filing. Respectfully submitted, Dated: ~/,2,0/0¢ McQUAIDE BLASKO By: ~quire Attorney f~ Plainti~ NOTICE THE PURPOSE OF THIS POWER OF ATTOFaNEY IS TO GIVE THE PERSON YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY INCLIYDE POWERS TO SELL OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY IN YOUR AGENT TO EXERCISE GRANTED POWERS, BUT WHEN POWERS ARE EXERCISED, YOUR AGENT MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS POWER OF ATTORNEY. YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME INCAPACITATED, UNLESS YOU EXPRESSLY LIMIT THE DURATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY. YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR AGENT'S FUNDS. A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR AGENT IS NOT ACTING PROPERLY. THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF ATTORNEY ARE EXPLAINED MORE FULLY IN 20 PA.C.S. CH. 56. IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU. I HAVE READ OR HAD EXPLAINED TO ME THIS NOTICE AND I UNDERSTAND ITS CONTENTS. uson {A290870:1 cash reserves; to borrow money; to manage, sell, exchange, pledge, assign, transfer and deliver any of my personal property or any interest therein which I now own or may hereafter acquire; to make, execute and deliver all relevant deeds, assignments and transfers; to transact all business concerning my personal property, to deposit the same under agreements of deposit and to participate in any plan of lease, mortgage, merger, consolidation, reorganization, recapitulation, liquidation, receivership, or foreclosure with respect thereto. To commence and prosecute, in person or by attorney, unto final decree, judgment and execution any legal proceeding for the protection or enforcement of any of my present or future rights, or for the protection or recovery of any property or any interest therein which I now own or may hereafter acquire; and, in person or by attorney, to appear for and defend me in any legal proceeding which may now or hereafter be instituted against me; and to settle, discontinue or compromise any actions, fights, claims or demands now or hereafter brought or asserted by or against me, and to enter into any stipulations and agreements relating thereto. To sell, exchange, mortgage, lease, pledge, assign, transfer, deliver, improve, repair and manage generally all or any part of or interest in real estate, including the minerals therein, which I now own or may hereafter acquire, and to sell, assign, transfer and cancel any policies of insurance of any sort now or hereafter placed on or in connection with any improvements upon such real estate or any interest therein; to enter upon such real estate ancl recover possession thereof or damages for any injury done thereto and to distrain or cause distress to be made or any action to be taken for any rent due or to become due thereon; to make, execute and deliver all relevant deeds, assignrnents and transfers with respect to such real estate; to buy, at any judicial sale, any real property on which I hold a mortgage. To satisfy or assign and transfer and to give receipts for payment on any mortgage or judgment or interest therein which I may now own or hereafter acquire, and to release from the lien thereof any property included therein, and to make or give such satisfiactions, assignments, transfers, receipts or releases by entries on the margins of the public records of such mortgages in the .Recorder's or other proper office, or by the execution, acknowledgment and delivery of separate instruments, or in any other proper manner; and to assign and transfer and to give receipts for payment in full or on account of any bonds or other instruments of indebtedness accompanying such mortgages. To have access to any safe deposit box which I now have rented or which I or My Agent may hereafter rent and to remove any of the contents thereof. My Agent shall not use said safe deposit box for My Agent's personal use. To prepare, execute, acknowledge and deliver or file any contracts, bonds, mortgages, deeds, leases, assignments, transfers, protests, claims for refund, closi!ng agreements, waivers of the statute of limitations, receipts, releases and other instruments of any nature whatsoever; to 1A290870: } -3- prepare and sign income and girl tax returns, including but not limited to federal forms 1040 and 709, for any year; to represent me before any taxing authority for any claim or proceeding concerning any tax liability for any such year; to make, negotiate, sign and perform any agreement and contract now in course ofnegotiation~ execution and settlement by me, or which may hereat~er in the opinion of My Agent be to my interest or advantage; to effect, procure and continue insurance of any kind and description. To employ attorneys at law and such other agents, employees; or representatives as My Agent may thi~dc proper. To act for me in all matters concerning any of my present and future liabilities and rights in and to any property, real, personal, tangible and intangible, as full), as I could do personally, and in so acting for me in my name to execute, acknowledge and deliver all papers and instruments and perform all acts and things necessa~ or convenient for or incidental to the proper exercise of the authority conferred by this power of attorney. For .any of the purposes aforesaid, except the investment of funds and payment of debts, to appoint and substitute any agent(s) under My Agent and to revoke such action at My Agent's pleasure. I hereby nominate My Agent to be guardian of my person and/or estate if incapacity proceedings for my person and/or estate are commenced after the date of execution of this power of attorney and request that my said nominee not be required to post bond or other security for the faithful performance of the duties of such guardian. I hereby ratify all that My Agent shall do or cause to be done under this power of attorney and any ofM A ent's decisionn Y g v, acts or failures to act shall be conclusive and binding upon me, my heirs, personal representatives and assigns, and I agree to indemnify My Agent, and hold My Agent harmless, from all claims that may be made against My Agent as a result of My Agent's good faith service hereunder and I hereby agree to reimburse My Agent in the amount of any damages, costs and expenses that may be incurred as a result of any such claim. No person dealing with WILLIAM KRENZ as My Agent hereunder shall have duty to inquire as to the inability of my original agent to act as agent hereunder if presented by WILLIAM KRENZ with an originally executed counterpart of this Durable Power of Att0mey or a court- certified copy thereof. This power of attorney shall not be affected by my subsequent disability or incapacity. This power of attorpey shall be construed in accordance with, a~ad governed by, the laws of the Commonwealth of Pennsylvania. {A290870:}..4- IN WITNES~ WHEREOF, I have hereunto set my hand and seal this e,~ ~ tJday of ~ O..