By BOB CHAREST, InDepthNH.org

The following list contains the star rankings for 74 nursing homes.

CMS provides federal funding to many long-term care facilities in New Hampshire and performs inspections to assure resident safety. These reports are public information. The star system (one star for much below average, to five stars for much above average) for our report is the OVERALL QUALITY ranking. Those who want to see more detailed rankings of staffing, health inspection and quality of life measures may go to Medicare.gov.

Five-Star Nursing Homes in New Hampshire

The Center for Medicare and Medicaid Services (CMS) rates all nursing homes in the United States, including the 74 in New Hampshire, on its website, www.medicare.gov.

The 25 nursing homes listed below have received five stars, which means “Well Above Average.”

Please also see our related story, “Where We Got Our Information,” to decipher how nursing homes compare on staffing minutes.

The listing is alphabetical by category.

*****

Applewood Center
8 Snow Road, Winchester
No. certified beds: 72; Recent census: 63 (6/4/2020)
Owner: For profit registered on the N.H. Secretary of State’s website as 8 Snow Road Operations LLC
No. residents with confirmed Covid-19*: 1
No. staff with confirmed Covid-19*: 0
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 39 minutes
Licensed Practical Nurse: 50 minutes
Nurse’s Aides: 114 minutes
COVID-19 Inspection: 6/4/2020, in compliance
Specific inspection reports:
Found two issues in 2016, nothing found for 2017-2020.

*****

Bedford Nursing & Rehab Center
480 Donald St., Bedford
No. certified beds: 102; Recent census: 62 (6/12/2020)
Owner: For profit registered on the N.H. Secretary of State’s website as Bedford Nursing & Rehab Services LLC
No. residents with confirmed Covid-19*: 57
No. staff with confirmed Covid-19*: 25
Resident deaths due to Covid-19*: 17
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 46 minutes
Licensed Practical Nurse: 42 minutes
Nurse’s Aides: 160 minutes
COVID-19 Inspection: 5/27/2020, 6/12/2020, in compliance
Specific inspection reports:
Found three issues in 2017, nothing found for 2018-2020.

*****

Bel-Air Nursing & Rehab Center
29 Center St., Goffstown
No. certified beds: 35; Recent census: 30 (6/9/2020)
Owner: For profit registered on the N.H. Secretary of State’s website as Bel-Air Nursing and Rehab Center Inc.
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 0
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 47 minutes
Licensed Practical Nurse: 43 minutes
Nurse’s Aides: 167 minutes
COVID-19 Inspection: 6/9/2020, in compliance
Specific inspection reports:
Found six issues in 2017 and two issues in 2018, nothing found for 2019-2020.

*****

Cheshire County Home
201 River Road, Westmoreland
No. certified beds: 150; Recent census: 118 (6/5/2020)
Owner: Government owned – Cheshire County
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 3
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 46 minutes
Licensed Practical Nurse: 60 minutes
Nurse’s Aides: 187 minutes
COVID-19 Inspection: 6/5/2020, in compliance
Specific inspection reports:
Nothing found.

*****

Coos County Nursing Home
364 Cates Hill Road, Berlin
No. certified beds: 100; Recent census: 94 (6/25/2020)
Owner: Government owned – Coos County
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 4
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 52 minutes
Licensed Practical Nurse: 34 minutes
Nurse’s Aides: 200 minutes
COVID-19 Inspection: 6/25/2020, in compliance
Specific inspection reports:
Found one issue in 2018, nothing found for 2019-2020.

*****

Coos County Nursing Hospital
136 County Farm Road, West Stewartstown
No. certified beds: 97; Recent census: 79 (6/24/2020)
Owner: Government owned – Coos County
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 0
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 53 minutes
Licensed Practical Nurse: 33 minutes
Nurse’s Aides: 218 minutes
COVID-19 Inspection: 6/24/2020, in compliance
Specific inspection reports:
Found one issue in 2018, nothing found for 2019-2020.

*****

Epsom Healthcare Center
901 Suncook Valley Hwy , Epsom
No. certified beds: 108; Recent census: 89 (6/9/2020)
Owner: For profit registered on the N.H. Secretary of State’s website as Heartland Healthcare Center LLC
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 1
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 32 minutes
Licensed Practical Nurse: 38 minutes
Nurse’s Aides: 114 minutes
COVID-19 Inspection: 6/9/2020, in compliance
Specific inspection reports:
8/23/2019: Facility failed to transmit the Minimum Data Set (MDS) within 14 days after completion for five residents reviewed for MDS assessments.

The facility failed to develop and implement a comprehensive person-centered care plan to meet a resident’s mental and psychosocial needs. Medical record revealed that resident was transferred to the hospital by the facility due to suicidal comments/ideations. Resident was then transferred from the local hospital to a second and discharged back to the nursing home. Resident reported drinking some cleaning fluid, “just a tiny teaspoon,” but was unable to drink more due to the taste. Current care plan failed to have any needs written to address the above behavior since being readmitted to the facility after expressing the desire to commit suicide.

*****

Golden View Health Care Center
19 NH Route 104, Meredith
No. certified beds: 131; Recent census: 62 (6/11/2020)
Owner: Nonprofit registered on the N.H. Secretary of State’s website as Metro Health Foundation of New Hampshire Inc.
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 2
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 56 minutes
Licensed Practical Nurse: 29 minutes
Nurse’s Aides: 165 minutes
COVID-19 Inspection: 6/11/2020, in compliance
Specific inspection reports:
1/17/2019: A monthly pharmacy drug regimen review was not done for six residents in a survey sample of 20 residents.

*****

Hackett Hill Healthcare Center
191 Hackett Hill Road , Manchester
No. certified beds: 70; Recent census: 38 (5/21/2020)
Owner: For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as 191 Hackett Hill Road Operations LLC
No. residents with confirmed Covid-19*: 57
No. staff with confirmed Covid-19*: 17
Resident deaths due to Covid-19*: 16
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 34 minutes
Licensed Practical Nurse: 69 minutes
Nurse’s Aides: 110 minutes
COVID-19 Inspection: 5/20/2020: The facility was laundering disposable isolation gowns. The facility responded that they will no longer wash disposable gowns.
Specific inspection reports:
5/17/2019: Comprehensive care plan lacking for one resident. Resident was seated at a table with a place setting of regular utensils and was receiving limited assistance to eat. Licensed nursing assistant stated that resident sometimes has built up utensils and sometimes does not. Medical record revealed a nutrition assessment stating resident has lost 3 pounds in 30 days and receives the house supplement cup two times per day. Further review revealed that there is no nutrition care plan.

*****

Hanover Hill Heath Care Center
700 Hanover St., Manchester
No. certified beds: 124; Recent census: 88 (5/7/2020)
Owner: For profit registered on the N.H. Secretary of State’s website as Hanover Hill Health Care Center Services Inc.
No. residents with confirmed Covid-19*: 79
No. staff with confirmed Covid-19*: 60
Resident deaths due to Covid-19*: 25
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 39 minutes
Licensed Practical Nurse: 57 minutes
Nurse’s Aides: 143 minutes
COVID-19 Inspection: 5/7/2020, in compliance
Specific inspection reports:
1/31/2020: The facility failed to maintain a complaint/grievance log. Director of Social Services revealed that grievances/complaints are addressed at the time of the grievance/complaint is reported to the facility. There was no documented complaint/grievance log to track and/or trend complaints/grievances investigated by the facility within 3 years from the date of a complaint/grievance resolution.

A physician ordered weekly skin assessment for as patient who developed a deep tissue injury on the heel. Review of resident’s medical record revealed no documentation that the heels had been looked at prior to the DTI developing.

*****

Hanover Terrace Health & Rehab
49 Lyme Road, Hanover
No. certified beds: 100; Recent census: 78 (6/15/2020)
Owner: For profit registered on the N.H. Secretary of State’s website as Bear Mt Hanover LLC (not in good standing)
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 2
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 21 minutes
Licensed Practical Nurse: 22 minutes
Nurse’s Aides: 74 minutes
COVID-19 Inspection: 6/15/2020, in compliance
Specific inspection reports:
Nothing found.

*****

Hillsborough County Nursing Home
400 Mast Road, Goffstown
No. certified beds: 300; Recent census: 257 (6/9/020)
Owner: Government owned – Hillsborough County
No. residents with confirmed Covid-19*: 160
No. staff with confirmed Covid-19*: 61
Resident deaths due to Covid-19*: 44
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 47 minutes
Licensed Practical Nurse: 32 minutes
Nurse’s Aides: 124 minutes
COVID-19 Inspection: 4/28/2020, 6/9/2020, in compliance
Specific inspection reports:
Found three issues in 2017 and three issues in 2018, nothing found for 2019-2020.

*****

Holy Cross Health Center
357 Island Pond Road , Manchester
No. certified beds: 40; Recent census: 36 (6/30/2020)
Owner: Nonprofit registered on the N.H. Secretary of State’s website as Holy Cross Health Center Inc.
No. residents with confirmed Covid-19*: 17
No. staff with confirmed Covid-19*: 18
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 32 minutes
Licensed Practical Nurse: 62 minutes
Nurse’s Aides: 150 minutes
COVID-19 Inspection: 6/2/2020, 6/30/2020, in compliance
Specific inspection reports:
2/27/2020: Facility failed to report four allegations immediately to the facility administrator and failed to report to the state agency in a timely manner, including verbal abuse by a licensed nursing assistant of a resident with severe cognitive impairment.

Allegation of abuse took place on 1/30/20 during the 3-11 and 11-7 shifts by an LNA.

Another LNA gave a  witness statement that the accused was over heard say, “Pee in your diaper I will change you. if you ever call out for help again I will put you on your recliner. I am not bothered by your screaming, I’ve got kids at home.” Staff member was reported to the Board of Nursing and was terminated.

*****

Jaffrey Rehab & Nursing Center
20 Plantation Drive, Jaffrey
No. certified beds: 83; Recent census: 40 (5/21/2020)
Owner: For profit registered on the N.H. Secretary of State’s website as Jaffrey Rehabilitation and Nursing Center LLC
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 1
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 37 minutes
Licensed Practical Nurse: 47 minutes
Nurse’s Aides: 151 minutes
COVID-19 Inspection: 5/21/2020: Staff are taking their own temperatures and recording the information on a form that is not reviewed before the staff enters the building. The thermometer was also showing unusually low readings. Staff were also not fit-tested for N95 masks. Screening tools have been adjusted, new thermometers ordered, and a fit-testing kit received.
Specific inspection reports:
Found three issues in 2017 and one issue in 2018, nothing found for 2019-2020.

*****

Kendal at Hanover
67 Cummings Road, Hanover
No. certified beds: 1; Recent census: 0 (6/15/2020)
Owner: Nonprofit registered on the N.H. Secretary of State’s website as Kendal at Hanover
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 0
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: n/a
Licensed Practical Nurse: n/a
Nurse’s Aides: n/a
COVID-19 Inspection: 6/15/2020, in compliance
Specific inspection reports:
Found three issues in 2017, nothing found for 2018-2020.

*****

Langdon Place of Keene
136A Arch St., Keene
No. certified beds: 25; Recent census: n/a
Owner: For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as Sunbridge Healthcare LLC
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 1
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 60 minutes
Licensed Practical Nurse: 83 minutes
Nurse’s Aides: 138 minutes
COVID-19 Inspection: 3/4/2020: Resident’s representative was not invited to care plan meetings. A sharps container in the training room was one-quarter full and not secured. The social service director was trained on proper procedure for meeting invitations. Sharps container was properly stored.
Specific inspection reports:
Found two issues in 2016, nothing found for 2017-2020.

*****

Morrison Nursing Home
6 Terrace St., Whitefield
No. certified beds: 57; Recent census: 53 (6/16/2020)
Owner: Nonprofit registered on the N.H. Secretary of State’s website as Morrison Hospital Association
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 0
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 63 minutes
Licensed Practical Nurse: 49 minutes
Nurse’s Aides: 175 minutes
COVID-19 Inspection: 6/16/2020, in compliance
Specific inspection reports:
Found one issue in 2017 and one issue in 2018, nothing found for 2019-2020.

*****

Presidential Oaks
200 Pleasant St., Concord
No. certified beds: 85; Recent census: 30 (6/10/2020)
Owner: Nonprofit registered on the N.H. Secretary of State’s website as New Hampshire Oddfellows Home
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 0
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 79 minutes
Licensed Practical Nurse: 21 minutes
Nurse’s Aides: 146 minutes
COVID-19 Inspection: 6/10/2020, in compliance
Specific inspection reports:
1/23/2019: A coordinated Plan of Care for hospice was lacking as evidenced by not including or documenting the hospice goals and interventions in order to ensure that facility’s staff is providing consistent care when hospice staff are not scheduled in the facility. The hospice care plans do not establish which services will be provided to one resident.

The facility failed to develop comprehensive care plans for infection control precautions, hospice care, dementia care, wandering and respiratory care for seven residents in a final survey sample of 16 residents.

*****

Riverwoods at Exeter
7 Riverwoods Drive, Exeter
No. certified beds: 78; Recent census: 63 (5/12/2020)
Owner: Nonprofit registered on the N.H. Secretary of State’s website as The Riverwoods Company at Exeter New Hampshire
No. residents with confirmed Covid-19*: 3
No. staff with confirmed Covid-19*: 4
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 77 minutes
Licensed Practical Nurse: 37 minutes
Nurse’s Aides: 210 minutes
COVID-19 Inspection: 5/12/2020, in compliance
Specific inspection reports:
Found one issue in 2017, nothing found for 2018-2020.

*****

St. Francis Rehab & Nursing Center
406 Court St., Laconia
No. certified beds: 51; Recent census: 47 (6/4/2020)
Owner: Nonprofit registered to N.H. Catholic Charities
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 4
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 58 minutes
Licensed Practical Nurse: 30 minutes
Nurse’s Aides: 152 minutes
COVID-19 Inspection: 6/4/2020, in compliance
Specific inspection reports:
6/19/2019: On 5/17/19, a resident, who is a full code, was sent to the emergency room for evaluation. The Advance Directive paperwork sent with that resident was the DNR (Do Not Resuscitate) form of the roommate. The facility’s policy is to educate all nurses to remind them to always take the time to check if the paperwork they gather is for the correct resident. Review of the Inservice Sign In Sheet and interview with the administrator confirmed that only 4 of the 13 licensed nurses at the facility had received education after the incident.

