cms_ME
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4,239 rows sorted by scope_severity
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| Link | rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity ▼ | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 5 | 5 | CEDARS NURSING CARE CENTER | 205003 | 630 OCEAN AVENUE | PORTLAND | ME | 4112 | 2019-02-28 | 582 | B | 0 | 1 | 51MR11 | Based on interview and clinical record review, the facility failed to ensure the Skilled Nursing Facility Advance Beneficiary Notices (SNFABN) were provided to 2 of 3 residents whose Medicare Part A services were discontinued (Residents #46 and #74). Findings: 1. On review of Resident #46's clinical record, a surveyor noted the resident received Medicare Part A services that ended on 1/17/19 but the surveyor could not locate evidence that the required Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) was provided to the resident so that he/she could make an informed decision to continue receiving the skilled services that may not be paid for by Medicare and assume financial responsibility. 2. On review of Resident #74's clinical record, a surveyor noted the Resident, received Medicare Part A services that ended on 1/14/19 but the surveyor could not locate evidence that the required Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) was provided to the resident so that he/she could make an informed decision to continue receiving the skilled services that may not be paid for by Medicare and assume financial responsibility. On 2/26/19 at 11:15 a.m., in an interview with the Licensed Social Worker, the surveyor confirmed that SNFABNs were not issued prior to the end of Medicare Part A services. | 2020-09-01 |
| 24 | 24 | MONTELLO MANOR | 205006 | 540 COLLEGE ST | LEWISTON | ME | 4240 | 2019-12-18 | 623 | B | 0 | 1 | UDD011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to notify the resident and/or the resident representative in writing of the transfer/discharge to the hospital for 3 of 3 sampled residents (#30, #34, #8 ). Findings: 1. Documentation in Resident's #30's clinical record indicated Resident #30 was transferred to the hospital on [DATE] and admitted . The medical record lacked evidence that Resident #30 or his/her representative was provided a written transfer/discharge notice. On 12/17/19 at 10:30 p.m., in an interview with a Director of Nursing, a surveyor confirmed that Resident #30 or his/her representative did not receive a written transfer/discharge notice for the hospital transfer on 11/9/19. 2. Documentation in Resident's #34's clinical record indicated Resident #34 was discharged /transferred to an acute hospital on [DATE]. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to include appeal rights to the resident and/or resident representative. On 12/17/19 at 11:11 a.m., in an interview with a Director of Nursing, a surveyor confirmed that Resident #34 his/her representative did not receive a written transfer/discharge notice for the hospital transfer on 12/3/19. 3. Documentation in Resident's #8's clinical record indicated Resident #8 was discharged /transferred to an acute hospital on [DATE]. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to include appeal rights to the resident and/or resident representative. On 12/16/19 at 2:00 p.m. in an interview wwith the Director of Nussing, a surveyor confirmed lack of discharge/transfer notice to include appeal rights to the resident and/or resident represented. | 2020-09-01 |
| 25 | 25 | MONTELLO MANOR | 205006 | 540 COLLEGE ST | LEWISTON | ME | 4240 | 2019-12-18 | 625 | B | 0 | 1 | UDD011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to issue a written bed hold notice to a known family member or legal representative for 3 of 3 sampled residents who had been transferred to an acute care facility (Residents #30, #34, #8). Findings: 1. Documentation in Resident #30's clinical record indicated that he/she transferred to an acute care hospital on [DATE] and subsequently admitted . The clinical record contained no evidence that the facility issued a written bed hold notice to the resident, a family member, or legal representative upon transfer. On 12/17/19 at 10:30 p.m., in an interview with a Director of Nursing, a surveyor confirmed that Resident #30 or his/her representative did not receive a written bed hold policy for the hospital transfer on 11/9/19. 2. Documentation in Resident #34's clinical record indicated Resident #34 was transferred on 12/3/19 to an acute care facility for treatment of [REDACTED]. On 12/17/19 at 11:11 a.m., In an interview with the Director of Nursing, a surveyor confirmed that no bed hold notice was issued. 3. Documentation in Resident #8's clinical record indicated Resident #8's was discharged /transferred to an acute hospital on [DATE]. The clinical record lacked evidence that the facility issued a written bed hold notice to include cost of care to the resident and/or resident representative. On 12/16/19 at 2:00 p.m., in an interview with the Director of Nursing, a surveyor confirmed that lack of discharge/transfer notice to include appeal rights was given to the resident and/or resident representative. | 2020-09-01 |
| 26 | 26 | MONTELLO MANOR | 205006 | 540 COLLEGE ST | LEWISTON | ME | 4240 | 2019-12-18 | 641 | B | 0 | 1 | UDD011 | Based on medical records review and interviews, the facility failed to ensure that a Minimum Data Set, version 3.0 (MDS) was accurately coded for 2 of 12 residents reviewed for accuracy of assessment (Resident #30 and #6). Findings: 1. Resident #30's Minimum Data Set (MDS) 3.0, dated 12/4/19, was coded to indicate that the resident received an anticoagulant during the 7 day look back period. Documentation in the medical record lacked evidence that Resident #30 received an anticoagulant during the look-back period of 11/28/19 to 12/4/19. On 12/16/19 at 2:16 p.m., during an interview with the MDS Coordinator, a surveyor confirmed the above finding. 2. Resident #6's Minimum Data Set (MDS) 3.0, dated 10/7/19, was coded to indicate that the resident received insulin. However, there was no evidence in the resident's clinical record to indicate the resident received insulin. On 12/17/19 at 1:58 p.m., during an interview with the MDS Coordinator, a surveyor confirmed that the MDS was inaccurately coded. | 2020-09-01 |
| 36 | 36 | BARRON CENTER | 205011 | 1145 BRIGHTON AVE | PORTLAND | ME | 4102 | 2017-10-26 | 514 | B | 0 | 1 | 7DKA11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure 1 of 29 sampled stage 2 resident's (#55) clinical records was complete with regards to medication regimen reviews. Finding: On review of Resident #55's clinical record, the surveyor noted an admission date of [DATE]. When reviewing Resident #55's monthly Drug Regimen Review, the surveyor could not locate any monthly reviews completed prior to 5/2017. In an interview with the surveyor on 10/26/17 at 11:39 a.m., the 2 North Unit Clerk stated that the facility switched to a different pharmacy and when the new Pharmacist completed the initial Drug Regimen Review in May, he removed the reviews done by (the previous pharmacy) and the Unit Clerk, didn't know what he did with them. The Unit Clerk then searched the entire clinical record and could not find any Drug Regimen Reviews completed prior to (MONTH) (YEAR). The Team Leader discussed this finding with the Interim Administrator on 10/26/17 at 12:35 p.m. | 2020-09-01 |
| 38 | 38 | BARRON CENTER | 205011 | 1145 BRIGHTON AVE | PORTLAND | ME | 4102 | 2018-12-07 | 625 | B | 0 | 1 | OYJ711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to issue bed hold notices to the resident's representative for 2 of 5 sampled residents who had been transferred to an acute care facility (#137 and 167). Finding: 1. Documentation in Resident #137's clinical record indicated that he/she was transferred to an acute hospital on [DATE] and subsequently admitted . The clinical record lacked evidence that the facility issued a bed hold notice to the resident's representative. On 12/4/18 at 1:29 p.m., during an interview with a surveyor, the Social Worker stated that she was unable to find evidence that the written transfer/discharge notice was given to Resident Representative #137. 2. Review of the documentation in the clinical record indicated that Resident #167 was transferred to an acute care facility and subsequently admitted on [DATE]. The clinical record lacked evidence that the facility issued a bed hold notice to the resident's representative. In an interview with the surveyor on 12/4/18 at 1:25 p.m., the Licensed Social Worker (LSW) provided a copy of the Notice of Transfer/Discharge form for Resident #167 provided to the resident's representative on 11/19/18. The written transfer form lacked evidence of bed hold policy and rate information provided to the representative. The LSW acknowledged the finding and confirmed the rate was not added to the form in error. In an interview with surveyor on 12/4/18, at 8:00 a.m., Resident #167 indicated he/she was made aware of the reason for the transfer but had received no written information on the facility's policy on bed hold. In an interview with the surveyor and the Director of Nursing Services on 12/7/18, at 8:15 a. m., the finding on Resident #167 was discussed. The surveyor confirmed the finding during the interview. | 2020-09-01 |
| 45 | 45 | NEWTON CENTER | 205012 | 35 JULY STREET | SANFORD | ME | 4073 | 2017-09-25 | 225 | B | 1 | 0 | 3PYW11 | > Based on interviews and facility policy review, the facility failed to ensure an alleged violation of abuse was reported immediately, to the administrator and to the State Survey Agency (Department of Health and Human Services, DHHS, Division of Licensing and Certification, for 1of 2 residents reviewed. (#1) Finding: On 9/11/17, a Nursing Facility Reportable Incident Form was received from The[NAME]Center via fax in the Division of Licensing and Certification offices which indicated an allegation of abuse of a resident (Resident #1) by a Certified Nursing Assistant (CNA) with an occurance incident date of 9/9/17, a Saturday. Interviews and record review indicated no evidence that the allegation was reported to the DHHS State Offices until the following Monday. Review of the facility's Preventing Abuse policy states that it is the policy of[NAME]Center to not condone any form of resident abuse and to continually monitor facility policies, practices, and training/education programs to assist in preventing abuse. The reporting directions of this policy are included under the Reporting Suspicion of Abuse, section # 2 which states the DON or designee will report the incident immediately (defined as within 24 hours): Division of Licensing and Certification by calling #1-800-383-2441 as soon as possible but in a timeframe not to exceed 24 hours of knowledge of the incident. In an interview on 9/25/17 at 2:00 p.m., the finding for late reporting was discussed with the Administrator and Director of Nursing. The Administrator confirmed the report was sent to the state offices after the CNA reported to administration on 9/11/17. The administrator further indicated the reporting CNA was re-educated on the reporting requirements to the state offices. | 2020-09-01 |
| 49 | 49 | NEWTON CENTER | 205012 | 35 JULY STREET | SANFORD | ME | 4073 | 2018-12-13 | 641 | B | 0 | 1 | IWWA11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical records review and interviews, the facility failed to ensure that a Minimum Data Set, version 3.0 (MDS) was accurately coded for 3 of 37 residents reviewed for accuracy of assessment (#44, #47 & #61). Findings: 1. Review of Resident #44's MDS, dated [DATE], was coded, in Section A1500, to indicate that the resident did not have a Level II Preadmission Screening and Resident Review (PASRR), by coding no to the question Has the resident been evaluated by Level II PASRR and determined to have a serious mental illness and/or mental [MEDICAL CONDITION] or a related condidtion? Documentation in the medical record revealed that a Level II PASRR was completed on 1/19/18. On 12/13/18, between 9:00 a.m. and 9:30 a.m., in an interview with two MDS Coordinators, a surveyor confirmed that Section A1500 was miscoded for Level II Preadmission Screening and Resident Review. 2. Review of Resident #47's MDS, dated [DATE], was coded, in Section N0400E, to indicate that the resident received an anticoagulant during the 7 day look back period. Documentation in the medical record revealed that the resident did not have a physicia'ns order for an anticoagulant. On 12/13/18, in an interview with two MDS Coordinators, a surveyor confirmed that Section N0400E was miscoded for use of anticoagulant. 3. Resident #61's MDS, dated [DATE], was coded, in Section N: Medications, N0400A to indicate that the resident received an antipsychotic during the 7 day look back period. A medical record review revealed that the resident did not have an order for [REDACTED].>On 12/12/18 at 9:36 a.m. in an interview with the MDS Coordinator, a surveyor confirmed the coding error for Section N0400[NAME] | 2020-09-01 |
| 63 | 63 | AROOSTOOK HEALTH CENTER | 205018 | PO BOX 410 | MARS HILL | ME | 4758 | 2018-12-10 | 656 | B | 1 | 0 | 246711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on clinical record reviews, facility policy review, and interviews, the facility failed to follow a care plan in the area of falls for 2 of 3 residents reviewed (Resident #1, Resident #2). Findings: The facility's policy Fall Prevention/Assessment, revised 3/7/14, defines a fall as an unplanned descent to the floor, with or without injury to the patient and includes falls that a staff member attempts to minimize the impact of the fall by easing the patient's descent to the floor or in some manner attempted to break the fall. It includes a PR[NAME]EDURE that indicates it will be documented on the resident plan of care that they are at risk for falls, appropriate interventions will also be documented here, and to notify the provider (physician) and family/significant other of fall as soon as possible or if injury requires immediate treatment then notify the family immediately regardless of the time of day. This policy also directs staff to complete an incident report (RL6) and document facts relevant to the fall and any follow up actions. 1. Resident #1's care plan, under the care area of falls, included an intervention, dated 10/11/18, that directed staff to follow the facility fall protocol. Resident #1's clinical record contained a paper, dated 10/16/18, that identified 3 family members that can be contacted regarding concerns with Resident #1 and that the Resident Representative, listed as #1, is to be attempted to be contacted first. On 10/20/18 at 12:37 p.m., Registered Nurse (RN) #1 documented in the clinical record that Resident #1 tried to move him/herself to bed and landed on the floor and that the physician was informed of the incident. The facility was unable to provide an incident report (RL6) for this fall and there is no evidence of the Resident Representative being notified. On 10/29/18 at 7:52 p.m., RN #2 documented in the clinical record that at approximately 12 p.m., Resident #1 had a fall with no injuries. This note … | 2020-09-01 |
| 64 | 64 | BANGOR NURSING & REHABILITATION | 205020 | 103 TEXAS AVE | BANGOR | ME | 4401 | 2019-07-17 | 584 | B | 0 | 1 | 2DG411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interview, the facility failed to adequately provide housekeeping and maintenance services necessary to maintain the building in good repair, and sanitary condition, for 1 of 1 environmental tour. Finding: On 7/10/19 from 9:30 a.m. to 10:00 a.m., a surveyor conducted an Environmental Tour on the Skilled and Long Term Care units with the District Manager and Maintenance Director in which the following observations were confirmed: -In room [ROOM NUMBER], the veneer is peeling off the dresser drawer. -In room [ROOM NUMBER], the floor is soiled with dirt and debris. On the floor, to the right of the hand sink, the cove base is pulled away from the wall creating an uncleanable surface. -In room [ROOM NUMBER], the wall at the foot of the beds is scuffed with black marks and the paint is chipped off. -In room [ROOM NUMBER]-1, the enamel on the metal grab rails are chipped creating an uncleanable surface. -In room [ROOM NUMBER]-1, the enamel on the metal grab rails are chipped creating an uncleanable surface. -In room [ROOM NUMBER]-1, the enamel on the left metal grab rail is chipped creating an uncleanable surface. -In room [ROOM NUMBER]-1, the enamel on the left metal grab bar is chipped creating an uncleanable surface. -In room [ROOM NUMBER], the wall to the right of the entrance of the room has chipped, peeling paint, exposing metal. The floor in the bathroom is soiled with dirt and debris. The door frame, at the entrance of the room, has paint chipped off. -In room [ROOM NUMBER], the wall at the head of the bed has paint chipped off. The door frame, at the entrance of the room, has paint chipped off. -In rooms [ROOM NUMBER], the bottom of the door frame, at the entrance of the rooms, has paint chipped off. On 7/10/19 from 10:00 a.m. to 10:05 a.m., a surveyor conducted an Environmental Tour on the secured Dementia Unit with the District Manager and Maintenance Director in which the following observations were confirmed: | 2020-09-01 |
| 66 | 66 | BANGOR NURSING & REHABILITATION | 205020 | 103 TEXAS AVE | BANGOR | ME | 4401 | 2019-07-17 | 623 | B | 0 | 1 | 2DG411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to issue a transfer/discharge notice to 1 of 2 sampled residents (#38) and failed to notify the Ombudsman Office of a facility initiated transfer/discharge to an acute care facility for 1 of 1 sampled residents reviewed for hospitalization (#253). Findings: 1. Resident #38's clinical record was reviewed and documentation indicated the Resident #38 was transferred to an acute care hospital, per family member's request, on 6/30/19 and was admitted . The surveyor was unable to find evidence of a written transfer/discharge notice being provided to Resident #38 or the Resident's Representative. On 7/17/19 10:57 a.m., during an interview with a surveyor, the Unit Secretary stated at the time of a Resident's discharge, she completes the Checklist for Closed Charts. She states that the nurse that completed the Physician order [REDACTED]. Usually, a copy of the discharge/transfer notices are put in the Social Worker's box and then they are placed in the clinical record under the Social Services section. The Unit Secretary was only able to find a blank transfer/discharge notice and was unable to find a completed notice in the closed record but she would check with the Licensed Social Worker (LSW) to see if she has a copy. On 7/17/19 at 11:47 a.m., during an interview with a surveyor, the LSW stated that she cannot find the transfer/discharge notice for Resident #38's transfer/discharge to the hospital on [DATE]. She states that it was an Agency Nurse that sent Resident #38 to the hospital but the practice should be that everyone that gets sent to the hospital receives a transfer/discharge notice. 2. Resident #253's clinical record was reviewed and documentation indicated that Resident #253 was transferred to an acute care facility on 1/6/19, and was admitted . On 7/17/19 at 11:47 a.m., during an interview with a surveyor, the LSW stated that she was unaware of having to notify the Ombudsman's … | 2020-09-01 |