~. ,2002. Witness L~oma Susan Clauston - COMMONWEALTH OF PENNSYLVANIA : t,' : COUNTY OF ~ ~,- ~> t ~ : On this, theo~g/t]~day of HE} ~' ~ L ,2002, before me, a Notary Public, the undersigned officer, personally appeared LAHOMA SUSAN CLAUSON, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within power of attorney, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal Notary Public My Commission Expires: Notarial S~al Chades A. C~, N~a~ ~blic Nosh Slmba~ ~.. Washington County My Commission Expires Feb. 27, 2~6 1A290870: }-5- ACKNOWLEDGMENT I, SANDRA RAIBLE BAREi~DS, have read the attached power of attorney and am the person identified as an agent for the principal, LAHOMA SUSAN CLAUSON. I hereby acknowledge that in the absence ora specific provision to the contrary in the power of attorney or in 20 Pa.C.S. when ! act as agent: I shall exercise the powers for the benefit of the principal. I shall keep the assets of the principal separate l¥om my assets. I shall exercise reasonable caution and prudence. I shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the principal. ACKNOWLEDGMENT I, WILLIAM KRENZ, have read the attached power of attorney and am the person identified as an agent for the principal, LAHOMA SUSAN CLAUSON. I hereby acknowledge that in the absence ora specific provision to the contrary in the power of attorney or in 20 Pa.C.S. when I act as agent: I shall exercise the powers for the benefit of the principal. I shall keep the assets of the principal separate fi'om my assets. I shall exercise reasonable caution and prudence. I shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the principal. William Krenz ~ D~te ~ {A290870:J-6- TH~= WC©D$ AT C:EDA;R ;RUN THI~ AGAEE~IANT made this I~"]~, day of/Joy', ~-,.- by and between The Great ~o. mmissicn Care Communities (GCCC), refereed to in this Agreement as 'Lessor', and L~ho ~4~,. Gi~u.~53~'P referred to in this Agreement as "Resident." If two or more persons sign this Agreement, the word "Resident" shall apply to both, they shall be jointly and severally liable for all Resident obligations contained in this Agreement. RECITALS: The Resident has made written application to the Lessor for residence in the living community known as The Woods At Cedar Run ("The Woods"), the contents of that application are hereby incorporated in this Agreement by reference, and the Lessor has approved the Resident's application, subject to the terms and conditions contained in this Agreement. NOW, THEREFORE, in consideration of the mutual undertaldngs contained herein, it is agreed as follows: I, RESIDENCE: LIVING UNIT- RELATED AMENITIES A, Livina Unit Subject to the terms and conditions of this Agreement, the Resident shall have the fight to occupy the living unit designated as apartment #/03 in The Woods (the "Living Unit'). Along with the Living Unit, the Lessor shall provide the Resident with: a single bed with a mattres,'~ and a platform, box spfing or coil frame foundation, a pillow, bed linens and blankets, towels and wash cloths, a chair, a bedside table (or shelf) and a bedside light, a small refrigerator, a dresser and mirror, desk, window covetings, towel bar and a clothing closet. In addition (but subject to the Lessor's rules end regulations), the Resident may furnish the Living Unit with personal possessions. (ii) The Lessor shall have the Hght (but not the obligation) to redecorate Ihs Rssident's Living Unit from time to time at Lessors expense, and R~side~t agrees to coo;erete with the Lessor in so doing. Redecoration of the Living Unit, other than redecoration required by the Lsssor, shall be at the Resident's expense and shall require the prior written approy'al of the Lessor and, if approved, shall be performed under the supervision of the Lessor. Certain Amenities Along with the Resident's fight to occupy the Living Unit, Resident shell have the right to use recreational and other common facilities as well as to participate in available activities. In addition, the Lessor, at Lessor's expense, shall provide heat, air conditioning, water, electric service, sewer and waste removal, and Satellite television service (i.e., the basic channel package). Telephone service for a Resident's Living Unit will be available to the Resident but shall be obtained at the Resident's sole cost and expense and costs including long distance, shall be billed directly to and paid by the Resident. ' The Lessor shall keep and maintain ail buildings, the grounds and common areas. The Lessor shall keep and maintain furnishings owned by or provided by the Lessor in working order. Repairs, m. aintenance and replacement of personal property of the Resident shall be the sole responsibility of the Resident. Notw'rthatanding the obligation of the Lessor to keep and maintain the buildings, grounds, commcn areas, and ~umiehi~gs as stated in this paragre~h, the --) tL A. The Lessor shall provide the Resident with the fcilo~,~-ng: Meals Throe nutriticnaliy well-balanced moab each day in a designated dining mom at The VVcods. The Resident agrees to partake in these meals. A~tematbe and special diets required by the Rssldent's personal physician may by provided by arrangement with the Lessor. The services of the dining room shall be available to the invited guests of the Resident provided that the Resident gives at lean one da:,' advance notice to the Lessor. Fees for such meals shall be in accordance with the meal rate schedule in effect at the time and shall be made a part of the Resident's bill as described in paragraph iV of the Agreement. Recreational and Social Proqrams Recreational and social activity programs, the scope of which will be defined from time to tiime by the Lessor, shall be available