How many inspection deficiencies does ELM WOOD CENTER AT CLAREMONT have?

ELM WOOD CENTER AT CLAREMONT has 29 deficiencies from recent inspections. None are at the Immediate Jeopardy level.

What are the staffing levels at ELM WOOD CENTER AT CLAREMONT?

ELM WOOD CENTER AT CLAREMONT has a three-star staffing rating from CMS with 0.54 RN hours per resident per day. This rating is based on registered nurse (RN), licensed practical nurse (LPN), and nurse aide staffing hours.

Where is ELM WOOD CENTER AT CLAREMONT located?

ELM WOOD CENTER AT CLAREMONT is located in CLAREMONT, NH. It is a Medicare and Medicaid certified skilled nursing facility.

How many beds does ELM WOOD CENTER AT CLAREMONT have?

ELM WOOD CENTER AT CLAREMONT has 68 certified beds.

Who owns ELM WOOD CENTER AT CLAREMONT?

ELM WOOD CENTER AT CLAREMONT is a for profit - corporation facility and is part of the GENESIS HEALTHCARE chain.

How does ELM WOOD CENTER AT CLAREMONT compare to other nursing homes?

ELM WOOD CENTER AT CLAREMONT has a 2-star overall rating, which is below average compared to other nursing homes in NH. Families should carefully review inspection findings and consider alternatives.

ELM WOOD CENTER AT CLAREMONT

Name: ELM WOOD CENTER AT CLAREMONT
Address: 290 HANOVER STREET, CLAREMONT, NH, 03743, US
Telephone: (603) 542-2606
Rating: 2.0

290 HANOVER STREET, CLAREMONT, NH 03743 · (603) 542-2606

For profit - Corporation 68 Beds GENESIS HEALTHCARE Data: November 2025

Trust Grade

50/100

#50 of 73 in NH

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Last Inspection: August 2025

Inspected within the last 6 months. Data reflects current conditions.

Overview

Elm Wood Center at Claremont has a Trust Grade of C, meaning it is average and falls in the middle of the pack compared to other nursing homes. It ranks #50 out of 73 facilities in New Hampshire, placing it in the bottom half, but it is the top option in Sullivan County where it ranks #1 of 3. The facility's trend is stable, showing no improvement or decline, with 7 issues reported in both 2024 and 2025. Staffing is rated average with a turnover of 48%, which is slightly below the state average, and the home has no fines on record, indicating good compliance. However, concerns include not serving meals to all residents at the same table simultaneously, failing to schedule necessary audiology appointments for a resident, and insufficient staffing on weekends, which may impact the quality of care.

Trust Score: C
In New Hampshire: #50/73
Safety Record: Low Risk
Inspections: Holding Steady
Staff Stability: 48% turnover. Above average. Higher turnover means staff may not know residents' routines.
Penalties: No fines on record. Clean compliance history, better than most New Hampshire facilities.
Skilled Nurses: Each resident gets 32 minutes of Registered Nurse (RN) attention daily — about average for New Hampshire. RNs are the most trained staff who monitor for health changes.
Violations: 29 deficiencies on record. Higher than average. Multiple issues found across inspections.

★★☆☆☆

2.0

Overall Rating

★★★☆☆

3.0

Staff Levels

★★★★☆

4.0

Care Quality

★★☆☆☆

2.0

Inspection Score

↔

Stable

2024: 7 issues

2025: 7 issues

The Good

4-Star Quality Measures · Strong clinical quality outcomes
Full Sprinkler Coverage · Fire safety systems throughout facility
No fines on record

Facility shows strength in quality measures, fire safety.

The Bad

2-Star Overall Rating

Below New Hampshire average (3.0)

Below average - review inspection findings carefully

Staff Turnover: 48%

Near New Hampshire avg (46%)

Higher turnover may affect care consistency

Chain: GENESIS HEALTHCARE

Part of a multi-facility chain

Ask about local staffing decisions and management

The Ugly 29 deficiencies on record

Sept 2025 1 deficiency

CONCERN (D) 📢 Someone Reported This

A family member, employee, or ombudsman was alarmed enough to file a formal complaint

Potential for Harm - no one hurt, but risky conditions existed

Free from Abuse/Neglect (Tag F0600)

Could have caused harm · This affected 1 resident

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Based on interview and record review, the facility failed to protect that residents' right to be free from emotional abuse and exploitation by staff for 3 of 6 residents reviewed for abuse. (Resident identifiers are Resident #1, #2 and #3.)Findings include: Review on 9/11/25 of the facility reported incident and investigation for Resident #1 revealed that Staff I (Licensed Nurse Aide (LNA)) was video recorded by Staff J (LNA) laying in Resident #1's bed next to them talking about cuddling and mocking the resident. Both Staff I and Staff J were giggling. This video was sent via social media to the daughter of Staff G (Registered Nurse) on 4/23/25. Staff G was shown the videos on 8/25/25 and reported it immediately to Staff A (Administrator) and Staff B (Director of Nursing).Review on 9/11/25 of Resident #1's care plan, initiated 8/26/25, revealed interventions due to the resident being a victim abuse related to a social media posting. Review on 9/11/25 of the facility reported incidents and investigation for Resident #2 revealed that Staff I video recorded themselves sitting on the edge of Resident #2's bed mocking the resident saying you do not even know who I am and giggling. This video was sent via social media to the daughter of Staff G (Registered Nurse) on4/22/25. Staff G was shown the videos on 8/25/25 and reported it immediately to Staff A (Administrator) and Staff B (Director of Nursing).Review on 9/11/25 of Resident #2's care plan, initiated 8/26/25, revealed interventions due to the resident being a victim abuse related to a social media posting. Review on 9/11/25 of the facility reported incidents and investigation for Resident #3 revealed that Staff I video recorded themselves standing next to Resident #3's bed mocking Resident #3 saying no, no while Resident #3 was talking to Staff I using nonsensical words. This video was sent via social media to the daughter of Staff G (Registered Nurse) on 3/26/25. Staff G was shown the videos on 8/25/25 and reported it immediately to Staff A (Administrator) and Staff B (Director of Nursing) Review on 9/11/25 of Resident #3's care plan, initiated 8/26/25, revealed interventions due to the resident being a victim abuse related to a social media posting. Review on 9/11/25 of the facility's Quality Assurance and Performance Improvement Meeting minutes, dated 8/26/25, revealed a plan to conduct interviews with all staff and residents (completed 8/26/25), to re-educate staff on the privacy and social media policy (Completed 8/28/25), and to perform continued auditing for compliance. Interview on 9/11/25 with Staff C (Social Services) revealed Staff C interviewed the above 3 residents and they did not recall the incidents. Staff C revealed the 3 residents were referred to telepsychology services to verify there was no psychosocial harm. Review of the Telepsychology visits for Resident #1, #2 and #3 revealed no identified trauma and there were no recommendations for any of the residents. Review on 9/11/25 of Staff I's and Staff J 's employee record revealed that disciplinary action (termination) was taken for the above incidents. Interview on 9/11/25 at approximately 11:00 a.m. with Staff A and Staff B confirmed the above findings. Interview with Staff A and B revealed that Staff I and Staff J were reported to the Board of Nursing and the local police for the above incidents.

Aug 2025 6 deficiencies

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Deficiency F0645 (Tag F0645)

Could have caused harm · This affected 1 resident

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Based on record review and interview, it was determined the facility failed have an accurate Level I Pre-admission Screening and Resident Review (PASARR) for 2 of 2 residents reviewed for PASARR in a final sample of 19 residents (Resident identifiers are #38 and #2).Findings include: Resident #38 Review on 7/30/25 of Resident #38's diagnosis list revealed mental illness diagnosis of Post Traumatic Stress Disorder, Anxiety, Major Depression, and a personal history of suicidal behavior. Review on 7/30/25 of Resident #38's PASARR Level I screening, dated 5/14/25, was checked no mental illness. Interview on 7/31/25 at approximately 11:00 a.m. with Staff A (Social Service Director) confirmed the above PASARR Level I was inaccurate. Resident #2 Review on 7/30/25 of Resident #2's medical record revealed Resident #2 was admitted to the facility in December 2023. Review on 7/30/25 of Resident #2's medical diagnosis revealed the following diagnosis: Post Traumatic Stress Disorder (5/9/23), Major Depressive Disorder, Recurrent, Unspecified (5/9/23), Anxiety Disorder, Unspecified (5/9/23), and Borderline Personality Disorder (4/17/23). Review on 7/30/25 of Resident #2's initial PASARR completed on 4/26/23 revealed: . Part B-Mental Illness, no diagnosis' were indicated. Review on 7/31/25 of Resident #2's PASARR completed on 5/16/25 by Staff A revealed Resident #2 would require PASARR involvement with a level II face-to-face. Interview on 7/31/25 at approximately 11:00 a.m. with Staff A confirmed that the PASARR that he/she completed on 5/16/25 required a level II face-to-face with a PASARR evaluator due to Resident #2's diagnosis'.