| 86 | 86 | ORONO COMMONS | 205031 | 117 BENNOCH RD | ORONO | ME | 4473 | 2018-05-10 | 804 | B | 0 | 1 | D1U111 | Based on observations and interview, the facility failed to serve attractive pureed and ground foods by serving pureed and ground foods that were all the same color for 1 of 3 lunch observations on the Homestead Unit. Finding: On 5/7/18 at 12:25 p.m., two surveyors observed lunch service in the Homestead Unit dining room. The two surveyors observed 13 residents who received pureed and/or ground foods. Each plate served to the 13 residents had one half cup scoop of white mashed potato and one half cup scoop of off white colored pureed or ground chicken. There were no other foods on the plates other than a scoop of potato and a scoop of pureed or ground chicken. On 5/7/18 at 1:00 p.m., a surveyor discussed this finding with the Interim Food Service Director (FSD), and during the interview, the FSD confirmed that the 13 residents plates had a scoop of white potato and a scoop of off white chicken. | 2020-09-01 |
| 87 | 87 | ORONO COMMONS | 205031 | 117 BENNOCH RD | ORONO | ME | 4473 | 2018-05-10 | 809 | B | 0 | 1 | D1U111 | Based on observation and interview, the facility failed to provide scheduled snacks to 19 residents on 5/3/18 and on 5/6/18. (Resident #1, #12, #14, #18, #24, #31, #41, #42, #45, #53, #60, #61, #62, #64, #67, #70, #71, #72 and #73) Finding: On 5/7/18 at 11:30 a.m. during the initial tour of the kitchen, a surveyor observed 2 trays in the walk-in refrigerator with snacks labeled with resident's names and time of snack to be delivered. On the trays were Vanilla health shakes, nutritional juice drinks, cups of cottage cheese, sandwiches, chocolate cream cookies, oatmeal cookies, gluten free cookies, crackers, yogurts, puddings and a label for 1/2 cup of milk for a Resident #61. A surveyor confirmed this finding with the Interim Food Service Director, at the time of the observation. | 2020-09-01 |
| 91 | 91 | ORONO COMMONS | 205031 | 117 BENNOCH RD | ORONO | ME | 4473 | 2017-06-12 | 514 | B | 1 | 0 | 1HKG11 | > Based on record review and interview, the facility failed to ensure that the clinical record for 4 of 7 sampled residents (#1, #2, #3 and #6) reviewed for bathing/showers and range of motion was complete, accurate, and consistent with the resident plan of care. Findings: 1. The facility's shower schedule indicated Resident #1 was scheduled to receive a shower on Mondays. Documentation indicated Resident #1 did not receive a shower or bath from 5/8/17 until 6/1/17. Documentation indicated that Resident#1 has not received a bath again since 6/1/17. In an interview with the surveyor on 6/12/17 at 10:55 a.m., Resident #1 indicated that he/she would like to have a shower but had not been offered one. 2. The facility's shower schedule indicated Resident #2 was scheduled to receive a shower on Wednesday evenings. Documentation indicated Resident #2 did not receive a shower or bath from 5/11/17 through 5/24/17, and in June, the resident received a bath on Saturday, 6/3/17 only. In an interview with the surveyor on 6/12/17 at 9:50 a.m., Resident #2 indicated that he/she would like to have a shower but had not been offered one. 3. The facility's shower schedule indicated Resident #6 was scheduled to receive a shower on Friday evenings. Documentation indicated Resident #6 received 1 shower on Sunday, 4/9/17 and did not receive a shower again until Monday, 5/15/17. 4. Resident #3's care plan, dated 5/15/17, directed the staff to provide range of motion to the resident's bilateral legs due to functional decline. There was no documentation in the resident's record to indicate staff provided range of motion to the resident's legs between 6/1/17 and 6/12/17. On 6/12/17 at 2:30 p.m., the surveyor confirmed with the Nurse Manager that there was no evidence that range of motion was provided to Resident #3. 4. Resident #6's care plan, dated 5/3/17, directed staff to provide passive range of motion (PROM) to the resident's right and left upper and lower extremities, 10 repetitions each twice daily. The documentation indicated that … | 2020-09-01 |
| 100 | 100 | ORONO COMMONS | 205031 | 117 BENNOCH RD | ORONO | ME | 4473 | 2019-10-09 | 623 | B | 0 | 1 | U94M11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to provide written transfer/discharge notices to resident representatives for facility-initiated transfer/discharges for 2 of 2 sampled residents that were transferred or discharged to an acute care facility (Resident #6 and #60). Findings: 1. Resident #6's clinical record was reviewed and documentation indicated the Resident #6 was transferred to an acute care hospital on [DATE]. Resident #6's notice was documented that information was provided by phone to the Resident Representative. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the Resident Representative. 2. Resident #60's clinical record was reviewed and documentation indicated the Resident #60 was transferred to an acute care hospital on [DATE]. Resident #60's notice was documented verbal Power of Attorney. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the Resident Representative. On 10/8/19 at 2:07 p.m., during an interview with a surveyor, the Director of Social Services stated that she is unsure who mails a copy of the transfer/discharge notice to the Resident Representative. At 10:00 a.m., during an interview with a surveyor, the Licensed Social Worker stated that she does not mail the transfer/discharge notices but a copy goes to the Business Office. At 10:09 a.m., during an interview with the Center Executive Director, the surveyor confirmed this finding. At 10:41 a.m., during an interview with a surveyor, the Administrator stated that the facility's practice is to read the notice to the Resident Representative and they are not mailing out a written copy of this notice. The surveyor further confirmed this finding at this time. | 2020-09-01 |
| 101 | 101 | ORONO COMMONS | 205031 | 117 BENNOCH RD | ORONO | ME | 4473 | 2019-10-09 | 625 | B | 0 | 1 | U94M11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed provide written bed hold notices, with the appropriate information completed on the forms, to resident representatives for facility-initiated transfer/discharges for 2 of 2 sampled residents that were transferred/discharged to an acute care facility (Resident #6 and #60). Findings: 1. Resident #6's clinical record was reviewed and documentation indicated the Resident #6 was transferred to an acute care hospital on [DATE]. Resident #6's notice was documented that information was provided by phone to the Resident Representative. Resident #6's payer is Medicaid. The notice was checked under PAYER: Medicaid - Hold the bed? Yes was checked, but the number of days was not filled in to indicate how many days the bed would be held. In addition, Medicare - was checked yes (not Resident #6's payer source) and that the Resident Representative wishes to hold a bed and agree to pay the financial terms listed above. There are no financial terms listed on this notice. The clinical record lacked evidence that the facility issued a written bed hold notice with the appropriate information completed to the Resident Representative. 2. Resident #60's clinical record was reviewed and documentation indicated the Resident #60 was transferred to an acute care hospital on [DATE]. Resident #60's notice was documented verbal Power of Attorney. Resident #60's payer is private pay. The notice was checked under PAYER: Hospice and did not indicate whether or not the Resident Representative wished to hold or not hold the bed. The clinical record lacked evidence that the facility issued a written bed hold notice with the appropriate information completed to the Resident Representative. On 10/8/19 at 2:07 p.m., during an interview with a surveyor, the Director of Social Services stated that she is unsure who mails a copy of the transfer/discharge notice to the Resident Representative. At 10:00 a.m., during an intervie… | 2020-09-01 |
| 102 | 102 | ORONO COMMONS | 205031 | 117 BENNOCH RD | ORONO | ME | 4473 | 2019-10-09 | 732 | B | 0 | 1 | U94M11 | Based on observations and interviews, the facility failed to post the current daily nurse staffing schedule that includes the facility name, day of the month, a breakdown of the number of registered and licensed nursing staff responsible for direct resident care and indicate which shifts the numbers corresponded to for 2 of 4 survey days. Findings: 1. On 10/6/19 at 10:15 a.m., upon entrance to the facility an initial tour was completed. Two surveyors observed that the current nurse staffing schedule had not been posted since 10/3/19. This finding was confirmed with the Center Executive Director on 10/6/19 at 12:00 noon. 2. On 10/9/19 at 12:30 p.m., two surveyors observed that the posted nurse staffing information date was for 10/8/19. The finding was confirmed with the Center Executive Director on 10/9/19 at 12:36 p.m. | 2020-09-01 |
| 108 | 108 | ORONO COMMONS | 205031 | 117 BENNOCH RD | ORONO | ME | 4473 | 2019-10-09 | 883 | B | 0 | 1 | U94M11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to provide education to the resident and/or responsible party on the risks versus the benefits of the Influenza Vaccine, prior to offering the vaccine for 3 of 5 residents (Resident #55, #69 and #28), failed to provide education to the resident and/or responsible party on the risks versus the benefits of the Pneumococcal/Prevnar Vaccine, prior to offering the vaccine for 3 of 5 residents (Resident #28, #55, and #69), and failed to follow their policy and obtain a vaccination history for 1 of 5 residents (Resident #73) reviewed for Influenza and Pneumococcal Immunization. Findings: The facility's policy Administration of Influenza Vaccine, revised 9/11/19, directs staff to ensure that appropriate Vaccine Information Statement (VIS) has been received by the patient or responsible party. 1. The clinical record of Resident #55 indicated the resident received the Influenza Vaccine on 10/5/19. Resident #55's Influenza Immunization Informed Consent form was signed on 8/20/19. The facility was unable to provide the evidence that the appropriate VIS was received by the resident or responsible party which would provide education on the risks versus benefits of the vaccine, prior to offering the vaccine. 2. The clinical record of Resident #69 indicated the resident received the Influenza Vaccine on 10/5/19. Resident #69's Influenza Immunization Informed Consent form was signed on 8/5/19. The facility was unable to provide the evidence that the appropriate VIS was received by the resident or responsible party which would provide education on the risks versus benefits of the vaccine, prior to offering the vaccine. 3. The clinical record of Resident #28 indicated the resident received the Influenza Vaccine on 10/5/19. Resident #28's Influenza Immunization Informed Consent form was signed on 1/22/19. The facility was unable to provide the evidence that the appropriate VIS was received by the reside… | 2020-09-01 |
| 111 | 111 | ORONO COMMONS | 205031 | 117 BENNOCH RD | ORONO | ME | 4473 | 2018-11-29 | 558 | B | 0 | 1 | X69P11 | Based on observations and interviews, the facility failed to ensure that a call bell was accessible to 2 of 39 sampled residents, (#19 and #67) Findings: 1. On 11/26/18 at 1:16 p.m., a surveyor observed Resident #19 lying in bed. The call bell ran under the head of bed, under the mattress and then onto the floor under the head of the bed. The resident tried to find the call bell and stated that he/she doesn't know where it is and he/she does and can use the call bell. On 11/26/18 at 1:18 p.m., a surveyor confirmed the finding in an interview with Certified Nursing Assistant (CNA) #3 that the call bell was caught under the bed and not accessible for the resident and that the resident is capable of using the call bell. CNA #3 placed the call bell in reach of Resident #19. On 11/27/18 at 8:20 a.m., a surveyor observed Resident #19 lying in bed. The call bell, which was attached to the bed control, was on the floor under the head of the bed. The resident tried to find the call bell and stated that he/she doesn't know where it is and he/she does and can use it. On 11/27/18 at 8:25 a.m., a surveyor confirmed the finding in an interview with Certified Nursing Assistant - Medication Technician, (CNA-M) #4 that the call bell was not accessible for the resident and that the resident is capable of using the call bell. CNA-M #4 placed the call bell in reach of Resident #19. 2. On 11/26/18 at 1:37 p.m., a surveyor observed Resident #67 lying in bed. The call bell was on the floor, out of reach of Resident #67. Resident #67 could not find his/her call bell and stated that he/she can use it and wants it near him/her. On 11/26/18 at 1:40 p.m., a surveyor confirmed the finding in an interview with CNA #2 that the call bell was on the floor, at the head of the bed, not accessible to the resident, and that the resident is capable of using the call bell. CNA #2 placed the call bell in reach of Resident #19. | 2020-09-01 |
| 120 | 120 | THE GARDENS | 205051 | 30 COMMUNITY DRIVE | CAMDEN | ME | 4843 | 2020-02-05 | 625 | B | 0 | 1 | JBM611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to issue a written bed hold notice to a resident and/or legal representative for 3 of 3 sampled residents who were transferred to an acute care facility (Residents #11, #13, and #27). Findings: 1. Documentation in Resident #11's clinical record indicated that he/she transferred to an acute care hospital on [DATE] and subsequently admitted . The clinical record lacked evidence that the facility issued a bed hold notice to the resident, a family member, or legal representative upon transfer. 2. Documentation in Resident #13's clinical record indicated that he/she transferred to an acute care hospital on [DATE] and then on 11/15/19 and subsequently admitted . The clinical record lacked evidence that the facility issued a bed hold notice to the resident, a family member, or legal representative upon transfer for either transfers. 3. Documentation in Resident #27's clinical record indicated that he/she transferred to an acute care hospital on [DATE], 8/27/19 and 12/14/19 and was subsequently admitted with each transfer. The clinical record lacked evidence that the facility issued a bed hold notice to the resident and a family member or legal representative at the time of transfers. On 2/4/2020 at 2:27 p.m., the surveyor confirmed in an interview with the Assistant Administrator that the clinical records lacked evidence of a bed hold notice provided to the resident and a family member or legal representative. | 2020-09-01 |
| 133 | 133 | RUSSELL PARK REHABILITATION & LIVING CENTER | 205052 | 158-178 RUSSELL ST | LEWISTON | ME | 4240 | 2018-10-18 | 625 | B | 1 | 1 | R9O111 | > Based on record reviews and interviews, the facility failed to provide a written bed hold notice to the resident and resident's responsible party for 2 of 3 residents reviewed for hospitalization (Resident #40 and #31). Findings: 1. On 10/17/18, during a review of Resident #40's clinical record, the surveyor could not find evidence that written bed hold notices were provided to the resident and his/her responsible party for transfer to a hospital which eventually led to an acute care admission on 10/10/18. On 10/17/18 at 11:13 a.m., in interview with the Licensed Social Worker, the surveyor confirmed the resident and his/her responsible party was not provided a written bed hold notice at the time of transfer. 2. On 10/16/18, during a review of Resident #31's clinical record, the surveyor noted that the resident was transferred and subsequently admitted to an acute care facility on 9/4/18. The surveyor could not find evidence that the resident and his/her responsible party was provided a written bed hold notice. On 10/16/18 at 11:03 a.m., during an interview with the Licensed Social Worker and Director of Nursing, the surveyor confirmed there is no evidence that a written bed hold notice was provided to the resident and his/her responsible party. | 2020-09-01 |
| 138 | 138 | RUSSELL PARK REHABILITATION & LIVING CENTER | 205052 | 158-178 RUSSELL ST | LEWISTON | ME | 4240 | 2017-11-02 | 371 | B | 0 | 1 | LJ0S11 | Based on observations and interviews, the facility failed to ensure the kitchen was maintained in a clean and sanitary manner for 4 of 4 days of survey. Findings: On 10/30/2017 at 9:08 a.m., 10/31/2017 at 8:38 a.m., 11/1/17 at 8:45 a.m., and 11/2/17 at 8:40 a.m., during a tour of the kitchen, a surveyor observed the following findings: > There were missing floor tiles under the dishwashing machine, approximately 2 feet 6 inches x 2 feet, exposing untreated cement creating an uncleanable surface. > The food disposal control box cover has chipped paint and is rusty, creating an uncleanable surface. On 11/2/17 at 8:40 a.m., a surveyor confirmed the findings in an interview with the Administrator, the Food Service Director and the Maintenance Supervisor. | 2020-09-01 |
| 141 | 141 | RUSSELL PARK REHABILITATION & LIVING CENTER | 205052 | 158-178 RUSSELL ST | LEWISTON | ME | 4240 | 2019-11-07 | 582 | B | 0 | 1 | 8LQC11 | Based on record reviews and interviews, the facility failed to ensure the Notice of Medicare Provider Non-Coverage (NOMNC) Form , which included appeal rights, was provided at least two days prior to the resident's last covered day for 2 of 3 residents whose Medicare Part A services were discontinued (Residents #7 and #29). In addition, the facility failed to ensure the Skilled Nursing Facility (SNF) Advance Beneficiary Notice (SNFABN) Form , which included appeal rights and liability of payment was provided to 1 of 2 residents who remained living in the facility after Medicare Part A services were discontinued (Resident #7). Findings: 1. Resident #7's SNF Beneficiary Protection Notification Review form indicated that the last day of Medicare Part A services was 9/8/19. Resident #7 remained in the facility after services ended. The facility was unable to provide the NOMNC Form or the SNFABN Form for Resident #7. 2. Resident #29's SNF Beneficiary Protection Notification Review form indicated that the last day of Medicare Part A services was 10/21/19. Resident #24 remained in the facility after services ended. Resident #29's NOMNC CMS- was signed by Resident #24 on 10/21/19 and was not provided to the resident at least two days prior to the resident's last covered day. On 11/5/19 at 11:14 a.m., during an interview with a surveyor, the Social Worker (SW) explained she was new to Long Term Care and has not been doing these forms yet. The Vice President of Clinical Services for North Country explained that someone else has been doing these forms until the SW learns her role. The surveyor confirmed that the notices were not provided timely or at all during this interview. | 2020-09-01 |