to the Resident. (iii') Van Service Courtesy van service or other assistance with transportation shall be provided in accordance with a schedule to be determined sclely by the Lessor. (v) Gratuities All gratuities for services are included in the rental fee described in this Agreement. Personal Care Assistance Personal care assistance shall be provided to the Resident, as ne, eded, and shall include daily assistance, if required, with the following: (a) bathing, (b) oral hygiene, (c) hair grooming and shampooing, (d) dressing and care of clothing, (e) shaving, (f) securing transportation, (g) shopping, (h) scheduling and keeping appointments, (i) ambulation, 0) eating ~) telephone use, (I) self-administration cf prescribed medication, (m) financial management (provided in accordance with the requirements of Title 55 Pa. Cede Section 2620.35) (vO Confidentiality of Records Resident's records shall remain confidential and Lessor shatl disclose them to no one (other than by Court order or to the Pennsylvania Department c¢ Pubiic Welfare) without Resident's pdcr ,,vd~en consent. By signi~',g this Agreement, the R~ident euihodzss disclosure of his c¢ her records to the Pennsylvania Bepa~lment of Pubtic Welfare. (vi~ Resident's Riahts 1. The Resident is nct restricted in the right to leave and return to The Woods at reasonable times. 2. The Resident is free to receive visitors for a maximum of 8 hours daily, 7 days per week. 3. The Resident has access in reasonable privacy to a telephone in The Woods, and can make local calls without charge, except where a standard pay telephone is used. On long distance calls, the charges must by reversed. 4. The Resident has access to the United States mail and can write and send mail, at the resident's own expense, and receive uncensored and unopened mail. 5. The resident is free to exercise the dght to attend and participate in religious activities. 6. The Resident has the dght to be treated with dignity and respect. 7. The resident is free to request and receive assistance in relocating. 8. The Resident is free to exercise cbil rights and, to this end, may voice gdevancss end recommend changes in policies and services of The Woods whhc,.2 fear of repd.s%-;t or intimida'~icn, tn addRion, ~he Rs$ident IV. when the Rssident feels the gdevancss hays not been properly resolvsd through The Woods grievance proca,dura. 9. The R~sident is to be com~nsat~ in acco~anca ~th State Federal labor ~stues for labor ~e~c~ed housekeeping tasks dira~ly to the msidem's ps.anal spaca b~ may n~ pedo~ talks in I~eu of a ~aff pecan. 10. ~e Resident has the ~M to pdvacy of self and posssssions. 11. ~e Rsside~ hss the d~ht to be free ~m abuse. 12. The Resident is ~e to associ~e and communicate with othem p~zatel~. 13. Th~ Reside~ is ~ee from m~mints. ill. IV. M~=DICAL EVALUATION & SCR~EN]~]G FOR AD?~I Resident agrees to have a medical evaluation by a physician pdor to commencement of residency and annually thereafter. Resident also agrees to provide a copy of his/her annual medical evaluation using the form designated by the Department of Public Welfare to THE WOODS AT CEDAR RUN. Prior to admission and annually thereafter, the Resident agrees to participate and provide needed information for the Administrator to complete the Screening Instrument to determine the appr0pdateness of care required i~ ii[iht of fh~'-msid~fi{i§ p~sent medical and social needs. Lessor's Determination In the event that the Lessor in its sole and absolute discretion determines that the Resident requires personal services beyond those for wh ch The Woads is licensed or is otherwise providing residents, the Resident agrees to accept this determination from the Lessor, the Resident shall vacate the Living Unit within the time designated in the notice by the Lessor, which shall provide the Resident with at least 30 days notice to so vacate, unless the Lessor, in its sole discretion, shall determine that a shorter notice period (or no notice prior) is required under the circumstances provided that the length of any such notice period (or lack thereof) shall comply with applicable law. Meat Crsdi~ it is the pcticy of The Woods that a resident who does not occupy the room but wishes to "h~ld Lhe room= after a foudeen (14) da~ ~edcd, will rscsiw a $5.00 ;er day Meal Credit, from ~he fi~ day cf absence. ~=~]~T~L $~ERV]CE F:F~ A~ID OTH~ER O~LIGAT]OH¢.; O~= Rental The Resident shall pay the Lessor one month of advance rental fees on the first day of each month, the amount due for the month's rent and the fee for such additional ser,/ices being rendered by the Lessor to the Resident for the days of that month as provided in paragraph IV. ~) of this Agreement. Upon signing this Agreement, the Resident shall pay one month's total charges and a secudty deposit in advance. The security deposit paid by Resident shall be held by Lessor until this Agreement is terminated. For your protection, it will be kept in a security deposit account. The full secudty deposit shall be. returned to Resident within thirty (30) days after termination of this agreement reduced by the following charges if applicable: (1) Securib! Deposit will net be returned if Resident terminates the Agreement without providing Lessor with the required flirty (30) days notice; (2) any rental payments or portions thereof required by the terms of this agreement and not paid; (3) unpaid late charges; (4) any attorney's fees caused by a breach of any provision or provisions of this Agreement on Resident's part; (5) any court costs caused by the enforcement of the terms and provisions of this Agreement; (6) the cost of any repairs, replacements, redecorating appliance caused by other than reasonable wear and tear;, (7) costs and expenses incurred by the Lessor adsing from the breach by Resident of any provisions of this Agreement; (8) a reasonable c!e~nin~ ax;ense p~vidad Rssid~nl does nc~ leave the ;rsmisss in a ci.san ranta~t~ SecuHt7 Deposit (transferred) ~¢v~, ~IOt~ITHLY RENTAL CHARGE Monthly Rental Charge Includes: Room and Board $ ~0~;$,oo ,G~~. included Pemonal Care Services Inc]udad Special / Additional Monthly Services As Requested by Resident Rental Commencement Date Daily Pm-Rated Rate $ Pro-Rated Rent for Current Month $ Rent Paid for Additional Months SUBTOTAL Rental C~di~s Reservation Deposit Deduction ($) Date