Nashua Post Acute Care

Inspectors wroteBased on observation and interview, it was determined that the facility failed to provide a safe and clean environment for 3 of 5 units observed and 1 of 5 kitchenettes observed.

Inspectors wroteBased on observation, interview, and policy review, it was determined that the facility failed to ensure that food was stored in accordance with professional standards for food service safety for main kitchen and 3 of 5 kitchenettes observed. Findings Include:Review of the facilities Food Receiving and Storage Policy , undated, on 11/18/25 revealed . Refrigerated/Frozen Storage 1. All foods stored in the refrigerator or freezer are covered, labeled and dated ( use by date).7. Refrigerated foods are labeled, dated and monitored so they are used by their use-by date, frozen, or discarded. Foods and Snacks Kept on Nursing Units.2. All foods belonging to residents are labeled with the resident's name, the item and the use by date. 3. Refrigerators must have a working thermometers and are monitored for temperature according to specific guidelines. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to ensure proper processing of resident's clothing and failed to implement policies and procedures for Enhanced Barrier Precautions (EBP) for 1 of 3 residents reviewed for EBP.

Inspectors wroteBased on interview and record review, it was determined that the facility failed to ensure residents who chose and were scheduled to have a weekly showers received showers for 3 of 8 residents reviewed for activities of daily living (ADL) in a final sample of 35 residents (Resident Identifiers are #36, #107 and #176).

Inspectors wroteBased on observation, record review, and interview, it was determined that the facility failed to keep a resident free from involuntary seclusion for 1 of 1 resident reviewed for restraints in a final sample of 35 residents (Resident identifier is #131).

Inspectors wroteBased on interview and record review, it was determined that the facility failed to ensure residents receive care in accordance with plan of care for 1 of 8 residents reviewed for choices in a final sample of 35 residents. (Resident identifier is #185.)

Inspectors wroteBased on observation, interview and record review, it was determined that the facility failed to label medications with open expiration dates, monitor proper temperature controls, and permit only authorized personnel to have access to the keys for 2 of 6 medication carts observed and 2 of 3 medication room refrigerators observed. Findings Include:Observation on 11/18/25 at approximately 10:45 a.m. on Unit #6 revealed Staff E (Regional Registered Nurse) going through medications inside medication cart #5302 with no other facility staff present. Staff E appeared to be removing medications. Interview on 11/18/25 at approximately 10:45 a.m. with Staff E revealed that he/she was not assigned to the cart. Further interview revealed that Staff E works at another facility and was in the facility assisting during the survey. Interview on 11/18/25 at approximately 11:40 a.m. [...]

Inspectors wroteBased on interview, and record review, it was determined that the facility failed to ensure that a nourishing snacks was provided to residents consistent with the resident's plan of care for 1 of 1 residents reviewed for food and 1 of 6 residents reviewed for nutrition in a final sample of 35 residents. (Resident identifiers are #53 and #181).

Inspectors wroteUnit 5 Kitchenette: Review on 10/8/2024 of September 2024 refrigerator temperature logs for Unit 5 Kitchenette revealed the following missing September temperatures: 9/18, 9/19, 9/21, 9/25, 9/26, 9/27, 9/28, 9/29. Based on observation, interview, and review, it was determined that the facility failed to ensure that dietary staff used facial hair restraints when cooking and serving food from the steam table for 1 of 1 kitchens observed for meal service, and failed to label and store food in accordance with professional standards for food safety to prevent foodborne illness for 1 of 1 kitchens and 5 of 7 kitchenettes observed.

Inspectors wroteBased on observation, record review, and interview, it was determined that the facility failed to follow established infection control guidelines for facility water management that had the potential to effect the facility census of 220 residents who resided at the facility.

Inspectors wroteBased on observation, interview and record review, it was determined that the facility failed to ensure a resident who was unable to carry out activities of daily living (ADL) received services to maintain good personal hygiene for 1 of 3 residents reviewed for ADL in a final sample of 37 residents (Resident Identifier #62).

Inspectors wrote5 East Medication Cart Observation on [DATE] at approximately 8:14 a.m. of the 5 East Medication Cart with Staff F (Licensed Practical Nurse) revealed one opened Lispro Insulin Quik Pen with no name, open date or expiration date. Interview on [DATE] at approximately 8:14 a.m. with Staff F confirmed the above findings. Review on [DATE] of policy titled, Insulin Pen, date reviewed 2/2024, revealed: .2. Insulin pens must be clearly labeled with the resident name, type of insulin, amount to be given, frequency, and expiration date. 3. If the label is missing, the pen will not be used . Based on observation, interview, and record review, it was determined that the facility failed to label and date opened multi-dose medications on 1 of 6 medications carts observed and 1 of 5 medication rooms observed.

Inspectors wroteBased on observation, interview and record review, it was determined that the facility failed to provide dental services and assist the resident with making dental appointments when referred to an oral surgeon for 1 of 1 residents reviewed for dental services in a final sample of 37 residents (Resident Identifier #88).

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to follow menu preferences, allergies, and intolerances for 2 of 8 residents reviewed for meal/food concerns in a final sample of 37 residents (Resident Identifiers are #4 and #49).