*****

St. Joseph Residence
495 Mammoth Road, Manchester
No. certified beds: 22; Recent census: 21 (6/10/2020)
Owner: Nonprofit registered on the N.H. Secretary of State’s website as Saint Joseph Residence Inc.
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 5
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 54 minutes
Licensed Practical Nurse: 51 minutes
Nurse’s Aides: 183 minutes
COVID-19 Inspection: 6/10/2020, in compliance
Specific inspection reports:
Found one issue in 2018, nothing found for 2019-2020.

*****

St. Teresa Rehab & Nursing Center
519 Bridge St., Manchester
No. certified beds: 51; Recent census: 40 (5/18/2020)
Owner: Nonprofit registered to N.H. Catholic Charities
No. residents with confirmed Covid-19*: 7
No. staff with confirmed Covid-19*: 6
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 66 minutes
Licensed Practical Nurse: 38 minutes
Nurse’s Aides: 158 minutes
COVID-19 Inspection: 5/18/2020, in compliance
Specific inspection reports:
2/22/2019: The facility failed to ensure that there was nursing coverage available for a full 24 hours on the night of Feb. 15. A licensed practical nurse went home for 5 to 25 minutes at 3 a.m. to check on a sick animal. Board of Nursing was notified and  the nurse’s employment was  terminated with the facility.

The facility failed to maintain infection control practices in regards to the use of Personal Protective Equipment (PPE) for one resident and handwashing between donning and doffing medical gloves during a dressing change for a wound for another resident. Staff said he/she did not know what the facility’s policy is regarding hand washing when changing a dressing.

While the inspector was touring the unit, a sign was posted outside a resident’s door stating see nurse before entering due to resident being on contact precautions. Laundry staff was seen standing on a ladder holding the resident’s privacy curtain against their body and failing to wear PPE (Personal Protective Equipment) while unclipping the privacy curtain from its track to be taken down to wash. The staff member was asked to don PPE.

*****

The Edgewood Centre
928 South St., Portsmouth
No. certified beds: 156; Recent census: 85 (6/9/2020)
Owner: For profit registered on the N.H. Secretary of State’s website as Edgewood Manor Inc.
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 3
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 53 minutes
Licensed Practical Nurse: 52 minutes
Nurse’s Aides: 152 minutes
COVID-19 Inspection: 6/9/2020, in compliance
Specific inspection reports:
2/1/2019:  The facility failed to report a case of neglect, to the state survey agency.  A nurse’s note dated 6/26/18 revealed a resident was heard calling for help from the whirlpool room. Staff entered to find resident sliding down in tub filled with water. Tub drain opened and several staff members assisted holding resident while Hoyer pad was placed under (resident). At no time was (resident’s) face or head under water. Resident then Hoyer transferred to wheelchair and back to bed to get dressed. No pain or apparent injures noted to resident. Director of Nurses and Power of Attorney notified of incident. Resident  said no one was with him at the time, even though the care plan requires a staff member be present. The staff member who was caring for resident quit due to the incident.  The administrator also was asked if the event was sent to the state survey agency. The administrator stated no because the resident was not hurt and it was not felt to be reportable.

*****

Villa Crest
1276 Hanover St., Manchester
No. certified beds: 126; Recent census: 100 (5/28/2020)
Owner: For profit registered on the N.H. Secretary of State’s website as Villa Crest Healthcare Center LLC
No. residents with confirmed Covid-19*: 47
No. staff with confirmed Covid-19*: 41
Resident deaths due to Covid-19*: 18
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 32 minutes
Licensed Practical Nurse: 66 minutes
Nurse’s Aides: 127 minutes
COVID-19 Inspection: 5/28/2020, in compliance
Specific inspection reports:
8/30/2019: The facility failed to ensure that services being provided meet professional standards for  resident whose weights were not properly documented and for a resident for whom physicians’ orders were not followed. One resident’s medical record revealed under the vital sign section of the chart that the last weight that was done was on 8/22/19 showing 154.6 pounds. The prior weight done was on 8/15/19 which was 167.7 pounds, a 7.8 % weight loss in one week. On 8/8/19 resident’s weight was 169.2 pounds, and on 8/1/19 was 163 pounds. Nurse stated that she will get a reweigh which was performed and resident’s weight is 157.6 as of 8/27/19. Staff said the issue stems from the staff using different types of equipment when weighing residents and not deducting the equipment being used. Another resident taking insulin was to have  physician notified if blood sugar was over 400. There was a reading of 415 and no note in the char that the doctor was called.

*****

Webster at Rye
795 Washington Road, Rye
No. certified beds: 61; Recent census: 31 (5/19/2020)
Owner: Nonprofit registered on the N.H. Secretary of State’s website as Rannie Webster Foundation
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 1
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 57 minutes
Licensed Practical Nurse: 41 minutes
Nurse’s Aides: 167 minutes
COVID-19 Inspection: 5/19/2020, in compliance
Specific inspection reports:
Nothing found.

Four-Star nursing homes in New Hampshire

The Center for Medicare and Medicaid Services (CMS) rates all nursing homes in the United States, including the 74 in New Hampshire, on its website, www.medicare.gov.

The 16 nursing homes listed below have received four stars, which means “Above Average.”

CMS provides federal funding to many long-term care facilities in New Hampshire and performs inspections to assure resident safety. These reports are public information. The star system (one star for much below average, to five stars for much above average) for our report is the OVERALL QUALITY ranking. Those who want to see more detailed rankings of staffing, health inspection and quality of life measures may go to Medicare.gov.

Please also see our related story, “Where We Got Our Information,” to decipher how nursing homes compare on staffing minutes.

The listing is alphabetical by category.

****

Courville at Manchester
44 W. Webster St., Manchester
No. certified beds: 70; Recent census: 52 (6/11/2020)
Owner: For profit registered on the N.H. Secretary of State’s website as Courville at Manchester LLC
No. residents with confirmed Covid-19*: 9
No. staff with confirmed Covid-19*: 21
Resident deaths due to Covid-19*: 2
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 46 minutes
Licensed Practical Nurse: 65 minutes
Nurse’s Aides: 153 minutes
COVID-19 Inspection: 5/18/2020 and 6/11/2020, in compliance
Specific inspection reports:
3/13/2019: Resident had a bottle of eye drops, for dry eye and a tube of medication on the bedside table. The resident self administers these medicines. Unit Manager revealed that resident was not assessed for self medicating and had no knowledge of resident having medications at bedside. There were no physician orders for the eye drops. Residents may self-administer their own medications only if the attending provider, in conjunction with the interdisciplinary team has determined that the resident has the decision making capability to do so safely.

One resident had a fall which resulted in a laceration to the back and another fall at a later date that also resulted in an emergency room visit for evaluation. Assessment was incorrectly documented and that the falls should have been noted on an assessment but were not.

The facility failed to label an opened insulin vial with an expiration date and failed to remove expired medications out of the medication cart.

****

Courville at Nashua
22 Hunt St., Nashua
No. certified beds: 100; Recent census: 58 (5/12/2020)
Owner: For profit registered on the N.H. Secretary of State’s website as Courville at Nashua Inc.
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 1
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 24 minutes
Licensed Practical Nurse: 70 minutes
Nurse’s Aides: 116 minutes
COVID-19 Inspection: 5/12/2020, in compliance
Specific inspection reports:
Five issues in 2017, but nothing found for 2018-2020.

****

Elm Wood Center at Claremont
290 Hanover St., Claremont
No. certified beds: 68; Recent census: 58 (6/15/2020)
Owner: For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as 290 Hanover Street Operations LLC
No. residents with confirmed Covid-19*: 1
No. staff with confirmed Covid-19*: 6
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 31 minutes
Licensed Practical Nurse: 46 minutes
Nurse’s Aides: 125 minutes
COVID-19 Inspection: 6/15/2020, in compliance
Specific inspection reports:
5/14/2019: Facility failed to have a system in place for reconciliation and management of controlled drugs for narcotic book. Narcotics are frequently counted and counts are made on a continuous basis with the opening of narcotic drawers and/or at shift change. A dose  was removed from the narcotic count and unaccounted for. Interviews with administrator and director of nurses revealed that the facility has no system in place for monitoring any narcotics once they are logged in the narcotic book. They would check if there was a suspected issue.

Also, the facility failed to post nursing staffing data on a daily basis at the beginning of each shift. The nurse staffing data that was posted was outdated.

The facility failed to provide a sanitary environment to prevent the potential transmission of communicable diseases during medication pass observations on one unit. Staff A gave out med, then returned to the medication cart without washing their hands or using hand sanitizer and proceeded to prepare medications for another resident. Another time during medication pass, the staff member coughed into their left hand as they were preparing a medication for a resident. Staff did not wash their hands or use hand sanitizer after coughing into their hand and they proceeded to continue to prepare the medication for the resident. During another medication pass, staff was preparing medications and attempted to pop a pill out of its blister pack but the pill got stuck in the blister pack, so staff used their bare fingers to remove the pill and put it into the medicine cup.  Also, staff was observed  preparing medications and  was holding a bottle of tablets, poured the tablets into the bottle’s cover and several tablets fell into the cover. Staff needed only two of the tablets, so staff put the extra tablets back into the bottle using bare fingers.

****

Grafton County Nursing Home
3855 Dartmouth Coll. Hwy., North Haverhill
No. certified beds: 135; Recent census: 111 (6/17/2020)
Owner: Government owned – Grafton County
No. residents with confirmed Covid-19*: 1
No. staff with confirmed Covid-19*: 3
Resident deaths due to Covid-19*: 1
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 39 minutes
Licensed Practical Nurse: 53 minutes
Nurse’s Aides: 188 minutes
COVID-19 Inspection: 6/17/2020, in compliance
Specific inspection reports:
2/7/2020: The facility failed to date an insulin pen with a discard date on medication cart. No discard date was written on the pen. Also, a feeding assistant should provide dining assistance only for residents who have no complicated feeding problems, and a resident eating a pureed texture diet due to trouble swallowing should not be assisted.

****

Havenwood-Heritage Heights
33 Christian Ave., Concord
No. certified beds: 70; Recent census: 53 (6/16/2020)
Owner: Nonprofit registered to United Church of Christ Retirement Community Inc.
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 3
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 72 minutes
Licensed Practical Nurse: 59 minutes
Nurse’s Aides: 206 minutes
COVID-19 Inspection: 6/16/2020, in compliance
Specific inspection reports:
5/23/2019: The facility failed to follow facility smoking policy for a resident who smoked. Interview with resident who said he/she smoked once a day at the parking lot with staff supervision. Resident stated that they kept their cigarettes in their bedside drawer and that the nurses kept their lighter. Observation in resident’s room revealed that resident had a box of cigarettes in their bedside table. Staff revealed that there was no smoking evaluation done.  Unit coordinator revealed that resident was supervised when smoking and utilized a smoking apron. Unit manager revealed that there was no smoking evaluation done after 10/7/2016.

****

Keene Center
677 Court St., Keene
No. certified beds: 106; Recent census: 96 (5/26/2020)
Owner: For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as 677 Court Street Operations LLC
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 2
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 27 minutes
Licensed Practical Nurse: 53 minutes
Nurse’s Aides: 120 minutes
COVID-19 Inspection: 5/26/2020, in compliance

Specific inspection reports:
7/25/2019: Facility distributed potentially hazardous foods, and maintained equipment in unsafe operating conditions. Several nutritional supplements located in the reach in refrigerator revealed two labels on them one on top of the other. Interview with Staff was asked what the discard date was for this product since it’s only good for 14 days after being thawed, Staff  stated it was the date on far right side of label. When looking at the label the date was 7/27/19. At this time Staff was asked if the label could be removed to see the prior label, Staff stated yes and removed the label and the date written on the far right side of the label was 7/16/19 which would have been the discard date 14 days after thawing and not 7/27/19. This practice was seen on several supplemental shakes.

The dish machine temperature log for the month of had several temperatures below the required 180 degrees for a high temperature dish machine. Interview with Staff A revealed that the hot water tank is broken and because of this the dish machine does not hold its temperature. Staff was asked how long this has been going on, Staff stated about a month. Two kitchen staff members were at the dish machine doing the dishes during observation the first rack went though the dish machine the temperature showed 184 degrees then the second rack went through the dish machine and the temperature went down to 178 degrees. The two kitchen staff who were doing the dishes did not notice the temperature change and continued to use the dish machine, then a third rack went though and the temperature went down to 176 degrees and the fourth rack went through and the temperature went down to 167 degrees. Staff was told of the temperature change and told the staff to stop doing the dishes and start to use chemical solution on the dish machine and to rerun the racks that went through at that time.

During the initial tour of the kitchen revealed that the can opener was in the ready to use position and when inspected, food build up on the cutting blade was observed. At this time the can opener was taken out of use by Staff and placed in the dish machine.

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Langdon Place of Dover
60 Middle Road, Dover
No. certified beds: 30; Recent census: 18 (6/2/2020)
Owner: For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as Sunbridge Healthcare LLC
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 0
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 70 minutes
Licensed Practical Nurse: 88 minutes
Nurse’s Aides: 155 minutes
COVID-19 Inspection: 6/2/2020, in compliance
Specific inspection reports:
4/1/2019: The facility failed to notify the physician about clinical changes in three residents. One resident fell March 20 and had acute hip/buttock pain. A radiology report dated March 21 revealed suspect left pubic fractures, consider CAT scan if indicated. Staff hoyered the patient into a recliner after the fall. The patient stayed in the recliner all night and was not moved until the nursing director was notified of the fall around 9 a.m. The patient was denying any discomfort anywhere. Skin was cold and clammy. Patient is very difficult to understand any verbal communication. EMS notified of need for transfer.

A resident fell on 1/20/19 and reported his/her right side was sore. The progress note indicated the nurse practitioner was notified. Resident was not examined by nurse (who said he/she was not notified) until 1/25/19 where there was bruising from a fall. Staff did not send resident to the hospital, did not think the ribs were broken and would not treat them any different if they were. Resident denied pain. On 1/26/19 resident was transferred to the hospital because the daughter insisted. Hospital discharge summary dated 1/31/19 revealed that resident was found to have right sided rib fractures and other unrelated diagnoses.

The facility failed to have person-centered comprehensive care plans for three residents.

One resident’s care plan failed to address how care and comfort would be provided and another had incorrect information.

Review on 3/28/19 of resident’s medical record revealed that there were no blood pressures or heart rates recorded prior to resident receiving heart medication, as a physician had directed.

