Arbors at Milford

Inspectors wroteBased on record review and staff interview, the facility failed to complete annual performance reviews for Certified Nursing Assistants (CNAs.) This had the potential to affect all of the residents residing in the facility. The facility census was 69 residents.

Inspectors wroteBased on observation and staff interview, the facility failed to properly store food. This had the potential to affect 65 facility-identified residents of 69 who consumed food prepared in the facility kitchen. The facility census was 69 residents.

Inspectors wroteBased on record review, review of facility Self-Reported Incidents (SRIs), resident interview, staff interview, and review of the facility policy, the facility failed to ensure staff spoke to residents in a respectful manner. This affected one resident (Resident #61) of three residents reviewed for dignity and respect. The facility census was 69 residents.

Inspectors wroteBased on medical record review, observation, review of Self-Reported Incidents (SRIs), staff interview, resident interview, and review of the facility policy, the facility failed to ensure residents were free from emotional/verbal abuse. This affected one (Resident #67) of three residents reviewed for abuse. The facility census was 69 residents.

Inspectors wroteBased on medical record review and staff interview, the facility failed to hold quarterly care conferences for residents. This affected two (Residents #1 and #7) of 17 residents sampled. The facility census was 69 residents.

Inspectors wroteBased on medical record review, review of medication error logs, staff interview, observation, and review of the facility policy, the facility failed to ensure residents were free from significant medication errors. This affected two (Residents #69 and #42) of 17 sampled residents. The facility census was 69 residents.

Inspectors wroteTHE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NONCOMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on medical record review, review of a hospital record, staff interview, review of the facility investigation, and policy review, the facility failed to ensure the physician or nurse practitioner was notified timely of a significant change in condition for a resident (#70). This resulted in Immediate Jeopardy and serious life-threatening harm, injuries, and/or death when on [DATE] at 7:46 P.M., Resident #70 was found to have elevated blood glucose levels by a nurse and after notification to the nurse practitioner, additional insulin was ordered, which the resident refused. [...]

Inspectors wroteTHE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NONCOMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on medical record review, review of a hospital record, staff interview, review of the facility investigation, and policy review, the facility failed to ensure a resident (#70) was free from neglect when the facility failed to provide appropriate and timely assessment, treatment, service, and notification to the physician or nurse practitioner. This resulted in Immediate Jeopardy and serious life-threatening harm, injuries, and/or death when on [DATE] at 7:46 P.M., Resident #70 was found to have elevated blood glucose levels by a nurse and after notification to the nurse practitioner, additional insulin was ordered, which the resident refused. [...]

Inspectors wroteBased on medical record review, observation, staff interview, interview with the outside wound nurse practitioner (NP), review of the facility policy, and review of online guidelines per the National Pressure Ulcer Advisory Panel (NPUAP), the facility failed to thoroughly assess residents' skin and failed to identify pressure ulcers until they reached an advanced stage. This resulted in Actual Harm for Resident #123 who was admitted to the facility with a pressure ulcer to his sacrum and developed an additional pressure ulcer to his right scapula which was not identified until it was an unstageable ulcer with slough (nonviable tissue which could impede wound healing) and necrotic (dead) tissue. This affected one (Resident #123) of five residents reviewed for pressure ulcers. The facility identified five residents with in-house acquired pressure ulcers. [...]

Inspectors wroteBased on medical record review, hospital documentation, personnel file review, review of self-reported incidents (SRIs), staff interview, and policy review, the facility failed to report allegations of neglect to the Administrator and State Survey Agency. This affected four (#59, #70, #122, and #123) of five residents reviewed for neglect. The facility census was 72.

Inspectors wroteBased on medical record review, hospital documentation, personnel file review, review of self-reported incidents (SRIs), staff interview, and policy review, the facility failed to report the results of an investigation regarding resident neglect to the State Survey Agency in a timely manner and failed to thoroughly investigate allegations of neglect. This affected four (#59, #70, #122, and #123) of five residents reviewed for neglect. The facility census was 72.

Inspectors wroteBased on medical record review, observation, staff interview, pharmacist interview, and review of a facility policy, the facility failed to ensure insulin was properly dated and stored. This affected 10 (#2, #21, #23, #30, #49, #55, #62, #121, #124, and #321) of 26 residents the facility identified as receiving insulin. The facility census was 72.

