Town Hall Estates Keene Inc

Inspectors wroteNumber of residents sampled: Number of residents cited: Based on interview and record review, the facility failed to consider the views of the resident or family group and act promptly upon the grievances and recommendations of such groups concerning issues of resident care and life in the facility or to demonstrate their response and rationale for such response for 1 of 1 Resident Council reviewed. The facility failed to follow up on concerns and requests expressed in Resident Council meetings for the months of April 2025 and June 2025. The facility failed to ensure Resident Council #1's concerns regarding the delay of call lights and resident care was being provided in a reasonable time during the evening and overnight shifts. This failure placed residents at risk of not having their preferences honored.

Inspectors wroteNumber of residents sampled: Number of residents cited: Based on interviews, and record review, the facility failed to maintain acceptable parameters of nutritional status, such as usual body weight or desirable body weight range unless the resident clinical condition demonstrated that this was not possible or resident preferences indicated otherwise for one (Resident #12) of one resident reviewed for nutrition status maintenance. The facility failed to ensure a weight variance was addressed and documented to ensure management of weight loss for Resident #12. The facility failed to keep accurate record of Resident #12's food intake per record review of the resident electronic health record. These failures could place residents at risk of further weight loss, malnutrition, and decreased quality of life.

Inspectors wroteNumber of residents sampled: Number of residents cited: Based on observation, interviews, and record reviews, the facility failed to store food by professional standards for food service safety in the reviewed 1 of 1 kitchen. - Food items were not labeled and/or dated. - Food items were out of date. - Tortillas that were 3 years old were being used. These failures can potentially cause foodborne illness.

Inspectors wroteNumber of residents sampled: Number of residents cited: Based on observation, interview, and record review, the facility failed to treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life for 1 (Resident #100) of 8 residents reviewed for dignity. The facility failed to ensure that all residents at a table was provided meals at the same time. Resident #10 was provided a meal 26 minutes after all other residents at a table were provided meals. This failure could place residents at risk of diminished dignity and affect their quality of life.

Inspectors wroteNumber of residents sampled: Number of residents cited: Based on interview and record review, the facility failed to provide accurate PASRR screenings for individuals with a mental disorder for 6 (Resident #3, Resident # 11, Resident #14, Resident #76, Resident #78, Resident #94) of 6 residents reviewed for PASRR. The facility failed to complete an accurate PASRR level one screening after Resident’s #3, #78, and #94 was admitted with a negative PASRR Level 1 screening but had a mental illness. The facility failed to ensure Resident # 11, Resident #14, Resident #76’s PASARR Level One screenings accurately reflected his diagnoses of mental illness and submit a corrected PASARR level one screening This failure could place residents at risk of not receiving or benefiting from specialized therapy and equipment services they may require. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide care and services needed for residents to attain or maintain the highest practicable physical, mental, and psychosocial well-being for 2 (Resident #19 and Resident #23) of 3 residents and 1 of 1 Resident Council reviewed. The facility failed to ensure Resident #19 was offered/provided timely incontinent care for urine as identified on the resident's Care Plan. The facility failed to ensure Resident #23 remained clean and dry throughout the day and night as identified on the resident's Care Plan. This failure could have a potential to cause a negative outcome to a resident's physical, mental, or psychosocial health or well-being.

Inspectors wroteBased on the interviews and record review the facility failed ensure residents were free of any significant medication errors for 1 (Resident # 1) of 6 reviewed for significant medication errors. The facility failed to ensure Resident #1 received his prescribed medications. According to residents' #1 MAR the missed medications are: clopidogrel prescribed for atrial fibrillation, flomax prescribed for prostate, flonase prescribed for allergies, isosorbide mononitrate prescribed for angina, nifedipine for hypertension, levothyroxine for thyroid, pantoprazole for peptic ulcer, furosemide for edema, lubiprostone for constipation, metoprolol for hypertension, sucralfate for peptic ulcer, and ranolazine for myocardial infarction/chest pain. According to the physicians' orders on 06/10/25 - 06/11/25, MA D and MA F failed to ensure that Resident #1 was free of a medication error. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure the resident had the right to reside and receive services in the facility with reasonable accommodations of resident needs and preferences except when to do so would endanger the health or safety of the resident or other residents for 2 of 7 residents (Residents #1 & #2) reviewed for resident rights. The facility failed to ensure Resident #1 & Resident #2's call lights were within reach on 03/19/2025. This failure could place residents at risk of their needs not being met.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure staff interacted with residents in a manner that assures communication, maintains respect, and enhances his/her quality of life for one (Resident #1) of six residents reviewed for resident rights. The facility failed to ensure Resident #1 was treated with respect and dignity while being fed by staff. These failures could place residents at risk for poor nutrition and hydration and diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure the comprehensive care plan was reviewed and revised by the interdisciplinary team after a change of condition for 1 of 6 residents (Resident #1) reviewed for care plans. The facility failed to ensure Resident #1's care plan was revised to reflect the resident's decline and inability to feed themselves. This failure could place residents at risk of not receiving appropriate care to meet their current needs, compromised nutritional intake, aspiration, and choking.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents who were unable to carry out activities of daily living received necessary services to maintain personal hygiene for one (Resident #1) of seven residents reviewed for bathing. The facility failed to provide showers to Resident #1 in compliance with her shower schedule. This deficient practice could place resident at risk of decline in skin integrity and overall health.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to maintain infection prevention and control designed to provide a safe and sanitary environment to help prevent the transmission of infections for 1 of 7 residents (Resident #1) reviewed for infection control. CNA A did not wear required protective equipment, for infection control, while providing services to Resident #1 in Resident #1's room. This failure placed residents in the facility at risk of exposure to infections.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure each resident had the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences for 3 of 9 residents (Resident #43, Resident #64, and Resident #21) reviewed for accommodation of needs. The facility failed to ensure Resident # 64's call light was within reach. The facility failed to ensure Resident # 43's call light was within reach. The facility failed to ensure Resident # 21s call light was within reach. This failure could place residents at risk of falls, skin breakdown, frustration, and having their needs gone unmet.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food safety for 1 of 1 kitchen reviewed for food safety and sanitation. The facility failed to ensure food that was prepped labeled and dated in the walk-in refrigerator and in storage bins. The facility failed to discard of food products that were past the use by date or in accordance with facility policy in the dry storage area. These failures could place residents at risk of cross contamination, loss of nutritional value, weight loss and food borne illness.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain an infection and prevention control program that included, at a minimum, a system for preventing and controlling infections for 2 of 7 residents (Resident #292 and Resident #50) reviewed for infection control, in that: 1. LVN A did not perform hand hygiene and change her gloves while performing wound care on Resident #292 and performed wound care on two wounds at the same time while performing wound care on Resident #292. 2. CNA E did not conduct hand hygiene and change gloves when performing peri-care (from the front to the back) for Resident #50. These failures placed residents at risk for infections, sepsis, and a diminished quality of life and death.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure the resident assessment accurately reflected the resident's status for 1 of 9 residents (Resident #68) who were reviewed for accuracy of assessments. The facility incorrectly coded Resident #68 with Pneumonia. This failure placed residents at risk of incorrect care and services necessary for their physical, mental, and psychosocial well-being.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that the resident environment remained free of accident hazards for 1 of 5 residents (Resident #1) reviewed for quality of care in that: CNA A failed to operate the Hoyer lift with 2 staff per facility policy when transferring Resident #1 from the chair to the bed. Resident #1 sustained a fracture of the right lower tibia / fibia. This failure could place residents at risk of harm or injury and contribute to avoidable accidents.