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Deficiency F0806 (Tag F0806)

Could have caused harm · This affected 1 resident

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Based on observation, interview, and record review, it was determined that the facility failed to ensure that residents' individual preferences for meals were given for 2 of 4 residents reviewed for food in a final sample of 19 residents. (Resident identifiers are #9 and #2.)Findings include:Resident #9Interview on 7/30/25 at approximately 8:15 a.m. with Resident #9 revealed that he/she does not always get the protein that they request. Half of the time I don't get items that are on my meal tickets, I really need the extra protein in my diet because I am on dialysis.Review on 7/30/25 of Resident #9's meal ticket revealed: 8 oz (ounces) chocolate milkObservation on 7/30/25 at approximately 8:15 a.m. of Resident #9's breakfast tray revealed that there was no chocolate milk on the tray. There was no substitution for the chocolate milk on the tray.Review on 7/31/25 of Resident #9's meal ticket revealed: 8 oz chocolate milkObservation on 7/31/25 at approximately 8:20 a.m. of Resident #9's breakfast tray revealed that there was no chocolate milk on the tray. There was no substitution for the chocolate milk on the tray.Review on 7/31/25 of Resident #9's meal ticket revealed: 8 oz chocolate milkObservation on 7/31/25 at approximately 12:30 p.m. of Resident #9's lunch tray revealed that there was no chocolate milk on the tray. There was no substitution for the chocolate milk on the tray.Resident #2Interview on 7/30/25 at approximately 8:30 a.m. with Resident #2 revealed he/she keeps getting scrambled eggs for breakfast and does not like them.Observation on 7/30/25 at approximately 9:00 a.m. of Staff L (Food Service Director) and Resident #2 revealed Resident #2 telling Staff L that they don't like scrambled eggs for breakfast and he/she keeps getting scrambled eggs for breakfast.Observation on 7/31/25 at approximately 8:30 a.m. of Resident #2's breakfast tray revealed scrambled eggs. Further observation revealed Resident #2 refusing to eat the eggs. A staff member removed Resident #2's untouched breakfast from his/her room. There was no offering of an alternate meal to Resident #2.Interview on 7/31/25 at approximately 10:30 a.m. with Resident #2 revealed that he/she was not offered anything different for breakfast when he/she refused the scrambled eggs.Review on 8/1/25 of Resident #2's Food Preference Assessment, Dated 8/1/25 revealed: scrambled eggs was not indicated as a dislike.Interview on 8/1/25 at approximately 8:30 a.m. with Staff L revealed that due to recent financial issues and vendor changes chocolate milk has not been available and an alternate drink should have been offered. Further interview revealed that Resident #2 did tell Staff L on 7/30/25 that they did not want scrambled eggs at breakfast. Staff L also revealed that if a resident refuses a meal, an alternate should be offered to them.Review on 8/1/25 of the facility policy titled, NSG270 Meal Service, Revision Date 3/1/24 revealed, . Policy, Person-centered meal service includes . meals which accommodates patient preference and personal choice. 3.2.6 Food offered takes into account patient food preferences. Offer alternative food if patient refuses to eat or desires something else .

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Deficiency F0849 (Tag F0849)

Could have caused harm · This affected 1 resident

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Based on record review and interview, it was determined that the facility failed to coordinate hospice care in 1 of 1 resident reviewed for hospice care in a final sample of 19 residents (Resident identifier is #24).Findings include:Review on 7/30/25 of Resident #24's medical record revealed admitted to [name of hospice provider omitted] Hospice 7/17. Review on 7/31/25 of Resident #24's hospice binder revealed no hospice certification and plan of care. Review on 7/31/25 of Resident #24's care plan revealed that following interventions for hospice initiated on 7/17/25: hospice licensed nursing assistant visits three times a week, hospice nursing daily and as needed visits, one hospice social work visit, and one hospice volunteer visit. Review on 7/31/25 of Resident #24's resident sign-in sheet showed Resident #24 had an admission visit on 7/17/25 and a spiritual care visit on 7/29/25. There were no other visits on the resident sign-in sheet. Interview on 7/31/25 at approximately 11:10 a.m. with Staff B (LNA) revealed that he/she did not know when hospice staff were coming or what care hospice staff provides to Resident #24.Interview on 7/31/25 at approximately 11:11 a.m. with Staff C (Registered Nurse) revealed he/she did not know when hospice staff were coming to provide hospice care to Resident #24.Interview on 8/1/25 at approximately 12:00 p.m. with Staff A (Social Services Director) revealed they are designated staff to coordinate with hospice and confirmed that the hospice provider did not provide a schedule or plan of care for the coordination and collaboration of hospice care for Resident #24.

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Infection Control (Tag F0880)

Could have caused harm · This affected 1 resident

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Based on observation, interview, record review, and policy review, it was determined that the facility failed to implement their policy on Enhanced Barrier Precautions (EBP) for 2 of 3 residents observed for EBP and failed to implement their policy on cleaning and disinfecting a point of care device for 1 of 1 glucometer observed. (Resident identifiers are #23 and #49.)Findings include: Observation on 7/30/25 at 9:45 a.m. of the [NAME] medication cart revealed a plastic cup on top of the medication cart with a glucometer in it. The glucometer had a dried pink/red smear on the back of the glucometer. Interview on 7/30/25 at 9:45 a.m. with Staff F (Licensed Practical Nurse) revealed that the glucometer is to be cleaned after each use with the Sani-wipes from the purple top container and confirmed the above substance on the glucometer. Review on 7/30/25 of the facility's policy Fingerstick glucose Measurement with a revision date of 7/15/25, revealed the following: 23. Clean and disinfect the blood glucose meter after use with EPA (Environmental Protection Agency) approved disinfection, following manufacturer's instructions. Review on 8/1/25 of the facility policy titled, Enhanced Barrier Precautions, revision date of 5/1/25, revealed .Precautions .Enhanced Barrier .Applies to .All patients with any on the following .Chronic wounds and/or indwelling medical devices (e.g. Central line, urinary catheter .PPE [Personal Protective Equipment] Used for These Situations During high contact patient care activities: .Providing hygiene .Changing briefs or assisting with toileting .Required PPE .Gown, gloves prior to high contact care activity . Resident #23 Interview on 7/30/25 at approximately 11:26 a.m. with Staff D (Registered Nurse) revealed that Resident #23 was on EBP for wounds and PICC line. Observation on 7/30/25 at approximately 1:30 p.m. in Resident #23's room revealed an EBP sign posted outside of Resident #23's room. Observation also revealed that Staff D (Registered Nurse) was in Resident #23's room with gloves and not wearing a gown putting linen that appeared to be soiled and dirty briefs in plastic trash bags. Interview on 7/30/25 at approximately 1:30 p.m. with Staff D revealed that Staff D was providing perineal care to Resident #23. Staff D also revealed that he/she did not wear a gown and only wore gloves while performing perineal care to Resident #23. Staff D stated that he/she would don gloves and gown while taking care of Resident #23's Peripherally Inserted Central Catheter (PICC) line and wounds. Review on 7/30/25 of Resident #23's medical record revealed an active physician's order for EBP with a start date of 7/21/25 and a care plan that indicated Resident #23's was at risk for Multidrug Resistant Organism (MDRO) infections due to wounds and PICC line (indwelling device) with an intervention for EBP. Resident #49 Observation on 7/30/25 between 10:19 a.m. to 10:42 a.m. in Resident #49's room revealed that Resident #49 had an EBP sign posted outside of Resident #49's room. Observation also revealed that Staff I (Licensed Nursing Assistant) was wearing gloves and no gown while providing personal hygiene to Resident #49. Further observation revealed that Resident #49 had an indwelling foley catheter hanging on the left side of their bed. Interview on 7/30/25 between 10:19 a.m. to 10:42 a.m. with Staff I confirmed the above observation in Resident #49's room. Staff I stated that Resident #49 was not on EBP. Interview on 7/30/25 at approximately 10:42 a.m. with Staff D confirmed that Resident #49 was on EBP for an indwelling foley catheter. Review on 7/30/25 of Resident #49's medical record revealed an active physician's order for EBP and an indwelling foley care plan with an intervention for EBP. Interview on 08/01/2025 at 11:24 a.m. with Staff H (Infection Preventionist) confirmed the above EBP policy. Staff H stated that a gown and gloves should be worn while performing high patient contact activities such as personal hygiene and perineal care for residents on EBP.

CONCERN (E)

Potential for Harm - no one hurt, but risky conditions existed

Resident Rights (Tag F0550)

Could have caused harm · This affected multiple residents

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Based on observation and interview, it was determined that the facility failed to treat the residents with dignity by not serving the whole table together in the dining room in 5 of 5 meals observed (Resident identifiers are #12, #32, #41, #42, and #46).Findings include: Observation on 7/30/25 from approximately 8:20 a.m. until 8:40 a.m. of the Main Dining Room revealed Resident #41 and Resident #32 seated at the same table. Resident #41 was almost done with his/her breakfast and Resident #32 did not have any food or drink. Another table had Resident #64 eating his/her breakfast and Resident #46 was seated at the same table without any food or drink. Interview on 7/30/25 at approximately 8:40 a.m. with Staff J (Licensed Practical Nurse) revealed there was no process for ensuring that all residents at the same table are served their meals together when dining in the Main Dining Room. Observation on 7/30/25 between at 12:19 p.m. to 12:31 p.m. in the main dining room during lunch revealed the following: At 12:19 p.m., there were two residents sitting at one table, one resident was eating their meal and the other resident was waiting for their meal. At another table, one resident was eating their meal, the other three residents (including Resident #42) were waiting for their meal. Resident #42 took the jello from the resident that was eating their meal. The residents that were waiting for their meal did not have any drinks. Resident #42 tried to leave the dining room four times and staff directed Resident #42 to stay in the dining room as meal their meal coming. At 12:22 p.m., Resident #41 was sitting at a table with another resident that was eating their meal. Resident #41 was asking for his/her meal. At 12:27 p.m., Resident #41 and Resident #42 were still waiting for their meal while the other residents sitting with them, who were served first, had finished their meal and left the dining room. At 12:31 p.m. Resident #41 and Resident #42 were served their meal. Observation on 7/31/25 at 8:21 a.m. in the main dining room for breakfast revealed that Resident #46 stated I'm starving and was visibly shaky. Resident #46 was seated with a resident that was already eating their meal. Observation on 7/31/25 between 12:21 p.m. to 12:45 p.m. in the main dining room for lunch revealed the following: At 12:21 p.m., Resident #46 stated Can I have something to eat? I'm starving, I haven't had any lunch yet. It takes too long to get my food. Resident #46 was seated with a resident that was already eating their meal. At 12:40 p.m., there were 3 residents finishing their lunch, and 19 residents were waiting for their meals to be served. At 12:44 p.m., Resident #12 stated, Where's our dinner? At 12:45 p.m., the residents were served their meals. Observation on 8/1/25 at approximately 8:15 a.m. of the Main Dining Room revealed that 4 out of the 10 residents had meals in front of them and were eating. Resident #46 was yelling out, I'm hungry with no meal in front of them. Interview on 8/1/25 at approximately 8:30 a.m. with Staff L (Food Service Director) revealed the facility has identified an issue with meal service in the Main Dining Room on a daily basis and with the facility ensuring that all the residents who at the same table being served at the same time.

