Jasper County Nh

Inspectors wroteBased on record review, interviews, and facility policy review, the facility failed to administer physician-ordered medications and treatments in accordance with professional standards of practice by failing to administer a physician-ordered oral diabetic medication and perform physician-ordered blood glucose monitoring as prescribed for one (1) of three (3) residents reviewed for medication administration. (Resident #1).

Inspectors wroteBased on record review and staff interviews, the facility failed to maintain complete and accurate clinical records by documenting physician-ordered medication administration and blood glucose monitoring as completed when the ordered services were not provided, for one (1) of three (3) residents reviewed for clinical record accuracy. (Resident #1)

Inspectors wroteBased on observation, interviews, record review, and facility policy review, the facility failed to ensure a resident was free from unnecessary medications when the resident received an antipsychotic medication without an appropriate diagnosis and without informed consent, which resulted in lethargy, weight loss, and poor meal intake for one (1) of five (5) residents reviewed for unnecessary medications. Resident #79.

Inspectors wroteBased on observation, staff interview, record review, and facility policy review, the facility failed to follow infection prevention and control practices, as evidenced by failure to wear gloves during the administration of eye drops and by placing medication containers on contaminated surfaces without cleaning or using a barrier for two (2) of three (3) residents observed for medication administration (Residents #14 and #96).

Inspectors wroteBased on observation, staff interview, record review, and facility policy review, the facility failed to ensure a resident's right to privacy and dignity during medication administration when licensed nursing staff administered prescribed eye drops to a resident in the dining room while other residents were present, for one (1) of three (3) residents reviewed for medication administration, Resident #96.

Inspectors wroteBased on staff interview, record review, and facility policy review, the facility failed to accurately code the Minimum Data Set (MDS) related to an insulin medication for Resident #2 and an anticoagulant medication for Resident #14 for two (2) of (21) sampled residents.

Inspectors wroteBased on observation, interviews, record review, and facility policy review, the facility failed to implement resident-specific care plan interventions when staff did not provide personal hygiene (shaving) as identified in the care plans (Residents #6 and #11), and failed to develop a care plan addressing triggers and interventions for a resident with Post-Traumatic Stress Disorder (PTSD) (Resident #2) for three (3) of (21) sampled residents.

Inspectors wroteBased on observation, interviews, record review, and facility policy review, the facility failed to provide shaving for residents who were dependent on staff for Activities of Daily Living (ADLs) for two (2) of (21) sampled residents, Residents #6 and #11.

Inspectors wroteBased on interviews and record review, the facility failed to ensure triggers and resident specific interventions were identified and initiated for a resident with Post Traumatic Stress Disorder (PTSD) for one (1) of (21) sampled residents. Resident #2.

Inspectors wroteBased on interview, record review and facility policy review, the facility failed to maintain an accurate resident clinical record related to a physician's order for a resident hospital transfer for one (1) of (21) sampled residents. Resident #7Findings include: A review of the facility's Physician's Orders Policy, revised 8/29/17 revealed .Reminders. The nurse noting the order is responsible for. Transcribing the orders to the appropriate place. A record review of the facility's admission Record revealed the facility admitted Resident #7 on 4/23/2019 with current diagnoses including Type 2 Diabetes Mellitus A record review of the Discharge Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 7/25/25 revealed Resident #7 was transferred from the facility due to a unplanned discharge to a Short-Term General hospital on 7/25/2025. [...]

Inspectors wroteBased on observation, staff interview, and facility policy review, the facility failed to ensure nurse staffing information was posted in a location daily that was visible to residents and the public for two (2) of four (4) survey days.

Inspectors wroteBased on interviews, record reviews, and facility policy review, the facility failed to ensure services provided met current professional standards when Licensed Practical Nurse (LPN) #1 prepared two (2) residents medications simultaneously and administered the wrong medications to Resident #1, resulting in the resident being admitted to the intensive care unit (ICU) of a local acute care hospital due to an adverse reaction for one (1) of four (4) sampled residents. Resident #1 Findings Included: A review of the facility policy titled Medication Set-Up and Administration, revised 5/31/2023, revealed, Medications are administered by licensed nurses .as ordered by the physician and in accordance with professional standards of practice .8. Identify residents by photo in the electronic medication administration record (EMAR). [...]

