Goffstown Nursing And Rehab Center

Based on interview and record review, it was determined that the facility failed to ensure that a Registered Nurse (RN) was on duty for 8 consecutive hours a day, 7 days a week, for 3 of 30 days reviewed between September 15, 2024 - October 20, 2024. Findings include: Review on 10/21/24 of the facility's daily nursing time sheets for September 15, 2024 - October 19, 2024, revealed the following: On 9/15/24 there were no RN hours documented as worked; On 9/28/24 there were no RN hours documented as worked; On 10/13/24 there were no RN hours documented as worked. Interview on 10/21/24 at 9:00 a.m. with Staff E (Scheduler) confirmed that there was no RN on duty on 9/15/24, 9/28/24, and 10/13/24. Interview on 10/21/24 at 10:00 a.m. with Staff B (Director of Nursing) revealed that he/she was on call every other weekend when there was not an RN working but was not physically in the building for 8 consecutive hours.

Based on interview and record review, it was determined that the facility failed to follow antibiotic use protocols related to the appropriate use of antibiotic monitoring, tracking, and reviewing antibiotic use for 9 of 12 months reviewed for antibiotic use. Findings include: Review on 10/21/24 of the facility's line listing for antibiotic use from November 2023 through October 2024 revealed that the facility did not have documentation of a system to track antibiotic use within the facility from November 2023 through May 2024 and September 2024 to present. Interview on 10/21/24 at 12:00 p.m. with Staff C (Infection Prevention) confirmed the above findings. Interview further revealed that the facility did not have antibiotic monitoring and tracking from September 13, 2024, to present, including documentation that antibiotics met criteria for use. Staff A (Administrator) confirmed that the facility had residents with infections and who were on antibiotics from September 2024 to date. Review on 10/21/24 of the facility's policy titled, Infection Control - Antibiotic Stewardship,…

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 interview and record review, it was determined that the facility failed to maintain resident care equipment according to manufacturer's instructions for the hoyer lift. Findings include: Interview on 10/22/24 at approximately 9:57 a.m. with Staff J (Maintenance Director) revealed that the legs on the hoyer lift were difficult to open. Staff J stated that they had not performed routine inspections on the hoyer lift to determine any wear since he/she became employed at the facility approximately four months ago. Staff J revealed they had never performed routine maintenance on the hoyer lift, and did not have any documentation that the hoyer lift had been maintained, inspected or repaired at any time. Staff J confirmed that the hoyer lift was more than a year old and routine inspection and maintenance was required. Interview on 10/22/24 at approximately 10:29 a.m. with Staff K (Licensed Nursing Assistant(LNA)) revealed the hoyer lift is difficult to maneuver when a resident is in the lift. Interview on 10/22/24 at approximately 10:37 a.m. with Staff L (LNA) revealed the hoyer…

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 interview and record review, it was determined that the facility failed to report alleged violations of neglect to the State Survey Agency (SSA) for 1 of 3 residents reviewed for falls in a final sample of 15 residents (Resident Identifier #26). Findings include: Interview on 10/20/24 at approximately 10:48 a.m. with Resident #26 revealed that Resident #26 had fell from the hoyer lift about six weeks ago. Review on 10/22/24 of Resident #26's medical record revealed an Incident Note, entered 8/21/24, dated 8/20/24, that stated: .resident was being transferred from [pronoun omitted] wheelchair to [pronoun omitted] bed using a hoyer lift .More staff were called in for assistance and resident was lowered to the floor after moving the bed away and releasing the hoyer lift pad . Review on 10/22/24 of Resident #26's medical record revealed a provider note, dated 8/23/24, that stated .nursing reported that 2 days ago, [pronoun omitted] had an accidental fall during a mechanical lift transfer and got between [pronoun omitted] bed and [pronoun omitted] window sill slightly bumping…