Inspectors wroteBased on record review and interview, it was determined that the facility failed to provide pneumococcal immunization for 1 of 5 residents reviewed for pneumoccocal vaccination in a final sample of 37 residents (Resident Identifier #73).

Inspectors wroteBased on record review and interview, it was determined that the facility failed to notify the resident or resident representative of the bed hold policy before discharge to the hospital for 2 of 2 residents reviewed for hospitalizations in a final sample of 37 residents (Resident Identifiers are #75 and #97).

Inspectors wroteBased on record review and interview, it was determined that the facility failed to conduct a comprehensive Minimum Data Set (MDS) assessment within 14 days after a significant change was determined for 2 of 4 residents reviewed for hospice in a final sample of 37 residents (Resident identifiers are #165 and #11).

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to provide services or assist a resident in making appointments to maintain good foot health for 1 of 3 residents reviewed for foot care (Resident Identifier #5).

Inspectors wroteBased on interview, observation, and record review, it was determined that the facility failed to ensure that physician's orders were followed for 4 residents in a final sample size of 41 residents and 1 out of 28 medication administrations observed. (Resident Identifiers are #3, #64, #83, #158, and #163)

Inspectors wroteObservation on 10/2/23 at approximately 6:00 p.m. revealed a strong odor of urine on the nursing units. Interview on 10/3/23 at approximately 8:45 a.m. with Resident #115 revealed that he/she had concerns with staffing at the facility. Sometimes I have to wait for a half hour for my call light to be answered and then another hour or so for them to find someone help me. Interview on 10/3/23 at approximately 9:00 a.m. with Resident #187 revealed that receiving help from staff can be anywhere from 30 minutes to 2 hours. It is horrible, I wet myself sometimes and will be in pain for that long because there is no one to answer my call bell. Interview on 10/3/23 at approximately 10:00 a.m. with Resident #186 revealed, Over this past weekend there were a bunch of no shows which meant we waited for anything we needed. [...]

Inspectors wroteBased on observation, interview, review of manufacturer's instructions, and review of the facility's policy and procedure it was determined that the facility failed to label opened multi-dose medications and biologicals, failed to ensure that medications were secured, and failed to ensure that expired medications were removed from supply and not given on 5 of 6 medications carts reviewed and in 1 of 3 medication rooms observed (Resident identifiers are #130, #140, #174, #234, #89, #146, and #20).

Inspectors wroteBased on observation and interview it was determined that the facility failed to provide meals served at an appetizing temperature for 22 residents in a final survey sample of 41 (Resident Identifiers are #3, #21, #41, #46, #56, #63, #82, #86, #107, #114, #118, #125, #136, #138, #181, #186, #204, #221, #224, #231, #387, #397).

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to follow menu preferences, allergies, and intolerances for 5 residents (Resident identifiers are #27, #56, #79, #138, and #210) of 19 residents reviewed for meal/food concerns (Resident Identifiers are #21, #41, #48, #53, #82, #83, #86, #107, #125, #136, #181, #186, #231, #397).

Inspectors wroteBased on interview and record review, it was determined that the facility failed to document a complete discharge summary for 1 out of 3 residents reviewed for closed records (Resident Identifier is #236).

Inspectors wroteBased on observation and interview, it was determined that the facility failed to follow their policy for labeling and dating resident food items brought in by visitors for 3 of 5 kitchenettes observed.

Inspectors wroteBased on observation, interview, and record review it was determined that the facility failed to include a data collection tool that tracked residents when admitted to the facility while COVID-19 positive for 1 of 1 resident reviewed for transmission-based precautions (Resident Identifier is #396).

Inspectors wroteBased on interview and record review it was determined that the facility failed to provide documentation of pneumococcal vaccination for 1 out of 5 residents reviewed for pneumococcal immunizations (Resident Identifier is #143). Findings Include: Review on 10/6/23 of Resident #143's Immunization Tab in the electronic record revealed under pneumococcal was coded Resident Refused. Review on 10/6/23 of Resident #143's Immunization Consent form dated 10/20/22 revealed under pneumococcal vaccination was checked I have already received pneumococcal vaccination . with no date of when. Review on 10/6/23 of Resident #143 medical record revealed no follow-up to what type of pneumococcal vaccination had been administered prior to admission or if Resident #143 needed a follow-up vaccination. Interview on 10/6/23 at 9:52 a.m. with Staff V (Licensed Practical Nurse) confirmed the above findings. [...]

Inspectors wroteBased on interview and record review, it was determined that the facility failed to implement policies and procedures regarding offering and educating residents and staff the COVID-19 vaccination series for 2 of 5 residents reviewed for COVID-19 immunizations and 1 of 1 staff reviewed for COVID-19 immunizations (Resident Identifiers are #143 and #208. Staff identifier is Staff AA).

Inspectors wroteBased on interview and record review, it was determined that the facility failed to ensure that discharge assessments were completed and transmitted to 2 of 2 residents reviewed for resident assessment Minimum Data Set (MDS) records over 120 days old (Resident Identifiers are #24 and #176).