Inspectors wroteBased on observation, interview, and record review the facility failed to immediately consult with the resident's physician when there was a need to alter treatment significantly for two of five residents (Resident's #19 and #188) reviewed for notification of changes. 1. The facility failed to notify Resident #188's physician when they held his metoprolol at 8:00 AM on 4/14/23-4/19/23, 4/21/23, 4/24/23 and at 8:00 PM on 4/15/23-4/16/23. There were no ordered parameters for holding the medication. 2. The facility failed to notify Resident #19's Physician when they held her Losartan on 04/26/23 without ordered parameters. These failures could place residents at risk of not having their physician notified when there was a need to alter treatment which could lead to a worsening of condition.

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a baseline care plan for each resident that included instructions needed to provide effective and person-centered care of the resident that met professional standards of care within 48 hours of the resident's admission for three (Residents #139, #238, and #66) of nine residents reviewed for baseline care plans. The facility failed to complete baseline care plans for Residents #139, #238, and #66 within 48 hours of admission that included the minimum required healthcare information including physician orders, dietary orders, therapy services, and social services. This failure placed residents at risk of not receiving effective and person-centered care.

Inspectors wroteBased on interview and record review, the facility failed to conduct a performance review of nurse aides at least once every 12 months and provide regular in-service education based on the outcome of these reviews for 3 of 3 CNAs (CNA A, CNA B, and CNA C) reviewed for performance reviews. The facility failed to conduct performance reviews at least every 12 months for CNA A, CNA B, and CNA C. This deficient practice could result in residents not receiving the necessary care and services due to nurse aides not receiving training based on their identified needs.

Inspectors wroteBased on observation, interview and record review, the facility failed to serve food in accordance with professional standards for food service safety/sanitation in the facility's only kitchen for one (lunch 04/26/2023) of one meal reviewed for food service, in that: 1. [NAME] Z failed to ensure proper sanitation of the thermometer gauge while taking the temperatures for food served for lunch meal. 2. [NAME] Z failed to record the correct temperatures of the food served during lunch meal. Failure could place residents at risk for food contamination, food borne illnesses and improper records.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that residents were treated with dignity in a manner and environment that promotes maintenance or enhancement of her quality of life for one resident (Resident #13) of 8 reviewed for residents' rights. CNA G, CNA H, CNA I failed to promote independence and dignity in the Shower Area with Resident #13 in the shower room. These failures could place residents at risk of feeling uncomfortable, disrespected, decreased self-esteem and a diminished quality of life. Findings Included: 1. Review of Resident #13's MDS assessment dated [DATE] revealed Resident #13 was an [AGE] year-old female admitted to the facility on [DATE]. Resident #13 has a BIMS Score of 12, which make her cognitive skills for daily decision-making moderate. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that residents were treated with dignity in a manner and environment that promotes maintenance or enhancement of her quality of life for one resident (Resident #13) of 8 reviewed for residents' rights. CNA G, CNA H, CNA I failed to promote independence and dignity in the Shower Area with Resident #13 in the shower room. These failures could place residents at risk of feeling uncomfortable, disrespected, decreased self-esteem and a diminished quality of life. Findings Included: 1. Review of Resident #13's MDS assessment dated [DATE] revealed Resident #13 was an [AGE] year-old female admitted to the facility on [DATE]. Resident #13 has a BIMS Score of 12, which make her cognitive skills for daily decision-making moderate. [...]