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 interview and record review, it was determined that the facility failed to ensure that alleged violations of neglect were thoroughly investigated for 1 of 3 residents reviewed for falls in a final sample of 15 residents (Resident Identifier #26). Findings include: Interview on 10/20/24 at approximately 10:48 a.m. with Resident #26 revealed that Resident #26 had fell from the hoyer lift about six weeks ago. Review on 10/22/24 of Resident #26's medical record revealed a provider note, dated 8/23/24, that stated .nursing reported that 2 days ago, [pronoun omitted] had an accidental fall during a mechanical lift transfer and got between [pronoun omitted] bed and [pronoun omitted] window sill slightly bumping [pronoun omitted] head . Interview on 10/22/24 at approximately 11:00 a.m. with Staff A (Administrator) revealed Staff A was not aware of the incident and Staff A was unable to provide documentation of an investigation of the incident. Interview on 10/22/24 at approximately 12:12 p.m. with Staff I (Licensed Nursing Assistant) revealed that he/she and another staff member…

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 interview and record review, it was determined that the facility failed to perform neurological assessments after a resident fell and hit their head for 1 out of 3 residents reviewed for falls in a final sample of 15 residents (Resident Identifier #26). Findings include: Journal of Nursing; AJN, November 2007 Vol. 107, No. 11. Retrieved from https://www.nursingcenter.com/pdfjournal?AID=751198&an=00000446-200711000-00030&Journal_ID=54030&Issue_ID=751137 on 10/30/20: When a Fall Occurs Step three: monitoring and reassessment. After the patient returns to bed, perform frequent neurologic and vital sign checks. Interview on 10/20/24 at approximately 10:50 a.m. with Resident #26 revealed that Resident #26 had a fall when being transferred with the hoyer lift, resulting in Resident #26 hitting their head. Review on 10/22/24 of Resident #26's medical record revealed an Incident note, dated 8/20/24, entered 8/21/24, that stated .Provider got notified and order was obtained to do neuro [neurological] checks for 72 hours . Further review revealed no electronic documentation…

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 record review and interview, it was determined that the facility failed to identify trauma triggers to eliminate or mitigate triggers that may cause re-traumatization of the resident in 1 of 1 residents reviewed for Post Traumatic Stress Disorder (PTSD) in a final sample of 15 residents (Resident Identifier #10). Findings include: Record review on 10/22/24 of Resident #10's diagnosis list revealed a diagnosis of PTSD. Record review on 10/22/24 of Resident #10's last Minimum Data Set Assessment (MDS) with an Assessment Reference Date (ARD) of 8/8/24 revealed PTSD was a current diagnosis. Record review on 10/22/24 of Resident #10's care plans revealed a care plan for behaviors of crying, withdrawal, and lack of appetite associated with PTSD without identified triggers listed. Record review on 10/22/24 of Resident #10's Generations Psychiatry Progress Note dated 10/9/24, revealed no identified triggers for PTSD. Record review on 10/22/24 of Resident #10's behavior monitoring for [DATE] revealed 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.

Based on record review and interview, it was determined that the facility failed to ensure that resident's who take psychotropic medications received a Gradual Dose Reduction (GDR) or document if GDR was clinically contraindicated for 1 of 5 resident's reviewed for unnecessary medications in a final sample of 15 residents (Resident Identifier #13). Findings include: Review on 10/21/24 of Resident #13's physician orders revealed an order for Seroquel 50 milligrams (mg), 1 tablet by mouth 3 times a day. Review on 10/21/24 of Resident #13's Pharmacy Consultant Report, dated 8/8/2024, revealed a recommendation to attempt a gradual dose reduction for Resident #13's Seroquel medication. The report further revealed the provider checked decline and wrote please see visit note from 9/5/24. The report was signed 9/24/24. There was no documentation of continued clinical appropriateness for the Seroquel. Review on 10/22/24 of Resident #13's Generations Geriatric Psychiatry Progress Note in Facility, dated 9/5/24, revealed the last GDR attempt was May 2021, and further revealed .Goals for Next…