MINOR (C)

Minor Issue - procedural, no safety impact

Deficiency F0838 (Tag F0838)

Minor procedural issue · This affected most or all residents

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Based on record review and interview, it was determined that the facility failed to ensure that the facility assessment included specific staffing needs for each resident unit in the facility, and specific staffing needs for each shift such as day, evening, night. Findings include:Review on 7/31/25 of the Facility Assessment (FA), dated 8/23/2024, revealed that the FA did not include specific staffing levels needed for specific unit and shifts, such as day, evening, and night. The facility assessment does not indicate that the building has two units. Further review of the FA revealed that the total number needed for staff are 5 licensed nurses, 12 nurse aides and 2 nurse Unit Managers. Review of the FA also revealed the following note: Average census of 60 we would use 3 day nurses, 2 LPN [Licensed Practical Nurses] and 1 RN [Registered Nurse], 2 LPNs at night change base on aquity(sic)/outbreak and census .6 LNAS (Licensed Nurse Aides) on days, 6 on evenings, 3 at night change base on aquity(sic)/outbreak and census - discussion happens in the morning meeting Interview on 7/31/25 at 11:36 a.m. with Staff G (Administrator) confirmed the above findings.

Jun 2024 7 deficiencies

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Deficiency F0658 (Tag F0658)

Could have caused harm · This affected 1 resident

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**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, it was determined that the facility failed to follow physician's orders for 3 residents in a final sample of 17 residents (Resident Identifiers are #22, #25, and #64). Findings include: Standards: [NAME], [NAME] A., and [NAME]. Fundamentals of Nursing. 7th ed. St. Louis, Missouri: Mosby Elsevier, 2009. Page 336- Physicians' Orders, .The physician is responsible for directing medical treatment. Nurses follow physician's orders unless they believe the orders are in error or harm clients. Therefore you need to assess all orders, and if you find one to be erroneous or harmful, further clarification from the physician is necessary . Resident #25 Review on 6/12/24 of Resident #25's June Medication Administration Record (MAR) revealed a physician's order for Metoprolol Tartrate 25 milligrams (mg) twice daily for blood pressure. Hold for systolic blood pressure (SBP) less than 100. Further review revealed the following: -On 6/2/24 at 8:00 a.m. a SBP of 99 and was documented as being administered. -On 6/5/24 at 8:00 p.m. a SBP of 90 and was documented as being administered. -On 6/11/24 at 8:00 a.m. a SBP of 99 and was documented as being administered. Review on 6/12/24 of Resident #25's May MAR revealed a physician's order for Metoprolol Tartrate 25 mg twice daily for blood pressure. Hold for systolic blood pressure (SBP) less than 100. Further review revealed the following: -On 5/27/24 at 8:00 a.m. a SBP of 94 and was documented as being administered. -On 5/27/24 at 8:00 p.m. a SBP of 92 and was documented as being administered. -On 5/31/24 at 8:00 a.m. a SBP of 97 and was documented as being administered. Interview on 6/13/24 at 12:36 p.m. with Staff E (Unit Manager) confirmed the above findings. Staff E stated that the blood pressure medication should not have been administered to Resident #25 on the above mentioned dates per the physician's orders. Interview on 6/13/24 at 12:36 p.m. with Staff A (Licensed Practical Nurse) confirmed that on 5/31/24, 6/2/24 and 6/11/24 he/she documented that the blood pressure medication was administered. Staff A stated that the blood pressure medication should have been held per physician's orders. Resident #22 Review on 6/12/24 of Resident #22's May and June 2024 Medication Administration Records revealed the following order: Metoprolol Tartrate Tablet, Give 12.5 mg by mouth two times a day for blood pressure control, hold for BP (blood pressure) less than 100/60 or pulse less than 50, Start Date 3/22/24. May 2024 On 5/9/24 at 8:00 p.m. BP was 84/55 and Metoprolol was documented as being administered to Resident #22 June 2024 On 6/3/24 at 8:00 a.m. BP was 93/56 and Metoprolol was documented as being administered to Resident #22. Resident #64 Review on 6/12/24 of Resident #64's May and June 2024 Medication Administration Records revealed the following order: Metoprolol Tartrate Tablet, Give 12.5 mg by mouth two times a day for HTN (Hypertension), Hold for SBP less than 100. May 2024 For the 8:00 a.m. dose, no documented blood pressure was obtained prior to administration on 5/26/24 and 5/30/24. June 2024 For the 8:00 p.m. dose, no documented blood pressure was obtained prior to administration on 6/3/24 and 6/4/24. Interview on 6/12/24 at approximately 1:30 p.m. with Staff B (Unit Manager) confirmed the above findings for Resident #22 and #64.

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Deficiency F0697 (Tag F0697)

Could have caused harm · This affected 1 resident

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**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, it was determined that the facility failed to ensure that a resident received effective pain management for 1 out 1 resident reviewed for pain in a final sample of 17 residents (Resident Identifier is #118). Findings include: Interview on 6/11/24 at approximately 11:00 a.m. with Resident #118 revealed that he/she was admitted to the facility on [DATE] around lunch time. Further interview revealed that Resident #118 was in pain at the time of admission and the pain continued until about 5:00 a.m. this morning when he/she received their pain medications. Resident # 118 stated I guess they were unable to get my pain medication and I was in pain all night, I barely slept. Review on 6/12/24 of Resident #118's Clinical Admission, dated 6/10/24 at 12:45 p.m. revealed resident #36's pain level was a 7 out of 10. Review on 6/12/24 of Resident #118's June 2024's Medication Administration Record revealed the following physician's order: Oxycodone Hydrochloric Acid (HCL) Tablet 5 milligrams (mg), Give 1 tablet by mouth every 4 hours as needed for moderate to severe pain, Start Date 6/10/24. Further review revealed that the 1st dose administered to Resident #118 was on 6/11/24 at 5:52 a.m. Interview on 6/12/24 at approximately 12:45 a.m. with Staff B (Unit Manager) revealed that Staff B was aware of Resident #118's pain when he/she was admitted . Further interview revealed that Resident #118 came from the hospital without a written prescription for the Schedule II narcotic and the facility was having a hard time reaching an on call provider that would be willing to write a prescription, which took approximately 3-4 hours. Staff B also revealed that the nurse should have notified the pharmacy once the prescription was obtained so that the Emergency Medication Kit in the facility could've been accessed to obtain Resident #118's Oxycodone. Review on 6/13/24 of the facility policy titled, 4.2 New Orders for Schedule II Controlled Substances, revision Date 1/1/22 revealed: .2. Physicians/Prescribers should provide Pharmacy with verbal authorization for Schedule II controlled substances in cases of an Emergency Situation. An Emergency Situation is one in which the prescribing practitioner determines that: 2.1 Immediate administration of the Schedule II controlled substance is necessary for proper treatment of the intended user; . Review on 6/13/14 of the facility policy titled, NSG227 Pain Management, revision Date 11/1/23 revealed: .Purpose, To maintain the highest possible level of comfort for patients by providing a system to identify, assess, treat, and evaluate pain .

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Pharmacy Services (Tag F0755)

Could have caused harm · This affected 1 resident

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Based on record review, interview, and policy review, it was determined that the facility failed to establish a system of records of receipt and disposition of controlled drugs in sufficient detail to enable an accurate reconciliation; and determine that drug records are in order; and that an account of all controlled drugs was maintained in 2 of 3 narcotic books reviewed. Findings include: Review on 6/11/24 of the facility's policy titled Controlled Substance Management, dated April 1, 2022, revealed: .Two licensed nurses must perform a shift count .Ongoing inventory: A complete count of all Schedule II-IV controlled substances is required at the change of shifts per state regulation or at any time when narcotic keys are surrendered from one licensed nursing staff to another. The count must be performed by two licensed nurses and/or authorized nursing personnel . Review on 6/11/24 at 8:55 p.m. of the Medication Cart #1 (200's) Shift Change Controlled Substance Inventory Count for May 2024 and June 2024 revealed the following days with only one of two required nurse signatures for narcotic shift count: 5/9/24, 5/10/24, 5/30/24, 6/8/24, and 6/11/24. Interview on 6/11/24 at 9:00 a.m. with Staff A (Licensed Practical Nurse) confirmed the above finding for Medication cart #1. Staff A stated that he/she forgot to sign his/her name this morning when he/she did the controlled inventory count. Review on 6/11/24 at 9:40 a.m. of the Medication Cart #2 (300's) Shift Change Controlled Substance Inventory Count Sheets for May 2024 and June 2024 revealed the following days with only one of two required nurse signatures for narcotic shift count: 5/9, 5/13, 5/30, 6/8 and 6/10. Interview on 6/11/24 at 9:45 a.m. with Staff K (Licensed Practice Nurse) confirmed the above findings for Medication cart #2. Interview on 6/11/24 at 2:30 p.m. with Staff D (Director of Nursing) revealed that Controlled Substance Inventory Count Sheets should be signed and dated by the nursing staff when the actual counts are done, and that nursing staff should document all information required on the form.