Inspectors wroteBased on interviews, record review, and facility policy review, the facility failed to prevent a significant medication error when Licensed Practical Nurse (LPN) #1 administered blood pressure medications to a resident that were prescribed for his roommate, resulting in Resident #1 being admitted to the intensive care unit (ICU) of a local acute care hospital due to an adverse reaction for one (1) of four (4) residents reviewed. Resident #1 Findings Included: Record review of the facility's policy titled Medication Set-Up and Administration, dated 5/31/23 revealed, .Policy .Medications are administered by licensed nurses .as ordered by the physician and in accordance with professional standards of practice .Policy Explanation and Compliance Guidelines .8. Identify residents by photo in the EMAR (electronic medication administration record) . [...]

Inspectors wroteBased on observation, record reviews, interviews, and facility policy review, the facility failed to treat residents in a dignified manner by posting clinical data in a resident room (Resident #85) and failing to knock before entering a resident's room (Resident #69) for two (2) of 21 sampled residents. Findings Include: A review of the facility's Dignity Policy, undated, revealed, .It is the policy of this facility to promote care for the residents .in a manner and environment that maintains or enhances each resident's dignity, with respect in full recognition of his or her individuality .Special Concerns .Respecting the resident's private space and property, knocking on doors and requesting permission to enter . [...]

Inspectors wroteBased on interviews, record review, and facility policy review, the facility failed to ensure grievances raised by resident council members were consistently resolved for six (6) of (12) months. Findings Include: A review of the facility's Grievance/Complaint Policy (undated) revealed It is the policy of this facility that a resident/responsible party/legal representative has the right to voice a grievance .All grievances should be directed/reported to Social Services . A review of the facility's Resident Council Policy (undated) revealed, It is the policy of this facility that residents have the right to form a Resident Council group to elect a governing body made up of fellow residents who preside over the resident council, conduct regularly scheduled meetings .Purpose .to identify problems within the nursing home, to help resolve the problems that have been identified . [...]

Inspectors wroteBased on observation, staff interview, record review and facility draft policy review, the facility failed to implement Enhanced Barrier Precautions (EBP) for one (1) of three (3) residents reviewed as high risk for acquiring multi-drug-resistant organisms (MDROs) Resident #69 and had the potential to affect six (6) residents identified as high risk for MDROs. Findings Include: Record review of the facility policy Draft Enhanced Barrier Precautions Policy dated reviewed 9/28/24 revealed This policy aims to mitigate the risk of transmission of Multidrug-Resistant Organisms (MDROs) within our facility by implementing Enhanced Barrier Precautions (EBP). [...]

Inspectors wroteBased on observation, interviews, record reviews, and facility policy review, the facility failed to maintain and provide a clean, sanitary, and home-like environment for one (1) of twenty-six (26) resident rooms on Unit 2. This affected Resident #2. Findings Include: A review of the facility's Environmental Policy (undated) revealed, .It is the policy of this facility to provide a safe, clean, comfortable, and homelike environment .Special Information - A determination of 'comfortable and homelike' should include whenever possible, the resident's or a representative of the resident's opinion of the living environment .'Environment' refers to any environment in the facility that is frequented by residents, including resident rooms, bathrooms . [...]

Inspectors wroteBased on observation, interviews, record review, and facility policy review, the facility failed to ensure a resident's right to be free from physical restraints by not identifying and documenting the use of a seatbelt as a restraint for one (1) of 21 sampled residents. Resident #44. Findings Include: A review of the facility's Restraint Policy dated 09/18/14 revealed, .It is the policy of this facility that restraints will be used as follows: Physical restraints are defined as any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident's body that the individual cannot remove easily, which restricts freedom of movement or normal access to one's body . On 11/04/24 at 12:07 PM, during an observation, Resident #44 was sitting in a wheelchair in the day room with a seatbelt attached across the waistline. [...]

