Marshall Health Care and Rehab

Inspectors wroteBased on record review, review of the facility's Abuse Policy and Procedure and interview, the facility failed to report an injury of unknown origin to the State Agency for 1 of 4 sampled resident who had an injury of unknown origin. On 8/19/25, a review of R1's clinical record was completed. Documentation indicated R1 has many diagnoses including mental health issues, dementia and cognitive impairments. Documentation in a nurse's note dated 7/24/25, indicted that in the early evening R1 told a staff member that they had injured their finger. When asked what happened, R1 told the nurse it happened from a fall. On 8/19/25 at 9:45 a.m., in an interview with Certified Nurse Assistant #1 (CNA1), she stated the resident told her it happened when she fell, but did not know where or when. CNA1 stated the resident is not reliable in what he/she says. [...]

Inspectors wroteBased on record review and interviews, the facility failed to monitor and adequately treat 1 of 2 residents (Resident #255 [R255]) reviewed for Skin Conditions, when the facility failed to follow discharge orders for the use of a diuretic medication (a medication used to treat fluid retention [edema] associated with conditions such as heart failure), obtain and monitor daily weights, and failed to report a potentially significant weight gain. These failures resulted in harm to R255 who required hospitalization for the treatment of worsening signs and symptoms of diastolic congestive heart failure.

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure the physician reviewed the resident's total program of care, ensure orders were complete, signed and dated for 2 of 4 residents reviewed under the general pathway (Resident #6 [R6] and [R255]).

Inspectors wrote2. On 6/24/25 at 10:04 a.m. during a review of R40's EMAR and nursing progress notes, it was noted that R40 had an order for Tramadol HCl [hydrochloric acid] Oral Tablet 50 milligrams (mg) (medication used to treat moderate to moderately severe chronic pain in adults), Give 50 mg by mouth every 4 hours for pain. The EMAR shows documentation that on 5/26/25 at 4:00 p.m. R40 did not receive his/her dose of Tramadol documented that the medication not available but has been ordered and should be here this p.m On 5/27/25 the EMAR documents that his/her 1200 dose was on hold due to waiting for shipment from pharmacy, and the medications had already shipped so pharmacy unable to give this nurse an override code without emergency prescription sent in from MD (doctor of medicine). [...]

Inspectors wroteBased on observations and interviews, the facility failed to ensure medications were stored properly in two medication storage refrigerators for 2 of 3 medication storage refrigerators reviewed (1 on [NAME] Wing, and 1 on South Wing), failed to ensure that an expired immunization was removed from the supply available for use in 1 of 3 medication storage refrigerators reviewed (West Wing), and failed to monitor medication refrigerator temperatures for 3 of 3 medication storage refrigerators (West Wing Medication refrigerator/freezer, South Wing Immunization refrigerator, and South Wing refrigerator/freezer).

Inspectors wroteBased on observation and interviews, the facility failed to promote care for all residents in a manner that maintains each resident's dignity and respect during repositioning on 1 of 4 survey days (6/23/25), and during breakfast meal service on 1 of 4 survey days (6/26/25).

Inspectors wroteBased on observations and interviews, the facility failed to ensure that the resident's environment was free of accident hazards regarding water temperatures for 1 of 4 days (6/26/25) and water spills for 4 of 4 days of survey (6/23/25, 6/24/25, 6/25/25, and 6/26/25).

Inspectors wroteBased on interview and employee personnel record reviews, the facility failed to implement and maintain an effective training program by failing to ensure that 2 of 5 Certified Nursing Assistant's (CNA) employed, completed training (CNA1 and CNA2).

Inspectors wroteBased on record review and interview, the facility failed to update a care plan for services outlined on the Preadmission Screening and Resident Review (PASRR) level II determination-Maine Summary of Findings, dated 4/20/23, for 1 of 1 sampled resident (Resident #11 [R11]).

Inspectors wroteBased on clinical record reviews and interviews, the facility failed to ensure the attending physician made required visits, at least every 30 or every 60 days (depending on date of admission) and wrote a progress note for 5 of 11 sampled residents (Resident #25 [R25,] R31, R11, R40, R44).

Inspectors wroteBased on observations and interviews, the facility failed to remove fresh food items and out dated meat timely from the walk in cooler for 1 of 1 initial tours (6/10/24). In addition, the facility failed to ensure that plumbing fixtures were properly installed to prevent backflow as required by the Maine State Plumbing Code and failed to ensure that equipment/cabinets were kept clean on 2 of 3 survey days (6/10/24 and 6/11/24).

Inspectors wroteBased on record reviews and interview, the facility failed to ensure residents were offered pneumococcal vaccinations in accordance with the Centers for Disease and Prevention Control (CDC) recommendations for 5 of 6 residents reviewed for immunizations (Resident #5 [R] , R18, R2, R39, and R244).