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Unnecessary Medications (Tag F0759)

Could have caused harm · This affected 1 resident

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Based on observation, interview, and record review, it was determined that the facility failed to ensure a medication error rate less than 5 percent (%) for medication administration for 2 of 25 medications observed (8% error rate) (Resident Identifier is #33). Findings include: Observation on 6/10/24 at approximately 9:45 a.m. of medication administration with Resident #33 revealed Staff A (Licensed Practical Nurse) prepared the following medications: Sacchromyces Boulardii (probiotic), 1 capsule; Folic Acid 400 mcg (micrograms) 1 tablet. Review on 6/11/24 of Resident #33's June 2024's Medication Administration Record (MAR) revealed the following physician's orders: Folic Acid Oral Tablet, 1 milligram (mg) (Folic Acid) Give 1 mg by mouth one time a day for supplement, Start Date 1/19/24. Lactobacillus Oral Capsule, (Lactobacillus) Give 1 capsule by mouth one time a day of supplement, Start Date 1/19/24. Interview on 6/11/24 at approximately 9:45 a.m. with Staff A (Licensed Practical Nurse) confirmed that the he/she was going to administer the wrong dose of Folic Acid and the wrong probiotic. Review on 6/10/24 of the facility policy titled, 6.0 General Dose Preparation and Medication Administration, revision date or 4/30/24 revealed: .3. Prior to administration of medication, facility staff should take all measures required by facility policy and applicable law, including, but not limited to the following: 3.1 Verify each time a medication is administered that is the correct medication, at the correct dose . There were 2 medication errors out of a total of 25 medication administration opportunities resulting in a 8% error rate.

CONCERN (E)

Potential for Harm - no one hurt, but risky conditions existed

Deficiency F0685 (Tag F0685)

Could have caused harm · This affected multiple residents

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Based on observation, interview and record review, it was determined that the facility failed to ensure that a resident received proper treatment to maintain hearing abilities by ensuring audiology appointments were made for 1 of 1 residents reviewed for Communication-Sensory in a final sample of 17 residents (Resident identifier is #36). Findings include: Interview on 6/11/24 at 10:38 a.m. with Resident #36 revealed that he/she was very hard of hearing and that his/her hearing aids were not working well. Resident #36 stated that he/she had been waiting a long time to see the hearing doctor and was not sure the status of the referral. Review on 6/11/24 of Resident #36's care plan revealed that the resident had impaired communication related to impaired hearing in both ears. Further review revealed an intervention initiated on 6/8/22 to obtain audiology exams as indicated. Review on 6/11/24 of Resident #36's Clinical Documentation Supporting Medical and/or Surgical Need for Audiology Services revealed that Complaints of vertigo and/or dizziness was checked. This form was signed on 10/27/23 by the practitioner and 11/8/23 by Staff E (Unit Manager). Review on 6/11/24 of Resident #36's medical record revealed no completed Audiology consult. Interview on 6/12/24 at 1:38 p.m. with Staff F (Customer Service Representative for the Audiology Company) confirmed that Resident #36 had not yet been seen by the audiologist. Staff F revealed that multiple audiology clinics had been set up for the facility in November and December of 2023; and in February, March and April of 2024, but were all canceled due to the facility sending incomplete orders and/or paperwork needed for the visits. Staff F revealed that emails had been sent to the facility regarding the incomplete orders/paperwork prior to each visit, including to Staff E; however, no response was received for any of these emails and therefore the clinics were canceled. Staff F revealed that there were approximately 22 residents from the facility waiting to be seen by the Audiologist, including Resident #36. Interview on 6/13/24 at 8:22 a.m. with Staff E revealed that he/she had faxed requests to be seen for multiple residents, including Resident #36, to the audiology company on 4/6/24, but the audiologist did not show up. Interview on 6/13/24 at 9:48 a.m. and 10:41 a.m. with Staff E confirmed the above findings.

CONCERN (E)

Potential for Harm - no one hurt, but risky conditions existed

Deficiency F0725 (Tag F0725)

Could have caused harm · This affected multiple residents

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Based on interview and record review, it was determined that the facility failed to provide sufficient staff to meet residents' needs on Saturdays and Sundays in January 2024, February 2024, and March 2024. Findings include: Review of the facility's Payroll Based Journal (PBJ) Staffing Data Report for Fiscal Year Quarter 2 2024 (January 1 - March 31) revealed that the facility triggered for excessively low weekend staffing. Interview on 6/13/ 24 at 8:30 a.m. with Staff B (Unit Manager) revealed that during the winter months especially in January, February and March, short staffing was a real concern on the weekends. Review on 6/13/24 of the 2024 Facility Assessment revealed the following staffing levels for direct care staff: Licensed Nurses (Registered Nurse (RN), Licensed Practical Nurse (LPN), or Medication Nursing Assistant (MNA)) - 12-hour day shift was 3 and 12-hour night shift was 2; Nurse aides (Certified Nursing Assistant (CNA), Licensed Nursing Assistant (LNA)) - 7:00 a.m. to 3:00 p.m. (day)shift was 6, 3:00 p.m. to 11:00 p.m. (Evening) shift was 6, and 11:00 p.m. to 7:00 a.m. (night) shift was 3. Interview on 6/13/24 at 10:00 a.m. with Staff C (Staff Scheduler) revealed that staff would be scheduled to either the Long-Term Care (LTC) unit or the Medical Skilled Unit (MCU). Review on 6/13/24 of the Daily Staffing Sheets from January 2024 to March 2024 revealed that staffing levels for direct care staff were lower than what was defined in the facility assessment for licensed nurses and nurses aides on the following weekend shifts: January: 1/6/24 - Saturday - LTC Unit - Day shift - 2 LPN, 3 CNA - Evening shift - 2 LPN, 3 CNA - Unit census 48; 1/13/24 - Saturday - LTC Unit - Evening shift - 2 LPN, 3 CNA - Unit census 50; 1/14/24 - Sunday - LTC Unit - Evening shift - 2 LPN, 3 CNA - Unit census 50; 1/20/24 - Saturday - LTC Unit - Evening shift - 2 LPN/RN, 3.5 CNA - Unit census 51; 1/27/24 - Saturday - LTC Unit - Day shift - 2 LPN, 3 CNA - Evening shift - 2 LPN, 2 CNA - Unit census 48; 1/28/24 - Sunday - LTC Unit - Day shift - 2 LPN, 3.5 CNA - Unit census 48. February: 2/3/24 - Saturday - LTC Unit - Day shift - 2 LPN/RN, 3.5 CNA - Evening shift - 3 LPN/RN, 2.5 CNA - Unit census 48; 2/4/24 - Sunday - LTC Unit - Day shift - 2 LPN, 3 CNA - Evening shift - 2 LPN/RN, 2.5 CNA - Night shift 1 RN, 1 CNA - Unit census 48; 2/10/24 - Saturday - LTC Unit - Day shift - 2 LNA, 3.5 CNA - Unit census 48; 2/11/24 - Sunday - LTC Unit - Day shift - 2 LPN, 3.5 CNA - Night shift - 1 LPN/RN, 1.5 CNA - Unit Census 49; 2/17//24 - Saturday - LTC Unit - Day shift - 2 LPN, 3 CNA - Evening shift - 2 LPN/MNA, 2.5 CNA - Unit Census 48; 2/18/24 - Sunday - LTC Unit - Day shift - 2 LPN, 2 CNA - Evening shift - 1.5 LPN, 1.5 CNA - Unit Census 48; 2/24/24 - Saturday - LTC Unit - Day shift - 2 LPN/RN, 3 CNA - Night shift - 1 LPN, 1.5 CNA - Unit Census 51; 2/25/24 - Sunday - LTC Unit - Day shift - 2 LPN, 3 CNA - Night shift - 1 LPN/RN, 1.0 CNA - Unit Census 51. March: 3/2/24 - Saturday - LTC Unit - Day shift - 2 LPN, 2 CNA - Evening shift - 2 LPN, 3 CNA - Night shift - 1 LPN, 1 CNA - Unit census 51; 3/3/24 - Sunday - LTC Unit - Day shift - 2 LPN, 3 CNA - Evening shift - 2 LPN/MNA, 2 CNA - Night shift 1 LPN, 1 CNA - Unit Census 51; 3/9/24 - Saturday - LTC Unit - Evening shift - 2 LPN, 3.5 CNA - Night shift - 1 LPN, 1.5 CNA - Unit census 50; 3/10/24 - Sunday - LTC Unit - Evening shift - 2 LPN, 3.5 CNA - Night shift - 1 LPN, 1.5 CNA - Unit census 50; 3/16/24 - Saturday - LTC Unit - Day shift - 2 LPN, 3 CNA - Evening shift - 2 LPN/MNA, 3 CNA - Unit census 51; 3/17/24 - Sunday - LTC Unit - Day shift - 2 LPN, 3 CNA - Evening shift - 2 LPN/MNA, 3 CNA - Unit census 51; 3/23/24 - Saturday - LTC Unit -Evening shift - 2 LPN, 2 CNA - Night shift - 1 LPN, 1 CNA - Unit census 50; 3/24/24 - Sunday - LTC Unit - Night shift - 1 LPN, 1.5 CNA - Unit census 50; 3/30 24 - Saturday - LTC Unit - Day shift - 2 LPN, 3 CNA - Night shift - 1 LPN, 1 CNA - Unit census 49; 3/31/24 - Sunday - LTC Unit - Day shift - 2 LPN, 3.5 CNA - Unit census 49. Interview on 6/13/24 at 12:40 p.m. with Staff C confirmed the above findings. Interview on 6/13/24 at 8:16 a.m. with Staff H (LNA) revealed that he/she felt that the staffing levels had improvement over the last month. Interview on 6/13/24 at 8:22 a.m. with Staff G (LPN) revealed that over the winter he/she would be forced to work additional shifts due to call outs. Interview further revealed that Staff G felt that currently staffing was in a very good place. Interview on 6/13/24 12:50 p.m. with Staff D (Director of Nursing) revealed that a staffing action plan resulted from staffing concerns from nursing management.