| 143 | 143 | RUSSELL PARK REHABILITATION & LIVING CENTER | 205052 | 158-178 RUSSELL ST | LEWISTON | ME | 4240 | 2019-11-07 | 623 | B | 0 | 1 | 8LQC11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to provide a notice of Transfer of Discharge in writing to residents and resident representatives for 2 of 4 residents reviewed for hospitalization (#38 and #22). In addition, the facility failed to notify the Ombudsman of a facility-initiated transfer/discharge for 3 of 4 resident's reviewed for hospitalization (#38, #22, and #44). Findings: 1. On 11/05/19 during a review of Resident #38's clinical record, the surveyor noted that the resident was sent to the hospital on [DATE] for evaluation of [MEDICAL CONDITION] and urinary tract infection [MEDICAL CONDITION]. The surveyor was unable to locate evidence a written notice of transfer or discharge was sent to Resident #38's representative/ power of attorney (POA). On 11/6/19 at 11:15 a.m., in an interview, the Licensed Social Worker, Conditional (LSX) stated that she doesn't know the process for issuing a Notice of Transfer of Discharge to the resident's representative. Further, The Licensed Social Worker, Conditional (LSX) stated that she does not know the process for notifying the Ombudsman of a facility- initiated transfer/discharge and that he/she was not aware that the Ombudsman was to be notified of facility- initiated resident discharges. On 11/6/19 at 11:25 a.m., in an interview with the Social Services Assistant and the LSX, the Social Services Assistant stated that he had taken care mailing transfer or discharge notices to resident representatives after the facility's former social worker resigned, but had stopped mailing the notices once the LSX was hired in (MONTH) 2019. Further, the Social Services Assistant stated that he was not aware that the Ombudsman was to be notified of facility-initiated, emergent discharges. The Social Services Assistant stated that he had been notifying the Ombudsman of facility-initiated resident discharges on a monthly basis until the LSX was hired in (MONTH) 2019, but had not included emergen… | 2020-09-01 |
| 144 | 144 | RUSSELL PARK REHABILITATION & LIVING CENTER | 205052 | 158-178 RUSSELL ST | LEWISTON | ME | 4240 | 2019-11-07 | 625 | B | 0 | 1 | 8LQC11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to issue a written bed hold notice to a resident and/or legal representative for 2 of 4 residents reviewed for hospitalization (#38 and #22). Findings: 1. On 11/5/19 during a review of Resident #38's clinical record, documentation indicated that Resident #38 was sent to the hospital on [DATE] for evaluation of [MEDICAL CONDITION] and urinary tract infection [MEDICAL CONDITION], and was admitted to the hospital. The surveyor was unable to locate evidence a written bed hold notice was sent to Resident #38's representative/ power of attorney (POA). On 11/6/19 at 11:15 a.m., in an interview with a surveyor, the Licensed Social Worker, Conditional (LSX) stated that she doesn't know the process for issuing a written bed hold notice to the resident's representative/ Power of Attorney (POA). On 11/6/19 at 11:25 a.m., in an interview with a surveyor, the Social Services Assistant, and the LSX, the Social Services Assistant stated that he had taken care mailing bed hold notices to resident representatives after the facility's former social worker resigned, but had stopped mailing the notices once the LSX was hired in (MONTH) 2019. On 11/6/19 at 11:30 a.m., a surveyor confirmed the finding in an interview with the LSX and the Social Services Assistant. 2. Documentation in the clinical record of Resident #22 indicated that the resident was transferred to an acute care hospital on [DATE] and subsequently admitted . There was no evidence in the clinical record that the facility issued a bed hold notice to the resident, or a known family member or legal representative. On 11/04/19 at 12:36 p.m., in an interview with the resident representative, he/she reported he/she did not receive any written notice of the bed hold policy when transferred to the hospital. On 11/05/19 at 9:58 a.m., in an interview with a surveyor, the Director of Nursing confirmed that the facility did not issue bed hold notices a… | 2020-09-01 |
| 152 | 152 | RUSSELL PARK REHABILITATION & LIVING CENTER | 205052 | 158-178 RUSSELL ST | LEWISTON | ME | 4240 | 2019-11-07 | 883 | B | 0 | 1 | 8LQC11 | Based on immunization record review, review of the facility's immunization policy, and interview, the facility failed to implement its Immunization Policy for 4 of 5 residents whose immunization records were reviewed (#3, #10, #344, #345). Findings: The facility's Infection Control Immunizations - Influenza, Pneumococcal Policy, with a revision date of 9/18, indicated in Procedure I: Before offering the Influenza or Pneumonia vaccine, each resident, and/or resident's legal representative will receive education produced by the Maine and/or Federal Centers for Disease Control regarding the benefits and potential side effects of the vaccines for the current year. A review of immunization records for Residents #3, #10, #344, and #345, indicated the residents or their legal representative had received the CDC Vaccine Information Statement (VIS), dated 8/7/15. On 11/7/19 at approximately 11:00 a.m., in an interview with a surveyor, the Infection Control Preventionist confirmed residents and/or their legal representatives were being provided with the 8/7/2015 version of the CDC Influenza VIS, and, was not aware of the current version dated 8/15/2019. | 2020-09-01 |
| 172 | 172 | MAINEGENERAL REHAB & LONG TERM CARE - GRAY BIRCH | 205054 | 37 GRAY BIRCH DRIVE | AUGUSTA | ME | 4330 | 2019-08-30 | 623 | B | 1 | 1 | 2LOL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record reviews and interviews, the facility failed to provide a Notice of Transfer or Discharge in writing to the residents and resident representatives for 4 of 36 residents transferred to an acute care facility, (Resident #46, #51, #53, #315). Findings: 1. Documentation in Resident #46's clinical record indicated she/he had facility initiated transfers to an Acute care hospital on [DATE] and 8/21/19. The clinical record lacks evidence that the resident and resident representative were notified in writing of the reason for transfer. On 8/29/19 at 11:10 a.m., in an interview with Resident #46's representative, she/he confirmed she/he does not remember receiving any Transfer/Discharge notices upon Resident #46's transfers to the Acute Care Hospital 2. Documentation in Resident #51's clinical record indicated that he/she was transferred/discharged and subsequently admitted to an acute hospital on [DATE], 4/11/19, 7/20/19, and 7/26/19. The clinical record lacked evidence that the facility issued a written transfer/discharge notice to Resident #51 or his/her legal representative for any of the transfers. 3. Documentation in Resident #53's clinical record indicated that he/she was discharged /transferred to an acute hospital on [DATE] and subsequently admitted . The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the resident and/or legal representative. 4. Documentation in Resident #315's clinical record indicated that he/she was discharged /transferred to an acute hospital on [DATE] & 8/24/19 to the emergency room . The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the resident and/or legal representative. On 8/28/19 at 3:00 pm in an interview with the surveyor, the Administrator confirmed that the facility does not provide such notices at the time of transfers to the hospital. | 2020-09-01 |
| 173 | 173 | MAINEGENERAL REHAB & LONG TERM CARE - GRAY BIRCH | 205054 | 37 GRAY BIRCH DRIVE | AUGUSTA | ME | 4330 | 2019-08-30 | 625 | B | 1 | 1 | 2LOL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record reviews and interviews, the facility failed to issue a written bed hold notice to a resident, known family member or legal representative for 4 of 36 sampled residents who had been transferred to an acute care facility (#46, #51, #53, #315). Findings 1. Documentation in Resident #46's clinical record indicated that he/she transferred to an acute care hospital on [DATE] and subsequently admitted . The clinical record contained no evidence that the facility issued a bed hold notice to the resident, a family member, or legal representative upon transfer. 2. Documentation in Resident #51's clinical record indicated that he/she was discharged /transferred to an acute care hospital and subsequently admitted , on 2/15/19, 4/11/19, 7/20/19, and 7/26/19. The clinical record lacked evidence that the facility issued a written bed hold policy/notice to the resident and/or legal representative for any of the transfers. 3. Documentation in Resident #53's clinical record indicated that he/she transferred to an acute care hospital on [DATE] and subsequently admitted . The clinical record lacked evidence that the facility issued a written bed hold notice to the resident and/or legal representative upon transfer. 4. Documentation in Resident #315 clinical record indicated that he/she was discharged /transferred to an acute hospital on [DATE] and 8/24/19 to the emergency room , and subsequently admitted . The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the resident and/or legal representative. On 8/28/19 at 3:00 pm in an interview with the surveyor, the Administrator confirmed that the facility does not provide such notices at the time of transfers to the hospital. | 2020-09-01 |
| 200 | 200 | BREWER CENTER FOR HEALTH & REHABILITATION, LLC | 205062 | 74 PARKWAY SOUTH | BREWER | ME | 4412 | 2018-01-30 | 732 | B | 1 | 0 | L3P511 | > Based on observation and interview, the facility failed to post in a prominent location for residents and visitors to view, the current daily nurse staffing information that included the facility name, day of the month, resident census, a breakdown of the total number of nursing staff responsible for direct resident care and total hours worked for each shift, for 1 of 2 survey days (1/29/18). Finding: On 1/29/18 at 5:05 p.m. , two surveyors observed the daily nurse staffing information posted near the Chamberlain Dining Room entrance with the date of (MONTH) 3, (YEAR). On 1/29/18 at 5:40 p.m., a surveyor confirmed this finding with the Administrator. On 1/29/18 at 6:00 p.m., a surveyor further confirmed that the current daily nurse staffing was not posted when the surveyors entered the building with the Director of Nursing. | 2020-09-01 |
| 205 | 205 | BREWER CENTER FOR HEALTH & REHABILITATION, LLC | 205062 | 74 PARKWAY SOUTH | BREWER | ME | 4412 | 2019-03-08 | 655 | B | 0 | 1 | 7MOS11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure a baseline care plan was developed and implemented within 48 hours that included the instructions needed to provide minimum healthcare information necessary to properly care for 2 of 5 sampled new admission residents (#102 and #11). Findings: 1. On 3/7/19, Resident #102's clinical record was reviewed and revealed that Resident #102 was admitted to the facility on [DATE] but a baseline care plan wasn't completed until 2/25/19, 1 day late. On 3/7/19 at approximately 2:30 p.m., a surveyor confirmed the above finding with the Director of Nursing Services. 2. On 3/8/19, Resident #11's clinical record was reviewed and revealed that Resident #11 was admitted to the facility on [DATE] and a baseline care plan wasn't completed until 2/25/19, 1 day late. On 3/8/19 at 9:14 a.m., a surveyor confirmed the above finding with the Facilities Clinical Specialist. | 2020-09-01 |
| 238 | 238 | CLOVER MANOR | 205063 | 440 MINOT AVE | AUBURN | ME | 4210 | 2017-07-13 | 428 | B | 1 | 0 | NKBI11 | > Based on interview and record review the facility failed to ensure the pharmacists completed a medication drug regimen review monthly on 2 of 6 residents sampled (#1 and #2). Findings: 1. In review of Resident #1's clinical record, there was no evidence that the medication drug regimen review was completed for the month of (MONTH) (YEAR). 2. In review of Resident #2's clinical record, there was no evidence that the medication drug regimen review was completed for the month of Feb (YEAR). On 7/10/17 at 1:37 p.m. the surveyors confirmed the above findings with the Director of Nursing. | 2020-09-01 |
| 248 | 248 | CLOVER MANOR | 205063 | 440 MINOT AVE | AUBURN | ME | 4210 | 2017-12-14 | 655 | B | 0 | 1 | 7C6H11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a baseline care plan was developed and implemented within 48 hours that included the instructions needed to provide minimum healthcare information necessary to properly care for 2 of 2 residents reviewed for new admissions (#353, #354). Findings: 1. In review of Resident #353's medical record, he/she was admitted in early (MONTH) (YEAR) with a primary [DIAGNOSES REDACTED]. As of 12/14/17 there was no evidence of a base line care plan that included the instructions necessary to properly care for Resident #353, in the area of [MEDICAL CONDITION]. 2. In review of Resident #354's medical record, he/she was admitted in early (MONTH) (YEAR) with a primary [DIAGNOSES REDACTED]. As of 12/14/17 there was no evidence of a base line care plan that included the instructions necessary to properly care for Resident #354, in the area of [MEDICAL CONDITION] with acute exacerbation. On 12/14/17 at 1:27 p.m., a surveyor confirmed the above findings with the Director of Nursing. | 2020-09-01 |
| 262 | 262 | ROSS MANOR | 205064 | 758 BROADWAY | BANGOR | ME | 4401 | 2018-03-09 | 623 | B | 1 | 0 | 9SQ811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record reviews and interviews, the facility failed to issue a written transfer/discharge notice to a resident or their legal representative for a facility-initiated transfer/discharge for 2 of 2 sampled residents transferred/discharged to an acute care facility (#82 and #234). Findings: 1. Documentation in Resident #82's clinical record indicated that he/she was admitted to the facility on [DATE] and discharged /transferred to an acute hospital on [DATE]. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the resident and/or legal representative. On 3/7/18 at 9:17 a.m., during an interview with a surveyor, the Director of Nursing (DON) stated that she was unable to find evidence of the written transfer/discharge notice for Resident #82. 2. Documentation in Resident #234's clinical record indicated that he/she was discharged /transferred to an acute care hospital on [DATE]. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the resident and/or legal representative. On 3/7/18 at 1:10 p.m., during an interview with a surveyor, the Medical Records/Admission person stated that the Charge Nurses are responsible for completing this form and she was unable to locate a written transfer/discharge notice for Resident #82 and #234 in the clinical records. The surveyor confirmed this finding at this time. | 2020-09-01 |
| 272 | 272 | RIVER RIDGE CENTER | 205065 | 3 BRAZIER LANE | KENNEBUNK | ME | 4043 | 2020-01-16 | 623 | B | 0 | 1 | Q3ER11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to issue a written transfer/discharge notice to residents or their representative for a facility-initiated transfer/discharge for 2 of 3 sampled residents transferred/discharged to an acute care facility (Residents #33 and #57). Findings: 1. On record review, the surveyor noted Resident #33 transferred to an acute care facility on 11/4/19 for further evaluation and treatment. The surveyor could not locate evidence that a written transfer/discharge notice was provided to the resident's representative. On 1/15/20 at 1:35 p.m., the Charge Nurse informed the surveyor she could not locate any evidence that the discharge/transfer notice was provided to the resident representative. The surveyor later confirmed the finding during an interview with the Director of Nursing and Administrator on 1/15/20 at 3:15 p.m. who confirmed a clear process was not in place to consistently insure a written notice is provided to the resident representatives. 2. On record review, the surveyor noted Resident #57 had transferred to an acute care facility on 11/15/19 for further evaluation and treatment of [REDACTED]. The surveyor could not locate evidence that a written transfer/discharge notice was provided to the resident's guardian. On 1/16/20 at 9:22 a.m., in an interview with the Administrator, the finding was discussed. The surveyor confirmed the finding for lack of evidence regarding written transfer notice provided to Resident's guardian. | 2020-09-01 |
| 278 | 278 | RIVER RIDGE CENTER | 205065 | 3 BRAZIER LANE | KENNEBUNK | ME | 4043 | 2018-04-05 | 584 | B | 0 | 1 | FXXO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to ensure resident areas were maintained in a clean and homelike environment during 3 of 4 survey days on 3 of 3 units. Findings: On 4/3/18 at 12:00 p.m., during facility tour with 2 surveyors present, the Administrator, Director of Nursing, Environmental Services Director, and head of Housekeeping/Laundry, the following findings were observed and confirmed: Resident Room #M04 on Mousam River Unit had mal-odor which permeated from the resident room into the Arrowhead pod with other resident rooms and 2 dining/common areas in close proximity, thus creating an un-homelike environment. This finding was observed by one surveyor on 4/2/18 at 10:38 a.m., again on 4/3/18 at 8:35 a.m. by 2 surveyors and then on environmental tour with facility staff present on 4/3/18 at 12:00 p.m. On 4/5/18, there was improved odor quality following cleaning. The lower portion of the walls that were carpeted outside the Kennebunk River Unit dining/common area contained dust, debris and gouges. Resident Room #S01 on Saco River Unit had a bedside table with laminate that had lifted up over one side of the table, creating an uncleanable surface. The facility removed the bedside table and replaced it with a new one following the tour. Resident Room #M10 on Mousam River Unit had corners of the closet walls that were scraped and the bathroom ceiling tile had a rust colored spot. The facility repaired the areas after the tour. Resident room [ROOM NUMBER]'s bathroom wall had exposed sheet rock above the floor board near the toilet. The facility repaired the area after the tour. The Emergency Carts on the Mousam River, Kennebunk River and Saco River Units, each had a suction machine and oxygen tank that were covered with visible dust debris on the equipment. The facility cleaned the areas after the tour. In the outside hallway near the kitchen door, the cove base had 2 areas that needed reinforcing, one on the outside … | 2020-09-01 |
| 281 | 281 | RIVER RIDGE CENTER | 205065 | 3 BRAZIER LANE | KENNEBUNK | ME | 4043 | 2018-04-05 | 842 | B | 0 | 1 | FXXO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to accurately document interventions utilized to manage behaviors prior to the administration of as needed [MEDICAL CONDITION] medications for 1 of 5 residents reviewed for unnecessary medications (Resident #22). Finding: On review of Resident #22's clinical record, the surveyor noted an order, initiated 1/10/18, for the antidepressant, [MEDICATION NAME], to be given twice a day as needed for anxiety. On review of the 3/2018 and 4/2018 electronic Medication Administration Record, [REDACTED]. Resident #22 received [MEDICATION NAME] 11 times in (MONTH) (3/1/18, 3/7/18, 3/12/18, 3/14/18, 3/15/18, 3/21/18, 3/22/18, 3/28/18, 3/29/18, 3/31/18 and 4/1/18) and once in (MONTH) (4/1/18). On review of the Resident's electronic and paper clinical record, the surveyor could not locate documented evidence that interventions were attempted prior to administering an as needed [MEDICAL CONDITION] medication throughout (MONTH) (YEAR) but did note documentation of unsuccessful interventions on the Behavior Monitoring and Interventions sheet for 4/1/18. During the 4 days of the survey, the surveyor noted multiple interventions utilized to decrease the Resident #22's behaviors such as 1:1, arts, snacks, socialization, card games and board games. On 4/4/18 at 8:49 a.m., during an interview with a surveyor, a Certified Nursing Assistant (CNA) who works primarily during the day shift stated Resident #22 responds well to 1:1 activities when he/she demonstrates anxiety or agitation by making animal noises or banging things on his chair, the table or the wall. On 4/4/18 at 2:15 p.m., in an interview with the Director of Nursing, the surveyor confirmed that the clinical record did not support the utilization of non-pharmacological prior to the administration of an as needed [MEDICAL CONDITION] medication. On 4/5/18 at 6:15 a.m., in an interview with a Registered Nurse (RN) who works 7 p.m. to 7 a.m… | 2020-09-01 |