Inspectors wroteBased on record review and interview, the facility failed to ensure that the Annual Minimum Data Set (MDS) 3.0 was coded accurately to indicate that a resident had a state Level II Preadmission Screening and Resident Review (PASRR) for 1 of 2 sampled residents reviewed for PASRR (Resident #11 [R11]).

Inspectors wroteBased on record review and interview, the facility failed to obtain recommendations from the Preadmission Screening and Resident Review (PASRR) level II determination-Maine Summary of Findings for 1 of 1 sampled resident (Resident #11 [R11]).

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure a baseline care plan was developed and implemented within 48 hours that included the problems, interventions, and initial goals needed to provide minimum healthcare information necessary to properly care for 1 of 3 residents that were reviewed for new admissions (Resident #195 [R195]).

Inspectors wroteBased on record reviews and interviews, the facility failed to implement a care plan approach in the area of nutrition for 1 of 2 residents reviewed for nutrition (Resident #31 [R31] and failed to develop a care plan for respiratory care for 1 of 2 residents reviewed for oxygen (R195).

Inspectors wroteBased on observations, interviews, and record review, the facility failed to follow physician orders and care plan for 1 of 4 residents reviewed for weight loss (Resident #40 [R40]).

Inspectors wroteBased on observations, record reviews and interviews, the facility failed to provide respiratory care consistent with professional standards of practice by failing to follow physician orders for oxygen administration, failing to date and label oxygen tubing/nebulizer set ups, and/or failing to ensure that respiratory equipment was clean, for 2 of 2 sampled residents (Resident #195 [R195] and R2).

Inspectors wroteBased on record review and interview, the facility failed to ensure the physician reviewed the resident's total program of care, which included signing orders for medications and treatments listed on the Physician Orders (block orders) in a timely manner for 1 of 4 newly admitted residents reviewed (Residents #40 [R40]).

Inspectors wroteBased on record review and interview, the facility's Quality Assurance Committee failed to ensure that the Plan of Correction (POC) for an identified deficiency from the annual Long Term Care Recertification Survey, dated 6/12/24, was effective. The Federal citations F712, and F812 were cited again during the re-visit to the annual Long Term Care Recertification Survey, dated 8/13/24.

Inspectors wroteBased on record review and interviews, the facility failed to notify the resident and/or resident representative in writing for the reason of a transfer/discharge from the facility, for 2 of 3 facility initiated hospital transfers for Resident #44 (R44). In addition, the facility failed to notify the Ombudsman of the transfer/discharges from the facility.

Inspectors wroteBased on facility policy review, the facility reportable incident report, the facility 5 day follow up report, the facility working schedule review, and interviews, facility failed to protect residents during their investigation by allowing the alleged perpetrator to work 5 of 5 scheduled shifts (4/1/24, 4/2/24, 4/3/24, 4/4/24, and 4/5/24), prior to investigation completion.

Inspectors wroteBased on record review and interviews the facility failed to inform and obtain consent from the resident or resident representatives for the holding of non-essential medications for staff convivence during a two-week span of time. (10/14/22 to 10/27/22) for 2 of 5 residents reviewed. (Resident #16 and Resident #21)

Inspectors wroteBased on record reviews and interviews the facility failed to ensure that physician orders for the use of medications were followed for 3 of 5 residents reviewed (Resident #16, Resident #21, and Resident #3).

Inspectors wroteBased on record reviews and interview, the facility failed to ensure that physician ordered medications were available for use to meet the needs of the residents for 4 of 5 residents reviewed (Resident #16, Resident #11, Resident #12, and Resident #3).

Inspectors wroteBased on review of the posted meal menus and interviews, the facility failed to ensure that all meal menus are prepared in advance and followed on 4 of 4 days of survey (4/2/23, 4/3/23 4/4/23 and 4/5/23).

Inspectors wroteBased on record review, review of the facility Abuse Policy and Procedure and interview, the facility failed to notify the State Agency of a resident reported allegation of abuse for 1 of 15 sampled residents (Resident #13).

Inspectors wroteBased on record review and interview, the facility failed to ensure that the State mental health authority was notified when the nursing home stay of a resident with a mental health diagnosis was expected to exceed 30 days for 1 of 3 residents reviewed for Pre-admission Screening and Resident Review (PASARR) (Resident #10).

Inspectors wroteBased on record reviews and interviews, the facility failed to follow up on pharmacist recommendations timely, and failed to keep all copies of Medication Regimen Reviews (MRR) in the resident's permanent health record for 1 of 5 residents reviewed for medications (Resident #10).

Inspectors wroteBased on observation and interview the facility failed to ensure food temperatures were taken before a meal service and were maintained at the proper holding temperature for 1 of 5 meal services observed. (4/2/23, lunch meal). In addition, the facility failed to ensure that plumbing fixtures were properly installed to prevent backflow as required by the Maine State Plumbing Code for 1 of 4 days of survey (4/2/23).