paid / / Number of Pro-Rated Days Deity Pro-Rated Rate Pro-Rated Rental Crodit for Currant Month $ $ days $ ($ The foregoing monthly charges shall be paid as follows: (to be billed) Resident Cona'ibuflon $ Third Party Contribution from Third Party Contribution from TOTAL Ail billings [or sep~J~s witl be for the previous month. All rates are subject to change with a 30-day notice. The listed charges represent the initial rental-and additional charges; however, the additional charges are subject to change as descrit~ed in this Agreement. Lessor agrees that there shall be no change in any rate charged to Reaident during the terms hereof or any renewal or extension thereof without the Resident's receipt of thirty (30) days advance written notice. Pro-rate Daily Refund Upon expiration or termination cf this Agreement (other than due to a Resident's default), the Lessor shall refund to Resident a pro-rated amount, through the date Resident vacates the Living Unit, of ail rental and other charges paid in advance by Resident. In the event this Agreement terminates as a result of Resident's default under this Agreement, then no such refund shall be made by Lessor. Upon sale or other transfer of The Woods by Lessor, this Agreement shall not terminate, however, the Resident shall either receive (i) a refund of all rental and other charges paid in advance and applicable to days after the sale or other transfer is consummated or (id a credit from the new owner on account of such payment. Late Chame for Overdue Payments/Default The Resident shall pay in addition to rent a late charge of five (5%) percent of the amount due on payments which are not paid in good funds to Lessor wr~hin five (5) days.after such a pay.m_.ent is._due. This. additional rent shall be paid by the Resident alone with the delinquent rent without any further notice or demand by the Lessor. If the Resident fails to make any payment required under their Agreement within thirty (30) days after its due, date, then the Resident shall be in default of this Agreern, ent. Lessor's Rules Resident shall follow all of Lessor's roles and regulations as they may be amended from time to time. Rules and Regulations are as follows: 1. Residents must have a personal attending physician. 2. No alcoholic beverages shall be permitted, 3. Administration must be notified if a Resident will be absent from The Woods overnight or for any extended time pedod. 4. Meals served will be: breakfast, lunch, and dinner. 5. A~'~er moving in, ail pac~dng containers must be dis.~osed of by the Resident or their responsible part,/. 8. Rental payments are due cn the first of evep/month. Any rents unpaid a~er 5 days after the first are subject to a late charge as specified in this Agreement. 7. Pets are not p~rmitted. 8. ~ Repair requests must be made by calling the Front Desk at 737-3373. 9. Redecoration of the Living Unit by the Resident shal]l only occur with the prior wntten approval of Administration. 10. No electrical appliances or other equipment may be, used in the Living Unit without prior approval of Administration. 11. The Resident may purchase and install a telephone in the Living Unit. It is the Resident's responsibility to arrange and pay for this service. 12. Any questions or complaints should be directed to, the Administrative office. All efforts will be made to resolve any problems as quickly as possible. Coooeration Resident shall cooperate in all matters with Lessor and the other residents related to Residents occupancy at The Woods including, without limitation, providing the Lessor with any and all information required by Pennsylvania Law to be kept by Lessor. Emeroenm/ Evacuation Exemise Resident agrees to participate in all fire drills and emergency evacuation exercises conducted by Lessor. Initial Term This A~gmement shall be on a month-t~mcnth basis. This term of the Agreement ~ t l]l~/~"t/and shall automatically renew itself on each succeeding month unless terminated as provided in this Agreement. Nobvithstandi{ng the fact that this Agreement is on a month-to-month basis, either arty may terminate this Agreement by providing the other party with at least thirty (30) days advance wfiffan notice in accordance with the provision set forth in paragraph IV. If lhe Lessor intends to terminate ibis Agreement for any reason other than Resident's inabili'b! to medically qualify provided in paragraph III (A) or paragraph V (C), V (D) or V(E), the Lessor will give to the Resident a~d a person designated by Resident thirty (30) days termination notice, and state, in writing, the reasons for terminaticn. All financial adjustments resulting from such termination shall be prorated according to the number of days in residency unless such termination is the result of the Resident's default in the per[ormance of Resident's obligations hereunder. Closure In accordance with the requirements of Pennsylvania law, the Resident acknowledges that Lessor hereby advises him that if ;['he Woods doses to all residents, Lessor shall submit to Resident, at least thirty (30) days before date. Copies shall be provided to the Department of Public Welfare; the Resident and his/her emergencY contact or deSignated person; any a~encies c~n:ently previdi"g ServiC~ to tl~-Resid~t~ ThJ~ Agreement shall terminate on the date of closure orthe date stated in the notice, whichever is earlier. Resident's Death This Agreement shall terminate on the death of the Resident. If termination occurs as a result of the Resident's death, the advance rent shall be pro-rated as of the date of the Resident's death, provided that a representative designated by the Resident shall remove the Resident's personal belongings within seven (7) days, of such Resident's death. In the event that such personal belongings are not removed within the seven (7) day period as provided in the preceding sentence then the charges thereinafler referred to shall become effective from the date of the Resident's death and the P, esident hereby agrees that Lessor may, without liability'for damages, (i) remove and stor~ such personal prope~j and charge all costs involved in so doing to the Resident's estate or (ii) permit such personal property to remain in the Reeidant's Living Unit at a cost equal to th~.