Madison Co Nh

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, facility policy review and record review, the facility failed to ensure staff followed infection prevention and control practices to prevent the spread of infection during resident care for two (2) of five (5) care observations. Resident #2 and Resident #82Findings Include: Record review of the facility policy Policy for Handwashing undated, revealed, Objective: To prevent and to control the spread of infectious disease.1. Appropriate 15 second hand washing with antimicrobial soap and water must be performed under the following conditions: a. when hands are visibly dirty or soiled with blood or other body fluids; b. after contact with blood, body fluids, secretions, mucous membranes or non-intact skin; c. after handling items potentially contaminated with blood, body fluids, or secretions; d. before eating; e. after using a restroom .3. If hands are not visibly soiled, use an alcohol-based hand rub for all the following situations: a. before direct contact with residents.f. after…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and facility policy review, the facility failed to ensure other alternatives were implemented prior to the installation of bed rails and failed to assess and monitor the use of bed rails as a restraint and ensure they were medically necessary and the least restrictive intervention for one (1) of five (5) resident reviewed for restraints. Resident #42Findings Include: Record review of the facility policy Use of Side Rails revealed, The resident should be observed and assessed daily in order to assure the maintaining of his/her practicable physical, mental, and psychosocial well-being .Record review of the facility policy, Restraint Policy undated revealed, .It is the objective of this facility for each resident to be free from any physical restraint to maintain the highest practicable well-being in an environment that prohibits the use of restraints for discipline or convenience and limits restraint use to circumstances to which the resident has medical symptoms…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on staff interview, record review, and facility policy review the facility failed to ensure a resident was free from abuse and misappropriation of resident property when a resident was found to have 36 oxycodone pain pills missing from the narcotic box for (1) one of (6) six residents narcotics reviewed. (Resident #1) Findings include: Review of the facility policy titled, Abuse Policy & Procedure, with no revision date, revealed that each resident of the facility has the right to be free from misappropriation of property. The policy further defines misappropriation of resident property as the deliberate misplacement, exploitation, or wrongful use of a resident's belongings without the resident's consent. During an interview on 5/12/25 at 11:30 AM with the Director of Nursing (DON) related to a facility reported incident of drug diversion, she confirmed that narcotic drug diversion occurred involving Resident #1. The DON reported that on the morning of 2/13/25, staff notified her that a card of oxycodone…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, staff interview and facility policy review the facility failed to ensure a resident's dignity as evidenced by allowing the resident to sit in a public area with a private body part exposed for one (1) of 21 residents sampled. Resident #85 Findings include: Review of the facility policy titled, Dignity with no revision date revealed under, Policy Interpretation and Implementation .#11. Staff promote, maintain and protect resident privacy, including bodily privacy . An observation on 7/8/24 at 12:10 PM revealed Resident #85 sitting in a reclined wheelchair across from the centralized nurse's station wearing a tank top that had fell from her left shoulder exposing her breast. At this time there were approximately 10 other residents sitting in the area of the nurse's station and day room with staff and visitors walking past the resident. An interview and observation on 7/8/24 at 12:15 PM with Licensed Practical Nurse (LPN) #1 revealed she is Resident #85's nurse and confirmed that the resident…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, staff interview, record review, and facility policy review, the facility failed to implement a comprehensive person-centered care plan for a resident requiring grooming and personal hygiene and failed to develop a care plan for splint/mobility devices for three (3) of 21 care plans reviewed. Resident #20, Resident #44 and Resident #68 Findings Include: Review of the facility policy titled, Care Plans-Comprehensive with no revision date revealed under the Policy Statement .A comprehensive care plan that includes measurable objectives and timetables to meet the resident's medical, nursing, mental and psychological needs shall be developed for each resident. Resident #20 Review of Resident #20's Care Plan revealed, ADLS (activities of daily living): Requires assistance with ADLS related to impaired functional ability/right sided hemiplegia, and cognitive impairment. Also revealed under, Approaches: . Hygiene and grooming daily . shave daily if facial hair is present . On 7/8/2024 at 11:44 AM,…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, staff interview, record review, and facility policy review, the facility failed to provide assistance with activities of daily living (ADLs) for a resident dependent on staff for shaving and changing visibly soiled clothing for two (2) of 21 sampled residents. Resident #20 and Resident #44 Findings Include: Review of the facility policy titled Activities of Daily Living undated, revealed, Policy Statement: Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene . Resident #20 An observation on 7/8/2024 at 11:44 AM, revealed Resident #20 lying in bed, non-communicative with grayish-black facial hair observed above the upper lip, under the lower lip, and to her chin, measuring approximately 1/4 (one-fourth) inch in length. The resident was wearing a hospital gown and had a tan colored liquid substance spread across the chest area of the gown and two (2) small, cubed…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, staff interview, record review and facility policy review, the facility failed to provide services to assure a resident maintained