| 294 | 294 | COVE'S EDGE | 205067 | 26 SCHOONER STREET | DAMARISCOTTA | ME | 4543 | 2017-07-27 | 253 | B | 0 | 1 | 5J3U11 | Based on observations and interviews, the facility failed to maintain in good repair and sanitary condition resident room walls, resident room woodwork, a medication storage room wall and cabinets, resident room furniture, resident area floors, a privacy curtain, common area baseboard, a bathroom door, common area carpeting, and a strong urine odor for 3 of 4 days of survey. Finding: On 07/26/2017 at 8:25 a.m., an environmental tour was conducted. The following were observed: The walls were marred and/or scratched in resident rooms and resident bathrooms: -Room # 112(bathroom above baseboard) -Room #105 (board behind bed-B), -Room #109 (above baseboard in bathroom) -Room #127(walls and board behind bed-B and bathroom) The walls were marred and/or scratched and cabinets had sticky, tape like substance on the exterior creating an uncleanable surface: -Medication room shared by the Periwinkle and Hummingbird Units The nightstands were marred missing wood and /or laminate: -Room #105 (bed-B) -Room #122 (bed -B) -Room #127 The bathroom floor was stained around the base of the toilet -Room #103/#105(shared bathroom) The floor is gouged, creating an uncleanable surface: -Room #109 (between the beds) The privacy curtain was stained -Room: #103(bed-A) The baseboard was marred and/or chipped at the corner of the dining room entrance: -Hummingbird Unit. The bathroom door kick plate was chipped and scratched: - Room #105 The hallway floor carpeting was stained: -Hummingbird Unit and -Periwinkle Unit Strong urine odor noted: -Room #122 -Room #124 -Periwinkle Unit common hallway On 7/26/17 from 8:25 a.m. - 9:15 a.m., a surveyor confirmed the finding in an interview with the Facility Administrator and the Senior Facility's Manager. | 2020-09-01 |
| 305 | 305 | SPRINGBROOK CENTER | 205068 | 300 SPRING ST | WESTBROOK | ME | 4092 | 2018-04-12 | 812 | B | 0 | 1 | 3T2F11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to remove unlabeled, expired and/or out of date food items from 3 of 7 resident snack refrigerators (Wayside, Mayflower, and [NAME] House). Findings: On [DATE] between 7:30 a.m. to 8:00 a.m., the facility resident snack refrigerators were observed to contain unlabeled, expired, and/or out of date food items which were available for resident use. 1.) Wayside Unit, first floor, contained the following food items: * One open, unsecured bread package with manufacture date of [DATE] on the bag. * One closed container of MUUNA Cottage Cheese, manufacture date of [DATE] stamped on the container, unopened with no resident name on the food item. * One closed container of Activa Low Fat Yogurt, Black Berry, with manufacture date stamp of [DATE] and with no resident name on the food item. * One closed container of Dannon Lite and Fit Greek Yogurt, with manufacture date stamp of [DATE] and with no resident name on the food item. * One undated clear plastic drink cup with an orange liquid with a straw in the lid. * One closed small bottle of Cranberry drink with a manufacture date stamp of [DATE] on the bottle and with no resident name on the food item. On [DATE] at 7:50 a.m., the surveyor confirmed the above findings with the Director of Nursing (DON). The DON discarded the unlabeled/undated/expired food items from the resident's snack refrigerator. On [DATE] between 8:15 a.m. to 8:45 a.m., the facility resident snack refrigerators on the third floor was observed to contain expired, and/or out of date food items which were available for resident use. 2.) The Mayflower unit contained one quart size container of V8 Fusion Peach Mango drink which was opened but contained no opening date, with manufacture date stamp of [DATE] on the bottle. 3.) The [NAME] House unit contained one unopened pouch of Graduates Grabbers Pear and Squash which was tightly swollen with a Best by manufacture date… | 2020-09-01 |
| 330 | 330 | PINE POINT CENTER | 205070 | 67 PINE POINT RD | SCARBOROUGH | ME | 4074 | 2019-03-07 | 623 | B | 0 | 1 | R6EW11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to issue written transfer/discharge notices to residents' legal representatives for a transfer/discharge for 2 of 3 sampled residents transferred/discharged to an acute care facility (Resident #29 and #49). Findings: 1. Documentation in Resident #29's clinical record indicated that he/she was discharged /transferred to an acute care facility on 1/29/19 for treatment of [REDACTED]. The finding was confirmed by a surveyor in an interview with the Administrator on 3/5/19 at 2:00 p.m., stating the notices were not sent to the resident representative. 2. Documentation in Resident #49's clinical record indicated that he/she was discharged /transferred to an acute care facility on 1/24/19 for planned surgery. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the resident's legal representative. The finding was confirmed by a surveyor in an interview with the Administrator on 3/5/19 at 2:00 p.m., stating the notices were not sent to the resident representative. | 2020-09-01 |
| 331 | 331 | PINE POINT CENTER | 205070 | 67 PINE POINT RD | SCARBOROUGH | ME | 4074 | 2019-03-07 | 625 | B | 0 | 1 | R6EW11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to issue written bed hold notices to residents' legal representatives for a transfer/discharge for 2 of 3 sampled residents transferred/discharged to an acute care facility (Resident #29 and #49). Findings: 1. Documentation in Resident #29's clinical record indicated that he/she was discharged /transferred to an acute care facility on 1/29/19 for treatment of [REDACTED]. The finding was confirmed by a surveyor in an interview with the Administrator on 3/5/19 at 2:00 p.m., stating the notices were not sent to the resident representative. 2. Documentation in Resident #49's clinical record indicated that he/she was discharged /transferred to an acute care facility on 1/24/19 for planned surgery. The clinical record lacked evidence that the facility issued a written bed hold notice to the resident's legal representative. The finding was confirmed by a surveyor in an interview with the Administrator on 3/5/19 at 2:00 p.m., stating the notices were not sent to the resident representative. | 2020-09-01 |
| 341 | 341 | MARSHWOOD CENTER | 205072 | 33 ROGER STREET | LEWISTON | ME | 4240 | 2019-01-22 | 623 | B | 0 | 1 | IF4Z11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to notify the resident and the resident's representative of a transfer or discharge and the reasons for the move in writing and in a language and manner that they understand for 1 of 3 episodes of facility-initiated transfer/discharge reviewed (Residents #73). Findings: On review of the clinical record for Resident #73, the surveyor noted the resident was transferred to an acute care hospital on [DATE] for respiratory distress with fever, and was subsequently admitted . The clinical record lacked evidence that Resident #73 and their representative were notified in writing of the transfer/discharge. On 1/17/19, at 2:30 p. m., in an interview with a surveyor and the Licensed Social Worker (LSW), the finding was discussed. The surveyor confirmed the finding for no written transfer/discharge notice at the time of the interview. | 2020-09-01 |
| 342 | 342 | MARSHWOOD CENTER | 205072 | 33 ROGER STREET | LEWISTON | ME | 4240 | 2019-01-22 | 625 | B | 0 | 1 | IF4Z11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to provide the resident and the resident representative with a written notice which specifies the duration of the bed-hold policy upon transfer to the hospital for 1 of 3 episodes of transfer to the hospital reviewed (Resident #73). Findings: A review of Resident #73's clinical record, the surveyor noted the resident was transferred to acute care hospital on [DATE] for respiratory distress with fever and was subsequently admitted and again on 12/11/18 for respiratory distress with fever during antibotic treatment, and was subsequently readmitted . A review of the clinical record indicated no evidence that the Resident #73, and their representative, were provided written notice of the bed-hold policy for this transfer. On 1/17/19, at 2:30 p. m., in an interview with a surveyor and the Licensed Social Worker (LSW), the findings were discussed. The surveyor confirmed the findings during the interview. | 2020-09-01 |
| 355 | 355 | MARSHWOOD CENTER | 205072 | 33 ROGER STREET | LEWISTON | ME | 4240 | 2018-02-09 | 565 | B | 0 | 1 | F0KU11 | Based on review of resident counsel meeting minutes and interview, the facility failed to act promptly upon the grievances and recommendations of the resident counsel. Finding: On 02/07/18 from 10:00 a.m. to 11:00 a.m., resident counsel members indicated that we express our concerns and then they are never acted on. Resident counsel members indicated that staff members are constantly texting on the units and in resident rooms. The members indicated that they have brought up the concerns many times and it continues to happen. In review of resident counsel meeting minutes from (MONTH) (YEAR) to (MONTH) (YEAR), each month contained complaints of cell phone usage on units/resident rooms. The resident counsel meeting minutes lacked evidence that this area of concern was addressed and the outcome conveyed to the resident counsel. In an interview with the Activities Director on 02/09/18 at 1:56 p.m. he/she indicated that when the resident counsel voice a concern he/she fills out a grievance and gives it to the department indicated. The Activity Director stated that he/she does not usually get the outcome of the concern and does not document the outcome of the concern noted. This finding was confirmed with the Activities Director at this time. | 2020-09-01 |
| 356 | 356 | MARSHWOOD CENTER | 205072 | 33 ROGER STREET | LEWISTON | ME | 4240 | 2018-02-09 | 572 | B | 0 | 1 | F0KU11 | Based on review of resident counsel meeting minutes and interview, the facility failed to inform residents of his or her rights during the resident's stay. Finding: On 02/07/18 from 10:00 a.m. to 11:00 a.m., resident counsel members indicated that the rights of resident's are not reviewed with the resident counsel. In review of resident counsel meeting minutes from (MONTH) (YEAR) to (MONTH) (YEAR), the minutes lacked evidence that resident's rights were reviewed with the resident counsel. In an interview with the Activities Director on 02/09/18 at 1:56 p.m. he/she indicated that he/she does not review the resident rights in the meetings. This finding was confirmed with the Activities Director at this time. | 2020-09-01 |
| 405 | 405 | SEASIDE REHAB & HEALTH CARE | 205074 | 850 BAXTER BOULEVARD | PORTLAND | ME | 4103 | 2017-05-26 | 257 | B | 0 | 1 | FTBL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to maintain comfortable temperature levels ranging from 71 to 81 degrees Fahrenheit on 3 of 6 wings. Findings: On 5/22/17 and 5/23/17, 5 residents (#20, #204, #148, #302, and #308) expressed concerns of the facility air temperatures being cold in the facility. On 5/24/17 between 8:35 a.m. and 9:35 a.m., during a tour of the facility, the surveyor and the Environmental Services Director observed and confirmed the following temperatures below 71 degrees Faharenheit: 1. Wing 2 corridor temperature was 69 degrees Fahrenheit 2. Resident room [ROOM NUMBER] was 68 degrees Fahrenheit 3. Resident room [ROOM NUMBER] was 69 degrees Fahrenheit 4. Resident room [ROOM NUMBER] was 69 degrees Fahrenheit 5. Resident room [ROOM NUMBER] was 65 degrees Fahrenheit 6. Resident room [ROOM NUMBER] was 65 degrees Fahrenheit 7. Resident room [ROOM NUMBER] was 70 degrees Fahrenheit 8. Resident room [ROOM NUMBER] was 70 degrees Fahrenheit 9. Wing 5 common area was 70 degrees Fahrenheit | 2020-09-01 |
| 417 | 417 | ISLAND NURSING HOME & CARE CTR | 205075 | 587 NORTH DEER ISLE RD | DEER ISLE | ME | 4627 | 2017-08-02 | 156 | B | 1 | 1 | MHYX11 | > Based on record reviews and interviews, the facility failed to issue a Skilled Nursing Facility (SNF) Determination on Continued Stay denial letter, at least two days prior to the end of services, for 1 of 1 sampled Residents that was discharged from skilled care and left the facility to go home (#2). Finding: On 8/2/17 at 1:55 p.m., a surveyor requested to review a copy of Resident #2's, Resident #6's, and Resident #8's Skilled Nursing Facility (SNF) Determination on Continued Stay denial letters. The Admissions Coordinator/Billing Specialist provided a signed denial letter for Resident #6 and Resident #8 who were discharged from skilled services but remained in the facility. The Admissions Coordinator/Billing Specialist stated that she didn't have a denial letter for Resident #2 because Resident #2 went home and she doesn't give Residents a letter if they go home. On 8/2/17 at 2:00 p.m., Resident #2's clinical record was reviewed with the Administrator, the Director of Nursing, the Admissions Coordinator/Billing Specialist, and the Intermediate Care Facility (ICF) Coordinator. The clinical record revealed that Resident #2 was discharged from Physical Therapy on 3/7/17 and was discharged from Occupational Therapy on 3/8/17 because Resident #2 had met their goals. Resident #2 was discharged from the facility and went home on 3/9/17. At this time, the surveyor confirmed that Resident #2 was not given a denial letter 2 days prior to discharge from skilled care. | 2020-09-01 |
| 430 | 430 | ISLAND NURSING HOME & CARE CTR | 205075 | 587 NORTH DEER ISLE RD | DEER ISLE | ME | 4627 | 2018-08-23 | 623 | B | 1 | 1 | 056Y11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record reviews and interviews, the facility failed to provide the resident and/or resident representative a written notice with the reason for a transfer/discharge to the hospital for 2 of 2 sampled residents (#20 and #37). In addition, the facility failed to notify the Ombudsman of the facility initiated resident transfer/discharges for the months (MONTH) (YEAR) through (MONTH) (YEAR). Findings: 1. Documentation in Resident #20's clinical record, under the nurse's note section, indicates that Resident #20 was transferred to the hospital with quiac positive stool (blood in stool). There is no evidence in the clinical record that the resident or resident representative was provided a written transfer/discharge notice that indicated the reason for the transfer. 2. Documentation in Resident #37's clinical record indicates that Resident #37 was transferred to the hospital on [DATE] for dangerous behaviors. There is no evidence in the clinical record that the resident or resident representative was provided a written transfer/discharge notice that indicated the reason for the transfer. On 8/23/18 at 1:40 p.m., a surveyor confirmed in an interview with the Registered Nurse-Charge Nurse, that she fills the transfer forms out electronically and gives a copy to the ambulance attendant and one for the hospital, but she does not provide a copy of the transfer/discharge notice to the resident or to the resident representative. On 8/23/18 at 1:00 p.m., a surveyor confirmed in an interview with the Finance and Admission Manager, that she does not provide residents or representatives with a written transfer/discharge notice and stated she thought the Administrator sent the notices to the Ombudsman. On 8/23/18 at 1:20 p.m., the current Administer confirmed in an interview, that he spoke with the Ombudsman office and they told him the last notices sent to them was in (MONTH) of (YEAR). | 2020-09-01 |
| 438 | 438 | ISLAND NURSING HOME & CARE CTR | 205075 | 587 NORTH DEER ISLE RD | DEER ISLE | ME | 4627 | 2019-09-12 | 550 | B | 0 | 1 | ZGMU11 | Based on observations and interviews, the facility failed to promote care for residents in a manner that maintains each resident's dignity in the area of incontinence care observed on 2 of 3 Wings (North and East). Findings: On 9/9/19 on the North Wing, a surveyor observed the following incontinence care products which was visible to other passersby while walking down the hallway: At 11:45 a.m., a washable incontinence pad (Dundee) was visible on Resident #3's bed. At 11:57 a.m., a surveyor observed a disposable incontinence pad (chux) visible on top of the covers on Resident #1's bed and Resident #24's bed. A second observation of Resident #1 and #24's bed was conducted at 12:59 p.m. with Resident #1 in bed and a chux still visible on top of the covers on Resident #24's bed. On 9/11/19 at 9:20 a.m., a surveyor was near the nurse's station located between the North and East Wings. The area in front of the nurse's station was busy with multiple residents in the area. The surveyor was leaving the area when Licensed Practical Nurse (LPN) #1 was heard asking staff who has Resident #13 because he/she needs to be changed, in a voice loud enough for other resident's to hear. At 9:30 a.m., during an interview with LPN #1, the surveyor pointed towards a Resident who was sitting in a wheelchair in front of the whirlpool/bathroom and asked if that was Resident #13. LPN #1 stated yes and she was waiting to be changed. The surveyor explained that she heard that a few minutes ago when LPN #1 asked who had Resident #13 because he/she needed to be changed. The surveyor confirmed that the statement made in front of other residents towards Resident #13's incontinence care needs was not stated in a dignified manner. On 9/11/19 at 11:43 a.m., a surveyor discussed the observations of the incontinence pads observed on 9/9/19 for Resident #3, #1, and #24 with the Director of Nursing (DON). During this interview, the DON and surveyor were walking down the North Wing and observed a chux on Resident #10's pillow which was visible to passe… | 2020-09-01 |
| 439 | 439 | ISLAND NURSING HOME & CARE CTR | 205075 | 587 NORTH DEER ISLE RD | DEER ISLE | ME | 4627 | 2019-09-12 | 561 | B | 0 | 1 | ZGMU11 | Based on observations and interviews, the facility failed to ensure that residents were allowed to choose their preferences for meals offered by the facility for Breakfast, Lunch and Dinner. Findings: The facilities admission contract page 10 under Dining Services indicates that Daily specials (main meal or second choice meal) are posted in the dining room. Residents wishing to have an alternate meal to the daily specials may choose any item from the alternatives posted (A-La-Carte Menu) on the BB'S kitchen menu board. Your order will be taken, and you will be served as you would be in a restaurant. On 9/10/19 at 1:00 p.m., during a resident group meeting, residents present at the meeting stated that they are not offered alternate meals as described in the admission contract. Resident # 13 stated he/she has been a resident at the facility for a while and they remembered being offered the A- La-Carte Menu in the past, but they haven't provided him/her with options off the menu in a long time. Residents #20, #29 and #15 stated they have not been made aware of the A-La-Carte Menu or the options they could have. On 9/10/19 at 2:00 p.m., during an interview with the Administrator, the surveyor confirmed that the Residents are not being allowed to choose their preferences for their meals, he stated that they have an A-La-Carte Menu and that staff are supposed to be offering the menu when the residents fill out their diet slips for the day. They are supposed to be asking the residents what they would like, if they don't want the main meal or the second choice they are to be offered options from the A-La-Carte Menu. He then stated staff are currently not doing this. | 2020-09-01 |