~ rental change then in effs~ for the said Living Unit fr~m the date of the P, esident's death ur~il the date the ~esidant's personal representative removes such belongings, in all events, any and ail monies due with respect to the Resident's personal properly as described in this paragraph shail be paid in full ~:dcr to delivery of such property to the duly appointed representative of the Resident's estate. Reside~t's Behavior In the event that the Resident's bahevior, in Lessor's sole discretion, endangers property or the safety of the Resident or other persons in The Woods, and the behavioral problem (s) cannot be solved to Lessor's eatisfacticn, then Resident may be removed without thirty (30) days notice. Resident's Medical Condition If, in the opinion of the Resident's licensed physician or Lessor, the Resident's medical condition deteriorates to the extent that the Resident requires skilled nursing (or other services for which Lessor is not licensed), then this Agreement shall be terminated effective upon Resident's vacationing the Living Unit and the Resident or person designated by Resident witl immediately make arrangements for transfer to a nursing home (or other appropriate facility). The Lessor will assist in arranging such a transfer. Violation of Rules/Other Default If at any time durin~g the term of this Agreement, the Resident shall be in default under this Agreement or in violation of the Lessor's rules and regulations, then Lessor shall have the right, in addition to the Lessor's other rights, to terminate this Agreement. Termination shall not occur until the Resident has received thirt~ (30) da~,s advance written notice unless a shorter notice period or nc notice is permitted u~dsr a~p!{c~l~ pr~visic~ of i~is .) A. Notice Procedure Notices to be given the Lessor shall be served at the Office of the Administrator. Nctices to be given the Resident shall be seP~ed on the Resident at the Living Unit and on a person designated by Resident at the address provided by Resident. All notices shall be sePzed personally or by certified or registered mail. Either party may change its address by giving written notice thereof to the other perbj. The Resident's designees shall notify the Lessor of any change in Ms/her or their name (s), addresses and/or telephone number. L:E$$OR'$ LI,~tlLITY Limitation on Lessor's Liability Notwithstanding an,./thing in this Agreement to the contrary, no personal liabilit7 shall accrue against tlse Lessor, or any employee, agent, subsidiary or affiliate of the Lessor, or any individual, partner, shareholder, officer, director, joint venture, representative or fiduciary of the Lessor or any heir, personal representative, successor or assign of the forngoing, nor shall any of their personally owned properbj be realized against for the satisfaction of any claims, losses or damages, it being expressly understood and agreed that th(; Resident shall look solely to the Lessors interest in the leasehold of The Woods and the real property upon which The Woods is located for the satisfaction of any and all ,~-Iaims, losses and damages arising out of or relating to this Agreement. VIII, UI$CELLANEOU$ . Entrv The Lessor shall have the right at any time to enter into the Living Unit of the resident for the purpos~ of exercising its rights and/or performing its obligations under this Agreement and/or verifying the Resident's performance of the Resident's obligations under this Agreement, provided that, except in the case of emergencies, the Lessor shall use reasonable efforts not to interfere with the privacy and use of the Living Unit by the Resident. Waiver of one Breach Not a Waiver of An,/Other The failure of the Lessor in any one or more instance to insist upon the strict performance, observance, or compliance by the Resident with any of the terms or provisions of this Agreement, shall not be construed to be a waiver or relinquishment by the Lessor or its right to insist upon strict compliance by the Resident ,with ell of the terms and provisions of this Agreement. Resident's Personal Effect The Lessor shall have no dubj to examine the Resident's furniture, furnishings, or personal effects for possible hazards, but the Lessor does 'reserve the right to require removal, repair or relocation of furniture, furnishings or personal effects of the Resident, the condition, IocetJ[on, or retention of which the Lessor believes to be dangerous to the Resident or other residents of The Woods or any other person or property. Insurance The Resident shall be responsible for maintaining such insurance as he/she desires against liability, or loss of the Resident's personal properly and the Resident shall be responsible for the cost thereof. Lessor shall not ibe liabte for any damage or injury to the properly of the Resident or any other person. Em Entire Aoreement This Agreement constitutes the entire Agreement between the Lessor and the Resident and supercedes any and all other pdor agreements, both oral and written. This Agreement may only be amended in ~witing by agreement of the parties, and Lessor hereby agrees to provide at least thirty (30) days advance written notice of any proposed amendment. Headinos The section and paragraph caption{ of this Agreement are for convenience and shall not in any way limit or be deemed to construe or interpret the terms and provisions thereof. H. Sever~bilJb~ Should any provision of this Agreement in an)' wa)' contravene the laws of the Commonwealth of Penns)'lvania or any other applicable jurisdiction, such provisions shalt be deemed not to be a pa,,'t of this Agreement in that jurisdiction, and the par~ies agree to remain hound b)' ail remaining provisions. L Rent Rebate Funds The Woods does not provide assistance handling the filing for rent rebate funds received by the Resident under the Senior Citizens Rebate and Assistance Act. The Woods does not ctaim any of the rent rabble received by the Resident. Personal Needs Allowance Resident shall retain ~0.00 per month of cwn funds for personal expenditures. Said minimum amount shall be amended from time to time as published in the Pennsylvania Bulletin. tN WITNESS WHEP, EOF, the parties signed, sealed and delivered this Agreement the day and year first above written. RES]DENT(e): LESSOR: Signa~m Signature The Woods at Cedar Run 824 Lisbum Road Camp Hill, PA 17011 Addrass ( ) (7t7) 737-8373 Te]e~iho~e Telephone ATTORN~.'Y-IN-FACT Naroe ~.