The facility failed to maintain complete and accurate medical records on two residents, one who had died, and another for a decline in condition.

Housekeeping staff were not trained on the proper use of PPE (Personal Protective Equipment) when entering and exiting a resident’s room.

After cleaning a room that was on contact precautions, the housekeeper came out into the hallway with their PPE on and walked to their cleaning cart, where he/she removed their PPE placing their yellow gown into the trash container located on the back of their cleaning cart. The person should have changed and left the PPE in the room. A training session was held.

The facility failed to document a stop date for an antibiotic for a resident.

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Merrimack County Nursing Home
325 DW Highway, Boscawen
No. certified beds: 290; Recent census: 262 (6/3/2020)
Owner: Government owned – Merrimack County
No. residents with confirmed Covid-19*: 2
No. staff with confirmed Covid-19*: 9
Resident deaths due to Covid-19*: 1
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 35 minutes
Licensed Practical Nurse: 32 minutes
Nurse’s Aides: 186 minutes
COVID-19 Inspection: 6/3/2020, in compliance
Specific inspection reports:
2/11/2019: The facility failed to use assessments as part of an ongoing process to identify each resident’s preferences and goals of care, functional and health status, strengths and needs, as well as offering guidance for further assessment once problems have been identified. This was based on the case of a resident, who was articulate and well spoken, verbalized an ongoing wish to leave the facility. Resident stated that they had some issues at the time of admission, was in agreement with the admission at the time, but since then, feels he/she has gotten much better and would like to be discharged from the facility and go back to living more independently.  A record review was conducted on Feb. 11 and it revealed that the most current assessment which was completed on Jan. 23 demonstrates that the resident has no reported psychiatric behaviors and was assessed be independent. The Care Plan did not indicate updates to reflect the improvement in the resident cognitive status, and the most current nurse’s notes did not reflect resident’s cognitive, emotional and physical status. Unit manager reported resident’s daughters had seen evidence that resident had improved to a point that they felt that resident could live outside the facility again, however, it was stated that resident’s son, who is currently the activated Durable Power of Attorney, was not in agreement with the resident living more independently.

Medical record for a resident failed to show a coordinated plan of care by not including or documenting the hospice goals and interventions in order to ensure that facility staff is providing consistent care when hospice staff are not scheduled in the facility.

Review of a care plan for another resident revealed a generic hospice plan of care. No volunteer services provided for resident as outlined in the care plan. Unit manager reported that facility staff were not aware whether resident was receiving volunteer hospice services during this recertification period.

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Merriman House
3073 White Mtn. Hwy., North Conway
No. certified beds: 45; Recent census: 42 (6/26/2020)
Owner: Nonprofit registered to Memorial Hospital – Maine Health
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 0
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 97 minutes
Licensed Practical Nurse: 7 minutes
Nurse’s Aides: 163 minutes
COVID-19 Inspection: 6/26/2020, in compliance
Specific inspection reports:
5/31/2019: Staff confirmed that the facility does not provide in-house behavioral health services/psychiatry consults for a resident with daily documentation of anxiousness, crying, yelling out, refusing care at times, refusing medication at times, hallucinations at times, redirectable at times, unable to console at times.  Staff stated that the in-house nurse practitioner followed up with resident’s psychiatric needs. Staff stated that the in-house nurse practitioner would consult with  a hospital psychiatrist verbally for any recommendations about resident but no psychiatrist has seen resident in the facility. Administrator confirmed findings on the facility assessment and that the facility had no in-house behavioral health services or psychiatrist. Resident  had multiple adjustments made of psychotropic medications. Resident was awake all night, on several occasions, wandering into rooms, repeatedly saying, help me, and what should I do? Case manager stated that resident did require 1:1 support at times and did verbalize, “I just want to die, I’ll just kill myself,” and that this behavior/statement was care planned for and that there are no further behavioral health services that have been offered.

Employees are to perform hand hygiene before and after contact with any patient, their supplies, and the patient’s room. Observation of registered nurse revealed that he/she popped 1 tablet of antidepressant from the medication pack into a pill cutter then used their right bare hand and touched the tablet to align the tablet in the pill cutter. After cutting the tablet in half, the nurse grabbed, with their right bare hand, two one-half tablets and placed them into 2 separate medicine cups, 1 one-half tablet was discarded via toilet and 1 one-half tablet was placed with the other morning medications for resident. Nurse went to resident’s room and handed resident the medicine cup with morning medications and a cup of water, then resident handed back the empty medicine cup and a cup of water. Nurse then went out of resident’s room without hand washing or utilizing a hand sanitizer.Nurse went back to the medication cart and proceeded to obtain medication for another resident without hand washing.Nurse then proceeded to start another resident’s medication administration without hand washing.

****

Mount Carmel Rehab/ Nursing Center
235 Myrtle St., Manchester
No. certified beds: 122; Recent census: 96 (6/4/2020)
Owner: Nonprofit registered to N.H. Catholic Charities
No. residents with confirmed Covid-19*: 38
No. staff with confirmed Covid-19*: 10
Resident deaths due to Covid-19*: 6
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 33 minutes
Licensed Practical Nurse: 72 minutes
Nurse’s Aides: 152 minutes
COVID-19 Inspection: 6/4/2020, in compliance
Specific inspection reports:
6/28/2019: The facility failed to follow the manufacturer’s specifications regarding the preparation and administration of insulin.  Unit Manager does not turn the flex pen dose selector to 2 units prior to administering insulin, only priming the pen if it is the first dose. To avoid injecting air and to ensure proper dosing, the manufacturer recommends turning the dose selector to select 2 units. Hold with the needle pointing up. Tap the cartridge gently with your finger a few times to make any air bubbles collect at the top of the cartridge. Keep the needle pointing upwards, press the push-button all the way in. The dose selector returns to 0. A drop of insulin should appear in the needle tip.

The facility failed to maintain a complete medical record of medication administration and self administrations assessment for a resident who self-administers Afrin nasal spray.

****

Rockingham County Nursing Home
117 North Road, Brentwood
No. certified beds: 226; Recent census: 152 (7/7/2020)
Owner: Government owned – Rockingham County
No. residents with confirmed Covid-19*: 1
No. staff with confirmed Covid-19*: 10
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 44 minutes
Licensed Practical Nurse: 60 minutes
Nurse’s Aides: 149 minutes
COVID-19 Inspection: 5/27/2020, 7/7/2020, in compliance
Specific inspection reports:
Found two issues in 2017 and one issue in 2018, nothing found for 2019-2020.

****

St. Ann Rehab & Nursing Center
195 Dover Point Road, Dover
No. certified beds: 54; Recent census: 48 (6/3/2020)
Owner: Nonprofit, registered to N.H. Catholic Charities
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 2
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 43 minutes
Licensed Practical Nurse: 55 minutes
Nurse’s Aides: 147 minutes
COVID-19 Inspection: 6/3/2020, in compliance
Specific inspection reports:
6/19/2019: the facility failed to follow physician’s orders for laboratory testing and professional standards for documenting medication administration for  resident on anticoagulation therapy. Interview with director of nursing revealed that when the facility receives PT/INR results, they are called in to the physician and new medication orders are obtained. Staff  revealed that Resident’s PT/INR specimen was not collected.

****

St. Vincent Rehab & Nursing Center
29 Providence Ave., Berlin
No. certified beds: 80; Recent census: 63 (6/24/2020)
Owner: Nonprofit registered to N.H. Catholic Charities
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 2
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 23 minutes
Licensed Practical Nurse: 57 minutes
Nurse’s Aides: 174 minutes
COVID-19 Inspection: 6/24/2020, in  compliance
Specific inspection reports:
7/19/2019: Resident revealed a concern that a nurse attempted to give him/her more medication than was ordered. “The nurse attempted to give me 5 times the amount of my diabetes medication.” When resident tried to tell the nurse that this was too much medication, the nurse responded with, “This is what my computer is telling me that you get and you will take this medication.” Resident had to get stern with the nurse and tell the nurse that they were not going to take this medication because it is too much and it would give them diarrhea and put them in the hospital. Resident said the nurse, told him/her, “I was being belligerent and then she left.” At a care plan meeting, resident mentioned the incident as being a concern. Administrator was not aware of the above situation and had not reported it to the state. Additional education regarding resident rights were reviewed with staff.

Resident’s weight log revealed that he/she had not had a documented weight since 5/8/19, which was 91.5 pounds. Review on 7/18/19 of Nutritional Assessment, dated 5/31/19, which was their most recent nutritional assessment, revealed that resident  had weight fluctuations, both loss and gain in the past 90 days, and that the nutrition plan was to monitor weight. Review on 7/19/19 of current care plan revealed that there was no documentation for the reason that resident had not had any weights documented since 5/8/19. Director of Nursing revealed that no weights were taken since 5/8/19 because resident  frequently refused them. The refusal of weights was not documented on their care plan and that it should have been.

One resident who received all of their nourishment and medications through a feeding tube did not have this documented on a care plan.

Review on 7/18/19 of another resident’s care plan reveals that there is not a care plan for diabetes and that there is no mention of the diagnosis.

The facility failed to update and revise the care plan for three residents, including one on a mechanically soft diet, another who had taken anticoagulation medications for 7 days, and another who had taken anticoagulation medications for 5 days.

The facility failed to provide emergency dental services for a resident. The resident’s right tooth, adjacent to the front tooth, had broken down the middle from the gum line. He/she didn’t know if his/her insurance would pay for it or if he/she would have to pay for it himself/herself. Resident stated that he/she did not have an appointment yet for the consultation or repair. Resident revealed that he/she wasn’t having any pain from this broken tooth. Director of Nursing revealed that resident did have a broken tooth that occurred on 7/10/19 and that an appointment had been made for the resident the same day the tooth broke. Resident canceled the same-day appointment. Staff was unable to provide any supporting documentation that an appointment had been made or that the resident had canceled it.

The facility failed to document free water flushes that were being administered to a resident. Dietitian recommended that a resident was to receive free water flushes, through their feeding tube, of 150 cubic centimeters four times per day. Review on 7/18/19 of physician orders, revealed that resident had an order, dated 6/11/19, for free water flush four times daily starting 6/11/19. Review on 7/18/19 revealed that there was no documentation that resident had received the ordered free water flushes.

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Sullivan County Health Care
5 Nursing Home Drive, Unity
No. certified beds: 156; Recent census: 131 (6/17/2020)
Owner: Government owned – Sullivan County
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 2
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 23 minutes
Licensed Practical Nurse: 61 minutes
Nurse’s Aides: 161 minutes
COVID-19 Inspection: 6/17/2020, in compliance
Specific inspection reports:
Found two issues in 2017, nothing found for 2018-2020.

****

The Elms Center
71 Elm St., Milford
No. certified beds: 52; Recent census: 46 (6/18/2020)
Owner: For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as Harborside New Hampshire Limited Partnership
No. residents with confirmed Covid-19*: 1
No. staff with confirmed Covid-19*: 1
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 30 minutes
Licensed Practical Nurse: 43 minutes
Nurse’s Aides: 117 minutes
COVID-19 Inspection: 5/14/2020 and 6/18/2020, in compliance
Specific inspection reports:
3/22/2019: Facility had failed to ensure that residents who wanted to vote were able to exercise that right during the midterm election. Twelve members of the Resident Council revealed that they had not been able to vote. Administrator confirmed that the facility had failed to ensure that any of its residents were able to exercise their right to vote.

Facility failed to ensure proper storage and labeling of medications for two medication carts. Medications and biologicals had an expired date on the label; two had been retained longer than recommended by manufacturer or supplier guidelines.

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Warde Health Center
21 Searles Road, Windham
No. certified beds: 32; Recent census: 30 (6/8/2020)
Owner: Nonprofit registered to N.H. Catholic Charities
No. residents with confirmed Covid-19*: 3
No. staff with confirmed Covid-19*: 1
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 70 minutes
Licensed Practical Nurse: 43 minutes
Nurse’s Aides: 131 minutes
COVID-19 Inspection: 6/8/2020, in compliance
Specific inspection reports:
5/10/2019: The facility failed to develop a comprehensive care plan for 2 residents. Resident  had an indwelling catheter inserted on 4/29/19 at the urologist’s office. Record  revealed no treatments for urinary indwelling catheter maintenance. Director of Nursing confirmed that resident  had no care plan for use and care for the indwelling catheter. Another resident placed on hospice care on 8/2/18. Care plan in electronic record reveals no determination of services to be provided by the Hospice provider.

Three-Star nursing homes in New Hampshire

The Center for Medicare and Medicaid Services (CMS) rates all nursing homes in the United States, including the 74 in New Hampshire, on its website, www.medicare.gov.

The 11 nursing homes listed below have received three stars, which means “Average.”

CMS provides federal funding to many long-term care facilities in New Hampshire and performs inspections to assure resident safety. These reports are public information. The star system (one star for much below average, to five stars for much above average) for our report is the OVERALL QUALITY ranking. Those who want to see more detailed rankings of staffing, health inspection and quality of life measures may go to Medicare.gov.

Please also see our related story, “Where We Got Our Information,” to decipher how nursing homes compare on staffing minutes.

The listing is alphabetical by category.

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Belknap County Nursing Home
30 County Drive, Laconia
No. certified beds: 94; Recent census: 85 (6/5/2020)
Owner: Government owned – Belknap County
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 0
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 38 minutes
Licensed Practical Nurse: 41 minutes
Nurse’s Aides: 174 minutes
COVID-19 Inspection: 6/5/2020, in compliance
Specific inspection reports:
12/6/2019: Resident revealed sliding right out of a wheelchair pad.  Scooting forward in wheelchair from middle of room to get to lunch, lift pad in wheelchair, fell on floor. Unit revealed that lift pads are not left under residents in wheelchairs unless they have been assessed and it is care planned. Unit manager confirmed that resident had not been assessed and was not care planned to leave the lift pad on after transfer to wheelchair.

Another resident’s portable oxygen tanks are to be filled prior to end of shift every day shift. Nursing notes revealed resident upset and complained to staff that tanks are empty and not being filled consistently. Task entered for licensed nursing assistant to fill prior to end of shifts. Nursing note dated 11/1/19 reported call from social services stating that resident was having shortness of breath and complained of chest pain. Noted oxygen tank empty. Unit Manager revealed that there would be a 1-2 hour window that resident’s portable oxygen tank would be empty on a regular basis due to volume of oxygen that the resident is on.