| 440 | 440 | ISLAND NURSING HOME & CARE CTR | 205075 | 587 NORTH DEER ISLE RD | DEER ISLE | ME | 4627 | 2019-09-12 | 582 | B | 0 | 1 | ZGMU11 | Based on record reviews and interviews, the facility failed to ensure the Notice of Medicare Provider Non-Coverage (NOMNC) Form , which included appeal rights, was provided at least two days prior to the resident's last covered day for 3 of 3 residents whose Medicare Part A services were discontinued (Residents #15, #24, and #34). In addition, the facility failed to ensure the Skilled Nursing Facility (SNF)Advance Beneficiary Notice (SNFABN) Form , which included appeal rights and liability of payment was provided to 2 of 2 residents who remained living in the facility after Medicare Part A services were discontinued (Resident #15 and #24). Findings: On 9/9/19, the SNF Beneficiary Protection Notification Review forms were received from the facility for Resident #15, #24, and #34. Each form indicated that the facility initiated the discharge from Medicare Part A services when benefit days were not exhausted and neither NOMNC Form or SNFABN Form were issued. 1. Resident #15's SNF Beneficiary Protection Notification Review form indicated that the last day of Medicare Part A services was 7/24/19. Resident #15 remained in the facility after services ended. The facility was unable to provide the NOMNC Form or the SNFABN Form for Resident #15. 2. Resident #24's SNF Beneficiary Protection Notification Review form indicated that the last day of Medicare Part A services was 5/7/19. Resident #24 remained in the facility after services ended. The facility was unable to provide the NOMNC Form or the SNFABN Form for Resident #24. 3. Resident #34's SNF Beneficiary Protection Notification Review form indicated that the last day of Medicare Part A services was 6/30/19. The facility was unable to provide the NOMNC Form for Resident #34. On 9/10/19 at 11:30 a.m., during an interview with a surveyor, the Licensed Social Worker (LSW) explained she was new to Long Term Care. She was unaware of the NOMNC Form or the SNFABN Form . On 9/10/19 at 12:04 p.m., during an interview with a surveyor, the Director of Business Operations stated t… | 2020-09-01 |
| 444 | 444 | ISLAND NURSING HOME & CARE CTR | 205075 | 587 NORTH DEER ISLE RD | DEER ISLE | ME | 4627 | 2019-09-12 | 712 | B | 0 | 1 | ZGMU11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interview, the facility failed to ensure the Physician made required visits, reviewed the total plan of care, and wrote a progress note every 30 days for 2 of 3 newly admitted sampled residents reviewed (Resident #8 and #9). Findings: The facility's policy, Medication Orders indicates that Physician Orders/Progress Notes must be signed and dated every 30 days. This may be changed to every 60 days after the first 90 days of the resident's admission, provided it is approved by the Attending Physician and the Utilization Review Committee. 1. During clinical record review for Resident #8, the surveyor noted that he/she was admitted to Long Term Care on 6/18/19 from their assisted living section of the facility. The initial physician visit, first 30 day was done on 6/20/19, with block orders signed and a progress note written. The second 30-day visit was completed on 7/18/19 with block orders being signed and a progress note written. The third 30-day visit was due on 8/17/19, with the 10-day grace period allowed he/she would have been due no later than 8/27/19. Block orders and visit is currently 15 days late after the allowed grace period. On 9/11/19 at 11:02 a.m., two surveyors confirmed with the Minimum Data Set Coordinator the above finding. 2. Documentation in Resident #9's clinical record, under the physician order [REDACTED]. The next Physician Block Orders were signed on 7/25/19 and had a 30 day renewal period, with the last Physician Block Orders with a 30 day renewal due by 9/3/19 (including a 10 day grace period). The Physician visited on 8/15/19 and wrote a progress note but as of 9/11/19, there is no evidence of the Physician Block Orders signed and is now 8 days late, beyond the grace period. On 9/11/19 at 11:02 a.m., during an interview with the Minimum Data Set (MDS) Coordinator, two surveyors confirmed these findings. | 2020-09-01 |
| 464 | 464 | AUGUSTA CENTER FOR HEALTH & REHABILITATION, LLC | 205077 | 188 EASTERN AVE | AUGUSTA | ME | 4330 | 2019-10-10 | 623 | B | 0 | 1 | D44K11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to issue written transfer/discharge notices to the resident and/or resident's representative for a facility-initiated transfer/discharge for 2 of 2 sampled residents transferred/discharged to an acute care facility (Residents #21 and #67). Findings: 1. Documentation in Resident #21's clinical record indicated that he/she was discharged /transferred to an acute hospital on [DATE]. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the resident and/or resident representative. On 10/8/19 at 2:37 p.m., during an interview with the Director of Nursing, the surveyor confirmed that the clinical record did not contain evidence that the written transfer/discharge notice was given to the resident and/or resident representative. 2. Documentation in Resident #67's clinical record indicated that he/she was discharged /transferred to an acute hospital on [DATE]. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the resident and/or resident representative. On 10/10/19 at 10:09 a.m., during an interview with the Social Worker, the surveyor confirmed that the clinical record did not contain evidence that the written transfer/discharge notice was given. | 2020-09-01 |
| 465 | 465 | AUGUSTA CENTER FOR HEALTH & REHABILITATION, LLC | 205077 | 188 EASTERN AVE | AUGUSTA | ME | 4330 | 2019-10-10 | 625 | B | 0 | 1 | D44K11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to issue a written bed hold notice to a known family member or legal representative for 2 of 2 sampled residents who had been transferred to an acute care facility (Residents #21and #67). Findings: 1. Documentation in Resident #21's clinical record indicated that he/she was discharged /transferred to an acute hospital on [DATE]. The clinical record lacked evidence that the facility issued a written bed hold notice to the resident and/or resident representative. On 10/8/19 at 2:37 p.m., during an interview with the Director of Nursing, the surveyor confirmed that the clinical record did not contain evidence that a written bed hold notice was given to the resident and/or resident representative. 2. Documentation in Resident #67's clinical record indicated that he/she was discharged /transferred to an acute hospital on [DATE]. The clinical record lacked evidence that the facility issued a written bed hold notice to the resident and/or resident representative. On 10/10/19 at 10:09 a.m., during an interview with the Social Worker, the surveyor confirmed that the clinical record did not contain evidence that a written bed hold notice was given to the resident and/or resident representative. | 2020-09-01 |
| 479 | 479 | WINSHIP GREEN CENTER FOR HEALTH & REHAB, LLC | 205078 | 51 WINSHIP ST | BATH | ME | 4530 | 2017-04-13 | 253 | B | 0 | 1 | MHZ711 | Based on observations and interviews, the facility failed to ensure that resident bathing areas were maintained in good repair for 2 of 3 shower rooms. Findings: 1. On 4/10/17 from 9:00 - 10:00 a.m., during the initial tour of the facility, 3 surveyors observed that the Seguin shower room had cracked and broken floor tiles and shower tiles. A plastic sheeting was tacked up on the back wall of the shower. 2. On 4/10/17, during the initial tour of the facility, 3 surveyors observed that the Passport shower room had cracked and broken floor and shower tiles. On 4/10/17 at 9:30 a.m., in an interview with the maintenance worker, it was explained to surveyors that caulking had been temporarily applied to the back of the Segun shower wall and was covered with plastic sheeting until repairs could be completed. The maintenance worker stated bids to have the shower rooms repaired and retiled had been requested in November, (YEAR). On 4/11/17 at 11:15 a.m., the Administrator confirmed the shower rooms were in disrepair and that an estimate for work was completed in November, (YEAR), however, capital funding had still not been approved. | 2020-09-01 |
| 494 | 494 | BRENTWOOD CENTER FOR HEALTH & REHABILITATION, LLC | 205079 | 370 PORTLAND ST | YARMOUTH | ME | 4096 | 2018-04-17 | 725 | B | 1 | 0 | NB9111 | > Based on observations, interviews and record review the facility failed to provide services by sufficient numbers of personnel to provide nursing care to residents on 1 of 3 units. Finding: On 4/17/18, the surveyor tested call bells in 5 resident rooms on 3 units. Of the 5 call bells tested , staff response time was 20-25 minutes to respond to 2 of the call bells tested in Resident Rooms #120 and #109 on the Skilled Unit. On 4/17/18 at 10:00 a.m., in an interview with a Registered Nurse, he/she stated the facility is short staffed, especially on day shift, making it challenging to meet resident care needs. On 4/17/18 at 11:42 a.m., in an interview with Resident #1, he/she stated call bell wait times can be excessive on the day shift, thus impeding on resident care. In review of clinical staffing schedules from (MONTH) 1, (YEAR) through (MONTH) 17, (YEAR), there were 5 days in which the facility was under staffing ratio on the following day shifts: 3/3/18, 3/29/18, 3/31/18, 4/1/18 and 4/15/18. On 4/17/18 at approximately 1:00 p.m., in an interview with the Director of Nursing, the surveyor reviewed investigative points related to staffing and confirmed the finding. | 2020-09-01 |
| 525 | 525 | GARDINER HEALTH CARE FACILITY | 205080 | PO BOX 520 | HOULTON | ME | 4730 | 2018-02-28 | 812 | B | 0 | 1 | 58CU11 | Based on observations and interviews, the facility failed to label whipped topping with a thaw date on 3 of 3 days of survey. (2/26/18, 2/27/18, 2/28/18) Findings: On 2/26/18, 2/27/18 and 2/28/18 during tours of the kitchen, a surveyor observed there were 5 thawed cartons of whipped topping that were not labeled with a thaw date in the walk-in refrigerator. Storage and handling instructions on the cartons was; once thawed unopened product keeps for 21 days in the refrigerator. The Surveyor confirmed these findings with the Food Service Manager at the time of the observations. | 2020-09-01 |
| 526 | 526 | GARDINER HEALTH CARE FACILITY | 205080 | PO BOX 520 | HOULTON | ME | 4730 | 2018-02-28 | 842 | B | 0 | 1 | 58CU11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to ensure a verbal Physician order [REDACTED].#33). Finding: On 2/26/18 at 2:30 p.m., Resident #33's clinical record was reviewed. The Physician orders, signed and dated 1/23/18, indicated Resident #33 had a Foley catheter. On 1/26/18 at 5:52 p.m., a clinical note entry was completed by Licensed Practical Nurse (LPN) #1 that indicated the Foley catheter was discontinued per Physician (MD) order with out incident. On 2/26/18 at 2:50 p.m., during an interview with a surveyor, the Unit Manager stated that she received a verbal order from the Physician to discontinue the Foley catheter on 1/26/18 and thought an order was written. The Unit Manager and surveyor reviewed Resident #33's Physician orders [REDACTED]. The surveyor confirmed with the Unit Manager that the clinical record lacked evidence of a written order to discontinue the Foley catheter, 31 days after it was removed. On 2/26/18 at 3:22 p.m., during an interview with a surveyor, LPN #1 stated she received the verbal order from the Unit Manager to remove the Foley catheter. | 2020-09-01 |
| 532 | 532 | GARDINER HEALTH CARE FACILITY | 205080 | PO BOX 520 | HOULTON | ME | 4730 | 2019-06-24 | 842 | B | 1 | 0 | 6FFV11 | > Based on clinical record review and interviews, the facility failed to ensure that a clinical record contained complete and accurate documentation for elopement interventions listed in a care plan 1 of 1 residents who has successfully eloped (Resident #1). Finding: On 6/24/19, Resident #1's clinical record was reviewed. Resident #1's current care plan included an intervention, added 5/29/19, for 30 minutes checks daily for the Certifiied Nursing Assistants (CNA) and for the Licensed Nurse to monitor and document Resident #1's whereabouts between 5 p.m. and 7 a.m. On 6/17/19, the Licensed Nurses are to now monitor and document Resident #1's whereabouts every hour between 5 p.m. and 7 a.m. On 6/24/19 at 1:00 p.m., during an interview with a surveyor, the Administrator finds the daily checks (every 15 minutes) paperwork for 6/14/19 - 6/17/19 for Resident #1 in her recycle pile not realizing that these were the originals. Review of these documents reveal that some of the dates are missing. The surveyor also confirms that some of the daily checks paperwork located in Resident #1's binder located at the nurse's station and in the clinical record are not filled out completely, are missing dates on the daily checks, and daily checks are missing completely. On 6/24/19 at 3:00 p.m., during an interview with a surveyor, the Director of Nursing (DON) stated that the intervention for the Licensed Nurses to monitor Resident #1 is on the Treatment Administration Record for the Nurses to sign off on but they are not always documenting Resident #1's whereabouts as directed by the care plan. The surveyor confirmed this finding at this time. On 6/24/19 at 3:15 p.m., during a joint interview with 2 CNAs and the DON, the surveyor asked the CNAs how often they are monitoring Resident #1's whereabouts. The CNAs report they check on Resident #1's whereabouts every 15 minutes and document this on the daily at the nurse's station and that they have never done 30 minute checks, always 15 minutes. On 6/24/19 at 3:25 p.m., during a joint i… | 2020-09-01 |
| 552 | 552 | GARDINER HEALTH CARE FACILITY | 205080 | PO BOX 520 | HOULTON | ME | 4730 | 2017-12-28 | 732 | B | 1 | 0 | SYIY11 | > Based on observations and interview, the facility failed to post the current daily nurse staffing information that includes the facility name, facility census, day of the month, a breakdown of the number of registered and licensed nursing staff responsible for direct resident care and indicate which shifts the numbers corresponded to, for 1 of 1 survey days. Findings: 1. On 12/28/17 at 10:15 a.m., a surveyor was unable to visualize the census and staffing posted. 2. On 12/28/17 at 3:08 p.m., a surveyor was unable to visualize the census and staffing posted. On 12/28/17 at 4:44 p.m., in an interview, a surveyor confirmed the finding with the Administrator. | 2020-09-01 |
| 556 | 556 | PINNACLE HEALTH & REHAB AT SANFORD | 205082 | 1142 MAIN ST | SANFORD | ME | 4073 | 2017-06-22 | 253 | B | 0 | 1 | 4T8Z11 | Based on observations and interview, the facility failed to ensure housekeeping services maintained a sanitary environment related to odors on 4 of 6 wings in the facility. Findings: First Floor Wing 1: -On 6/19/17 between 9:10 and 9:50 a.m., during the initial tour of the facility, 1 surveyor noted a strong urine odor in the hallway. First Floor Wing 3: -On 6/20/17 at 11:38 a.m., a surveyor noted a urine smell in the hallway. -On 6/21/17 at 6:39 a.m. a surveyor noted a urine odor in the hallway. Second Floor Wing 2: -On 6/19/17 between 9:10 and 9:50 a.m., during the initial tour of the facility, 2 surveyors noted a strong urine odor. -On 06/19/17 at 10:53 a.m., Resident #88 and his/her family member complained of strong urine odors at times. -On 6/19/17 at 11:57 a.m., a surveyor noted a very strong urine odor in the hallway. -On 6/20/17 at 11:38 a.m., a surveyor noted a strong urine odor in the hallway. -On 6/20/17 at 2:00 p.m., a surveyor noted a urine smell in the hallway. -On 6/21/17 at 6:39 a.m. a surveyor noted a urine odor in the hallway. On Second Floor Wing 3, Residents #37 and #39 stated during Stage 1 interviews that there is strong urine odor on the unit at times. On 6/20/17 at 3:30 p.m. during an interview with the surveyor, the Administer confirmed there are episodes of strong urine odors on some wings. | 2020-09-01 |
| 584 | 584 | HORIZONS LIVING AND REHAB CENTER | 205085 | 29 MAURICE DRIVE | BRUNSWICK | ME | 4011 | 2017-09-21 | 514 | B | 0 | 1 | LBFR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to maintain an accurate Medication Administration Record (MAR) in accordance with physician orders [REDACTED].#69). Finding: On 9/20/17, in review of Resident #69's record, he/she was diagnosed with [REDACTED]. On 6/22/17, the provider increased the scheduled Trazadone frequency to 25 mg twice daily (BID) and according to a Gradual Dose Reduction (GDR) signed by the Provider on 7/14/17 he/she ordered the discontinuation of Trazadone 25 mg PRN every 6 hours. Review of MAR's dated (MONTH) (YEAR) and (MONTH) (YEAR) reveals the PRN order remained on the MAR and as a result the resident received Trazadone 25 mg PRN on the following 5 dates after the medication had been discontinued: 7/16, 7/20, 7/29, 8/3, 8/4. On 8/8/17, the provider reinitiated the Trazadone 25 mg PRN. Following the incident the facility completed an incident report and the issue was corrected, this finding reflects past non-compliance. On 9/20/17 at 12:16 p.m., in an interview with the Director of Nursing (DON), he/she confirmed the past non-compliance finding. | 2020-09-01 |
| 591 | 591 | HORIZONS LIVING AND REHAB CENTER | 205085 | 29 MAURICE DRIVE | BRUNSWICK | ME | 4011 | 2019-10-24 | 730 | B | 0 | 1 | Q1W711 | Based on performance evaluation reviews and interview, the facility failed to complete a performance evaluation at least every twelve months for 4 of 4 Certified Nurse Assistant (C.N.[NAME]) performance evaluations reviewed (C.N.[NAME]#1, 2, 3 and 4). Findings: 1. A review of C.N.[NAME] #1's performance evaluations indicated that C.N.[NAME] #1 received a performance evaluation on 8/20/18. 2. A review of C.N.[NAME] #2's performance evaluations indicated that C.N.[NAME] #2 received a performance evaluation on 5/17/18. 3. A review of C.N.[NAME] #3's performance evaluations indicated that C.N.[NAME] #3 received a performance evaluation on 6/29/18. 4. A review of C.N.[NAME]#4's performance evaluations indicated that C.N.[NAME] #4 received a performance evaluation on 5/15/18. On 10/23/19 at 1:21 PM, in an interview with the Director of Nursing (DON) and the Licensed Practical Nurse (LPN), Nursing Support Services, the surveyor confirmed the 4 sampled CNA employee files lacked performance evaluations in the past 12 months. | 2020-09-01 |
| 592 | 592 | HORIZONS LIVING AND REHAB CENTER | 205085 | 29 MAURICE DRIVE | BRUNSWICK | ME | 4011 | 2019-10-24 | 947 | B | 0 | 1 | Q1W711 | Based on review of the facility's Staff Attendance records and interview, the facility failed to monitor and ensure Certified Nursing Assistants (CNAs) attended the required 12 hours of annual in-service education which included Abuse, Resident Rights and Dementia in-services for 2 of 4 randomly selected CNAs employed greater than 1 year (CNA #3 and #4). Findings: 1. Documentation on CNA #3's Staff Attendance sheet indicated a hire date of 5/5/16. The in-services documented between 10/2018 and 10/2019 indicated that CNA #3 received 6 hours of training. 2. Documentation on CNA #4's Staff Attendance sheet indicated a hire date of 11/12/15. The in-services documented between 10/2018 and 10/2019 indicated that CNA #4 received 3.33 hours of training and did not receive any dementia training. On 10/23/19 at 1:21 PM in an interview with the Director of Nursing (DON) and the Nursing Support Services Licensed Practical Nurse, the surveyor confirmed that both CNAs did not receive the required annual12 hours of training and that CNA #4 did not attend an in-service on Dementia in the past 12 months. | 2020-09-01 |