Inspectors wroteBased on observation, staff interview, review of a planned menu, and policy review, revealed the faciity failed to follow the menu for residents ordered a regular diet. This affected 47 (#26, #21, #8, #28, #40, #58, #51, #49, #19, #31, #323, #44, #62, #56, #43, #30, #272, #37, #63, #24, #7, #48, #45, #271, #60, #57, #35, #3, #18, #32, #41, #10, #14, #324, #25, #33, #122, #15, #2, #50, #47, #64, #27, #38, #322, #39, and #54) of 47 residents ordered a regular diet. The facility census was 72.

Inspectors wroteBased on observation, staff interview, and policy review, the facility failed to store and prepare foods in a manner to prevent spoilage and contamination. This had the potential to affect all 62 residents who received food from the facility kitchen. The facility identified 10 (#1, #5, #23, #29, #59, #65, #121, #123, #124, and #321) who received no food from the kitchen. The facility census was 72.

Inspectors wroteBased on medical record review and staff interview, the facility failed to ensure a resident's advance directive was fully completed and dated by the physician. This affected one (#65) of three residents reviewed for advanced directives. The facility census was 72.

Inspectors wroteBased on observation, resident and staff interview, medical record review, review of the Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual, and review of a government website, the facility failed to accurately code the status of a non-invasive mechanical ventilation on Minimum Data Set (MDS) assessments. This affected one (#60) of four residents reviewed for ventilators. The facility census was 72.

Inspectors wroteBased on medical record review, staff interview, and policy review, the facility failed to ensure a resident's Preadmission Screening and Resident Review (PASRR) was accurately completed. This affected one (#25) of two residents reviewed for PASRR. The facility census was 72. Findings Include: Medical record review for Resident #25 revealed she was admitted to the facility on [DATE] with hospice services. Diagnoses included morbid obesity, acute and chronic respiratory failure, obstructive sleep apnea, hypothyroidism, bipolar disorder, diabetes mellitus, peripheral vascular disease, anxiety disorder, major depressive disorder, and alcohol dependence. Review of the Minimum Data Set (MDS) assessment for Resident #25, dated 02/15/25, revealed the resident was cognitively intact. [...]

Inspectors wroteBased on observations, resident and staff interviews, medical record review, and policy review, the facility failed to develop care plans for dental care for residents with dental concerns. This affected one (#49) of three residents reviewed for dental care. The facility census was 72. Findings Include: Review of the medical record revealed Resident #49 was admitted to the facility on [DATE]. Diagnoses included end stage renal disease with dependence on renal dialysis, combined congestive heart failure, and oropharyngeal dysphagia. Review of the most recent Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #49 had moderately impaired cognition, had no behaviors, did not wander, and did not reject care. Resident #49 had no natural teeth and was not assessed as having loose fitting dentures. [...]

Inspectors wroteBased on observation, staff interview, and medical record review, the facility failed to ensure fall interventions were implemented as care planned. This affected one (#55) of five residents reviewed for falls. The facility census was 72. Findings Include: Review of the medical record revealed Resident #55 was admitted to the facility on [DATE]. Diagnoses included chronic obstructive pulmonary disease, epilepsy, type II diabetes, major depressive disorder, and stage III chronic kidney disease. Review of the most recent Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #55 had moderately impaired cognition, had no behaviors, did not wander, and did not reject care. [...]

Inspectors wroteBased on medical record review, staff interview, and physician interview, the facility failed to ensure a resident was assessed timely by the physician after admission. This affected one (#25) of three residents reviewed for physician visits. The facility census was 72. Findings Include: Medical record review for Resident #25 revealed she was admitted to the facility on [DATE] with hospice services. Diagnoses included morbid obesity, acute and chronic respiratory failure, obstructive sleep apnea, hypothyroidism, bipolar disorder, diabetes mellitus, peripheral vascular disease, anxiety disorder, major depressive disorder, and alcohol dependence. Resident #25 was discharged to the hospital on [DATE] and readmitted to the facility on [DATE]. Review of the Minimum Data Set (MDS) assessment for Resident #25, dated 02/15/25, revealed Resident #25 was cognitively intact. [...]

Inspectors wroteBased on observation, staff interview, medical record review, and policy review, the facility failed to ensure proper personal protective equipment was worn while providing care and services for a resident on enhanced barrier precautions, failed to perform adequate hand hygiene between resident contact, and failed to ensure blood-contaminated materials were properly disposed of. This affected one (#47) of five residents reviewed for enhanced barrier precautions, one (#324) of two residents reviewed for laboratory services, one (#37) of one residents reviewed for blood glucose monitoring. The facility census was 72.