Based on interview and review of the facility daily nursing department schedules, it was determined that the facility failed to ensure that a registered nurse was on duty eight consecutive hours a day seven days a week. It was also noted the facility failed to retain the posted daily nursing staff data for a minimum of 18 months. Director of Nursing revealed the facility does not retain the posted daily nursing staff data and these postings are thrown out.

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Colonial Poplin Nursing Home
442 Main St., Fremont
No. certified beds: 50; Recent census: 36 (5/28/2020)
Owner:  For profit registered on the N.H. Secretary of State’s website as Colonial Poplin Nursing Home Inc.
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 1
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 29 minutes
Licensed Practical Nurse: 38 minutes
Nurse’s Aides: 171 minutes
COVID-19 Inspection: 5/28/2020, in compliance
Specific inspection reports:
Five issues in 2017 and two in 2018, but nothing found in 2019 and 2020.

***

Dover Center for Health & Rehabilitation
307 Plaza Drive, Dover
No. certified beds: 112; Recent census: 87 (6/1/2020)
Owner:  For profit registered on the N.H. Secretary of State’s website as  VK Dover LLC
No. residents with confirmed Covid-19*: 1
No. staff with confirmed Covid-19*: 3
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 52 minutes
Licensed Practical Nurse: 44 minutes
Nurse’s Aides: 113 minutes
COVID-19 Inspection: 6/1/2020, in compliance
Specific inspection reports:
5/13/2019: Observation on 5/8/19 at 1 p.m. during mealtime, the meal carts on the Glennwood unit arrived over an hour late. The carts were to arrive at noon. Staff on the unit stated to surveyor that this happens a lot and it’s difficult to care for residents and for staff to schedule their lunch breaks when the food cart come to the floor so late. Several residents on the unit during interviews stated that the food is cold lots of time, staff will heat it up but then it gets tough and chewy because it has to be microwaved.

Administrator, regional manager and director of food services from Massachusetts confirmed that all food products are canned foods and are not cooked to order just poured out of a can and heated. Staff questioned the looks of the turkey and the taste along with the potatoes, stating they need to work outside the food menu that is provided by corporate to have these foods taste better. A Resident’s Council meeting of 5/9/19 revealed that all 12 present felt that the food at the facility was not palatable.

Observation on 5/8/19 during the initial tour of the kitchen walk-in refrigerator at 9 a.m. revealed a jar of pickles with multiple use by dates of 11/15, 3/19, 3/17/19, and 4/25/19. The jar itself internally had buildup on the inside of the glass and cover. This finding was shown to administrator who discarded the product right away. A second jar of pickles had use-by dates of 3/22/19 and 4/19/19. This product was also discarded. Observation on 5/8/19 at 10:25 a.m. revealed a counter mounted can opener that was ready for use covered with food product that was not properly cleaned. Administrator was also shown this and removed it from service.

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Glencliff Home for the Elderly
393 High St., Glencliff
No. certified beds: 130; Recent census: 117 (6/26/2020)
Owner: Government owned – State of New Hampshire
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 2
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 48 minutes
Licensed Practical Nurse: 35 minutes
Nurse’s Aides: 162 minutes
COVID-19 Inspection: 6/26/2020, in compliance
Specific inspection reports:
8/7/2019: The facility failed to obtain radiology services in a timely manner for three residents. One resident fell  4/2/19 at 9:05 p.m. and assessment  showed positive range of motion for all four extremities, no complaints of pain, abrasions to  knees noted. The next day, at  12:39 p.m., resident was not able to stand and walk on right ankle. Mild swelling with no redness was noted. The resident said “It feels like its broken’” and “I can’t  walk.” Advanced Practice Registered Nurse examined patient on 4/3/19 and determined right ankle appeared to be slightly swollen. Resident reported and was sent  for a right ankle x-ray to rule out a fracture. Results, dated 4/4/19, revealed an oblique nondisplaced  fibula. No documented evidence that 911 was called so that resident could be transported to the hospital and have the x-ray done in a timely manner.

Another resident had an unwitnessed fall on 6/16/19 at 8:45 a.m. and complained of severe pain in right leg while bearing weight. Resident was transported to the emergency room eight hours later by ambulance at 5:05 p.m. and returned to the facility at 10:20 p.m.

Yet another resident on 2/13/19 had an unwitnessed fall on 2/13/19 at 3:50 a.m. Nursing assessment revealed a 1 centimeter laceration to the head after hitting it on the knob of the dresser. Resident complained of severe pain to left hip and tenderness to the neck area while moving it. Progress note further states that the physician was notified by phone and gave instructions to give resident Tylenol for pain and to wait until after 7 a.m. to send resident to the emergency room for evaluation. Progress note indicated resident did not leave the facility until 8:40 a.m. to be evaluated at the emergency room . Resident returned to facility with no further injury identified and no new orders.

12/16/2019: Insulin administration and blood glucose testing were not done in private for two residents. While eating in the dining area, a resident was approached by an LPN who lifted the resident’s clothing on their leg exposing their upper right thigh and then injecting insulin.

Another resident was told by an LPN that he/she needed to check their blood sugar. While at lunch, resident extended their hand and LPN pricked their finger, drew blood and tested the blood using a glucometer. LPN then walked over to the medication cart and returned, after a few minutes, with a syringe of insulin. The LPN then told the resident he /she needed to administer their insulin. LPN then lifted resident’s shirt and administered the insulin into the resident’s abdomen.

The facility failed to label a resident’s insulin pens with the date of removal from cold storage in the refrigerator. Licensed practical nurse confirmed that there were two Insulin pens that were not dated or labeled when removed from refrigeration. The LPN confirmed that there was no way to tell how long these two Insulin pens had been stored on the medication cart and not refrigerated.

***

Lafayette Center
93 Main St., Franconia
No. certified beds: 72; Recent census: 56 (6/17/2020)
Owner: For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as 93 Main Street SNF Operations LLC
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 0
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 50 minutes
Licensed Practical Nurse: 36 minutes
Nurse’s Aides: 141 minutes
COVID-19 Inspection: 6/17/2020, in compliance
Specific inspection reports:
6/3/2019: LPN brought medications in three cups to a resident who at the time was participating in an activity. The LPN placed all three cups of medicine on the carpet beside the chair, assessed resident’s vital signs, then administered the medications. The medicines were prepared by another staff member, and medications are to be administered by the same person who prepares the doses for administration.

Drugs must be labeled with the expiration date and expired medications be stored away from medications being utilized when applicable.

Medication room refrigerator had six high dose vials with an expiration date of 4/25/19 and one opened multi-dose vial with no date of opening on it.

Registered nurse confirmed that the individual doses were expired and the multi-dose vial did not have a date of opening on it. In addition, several insulin flex pens had no opening date written on then or were labeled not to use after a date already past.

***

Maple Leaf Health Care Center
198 Pearl St., Manchester
No. certified beds: 114; Recent census: 96 (6/3/2020)
Owner: For profit registered on the N.H. Secretary of State’s website as Pearl Street Healthcare Center LLC
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 4
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 29 minutes
Licensed Practical Nurse: 52 minutes
Nurse’s Aides: 140 minutes
COVID-19 Inspection: 6/3/2020, in compliance
Specific inspection reports:
5/3/2019: The facility failed to follow physician’s orders in removing an adhesive pain patch from a patient’s back. It should have been removed after 8 hours.

The facility failed to establish and follow written policies and procedures for standard and transmission-based precautions and when and how isolations should be used for four residents on precautions. Staff changing one of the resident’s beds had a gown hanging off shoulders. In another room, housekeeper was cleaning room and mopping floor around the resident’s bed and not wearing a gown or gloves. Two LNAs were also seen in the room not wearing a gown or gloves. An LNA removed the garbage bag from the trash container that contained used gowns and took it down the hallway to the soiled utility room.  Staff delivering food to resident put food on top of the precaution cart in the hallway and put on a mask and brought the tray into the resident, who was in bed and on contact precautions. A nurse revealed that a mask is not a recommendation for contact precautions but is available for use if staff want to wear one.

 A registered nurse revealed that there was a question of bed bugs in one resident’s room, and the room had been treated. A precaution cabinet was located outside the room with PPE (personal protective equipment), but there were no precautions signage or stop/see nurse signage at the room entrance. Instruction was to wear gown and gloves to go into the room. A visitor, without donning any personal protective equipment (PPE), walked into the room and spoke with the resident, then carried two framed pictures, one at a time, out of the room into the hallway, showing them to people in the hall, then returning the pictures to the room. Interview with director of nursing revealed the bed bugs were for a resident who was admitted with a couple of live bed bugs, and he has one treatment to go.

Staff members were observed in a couple of occasions not wearing PPE with patients who were on contact precautions.

***

Mountain View Community
93 Water Village Road, Ossipee
No. certified beds: 103; Recent census: 97 (7/2/2020)
Owner: Government owned – Carroll County
No. residents with confirmed Covid-19*: 5
No. staff with confirmed Covid-19*: 5
Resident deaths due to Covid-19*: 1
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 34 minutes
Licensed Practical Nurse: 21 minutes
Nurse’s Aides: 157 minutes
COVID-19 Inspection: 6/10/2020 and 7/2/2020, in compliance
Specific inspection reports:
Three issues in 2017 and four in 2018, but nothing found in 2019 and 2020.

***

Riverside Rest Home
276 County Farm Rd., Dover
No. certified beds: 215; Recent census: 189 (6/1/2020)
Owner: Government owned – Strafford County
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 0
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 51 minutes
Licensed Practical Nurse: 35 minutes
Nurse’s Aides: 172 minutes
COVID-19 Inspection: 6/1/2020, in compliance
Specific inspection reports:
4/18/19: The facility failed to promote dignity in a dining area by allowing three workers to stand and feed residents.  One staff member was feeding three residents simultaneously. A fourth resident seated at the table was without a meal. The other five residents in the dining room were seated at other tables waiting for their meals. A licensed nursing assistant reported that residents who require more assistance receive their trays approximately 15 to 20 minutes earlier than the other residents who don’t require assistance. While the residents who require more assistance are eating, the residents that require less assistance are waiting at tables for 15-20 minutes daily until their meals arrive. The facility’s policy states that to serve in an appropriate and appealing manner, staff must sit in a chair facing the resident during feeding.

The facility failed to post notice of availability of surveys and complaint investigations for three preceding years in a prominent place and accessible to the public.

The facility failed to protect residents from potential abuse following an allegation of sexual misconduct by a staff member. On 4/16/19 a reported incident alleged that on 3/28/19, a resident was the recipient of sexual misconduct by a licensed nursing assistant. The facility allowed the LNA to remain on the floor and finish the scheduled shift, but was told to stay out of the room of the resident. The LNA was not placed on immediate administrative suspension pending investigation of the reported allegations.

The facility failed to perform an initial, scheduled, and as needed assessment for the safety of  four residents, related to smoking and storage of supplies with the nurses’ station. The designated smoking room had no devices available for staff to observe room activities from a remote location. A resident with poor safety awareness, falls, mild cognitive impairment, dementia, and depression was allowed to smoke unobserved and the resident was observed on two occasions smoking in his/her personal room. A progress note dated 1/6/19 revealed that staff discovered resident attempting to light a cigarette with the facility toaster.

***

Rochester Manor
40 Whitehall Road, Rochester
No. certified beds: 108; Recent census: 87 (6/4/2020)
Owner: For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as 40 Whitehall Road Operations LLC
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 1
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 26 minutes
Licensed Practical Nurse: 38 minutes
Nurse’s Aides: 113 minutes
COVID-19 Inspection: 6/4/2020, in compliance
Specific inspection reports:
7/11/2019: The facility failed to notify a resident’s physician and/or representative when treatment had been discontinued or delayed. Resident was upset because he/she had not been given all of their prescribed pain medications and they were having constant moderate to severe pain. Notes for the first 10 administration times indicated the medication was not given because it was not available from the pharmacy. There was no documentation of notification of the missed administration to resident’s physician. Another resident’s Durable Power of Attorney revealed that the facility had stopped the resident’s orders for medications, and that they needed to be restarted as the resident had some health issues, in particular acid reflux, without the medications. Durable Power of Attorney stated that they were not aware that the medications were being discontinued and that when they realized it, they asked to have them restarted. Unit Manager confirmed that some of resident’s medications were discontinued, because they were on Hospice, and that their DPOA was not notified of the discontinuation.

The facility failed to follow professional standards to ensure that a resident did not receive four times the dose ordered for a medication. LPN popped a 40 mg tablet from a medication card into a medicine cup. After popping the medication into the cup, LPN put the medication card back into the medication cart drawer. LPN revealed that they said that they had taken the tablet from another resident’s medication card in error. After being interviewed, LPN reached into the medication cup and removed the tablet and discarded it. Staff then went back into the medication cart drawer and removed the other resident’s 10 mg from the correct medication card and popped it into the medication cup.

***

Westwood Center
298 Main St., Keene
No. certified beds: 85; Recent census: 59 (5/19/2020)
Owner: For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as 298 Main Street Operations LLC
No. residents with confirmed Covid-19*:  0
No. staff with confirmed Covid-19*: 0
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 58 minutes
Licensed Practical Nurse: 39 minutes
Nurse’s Aides: 134 minutes
COVID-19 Inspection: 5/19/2020, in compliance
Specific inspection reports:
11/22/2019: The facility failed to follow manufacturer’s specifications regarding the preparation and administration of insulin with an insulin pen, which according to the manufacturer must be primed prior to administering.

***

Woodlawn Care Center
84 Pine St., Newport
No. certified beds: 53; Recent census: 48 (6/23/2020)
Owner: For profit registered on the N.H. Secretary of State’s website as Greenleaf Properties Inc.
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 2
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 22 minutes
Licensed Practical Nurse: 46 minutes
Nurse’s Aides: 150 minutes
COVID-19 Inspection: 6/23/2020, in compliance
Specific inspection reports:
Four issues in 2018, but nothing found for 2019-2020.

Two-Star nursing homes in New Hampshire

The Center for Medicare and Medicaid Services (CMS) rates all nursing homes in the United States, including the 74 in New Hampshire, on its website, www.medicare.gov.

The nine nursing homes listed below have received two stars, which means “Below Average.”

CMS provides federal funding to many long-term care facilities in New Hampshire and performs inspections to assure resident safety. These reports are public information. The star system (one star for much below average, to five stars for much above average) for our report is the OVERALL QUALITY ranking. Those who want to see more detailed rankings of staffing, health inspection and quality of life measures may go to Medicare.gov.

