Hampshire Memorial Hospital

Inspectors wroteBased on record review and staff interview, the facility failed to ensure all code status documentation for Resident #20 and Resident #25, who both requested to be a Do Not Resuscitate (DNR) matched. This failure placed Resident #20 and Resident #25 in an immediate risk for serious harm and/or death. The state agency notified the facility of the immediate jeopardy situation on 01/22/26 at 1:37 PM. The state agency accepted the facility's plan of correction on 01/22/26 at 3:28 PM. After observation of the implementation of the plan of correction, the immediate jeopardy was abated at 9:00 AM on 01/23/26. Resident Identifiers: #20 and #25. Facility Census:28. During an interview on 01/22/26 at approximately 12:10 PM, Licensed Practical Nurse (LPN) #19, reported staff could use the following methods to double-check a resident's code status should they be found pulseless and not breathing: [...]

Inspectors wroteBased on record review and staff interview, the facility failed to follow physician's order for resident care. The physician order for Gabapentin was not properly followed for Resident #7. This failed practice was true for one (1) of five (5) residents reviewed under the Unnecessary Medications pathway in the Long-Term Care Survey Process (LTCSP) pathway. Resident #7. Facility census: 28.a) Resident #7 During a record review, completed on 01/21/2026 at 11:10 AM, the following physician order was found for Resident #7: Gabapentin Oral Capsule (Gabapentin) - Give 100 mg by mouth three times a day for Diabetic Neuropathy. Review of Resident #7's Medication Administration Records (MARs) from August 2025 - January 2026 revealed the following dates and times the MAR was left blank: [...]

Inspectors wroteBased on observation, record review and staff interview, the facility failed to ensure safe storage of food. This failed practice had the potential to effect more than a limited amount of residents receiving nourishment from the kitchen. Facility census: 28.a) Kitchen During the initial walkthrough of the kitchen it was found that the following food items did not have an 'opened on date or a use by date:-Frozen strawberries-Frozen blueberries-Pickles-Ice cream-Sherbet-Tater tots-Sausage patties-Liquid eggs Dietary Employee #32 and Dietary Employee #53 were not wearing beard nets. It was also found that there was no lid on trash can. The Dietary Manager verified the above-mentioned details.

Inspectors wroteBased on observation, record review and staff interview, the facility failed to maintain a proper infection control program for medication administration. These was a random opportunity for discovery. Facility Census: 28. Findings Included: a) Medication Administration On 01/23/26 at 8:34 AM, medication administration for Resident #7 by Licensed Practical Nurse (LPN) #19 was observed. Upon entering Resident #7's room, LPN #19 sat the resident's Flonase nasal spray and Moxifloxin eye drops directly on the over-the-bed table with using a barrier. On 01/23/26 at 8:41 AM, LPN #19 confirmed she did not place the medication on a barrier. On 01/23/26 at 8:48 AM, the Director of Nursing (DON) was notified and confirmed the medication should have been placed on a barrier.

Inspectors wroteBased on record review and staff interview, the facility failed to develop a comprehensive care plan care which included a resident's preference and potential for future discharge. The facility failed to document whether the resident's desire to return to the community was assessed for Resident #10. This was true for one (1) of 19 residents reviewed throughout the Long-Term Care Survey Process. Resident identifier: #10. Facility census: 28.a) Resident #10 During a record review, completed on 01/21/2026 at 11:44 AM, it was determined that the comprehensive care plan for Resident #10 did not include the resident's preference and potential for future discharge. There was no evidence the facility had assessed the resident's potential for discharge from the facility. [...]

