Inspection Reports for
Alpine Healthcare Center
298 MAIN ST, KEENE, NH, 03431
Back to Facility ProfileDeficiencies (last 4 years)
Deficiencies (over 4 years)
5.5 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
34% worse than New Hampshire average
New Hampshire average: 4.1 deficiencies/yearDeficiencies per year
8
6
4
2
0
Inspection Report
Complaint Investigation
Deficiencies: 4
Date: Jan 20, 2026
Visit Reason
The inspection was conducted due to complaints and allegations of improper use of physical restraints and failure to prevent, report, and investigate abuse incidents involving residents.
Complaint Details
The complaint investigation involved allegations of improper restraint use and abuse incidents involving Residents #1, #2, and #3. The facility failed to investigate or report these incidents to the State Survey Agency as required. Staff abuse training and background checks were also found deficient.
Findings
The facility failed to ensure appropriate use of physical restraints for one resident and failed to implement and follow policies for abuse reporting, investigation, staff abuse training, and staff screening for multiple residents. Several abuse incidents were not reported to the State Survey Agency and were not properly investigated.
Deficiencies (4)
Failure to ensure appropriate use of physical restraints for Resident #1.
Failure to implement policies and procedures to prevent abuse, neglect, and theft, including failure to report and investigate allegations of abuse for Residents #1, #2, and #3.
Failure to timely report suspected abuse to the State Survey Agency for Residents #1, #2, and #3.
Failure to respond appropriately and thoroughly investigate alleged violations of abuse for Residents #1 and #2.
Report Facts
Residents affected: 1
Residents affected: 3
Staff reviewed for abuse: 4
Date of hire: Mar 4, 2025
Last abuse education dates: Jun 21, 2021
Last abuse education dates: Sep 29, 2021
Last abuse education dates: May 29, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff C | Licensed Nursing Assistant | Involved in restraint and abuse incidents with Resident #1 and others |
| Staff D | Licensed Nursing Assistant | Witnessed restraint incident and abuse allegations |
| Staff A | Administrator | Confirmed awareness of incidents and failures to report or investigate |
| Staff B | Director of Nursing | Confirmed incidents and failures to report or investigate; provided emails and policy reviews |
| Staff G | Registered Nurse | Reported abuse incident involving Resident #2 |
| Staff I | Unit Manager | Reported abuse incident involving Resident #3 |
| Staff H | Registered Nurse | Reviewed for abuse training |
| Staff J | Medication Nursing Assistant | Reviewed for abuse training |
Inspection Report
Routine
Deficiencies: 7
Date: Jun 13, 2025
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to resident notices, safety, care quality, medication management, food safety, and hospice services at Alpine Healthcare Center.
Findings
The facility was found deficient in multiple areas including failure to provide timely Medicare beneficiary notices, unsafe and unsanitary environmental conditions, failure to follow physician wound care orders, inadequate trauma-informed care planning, expired medications on medication carts, improper sanitization of dishware, and incomplete hospice care plans.
Deficiencies (7)
Failed to provide timely Skilled Nursing Facility Advance Beneficiary Notice (ABN) to residents or their representatives for 2 of 3 residents reviewed.
Failed to provide a safe, sanitary, and homelike environment in the memory care unit with multiple chipped doorways, missing laminate, crumbling sheetrock, lifted floor tiles, faded handrails, and holes in tile.
Failed to follow physician's wound care orders for 1 of 1 resident reviewed, with multiple missed wound care treatments documented.
Failed to ensure trauma survivors had identified triggers in care plans, missing documentation of triggers that may cause re-traumatization for 1 of 5 residents reviewed.
Failed to ensure expired medications were removed from use on 2 of 4 medication carts observed, including expired Morphine Sulfate and Lorazepam, and unlabeled/expired insulin pens.
Failed to ensure appropriate sanitization of dishware in the kitchen; chemical sanitizer solution tested at 150 ppm, below required 200-400 ppm, and no documentation of testing prior to use.
Failed to ensure resident's written plan of care included the most recent hospice plan of care and description of services furnished by the hospice agency for 1 of 1 resident reviewed.
Report Facts
Residents reviewed for beneficiary notices: 3
Residents reviewed for wound care: 18
Residents reviewed for behavioral and emotional status: 18
Medication carts observed: 4
Chemical sanitizer solution ppm: 150
Residents reviewed for hospice services: 18
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff G | Business Office Manager | Confirmed failure to provide timely Skilled Nursing Facility Advance Beneficiary Notice |
| Staff C | Licensed Medication Nursing Assistant | Confirmed environmental observations in memory care unit |
| Staff B | Maintenance | Confirmed work order status for lifted floor tiles in memory care unit |
| Staff H | Director of Nursing | Confirmed wound care deficiencies and medication discontinuations |
| Staff E | Social Services | Confirmed trauma triggers missing from care plan and hospice services coordination |
| Staff L | Medication Nursing Assistant | Confirmed expired medications on medication cart |
| Staff M | Registered Nurse | Confirmed unlabeled and expired insulin pens on medication cart |
| Staff A | Cook | Confirmed chemical sanitizer solution testing and results in kitchen |
| Staff F | Registered Nurse | Confirmed hospice care plan status and resident hospice service status |
Inspection Report
Routine
Deficiencies: 5
Date: Jul 18, 2024
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to resident safety, medication storage and labeling, infection prevention and control, and antibiotic stewardship at Alpine Healthcare Center.