Please also see our related story, “Where We Got Our Information,” to decipher how nursing homes compare on staffing minutes.

The listing is alphabetical by category.

**

Country Village Center
91 Country Village Rd., Lancaster
No. certified beds: 86; Recent census: 75 (6/3/2020)
Owner: For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as 1 Country Village Road Operations LLC
No. residents with confirmed Covid-19*: 1
No. staff with confirmed Covid-19*: 0
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 50 minutes
Licensed Practical Nurse: 31 minutes
Nurse’s Aides: 110 minutes
COVID-19 Inspection: 6/3/2020, in compliance
Specific inspection reports:
Two issues found in 2017 and 2018, but nothing in 2019-2020.

**

Crestwood Center
40 Crosby St., Milford
No. certified beds: 82; Recent census: 47 (5/28/2020)
Owner: For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as 40 Crosby Street Operations LLC
No. residents with confirmed Covid-19*: 54
No. staff with confirmed Covid-19*: 36
Resident deaths due to Covid-19*: 19
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 38 minutes
Licensed Practical Nurse: 50 minutes
Nurse’s Aides: 115 minutes
COVID-19 Inspection: 5/28/2020, in compliance

Specific inspection reports:
5/3/2019: The facility failed to document that they informed a resident’s Durable Power of Attorney of the administration of antipsychotic medication. Facility staff should have informed the resident and/or resident representative of the initiation, reason for use, and the risks associated with the use of certain medications. There was no documented evidence that resident’s DPOA was notified.

The facility failed to maintain the walls, floors and residents’ furniture in good repair to maintain a home-like environment throughout the facility. The inspector noted areas of marked walls, scraped paint and broken baseboard heaters. The floors throughout the unit were dirty and stained. All resident room walls were in need of paint and sheetrock repair due to holes from hung items hitting the walls. One resident’s wardrobe laminate was chipped and broken. This was a potential infection control issue due to it not being able to be cleaned completely. The nurses’ station was in need of repair due to chipped and missing laminate along its sides. This was a potential infection control issue due to it not being able to be cleaned completely.

Facility failed to develop a care plan for the use of an indwelling catheter and for an advance directive choice for another resident.

A pain management effectiveness sheet was not completely filled out.

A resident on antipsychotic medication should have had behavior monitored and documented.

Three kitchenette refrigerators contained opened cartosn of nectar-thick apple juice with labeled open dates of 10 days previous. Further observation of the opened cartons of nectar-thick juices revealed that on the juice carton a written manufacturer’s instructions showed to discard the nectar thick juices after 7 days once opened.

**

Harris Hill Center
20 Maitland St., Concord
No. certified beds: 85; Recent census: 73 (6/4/2020)
Owner:  For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as 20 Maitland Street Operations LLC          
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 3
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 33 minutes
Licensed Practical Nurse: 50 minutes
Nurse’s Aides: 118 minutes
COVID-19 Inspection: 6/4/2020, in compliance
Specific inspection reports:
Several issues listed in two inspections in 2017 but nothing found in 2018-2020.

**

Hillsboro House Nursing Home
67 School St., Hillsboro
No. certified beds: 33; Recent census: 28 (6/10/2020)
Owner:  For profit registered on the N.H. Secretary of State’s website as School Street Associates
No. residents with confirmed Covid-19*:  0
No. staff with confirmed Covid-19*: 0
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: $10,205 on 2/15/2019
Staff hours per resident*:
Registered nurse: 45 minutes
Licensed Practical Nurse: 20 minutes
Nurse’s Aides: 134 minutes
COVID-19 Inspection: 6/10/2020, in compliance
Specific inspection reports:
2/15/2019: The facility failed to notify the physician of resident who developed a pressure ulcer.

The facility failed to provide necessary treatment to prevent development/progression of a non-pressure ulcer lesion to an unstagable pressure ulcer and failed to assess a pressure ulcer for a resident. The facility had no documentation of when the area on Resident’s coccyx went from a baseline slit to a pressure ulcer.

A resident said a nurse yelled at him/her, telling  the resident to go to bed. While talking about the event, the resident started to cry, stating, “I’m so scared of them I do not want to see them again.”

Another nurse voiced concern to this writer regarding another staff member she felt  could have worded differently her noise level, appeared upset, but emotional support and reassurance provided. Resident satisfied and in agreement that this writer can speak with staff member regarding her feelings .

Resident said that the aide that got her upset came into her room and apologized for upsetting her. She said she was telling me to go to sleep, so that I would not try to get up without assistance. I have forgiven her and I’m all set. Director of Nurses, when asked if the above event was or would be reported,  stated no, we have addressed the issue and resident is okay with the outcome. Staff was then asked why there have not been any facility reported incidents in the past year by evidence of the complaint tracking system, and the staff stated when they have allegations, they are taken care of right away and never become an issue.

**

Lebanon Center
24 Old Etna Road, Lebanon
No. certified beds: 110; Recent census: 100 (6/17/2020)
Owner:  For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as 24 Old Etna Road Operations LLC
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 2
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 26 minutes
Licensed Practical Nurse: 54 minutes
Nurse’s Aides: 110 minutes
COVID-19 Inspection: 6/17/2020, in compliance

Specific inspection reports:
7/3/2019: The facility failed to ensure that medication administration were followed according to professional standards for 10 out of 25 observed medication administrations.

Kitchen floors were dirty with food product and stains throughout from spilled products, along with a strong smell of waste coming from the dish room.

Director of Food Services stated the next day that the facility ran out of cleaning solutions and the floors had not been cleaned at the time of interview. The floors were still in the same condition.

The same smell of waste that was smelt the day before was coming from the dish room. When entering the dish room all the floor tiles were lifted with water pooling under the tiles. The walls throughout the area were covered with a black substance like material (mold like) and under the tiles that were lifted it was observed that the same black substance-like material (mold like). These finding were shown to the manager who stated that this area has been like this for a long time. He/she said  the facility has tried to clean it before but the mold comes right back. The manager said the facility is planning something but not until the middle of the summer with no date identified.

A medication was missing for one patient and was taken from another patient’s supply as the second patient had the patch discontinued. LPN later revealed that it is not normal practice to borrow from another resident but in this case the second resident was no longer using the patch and the other resident had chronic pain.

A resident-shared bathroom revealed a substantially charred area approximately 5 inches by 3 inches on the tile floor. The inspector learned that on 12/11/18 at 9:30 p.m. a resident was found in the bathroom with burnt hair and red spots on face. The resident, a smoker, had gotten hold of a cigarette and matches and was on a nasal cannula for oxygen.  Cigarette found in toilet and oxygen cannula found on ground. Both the physician and the spouse agreed not to send the patient out to the hospital but to continue to monitor. The room was checked and lighters, cigarettes and other flammable items were removed. Patients are not supposed to be allowed to maintain their own lighter, lighter fluid, or matches, and a staff member indicated that the facility had holiday party the night of the incident and this was possibly where the resident may have obtained smoking materials.

**

Mineral Springs
1251 White Mtn. Hwy, North Conway
No. certified beds: 87; Recent census: 61 (7/13/2020)
Owner:  For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as Sunbridge Clipper Home of North Conway LLC
No. residents with confirmed Covid-19*: 1
No. staff with confirmed Covid-19*: 3
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 48 minutes
Licensed Practical Nurse: 26 minutes
Nurse’s Aides: 117 minutes
COVID-19 Inspection: 6/17/2020 and 7/13/2020, in compliance

Specific inspection reports:
10/18/2019:  A care plan that reflected the current interventions for IV (Intravenous) care and transmission based precaution care for resident receiving medicine through a PICC line (Peripherally Inserted Central Catheter) was not properly documented. The resident had contact precautions listed, but the director of nursing confirmed that the resident was not on contact precautions and that it was incorrectly documented in the care plan.

Weights were not obtained and monitored as per the registered dietitian’s recommendations for three residents. One resident had a weight documented on 9/27/19 of 175 lbs. The next weight documented was on 10/3/19 for 160 lbs. This represented a 8.57% weight loss. There were no other documented weights listed.  Director of nursing confirmed that no further weights were obtained after 10/3/19 and that a reweigh should have been done.

Another resident had weights taken monthly and not weekly as recommended by the registered dietician in a nutrition assessment.

Expiration dates were past due for medications on two medication carts. Facility staff should record the date opened on the medication container when the medication has a shortened expiration date once opened.

There was a sticker attached to a plastic bag holding a medication pen that read “Refrigerate until open. Discard unused medication after 28 days. Date opened.” The date opened part of the sticker had a line to write in the date opened, but it was blank with no date entered. There was also a sticker on the pen that read Date opened . After opening do not use after 28 days. The date opened part of that sticker also had a line to write in the date opened, but it was blank with no date entered.

Eye drop vials for another resident  had a sticker on both of the plastic containers holding the vials that read “Refrigerate until opened. Date opened .After opening do not use after 42 days.” The date opened part of the stickers had lines to write in the date opened, but they were blank with no date entered.

**

Pleasant Valley Nursing Home
8 Peabody Road, Derry
No. certified beds: 112; Recent census: 68 (5/12/2020)
Owner:  For profit registered on the N.H. Secretary of State’s website as Pleasant Valley Operating Company LLC
No. residents with confirmed Covid-19*: 89
No. staff with confirmed Covid-19*: 36
Resident deaths due to Covid-19*: 22
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 37 minutes
Licensed Practical Nurse: 62 minutes
Nurse’s Aides: 96 minutes
COVID-19 Inspection: 5/12/2020, in compliance

Specific inspection reports:
2/2/2019: Facility failed to provide written information to residents in regards to notice of bed-hold policy and return before a transfer for three residents who were transferred out of the facility. Social Service Director said that they have never done a written notice of bed-hold policy to any resident upon transfer and that it was given to the residents on admission in the admission packet. A bed hold policy form is no longer used at the facility.

A kitchen aide served hot food from two individual portable counter top hot water warmers. Following the meal service staff placed stainless steel covers on top of each of the individual hot water warmers after removing the hot food. Staff proceeded to leave the unit with the warming units unattended.

The two individual portable hot water warmers are positioned on the kitchen counter located on the MSU unit in the open dinning/kitchen/common area where residents eat, watch TV, sit for leisure activities and visit with family and staff members all times of the day.

Licensed Practical Nurse did not follow physician’s order to give 25 mg by mouth 2 times a day related to heart condition, hold if systolic blood pressure less than 100. Take blood pressure on lower arm manually. Observation on 1/30/19 of medication pass with LPN did not reveal the blood pressure being taken. Staff was stopped prior to administering the medication to confirm that the blood pressure was not taken.

The facility failed to ensure medication was locked and not accessible to unauthorized individuals.

The top drawer of the Emergency Code Cart located in the resident hallway adjacent to the common area was easily opened.

The facility failed to have hair covered when serving food in the common area on the Medical Surgical Unit, failed to maintain infection control food steam tables and wear gloves to a resident while administering eye drops .

Kitchen aide serving lunch food from the two individual portable hot water warmers and cold food containers with a baseball cap in place not fully covering head hair.

On several occasions, the glass above the steam tables and around the serving area revealed that there was a visible substance adhered to it. When the glass and area on the steam table was touched there was a substance that was dried on the glass and on the steam tables was a greasy substance.

Licensed Practical Nurse without gloves administered eye drops to a resident.

2/24/2020: A resident’s fall was witnessed by LNA during attempt to transfer from the wheelchair to the toilet with the slide board. A slipper sock was applied to foot as it was not on at the time of the fall.

The facility failed to obtain weights as needed to monitor weight loss for two residents. As residents are weighed, staff are expected to compare current weight to previous weight. Residents with weight variance are supposed to be re-weighed within 48 hours.

The facility failed to ensure that drugs used in the facility must be labeled with the expiration date when applicable.

**

Salemhaven
23 Geremonty Drive, Salem
No. certified beds: 110; Recent census: 67 (6/10/2020)
Owner:  Nonprofit registered on the N.H. Secretary of State’s website as Salemhaven Inc.
No. residents with confirmed Covid-19*: 38
No. staff with confirmed Covid-19*: 25
Resident deaths due to Covid-19*: 14
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 33 minutes
Licensed Practical Nurse: 62 minutes
Nurse’s Aides: 138 minutes
COVID-19 Inspection: 5/22/2020 and 6/10/2020, in compliance

Specific inspection reports:
1/3/2020: The facility failed to properly assess a resident after a fall with fracture. It is the policy of the facility that residents experiencing a fall with obvious or probable injury will be transported to the Emergency Department for evaluation. On 11/30/2019 resident was found after this writer and 2 other staff members rushed to the wheelchair alarm, sitting on the floor in front of her wheelchair with shoes on and cushion on wheelchair. Resident complained of pain in the groin and states (he/she) hit (himself/herself) on the side of the head and that (he/she) twisted (his/her) left ankle. Three staff transferred resident on to wheelchair and was being observed in front of the nurse’s station, until ambulance arrived to transfer to hospital. Manager alerted doctor and son. Resident will be admitted for left hip fracture and was scheduled for surgery the next day. Director of Nursing stated the resident should not have been moved from the floor after a fall when resident complained of left groin pain. The facility failed to provide the appropriate care after the fall by transferring resident to a wheelchair.

The facility failed to provide the necessary supplements identified as a dietary need for a resident. Nutrition care plan dated 12/6/19 revealed that resident had an intervention for mighty shakes once daily. Review of weight records revealed that resident’s weight on 11/5/19 was 128.3 lbs. and on 12/5/19 was 113 lbs., which was a 15.3 lbs. weight loss in a month. The next recorded weight after 12/5/19 was on 12/20/19 which was 106 lbs. On 12/6/19 dietician recommended to start mighty shakes (supplement). Progress notes revealed that on 12/13/19 and 12/27/19 resident was on mighty shakes and overall oral intake was not great. Medication Administration Record revealed no documentation to administer mighty shakes once daily. Dietitian stated that they forgot to notify the nursing staff on the dietary recommendation for the mighty shakes.

**

Wolfeboro Bay Center
39 Clipper Drive, Wolfeboro
No. certified beds: 104; Recent census: 79 (6/9/2020)
Owner:  For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as Sunbridge Clipper Home of Wolfeboro LLC
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 3
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 37 minutes
Licensed Practical Nurse: 54 minutes
Nurse’s Aides: 122 minutes
COVID-19 Inspection: 6/9/2020, in compliance

Specific inspection reports:
1/17/2019: A resident was given diabetes medication after breakfast, when it should have been given before. Interview with the LPN confirmed that resident had consumed the morning meal before being tested for his blood glucose levels and before receiving the anti-diabetic medications.