MINOR (B)

Minor Issue - procedural, no safety impact

Deficiency F0582 (Tag F0582)

Minor procedural issue · This affected multiple residents

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Based on interview and record review, it was determined that the facility failed to ensure that the resident and/or resident representative was informed timely of the Skilled Nursing Facility (SNF) Notice of Medicare Non-Coverage (NOMNC) or Advance Beneficiary Notice (ABN) for 2 out of 3 residents reviewed for beneficiary notices (Resident Identifiers are #33 and #217). Findings include: Resident #33 Review on 6/11/24 of the Beneficiary Notice - Residents discharged Within the Last Six Months form, completed by the facility, revealed that Resident #33 was discharged from Medicare Services on 2/28/24 and remained in the facility. Review on 6/11/24 of Resident #33's SNF Beneficiary Notification Review form, completed by the facility, revealed that Resident #33's last covered day of Medicare Part A Skilled Services was 2/28/24 and that the facility/provider initiated the discharge from Medicare Part A Services when benefit days were not exhausted. Further reviewed of this form under Question 1 Was SNF ABN, Form CMS-10055 provided to resident? was checked No. Interview on 6/11/24 at 1:16 p.m. with Staff J (Business Officer) confirmed the above findings. Staff J stated that they had not filled out the the SNF ABN, Form CMS-10055 with Resident #33. Resident #217 Review on 6/11/24 of the Beneficiary Notice - Residents discharged Within the Last Six Months form, completed by the facility, revealed that Resident #217 was discharged from Medicare Services on 2/12/24 and discharged home. Review on 6/11/24 of Resident #217's SNF Beneficiary Notification Review form, completed by the facility, revealed that Resident #217's last covered day of Medicare Part A Skilled Services was 2/12/24 and that the facility/provider initiated the discharge from Medicare Part A Services when benefit days were not exhausted. Further reviewed of this form under Question 2 Was a NOMNC, form CMS-10123 provided to the resident? was checked No. Interview on 6/11/24 at 1:55 p.m. with Staff J confirmed that above findings. Staff J stated that Resident #217 was not provided the NOMNC form or notice of non-coverage prior to Resident #217's last covered day of Medicare services. Review on 5/7/24 of Form Instructions for the NOMNC CMS-10123, retrieved from https://www.cms.gov/medicare/medicare-general-information/bni/downloads/instructions-for-notice-of-medicare-non-coverage-nomnc.pdf revealed: . The NOMNC must be delivered at least two calendar days before Medicare covered services end or the second to last day of service if care is not being provided daily .

May 2023 15 deficiencies

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Deficiency F0552 (Tag F0552)

Could have caused harm · This affected 1 resident

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**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, it was determined that the facility failed to inform a resident's representative of the risk and benefits of an antipsychotic medication use for a resident that lacked capacity for making their own decisions for 1 out of a final sample of 26 residents (Resident Identifier is #38). Findings include: Interview on 4/30/23 at approximately 9:30 a.m. with Resident #38 revealed that he/she was oriented to self only. Review on 5/1/23 of Resident #38's medical record revealed that Resident #38 was his/her own decision maker. Further review of Resident #38's medical record revealed that Resident #38 was admitted to the facility on [DATE]. Review on 5/1/23 of Resident #38's physician note dated, 3/15/23 revealed: .DPOA [Durable Power of Attorney] activated as pt [patient] not able to comprehend complex medical issues and not able to make decisions for [pronoun omitted] . Review on 5/1/23 of Resident #38's Psychotropic Medication Administration Disclosure, dated 4/3/23 revealed that Resident #38 signed his/her consent for the use of Seroquel. Interview on 5/1/23 at approximately 11:45 a.m. with Staff G (Director of Nurses) confirmed that Resident #38 was not able to make informed medical decisions for his/herself and that Resident #38 should have had their DPOA activated in reviewing the physician's note dated 3/15/23. Staff G stated that Resident #38's DPOA should have been informed of Resident #38's use of Seroquel.

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Deficiency F0578 (Tag F0578)

Could have caused harm · This affected 1 resident

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**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, it was determined that the facility failed to ensure that residents' formulated advance directives would be followed for 2 out of 26 residents reviewed (Resident Identifiers are #36 and #38). Findings include: Review on [DATE] of Resident #36's Electronic Health Record (EHR) revealed that Resident #36's code status was a Full Code, initiated on [DATE]. Review on [DATE] of Resident #36's paper medical record revealed that Resident #36's code status was a Do Not Resuscitate (DNR), initiated on [DATE]. Interview on [DATE] at approximately 11:30 a.m. with Staff J (Unit Manager) confirmed that Resident #36 wanted to be a DNR. Staff J confirmed that there was no current order or information in Resident #36's Electronic Medical Record (EMR) identifying them as a DNR. Interview on [DATE] with Staff B (Licensed Practical Nurse) stated that in an emergency they would look in the EMR for the code status to determine whether or not to initiate Cardiopulmonary Resuscitation (CPR). Review on [DATE] of facility's policy titled Code Status Orders initiated on [DATE], revealed .Code status communicates to the clinical staff whether the patient desires Cardiopulmonary Resuscitation (CPR) in the event of cardiopulmonary arrest. Patient identification mechanisms and information about each patient's code status (Full code vs. [versus] Do Not Rescusitate (DNR)) will be readily accessible to the clinical staff for all patients .If the patient wishes are different than the admission orders, immediately document the patient's wishes in the medical record, notify the physician, and obtain the correct order .Resident #38 Interview on [DATE] at approximately 9:30 a.m. with Resident #38 revealed that he/she was oriented to self only. Review on [DATE] of Resident #38's medical record revealed that Resident #38 was his/her own decision maker. Further review of Resident #38's medical record revealed that Resident #38 was admitted to the facility on [DATE]. Further review of Resident #38's medical record revealed no order for an activated Durable Power of Attorney (DPOA). Review on [DATE] of Resident #38's physician note dated, [DATE] revealed: .DPOA activated as pt [patient] not able to comprehend complex medical issues and not able to make decisions for [pronoun omitted] . Review on [DATE] of Resident #38's Psychotropic Medication Administration Disclosure, dated [DATE] revealed that Resident #38 signed his/her consent for the use of Seroquel. Interview on [DATE] at approximately 11:45 a.m. with Staff G (Director of Nursing) confirmed that Resident #38 was not able to make informed medical decisions for his/herself and that Resident #38 should have had their DPOA activated in reviewing the physician's note dated [DATE]. Interview on [DATE] at approximately 12:10 p.m. with Staff I (Social Worker) revealed that he/she did do a Brief Interview Mental Status (BIMS) assessment with Resident #38 his/her score was a 3 (severe cognitive impairment). Further interview with Staff I revealed that he/she does not inform the physician or nursing staff of resident BIMS scores, It is in the medical record for them to review. Interview on [DATE] at approximately 2:45 p.m. with Staff M (Physician) revealed that he/she relies on the facility to inform him/her of a resident's cognition that would require activating a DPOA. Review on [DATE] of the facility policy titled, OPS117 Health Care Decision Making, Revision Date [DATE] revealed: .Identifying a Substitute Decision Maker: 3. If the patient is determined to be incapable of making health care decisions for medical treatment, identify a substitute decision maker in accordance with state law. 3.1 If an advance directive that includes a Health Care Proxy/DPOA Health Care/Health Care Agent or Representative is in place, the physician will activate the directive in accordance with state law, write orders reflecting patient wishes, and document in the medical record. 3.1.1 The health care decision maker will uphold patient wishes set forth in the advance directive.

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Notification of Changes (Tag F0580)