Inspectors wroteBased on medical record review, observation, and staff interview, the facility failed to maintain a safe and clean environment. This affected three (#12, #14, and #46) of 12 residents reviewed for environment. The facility census was 72.

Inspectors wroteBased on a closed medical record review, staff interviews, and review of the facility policy, the facility failed to administer appropriate respiratory care, administration of a ventilator at night, as ordered for Resident #10, who had a compromised respiratory status. This resulted in Immediate Jeopardy when the ventilator was not applied, and Resident #10 was found unresponsive, and required cardiopulmonary resuscitation (CPR) and hospitalization. This affected one (Resident #10) of five residents reviewed for ventilator use in the last three months. The census was 62 residents. [...]

Inspectors wroteBased on medical record review, staff interview, and review of the facility policy, the facility failed to ensure a resident received the appropriate care and services for a treatment change to a nephrostomy tube. This resulted in Actual Harm to Resident #42 when a registered nurse utilized scissors to cut a dressing off and accidentally cut Resident #42's nephrostomy tube. Resident #42 had to undergo a surgical procedure to put the nephrostomy tube back into the right kidney and be monitored at the hospital for seven days. This affected one of three residents reviewed for an ostomy tube.

Inspectors wroteBased on record review, observations, review of the guidance from Centers for Disease Control and Prevention (CDC). staff interviews, and review of the facility policy, the facility failed to implement recommended infection control practices to prevent the spread of COVID-19 and failed to perform appropriate hand hygiene and sterile practices during a resident's wound treatment. This affected (#2, #9, #14, #19, #20, #21, #22, #23, #24, #25, #26, #27, #28, #29, #30, #31, #33, #34, #35, #36, #37, #38, #40, #42, #43, #44, #46, #47, #48, #49, #50, #51, #52, #53, #54, #55, #56, #57, and #73). The facility census was 76.

Inspectors wroteBased on record review, observation, resident and staff interview, and review of the facility policy, the facility failed to ensure a resident was treated with respect and dignity. This affected one (Resident #1) of three residents reviewed for dignity and respect. The facility census was 76.

Inspectors wroteBased on record review, resident and staff interviews, observations, and review of the facility policy, the facility failed to provide activities to the residents. This affected two (#73 and #74) of five residents reviewed for activities. The facility census was 76.

Inspectors wroteBased on observation, record review, staff interview, and policy review, the facility failed to ensure a resident was transferred safely using a mechanical lift with two-person assistance as specified in the care plan. This affected one (#26) of three residents reviewed for accident hazards. The facility identified 26 residents that utilize mechanical lifts for transfers. The facility census was 72.

Inspectors wroteTHE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on medical record review, review of video camera footage, review of the ventilator manual, family and staff interview, and review of the facility policy, the facility failed to timely respond to a resident's ventilator alarm. This affected one (Resident #34) of three residents reviewed for ventilators. The facility identified five residents who were on a ventilator. The facility census was 76.

Inspectors wroteBased on medical record review, review of video footage, family and staff interview, and review of the facility policy, the facility failed to provide timely assessment and pressure to a resident's dialysis access site that was actively bleeding. This affected one (Resident #34) of three residents reviewed for dialysis. The facility census was 69.

Inspectors wroteBased on record review, interview and policy review, the facility failed to ensure residents were assessed for alterations in skin integrity weekly and failed to ensure a treatment was ordered for a pressure ulcer. This resulted in Actual Harm when Resident #55 was admitted with a stage II pressure ulcer. No assessment or treatment was initiated on admission and the ulcer progressed to a stage III. This affected one (Resident #55) of ten residents reviewed for pressure ulcers. The census was 78.

Inspectors wroteBased on record review, interview and policy review, the facility failed to ensure a resident experiencing chronic pain received as needed (PRN) pain medication in a timely manner. This resulted in actual harm when staff failed to ensure Resident #277 received PRN pain medication in a timely manner, when she reported pain. This affected one (#277) of three residents reviewed for pain. The facility identified 68 residents who received pain medication. The facility census was 78.

Inspectors wroteBased on observation, interview and policy review the facility failed to maintain a sanitary kitchen and acceptable food storge practices. This had the potential to affect 72 out of 72 residents who received food from the kitchen. The facility census was 78.