Inspectors wroteBased on staff, Resident Representative (RR) interview and record review, the facility failed to provide written notification to the resident or RR of a transfer to an acute care hospital for one (1) of (21) residents sampled. (Resident #7) Findings Include: A record review of the Discharge Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 08/06/24 indicated Resident #7 was discharged to an acute hospital and it was anticipated she would return to the facility. On 11/06/24 at 8:38 AM, during an interview with the Director of Nursing (DON), she acknowledged that the facility did not provide written documentation to Resident #7's Representative (RR) to inform them of the resident's transfer to the hospital or the reason for the transfer. The DON confirmed that the facility calls the resident's RR by phone to inform them that the resident has been sent to the hospital. [...]

Inspectors wroteBased on interviews, record review, and facility policy review, the facility failed to obtain a Level II Preadmission Screening and Resident Review (PASARR) for a resident receiving psychotropic medications and diagnosed with a new mental health diagnosis for one (1) of one (1) resident reviewed for PASARR. (Resident #69) Findings Include: Record review of the Resident Assessment-Coordination with PASARR Program, undated, revealed Policy: This facility coordinates assessment with the preadmission screening and resident review (PASARR) under Medicaid to ensure that individual with a mental disorder, intellectual disability or related condition receives care and services in the most integrated setting appropriate to their needs .9. [...]

Inspectors wroteBased on observation and interviews, the facility failed to maintain an audible call light system for one (1) of (16) rooms observed on Unit 4 hall. room [ROOM NUMBER] Findings Include: On 11/04/24 at 11:12 AM, during an observation, the call light in room [ROOM NUMBER] was noted to be hanging from the outlet. The resident in the room activated the call light, but it did not illuminate above the door or sound. During an interview and observation on 11/04/24 at 11:15 AM, Housekeeper #3 attempted to activate the call light unsuccessfully and stated this was the first time she noticed the light not working, despite Resident #76 frequently using the call light for assistance. During an interview and observation on 11/04/24 at 11:20 AM, Licensed Practical Nurse (LPN) #3 also attempted to activate the call light in room [ROOM NUMBER] and confirmed it was not working properly. [...]

Inspectors wroteBased on staff interviews, record reviews, and facility policy review, the facility failed to transmit Minimum Data Set (MDS) Assessments by the target date, for seven (7) of 20 residents reviewed for MDS assessments. Resident #4, #12, #37, #40, #46, #49, and #59. Findings Include: Review of the Resident Assessment Instrument Policy (undated) revealed, It is the policy of this facility that the RAI (Resident Assessment Instrument) will be done as follows: According to the guideline specified by: State Department of Health, Division of Medicaid, Case Mix Trainers, Completed by Inter Disciplinary Team, Coordinated by the RN (Registered Nurse) . MDS Assessments will be submitted in timely manner within the 14 day timeframe . Record review of MDS Assessments revealed the following: 1. The yearly assessment for Resident #4 had a target date of 2/10/23 and was not transmitted until 3/17/23. 2. [...]

Inspectors wroteBased on observation, interview, and facility policy review, the facility failed to discard expired food and failed to serve food in a sanitary manner related to staff touching a resident's food item for two (2) of five (5) kitchen and dining observations.

Inspectors wroteBased on interviews, record review, and facility policy review, the facility failed to accommodate resident preferences by not allowing bedfast residents to receive showers as their preferred bathing method for two (2) of two (2) residents reviewed for preferences. (Resident #7 and Resident #41) This had the potential to affect (12) of (12) bedfast residents.

Inspectors wroteBased on observation, interview, record review and facility policy review, the facility failed to ensure a resident who was dependent on staff for personal hygiene received services related to nail care for one (1) of three (3) residents reviewed for Activities of Daily Living (ADLs).

Inspectors wroteBased on observation, interview, record review, and facility policy review, the facility failed to ensure policies and procedures addressed a process for ensuring the implementation of additional precautions intended to mitigate the transmission and spread of COVID-19 for all staff who are not fully vaccinated for COVID-19. This had the potential to affect 95 of 95 residents in the facility.