Could have caused harm · This affected 1 resident

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Resident #58 Review on 5/1/23 of Resident #58's April 2023 Medication Administration Record (MAR) revealed the following order: Weigh daily, every day shift, Congestive Heart Failure (CHF), Start Date 2/17/23. Further review of Resident #58's MAR's revealed: 4/5/23 weight 204.6 lbs 4/6/23 weight 210.0 lbs (5.4 lbs gain) 4/11/23 weight 205.0 lbs 4/12/23 weight 212.2 lbs (6.8 lbs gain) 4/16/23 weight 206.4 lbs 4/17/23 weight 214.8 lbs (8.4 lbs gain) Review on 5/2/23 of Resident #58's medical record revealed that there was no documented evidence of the physician being notified of the above weight gain. Interview on 5/2/23 at approximately 1:40 p.m. with Staff G (Director of Nurses) revealed that a weight change of 5 lbs should be reported. Resident #118 Review on 5/1/23 of Resident #118's MAR revealed an order for Spiriva Resplmat Inhalation Aerosol Solution 2.5 microgram/actuation (MCG/ACT) Tiotropium Bromide Monohydrate 2 puffs inhale orally one time a day for Chronic Obstructive Pulmonary Disease (COPD) with a start date of 4/13/23. Further review of Resident #118's MAR revealed that on 4/22, 4/23, and 4/28/23 Resident #118 refused the medication and there was no documentation that the physician was notified. Interview on 5/1/23 at approximately 9:00 a.m. with Staff J (Unit Manager) confirmed that there was no documentation in Resident #118's nursing progress notes that the physician was notified of Resident #118's refusal of medication. Interview on 5/2/23 with Staff G (Director of Nursing) revealed that the facility's medical director reviews orders for residents of the facility monthly and is notified of resident refusals of medication at that time.Based on interview and record review, it was determined that the facility failed to ensure that the provider was updated regarding changes in the residents' status for 3 residents in a final sample of 26 residents (Resident Identifiers are #29, #58 and #118). Findings include: Resident #29 Review on 5/1/23 of Resident #29's monthly weights revealed the following: 4/23/23 - 104.5 pounds (lbs) 3/12/23 - 113 lbs 2/26/23 - 108.2 lbs 1/1/23 - 101.9 lbs 12/1/22 - 113.3 lbs 11/1/22 - 115.9 lbs Review on 5/1/23 of Resident #29's Nutritional Assessment completed by Dietitian, dated 4/12/23, revealed .has had sig [significant] wt [weight] loss past month. Appears to have had an overall decline. Staff note that [pronoun omitted] is not eating as much as [pronoun omitted] used to. Intakes not adequate. Finger food items provided as [pronoun omitted] prefers this than to having staff assist [pronoun omitted], however, intakes declining. Altered diet tolerated for ease of chewing and swallowing. No restrictions needed, and significant decline in oral intake. Wt loss has brought BMI [Basic Metabolic Index] into underwt [underweight] range and appears this and cachectic .19.5 % [percent] wt loss past month . Review on 5/1/23 of Resident #29's Nutritional Assessment completed by Dietitian, dated 1/11/23, revealed .has had sig wt loss past month and significant decline in oral intakes. Wt loss has brought BMI into underwt range and appears this and cachectic . Review on 5/1/23 of Resident #29's Provider Visit notes dated 1/30/23 through 4/3/23, revealed no mention of overall decline, significant weight loss, or concern with nutritional status. Review on 5/1/23 of Resident #29's Progress Notes dated 1/11/23 through present, revealed no documentation of written notification to the provider of significant weight changes. Interview on 5/1/23 at approximately 3:17 p.m. with Staff J (Unit Manager) confirmed there was no evidence in Resident #29's medical record that the provider was notified of the resident's weight loss. Review on 5/2/23 of facility's procedure titled Weights and Heights, revised on 2/1/23, revealed 2. Significant weight change management: .The licensed nurse will: 2.2.1 Notify the physician/APP [advanced practice provider] and Dietitian of significant weight changes 2.2.2 Document notification of physician/APP and Dietitian in the PCC [Point Click Care] Weight Change Progress Note .

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Safe Environment (Tag F0584)

Could have caused harm · This affected 1 resident

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**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, it was determined that the facility failed to ensure a safe and homelike environment for 1 resident out of a census of 63 residents (Resident Identifier is #38). Findings include: Observation on 4/30/23 at approximately 10:25 a.m. of Resident #38's room revealed that the other bed in his/her room had 4 mattresses piled on top of one another on a bed frame (visible from the door way). Observation on 5/1/23 at approximately 9:20 a.m. of Resident #38's room revealed that the other bed in his/her room had 3 mattresses piled on top of one another on a bed frame (visible from the door way). Review on 5/1/23 of Resident #38's medical record revealed Resident #38 was admitted to the facility on [DATE]. Interview on 5/1/23 at approximately 9:20 a.m. with Staff E (Unit Manager) revealed that he/she was not aware how long the mattresses have been stored in Resident #38's room. Interview on 5/1/3 at approximately 9:25 a.m. with Staff C (Registered Nurse) revealed the mattresses were stored in Resident #38's room since 4/24/23. Interview on 5/1/23 at approximately 9:30 a.m. with Staff D (Maintenance Director) revealed that he/she did not know that the mattresses were being stored in residents' rooms while residents were residing in them.

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Deficiency F0658 (Tag F0658)

Could have caused harm · This affected 1 resident

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**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review it was determined that the facility failed to follow physicians' orders for 3 out of 26 residents reviewed (Resident Identifier's are #26, #47, and #167). Findings include: Standards: [NAME], [NAME] A., and [NAME]. Fundamentals of Nursing. 7th ed. St. Louis, Missouri: Mosby Elsevier, 2009. Page 336- Physicians' Orders The physician is responsible for directing medical treatment. Nurses follow physician's orders unless they believe the orders are in error or harm clients. Therefore you need to assess all orders, and if you find one to be erroneous or harmful, further clarification from the physician is necessary . Resident #26 Review on 4/30/23 of Resident #26's April 2023 Medication Administration Record (MAR) revealed the following physician's order, dated 3/13/23: Acetaminophen Oral Tablet 325 mg [milligrams], Give 2 tablet by mouth every 4 hours as needed for fever greater than 38.2 C [Celsius] Temp [temperature], do not exceed 3 grams from all sources within 24 hours. Further review of Resident #26's April 2023 MAR revealed the following administration of the above order: 4/8/23 98.0 F [Fahrenheit] = 36.667 C 4/9/23 97.8 F = 36.556 C 4/10/23 98.2 F = 36.778 4/27/23 97.7 F = 36.5 C Interview on 5/1/23 at approximately 4:00 p.m. with Staff G (Director of Nursing) confirmed that the medication was administered outside of the parameters indicated on the physician's order. Resident #47 Review on 4/30/23 of Resident #47's April 2023's MAR revealed the following physician's order dated 10/27/21: Metoprolol Tartrate Tablet 25 mg, Give 25 mg by mouth two times a day for HTN [hypertension] hold if SBP [systolic blood pressure] is less than 110, HR [heart rate] less than 65. Further review of Resident #47's April 2023's MAR revealed the following administration of the above order: 4/2/23 9:00 p.m., SBP 106, the medication was administered 4/3/23 9:00 p.m., SBP 106, the medication was administered 4/4/23 9:00 a.m., SBP 107, the medication was administered 4/5/23 9:00 a.m., SBP 100, the medication was administered 4/10/23 9:00 a.m., SBP 107, the medication was administered 4/13/23 9:00 p.m., SBP 96 and HR 56, the medication was administered 4/15/23 9:00 a.m., SBP 106, the medication was administered 4/16/23 9:00 a.m., HR 57, the medication was administered 4/21/23 9:00 p.m., SBP 107, the medication was administered 4/23/23 9:00 p.m., SBP 102, the medication was administered 4/30/23 9:00 a.m., SBP 108, the medication was administered Interview on 5/2/23 at approximately 11:00 a.m. with Staff G confirmed that the above medications were administered outside of the physician's parameters. Tramadol HCl [Hydrochloric Acid] Tablet 50 mg, Give 1 tablet by mouth as needed for moderate to severe pain twice daily as needed, start date 8/18/22. Further review of Resident #47's April 2023 MAR revealed the following administration of the above order: 4/1/23 the medication was administered for a pain level of 0 4/3/23 the medication was administered for a pain level of 2 4/4/23 the medication was administered for a pain level of 0 Review on 5/2/23 of the facility policy titled, NSG227 Pain Management, Revision Date 10/24/22 revealed: . 6. PRN (as needed) pain medications will: . 6.2 Have defined parameters for use, . Interview on 5/2/23 at approximately 11:00 a.m. with Staff G confirmed that the above medications were administered outside of the physician's parameters. Staff G revealed that as needed pain medication should have a numeric parameter based on a pain scale for administration. Resident # 167 Observation on 4/30/23 at approximately 8:58 a.m. of Resident #167's right arm revealed 2 dressings dated 4/28/23. Interview on 4/30/23 at approximately 9:10 a.m. with Staff B (Licensed Practical Nurse) confirmed the 2 dressings were dated 4/28/23 on Resident #167's right arm. Review on 4/30/23 of Resident #167's MAR and Treatment Administration Record (TAR) revealed that there was no order for the 2 dressings to Resident #167's right arm. Interview on 5/1/23 at approximately 11:30 a.m. with Staff E (Unit Manager) revealed that the order for dressing change was put into the system incorrectly and that was why it was not changed on 4/29 and 4/30. Staff E then provided the following physician's order: Two open wounds on lateral right arm; cleanse with sterile saline and cover with foam adhesive dressing daily and as needed for dislodgement or strike through, dated 4/28/23.

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Pressure Ulcer Prevention (Tag F0686)

Could have caused harm · This affected 1 resident

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Based on interview and record review, it was determined that the facility failed to assess pressure ulcers weekly for 1 out of 4 residents reviewed for pressure ulcers in a sample of 26 residents (Resident Identifier #56). Findings include: Resident #56 Review on 5/1/23 of Resident #56's medical record revealed the following Skin and Wound Evaluations for a pressure injury obtained in facility to the sacrum: 1/17/23 Stage 3 measuring 0.8 centimeters (cm) x [by] 0.4 cm; 2/16/23 Stage 3 measuring 1.1 cm x 0.6 cm; 4/26/23 Stage 3 measuring 0.5 cm x 0.5 cm; Review on 5/1/23 of Resident #56's medical record revealed the following Skin and Wound Evaluations for a pressure injury obtained in the facility to the right ankle: 12/13/22 DTI [Deep Tissue Injury] measuring 2.1 cm x 1.0 cm; 1/17/23 DTI measuring 1.9 cm x 1.3 cm; 1/30/23 DTI measuring 2.0 cm x 1.0 cm; 2/16/23 DTI measuring 1.9 cm x 1.2 cm; 4/26/23 Stage 3 measuring 1.3 cm x 0.7 cm. Interview on 5/2/23 at approximately 1:30 p.m. with Staff Q (Wound Nurse) confirmed that there were missing weekly wound measurements and descriptions for both of Resident #56's in facility acquired pressure injuries.