During  a tour of kitchen with the director of food services, a cook was making a sandwich bag to go. The cook emptied the contents (chicken salad) out of a single serving plastic holding container onto a piece of bread. Then using the bottom of the outside part of the plastic serving container spread the chicken salad onto the bread.

4/10/2019: A resident reported to one LNA that another  LNA “was very rough with” him/her, “up and out of bed very rapidly and seemed angry.” Report dated 3/24/19 at 2:45 a.m.  observed by LNA that the person named by the resident  came into resident ‘s room and “ripped the blankets off of” the resident. No prior allegations of abuse were noted in regards to the staff member, who was told to leave. The supervising nurse was not made aware of the incidents until return from break at 4:15 a.m. Staff were asked if the facility LNAs had the ability to send staff home when there is an allegation of abuse from residents, and the charge nurse was not made aware of the allegations prior to staff leaving. The answer was “No.”

12/13/2019:  Facility failed to provide an environment that is free from accident hazards and to eliminate the risk for elopement when a resident was able to exit the building through the employee entry door. The door reportedly does not always fully shut due to the pressure between the outside door and inside door. Staff explained it’s like a wind tunnel. Staff was then asked what testing was done when checking the doors. Staff  stated they make sure the door latches correctly and that the magnet releases within the 15 seconds when testing. Staff was then asked if they check the alarm/security panel at the nurse station.  Staff stated No that is not on the Logbook Documentation check off. A relay was replaced and the nurse’s station now is aware of the doors.

One-Star nursing homes in New Hampshire

The Center for Medicare and Medicaid Services (CMS) rates all nursing homes in the United States, including the 74 in New Hampshire, on its website, www.medicare.gov.

The 12 nursing homes listed below have received one star, the lowest rating, which means “Much Below Average.”

CMS provides federal funding to many long-term care facilities in New Hampshire and performs inspections to assure resident safety. These reports are public information. The star system (one star for much below average, to five stars for much above average) for our report is the OVERALL QUALITY ranking. Those who want to see more detailed rankings of staffing, health inspection and quality of life measures may go to Medicare.gov.

Please also see our related story, “Where We Got Our Information,” to decipher how nursing homes compare on staffing minutes.

The listing is alphabetical by category.

*

Bedford Hills Center
30 Colby Court, Bedford
No. certified beds: 147; Recent census: 110 (6/24/2020)
Owner: For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as Harborside New Hampshire Limited Partnership
No. residents with confirmed Covid-19*: 70
No. staff with confirmed Covid-19*: 39
Resident deaths due to Covid-19*: 7
Fines in past 20 months*: $8,291 on 10/11/2019
Staff hours per resident*:
Registered nurse: 45 minutes
Licensed Practical Nurse: 52 minutes
Nurse’s Aides: 115 minutes
COVID-19 Inspection: 4/21/2020, 6/10/2020, and 6/24/2020, in compliance
Specific inspection reports (condensed listing):
Bedford Hills is a Special Focus Facility candidate, on the list for 17 months. (See our story on how these nursing homes are ranked to find out what a special focus facility is and how a facility becomes a candidate for the list.)
1/8/2019: Among the citations: Facility failed to notify resident’s physician of a weight change of 5.4 pounds in one day; dried feeding tube residue found on base of feeding tube pole, where it remained for two days; bruise on resident’s wrist was not investigated; space heaters being used in a resident’s room, a safety violation; residents reported that it often takes staff a half hour to an hour or longer to respond to their call lights. Some reported missing their weekly baths or showers, having a catheter bag not being emptied in a timely manner, and staff failing to get them up in time to attend activities or appointments.
10/11/2019: Resident’s Council group reported facility failed to effectively respond to residents’ grievances that staff do not answer the resident’s call lights in a timely manner. Facility failed to provide a sanitary environment for wound treatments for two residents in a final survey sample of 27 residents. Facility reported incident to the state agency on 10/15/2019 a resident received medication – insulin via Solution Pen Injector – that was intended for another resident. The facility failed to thoroughly investigate the medication error that resulted in immediate jeopardy for a resident, including infection control for insulin pens.
10/12/19: Based upon a Resident’s Council group interview, staff interview and a review of the facility audits revealed that the facility failed to effectively respond to resident’s grievances that staff do not answer the resident’s call lights in a timely manner.

*

Clipper Home of Portsmouth LLC
188 Jones Ave., Portsmouth
No. certified beds: 102; Recent census: 90 (5/28/2020)
Owner: For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as SunBridge Clipper Home of Portsmouth, LLC
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 8
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 38 minutes
Licensed Practical Nurse: 52 minutes
Nurse’s Aides: 119 minutes
COVID-19 Inspection: 5/28/2020, in compliance
Specific inspection reports:
7/29/2019: This home is a Special Focus Facility candidate, on the list for seven months.

A resident injured him/herself while tending to toileting, pressed the call signal, and no one came. Afterwards, the resident reported questioning the nurse as to why he/she did not answer the call light and come into the room, and the resident reported the nurse said he/she had fallen asleep. Also, in another case, improper documentation of care plan for a pressure ulcer. Facility failed to follow doctor’s orders regarding obtaining weights for two residents, one who lost 16.8 pounds over 180 days. The doctor had ordered weights be recorded three times week, and records indicated only two weights were recorded in a 12-day period. For another patient, unit manager was unable to provide explanation why weights were not obtained per physician orders. In another incident, after breakfast was delivered at 8:50 a.m. to 10 residents in a common dining area, four residents needed assistance, the first one at 9:15 a.m., the last one at 9:35 a.m. Later, staff member told the investigator “This is always how it is. We don’t have enough staff here to assist with meals. If there is a call out, this unit is always pulled from. It is not fair to the residents that there are not enough people to assist them at meals. There is always 1-2 of us to help with meals.”

A resident was observed smoking outside in the designated smoking area without a smoking apron on. This resident had a burn on right abdomen and as a result the resident was provided a smoking apron. Review of resident’s most recent smoking evaluation dated 5/3/19 revealed that the resident is allowed to smoke independently while wearing a smoking apron. The facility’s policy requires the resident’s cigarette lighter be kept at the nurse’s station, and at a later date an observer visited the resident’s room and found an extinguished cigarette butt on the floor.

Dressing wounds was not done in a safe manner, by failing to change gloves before applying a new dressing after removing old dressing.

*

Colonial Hill Center
62 Rochester Hill Rd., Rochester
No. certified beds: 79; Recent census: 68 (6/16/2020)
Owner: For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as Sunbridge Clipper Home of Rochester LLC
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 0
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 42 minutes
Licensed Practical Nurse: 54 minutes
Nurse’s Aides: 113 minutes
COVID-19 Inspection: 6/1/2020, Not in compliance. Failed to provide bath linens in good condition. Resident reported no washcloths or towels were available after a shower, and the nurse’s aide cut up bed sheets to dry the resident, and this has occurred “on and off” over several months, according to the resident. More facecloths were ordered. A contracted psychologist failed to handle disposal of personal protective equipment correctly. Also, some staff failed to wear N95 masks properly. Training was held and a test-fit kit was ordered. Re-inspected on 6/16/2020, in compliance.
Specific inspection reports:
4/26/2019: Facility failed to document follow-up assessments of the resident’s pain relief after the administration of pain medication. Resident was unable to answer the question of whether or not they got relief from pain medications administered to them. Pain management policy states that patients receiving interventions for pain will be monitored for the effectiveness in providing pain relief. Unit Manager confirmed that the documentation for pain medication results was missing and that the nurses should have documented how much relief the resident had with each administration.

The facility failed to document behavior monitoring for a resident who received antipsychotic medication. Unit Manager revealed that residents who take antipsychotic medication are to have their behaviors documented using a behavior flow record. There was no behavior flow record for a resident and that there should have been one.

The facility failed to label two insulin pens and two insulin vials with no indication of opening dates or expiration dates.

The facility failed to ensure complete resident records for a resident fall and progress notes after a physician visit for two residents.

The facility failed to adhere to infection control procedures with glucometer cleanings between residents.

 An LPN revealed that staff uses alcohol prep pads to disinfect the glucometer between resident use.

Facility policy requires an EPA-approved disinfectant against Human Immunodeficiency Virus and not an alcohol prep pad.

A registered nurse without wearing a glove was also seen popping a tablet from a blister pack directly into the hand of a resident. The nurse stated that the tablet was small and they popped it into their hand so that there was less likelihood of it falling on the floor.

*

Derry Center for Rehabilitation & Health
20 Chester Road, Derry
No. certified beds: 62; Recent census: 37 (5/19/2020)
Owner:  For profit registered on the N.H. Secretary of State’s website as Axis Health at Derry OPCO LLC
No. residents with confirmed Covid-19*: 15
No. staff with confirmed Covid-19*: 6
Resident deaths due to Covid-19*: 11
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 18 minutes
Licensed Practical Nurse: 43 minutes
Nurse’s Aides: 81 minutes
COVID-19 Inspection:  5/13/2020: not in compliance. A staff member was not wearing proper personal protective equipment while tending to a COVID-19-positive resident. Staff education was provided. The staff member is no longer employed at the facility.
Specific inspection reports:

This home is a Special Focus Facility candidate, on the list for six months.
2/22/2019: Preadmission Screening and Resident Review included incorrect information.  A box was checked “no” on a mental illness assessment, and the patient did have a diagnosis.

The facility failed to report to the State Survey Agency and thoroughly investigate an alleged drug diversion in a timely manner. All personnel must promptly report any incident or suspected incident of resident abuse, including injuries of an unknown source. A licensed practical nurse had signed for a medication delivery slip from the pharmacy, however they were not signed into the narcotic book and were unable to be found after multiple searches. A complaint was made to the local police department and the Ombudsman. A response letter to the Administrative Prosecutions Unit was written on 4/25/19. Local police have not been in touch with anyone since the original report. The original patch was due to be changed on 4/11/19 and the nurse was unable to do so. A call to the pharmacy determined a delivery had been made on 4/8/19 and the medication should have been available. Employee was later terminated. A confidential informant said this has been going on for a while and no one has done anything about it. Counts are off, bottles smell different and appear to be tampered with.

Resident on 6/28/19 was on a continuous glucose monitoring system, used until 8/15/19. LPN later said she did not receive any training or education regarding the new continuous glucose monitoring device. There were also no manufacturer’s instructions available at the facility, no policy and procedure for the device.

The facility has failed to promptly identify the loss of controlled medications and maintain accurate physical account of narcotics in the facility.

The facility failed to provide written notice of transfer or discharge for two residents.

Director of Nursing confirmed that the facility did not have documentation to show that licensed nurses have demonstrated competencies and were not following the document outlined in the facility assessment titled Staff training and competency program. The facility has developed a competency program; however, it has not yet been implemented.

 Observation on 2/14/20 of charge nurse performing wound care to resident’s right lower leg revealed concerns with professional standards of practice by not following the facility’s policies and procedures for wound care. The nurse could not recall when he/she had last had a skills check for wound care.

The facility failed to ensure that a registered nurse was on duty for eight consecutive hours a day seven days a week. Review on 2/13/20 of the facility daily staffing on weekends from 1/4/20 through 2/9/20 revealed that there was no registered nurse scheduled to be on duty for Saturdays and Sundays.

The facility failed to adequately monitor the use of antipsychotic medications for a resident whose medical record revealed that there was no Abnormal Involuntary Movement Scale (AIMS) assessment done to monitor for side effects from the use of antipsychotic medication.

The facility failed to maintain infection control practices in regards to hand hygiene during wound care and failed to use proper PPE (Personal Protective Equipment) to prevent the potential transmission of communicable diseases in one resident on contact precautions for a draining wound.

*

Exeter Center
8 Hampton Road, Exeter
No. certified beds: 81; Recent census: 69 (5/12/2020)
Owner: For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as Sunbridge Goodwin Nursing Home LLC
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 1
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: $11,278 on 2/27/2019
Staff hours per resident*:
Registered nurse: 47 minutes
Licensed Practical Nurse: 53 minutes
Nurse’s Aides: 116 minutes
COVID-19 Inspection: 5/12/2020, in compliance
Specific inspection reports:
Exeter Center is a Special Focus Facility candidate (See separate story), on the list for 11 months.

2/27/2019: Facility failed to develop care plans for a resident’s ruptured spleen and pressure ulcer. Resident had a fall on 1/8/19 that resulted in a ruptured spleen, was sent to the hospital and returned to the facility. Moisture Associated Skin Damage was noted but not added to the comprehensive care plan until a few days later. A month later a stage 2 pressure ulcer was detected. Review indicated care plan was not updated. Also, another resident was injured in a fall from a mechanical lift during a transfer from bed to chair. Apparently, a bolt became loose and LNAs heard a “crack” and the patient fell to the floor. The locking nut on the mechanical lift was missing and was noted on a previous shift. The 3-11 shift staff realized that the lift was broken and put a sign on it that read “Broken, Do Not Use,” and removed the battery so that no staff would use it. An LNA on the next shift replaced the battery and removed the broken sign, checked for signs of damage and saw none.

7/11/2019: The facility failed to ensure that a resident was clinically appropriate to self-administer his/her own medications, with no assessment filed in the record. In another case, three dressings that were applied to a resident were not dated and there was no way to indicate when the dressings were applied. Medications for several residents were given later than scheduled times, sometimes up to two to seven hours later. Also, a resident in a wheelchair without foot pedals and leg rests being pushed by a hospice LNA had a foot driven over by the front right wheel of the wheelchair. The LNA then pulled the chair backwards and forward four times in a repetitive motion, going over the resident’s foot four times, enough that the resident’s right sock came off and there was blood on the foot and the ground. Also, in a separate incident, staff did not wear personal protective equipment with a patient who had positive Extended Spectrum Beta Lactamase in urine. Staff were observed in the patient’s room with no gown or gloves, touching resident and doing slide board transfer.