| 593 | 593 | PINNACLE HEALTH & REHAB AT N BERWICK | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2020-02-18 | 609 | B | 1 | 0 | EG5Z11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interviews the facility failed to report an incidents of potential neglect (elopement) to the Division of Licensing and Certification (State Survey Agency) and Adult Protective Services within 24 hours for 1 of 3 sampled residents with elopement risk potential. (Resident #1) Finding: Review of Resident #1's record reveals two incidents in which Resident #1 was found outside of the facility without the knowledge/supervision of facility staff, on 12/25/19 and again on 2/1/20. A review of Resident #1's Minimum Data Set, Version 3.0 assessment dated [DATE] under cognitive patterns indicates a moderate impairment. Further review reveals reportable incident forms were completed by the facility, however; the surveyor could not locate evidence that the two incidents of potential neglect (elopement) were reported to the State Survey Agency and Adult Protective Services within 24 hours as required. On 2/18/20 at 1:40 p.m., in an interview with the Administrator the surveyor confirmed the incidents of potential neglect (elopement) were not reported to the State Survey Agency and Adult Protective Services. | 2020-09-01 |
| 596 | 596 | PINNACLE HEALTH & REHAB AT N BERWICK | 205086 | 47 ELM ST | NORTH BERWICK | ME | 3906 | 2019-08-19 | 606 | B | 1 | 0 | IZH111 | > Based on interviews and record reviews, the facility failed to ensure employment of 1 of 6 sampled nursing staff did not have disciplinary action against their professional license by a state licensure body as a result of a finding of exploitation and misappropriation of resident funds. Finding: On 8/19/19, surveyor reviewed Registered Nurse #1's personnel record, who was hired at facility 6/4/19 with a New Hampshire multi-state license, she oriented 6/19-7/17/19 and worked 7/19/19 prior to termination. On 7/31/19, the facility notified the State of Maine that this nurse had an outstanding settlement for exploitation of a Resident in Vermont, having accepted money from a Resident and being brought before the New Hampshire State Board of Nursing. Although the facility had conducted background check and verified the nurse had an active license, the facility overlooked outstanding settlement against this nurse upon hire. On 8/19/19 at 10:45 am, in an interview with the Administrator, the surveyor confirmed the finding. | 2020-09-01 |
| 604 | 604 | OAK GROVE CENTER | 205091 | 27 COOL ST | WATERVILLE | ME | 4901 | 2017-02-02 | 278 | B | 0 | 1 | OWYP11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to ensure that the Minimum Data Set (MDS) Version 3.0 was accurately coded in the areas of medication, [DIAGNOSES REDACTED].#76 and #75). FINDINGS: 1. Resident #76's signed physician's orders [REDACTED]. Resident #76's signed physician's orders [REDACTED]. However, the resident's MDS, dated [DATE], was inaccurately coded, in Section N0410 to indicate that the resident was not receiving a antidepressant. The surveyor confirmed that the MDS was inaccurately coded in an interview with the Clinical Reimbursement Coordinator, on 2/1/17 at 11:32 AM. 2. Resident #75's electronic charting contained a signed physician's orders [REDACTED]. A hospice progress note dated 12/12/16 at 2:00 p.m. indicated that the resident was opened to hospice services. The 12/12/16 2:00 p.m. progress note reads, Prognosis 6 mos (months) or less. Resident #75's Significant Change MDS dated [DATE] was inaccurately coded no in section J1400 Prognosis, to incorrectly indicate that the resident did not have a condition or chronic disease that may result in a life expectancy of less than 6 months. The surveyor confirmed that the MDS was inaccurately coded in an interview with the Clinical Reimbursement Coordinator, on 2/2/17 at 1:55 p.m. | 2020-09-01 |
| 608 | 608 | OAK GROVE CENTER | 205091 | 27 COOL ST | WATERVILLE | ME | 4901 | 2019-02-14 | 565 | B | 0 | 1 | MABU11 | Based on review of Resident Council meeting minutes and interviews, the facility failed to act promptly upon the grievances of the Resident Council and also failed to document and answer the grievances of the Resident Council. Findings: On 2/12/19 at 08:26 a.m., a surveyor conducted an interview with the Activity Director about the Resident Council Meetings. A surveyor asked if the grievances/concerns by the residents, that are raised at the meetings, are addressed, answered and documented. The Activity Director stated yes, they are and they are in the next month's minutes. A surveyor and the Activities Director reviewed the last three months (January 2019, (MONTH) (YEAR), and (MONTH) (YEAR)) of the Resident Council minutes and could find no documented answers to the grievances/concerns raised. The Activity Director said he/she would look for the responses to the resident's grievances/concerns. The Activity Director returned a short time later and stated that the grievances/concerns departmental response forms were not being used and that there was no evidence, in the Resident Council Meeting minutes, of follow through or documentation for the concerns that the residents had. On 02/12/19 at 09:07 a.m., a surveyor confirmed, in an interview with the Activity Director and the Administrator, that the facility lacked documentation that the grievances/concerns of the Resident Council were acted upon and the facility also failed to document and answer the grievances/concerns of the Resident Council. On 2/13/19 from 11:30 a.m. to 12:10 p.m., a surveyor attended a Resident Council Meeting at which time the Resident Council stated that they never heard from the facility after they had brought up grievances/concerns. The Resident Council members stated that the grievances/concerns brought up over the past three months included Housekeeping and Nursing Staffing, Outside Deck usage, Lighter Dinner Meals, Wrong Clothing in their Closets, Personal Items Missing, CNA's Cleaning up Resident's Rooms after care given, CNA's being … | 2020-09-01 |
| 613 | 613 | OAK GROVE CENTER | 205091 | 27 COOL ST | WATERVILLE | ME | 4901 | 2018-03-15 | 623 | B | 0 | 1 | 6L3L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to issue a written transfer/discharge notice to a resident or their legal representative and failed to notify the ombudsman's office of a resident transfer/discharge for a facility-initiated transfer/discharge for 1 of 3 residents whose discharge records were reviewed (#85). Findings: 1. Documentation in Resident #85's clinical record indicated that he/she was admitted to the facility on [DATE] and discharged /transferred to an acute hospital on [DATE]. The clinical record lacked evidence that the facility issued a written transfer/discharge notice to the resident and/or legal representative. 2. In addition, the clinical record lacked evidence that the Office of the State Long-term Care Ombudsman had been notified of the transfer/discharge of Resident #85. In an interview with the Director of Nursing (DON) on 3/15/18 at 3:09 p.m., he/she stated that the facility had not been notifying the Ombudsman's office of facility-initiated transfers/discharges and that the facility would start to compile a list of facility-initiated transfers/discharges for the Ombudsman's office for (MONTH) (YEAR). On 3/15/18 at 3:09 p.m., a surveyor confirmed the findings in an interview with the Director of Nursing (DON). | 2020-09-01 |
| 614 | 614 | OAK GROVE CENTER | 205091 | 27 COOL ST | WATERVILLE | ME | 4901 | 2018-03-15 | 625 | B | 0 | 1 | 6L3L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to issue a written bed hold notice to a resident and/or legal representative for 1 of 1 sampled residents who was discharged to the hospital (#85). Finding: Documentation in Resident #85's clinical record indicated that he/she transferred to an acute care hospital on [DATE] and was subsequently admitted to the acute care hospital. The clinical record lacked evidence that the facility issued a bed hold notice to the resident, a family member, or legal representative upon transfer. On 3/15/18 at 3:09 p.m., a surveyor confirmed the finding in an interview with the Director of Nursing (DON) and the Director of Clinical Operations. | 2020-09-01 |
| 620 | 620 | OAK GROVE CENTER | 205091 | 27 COOL ST | WATERVILLE | ME | 4901 | 2018-03-15 | 730 | B | 0 | 1 | 6L3L11 | Based on record reviews and interview, the facility failed to complete performance reviews at least once every twelve months for 2 of 5 randomly selected Certified Nursing Assistants (CNA) (#3, #4). Findings: 1. CNA #3 has been employed by the facility since 8/27/12. CNA #3 had a performance evaluation completed on 10/21/16. The next performance evaluation would be due by 10/31/17 but was not completed until 12/2/17, 2 months late. 2. CNA #4 has been employed by the facility since 8/25/14. CNA #4 had a performance evaluation completed on 9/26/16. The next performance evaluation would be due by 9/30/17. As of 3/15/18, there was no performance evaluation completed for CNA #4, 6 months late. On 3/15/18 at 10:21 a.m., during an interview with the Director of Nursing, the surveyor confirmed that the performance evaluations are not completed once every 12 months. | 2020-09-01 |
| 624 | 624 | OAK GROVE CENTER | 205091 | 27 COOL ST | WATERVILLE | ME | 4901 | 2018-03-15 | 943 | B | 0 | 1 | 6L3L11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on Facility Assessment review, in-service review, and interviews, the facility failed to implement and monitor an effective training program by ensuring Certified Nursing Assistants (CNA) attended the required abuse and/or dementia in-services for 3 of 5 randomly selected CNA's employed greater than 1 year (#2, #3, #4). Findings: Review of Page 2 of the Facility Assessment provided at survey, under Resident Population, Section 1.3 Types of Disease and Conditions, under the category Neurological Symptoms, revealed one of the common [DIAGNOSES REDACTED]. On the morning of 3/15/18, a surveyor requested 5 randomly sampled Certified Nursing Assistants (CNA) annual training records from the Nurse Practice Educator (NPE). The facility did not have a written record of in-services attended for each CNA so in-services based on each CNA's annual hire date were separated for review, but not all in-services contained information on how much education time was given for each in-service attended. The NPE stated that she could make an in-service record for each CNA requested that would contain the time. On 3/15/18 at 1:50 p.m., the in-service records were reviewed by a surveyor and the NPE. 1. CNA #2 was hired on 11/30/15. Documentation provided by the facility indicated there was no record of a dementia training having been attended by CNA #2. 2. CNA #3 was hired on 8/27/12. Documentation provided by the facility indicated that CNA #3's most recent dementia training was 9/1/16. 2. CNA #4 was hired on 8/25/14. Documentation provided by the facility indicated CNA 4's most recent dementia training was (MONTH) (YEAR). On 3/15/18 at 1:50 p.m. a surveyor confirmed that CNAs were not attending their required dementia training with the NPE. The NPE stated that she posts a calendar on her door so staff are aware where an in-service is scheduled. She had a full day of training offered for dementia in (MONTH) but will be breaking the time up on future months. | 2020-09-01 |
| 630 | 630 | OAK GROVE CENTER | 205091 | 27 COOL ST | WATERVILLE | ME | 4901 | 2017-10-04 | 242 | B | 1 | 0 | HGW511 | > Based on record review and interviews, the facility failed to ensure that a resident's choice in the area of bathing was being followed for 4 of 6 sampled residents (#2, #3, #5 and #6). 1. On 10/4/17 at 10:00 a.m., during an interview with a surveyor, Resident #2 stated that he/she is scheduled to have a whirlpool on Wednesday and a shower on Saturday. Resident #2 stated that he/she was not able to do whirlpool today because they are short on help, it's been bad. Last week I didn't have whirlpool on Wednesday but did get shower on Saturday. The CNA documentation was reviewed between 9/5/17 thru 10/4/17 which indicated that Resident #2 received a whirlpool on 9/6/17, 9/20/17 and 10/1/17 and a shower on 9/9/17 and 9/23/17.9/23/17. During the 9/5/17 thru 10/4/17 time period the resident went 7 days and 9 days without a shower or whirlpool as desired. The documentation for the remaining days and shifts revealed that Resident #2 received a bed bath/sponge on all other days. No refusals were noted. The Surveyor discussed this finding in an interview with the Director of Nursing, on 10/4/17 at 3:10 p.m. 2. On 10/4/17 at 10:25 a.m., during an interview with a surveyor, Resident #3 stated that he/she is scheduled for a whirlpool weekly. Resident #3 stated I don't get it every week. He/she stated that they are so short on nurses that can't do everything. The CNA documentation was reviewed between 9/5/17 thru 10/4/17 which indicated that Resident #3 received a shower on 9/20/17. The documentation for the remaining days and shifts revealed that Resident #3 received a bed bath/sponge bath. No refusals were noted. The Surveyor discussed this finding in an interview with the Director of Nursing, on 10/4/17 at 3:10 p.m. 3. On 10/4/17 at 11:05 a.m., during an interview with a surveyor, Resident #5 stated that he/she takes a whirlpool and is suppose to take one on Thursdays. Resident #5 stated I haven't got a whirlpool in 3-4 weeks. I get a bed bath but that is not the same thing. Resident #5 stated that he/she never refuses a w… | 2020-09-01 |
| 633 | 633 | OAK GROVE CENTER | 205091 | 27 COOL ST | WATERVILLE | ME | 4901 | 2019-12-11 | 623 | B | 1 | 0 | IDZF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record reviews and interviews, the facility failed to provide written transfer/discharge notices to the residents and the resident representatives for facility-initiated transfer/discharges for 4 of 4 sampled residents that were transferred or discharged to an acute care facility (Resident #6, #7, #8 and #9). Findings: 1. During a medical record review, Resident #6's medical record indicated that he/she was transferred to an acute care hospital on [DATE]. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the resident and the resident representative. 2. During a medical record review, Resident #7's medical record indicated that he/she was transferred to an acute care hospital on [DATE]. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the resident and resident representative. 3. During a medical record review, Resident #8's medical indicated that he/she was transferred to an acute care hospital on [DATE]. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the resident and resident representative. 4. During a medical record review,Resident #9's medical record indicated that he/she was transferred to an acute care hospital on [DATE]. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the resident and resident representative. On 12/11/19 at 2:07 p.m., a surveyor confirmed in an interview with the Center Executive Director(Administrator) that the facility did not provide, in writing, discharge/transfer notice to the residents and resident representatives. | 2020-09-01 |
| 644 | 644 | KENNEBUNK CENTER FOR HEALTH & REHABILITATION, LLC | 205095 | 158 ROSS RD | KENNEBUNK | ME | 4043 | 2018-09-20 | 623 | B | 0 | 1 | 7MCT11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to provide a Notice of Transfer or Discharge in writing to the resident and resident's representative for 4 of 4 residents reviewed for hospitalization (Residents #29, #37, #58 & #68). Findings: On 9/19/18, during review of Resident #29's medical record, the surveyor was unable to locate evidence that a written Transfer or Discharge Notice was provided to the resident and the resident's representative for a hospitalization on [DATE]. On 9/19/18 between 11:00 a.m. and 12:00 p.m. the surveyor confirmed the finding with the Director of Nursing (DON). On 9/19/18, during review of Resident #37's medical record, the surveyor was unable to locate evidence that a written Transfer or Discharge Notice was provided to the resident and the resident's representative for a hospitalization on [DATE]. On 9/19/18 between 1:00 p.m. and 2:00 p.m. the surveyor confirmed the finding with the Director of Nursing (DON). On 9/20/18 at 1:05 p.m., during review of Resident #58's medical record, the surveyor was unable to locate evidence that a written Transfer or Discharge Notice was provided to the resident and the resident's representative for a hospitalization on [DATE]. The surveyor confirmed the finding with the Director of Nursing (DON) at the time of the finding. On 9/20/18, during review of Resident #68's record, the surveyor was unable to locate evidence that a written Transfer or Discharge Notice was provided to the resident and the resident's representative for a hospitalization on [DATE] for metastatic [MEDICAL CONDITION] and transfusion. On 9/20/18 at 8:17 a.m., in an interview with the Director of Nursing Services (DNS), he/she confirmed there's no evidence a written Transfer or Discharge Notice was provided to resident and resident's representative. | 2020-09-01 |
| 645 | 645 | KENNEBUNK CENTER FOR HEALTH & REHABILITATION, LLC | 205095 | 158 ROSS RD | KENNEBUNK | ME | 4043 | 2018-09-20 | 625 | B | 0 | 1 | 7MCT11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to provide a Bed-Hold Notice in writing to the residents and resident representatives for 4 of 4 residents reviewed for hospitalization (Residents #29, #37, #58, and #68). Findings: On 9/19/18, during review of Resident #29's medical record, the surveyor was unable to locate evidence that a written Bed-Hold Notice was provided to the resident and the resident's representative for a hospitalization on [DATE]. On 9/19/18 between 11:00 a.m. and 12:00 p.m. the surveyor confirmed the finding with the Director of Nursing (DON). On 9/19/18, during review of Resident #37's medical record, the surveyor was unable to locate evidence that a written Bed-Hold Notice was provided to the resident and the resident's representative for a hospitalization on [DATE]. On 9/19/18 between 1:00 p.m. and 2:00 p.m. the surveyor confirmed the finding with the Director of Nursing (DON). On 9/20/18 at 1:05 p.m., during review of Resident #58's medical record, the surveyor was unable to locate evidence that a written Bed-Hold Notice was provided to the resident and the resident's representative for a hospitalization on [DATE]. The surveyor confirmed the finding with the Director of Nursing (DON) at the time of the finding. On 9/20/18, during review of Resident #68's record, the surveyor was unable to locate evidence that a written Bed-Hold Notice was provided to the resident and the resident's representative for a hospitalization on [DATE] for a metastatic [MEDICAL CONDITION] and transfusion. On 9/20/18 at 8:17 a.m., in an interview with the DNS, he/she confirmed there is no evidence that a written Bed-Hold Notice was provided to resident and resident's representative. | 2020-09-01 |