~eese .~'~) Signature Address ( ) 'relephone [cOP, V~.~I. UA~BLE CON~E;P, AT]ON, the undersigned, does hereby absolutely and unccnditJcnaJly guaranty to the Lesscr and its successors and assigns the prompt and timely pederm, ance of all the Residents; obligations ueder the Agreement to which this Guarant7 is appended, including, withcut limitation, the payment of any and ail rent or other sums of money othe{~,visedue under this Agreement. The undersigned hereby ,~vaives notice of default by the Resident under the Agreement and any ether notice demand to which the undersigned may not be required to exhaust or exemise its remedies against, or to proceed against, the Resident before proceeding against the guarantor. The Lessor may proceed immediately against the guarantor in the event of a default by Resident under this Agreement. The guarantor further agrees that this Guarant~j shall remain in full effac~ even if the Agreement is renewed, changed or extended in any way and even it Lessor has to make a claim against guarantor. Guarantor agrees to waive trial by juPj in any action, proceedings or ceuntemlaim brought against the guarantor on any matter concerning this Agreement or GuarantT. GUAP`ANTOR: LESSOR: Name (P/ease Signature Name $;gnature The Woods at Cedar Run 824 Llsbum IF~oed Camp Hill, PA 17011 Address ) Ta]epho;~a (717) 737-3373 Nondiscdmina~on in Services Admissions, the provision of services, and referrals of residents shall be made without regard to race, coJor, religious creed, handicap, ancestry, national origin, age or se;(. Program services shall be made accessible to eligible handicapped persons through the most practical and economically feasible methods available. These methods include, but are not limited to, equipment redesign, the provision of aids, and the use of alternative service delivery locations. Structural mcdifications shall be considered only as a last resort among available methods. Any resident who believes they have been discriminated against may file a complaint of discrimination with: The Weeds at Cedar Ran 824 Lisbum Road Camp Hill, PA 17011 BUreau of Civil Rights ComPliance Department of Public Welfare Room 412 Health and Welfare Building P.O. Box 2675 Harrisburg, PA 17105 Office f~r Civil Rights U.S. Department of Health and Human Services Region II1, P.O. Bo;( 13716 Philadelphia, PA 19101 PennsyJvania Human Rala~=ns Con, mis=ion 101 So~th Second Street Suite 300 Harrisburg, PA 17105 ats AT CEDAR RUN Confidential Application for Occupancy 824 Lisburn Road Camp Hill, Pennsylvania 17011 (717) 737-3373 AT CEDAR RUN Confidential Application for Occupancy The following materials are included in this Confidential Application for Occupancy: Personal History Financial Statement Health History AT CEDAR RUN Confidential Application for' Occupancy Personal History The information on this application will be confidential. If you need more space, please attach another page. [] Mr. & Mrs. [] Mr. ~ Mrs. Name [] Miss Spouse C1 auson, Lahoma Sue Last First Middle Wi dow Last Fimt Middle Address 134 Kinq George Court, Apt; 203 City and State Palatine, Illinois Social Security No. 445 / 18 /6884 Social Security No / / Zip 60067 Telephone No.(708) 991-5762 Previous Address 16201 E1 Camino Real #9 Years at this address 12 City and State Houston, Texas Age: 68 Birthdate: 9-13-24 ~ Married: Widow/Widower: XX Single: If married, when and where: n What are your present living arrangements? Own Home: Choice of accommodation: One- X× Two- Approximate date of occupancy desired: 4/15/93 Do you plan to share your apartment? Zip Code 77062 Divorced: Rent XX bedroom apartment No If so,with whom: Applicant's Occupation (If retired, please indicate and give former occupation): Housewife/Widow of Engineer (Retired from Amoco Chemical Co,) Employed by (last or present employer) N/A Children and/or close relatives: 1. Name Sandra Barends Address 205 Sassafras Street City and State Harrisburq, PA Relationship_ Daughter Telephone No. ( Age 47 717 ) ~2-36 -2022~:~FF~ · 787-73,7_5 Zip C~e 171~2 Children and/or close relatives: (conrd.) 2. Name Mrs. 0pal Porter Address .31fl.3 Nnt'~h Ann City and State Oklahoma Clty~ Oklahoma 3. Name t~lrs. Jeanne [-lopper Address 2829 N, ~t. 18th ~tt, eet City and State 0klabo~a C~ty~ Oklahoma 4. Name Address City and State Relationship Sister Age 79 Telephone No. ( 405 ) qae,~R~ Zip Code 73112 Relationship ~;t~te~ Age 76 Telephone No. ( 405 ) 948-7823 Zip Code 73107 Relationship Age Telephone No. ( ) Zip Code Acquaintances {not relatives) whom you have known for five years or more: 1. Name Ed Tnlnr~,En Address801 N. Brafnard Ave. 2. Name Bernice £h~vml i.~7 Address 136 King George Court Telephone No. ( 708 ) City and State LaGrange Park, IL Zip 60525 Telephone No. { 7087 ) 359-0024 ~;ityandState Palatine,. Illinois Zip 60067 Whom should we contact in case of emergency? Name S~ndra Barends Address 205 Sassafras Street City and State In case of death, who would handle your affairs? Name Sandra Barends Telephone No. ( 717 Address 20.~ s~¢~,~ ~-~ City and State Harrisburg. PA Do you have a will? XX Yes No -TL. Hobbies you'd like to pursue at the Woods at Cedar Run? 0il Painting or ? Telephone No. ( 717 )_~_~6-_~0_~_~ er.,787-7175 Relationship Dauahter ~[arrisburg, PA , Zip 17102 ). 236-2022 Zip 17102 Do you currently have an automobile? ×X Yes Church Affiliation: Name of Church Address ~No Make: 1990 Buick Reqal License No: Telephone No. ( ). · City and State Zip Name of Pastor Time Associated Clubs_and organizations (church-related or social), to which you presently belong or have belonged? AT CEDAR RUN. Confidential Application for Occupancy Financial Statement Fixed Monthly Income Social Security Pensions {Please indicate source; i.e., government, private sources) 1001.00 2000.00 2000.00 5001.00 + Interest from stocks and bonds Other Interest from Money Market Funds Total Fixed Monthly Income Additional Questions 1. For the purposes of this transaction, must your present home be sold? Yes [] No'[~ 2. Will you need to arrange for a short-term loan with your bank to complete this transaction? 3. Does your pension (income) cease when you die or does it continue to go to your spouse? 