the level of range of motion (ROM) for one (1) of three (3) residents positioning and mobility. Resident # 68 Findings include: Review of the policy titled, Contracture Prevention Protocol, revealed Policy: .A resident with a limited ROM (Range of Motion) receives appropriate treatment and services to increase ROM and/or to prevent further decrease in ROM, thus preventing contracture formation . An observation of Resident #68 on 7/8/24 at 11:00 AM revealed the resident's left hand/wrist to be contracted, a splinting device was observed lying on the counter next to the sink. An observation of Resident #68 on 7/8/24 at 2:45 PM revealed a hand splint laying on the counter next to the sink, resident observed with no splinting devices observed on left hand. Interview with Licensed Practical Nurse (LPN) #2 on 7/9/24 at 10:30 AM, confirmed Resident #68 should have been wearing the resting left-hand splint on 7/8/24 but confirmed she did…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observations, staff interviews, record review and facility policy review, the facility failed to prevent the possibility of infection as evidenced by failing to cleanse and properly store a Percutaneous Endoscopic Gastrostomy (PEG) tube syringe for (1) one of (5) five resident care observations. Resident # 68 Findings include: Review of the facility policy titled, Standard Precaution, revealed, .Policy Interpretation: Any equipment or items that may be suspected of contamination with body fluids must be handled in a manner to prevent possible transmission of infectious agents . Review of the facility policy titled, Feeding Syringe Policy, revealed, Our policy for the cleanliness of syringes is they are dated and stored on a pole bag. Syringes are stored separated after use. An observation of Resident #68's room on 7/8/24 at 11:00 AM, revealed a PEG tube syringe separated and laying on the bedside table, with no clean barrier or storage bag observed on the table. Interview with Licensed Practical Nurse (LPN) #2 on 7/9/24 at 10:30 AM revealed she was assigned to Resident #68…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, staff/resident interview, record review and facility policy review the facility failed to provide a safe, clean environment for three (3) of the eighteen residents sampled. Resident Resident #25, Resident# 49 and Resident #65. Findings include: Record review of the facility policy titled, Resident Equipment Cleaning and Disinfection, undated revealed, . All equipment used for resident care shall be kept clean and in proper working condition . Resident #25 An observation on 01/24/23 at 9:51 AM, revealed Resident #25 sitting in a geriatric-chair (geri-chair), the footrest noted with torn vinyl on both sides exposing tattered foam padding. A further observation on 01/24/23 at 4:40 PM, of Resident #25's geri-chair revealed the footrest vinyl was peeled back on both sides exposing tattered foam padding. The bilateral armrest was loose and moved back and forth when touched. A tan-colored substance was noted on the left armrest with a dried light brownish substance down both sides of the chair.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, staff and resident representative interview, record review and facility policy review the facility failed to ensure residents were free from physical restraints for three (3) of eighteen residents on sample. Resident #25, #31, and #72. Findings include: Record review of the facility policy titled, Guidelines and Policy with no revision date revealed under, Purpose .Physical restraints are defined as any manual method, physical or mechanical device, material or equipment attached to the resident's body that the resident cannot remove easily which restricts freedom of movement or normal access to one's body. The resident must be physically and cognitively able to self-release device such as Velcro lap-trays or tables, seat belt with Velcro, or snap seat belts, if a resident cannot mentally and physically self-release, then the device is considered a restraint . Resident #31 An observation on 01/23/23 at 9:00 AM, revealed Resident #31 lying in bed with eyes closed, and three quarter (3/4)…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on staff interviews and record review the facility failed to accurately code the Minimum Data Set (MDS) for one (1) of eighteen residents sampled. Resident #25 Findings include: Record review of an unsigned, undated statement on facility letterhead revealed, It is [NAME] County Nursing home protocol to follow the Resident Assessment Instrument (RAI) Manual for MDS's and Care Plans. Resident #25 An interview and observation on 01/25/23 at 9:38 AM, the Director of Nurses (DON) confirmed that Resident # 25 had a lap belt in place. The DON encouraged Resident # 25 to release the belt and Resident # 25 was unable to release the belt. The DON revealed she's not even supposed to have this waist belt on. I don't know why she has it on. An interview on 01/25/23 at 11:16 AM, with the DON revealed there was no restraint assessment for the waist belt or physician's order or care plan because she wasn't aware it was being used. An interview on 01/26/23 at 11:40 AM, the Minimum Data Set (MDS) nurse confirmed that the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on staff interview, record review and facility policy review the facility failed to develop a comprehensive care plan for physical restraints for one (1) of eighteen residents sampled. Resident #25 Findings include: Record review of the facility policy Care Plans-Comprehensive undated, revealed Policy Statement: A comprehensive care plan that includes measurable objectives and timetables to meet the resident's medical, nursing, mental and psychological needs shall be developed for each resident. Policy Interpretation and Implementation .2. The comprehensive care plan has been designed to: a. Incorporate identified problem areas. b. Incorporate risk actors associated with identified problems .d. Reflect treatment goals and objectives in measurable outcomes.e. Identiy the professional services that are responsible for each element of care .3.The resident's comprehensive care plan is developed with seven (7) days of the completion of the resident's comprehensive assessment . Resident #25 An interview and…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.