| 666 | 666 | NORWAY CENTER FOR HEALTH & REHABILITATION, LLC | 205097 | 29 MARION AVE | NORWAY | ME | 4268 | 2018-04-04 | 814 | B | 0 | 1 | NO9V11 | Based on observations and interviews, the facility failed to ensure that garbage and refuse were disposed of in a manner to prevent pest infestation for 3 of 3 survey days. Findings: 1. On 4/2/18 at approximately 9:34 a.m., during the initial tour of the kitchen, a surveyor observed 2 dumpsters outside of the facility with loose trash (several disposable gloves, several tissues and paper products) on the ground near the dumpsters. 2. On 4/3/18 at 8:06 a.m., a surveyor observed 2 dumpsters outside of the facility with loose trash (several disposable gloves, several tissues and paper products) on the ground near the dumpsters. 3. On 4/4/18 at 8:13 a.m., two surveyors observed 2 dumpsters outside of the facility with loose trash (several disposable gloves, several tissues and paper products) on the ground near the dumpsters. A surveyor confirmed the above findings on 4/4/18 at 12:07 p.m., with the Administrator. | 2020-09-01 |
| 691 | 691 | RUMFORD COMMUNITY HOME | 205099 | 11 JOHN F KENNEDY LANE | RUMFORD | ME | 4276 | 2019-07-26 | 730 | B | 0 | 1 | QN6L11 | Based on Certified Nursing Assistant (CNA) performance evaluation reviews and interviews, the facility failed to complete a performance evaluation at least every 12 months for 4 of 5 CNA annual performance evaluations randomly reviewed ( CNA's #1, #2, #3, #4.) In addition, the facility failed to monitor and ensure that 1 of 5 randomly selected CNA's attended the required 12 hours of annual in-service education (CNA #4). Findings: CNA #1's date of hire was 11/1/16. A review of CNA #1's annual performance evaluations indicated that CNA #1 received an annual performance evaluation on 12/21/17 with the next annual performance evaluation due by 12/31/18. CNA #1's employee file lacked evidence that an annual performance evaluation was completed since 12/21/17. CNA #2's date of hire was 2/20/85. A review of CNA #2's annual performance evaluations indicated that CNA #2 received an annual performance evaluation on 3/27/18, with the next annual performance evaluation due by 3/31/18. CNA #2's employee file lacked evidence that an annual performance evaluation was completed since 3/27/18. CNA #3's date of hire was 4/4/16. A review of CNA #3's annual performance evaluations indicated that CNA #3 received an annual performance evaluation on 3/26/18, with the next annual performance evaluation due by 3/31/19. CNA #3's employee file lacked evidence that an annual performance evaluation was completed since 3/26/18. CNA #4's date of hire was 6/29/16. CNA #4 now works as a Personal Support Specialist(PSS) on the facility's residential care unit, and CNA #4 also works as a CNA on the facility's nursing home units. A review of CNA #4's annual performance evaluations indicated that CNA #4 received an annual performance evaluation on 6/9/18, with the next annual performance evaluation due by 6/30/19. CNA #4's employee file lacked evidence that an annual performance evaluation was completed since 6/9/18. In addition, documentation on CNA #4's in-service attendance sheets indicated that from 6/29/18 and 6/29/19, CNA #4 did not complete t… | 2020-09-01 |
| 693 | 693 | PRESQUE ISLE REHAB AND NURSING CENTER | 205100 | 162 ACADEMY ST | PRESQUE ISLE | ME | 4769 | 2018-04-11 | 655 | B | 0 | 1 | H3F211 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to provide the resident and their representative with a summary of the baseline care plan for 3 of 4 sampled residents that were newly admitted (#36, #53, #257). Findings: 1. Resident #36 was admitted to the facility on [DATE]. On 4/10/18, Resident #36's clinical record was reviewed and revealed that it lacked evidence that the resident or resident representative was involved in the development of his/her care plan or that he/she received a summary of the baseline care plan. On 4/10/18 at 11:30 a.m., in an interview with the Social Services Director, she indicated that the facility did not have a meeting with the resident or resident representative to discuss Resident #36's plan of care. The Social Services Director was unable to provide evidence that the resident and resident representative was provided a summary of Resident #36's plan of care. 2. Resident #53 was admitted to the facility on [DATE]. On 4/11/18, Resident #53's clinical record was reviewed and revealed that it lacked evidence that the resident or resident representative was involved in the development of his/her care plan or that he/she received a summary of the baseline care plan. On 4/11/18 at 10:30 a.m., in an interview with the Social Services Director, she indicated that the facility did not have a meeting with the resident or resident representative to discuss Resident #53's plan of care. The Social Services Director was unable to provide evidence that the resident and resident representative was provided a summary of Resident #53's plan of care. 3. Resident #257 was admitted to the facility on [DATE]. On 4/10/18, Resident #257's clinical record was reviewed and revealed that it lacked evidence that the resident or resident representative was involved in the development of his/her care plan or that he/she received a summary of the baseline care plan. On 4/10/18 at 11:30 a.m., in an interview with the Social Serv… | 2020-09-01 |
| 707 | 707 | SEAL ROCK HEALTH CARE | 205103 | 88 HARBOR DRIVE | SACO | ME | 4072 | 2018-12-20 | 582 | B | 0 | 1 | 3V0G11 | Based on interview and clinical record review, the facility failed to ensure the Skilled Nursing Facility Advance Beneficiary Notices (SNFABN) were provided to 2 of 3 residents reviewed whose Medicare Part A services were discontinued (Residents #32 and #48). Findings: 1. On review of Resident #32's clinical record, a surveyor noted a current resident, Resident #32, received Medicare Part A services that ended on 11/15/18 but the surveyor could not locate evidence that the required Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) was provided to the resident so that he/she could make an informed decision to continue receiving the skilled services that may not be paid for by Medicare and assume financial responsibility. 2. On review of Resident #48's clinical record, a surveyor noted a current resident, Resident #48, received Medicare Part A services that ended on 11/8/18 but the surveyor could not locate evidence that the required Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) was provided to the resident so that he/she could make an informed decision to continue receiving the skilled services that may not be paid for by Medicare and assume financial responsibility. On 12/18/18 at 8:15 a.m., in an interview with the Director of Nursing, the surveyor confirmed that SNFABNs were not issued prior to the end of Medicare Part A services. | 2020-09-01 |
| 710 | 710 | WESTGATE CENTER FOR REHAB & ALZHEIMERS CARE | 205105 | 750 UNION ST | BANGOR | ME | 4401 | 2019-01-16 | 730 | B | 0 | 1 | HQQM11 | Based on review of performance evaluations and interviews, the facility failed to complete annual performance evaluations timely, at least once every 12 months, for 2 of 3 Certified Nursing Assistants (C.N.[NAME]) (#1, #2). Findings: 1. C.N.[NAME] #1's employee file contained an employee evaluation last completed on 9/3/17. As of 1/16/19, there was no additional evaluation completed. On 1/16/19 at 9:40 a.m., during an interview with the Regional Director of Clinical Operations, the surveyor confirmed that the annual evaluation is past due. 2. C.N.[NAME] #2's employee file contained an employee evaluation completed on 8/14/17. The next annual evaluation was completed on 10/30/18. On 1/16/19 10:11 a.m., during an interview with the Regional Director of Clinical Operations, the surveyor confirmed that this evaluation was completed late. | 2020-09-01 |
| 713 | 713 | WESTGATE CENTER FOR REHAB & ALZHEIMERS CARE | 205105 | 750 UNION ST | BANGOR | ME | 4401 | 2019-01-16 | 947 | B | 0 | 1 | HQQM11 | Based on review of employee in-service tracking forms and interview, the facility failed to monitor and ensure Certified Nursing Assistants (C.N.[NAME]) attended the required 12 hours of annual in-service education which included abuse in-services for 2 of 3 randomly selected C.N.[NAME]'s employed greater than 1 year (#2, #3). Findings: 1. Documentation on C.N.[NAME] #2's employee in-service indicates she was hired on 6/9/1999. The in-services revealed that C.N.[NAME] #2 did not attend an abuse in-service between 6/9/2017 and 6/8/2018. 2. Documentation on C.N.[NAME] #2's employee in-service indicates she was hired on 3/26/2009. The in-services revealed that C.N.[NAME] #3 did not attend an abuse in-service between 3/26/2017 and 3/26/2018. On 1/16/19 at 11:01 a.m., during an interview with the Regional Director of Clinical Operations, the surveyor confirmed that the C.N.[NAME] had not attended a required annual abuse training. | 2020-09-01 |
| 715 | 715 | WESTGATE CENTER FOR REHAB & ALZHEIMERS CARE | 205105 | 750 UNION ST | BANGOR | ME | 4401 | 2018-09-04 | 609 | B | 1 | 0 | QQ4D11 | > Based on interviews and record review, the facility failed to ensure two alleged violations involving Resident to Resident Altercations were reported within 24 hours to the Division of Licensing and Certification for 2 of 5 Resident to Resident Altercations reviewed. Findings: 1. On 4/16/18, the Division of Licensing and Certification received from the facility a faxed incident form for a Resident to Resident altercation. Review of the Incident form and facility investigation revealed the date of the alleged altercation to be 4/14/18. The Facilities fax transmittal page indicates the Incident form was faxed to the Division of Licensing and Certification on 4/16/18 2 days, after the alleged altercation occurred. 2. On 9/2/18, the Division of Licensing and Certification received from the facility a faxed incident form for a Resident to Resident altercation. Review of the Incident form and facility investigation revealed the date of the alleged altercation to be 8/31/18. The Facilities fax transmittal page indicates the Incident form was faxed to the Division of Licensing and Certification on 9/2/18, 2 days after the alleged altercation occurred. On 9/4/18 at 2:10 p.m. two surveyors confirmed with the Administrator that the facility did not report the alleged incidents within the required 24 hours. | 2020-09-01 |
| 734 | 734 | ST ANDRE HEALTH CARE FACILITY | 205108 | 407 POOL ST | BIDDEFORD | ME | 4005 | 2019-01-10 | 584 | B | 0 | 1 | SX4O11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to ensure the resident environment was clean and homelike on 3 of 3 resident floors. On 1/9/19 at 9:15 a.m., during tour of the facility, the surveyor and Director of Environmental Services observed the following findings: -Resident room [ROOM NUMBER] had long tears and worn areas in wall paper approximately 2 feet in length from bed along wall. -Resident room [ROOM NUMBER] had worn wall paper and gouged sheet rock approximately 1 foot in length from bed along wall. -Resident room [ROOM NUMBER] had 2 wood closet doors that were marred and a soiled/stained privacy curtain. -Resident room [ROOM NUMBER] had sheet rock in disrepair behind the toilet in the bathroom and floor edges were duct taped between the doorway threshold from the bathroom into the Resident's room. -Resident room [ROOM NUMBER] had marred walls and chipped paint on the left wall as you enter the room. -Resident room [ROOM NUMBER] had marred walls and chipped paint on the wall as you enter the room. -Resident dining area on the 3rd floor had a table missing laminate extending approximately 3 feet along the side of the table. -Ground floor bathroom used by residents has a mold like substance behind the toilet and a wall in disrepair under the soap dispenser. On 1/9/19, during tour of the facility, the surveyor confirmed the above findings in an interview with the Director of Environmental Services. | 2020-09-01 |
| 751 | 751 | MARSHALL HEALTH CARE AND REHAB | 205109 | 16 BEAL STREET | MACHIAS | ME | 4654 | 2018-12-19 | 812 | B | 0 | 1 | VQSW11 | Based on observations and interview, the facility failed to ensure the fans blowing on the clean dishes in the dish room were clean on 2 of 3 days of survey (12/17/18 and 12/18/18). Findings: On 12/17/18 at 11:15 a.m., during an initial tour of the kitchen, a surveyor observed the fan in the dish room was heavily soiled with dust and blowing on the rack with the clean dishes. A surveyor confirmed this finding with a Food Service Director at the time of the observation. On 12/18/18 at 9:30 a.m., during a follow up tour of the kitchen, a surveyor observed a fan, directly behind a tray of clean cups located on the top shelf of the clean dish rack, soiled in dust blowing on the clean cups. A surveyor confirmed this finding with the Food Service Director and a dietary aide at the time of the observation. | 2020-09-01 |
| 775 | 775 | FALMOUTH BY THE SEA | 205112 | 191 FORESIDE RD | FALMOUTH | ME | 4105 | 2019-05-15 | 609 | B | 1 | 0 | R4MN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on Reportable Incident Forms review with investigation, policy review, and interview, the facility failed to provide the State agency with an incident of alleged misappropriation within 24 hours of the incident report on 1 of 2 resident reports of missing property (#3); and failed provide the State agency with a 5 day follow up report on an allegation of misappropriation of property for 2 of 2 resident reports of missing property. (#3 and #5). Findings: A review of the facility policy entitled Abuse Investigations and Reporting, N0190, Resident Rights and Dignity, revised 11/2017, section Reporting, #2 states, An alleged violation of abuse, neglect, exploitation, or mistreatment (including injuries of unknown source and misappropriation of resident property will be reported immediately, but not later than: b. stated, Twenty-four (24) hours if the alleged violation does not involve abuse AND has not resulted in serious bodily injury. AND under #5 which states The Administrator, or his/her designee, will provide the appropriate agencies or individuals listed above with a written report of the findings of the investigation within five (5) working days of the occurrence of the incident. 1. On 03/11/19 at 3:42 p.m., the state agency recieved a Nursing Facility Reportable Incident Form, which indicated an allegation of misappropriation of a resident (#3) property was reported to the facility on [DATE]. Furthermore, there is no evidence the State offices were provided the 5 Day follow up incident report as was indicated. A review of the clinical record, and internal investigation, indicated the facility conducted a review of the Resident's #3 inventory list which indicated a wallet with no credit cards listed on the sheet. The police were notified by the facility. A review of the facility's incident charting record, dated 3/10/19, at 1903 p.m., indicated that on 3/6/19, at 1856 p.m., a family member noticed that Resident #3's credit card was… | 2020-09-01 |
| 776 | 776 | FALMOUTH BY THE SEA | 205112 | 191 FORESIDE RD | FALMOUTH | ME | 4105 | 2017-07-26 | 253 | B | 0 | 1 | XDGO11 | Based on observations and interviews, the facility failed to ensure resident areas were maintained in clean and good repair in 6 of 36 resident rooms. During a tour of the facility with the surveyor on 7/26/17 between 9 a.m. and 9:45 a.m. the Director of Maintenance, Director of Nursing and RAI Director observed and confirmed the following findings: -Room 101: Bathroom wall marred. -Room 103: Wall marred by closet. -[RM #]1: Corner of wall near entrance door marred, exposing sheetrock. -[RM #]5: Wall behind toilet with yellowish/rust colored stain along the length of the wall. -Room 403: Marred wall by bathroom door. -Room 406: Marred wall in bathroom. | 2020-09-01 |
| 787 | 787 | COLONIAL HEALTH CARE | 205113 | 36 WORKMAN TERRACE STREET | LINCOLN | ME | 4457 | 2019-06-12 | 623 | B | 0 | 1 | J2S511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to provide 3 written transfer/discharge notices to a resident and/or resident representative for facility-initiated transfer/discharges for 1 of 1 sampled Residents that was transferred/discharged to an acute care facility on 3 different occasions in (MONTH) 2019 (Resident #24). In addition, the facility failed to notify the Ombudsman's Office of any facility initiated transfers/discharges. Findings: 1. Resident #24's clinical record was reviewed and documentation indicated the Resident #24 was transferred to an acute care hospital on [DATE], 2/22/19, and on 2/27/19 when Resident #24 was admitted to the hospital. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the Resident and/or Resident Representative. On 6/12/19 at 8:33 a.m., during an interview with a surveyor, the State Guardian (Resident Representative) for Resident #24 stated that she did not receive a written transfer/discharge notice from the facility for any of Resident #24's (MONTH) transfers to the hospital. On 6/12/19 8:53 a.m., during an interview with a surveyor, the Social Worker stated that the Nurses print out the transfer/discharge forms and she will mail a copy to Resident Representative but she was not working at the facility in February. On 6/12/19 at 8:57 a.m., during an interview with a surveyor, the Nurse stated that the Nurses print off the transfer/discharge notices and sends them to the hospital with the resident information. The surveyor asked what does she do if the resident is not their own guardian or is incapable of understanding or reading the transfer notice, does she mail a copy to the Resident Representative and the Nurse stated she does not do that. On 6/12/19 at 9:07 a.m., during an interview with the Administrator, the surveyor confirmed there is no evidence in the clinical record that a written transfer/discharge notice was provided to the re… | 2020-09-01 |
| 788 | 788 | COLONIAL HEALTH CARE | 205113 | 36 WORKMAN TERRACE STREET | LINCOLN | ME | 4457 | 2019-06-12 | 625 | B | 0 | 1 | J2S511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to provide the Resident and/or Resident Representative a written bed-hold notice which specifies the duration of the bed-hold for 1 of 1 sampled residents reviewed for hospitalization . who was transferred/discharged to an acute care facility on 3 different occasions in (MONTH) 2019 (Resident #24). Finding: Documentation in Resident #24's clinical record indicated that he/she was transferred to an acute care hospital on [DATE], 2/22/19, and on 2/27/19 when Resident #24 was admitted to the hospital. There is no evidence in the clinical record that indicates the Resident and/or Resident Representative was provided a written bed-hold notice that specified the duration of the bed-hold. On 6/12/19 at 8:33 a.m., during an interview with a surveyor, the State Guardian (Resident Representative) for Resident #24 stated that she did not receive a written bed hold notice from the facility for any of the (MONTH) transfers to the hospital. On 6/12/19 8:53 a.m., during an interview with a surveyor, the Social Worker stated that the Nurses print out the bed hold forms and she will send a copy to the Resident Representative via mail but she was out of the building from 2/1/19 and did not return until 3/4/19. On 6/12/19 at 8:57 a.m., during an interview with a surveyor, the Nurse stated that nursing prints off the bed hold notices and sends them to the hospital with the resident information but does not mail a copy to the Resident Representative. On 6/12/19 at 9:07 a.m., during an interview with the Administrator, the surveyor confirmed there is no evidence in the clinical record that a written bedhold notice was provided to the resident and/or Resident Representative. | 2020-09-01 |