Inspectors wroteBased on observation, record review, review of personnel files, staff interview, and policy review the facility failed to ensure the facility implemented contact precautions for a resident with methicillin resistant staphylococcus aureus (MRSA). This affected one resident (#42) out of two residents reviewed for transmission based precautions. The facility identified 12 residents that were assisted by respiratory therapists. In addition, the facility failed to implement their tuberculosis control plan and ensure all newly hired employees were tested for tuberculosis. This had the potential to affect all 78 residents who resided in the facility. The facility census was 78.

Inspectors wroteBased on observation, record review, interview and policy review, the facility failed to provide timely feeding assistance to a dependent resident. This affected one (Resident #5) of three residents reviewed for feeding assistance. The facility identified nine residents that required assistance with feeding. The facility also failed to ensure residents were provided with routine showers and/or bathing. This affected four (Residents #5, #33, #53, and #63) of five residents reviewed for hygiene. The facility census was 78.

Inspectors wroteBased on record review, observation, and interview, the facility failed to ensure there was enough staff to respond to call lights, provide timely incontinence care, provide assistance with meals and provide treatments. This affected 11 (Residents #45, #34, #42, #33, #24, #68, #10, #64, #26, #5, #63, ) of 25 residents reviewed for staffing. The census was 78.

Inspectors wroteBased on medical record review, review of pharmacy recommendations, staff interview and policy review, the facility failed to ensure pharmacy recommendations were timely addressed by the physician and timely implemented pharmacy recommendations agreed by the physician. This affected four (Residents #5, #31, #45, and #52) of five residents reviewed for unnecessary medications. The facility census was 78.

Inspectors wroteBased on record review, observation, interview and policy review, the facility failed to answer call lights in a timely manner. This affected seven (Residents #10, #24, #34, #42, #45, #64, and #68) of 25 residents reviewed for call lights. The census was 78.

Inspectors wroteBased on record review and interview, the facility failed to complete accurate comprehensive and quarterly assessments. This affected two (Residents #46 and #60) of 28 residents reviewed for accuracy of assessments. The facility census was 78.

Inspectors wroteBased on record review, interview and policy review, the facility failed to ensure routine care conferences were completed. This affected three (Residents #33, #51, and #53) of three residents reviewed for care conferences. The facility census was 78.

Inspectors wrote2. Record review revealed Resident #31 was admitted to the facility on [DATE]. Diagnoses included congestive heart failure, cerebrovascular disease, anxiety disorder, diabetes, and weight loss. Review of the Minimum Data Set, (MDS) comprehensive assessment dated [DATE] revealed the resident had severely impaired cognition. Review of physician orders revealed Resident #31 had a new physician order dated 04/20/22 for hospice services. Review of the medical record revealed no hospice provider documentation, including the hospice plan of care and hospice progress notes. Review of the Plan of Care dated 04/20/22, revealed Resident #31 was identified to receive hospice services. The interventions included to coordinate facility care with the hospice provider. [...]

Inspectors wroteBased on observation, interview and policy review, the facility failed to ensure incontinence care was provided to residents. This affected two (Residents #33 and #26) of two residents reviewed for incontinent care. The facility identified there were 46 residents who were incontinent. The census was 78.

Inspectors wroteBased on observation, interviews, and record reviews the facility failed to ensure physician orders were accurate and implemented. This affected two (Residents #5 and #60) of 28 residents reviewed for accuracy of physician orders. The facility census was 78.

Inspectors wroteBased on medical record review, observation, staff interview and policy review the facility failed to ensure insulin was administered without error. This affected one (Resident #31) of three residents observed for medication administration. The facility census was 78.

Inspectors wroteBased on observation, record review, staff and resident interview and policy review, the facility failed to ensure a resident received routine dental services. This affected one (Resident #45) of three residents reviewed for dental services. The facility census was 78.

Inspectors wroteBased on record review, observation, interview and policy review, the facility failed to ensure the menu was followed and provide the correct puree diet food portion. This affected one (Resident #31) of three residents who received a physician ordered puree diet. The facility census was 78.

Inspectors wroteBased on personnel file review and staff interview, the facility failed to ensure State Tested Nurse Aide (STNAs) received annual performance review evaluations. This had the potential to affect all 78 residents who reside in the facility. The facility census was 78.