*

Fairview Nursing Home
203 Lowell Road, Hudson
No. certified beds: 101; Recent census: 85 (4/15/2020)
Owner: For profit – registered on the N.H. Secretary of State’s website as Merrimac Medical Investors LLC
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 0
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 33 minutes
Licensed Practical Nurse: 52 minutes
Nurse’s Aides: 113 minutes
COVID-19 Inspection: 4/15/2020, in compliance
Specific inspection reports:
3/5/2019: The facility failed to discard medications in accordance to professional standards. An antibiotic tablet, stool softener, antidepressant and anti-epileptic that dropped off the medication cart were disposed in the medication cart trash bin with no lid. Another dosage of the same medicines were mixed in pudding, declined by the patient, and also thrown in the medication cart trash bin with no lid.  Charge nurse said medications would be discarded by flushing down the toilet.

The hospice and the facility failed to collaborate care for a resident receiving hospice services. Patient with a swallowing disorder was transferred to hospice care. Clinician provided hospice nurse with diet recommendations and safe swallow strategies. Unit manager revealed that there were no diet recommendations given to the physician by hospice or SLP which resulted in the diet texture not being changed.

The facility failed to follow expiration dates for multidose bottles of insulin found on two medication carts.

The facility failed to ensure that the paid feeding assistants provided dining assistance only for residents who have no complicated feeding problems for four residents. Paid feeding assistants provide dining assistance only for residents with no complicated feeding problems, including difficulty swallowing, recurrent lung aspiration and tube or intravenous feedings. In one case, a feeding assistant for seven years stated that they were not given a list of residents that they would feed. Staff states that they would feed anybody that would need help as long as they do not have any complicated swallowing difficulties such as choking hazards. Staff also revealed that they physically assisted a resident with issues for eating.

A white dust-like substance was covering the resident hallway flooring, handrails and walls. Further observation revealed an unattached lifted blue matt on the resident hallway floor with a white dust like substance on this matt. Staff confirmed that this area was undergoing construction. No barrier was in place to prevent dust and debris from entering areas in the facility outside of the construction area. In the construction area,  an unlocked room contained unattended construction tools and equipment which were accessible to unauthorized individuals and to residents on the East and West units. The construction project manager confirmed that there were no containment measures or barriers in place for the facility ventilation, plumbing and electrical construction. The construction project manager confirmed that an Infection Control Risk Assessment was not done for this facility construction project.

Several items in the kitchen area are in need of repair or placement. Both the walk-in refrigerator and freezer floors were dirty due to the condition of the floor being unable to be cleaned due to pitting of the flooring and the lifting of the floors due to wear and tear of both units.  A large amount of dust was observed on the condenser fan in the walk-in refrigerator and build-up of rust. Storage racks in the walk-in refrigerator are rusted pitted and unable to be properly cleaned due to conditions.  On top of the stove is a griddle covered in build-up and unable to be properly cleaned.

A system for the monitoring and recording of pneumococcal immunizations was lacking.

1/24/2020: Seven residents who required staff assistance with meals were sitting at 4 different tables in the dining area. The meals were left uncovered for greater than 15 minutes and not offered to be reheated prior to assistance being provided.

The facility failed to remove an open expired vial of medicine from the medication cart.

The facility failed to provide a nourishing snack at bedtime while having 15 hours between the evening meal and the breakfast meal. Breakfast is served at 7:30 a.m. and dinner is served at 4:30 p.m. which leaves a space of 15 hours between meals. Resident council revealed that there are no snacks offered at bedtime, and resident council did not approve the span of time between meals. Of the 8 residents who attended resident council 7 were in agreement that there is no snack offered at bedtime, and that they would like to have a snack at bedtime. The 1 resident who stated there was a snack provided stated that he/she received a snack due to being diabetic.

The facility failed to ensure that residents were not fed by paid feeding assistants after the facility had discontinued the paid feeding assistant program. Three residents were instead fed by non-licensed staff.

The facility failed maintain quarterly meetings within the Quality Assurance and Performance Improvement program. The Director of Nurses said the facility is working on developing a new QAPI program which will be more data driven and proactive.

*

Laconia Rehabilitation Center
175 Blueberry Lane, Laconia
No. certified beds: 120; Recent census: 103 (6/4/2020)
Owner:  For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as 175 Blueberry Lane Operations LLC
No. residents with confirmed Covid-19*: 1
No. staff with confirmed Covid-19*: 7
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 44 minutes
Licensed Practical Nurse: 56 minutes
Nurse’s Aides: 122 minutes
COVID-19 Inspection: 6/4/2020, in compliance

Specific inspection reports:
9/13/2019: The facility failed to maintain acceptable parameters of nutritional status due to not consistently using a method of weighing and re-weighing four residents. On 7/28/19 when the last weight was taken, one resident weighed 131.6 lbs. and resident was then transferred to another unit. The next weight taken was not until 8/11/19 at which time the resident weighed 123 pounds, showing a 8.6 lbs weight loss. A reweigh was not performed and a nutrition assessment was not completed until 8/18/19.

Another resident, reviewed 9/13/19, revealed a 7.5 percent weight loss (143.4 lbs. on 7/23/19 vs. 138.5 lbs. on 8/3/19).  A re-weigh was not performed nor was there a notification to the nutritionist. The weight loss wasn’t addressed until 8/24/19. Director of nurses revealed that reweighs are expected to be done if there is a 5-pound weight difference from the last weight obtained.

A resident’s weights from 8/9/19 to 9/12/9 were 150.2 lbs. to 159.8 lbs. and was not re-weighed to determine the accuracy of the discrepancy. Re-weighs are expected to be done if there is a 5 lbs. weight difference from the last weight obtained.

Opened vials of medication in the refrigerator were not dated with an opening date or expiration date.

Registered nurse confirmed that three insulin pens were opened and not dated.

*

Mountain Ridge Center
7 Baldwin St.  Franklin
No. certified beds: 86; Recent census: 66 (5/29/2020)
Owner:  For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as 7 Baldwin Street Operations LLC
No. residents with confirmed Covid-19*: 50
No. staff with confirmed Covid-19*: 26
Resident deaths due to Covid-19*: 11
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 16 minutes
Licensed Practical Nurse: 69 minutes
Nurse’s Aides: 107 minutes
COVID-19 Inspection: 5/29/2020, in compliance
Specific inspection reports:
3/15/2019: A complainant reported that during their stay they were given the wrong dose of a medication and the facility implemented every hour checks to make sure the complainant stayed awake. Medication nursing assistant was not provided properly documented re-training.

10/4/2019: Another resident complained that staff did not use the hoyer lift properly, causing him/her pain and discomfort and physical therapy needed to reposition the resident in their wheelchair.  On 10/2/19, resident was seen in the dining area crying quietly. Interview revealed that resident stated that staff had used the wrong hoyer lift strap to transfer him/her and was crying because he/she was in pain. The resident stated the facility should be using a split hoyer lift but had been using a full lift pad and the resident had told the staff but they would not listen. Assessment done 9/17/19 indicated resident required a large full body lift pad. Physical therapist said staff did use a full lift pad to transfer resident to wheelchair on 9/30/19 and after the resident complained of being uncomfortable recommended a split lift pad  at a care plan meeting and that a full lift pad negates the pressure relieving cushion on the resident’s wheelchair.  Unit manager revealed there was no intervention to use a split pad with the hoyer lift on resident’s care plan and confirmed the lift transfer reposition assessment says to use a full pad but should say a split hoyer lift pad.

A resident who usually smoked about one time a day did not have this recorded in a care plan. Further, the resident  was on contact precautions in a wound. Nurse Practice Educator confirmed that resident was on contact precautions and that there was no care plan in place.

The facility failed to identify a change in bowel incontinence, assess the resident and provide appropriate treatment and services to restore as much normal bowel function as possible for a resident. Nurse practice educator confirmed the above, stating that the facility failed to perform a new bowel assessment and also failed to complete a care plan for both bowel and bladder.

Pneumococcal immunizations were not given to two residents, even though one of the residents signed a consent, and another’s health care decision maker signed it.

The residents’ call system volume was not maintained at a level that could be heard. Tape was placed over the speaker system at the nurse’s station lowering the sound so it could not be heard as designed. The unit manager removed the tape and immediately the audible sound could be heard as designed.

*

Oceanside Skilled Nursing & Rehabilitation
22 Tuck Road, Hampton
No. certified beds: 117; Recent census: 94 (7/8/2020)
Owner: For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as 22 Tuck Road Operations LLC
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 2
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 35 minutes
Licensed Practical Nurse: 41 minutes
Nurse’s Aides: 124 minutes
COVID-19 Inspection: 6/2/2020, 7/8/2020, in compliance
Specific inspection reports:
Oceanside is a Special Focus Facility candidate, on the list for 17 months.
1/11/2019: Three residents were not notified of a room change, including written notice, with the reason for the change.
Improper offloading device consistent with professional standards of practice for the healing of a deep tissue injury for a patient, who was observed wearing a black type boot on their left foot. Unit manager reported this was because of a pressure area on left heel facility acquired due to using heels to propel themselves in their wheelchair. Inspection revealed the boot failed to have any off loading features for the healing of a pressure sore.
Unsafe environment to prevent accidental fire hazards on the secured dementia unit where 28 residents reside. The nursing station/room did not have a lock or door on entrance, and staff purses, bags were unattended. Residents were also seen coming in and out of the room without staff being present or in line of sight of the room. This writer was notified by nursing staff, resident had been smoking in room. Nursing staff could smell smoke, entered resident’s room to find (pronoun omitted) holding a cup of water with 4 cigarette butts in water. Resident noted to be holding a pack of cigarettes and lighter. Nursing staff went through their own belongings, one of the nursing staff noticed a pack of cigarettes and lighter gone. Resident had gone into nursing staff purse and took them.
Failed to ensure that drugs used in facility must be labeled with the expiration date when applicable.
Failed to store food in accordance with professional standards for food service safety and ensure sanitary conditions of the kitchen All foods should be dated upon receipt before being stored .food labels must include: the food item name, the date of preparation/receipt/removal from freezer, the use by date .items that are removed from a labeled case in the freezer and placed in the refrigerator for thawing should be labeled with the date of removal from freezer and the use by date .leftovers must be labeled and dated with the date they are prepared and the use by date . Kitchen initial tour revealed that the hood vents that were above the cooking grill and stove, which had a pot of soup that was boiling, had a thick coat of dust and grease when swiped with the bottom of a pen. Food manager said the hood vents are cleaned and maintained every 6 months by an outside contracted vendor. Facility staff do not clean the hood vents in between the 6 months maintenance and cleaning by the outside contracted vendor. Black debris and dust under the steam table. Further observation revealed there was black debris and dust under the sink, also black debris, dust, napkin, and spoon were under the preparation table. Further observation also revealed that there was black debris, dust, empty packet of butter, spoon and knife under the table near the coffee machine and juice machine. Staff states that those areas were not cleaned and will be cleaned right away.
Failed to protect the right of a resident to have privacy during an ear examination. Resident was sitting at a table in the dining room eating lunch. Other residents and some staff were also present in the dining room. Nurse practitioner approached resident and asked to look in their ears. Staff L took an otoscope and examined both of Resident’s ears and then Staff L made a loud comment, which could be heard across the dining room, that Resident #67’s ears were both full of soft wax. Unit manager confirmed that any resident examinations should be done in private and should not be done in a public area, including a dining room.
Three residents or their representatives were not notified of care plan meetings.
Failed to maintain exits free of obstructions when the facility failed to remove snow from facility designated exit gates resulting in the gates being inoperable during a potential evacuation.
Facility failed to label a medication when opened and failed to monitor freezer temperatures for a freezer that was being used to store dietary supplements in medication room refrigerators.
Facility failed to maintain the walk-in freezer in good working condition to keep frozen foods frozen solid and failed to maintain the freezer floor in good condition to be cleaned properly. Thermometer that was placed inside the freezer was not functioning properly. Two new thermometers were reading between 30-32 degrees. Staff discarded all unfrozen foods at time of finding.

*

Pheasant Wood Center
50 Pheasant Road, Peterborough
No. certified beds: 99; Recent census: 95 (5/28/2020)
Owner:  For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as 50 Pheasant Road Operations LLC
No. residents with confirmed Covid-19*: 1
No. staff with confirmed Covid-19*: 1
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 37 minutes
Licensed Practical Nurse: 35 minutes
Nurse’s Aides: 124 minutes
COVID-19 Inspection: 5/28/2020, in compliance

Specific inspection reports:
10/21/2019: A resident was not provided with appropriate orthotic shoes. Interview with Resident revealed that due to her orthopedic-fitted shoes not fitting correctly, she no longer is able to walk due to the pain when standing in them. Physician orders on May 18 noted that nurses were to monitor big toe for infection, redness, discharge and pain every shift. On Aug. 21, redness, streaking, warmth to great left toe resident has pain to area, infection suspected, localized. A 9/11/19 podiatry indicated great toe infection. A podiatry note dated 7/29/19 stated resident had an ulcer on left toe measuring 0.1mm x 0.1 mm x 0.2mm. Extra-depth shoes and custom-molded inserts were recommended. On 8/19/19 inspector reviewed podiatric medical records and agreed that the patient has the qualifying foot conditions which would render diabetic shoes and inserts a medical necessity. The note/order was not signed by the physician until 10/9/19 (approximately two months after the original request). Administrator confirmed the request for new shoes was made after the order was signed but it would still take another month before resident would have proper fitting shoes. As of the date of survey on 10/21/19, resident still had not received proper fitting shoes.

The facility failed to reassess a resident’s psychosocial adjustment to the facility when the resident’s service dog was removed from the facility. On 10/16/19 a resident was observed sobbing and revealed his/her service dog at the facility was removed the day before. “This is when my dog knows to comfort me, if my dog sees me upset and crying like it crawls right up on me and makes me feel better,” the resident said. “The only reason I came to this facility was because they told me I could have my service dog with me. I just had to send my company away because I can’t even visit with them without crying.”

There were no documented visits by social worker after the dog being removed. The director of nurses revealed that the service dog was removed from the facility for several reasons. Resident had fallen out of the wheelchair while attempting to take the dog to the bathroom outside. The dog was not housebroken and also jumped onto other residents, including a resident with wounds on the lower extremities. The caregiver for the service dog was encouraged to bring the dog to visit. Administrator said there was a verbal agreement that resident could have the service dog in the facility as long as the resident could care for the dog. Administrator confirmed that after the dog was removed from the facility that there were no assessments performed or new interventions put into place for the resident’s psychosocial well being.

The facility failed to maintain both the walk-in refrigerator and freezer in proper working order to prevent ice build up and maintain cleanliness of the equipment and environment.