| 789 | 789 | COLONIAL HEALTH CARE | 205113 | 36 WORKMAN TERRACE STREET | LINCOLN | ME | 4457 | 2019-06-12 | 730 | B | 0 | 1 | J2S511 | Based on performance evaluation reviews and interviews, the facility failed to complete a performance evaluation at least every twelve months for 3 of 3 Certified Nurse Assistant (C.N.[NAME]) performance evaluations reviewed. Findings: 1. A review of C.N.[NAME] #1's performance evaluations indicated that C.N.[NAME] #1 received a performance evaluation on 5/1/18 with the next annual evaluation due by (MONTH) 2019. The 2019 evaluation was completed by the facility on 6/6/19 but has not been given to the C.N.[NAME] yet. 2. A review of C.N.[NAME] #2's performance evaluations indicated that C.N.[NAME] #2 received a performance evaluation on 4/30/18 with the next one due by (MONTH) 2019. The 2019 evaluation was completed by the facility on 6/6/19 and given to the C.N.[NAME] on 6/11/19. 3. A review of C.N.[NAME] #3's performance evaluations indicated that C.N.[NAME] #3 received a performance evaluation on 4/30/18 with the next one due by (MONTH) 2019. The 2019 evaluation was completed by the facility on 6/11/19 and given to the C.N.[NAME] on 6/11/19. On 6/12/19 at 9:26 a.m., during an interview with the Administrator and Director of Nursing (DON), the surveyor confirmed that the annual evaluations were not completed within twelve months. On 6/12/19 at 10:50 a.m., during an interview with a surveyor, the Administrator stated that the old (DON) had a tickler file on her computer which notified her when the annual evaluations were due, but when the new DON started, that file did not transfer to her computer so the new DON was unaware that evaluations were due. | 2020-09-01 |
| 792 | 792 | COLONIAL HEALTH CARE | 205113 | 36 WORKMAN TERRACE STREET | LINCOLN | ME | 4457 | 2017-07-13 | 226 | B | 1 | 1 | OVE811 | > Based on facility policy review, personnel files review, and interviews, the facility failed to follow its own policies to ensure employees received trainings for Abuse for 2 of 5 sampled employees (#1, #5). Findings: The facility's Resident Abuse Prevention Policy and Procedure under the training section, revealed that Resident Abuse Prevention will be included in each year's in-service schedule and is mandatory for all staff members. 1. On 7/12/17, Employee #1's personnel file was reviewed and documentation in the file revealed that trainings for Abuse had not been completed by Employee #1 since 3/25/15. On 7/12/17 at 2:28 p.m., during an interview with a surveyor, the Administrator confirmed they were unable to find a more recent training for Abuse. 2. On 7/13/17, Employee #5's personnel file was reviewed and documentation in the file revealed that trainings for Abuse had not been completed by Employee #5 since 11/13/14. On 7/13/17 at 8:57 a.m., during an interview with a surveyor, the Director of Nursing confirmed they were unable to find a more recent training for Abuse. | 2020-09-01 |
| 794 | 794 | COLONIAL HEALTH CARE | 205113 | 36 WORKMAN TERRACE STREET | LINCOLN | ME | 4457 | 2017-07-13 | 354 | B | 1 | 1 | OVE811 | > Based on interviews, review of the facility's Licensed Nurse Schedule and timecards, the facility failed to ensure that a Registered Nurse was on duty daily, at least 8 consecutive hours, for 26 of 34 weekend shifts reviewed over a 4 month period in (YEAR) (March, April, May, June). Findings: On 7/10/17 at 11:26 a.m., during the entrance conference with a surveyor, the Administrator stated the facility had no nursing staffing waivers. 1. Review of the Licensed Nurse Schedule and timecards for weekend shifts for the month of (MONTH) revealed the following weekend dates utilized no Registered Nurse services for 8 consecutive hours: 3/4/17, 3/11/17, 3/12/17, 3/18/17, and 3/19/17. 2. Review of the Licensed Nurse Schedule and timecards for weekend shifts for the month of (MONTH) revealed the following weekend dates utilized no Registered Nurse services for 8 consecutive hours: 4/1/17, 4/2/17, 4/8/17, 4/9/17, 4/15/17, 4/16/17, 4/22/17, 4/23/17, and 4/29/17. 3. Review of the Licensed Nurse Schedule and timecards for weekend shifts for the month of (MONTH) revealed the following weekend dates utilized no Registered Nurse services for 8 consecutive hours: 5/6/17, 5/13/17, 5/14/17, 5/27/17, and 5/28/17. 4. Review of the Licensed Nurse Schedule and timecards for weekend shifts for the month of (MONTH) revealed the following weekend dates utilized no Registered Nurse services for 8 consecutive hours: 6/3/17, 6/4/17, 6/10/17, 6/11/17, 6/17/17, 6/18/17, and 6/24/17. On 7/12/17 at 10:50 a.m., during an interview with three surveyors, the Administrator confirmed there was not a Registered Nurse on duty for many of the weekend shifts because they were unable to find a Registered Nurse to work as staffing agencies will only provide the facility with a Licensed Practical Nurse. The Administrator stated that the Director of Nursing is at home on the weekends and has her computer with her in case there are any issues. | 2020-09-01 |
| 796 | 796 | COLONIAL HEALTH CARE | 205113 | 36 WORKMAN TERRACE STREET | LINCOLN | ME | 4457 | 2017-07-13 | 514 | B | 1 | 1 | OVE811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record reviews and interviews, the facility failed to ensure that telephone orders were written after receiving a verbal telephone order from a Physician for 2 of 2, Stage 2 Residents receiving sliding scale insulin (#46, #67). Findings: 1. On 7/10/17 at 12:19 p.m., Resident #46's clinical record was reviewed. Resident #46 had a current physician order [REDACTED]. The Licensed Medication Administration Record [REDACTED]#1. The clinical record, paper and electronic, lacked evidence of a written order indicating how much insulin to administer for either event. On 7/12/17 at 9:46 a.m., during an interview with the surveyor, the Nurse Manager was unable to find physician orders [REDACTED]. On 7/12/17 at 11:27 a.m., during an interview with a surveyor, LPN #1 stated that she would have called the doctor to get an order for [REDACTED].#1 was unable to find a nurse's note or physician order [REDACTED].#2 (works for a travel agency) on the telephone and that LPN #2 stated that she called the Physician to obtain an order on how much insulin to administer (on 7/6/17) but did not realize in this State you needed to write a telephone order for a verbal order received. The Nurse Manager confirmed that LPN #2 did not write a telephone order for the verbal order received and that LPN #2 has been educated. 2. On 7/10/17 at 2:07 p.m., Resident #67's clinical record was reviewed. Resident #67 had a current physician order [REDACTED]. The Licensed Medication Administration Record [REDACTED]. The clinical record, paper and electronic, lacked evidence of a written order indicating how much insulin to administer for either event. On 7/12/17 at 2:17 p.m., during an interview with a surveyor, LPN #1 stated she remembered calling the Physician but was unable to find a written order on how much insulin to be administered. On 7/12/17 at 3:10 p.m., LPN #1 confirmed that she remembers calling the Physician but did not write an order on how much insulin to admi… | 2020-09-01 |
| 801 | 801 | DEXTER HEALTH CARE | 205115 | 64 PARK STREET | DEXTER | ME | 4930 | 2019-08-21 | 609 | B | 1 | 0 | LT5411 | > Based on facility incident report review, facility policy review, and interviews, the facility failed to notify a State Agency (Adult Protective Services) of 1 of 1 allegation of Abuse (8/12/19). Finding: The facility's policy, Resident Abuse Prevention Policy & Procedure, under section for Reporting/Response, indicates that mandated reporters will follow the guidelines in the Department of Human Services (DHS), Bureau of Elder and Adult Services (BEAS) publication Abuse, Neglect and Exploitation in Licensed Facilities. They will concurrently report the incident to the Administrator. The Administrator, Adult Protective Services (APS) and DHS Licensing and Certification will be notified immediately of any suspected abuse, neglect or exploitation. On 8/12/19, the Division of Licensing received an incident alleging that a Certified Nursing Assistant was rough with a resident. Review of the incident form indicated the type of incident was abuse and this form, under the section other authorities notified: was blank. On 8/20/19 at 11:54 a.m., during a joint interview with the Administrator and the Director of Nursing (DON), the surveyor asked who was notified of the allegation of abuse. The Administrator stated that he was notified by the DON. The surveyor asked if Adult Protective Services was notified while the Administrator reviewed the facility's policy. The DON stated that she was unaware of the need to notify APS for an allegation of Abuse. The surveyor confirmed the finding that APS was not notified of the allegation of abuse. | 2020-09-01 |
| 805 | 805 | DEXTER HEALTH CARE | 205115 | 64 PARK STREET | DEXTER | ME | 4930 | 2017-12-07 | 732 | B | 0 | 1 | F1K111 | Based on observations and interview, the facility failed to post the current daily nurse staffing information that includes the facility name, day of the month, a breakdown of the number of registered and licensed nursing staff responsible for direct resident care and indicate which shifts the numbers corresponded to, for 1 of 3 survey days. In addition, the updated nurse staffing information posted at the time of the survey did not include the daily resident census. Findings: 1. On 12/4/17 at 10:45 a.m., two surveyors observed that the posted nurse staffing information dates were for 11/22/17 through 11/25/17. On 12/4/17 at 12:15 p.m., a surveyor observed that the nurse staffing information was changed to the current date 12/4/17, but did not include the resident census. On 12/4/17 at 1:00 p.m., in an interview with the surveyor, the Scheduler and Office Supply Clerk stated that she had not changed the posted nurse staffing information since 11/25/17 because she had been too busy. She also confirmed that the daily resident census was left off the nurse staffing information for 12/4/17. | 2020-09-01 |
| 812 | 812 | STILLWATER HEALTH CARE | 205116 | 335 STILLWATER AVE | BANGOR | ME | 4401 | 2018-06-13 | 623 | B | 0 | 1 | W2VI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to provide the resident and/or the resident representative a written notice with a reason for a transfer/discharge to the hospital for 1 of 1 sampled residents (#39). In addition, the facility failed to notify the Ombudsman timely of the facility-initiated resident transfers/discharges for the months of (MONTH) (YEAR), (MONTH) (YEAR), (MONTH) (YEAR), (MONTH) (YEAR), (MONTH) (YEAR), and (MONTH) (YEAR). Findings: 1. Documentation in Resident #39's clinical record indicated that the resident was transferred to the hospital on [DATE]. There was no evidence in the clinical record that Resident or Resident Representative was provided with a written transfer notice that indicated the reason for the transfer. On 6/12/18 1:53 p.m., during an interview with the Nurse Manager, a surveyor confirmed that there was no evidence that a transfer/discharge form was completed and provided to the resident or resident's representative at the time of transfer to the hospital. 2. On 6/12/18 at 2:30 p.m., during an interview with Licensed Social Worker (LSW), the surveyor requested a copy of Ombudsman notification of the facility-initiated transfers/discharges for the months of (MONTH) (YEAR) to (MONTH) (YEAR). The LSW was unaware of what this was. On 6/12/18 at 2:36 p.m., during an interview with the Nurse Manager, the surveyor requested a copy of the Ombudsman notification of the the facility-initiated transfers/discharges for the months of (MONTH) (YEAR) to (MONTH) (YEAR). The Nurse Manager was unaware of what this was. On 6/13/18 at 8:35 a.m., the Administrator provided the surveyor with faxes that were sent to the Ombudsman office on 6/12/18, notifying the Ombudsman office of the facility-initiated transfer/discharges for the months of (MONTH) (YEAR)-April (YEAR). On 6/13/18 at 8:52 a.m., during an interview with the Administrator, the surveyor confirmed that the notices were sent late. | 2020-09-01 |
| 813 | 813 | STILLWATER HEALTH CARE | 205116 | 335 STILLWATER AVE | BANGOR | ME | 4401 | 2018-06-13 | 625 | B | 0 | 1 | W2VI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to provide the Resident or Resident's Representative a written bed-hold notice which specifies the duration of the bed-hold for 1 of 1 sampled Residents reviewed for hospitalization (#39). Finding: Documentation in Resident #39's clinical record indicated that the resident was transferred to the hospital on [DATE]. There was no evidence in the clinical record indicating that Resident #39 or the Resident's Representative was provided a written bed-hold notice that specified the duration of the bed-hold. On 6/12/18 at 1:53 p.m., during an interview with the Nurse Manager, a surveyor confirmed that there was no evidence that the bed hold notice was completed and provided to the Resident or Resident's Representative at the time of transfer to the hospital. | 2020-09-01 |
| 815 | 815 | STILLWATER HEALTH CARE | 205116 | 335 STILLWATER AVE | BANGOR | ME | 4401 | 2017-07-20 | 253 | B | 1 | 1 | QFTY11 | > Based on observations and interviews, the facility failed to provide housekeeping and maintenance services to ensure that walls and wardrobes were maintained in good repair in 7 of 31 Resident rooms and ensure that: floor mats were maintained to promote sanitization in 1 of 31 Resident rooms. Findings: 1. On 7/20/17 during the environmental tour from 10:00 a.m. to 11:00 a.m. with the Maintenance Director, scratches, gouges, and other damage to the walls was observed in the following rooms: -Resident room 2 (under the sink), -Resident room 4 (under the window and near the trash can), -Resident room 6 (just over the cove base to the right of bed A), -Resident room 8 (by the sink), -Resident room 9 (behind the headboard of bed A), -Resident room 21 (behind the headboard of bed A and near the trash can). Additionally, the edge of a drawer of a wardrobe was observed to be missing in Resident room 28, exposing unsealed fiberboard. These findings were confirmed at the time of the observations with the Maintenance Director. 2. On 7/20/17 at 12:30 PM, a foam floor mat with tattered edges was observed in Resident room 29, next to bed A, that did not have a vinyl cover creating a surface which could not be easily cleaned and sanitized. This was confirmed with the Maintenance director at the time of the observation and with the Director of Nursing at 12:45 p.m. | 2020-09-01 |
| 820 | 820 | CARIBOU REHAB AND NURSING CENTER | 205117 | 10 BERNADETTE ST | CARIBOU | ME | 4736 | 2020-02-05 | 761 | B | 0 | 1 | N1X711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to ensure that 3 bottles of an expired vitamin (Vitamin E) and 1 bottle of an expired [MEDICATION NAME]/antipyretic ([MEDICATION NAME]) were removed from the supply available for use, in 1 of 2 medication storage rooms (B Wing). Finding: On 2/4/20 at 8:40 a.m., a surveyor observed in the B Wing medication storage room [ROOM NUMBER] unopened bottles of Vitamin [NAME] with an expiration date of 11/19 and 1 unopened bottle of [MEDICATION NAME] with an expiration date of 12/19. The surveyor confirmed the expired medications were not removed from the supply available for use at the time of the observation with the Registered Nurse. | 2020-09-01 |
| 841 | 841 | MOUNT ST JOSEPH NURSING HOME | 205120 | 7 HIGHWOOD ST | WATERVILLE | ME | 4901 | 2019-10-24 | 625 | B | 0 | 1 | B81E11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to issue a bed hold notice to the resident, or a known family member or legal representative, for 4 of 4 sampled residents, who had been transferred to an acute care facility (#46, #66, #105, #128). Findings: 1. Documentation in the clinical record of Resident #66 indicated that the resident was transferred to an acute care hospital on [DATE]. There was no evidence in the clinical record that the facility issued a bed hold notice to the resident, or a known family member or legal representative. 2. Documentation in the clinical record of Resident #105 indicated that the resident was transferred to an acute care hospital on [DATE]. There was no evidence in the clinical record that the facility issued a bed hold notice to the resident, or a known family member or legal representative. On 10/24/19 at 9:58 am, in an interview with a surveyor, the Administrator confirmed that the facility does not issue bed hold notices at the time residents are transferred to acute care facilities. 3. Documentation in Resident #128's clinical record indicated that he/she transferred to an acute care hospital on [DATE] and 10/20/19 and was subsequently admitted . The clinical record lacked evidence that the facility issued bed hold notices to the resident, a family member, or legal representative upon transfer. 4. Documentation in Resident #46's clinical record indicated that he/she transferred to an acute care hospital on [DATE] and subsequently admitted . The clinical record contained no evidence that the facility issued a bed hold notice to the resident, a family member, or legal representative upon transfer. On 10/21/19 at 10:40 a.m., in an interview with the resident representative, he/she reported he/she did not receive any written notice of the bed hold policy when transferred to the hospital. On 10/24/19 at 9:58 a.m., in an interview with the Administrator and the Business Office Manager, a survey… | 2020-09-01 |
| 842 | 842 | MOUNT ST JOSEPH NURSING HOME | 205120 | 7 HIGHWOOD ST | WATERVILLE | ME | 4901 | 2019-10-24 | 641 | B | 0 | 1 | B81E11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure a Minimum Data Set (MDS) Version 3.0 Assessment was accurately coded in the areas of Cognitive Patterns, Mood, and Behaviors, and Falls for 2 of 24 sampled residents (#66) (#90). Findings 1. On review of Resident #90's clinical record, a surveyor noted Resident #90 had a fall on 9/8/19 and obtained a minor injury. Resident #90's Quarterly MDS Version 3.0 Assessment with an ARD date of 9/24/19, section J1900 number of falls since admission/entry or reentry or prior assessment (OBRA or scheduled PPS), whichever is more recent did not indicate resident had a fall with a minor injury. On 10/23/19 at 10:53 a.m., during an interview with the MDS Coordinator, the surveyor confirmed the above assessment was not completed accurately. 2. On review of Resident #66's clinical record, a surveyor noted Resident #66's [DIAGNOSES REDACTED]. Resident #66's Quarterly Minimum Data Set (MDS) Version 3.0 Assessment, with an Assessment Reference Date (ARD) date of 8/4/19, and completed on 9/9/19, Section C - Cognitive Patterns, Sections C0100-C1000; Section D - Mood, Sections D0100-D0600; and Section [NAME] - Behavior, Sections E0100-E1100, were incomplete. On 10/24/19 at approximately 10:00 a.m., in an interview with a surveyor, the Long Term Care MDS Coordinator confirmed Sections C, D, and E, including staff assessments, had not been completed due to the assessment being completed nearly 3 weeks late, and did not accurately reflect the status of the resident. | 2020-09-01 |
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CREATE TABLE [cms_ME] ( [facility_name] TEXT, [facility_id] INTEGER, [address] TEXT, [city] TEXT, [state] TEXT, [zip] INTEGER, [inspection_date] TEXT, [deficiency_tag] INTEGER, [scope_severity] TEXT, [complaint] INTEGER, [standard] INTEGER, [eventid] TEXT, [inspection_text] TEXT, [filedate] TEXT );