Inspectors wroteBased on record review and staff interview, the facility failed to ensure an accurate and complete documentation of a discontinued medication for Resident #14. This was true for one (1) of five (5) medications reviewed under the care area of unnecessary medications. Additionally, based on record review and staff interview, the facility failed to maintain an accurate medical record for one (1) out of 19 records reviewed for accurate POST forms. This failed practice applied to Resident #25. Resident identifiers: #14 and #25. Facility census: 28. Findings Included: a) Resident #14 On [DATE] at 1:20 PM, a record review was completed for Resident #14. The review found a physician's order stating, Continue to monitor for antidepressant side effects. However, the antidepressant, Trazodone, had been discontinued on [DATE]. [...]

Inspectors wroteBased on record review and staff interview, the Quality Assessment Performance Improvement meetings did not include all required members for two (2) of four (4) meetings. This deficient practice had the potential to affect all residents residing in the facility. Facility census: 27.

Inspectors wroteBased on observation and staff interview the facility failed to provide residents the opportunity to file grievances anonymously by not making grievance forms accessible to residents. This has the potential to affect more than a limited number of residents. Facility Census:

Inspectors wroteBased on record review and staff interview the facility failed to develop and/or implement the comprehensive care plan for seven (7) of fourteen (14) residents reviewed in the long term care survey sample. Resident Identifiers: #1, #27, #24, #11, #13, #20 and #3. Facility Census: #27.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure residents received treatment and care in accordance with professional standards of practice. The facility failed to document vital signs when medications were held for Resident #13 and Resident #7. The facility failed to follow the physician's orders for side rails for Resident #11. This deficient practice had the potential to affect three (3) of 14 residents reviewed in the long-term care survey sample. Resident identifiers: #13, #7, #11. Facility census: 27.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure each resident's drug/medication regimen is managed and monitored to promote or maintain the resident's highest practicable mental, physical, and psychosocial well-being. Resident's #13, #24, #7 and #3 received psychotropic medications without adequate indication for use. Nonpharmacological interventions were not provided prior to starting the medication and the facility failed to monitor medications for side effects and efficacy. This was true for four (4) of five residents reviewed for unnecessary medications. Resident identifiers: #13, #24, #7, and #3. Facility census: 27.

Inspectors wroteBased on observation and staff interview, the facility failed to ensure medications were stored in accordance with currently accepted professional principles of practice. This was a random opportunity for discovery that had the potential to affect more than a limited number of residents. Facility census: 27.

Inspectors wroteBased on staff interview and record review the facility failed to employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service when one (1) of eight (8) dietary staff members did not have their Food Handlers/SafeServ certification. Facility Identifier: Facility Facility Census: 27 Findings Included: a) Facility On 02/19/24 at 01:17 PM, the Dietary Manager #49 failed to provide the required Food Handler or Safe/Serve certification for one (1) of the eight (8) staff members on the dietary staff. On 02/20/24 at 09:30 AM a telephone interview with the County Sanitarian at the Hampshire County Health Department states they must have the Food Handlers or Safe/Serve certification in order to work in any food area in this county. This was confirmed with the Director of Nursing on 02/20/24 at 02:45 PM.

Inspectors wroteBased on record review and staff interview, the facility failed to identify and correct quality deficiencies of which it should have been aware. The facility's Quality Assessment and Assurance Committee failed to identify and correct deficiencies regarding psychotropic medications. This deficient practice had the potential to affect four (4) of five (5) residents reviewed for the care area of unnecessary medications. Resident identifiers: #13, #24, #7, #3. Facility census: 27.

Inspectors wroteBased on record review and staff interview, the facility failed to inform the resident/responsible party of the risks and benefits of receiving an antipsychotic medication. This was found for one (1) of five (5) residents reviewed for unnecessary medications. Resident identifier: #13. Facility census: 27.

Inspectors wroteBased on record review and staff interview, the facility failed to notify the residents' representatives when Resident #20 had a significant change in status and when Resident #13 had a significant alteration in treatment. This deficient practice had the potential to affect two (2) of 14 residents reviewed in the long-term care survey sample. Resident identifiers: #20, #13. Facility census: 27.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure three (3) of three (3) residents reviewed for the care area of beneficiary notices received the required notices when the facility initiated a discharge from Medicare A and the three (3) residents elected to remain at the facility with benefit days remaining. Resident identifiers: #28, #13, and #17. Facility census: 27.

