HomeMy WebLinkAbout01-20-10 (2)ANNUAL REPORT OF GUARDIAN
OF THE PERSON
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
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I. INTRODUCTION
Keystone Guardianship Services was appointed
Plenary ^ Limited Guardian of the Person by Decree of M.L. Ebert, Jr. , J.,
dated 10/9/07.
This is the Annual Report for the period from November 1 2008
to October 9 2009 ,the "Report Period"); or
^ B. This is the Final Report for the period from ,
to , (the "Report Period"), and is filed
for the for the following reason:
1. The death of the Incapacitated Person. Date of death:
2. The Guardianship was terminated by the Court by Decree of
J., dated
For a Final Report, omit Sections II through IV.
Form G-03 rev. 10.13.06 Page 1 of 4
Estate of Virginia M. Taylor , an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: 79
Date of Birth: 7/10/1930
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
Masonic Village
600 Freemason Drive
Elizabethtown, PA 17022
B. The Incapacitated Person's residence is:
^ own home /apartment
nursing home
0 boarding home /personal care home
^ Guardian's home /apartment
^ hospital or medical facility
^ relative's home (name, relationship and address)
^ other:
C. The Incapacitated Person has been in the present residence since 9/13/07 .
If the Incapacitated Person has moved within the past year, state prior
residence and reason(s) for move:
Virginia was moved from The Lafayette East Unit, which is a secured dementia assisted
living unit to The Washington 4 Unit, which is a secured care unit with 24 hour care, on
September 15, 2009.
Farm G-03 rev. 10.13.06 Page 2 0£ 4
Estate of Virginia M. Taylor , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
Dr. John Mast
600 Freemason Drive
Elizabethtown, PA 17022
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person areas follows:
Virginia suffers from Alzheimers type with disruptive behaviors, dementia, paranoid
delusions, depression, anxiety, aphasia, dysphagia, hypothyroid, hypercholesteremia,
hyperlipidemia, hypotension, ostreoarthritis, incontinence, cataracts and a history of suicidal
ideation
B. Specify what, if any, social, medical, psychological and support services the
Incapacitated Person is receiving:
Virginia receives Evercare in addition to the services provided at Masonic Village.
She receives podiatry, dental, eye, beauty shop, and audiology.
V. GUARDIAN' S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
continue
^ be modified
^ be terminated
Form G-03 rev. 10.13.06
Page 3 of 4
Estate of Virginia M. Taylor . an Incapacitated Person
The reasons for the foregoing opinion are:
It is my opinion that Virginia would not be able to exist in any other type of
environment, as she lacks the mental and physical ability to care for herself.
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
24 times with the average visit lasting 30 minutes to an hour
The report of a social service organization employed by the Guardian to oversee and
coordinate the care of the Incapacitated Person for the period covered by this Report may be attached
to supplement this Report.
I verify that the foregoing information is correct to the best of my knowledge,
information and belief, and that this Verification is subject to the penalties of 18 Pa. C.S.A. § 4904
relative to unsworn falsification to authorities.
Date gnature of Guazdian of the Estate
Constance E. Stoneroad
Name of Guardian of the Estate (type or print)
PO Box 804
Address
Elizabethville. PA 17023
City, State, Zip
717-674-5757 OR 717-265-4056
Telephone
Form G-03 rev. 10.13.06 Page 4 of 4