Vantage at Westfield LLC

Inspectors wroteBased on interviews and records reviewed, the facility failed to ensure grievances and concerns reported during the Resident Council meetings in February and March 2026 were addressed timely and that a response/rationale by the facility was provided to the Council to address the concerns. Specifically, the facility failed to ensure that:-The facility provided a response to the concerns brought forth during Resident Council about timeliness of call bell response on the A-wing in February 2026.-The response by the facility relative to the repeated concerns about the timeliness of call bell response in March 2026 were relayed to the Resident Council.

Inspectors wroteBased on records reviewed, interviews, and observations, for one of three sampled residents (Resident #1) who required a wheelchair accessible platform scale for weight monitoring, the Facility failed to maintain a safe, hazard free environment, when the dual ramp platform scale was obstructed on three of four sides, limiting staff access needed to safely assist the resident during weighing. On 12/31/25, Resident #1 began to fall from his/her wheelchair, and due to the obstructed access, Certified Nurse Aide #1 was unable to position herself to provide adequate physical assistance. As a result, Resident #1 fell to the floor and sustained a forehead laceration requiring five sutures.

Inspectors wroteBased on records reviewed and interviews for four of four sampled residents (Resident #1, Resident #2, Resident #3, and Resident #4), who all had a diagnosis of Diabetes (a condition when a hormone called insulin does not work properly or there is not enough of it which causes the level of glucose (sugar) in the blood to become too high), the facility failed to ensure they maintained a complete and accurate medical record when Certified Nurse Aide (CNA) Activity of Daily Living (ADL) Flow Sheets related to meal intake were not consistently completed and often left blank.

Inspectors wroteBased on records reviewed and interviews for one of four sampled residents (Resident #1), who had a change in condition requiring a transfer to the Hospital Emergency Department (ED), the facility failed to ensure they communicated pertinent clinical information to the ED when there was no clinical, medical, or contact information sent with the resident or communicated to the ED at the time of transfer.

Inspectors wroteBased on record review, and interview, the facility failed to complete a performance review at least once every 12 months for five Certified Nurses Aides ([CNA's] #1, #2, #3, #4 and #5) out of five employee records reviewed. Specifically, the facility failed to complete annual performance evaluations for CNA's #1, #2, #3, #4 and #5 as required, to address areas of weakness identified in the evaluation and the special needs of the facility residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care consistent with professional standards of practice relative to the use of compression stockings for one Resident (#51) out of a total sample of 17 residents. Specifically, the facility failed to: -Assess Resident #51 for the proper use of compression stockings for the Resident's lower extremities when the Resident had lower extremity swelling and staff applied improperly fitted compression stockings, which increased the Resident's risk for impaired skin integrity and blood circulation.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care according to professional standards of practice for one Resident (#14) out of a total sample of 17 Residents, relative to nutrition interventions and weight monitoring when the Resident was identified as being at nutritional risk and had severe weight loss. Specifically, for Resident #14, the facility failed to: -Implement Provider recommendations in a timely manner for a nutrition consult. -Implement weekly weight monitoring, as recommended by the Physician Assistant (PA) when the Resident was identified with greater than 20 pounds weight loss over a period of two weeks. -Accurately monitor and record the Resident's meal intake percentage. -Accurately assess the Resident for weight loss when the Resident had a severe weight loss of greater than 10% in less than six months. Findings Include: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that staff competencies were assessed for three employees (Certified Nurses Aides [CNAs #7 and #8], and Activities Assistant [AA #1]) out of three employees reviewed and relative to meal monitoring and documentation for one Resident (#14). Specifically, the facility failed to: -Assess competency for Activities Assistant (AA) #1 relative to accurately monitoring meal percentage intakes when AA #1 was tasked with monitoring and recording resident meal percentage intakes in the facility's main dining room and AA #1 monitored and recorded an inaccurate meal intake for Resident #14. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure that one Resident (#366) out of a total sample of 17 residents, was free from unnecessary medication administration. Specifically, for Resident #366, the facility failed to ensure that the Resident had adequate indication for the use of an antibiotic medication (Clarithromycin - used to treat chest and skin infections) that was ordered by the Physician to be administered for twenty-nine days.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure that it was free of a medication error rate of five percent (5%), or greater when one Nurse (#1) out of three Nurses observed during the medication pass procedure, made two errors in 27 total opportunities, for a medication error rate of 7.41%, impacting one Resident (#45) out of five residents observed, out of a total sample of 19 residents. Specifically, for Resident #45, the facility failed to ensure that: -Nurse #1 did not crush medications that were not ordered to be crushed. -Nurse #1 properly administered two Extended Release (ER) medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that one Resident (#45) out of a total sample of 19 residents were free from significant medication errors. Specifically, the facility failed to ensure the proper administration of Isorbide Mononitrate ER (an extended release [ER] medication used to prevent chest pain) and Metoprolol Succinate ER (an extended-release medication used to treat chest pain and high blood pressure) when the manufacturer's specifications regarding the preparation and administration of both medications were not followed, putting the resident at risk for worsening cardiac symptoms.

Inspectors wroteBased on observation, interview, and record review, the facility failed to adhere to infection control standards of practice for one Resident (#25) out of a total sample of 18 residents, increasing the risk of contamination and the spread of infections to the Resident and other residents within the facility. Specifically, for Resident #25, the facility staff failed to appropriately follow Enhanced Barrier Precautions (EBP's: the use of protective gowns and gloves during high contact care activities that may provide opportunity for transmission of medication resistant organisms through staff hands and/or clothing), while providing: -high contact care to the Resident when performing ADLs (Activities of Daily Living such as bathing, dressing, grooming, personal hygiene). -administration of an Intravenous (IV- method of delivering medication through the vein) medication to the Resident.

Inspectors wroteBased on observations, interviews, record and policy review, the facility failed to provide Activities of Daily Living (ADLs - tasks such as bathing, grooming, maintaining dental hygiene, nail and hair care) assistance for one Resident (#12) out of a total sample of 15 residents. Specifically, the facility failed to ensure that the Resident's nails were trimmed, when the Resident was dependent for care.

Inspectors wroteBased on interview, policy and record review, the facility failed to ensure that routine dental services were provided for one Resident (#38), out of a total sample of 15 residents. Specifically, the facility staff failed to ensure that an annual dental exam and prophylactic (preventative) cleaning every six months were completed as recommended.

Inspectors wroteBased on record review and interview the facility failed to maintain complete medical records for one Resident (#57) out of a total sample of 15 residents. Specifically, for Resident #57, who was being monitored for weight loss, the Certified Nurses Aides (CNAs) failed to consistently monitor and document meal intake percentages as required, per the Resident's Nutritional Risk care plan.