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, record review, and interview, it was determined that the facility failed to follow Center For Disease Control (CDC) guidance for wearing Personal Protective Equipment (PPE) for Enhanced Barrier Precautions (EBP) for 1 of 1 residents reviewed for an indwelling catheter in a sample of 15 residents (Resident Identifier #32). Findings include: Observation on 10/20/24 of Resident #32's room revealed an indwelling catheter bag hanging from the bed. There was no sign posted indicating Resident #32 was on EBP, and there was no PPE provided for care. Further observation revealed an Licensed Nursing Assistant (LNA) performing care without PPE. Interview on 10/22/24 at 8:34 a.m. with Staff M (LNA) confirmed he/she provided care to Resident #32 on 10/20/24 without using PPE. Staff M stated they were not aware Resident #32 was on EBP. Review on 10/22/24 of Resident #32's active orders revealed an order for a urinary catheter, entered on 10/15/24 and an order for EBP, entered on 10/20/24. Further review revealed an order for Ciprofloxacin (Cipro) Oral Table 250 milligrams…

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 interview and record review, it was determined that the facility failed to update a residents care plan with new or revised interventions after a fall for 1 of 1 residents reviewed for accidents in a final sample of 13 residents (Resident identifier is #1). Findings include: Observation on 10/24/23 at approximately 9:30 a.m. of Resident #1's room door revealed the door was closed. Review on 10/24/23 of Resident #1's nursing notes revealed that he/she had tested positive for COVID 19 on 10/20/23. Resident was placed on precautions on 10/20/23 with the residents room door being closed. Resident #1 had a fall on 10/22/23. Observation on 10/25/23 at approximately 8:00 a.m. of Resident #1's room door revealed the door was closed. Review on 10/25/23 of Resident #1's falls care plan revealed that there were no new interventions or revised interventions after the fall or with being placed on precautions. Interview on 10/25/23 at approximately 10:00 a.m. with Staff D (Licensed Nursing Assistant) confirmed that Resident #1 had been on precautions with the door closed since 10/20/23.…

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 interview and record review, it was determined that the facility failed to follow physician orders for 5 residents in a final sample of 13 residents (Resident identifiers are #25, #5, #6, #28, and #27). Findings include: Physician's Orders Standards: [NAME], [NAME] A., and [NAME]. Fundamentals of Nursing. 7th ed. St. Louis, Missouri: Mosby Elsevier, 2009. Page 336- Physicians' Orders The physician is responsible for directing medical treatment. Nurses follow physician's orders unless they believe the orders are in error or harm clients. Therefore you need to assess all orders, and if you find one to be erroneous or harmful, further clarification from the physician is necessary . Review on 10/24/23 of Resident #25's medical record revealed the following physician's order: 2,000 ml [milliliters] fluid restriction every shift, start date 8/11/23. Further review of Resident #25's medical record revealed the following: 9/3/23 Resident #25's intake was 2,610 ml. 9/22/23 Resident #25's intake was 2,040 ml.…

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 interview, observation, and record review, it was determined that the facility failed to ensure that a resident with a pressure ulcer had documentation of weekly assessments that contained measurements and descriptions of the pressure ulcer for 1 out of 1 resident reviewed for pressure ulcers in a final sample of 13 residents (Resident identifier is #19). Findings include: Review on 10/24/23 of Resident #19's nursing notes revealed the following: 9/16/23 Res [resident] skin check performed. Res skin is not intact. [pronoun omitted] is intact everywhere, except on R [right] ear, there are 2 small areas on outer ear. one is 7 mm [millimeter] in diameter and one is 2 mm in diameter. Res says they have been there a very long time and [pronoun omitted] scratches them off occasionally. Buttocks are intact but does have red areas. Also continues to have red/brown areas on L [left]shoulder and L hip from insisting on lying on L side most of the day and night. 9/23/23 .Skin Issue #001: New. Issue type: Redness. Location: Buttocks-generalized . Observation on 10/25/23 at…