4. Does your pension increase along with the cost of living? Yes ~Q[ No [] 5. Do you have a financial advisor? Yes ~ No [] If yes, please indicate below. Name Gerry Weiner-Dean. Witter Telephone (312-) __g84~070 & Sandra ~Barend.s, 205 Sassafras St.. [~bg,, PA 17102 Address n,,~, ,.,~ ....... ~ - . onn ~-~ ~;.~ ~.~..~ ............... ~ .... ~G, ..~, ....... ~ , ,,~ ,,~,v,,~, C~ Chicago S~te Illinois Zip 60680 Relationship Weiner. Stock B~ker Barends - Daughter 717-236-2022 * Yes [] N/A No ~X Assets Cash Checking Account Savings Account U.S. Government Securities Certificates of Deposit Money Market Certificates $ 20.QQO.OO $ $ 13,000.00 $ 500,000.00 Stocks, Bonds, Mutual Funds Description 25 or more individual stocks # Shares ? Mutual Funds - Dean Witter Pension Profit sharing, retirement plans, IRA and/or KEOGH Description IRA - Dean Witter Real Estate (Residential, Commemial, Other) Type N/A [] Full ~ership [] Joint ~nemhip Current Market Value $ Businesses Owned Description N/A Type [] Full Ownership []. Joint Ownership Current Market Value $ Current Market Value $ ~N:NNN.NN $ ~NN;NNN.NN Current Market Value $ 500.000.00 $ $ $ Type ~I/A [] Full Ownemhip [] Joint Ownemhip Current Market Value $ Current Market Value $ Personal Pmperty Descdp~on Car, Jewelry, Fur Coat, Furniture, etc. ~. Life lnsurance N/A OtherAsse~ N/A Total Assets Current Market Value $ 25.Odd.n0 $ 5,000.00 $ Cash Value $ $ $ 1,065,000.00 Liabilities Loans Payable Description None Monthly Payment $ ,oo Balance Due $ .oo Notes Payable DeSCription None Monthly Payment $ .oo $ Balance Due $ ,oo $ Unpaid Taxes and Interest Real Estate Mortgage(s) Description None Other Debts (Explain) None Total Liabilities Net Worth Current Monthly Payment $ .o0 $ Balance Due $ .oo $ $ ,oo $ ,oo $ $ (Total Assets -- Total Liabilities = Net Worth) $ 1,065,000.00 For Period Pt, esent - 1993 Dates v/~Signature ~ Today's Date Application Process A separate application is required for each applicant This will include a Personal History, Health History and Financial Statement, using forms supplied by The Woods at Cedar Run. When all of the above have been received, application will be reviewed by Management. Following approval, the applicant may formally reserve an apartment with a payment of one (1) month's rent. Following approval of application and selection of an apartment, there will be a $500.00 processing fee if the resident then chooses to withdraw the application. NOTE: As part of the application process, a physician's report, usi~,g forms supplied by The Woods at Cedar Run, is also required. This report must be based on a physical examination completed not more than three months before residency. The Admission's Committee reserves the right of final approval following receipt of the physician's report. Signing of Application for Residency I understand that if this application for residency is approved by Management, the information supplied will become part of the agreement I wilt make with The Woods at Cedar Run at the time I become a resident and that any misrepresentation, concealment or omission may cause the agreement to be voided at the option of The Woods at Cedar Run. r~pplicant's signature (:~~~ fJ~,~,~-~' Date '//~,,~ .~ ~Ce U~ Application r~eived ~~ ~posit~ ~ Financial re~d Physician's report received Reviewed by Management Approved ,'~ Not approved For Personal Care: Recommendation made to Medical Committee Approved Not approved AT cEDAR RuN Confidential Application for Occupancy -- Health History Good, except, for' ost.eo/ar'thrit.i =-._ Estimate in your own words the condition o! your health. ---------- -- - e ---------- Fair --------- Poor d ---------- Averag Vision is X× Goo Fair --------- Poor Hearing is ---------- Good ~ Average ~ -- Color of eyes Br'own Color o! hair Br'ot~ra weiglnt 0__1.Q1_._~-- height ~ -- Describe any chronic diseases [heart, diabetes, kidney, etc.). S~me Specify any physical limitations. ~ ..... Desdribe any allergy, including reactions to drugs. ~~ Have you ever had the following, with what treatments and results: No TuberculOsis - Cancer -~ Emotional Breakdown ~ Alcoholism --------J~ Diabetes ~ ----~-n Blood Disease .____l/o_ Heart Disease ~ Stroke ~ 6. Are you presently under special medical care? Yes ';--f--No __IX _ _------- If yes, for what? 7. Do you have any physical condition that restricts your activities in any way? _ Osteo/ar'thritis, see above. 8. Do you use a cane, crutches, wheelchair or other p~rosthetic device? _------- Cane 9. Are you presently following a physician ordered restricted diet?. Yes No XX If yes, what kind? Do you have any food allergies or ntolerances? YesXX No _~ If yes, please list Rich sauces, acidic foods. What special medicines, vitamins, drugs are you now taking? Arthritis medicine~ calciums Zantac. 10. State any regular medicines and/or medical treatment you require to be administered by a nurse or physician. Nnn~ 11. Medical health insurance: Blue Cross . Blue Shield _.' G47~'~ ~ ~c/a~ b~ {~ ,r, n c h 0036000/0065/(~000 Your Medicare number 445-18,-6884A Do you have Medicare Medical Insurance? Other Other.. Amoco (Met Life), P.O, Box 2007, Aurora, IL 60507 Effective Date Current Yes XX No. _ 12. Your physicians: ~/--1. Name Cowley Associates. Telephone No.( 717 ) 761-7400 Address0ffice Plaza 21 · City and State. Camp Hill, PA Zip 17011 '~ 2. Nam~ Dr. Victor Lesniau~ka~ · - ur. L. amuerta..url:no, paealc Assoc., l~oa EF~ee.n/:)~e RNd°.',( ~08. ) ~r~n§ton Hgts. 60605, Address 855 E Palatine Ra. City and StatePalat~ne, ]L Zip60067 · .. 708-870-6100, 13. List hospitals in which you have been a patient in the last five y,ars: Name .. Northwest' Con~nunit,vHospital City and State J~rlin.qton Heights, IL 60605 Name .City and State Name City and State 14. Describe surgical operations, serious illness and hospitalization, for the past five years: Hip and shoulder fracture from tripping on phone cord. I hereby authorize my physician and hospital to release medical inforrnation to The Woods at Cedar Run for purposes of application and. residence. ,., '/'Signature of App, licapt Da'e_ 1N THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON Plaintiff V. THE WOODS AT CEDAR RUN No. 2003-05254 P Civil Action - Law Defendant CERT/FICATE OF SERVICE COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF DAUPHIN ) I, Deanna M. Hoey, a paralegal for McQuaide, Blasko, Schwartz, Fleming & Faulkner, Inc., certify that I this 20th day of May 2004, served true and correct copies of Plaintiff's Amended Notice o£Deposition of John Beshara on all counsel of record or parties of interest by sending the same via Federal Express, Priority Overnight Delivery and addressed as follows: C. Peter Hitson, Esquire Donald Smith, Esquire Hitson & Mason 20 Stanwix Street, 4th Floor Pittsburgh, PA 15222 McQUAIDE BLASKO Deanna M. ttoey ~ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON Plaintiff V. THE WOODS AT CEDAR RUN Defendant No. 2003-05254 P Civil Action - Law AFFIDAVIT OF SERVICE COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF CUMBERLAND ) Grant H. Fleming, Esquire, attomey for Plaintiff, Lahoma S. Clauson in the above-captioned matter, after having been duly swom according to law, deposes and says that a tree and correct copy of Plaintiff's Third Set of Request for Production of Documents and Second Set of Interrogatories was sent by Federal Express this ,~.