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Deficiency F0712 (Tag F0712)

Could have caused harm · This affected 1 resident

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**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, it was determined that the facility failed to ensure that a resident was seen by a physician at least once every 60 days for 2 out of 5 residents reviewed for physician visits, and that the required visits alternated between the physician and the physician assistant (Resident Identifiers are #4 and #47). Findings include: Resident #4 Review on 5/2/23 of Resident #4's admission record revealed that Resident #4 was admitted to the facility on [DATE]. Review on 5/2/23 of Resident #4's physician and physician assistant (PA) visits from 7/28/22 - 4/3/23 revealed: 7/28/22 Resident #4 was seen by the physician 11/30/22 Resident #4 was seen by the PA 1/30/23 Resident #4 was seen by the PA 4/3/23 Resident #4 was seen by the physician Interview with Staff G (Director of Nursing) confirmed that the timeframe for a resident to be seen by a physician every 60 days was not correct for the visits dated 7/28/22 through 11/30/22 and for the visits dated 1/30/23 through 4/3/23. Staff G further confirmed that the visit on 1/30/23 should have been made by the physician. Resident #47 Review on 5/2/23 of Resident #47's physician and PA visits from 9/9/22 - 4/17/23 revealed: 9/9/22 Resident #47 was seen by the physician 12/16/22 Resident #47 was seen by the PA 2/20/23 Resident #47 was seen by the PA 4/17/23 Resident #47 was seen by the PA Interview on 5/2/23 at approximately 3:00 p.m. with Staff G (Director of Nurses) confirmed the above findings.

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Deficiency F0726 (Tag F0726)

Could have caused harm · This affected 1 resident

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Based on record review and interview it was determined that the facility failed to ensure that licensed nurses have specific intravenous (IV) certificate/competencies necessary to care for residents needs for 1 out of 6 Licensed Practical Nurses (LPNs) reviewed. Findings include: Review on 5/2/23 of Staff B (LPN) IV therapy certificate/competencies revealed that Staff B did not provide a completed Board of Nursing approved certificate of IV Therapy for LPN's upon hire by the facility. Interview on 5/2/23 with Staff G (Director of Nursing) and Staff N (Regional Clinical Manager) confirmed that Staff B was providing IV care to residents without having the required certification and competencies.

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Deficiency F0757 (Tag F0757)

Could have caused harm · This affected 1 resident

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Based on interview and record review it was determined that the facility failed to ensure adequate monitoring for 1 resident reviewed for insulin in a final sample of 26 residents (Resident Identifier is #168). Findings include: Review on 4/30/23 of Resident #168's April 2023 Medication Administration Record (MAR) revealed the following physician's order: Humalog Kwik-Pen Subcutaneous Solution Pen-injector 100 unit/ml [milliliters] Inject as per sliding scale: .241+ = 6 units, if BG [blood sugar] greater than 240 give 6 units and recheck BG in 2 hours, subcutaneously four times a day for DM [Diabetes Mellitus], start date 4/21/23. Further review of Resident #168's April 2023 MAR revealed the following BG's above 240: 4/25/23 at 4:30 p.m. BG 321 4/26/23 at 11:30 a.m. BG 252 4/27/23 at 11:30 a.m. BG 384 4/27/23 at 4:30 p.m. BG 348 4/27/23 at 9:00 p.m. BG 331 4/28/23 at 6:30 a.m. BG 300 4/28/23 at 4:30 p.m. BG 288 4/28/23 at 9:00 p.m. BG 377 4/29/23 at 11:30 a.m. BG 308 4/30/23 at 11:30 a.m. BG 328 4/30/23 at 4:30 p.m. BG 310 4/30/23 at 9:00 p.m. BG 279 Review on 5/1/23 of Resident #168's medical record revealed there was no documentation of BG's being rechecked in 2 hours after a BG result greater than 240. Interview on 5/2/23 at approximately 9:00 a.m. with Staff G (Director of Nurses) confirmed that there was no documentation of Resident #168's BG's being rechecked.

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Deficiency F0761 (Tag F0761)

Could have caused harm · This affected 1 resident

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Based on observation, interview, and record review it was determined that the facility failed to ensure expired medications were removed from the medication cart for 1 out of 2 medication carts observed and that controlled medications were separately locked in the medication room for 1 out of 1 medication rooms observed. Findings include: Observation on 4/30/22 at approximately 8:05 a.m. of the 200 Hall Medication Cart revealed the following: Resident #20's medication card of Simvastatin 20 milligrams (mg) with an expiration date of 9/30/22. Interview on 4/30/23 at approximately 8:05 a.m. with Staff A (Licensed Practical Nurse (LPN)) confirmed the above finding. Observation on 4/30/23 at approximately 8:20 a.m. of the Intermediate Care Facility (ICF) Medication Room revealed: Resident # 13's Lorazepam 2 milligram per milliliters (mg/ml) in the unlocked refrigerator. Interview on 4/30/23 at approximately 8:20 a.m. with Staff F (LPN) confirmed the above finding. Review on 4/30/23 of the facility policy titled, 5.3 Storage and Expiration Dating of Medications, Biologicals, Revision Date 7/21/22 revealed: . 4. Facility should ensure that medications and biologicals that: .(2) have been retained longer than recommended by manufacturer or supplier guidelines; ., are stored separate from other medications until destroyed . 12. Controlled Substances Storage: . 12.4 Controlled Substances stored in the refrigerator must be in a separate container and double locked .

CONCERN (D)

Potential for Harm - no one hurt, but risky conditions existed

Deficiency F0838 (Tag F0838)

Could have caused harm · This affected 1 resident

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Based on interview and record review, it was determined that the Facility Assessment failed to include the number of staff needed to ensure sufficient numbers of qualified staff are available to meet each residents' needs, and to ensure the residents attain or maintain their highest practicable level of physical, functional, mental and psychosocial well-being. Findings include: Review on 5/2/23 of the Facility Assessment revealed that the assessment did not include the number of staff needed to care for each residents' needs. Interview on 5/2/23 with Staff R (Administrator) confirmed the above findings.

CONCERN (E)

Potential for Harm - no one hurt, but risky conditions existed

Unnecessary Medications (Tag F0759)

Could have caused harm · This affected multiple residents

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Based on observation, interview, and record review it was determined that the facility failed to ensure a medication error rate less than 5 percent (%) (Resident Identifiers are #40, #117 and #169). Findings include: Resident #169 Observation on 4/30/23 at approximately 11:00 a.m. of the Gastrostomy (G) Tube medication administration with Resident #169 and Staff B (Licensed Practical Nurse LPN)) revealed the following medications were administered: Aspirin 81 milligrams (mg) Folic Acid 1 mg Lamotrigine 25 mg Levetiracetam 1000 mg Rosuvastatin Calcium 10 mg Thiamine 100 mg Tizanidine 2 mg Further observation revealed Staff B flushed the G Tube with 5 milliliters (mls) of Normal Saline 0.9% in between each medication being administered. Review on 4/30/23 of Resident #169's physician's orders revealed the following order: Enteral Feed : . Flush tube with at least 15 ml of Normal Saline 0.9% between each medication. Interview on 4/30/23 at approximately 11:00 a.m. with Staff B confirmed the above findings. Resident #117 Observation on 5/1/23 at approximately 7:25 a.m. of the medication administration with Staff H (Licensed Practical Nurse (LPN)) and Resident #117 revealed: Staff H prepared 200 mg of Calcium Citrate 200 mg (1 tablet) Review on 5/1/23 at approximately 7:25 a.m. of Resident #117's physician's orders revealed the following order: Calcium Citrate, Give 600 mg by mouth one time a day for calcium deficiency, dated 4/13/23. Interview on 5/1/23 at approximately 7:30 a.m. with Staff H confirmed that he/she prepared the wrong dose of the Calcium Citrate. Resident #40 Observation on 5/1/23 at approximately 7:40 a.m. of the medication administration with Staff H and Resident #40 revealed: Staff H prepared 81 mg of Aspirin EC [Enteric Coated] Review on 5/1/23 at approximately 7:40 a.m. of Resident #40's physician's orders revealed the following order: Aspirin 81 mg, Give 1 tablet by mouth one time a day for heart health, dated 1/2/20. Interview on 5/1/23 at approximately 7:40 a.m. with Staff H confirmed that he/she prepared the wrong aspirin. Review on 5/1/23 of the facility policy titled, 6.0 General Dose Preparation and Medication Administration, Revision Date 1/1/22 revealed: . 3.7 Facility staff should verify that the medication name and dose are correct when compared to the medication order on the medication administration record. . There were 3 medication errors out of a total 28 medication opportunities observed resulting in a 10.71% error rate.