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 interview and record review, it was determined that the facility failed to ensure that licensed nursing staff had demonstrated competencies and skills necessary to care for residents' needs for 7 out of 7 licensed staff reviewed for competencies (Staff identifiers are Staff B, Staff J, Staff K, Staff L, Staff P, Staff M, Staff N). Findings include: Annual Competencies Review of annual competencies for licensed staff revealed: Staff P (Licensed Practical Nurse) was hired 5/29/2019 and had no annual competencies. Competencies at hire: Review of the competencies upon hire for licensed staff revealed: Staff B (Infection Preventionist) was hired 5/02/2023 and no competencies were completed. Staff J (Licensed Nursing Assistant) was hired 6/29/23 and no competencies were completed. Staff K (Licensed Nursing Assistant) was hired 7/31/23 and no competencies were completed. Staff L (Medication Assistant) as hired 7/24/23 and no competencies were completed. Contracted Agency Staff: A review of the competencies prior to working at the facility revealed: Staff M (Registered Nurse) had…

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 interview and record review it was determined that the facility failed to ensure that a Registered Nurse (RN) was on duty for 8 consecutive hours a day, 7 days a week, for 5 of 90 days reviewed between April 1, 2023 and June 30, 2023. Findings include: Review on 10/25/23 of the facility's Payroll Based Journal Staffing Data Report for Quarter 3 (April 1, 2023-June 30, 2023) revealed that there were no RN hours for the following days: 5/27/23, 6/03/23, 6/04/23, 6/10/23, 6/25/23. Interview on 10/25/23 at 10:00 a.m. with Staff B (Infection Preventionist/Staffing Coordinator) confirmed the above findings.

Based on record review and interview, it was determined that the facility failed to provide a stop date for a as needed (PRN) psychotropic medication for 1 of 5 residents reviewed for unnecessary medications in a final sample of 13 residents (Resident identifier is #26). Findings include: Record review on 10/25/23 revealed that Resident #26 had an order for Ativan 0.5 milligram (mg): Give 1 tablet by mouth every 4 hours as needed for anxiety/agitation, start date 9/25/23. Interview on 10/25/23 at approximately 1:30 p.m. with Staff A (Director of Nursing) confirmed the above findings.

Based on observation, interview, and record review, it was determined that the facility failed to follow manufacturer's recommendations on 1 of 2 medication carts observed (Resident identifier is #10). Findings include: Observation on 10/24/23 at 8:30 am of the South Wing Medication Cart with Staff F (Medication Nursing Assistant) revealed an open multidose vial of Humalog insulin Lispro with an open date of 9/23/23 and a discard date of 10/21/23 for Resident #10. Interview on 10/24/23 at 8:30 a.m. with Staff F confirmed the above findings. Review on 10/24/23 of the Manufacturer's Recommendations for the use of Humalog Lispro Insulin: .Preparing your Humalog dose .Do not use Humalog past the expiration date printed on the label or 28 days after you first use it. Review on 10/25/23 of the facility's policy titled Storage of Medications revised April 2007 Policy Interpretation and Implementation .4. The facility shall not use discontinued, outdated or deteriorated drugs or biologicals

Based on observation, interview, and record review, it was determined that the facility failed to provide residents with the necessary assistive devices for dining for 4 residents observed for assistive devices out of a sample of 6 residents reviewed (Resident identifiers are #6, #88, #24, and #1). Findings Include: Review on 10/24/23 of a list of residents that use adaptive equipment, provided by the facility, revealed that 6 residents require adaptive equipment with meals. Resident #88: Observation on 10/25/23 at approximately 7:45 a.m. of Resident #88's breakfast tray revealed that Resident #88 received plastic utensils, a paper plate and a 1 handle coffee mug. Review on 10/25/23 of Resident #88's dietary meal ticket, under adaptive, revealed the following items that should be on Resident #88's meal tray: a divided red plate, built up foam for all utensils and a two handle cup. Resident #1: Observation on 10/25/23 at approximately 8:00 a.m. of Resident #1's breakfast tray revealed that he/she had a paper plate. Review on 10/25/23 of Resident #1's dietary meal ticket, under…