The door to the walk-in freezer was bent/separated from the front of the freezer box preventing the gasket to seal which caused ice build up on the outside of the freezer door. Observation revealed that the floors of the walk-in freezer unit in the kitchen were dirty and in poor condition. The kitchen floor by the three-compartment sink had a grease trap that was lifted above the floor making it a tripping hazard.

*

Pleasant View Center
239 Pleasant St., Concord
No. certified beds: 176; Recent census: 151 (6/11/2020)
Owner: For profit – Genesis Healthcare, registered on the N.H. Secretary of State’s website as 239 Pleasant Street Operations LLC
No. residents with confirmed Covid-19*: 0
No. staff with confirmed Covid-19*: 3
Resident deaths due to Covid-19*: 0
Fines in past 20 months*: $22,568 on 4/3/2019
Staff hours per resident*:
Registered nurse: 36 minutes
Licensed Practical Nurse: 46 minutes
Nurse’s Aides: 109 minutes
COVID-19 Inspection: 6/11/2020, in compliance

Specific inspection reports:
Pleasant View is a Special Focus Facility candidate, on the list for 14 months.

1/9/2019: On  Nov. 17, 2018,  a resident reported an allegation of abuse to oncoming morning staff at 7:30 a.m. Staff documented that patient reported being punched in stomach, poked in right eye and having left wrist grabbed. Patient physically shaken when reporting incident. Observed were a skin tear to left wrist, with a moderate amount of blood to the sleeve of left arm and on bedding. Right eye was red and swollen. Sent to hospital for evaluation. Director of nursing and police department notified. A male license practical nurse was identified as the suspect.  He was employed by a traveling nurse agency and was terminated. The agency has placed a do not use for all nursing facilities in New England. Resident reported that “the tall skinny guy with glasses punched me in the gut, poked me in the eye, and grabbed my wrist.” According to the reports, the resident tugged on the LPN’s pants as he was tube-feeding the resident’s roommate. When the LPN’s pants started coming down, the resident said the LPN attempted to pull them back up and punched him.

The facility failed to fully inform residents of the risk of treatment from antipsychotic medications. No documented evidence shown that the facility had informed a resident’s activated power of attorney about the use and side effects of ABH gel before administering the ABH gel. Another resident who makes his/her own medical decisions did not give informed consent for a medication.

One resident’s fingernails on both hands were observed to be over an inch long, they were thick and yellow and brown in color. Nurse’s notes revealed resident had not received nail care. The resident’s sibling said he/she has brought many of his/her concerns, including the lack of fingernail care, to the attention of staff and he/she stated that nothing has been done since bringing these concerns to the unit manager about 2 weeks ago. A staff member confirmed that the resident has not seen a doctor or had care provided to his/her fingernails because he/she has behaviors and has refused these services. There are no nurse’s notes or physician notes that support care has been offered or attempted regarding nail care for this resident.

The facility failed to develop comprehensive care plans with accurate information about pressure sores and oxygen use for three residents.

The facility failed to develop a discharge care plan with identified goals for a resident.

A nurse’s note (undated in the report) indicated a resident was found sitting on the floor, and stated that he/she fell and hit (their) head on the foot of bed. Resident had a lump on back of head due to the fall. A cold compress was applied and patient declined pain medication. About 90 minutes later, an LNA stated that he/she found resident on bed unresponsive with eyes opened and moving side to side. Nurse practitioner called, then 911. The resident “not looking good,” “lying across the bed,” and the resident’s arm was deep purple. Resident complained of a horrible headache. Vitals taken and blood pressure was over 200. Review of the hospital notes revealed that CAT scan showed a large right-sided subdural hematoma with midline shift. Family decided to terminally extubate resident,  who expired rapidly. Nurse practitioner revealed that whenever a resident sustains a fall, the facility’s fall protocol is indicated, which would include neurological and vitals. Each unit has a sheet of paper that shows which steps are to be started and an order is not needed, it is expected to be provided by staff. Based on  the clinical information, it was determined that the facility failed to perform neurological assessments and vitals to monitor the resident’s condition from 4:30 p.m. to approximately 6:15 p.m. at which time resident was found on their bed unresponsive with eyes opened moving side to side and assessed by nurse practitioner.

A resident who had unwitnessed falls had a neurological assessment flow sheet started for each fall but none of them were complete based on the facility’s falls protocol. Each fall either was not completed for a full three days or was missing vital sign assessments during the assessment period or was missing the neurological part of the assessment or a combination of the above.

The facility failed to provide appropriate supervision which resulted in harm for two residents. One resident fell from a shower chair after receiving a tub bath. The resident needed supervision for ambulation and for activities of daily living. Another patient) was observed in a shower mechanical lift after being given a shower. This nurse was called to examine’s patient’s right toe nails in which it was reported that LNA had cleaned feet and then a toenail came off of the third digit. Patient was placed in bed. About 15 minutes later, this nurse was passing by room and observed patient on the floor at the same time LNAs were walking in. Patient was alert and breathing even and unlabored. The left foot was bent under the bed in an awkward position. The patient was repositioned and placed back in hoyer lift to place in bed. Patient also reported hitting head. Ambulance called and patient transported to hospital. Director of Nurses confirmed that staff had left resident alone due to lack of communication for a period of time and resident fell from the tub chair fracturing both ankles.

Another resident attended an activity in the midmorning on 3/14/19. As the activity concluded, resident told the activities aide that they preferred to stay in the solarium/sun room. Shortly after that, resident got up from wheelchair and was found on the floor in the hallway, and was sent to the hospital due to a question of a fracture. Resident was a risk for elopement (meaning escape) and should have been supervised. Resident remained on the floor unmoved until 911 arrived. Patient had a closed fracture of left proximal humerus, closed fracture of left distal radius, and fracture of right iliac wing. Director of nurses confirmed that resident was left unattended and the activities director is new and did not know that resident could not be left alone.

The facility failed to ensure acceptable parameters of nutritional status in regards to reweights and physician and dietician notification for three residents.

The facility failed to ensure that residents requiring oxygen therapy received respiratory care consistent with professional standards of practice, for six residents.

The facility failed to ensure that residents with “as-needed” orders for antipsychotic medications are evaluated and have a duration in the medical record for the antipsychotic medication and failed to maintain behavior monitoring for one resident.

The facility failed to ensure that clinical records were complete and accurately maintained for seven residents in a final survey sample of 41 residents.

During lunch in the third floor main dinning room a resident  sitting in a wheelchair positioned at a table was self propelling back and forth in a wheelchair, appearing agitated and visibly distraught, sobbing and crying out loudly for her babies, stating he/she wanted to die. This behavior continued in the presence of approximately 20 other residents eating lunch with no staff intervention. Other residents present at this dining observation appeared upset by this behavior. One resident at another table walked over to resident and spoke to him/her in a low comforting voice and proceeded to rub the resident’s back in a comforting manner. This behavior continued for approximately 10 minutes before a staff member intervened and sat down calmly redirecting resident to the lunch meal.

The facility failed to ensure that a resident received the necessary supervision to avoid sustaining a fall with injury.

One resident sustained a fall on 11/12/19 in the bathroom and was hospitalized. Resident was assisted to the bathroom by an LNA who then left resident alone in the bathroom to get towels. While out of this resident’s bathroom the LNA heard a bang. Resident was noted to be lying on left side with left hand behind and right leg crossing over left leg, with blood noted on floor under resident’s left forehead. Staff called 911 and resident  was transported to the hospital. Resident’s care plan indicated total assistance needed with toileting and is not supposed to be left alone in the bathroom.

The facility failed to ensure the availability of the emergency insulin supply kit for the facility.

The facility failed to limit the as-needed use of an antipsychotic medication to 14 days and to evaluate and give a rationale for their continued use.

The facility failed to ensure that expired medication and medical supplies were stored in accordance to professional standards and medications were labeled in accordance to professional standards for two medication rooms observed and six medication carts.

The facility failed to deliver food either in a timely manner or with the necessary staff available for ensuring residents received the assistance they required to eat their meals.

The facility failed to prevent cross contamination due to staff practices. A dishwasher was observed scraping plates covered with food debris and then came to the clean side without washing their hands. Staff then started to pick up the clean utensils with their hands and place them in holding racks.

The facility failed to provide the rehabilitative services that followed a resident’s transfer requirements.

A resident said a therapist came to his/her room to give therapy and he/she told the therapist to use the gate belt, but instead the therapist took his/her gown and rolled it up in their fist making it so tight “it hurt my chest where I had open heart surgery. At that time the pain was so bad they had to send me to the hospital.” Therapy notes indicated strict sternal precautions for eight weeks post-op.

The facility failed to follow hand hygiene practices in two different areas.

A contact precaution cart was located in the middle of the hall between two and an LPN went to enter one of the rooms when a staff member called out saying, you need to gowned up that resident is on contact precautions. LPN was unaware that this room was a contact precaution room and stated, how come there is no sign letting me know.

*

Ridgewood Center
25 Ridgewood Road, Bedford
No. certified beds: 150; Recent census: 137 (4/22/2020)
Owner: For profit, Genesis Healthcare,  registered on the N.H. Secretary of State’s website as 25 Ridgewood Road Operations LLC
No. residents with confirmed Covid-19*: 67
No. staff with confirmed Covid-19*: 34
Resident deaths due to Covid-19*: 24
Fines in past 20 months*: None
Staff hours per resident*:
Registered nurse: 37 minutes
Licensed Practical Nurse: 41 minutes
Nurse’s Aides: 119 minutes

COVID-19 Inspection: 4/22/2020: Not in compliance. Report of resident who expired not receiving CPR. Patient did not have a DNR (Do Not Resuscitate) order. Staff thought the resident did have a DNR and possibly looked in the wrong patient record. The facility now has a policy that two nurses must verify the DNR status in the file. Another infection control inspection was performed on 6/8/2020 and the facility was found in compliance.

Specific inspection reports:

Ridgewood Center is a Special Focus Facility candidate, on the list for seven months.
11/4/2019: The facility failed to follow physician orders. Review on 10/30/19 of physician orders had an order to change catheter site transparent dressing. Indicate external catheter and upper arm circumference. LPN went to resident’s room to change PICC line dressing on their right upper arm. Staff did not obtain an arm circumference on resident’s right arm during the PICC line dressing change. When LPN asked for unit manager’s assistance to finish the PICC line dressing change, staff failed to aspirate for blood return when flushing the PICC line catheter with a 10 ml normal saline flush as no red substance blood-like was noted when PICC line catheter was flushed.

A resident who reported that the facility was short staffed and that they, at times, had to wait for their call light to be answered. Resident revealed that a while back, they had to wait for approximately a half-hour for their call light to be answered. Resident stated that it was a problem because he/she first put their light on, they felt that they were starting to have a hypoglycemic episode. By the time staff responded, resident stated that they were weak, sweating and had blurred vision.

The facility has failed to provide the necessary treatment and services regarding a resident’s acquired pressure sore.

Third-floor kitchenette revealed that the three-bay steam table had covers over the bays which were extremely hot and unable to be touched. At time of observation staff were in the area but at any time a resident could walk into the area and burn themselves.

Interview on 10/30/19 at 9:18 a.m. with Resident revealed that Resident fell outside the facility while going out for a smoke as the sidewalk had cracks. Resident fell out of their wheelchair when resident hit an uneven area in the parking lot and had a left knee abrasion. At the back of the building while exiting there was a 4 to 6 inches gaping hole between the transition from the cement to asphalt where resident stated they fell. Further observation on the right-hand side while exiting the back of the building also revealed an approximately 2 feet (length) by 2 feet (wide) by 8 inches (depth) square hole on the cement walkway. Further observation of the left-hand side while exiting the back building also revealed that there were 3 patches that were broken with gaping cement on the cement walkway making it an uneven surface. Staff stated that they should have had an orange cone on the square hole at the cement walkway and that staff had called for contractors to fix the gaps on the walkways. Staff was unable to provide documentation related to contacting contractors to fix the cement walkway prior to 11/1/19.

The facility failed to provide services to maintain urinary continence for a resident. The care plan intervention that was documented was to assist the resident to the toilet upon rising, before meals, after meals, nightly and as needed. Review on 11/4/19 of Resident’s nurses notes and LNA documentation revealed that there was no documented evidence that resident was toileted as scheduled or what the results of the toileting were.

The facility failed to provide early identification for resident with impaired nutrition risk to allow the interdisciplinary team to develop and implement interventions to stabilize or improve nutritional status before complications arise. Unit manager reviewed the weight sheets and confirmed that the staff have not re-weighed one resident after a 5-pound weight loss/gain and nursing have not verified accuracy.

One resident stated that they do not always get adequate pain control with the pain medications that are administered to them. Record review revealed that each time resident reported ineffective results from their pain medication, there was no documentation of any other interventions that were attempted or any physician notification of the ineffective results.

The facility failed to ensure proper labeling of medications for two medication carts observed and proper storage of expired treatment supplies for one medication room.

Main kitchen meat slicer sitting on the counter top was uncovered.  Director of food services was asked if the meat slicer was ready for use and he/she stated yes. On inspection of the slicer it was noted that food build up was on the cutting blade.

The upright reach in refrigerator revealed the temperature logs that were written for the month had more then half the temperatures greater then 41 degrees. When inspecting the inside thermometer it showed an inside temperature of 43 degrees. The food service director stated the refrigerator is opened and closed so much it’s hard to maintain the temperature. The walk-in refrigerator revealed a bowl of chopped potatoes and chopped eggs that were to be mixed together before serving. This bowl had cellophane covering over it but inside this bowl laying on top of the potatoes and eggs was another plastic bowl that held onion chunks to be added to the salad when served to residents who wanted them. Staff was shown the finding and agreed that this bowl holding the onions should not be in direct contact with a food product. A table top mixer that had marked and chipped paint made it hard to clean and maintain. The underside of the mixer had food buildup stuck on it that was hard to remove due to the unit’s condition.

Sterile procedures were not maintained during a PICC dressing change for a resident.

The call light system was not adequately equipped to allow residents to call for staff assistance to a centralized work area on one unit. On the third floor unit near the solarium, there were beeping sounds heard but no visual light signal observed.

About the author

Bob Charest has been in the news business for three decades, formerly at the New Hampshire Union Leader and Eagle Tribune of Lawrence.  He currently reports and writes a column “Why You Should Care New Hampshire” for InDepthNH.org. He also serves as board secretary for the New Hampshire Center for Public Interest Journalism, the parent organization of InDepthNH.org. He was this year’s first-place recipient of the Community Service Award from the New Hampshire Press Association.