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ANNUAL REPORT OF GUARDIAN ~' ~: = --
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OF THE PERSON ~~ ~:
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COURT OF COMMON PLEAS OF D r- ~f~ ~_
CUMBERLAND COUNTY, PENNSYLVANIA ~'
ORPHANS' COURT DIVISION
Estate of JANETTE NEELY , an Incapacitated Person
No. 21-08-0032
I. INTRODUCTION
Keystone Guardianship Services was appointed
® Plenary Limited Guardian of the Person by Decree of Edgar B. Ba~v __ , J.,
dated March 5. 2008
® This is the Annual Report for the period from March 6 2011
to March 5, 2012 (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
,t';
Estate of JANETTE NEELY , an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: 90 Date of Birth: August 2:Z 1921
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
Courtyard Gardens Nursing & Rehab Center
999 West Harrisburg Pike
Middletown, PA 17057-4801
B. The Incapacitated Person's residence is:
own home /apartment
® nursing home
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 4/ 1 / I 0 _ _
If the Incapacitated Person has moved within the past year, state prior
residence and reason(s) for move:
r~a.m c-n3 rev. ro i_3.nr> Page 2 0£ 4
Estate of JANETTE NEELY , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
Courtyard Gardens Nursing & Rehab Center
999 West Harrisburg Pike
Middletown, PA 1 705 7-480 1
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person areas follows:
Ms. Neely suffers from HTN, Anemia, depression, dementia w/behavioral disturbance,
hypothyroidism, GERD, agitation, allergies, dry eyes, dysphasia, arterial insufficiency, venous
insufficiency, kyphosis, corneal dystrophy, retinal hemorrhage, conjunctivitis, PVD (peripheral
vascular disease)
B. Specify what, if any, social, medical, psychological and support services the
Incapacitated Person is receiving:
Though Ms. Neely is prompted and encouraged to attend games and all other
social events within Courtyard Gardens she refuses most of the events. She will sit in
the common area to watch the large TV. Ms. Neely enjoys chewing gum which seems
to ease some of her anxious moods swings.
Ms. Neely is visited once a month by Dr. Nipple, the in-house doctor at
Courtyard Gardens, for monthly check-ups and for any medical issues that may bE:
presented.
Ms. Neely is seen by geri psych and social services as staff feels is needed.
Ms. Neely has been seen by an occupational therapist on staff to assess heir
capabilities in eating. She is on a mechanical food diet.
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
® continue
be modified
- be terminated
Forme-113cc~. U).13.UG
Page 3 of 4
Estate of JANETTE NEELY _, an Incapacitated Person
The reasons for the foregoing opinion are:
[t is my opinion that Ms. Neely would not be able to exist in any other type of environment, as
she lacks the mental and physical ability to care for herself .
Ms. Neely can no longer walk on her own; creating a need to be in a geriatric chair with alerts
which activate when she forgets and tries to get out of her chair and/or when she is iri a poor
mood and tries to get up and walk.
Ms. Neely's moods change from day to day. She has been combative to the staff on numerous
occasions and also loves them on other occasions.
Over all Ms Neely seems to have a good relationship with most of the staff and the guardian and
appears to be content in her environment.
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
24-30 times with the average visit lasting 30 - 90 minutes
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 mciy 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.
'S ~ `~~°'~ -- 6z
Date ignature of Guardian of the Estate
Constance E. Stoneraad __
.dame of Guardian of the Estate (type or print/
PO Box 804
Address
Elica6ethville Pa !7023
City. State. Zip
717-674-5757
Telephone
Form G-03 rev. 10.13.06 Page 4 of 4