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 and interview, it was determined that the facility failed to dispose of garbage and refuse properly in a contained dumpster with a lid or cover. Findings Include: Observation on 10/25/23 at 9:15 a.m. of the dumpster located in the back of the facility revealed multiple clear bags with waste noted on the ground in front of the dumpster. The dumpster was not covered. Observations on 10/26/23 at 9:00 a.m. of the dumpster located in the back of the facility revealed multiple clear bags with waste noted on the ground in front of the dumpster. The dumpster was not covered. Interview on 10/26/23 at 9:00 a.m. with Staff C (Administrator) confirmed the above findings. Review on 10/26/23 at 10:00 a.m. of the facility policy titled Solid Waste Disposal Policy .Garbage containers are covered at all times .All Employees Place trash and garbage directly into designated receptacles. Keep lids to all outside trash receptacles closed.

Based on interview it was determined that the facility failed to report to the State Department of Public Health an outbreak of COVID-19 Infection that included 16 out of 29 residents. Findings Include: Interview on 10/25/23 at 1:00 p.m. with Staff B (Infection Preventionist) revealed that Staff B had not reported the current COVID-19 outbreak that began on 10/19/23 to the State Department Of Public Health. Interview on 10/26/23 at 10:00 a.m. with Staff C (Administrator) confirmed the above findings. Review on 10/26/23 of the facility's Infection Control Policy and Procedure Manual Titled: Surveillance Dated 5/2014 .Outbreak of Communicable Diseases .The Administrator will be responsible for: 1. Telephoning a report to the health department .3. Submitting periodic progress reports to the health department as requested .6. Forwarding Communicable Disease Report Cards to the health department as required. Review on 10/27/23 of the New Hampshire Communicable Disease Report Form 2011. NH RSA 141-C and He-P300 mandate reporting of the listed communicable diseases by all physicians, labs…

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 interview and record review, it was determined that the facility failed to have an antibiotic stewardship program that included a system to monitor antibiotic use. Findings Include: Review on 10/24/23 of the facility's line listing for antibiotic use from January 2023 through October 2023 revealed that the facility did not track antibiotic use within the facility from February 2023 through April 2023. Interview on 10/25/23 at 1:30 p.m. with Staff B (Infection Preventionist) confirmed the above findings. Review on 10/25/23 at 2:00 p.m. of the facility's policy titled [NAME]-Air Nursing and Rehab Antibiotic Stewardship Program 2. Policy: [NAME]-Air Nursing and Rehab Center will implement an antibiotic stewardship program based on the Center for Disease Control's: Core Elements of Antibiotic Stewardship for Nursing Homes, and will be evaluated annually or more frequently if needed for effectiveness during review of the Infection Control Program 4.4 The infection Preventionist (IP) will track antibiotic…

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 record review and interview it was determined that the facility failed to revise the pneumococcal policy, and ensure/implement a facility system for the monitoring and recording of pneumococcal immunizations for 4 out of 5 residents reviewed for immunizations (Resident identifiers are #19, #12, #24, #27). Findings Include: Resident #19 Review on 10/24/23 of Resident #19's medical record revealed that he/she was admitted to the facility 10/2019. Further review of Resident #19's medical record revealed that there was no documented evidence of pneumococcal vaccination being offered or received. Resident #12 Review on 10/24/23 of Resident #12's medical record revealed that he/she was admitted to the facility 6/2022. Further review of Resident #12's medical record revealed that there was no documented evidence of pneumococcal vaccination being offered or received. Resident #24 Review on 10/24/23 of Resident #24's medical record revealed that he/she was admitted to the facility 12/2022. Further review of Resident #24's medical record revealed that there was no documented evidence…

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.