Inspectors wroteBased on record review and staff interview the facility failed to assess, monitor and provide timely interventions for residents experiencing weight loss. This was true for two (2) of three (3) residents reviewed for nutrition. Resident Identifiers: #17 and #20. Facility Census:

Inspectors wroteBased on record review and staff interview, the facility failed to ensure residents' care after significant weight loss was supervised by the physician. This deficient practice had the potential to affect two (2) of three (3) residents reviewed for the care area of nutrition. Resident identifier: #20, #1. Facility census: 27.

Inspectors wroteBased on record review and staff interview the facility failed to ensure a resident who is diagnosed with dementia, received the appropriate treatment and services to attain or maintain his or her highest practicable physical, mental, and psychosocial well-being. The facility failed to identify and address the needs of a resident diagnosed with dementia and develop a person-centered care plan that included individual non-pharmacological approaches to care using meaningful activities to address the resident's customary routines, interests, preferences and choices to enhance the resident's well-being. This was found for one (1) of two (2) residents reviewed for dementia care. Resident identifier: #13. Facility census: 27.

Inspectors wroteBased on observation, record review, resident interview, and staff interview, the facility failed to ensure dietary preferences were honored. Two (2) of six (6) residents reviewed for the care area of food did not receive the food items indicated on their tray ticket. Resident identifiers: #3, #10. Facility census: 27.

Inspectors wroteBased on record review and staff interview the facility failed to ensure complete and accurate medical records were available pertaining to Physicians Order for Scope of Treatment (POST). Resident Identifier: #17 and #27 Facility Census: #27 Findings Included: a) Resident #17 On 02/19/24 at 03:10 PM, record review shows that the POST form for Resident #17 was not completed in its entirety. The patient information on page one (1) did not have identifying information for a middle initial, last four (4) numbers of the social security number and an address. Section D for Medically Assisted Nutrition was not addressed. Page two (2) of the POST only provided a resident name and the Medical Power of Attorney name. The Primary Care Provider Name or telephone number was provided. [...]

Inspectors wroteBased on observation and staff interview, the facility failed to ensure the daily staff posting included the actual amount of hours worked per each shift for Nurse Aides, Licensed Practical Nurses and Registered Nurses. This had the potential to affect all residents at the facility. Facility census: 27.

Inspectors wroteBased on observation, resident council meeting and interview, the Resident Council members did not know how to file a grievance or with whom to file a grievance. This had the potential to affect more than a limited number of residents. Facility censs: 27.

Inspectors wroteBased on a review of nursing staffing sheets and interview, the facility failed to indicate Charge Nurse on the nursing schedules. This had the potential to affect more than a limited number of residents. Facility census: 27.

Inspectors wroteBased on facility documentation, staff interview, Centers for Medicare and Medicaid Services (CMS) Guidance and policy review the facility's Quality Assessment and Assurance (QAA) Committee did not meet at least quarterly. The failed practice had the potential to affect more than a limited number of residents. Facility census: 27.

Inspectors wroteBased on observation, record review and staff interview, the facility failed to administer oxygen to a Resident at the appropriate flow rate as directed by the physician order. The failed practice was true for for one (1) of two (2) residents reviewed for oxygen. Resident identifier: #127. Facility census: 27.

Inspectors wroteBased on record review and staff interview the facility failed to ensure unscheduled/as needed (PRN) narcotics were not in excessive duration. The failed practice was true for one (1) of five (5) residents reviewed for unnecessary medications. Resident identifiers: #12. Facility census: 27.

Inspectors wroteBased on record review, staff interview and policy review the facility failed to offer and educate a Resident on the annual influenza vaccination. The failed practice was true for one (1) of five (5) residents reviewed for vaccinations. Resident identifier: #10. Facility census: 27.