MINOR (B)

Minor Issue - procedural, no safety impact

Comprehensive Assessments (Tag F0636)

Minor procedural issue · This affected multiple residents

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Based on record review and interview, it was determined that the facility failed to accurately complete an Minimum Data Set (MDS) for 2 out of 3 residents in a final sample of 26 residents (Resident Identifiers are #56 and #215). Findings include: Resident #56 Review on 5/2/23 of Resident #56's medical record revealed a Skin and Wound Evaluation dated 4/26/23 that identified Resident #56 as having pressure injuries to their sacrum and right ankle. Review on 5/2/23 of Resident #56's MDS with an Assessment Reference Date (ARD) of 4/11/23 Section M Skin Condition revealed that M0100A, Resident has a pressure ulcer/injury, a scar over bony prominence, or a non-removable dressing/device, was not checked. Review on 5/2/23 of Resident #56's MDS with an ARD of 2/23/23 Section M Skin Condition revealed that M0100A, Resident has a pressure ulcer/injury, a scar over bony prominence, or a non-removable dressing/device, was not checked. Interview on 5/2/23 at approximately 11:28 a.m. with Staff L (MDS Nurse) confirmed that the coding of Resident #56's MDS's with ARD's of 2/23/23 and 4/11/23 was incorrect and both assessments should have had M0100A checked as having a pressure ulcer/injury. Resident #215 Review on 4/30/23 of Resident #215's April 2023 Electronic Medication Administration Record (eMAR) revealed they had used 3 different as needed medications for pain in April 2023. Review on 5/2/23 at approximately 8:00 a.m. Resident #215's MDS with an ARD of 4/24/23, revealed the following coding for section J0100 Pain Management, with a look back period of 5 days (4/20/23 - 4/24/23): J0100B Received PRN [as needed] pain medication OR was offered and declined? Coded 0 [No]; J0100C Received non-medication interventions for pain? Coded 0. Review on 5/2/23 of Resident #215's April eMAR from 4/20/23 - 4/24/23, revealed the following: 4/20/23 Acetaminophen PRN 650 milligrams (mg) administered twice for pain scores of 5 out of 10 and 6 out of 10; 4/21/23 Acetaminophen PRN 650 mg administered twice for pain scores 7 out of 10 and 6 out of 10; Gabapentin 300 mg PRN once for pain score 7 out of 10; 4/22/23 Acetaminophen PRN 650 mg once for pain score 2 out of 10; 4/23/23 Acetaminophen PRN 650 mg administered three times for pain scores 3 out of 10, 3 out of 10 and 4 out of 10; Voltaran Gel 1 % [percent] to left knee PRN for pain score 4 out of 10; and also received non-pharmacological interventions for pain score 4 out of 10; 4/24/23 Acetaminophen PRN 650 mg once for pain score 10 out of 10. Interview on 5/2/23 at approximately 11:28 a.m. with Staff L confirmed that the coding of Resident #215's MDS with an ARD of 4/24/23 for J0100B and J0100C were incorrect.

MINOR (B)

Minor Issue - procedural, no safety impact

Medical Records (Tag F0842)

Minor procedural issue · This affected multiple residents

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Based on interview and record review, it was determined that the facility failed to ensure that resident medical records were accurate and compete for 2 residents in a final sample of 18 residents (Resident Identifiers are #38 and #58). Findings include: Resident #38 Review on 5/1/23 of Resident #38's medical record revealed a care plan that related decline in cognition to a diagnosis of Parkinson's Disease. Further review of Resident #38's medical record revealed no diagnosis of Parkinson's Disease. Interview on 5/1/23 at approximately 1:50 p.m. with Staff L (Minimum Data Set Nurse) confirmed that Resident #38 does not have a diagnosis of Parkinson's Disease. Resident #58 Review on 5/2/23 of Resident #58's medical record revealed a Behavioral Health note, dated 3/31/23, with Post-Traumatic Stress Disorder (PTSD) listed under current diagnosis information. Further review of Resident #58's medical record revealed no active diagnosis of PTSD elsewhere in Resident #58's medical record. Interview on 5/2/10 at approximately 10:56 a.m. with Staff G (Director of Nursing) confirmed that Resident #58 is currently being treated for an active diagnosis of PTSD.

MINOR (B)

Minor Issue - procedural, no safety impact

Room Equipment (Tag F0908)

Minor procedural issue · This affected multiple residents

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Based on interview and observation it was determined that the facility failed to maintain patient care equipment in safe operating condition. Observation on 5/1/23 at approximately 9:45 a.m. of the Invacare Reliant 600 scale lift on the 300 Hall of the Owl's Nest Unit revealed a yellow sticky note on the floor that said scale off by 3.51 lbs [pounds]!! Interview on 5/1/23 at approximately 9:11 a.m. with Staff O (Licensed Nursing Assistant (LNA)) who confirmed that the yellow sticky note is supposed to be taped to the Invacare Reliant 600 scale lift, and that he/she uses the scale to weigh residents and has to subtract 3.51 pounds. Interview on 5/1/23 at approximately 9:30 a.m. with Staff P (LNA) who confirmed that he/she has been working at the facility for approximately one month and the lift scale has had that sticky note on it since he/she has been here. Interview on 5/1/23 at approximately 10:30 a.m. with Staff D (Maintenance Director) who stated that he/she was unaware that the scale lift was not calibrated correctly, and that a work order had not been submitted. Interview on 5/1/23 at approximately 11:00 a.m. with Staff D confirmed that the scale lift required a new part and was taken out of service.

Understanding Severity Codes (click to expand)

Life-Threatening (Immediate Jeopardy)

J - Isolated K - Pattern L - Widespread

Actual Harm

G - Isolated H - Pattern I - Widespread

Potential for Harm

D - Isolated E - Pattern F - Widespread

No Harm (Minor)

A - Isolated B - Pattern C - Widespread

Questions to Ask on Your Visit

"Can I speak with families of current residents?"
"What's your RN coverage like on weekends and overnight?"

Our Honest Assessment

Strengths

• No major safety red flags. No abuse findings, life-threatening violations, or SFF status.
• No fines on record. Clean compliance history, better than most New Hampshire facilities.

Concerns

• 29 deficiencies on record. Higher than average. Multiple issues found across inspections.
• Grade C (50/100). Below average facility with significant concerns.

Bottom line: Mixed indicators with Trust Score of 50/100. Visit in person and ask pointed questions.

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About This Facility

What is Elm Wood Center At Claremont's CMS Rating?

CMS assigns ELM WOOD CENTER AT CLAREMONT an overall rating of 2 out of 5 stars, which is considered below average nationally. Within New Hampshire, this rating places the facility higher than 0% of the state's 100 nursing homes. A rating at this level reflects concerns identified through health inspections, staffing assessments, or quality measures that families should carefully consider.

How is Elm Wood Center At Claremont Staffed?

CMS rates ELM WOOD CENTER AT CLAREMONT's staffing level at 3 out of 5 stars, which is average compared to other nursing homes. Staff turnover is 48%, compared to the New Hampshire average of 46%.

What Have Inspectors Found at Elm Wood Center At Claremont?

State health inspectors documented 29 deficiencies at ELM WOOD CENTER AT CLAREMONT during 2023 to 2025. These included: 24 with potential for harm and 5 minor or isolated issues.

Who Owns and Operates Elm Wood Center At Claremont?

ELM WOOD CENTER AT CLAREMONT is owned by a for-profit company. For-profit facilities operate as businesses with obligations to shareholders or private owners. The facility is operated by GENESIS HEALTHCARE, a chain that manages multiple nursing homes. With 68 certified beds and approximately 57 residents (about 84% occupancy), it is a smaller facility located in CLAREMONT, New Hampshire.

How Does Elm Wood Center At Claremont Compare to Other New Hampshire Nursing Homes?

Compared to the 100 nursing homes in New Hampshire, ELM WOOD CENTER AT CLAREMONT's overall rating (2 stars) is below the state average of 3.0, staff turnover (48%) is near the state average of 46%, and health inspection rating (2 stars) is below the national benchmark.

What Should Families Ask When Visiting Elm Wood Center At Claremont?

Based on this facility's data, families visiting should ask: "Can I visit during a mealtime to observe dining assistance and food quality?" "How do you handle medical emergencies, and what is your hospital transfer rate?" "Can I speak with family members of current residents about their experience?"

Is Elm Wood Center At Claremont Safe?

Based on CMS inspection data, ELM WOOD CENTER AT CLAREMONT has a clean safety record: no substantiated abuse findings (meaning no confirmed cases of resident harm), no Immediate Jeopardy citations (the most serious violation level indicating risk of serious injury or death), and is not on the Special Focus Facility watch list (a federal program monitoring the lowest-performing 1% of nursing homes). The facility has a 2-star overall rating and ranks #100 of 100 nursing homes in New Hampshire. While no facility is perfect, families should still ask about staff-to-resident ratios and recent inspection results during their visit.

Do Nurses at Elm Wood Center At Claremont Stick Around?

ELM WOOD CENTER AT CLAREMONT has a staff turnover rate of 48%, which is about average for New Hampshire nursing homes (state average: 46%). Moderate turnover is common in nursing homes, but families should still ask about staff tenure and how the facility maintains care continuity when employees leave.

Was Elm Wood Center At Claremont Ever Fined?

ELM WOOD CENTER AT CLAREMONT has no federal fines on record. CMS issues fines when nursing homes fail to meet care standards or don't correct problems found during inspections. The absence of fines suggests the facility has either maintained compliance or corrected any issues before penalties were assessed. This is a positive indicator, though families should still review recent inspection reports for the full picture.

Is Elm Wood Center At Claremont on Any Federal Watch List?

ELM WOOD CENTER AT CLAREMONT is not on any federal watch list. The most significant is the Special Focus Facility (SFF) program, which identifies the bottom 1% of nursing homes nationally based on persistent, serious quality problems. Not being on this list means the facility has avoided the pattern of deficiencies that triggers enhanced federal oversight. This is a positive indicator, though families should still review the facility's inspection history directly.

Facility Details

Beds: 68
Avg. Residents: 57
Occupancy: 84.6%
Ownership: For profit - Corporation
Chain: GENESIS HEALTHCARE
Medicare: Yes
Medicaid: Yes
Sprinklers: Yes

Trust Score Breakdown

Base Score: 50
2-Star Rating: +10
29 Deficiencies: -10
Final Score: 50/100

Nearby Alternatives

SULLIVAN COUNTY HEALTH CARE 2-star WOODLAWN HEALTHCARE CENTER LLC 2-star

View all in CLAREMONT →

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Data: CMS Medicare Care Compare

Updated: November 2025

Facility ID: 305041