~'~ day of May 2004 to the following: C. Peter Hitson, Esquire Donald Smith, Esquire Hitson & Mason 20 Stanwix Street, 4th Floor Pittsburgh, PA 15222 McQUAIDE BLASKO Sworn to and Su, bsc~ribed before me this ~_'day , 2004. -N/~tary Public By: C~antlH. FlYing, Esquirl l' NOTARIAL SEAL EIZ~ETH J, W~LSON, NOTARY PUDUC DERRYTWR DAUPHIN COUNTY MYCOMM SS)ON EXPIRES OCT. 2~L, 20~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON, Plaintiff, V. THE WOODS AT CEDAR RUN, Defendant. CIVIL DiVISION No. 2003-05254 P OBJECTIONS TO SUBPOENA PURSUANT TO RULE 4009.21 Filed on Behalf of Defendant The Woods at Cedar Run Counsel of Record for this Party: DONALD I-1. SMITH, ESQUIRE PA. Id. #41011 LAW OFFICES OF C. PETER HITSON 20 Stanwix Street, Fourth Floor Pittsburgh, PA 15222 (412) 288-6200 JURY TRIAL DEMANDED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON, Plaintiff, -vs- THE WOODS AT CEDAR RUN, Defendant. CI?VIL DIVISION No. 2003-05254 P OBJECTIONS TO SUBPOENA PURSUANT TO RULE 4009.21 Defendant, The Woods at Cedar Run, objects to the proposed subpoena that is attached to these objections for the following reasons: Without waiving any other applicable objection, the records set forth in the proposed subpoena are not relevant, and/or are not calcula~Ied to lead to the discovery of admissible evidence; the material is privileged; and the production of the requested items would cause unreasonable annoyance, embarrassment, and oppression to the defendant and will indirectly cause unreasonable burden or expense to the defendant. LAW OFFICES OF C. PETER HITSON ~i0ttSs~~~t~ e~~l; ~ Attorney for Defendant 1N THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON Plaintiff V. THE WOODS AT CEDAR RUN Defendant No. 2003-05254 P Civil Action - Law RECEIVED HAY 15 200 , BY: NOTICE OF INTENT TO SERVE SUBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 Defendants intend to serve a subpoena identical to the one attached to this notice. You have twenty (20) days from the dated listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If no objection is marie the subpoenas may be served. Date: Attorney for Plaintiff MCQUAIDE, BLASKO, SCHWARTZ, FLEMING & FAULKNER, INC. By: Grant H. Fleming, Esquire Identification No. 16212 Britt D. Russell, Esquire Identification No. 91360 Attorneys for Plaintiff 600 Centerview Drive, M.C. A560 Hershey, PA 17033 (717) 531-1199 COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON : CIVIL DIVISION by and tkrough her Daughter and Power of Attorney: Sandra R. Barends Plaintiff : No. 2003-05254P THE WOODS AT CEDAR RUN/ : Great Conunission Care Communities, Inc. : T/A/D/B/A The Woods at Cedar Run : Defendants : SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: The Pennsylvania Department of Public Welfare Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: ANY AND ALL RECORDS PERTAINING TO The Woods at Cedar Run, 824 Lisbum Road, Camp Hill, PA 17011, including but not limited to, On-Site Inspection Reports, any and all deficiency reports, plans of correction, founded complaints, information regarding other lawsuits, reports of unusual incidents, any and all logs of reports of unusual incidents in written log, telephone log, computer log, electronic communications, provisional status reports, or other documents, notes, correspondence, memoranda, etc. within your custody and control. at McQuaide Blasko Law Offices, 600 Centerview Drive, MC A560, Suite 5103, Hershey, PA 17033-2903 You may deliver or mail legible copies of the documents or produce things by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena, within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS Subpoena WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: Name: Grant H. Fleming, Esquire Address: McQuaide Blasko, 600 Centerview Drive, MC A560, Suite 5102, Hershey, PA 17033-2903 Telephone: 717-531-1199 Supreme Court ID#: 16212 Attorney for: Plaintiff By the Court: DATE: ir~%.t-~.D_rLY, y Se'al of-tlte C~d~-- - Prothonotary .CER T1FIC~4 TE 0 F SER VIC_.E I hereby certify that a true and correct copy of the within Objections to Subpoena Pursuant to Rule 4009.21 was faxed on May 24, 2004, and sent by overnight mail, and addressed as follows: Grant H. Fleming, Esquire McQuaide Blasko 600 Centerview Drive Hershey, PA 17033 LAW OFFICES OF C. PETER HITSON 20 Stanwix Street - Fourth Floor Pitt~ ,~/~//,~~ By:~(~?/~-- /./ ,- - ONALD H. SMITH, ESQUIRE Attorney for Defendant MCQUAIDE, BLASKO, SCHWARTZ, FLEMING & FAULKNER, INC. By: Grant H. Fleming, Esquire Identification No. 16212 Attorneys for Plaintiff 600 Centerview Drive, M.C. A560 Hershey, PA 17033 (717) 531-1199 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA LAHOMA S. CLAUSON by and through her Daughter and Power of Attorney Sandra R. Barends Plaintiff THE WOODS AT CEDAR RUN/ Great Commission Care Communities, Inc. T/A/D/B/A The Woods at Cedar Run Defendants CPVIL DIVISION No. 2003-05254P PRAECIPE TO DISCONTINUE WITH PREJUDICE PURSUANT TO Pa. R.C.P. 229 TO: THE PROTHONOTARY Please mark all claims filed by PlaintiffLahoma S. Clauson in the above emitled matter as discontinued with prejudice pursuant to Pa. R.C.P. 229. McQUAIDE, BLASKO, SCHWARTZ, Dated: ~t~L.~[OI4 Draft H. Fle ming, Esquire CERTIFICATE OF DISCONTINUANCE AND NOW, this,~_k~lay of -~.) L{.~OI~ , :2004, upon mraecipe of Plaintiff, Lahoma S. Clauson, the above matter is discontinued with prejudice as to/~3aintiff Lahoma S. C~ ~:~is~A[~ Long, Prothonotary