Findings
The facility was found deficient in maintaining a safe environment by not securing smoking materials for residents, failing to document and maintain proper medication refrigerator temperatures, improper disposal of expired medications, inadequate infection control practices related to Enhanced Barrier Precautions, and failure to properly monitor antibiotic use according to the facility's antibiotic stewardship program.
Deficiencies (5)
Failed to maintain an environment free of accident hazards by not securing lighters and cigarettes when not in use for 2 of 2 residents reviewed for smoking.
Failed to document and/or maintain temperature ranges according to manufacturer's instructions in 1 of 2 medication refrigerators and failed to dispose of expired medications in 1 of 4 medication carts.
Humalog U-100 insulin can only be used for a total of 28 days in-use (opened storage time).
Failed to follow CDC guidance for Enhanced Barrier Precautions for 1 of 3 residents with indwelling catheter and 1 of 1 residents with gastrostomy tube.
Failed to follow an established antibiotic stewardship program and system of monitoring antibiotic use for 3 out of 12 months reviewed (May, June, and July 2024).
Report Facts
Residents who smoke: 11
Medication refrigerator temperature deviations: 7
Missing temperature logs: 6
Expired insulin open date: 28
Antibiotic use monitoring months missed: 3
Antibiotics prescribed: 15
Antibiotics prescribed: 9
Current antibiotic treatment: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Registered Nurse | Staff C interviewed regarding smoking supplies and infection control findings. | |
| Unit Manager | Staff E interviewed regarding smoking supplies storage. | |
| Director of Nursing | Staff F confirmed smoking supplies should not be stored in resident rooms and confirmed antibiotic stewardship findings. | |
| Med Tech | Staff A confirmed medication refrigerator temperature findings. | |
| Clinical Consultant | Staff B confirmed medication refrigerator and antibiotic stewardship findings. | |
| Licensed Nursing Assistant | Staff H confirmed resident #16 was not on Enhanced Barrier Precautions. |
Inspection Report
Routine
Deficiencies: 6
Date: Jun 15, 2023
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to pressure ulcer care, accident hazard prevention, dialysis medication administration, psychotropic medication use, medication storage, and food safety in the nursing home.
Findings
The facility was found deficient in multiple areas including failure to perform weekly pressure ulcer assessments for some residents, unsecured hazardous chemicals accessible to residents, missed medication administration on dialysis days, lack of care plans for psychotropic medication use, unlocked medication carts and improperly labeled or expired medications, and unsanitary food preparation and storage conditions.
Deficiencies (6)
Failed to assess pressure ulcers weekly for 2 out of 5 residents reviewed.
Failed to ensure the residents' environment was free from accident hazards on the Memory Care Unit.
Failed to ensure residents received scheduled medications on dialysis days for 1 of 1 resident reviewed.
Failed to ensure residents only received necessary psychotropic medications with appropriate monitoring for 1 of 5 residents reviewed.
Failed to ensure medications were stored in locked compartments and properly labeled; expired medications were not removed.
Failed to ensure food was prepared and served in a sanitary environment.
Report Facts
Residents reviewed for pressure ulcers: 23
Residents reviewed for dialysis medication: 23
Residents reviewed for unnecessary medications: 23
Weekly wound observations missed for Resident #21: 6
Weekly wound observations missed for Resident #33: 13
Medication administration missed: 14
Psychotropic medication doses reviewed: 1
Expired medication found: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff D | Director of Nursing | Confirmed missed weekly wound observations for Residents #21 and #33 |
| Staff G | Licensed Nurse Assistant (LNA) | Confirmed unsecured chemicals and unlocked doors on Memory Care Unit |
| Staff E | Regional Registered Nurse | Confirmed missed medication administration for Resident #23 and lack of psychotropic medication care plan for Resident #72 |
| Staff A | Medication Nursing Assistant | Confirmed medication cart was left unlocked |
| Staff B | Licensed Practical Nurse | Confirmed opened insulins were unlabeled and unknown resident assignment |
| Staff C | Registered Nurse | Confirmed expired medication found in Unit 2 Medication Room |
| Staff F | Food Service Director | Confirmed unsanitary conditions in kitchen and dining room |
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