Inspection Reports for Forest Hills Guest Home
462 Derby Ave, West Haven, CT 06516, United States, CT, 06516
Back to Facility ProfileDeficiencies per Year
8
6
4
2
0
Unclassified
Inspection Report
Original Licensing
Deficiencies: 6
Oct 18, 2022
Visit Reason
An unannounced visit was made to Forest Hills Guest Home on October 18, 2022 by representatives of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting a licensure inspection.
Findings
The facility was found to have multiple violations including failure to post resident room capacity signage, failure to discard outdated food, failure to monitor freezer temperatures, failure to specify medication administration times, failure to document effectiveness of PRN medications, and failure to secure the medication refrigerator with a lock.
Deficiencies (6)
| Description |
|---|
| Facility failed to ensure the resident capacity for six of nine resident rooms was posted by each door; signage reflecting resident capacity was missing. |
| Facility failed to ensure outdated food was discarded; outdated food items were found in a standup refrigerator in the basement. |
| Facility failed to monitor freezer temperatures; freezers in the basement lacked documentation of monitoring. |
| Medication Administration Records for seventeen residents lacked specific scheduled medication administration times. |
| Facility failed to document the effectiveness of as needed (PRN) medications on the back of the Medication Administration Records. |
| Medication refrigerator was located on a counter without a lock, leaving resident medications unsecured. |
Report Facts
Resident rooms with missing capacity signage: 6
Residents reviewed for Medication Administration Records: 17
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sheri Stalsburg | Person-in-Charge | Named as the person-in-charge of Forest Hills Guest Home. |
| Karen Gworek | Supervising Nurse Consultant | Signed the letter as Supervising Nurse Consultant from Facility Licensing & Investigations Section. |
| Eric Stalsburg | Manager | Named as Manager in the Plan of Correction. |
Inspection Report
Renewal
Census: 17
Capacity: 17
Deficiencies: 0
Oct 18, 2022
Visit Reason
The inspection was conducted as a licensing renewal inspection for Forest Hills Guest Home, a Residential Care Home.
Findings
Violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies were identified at the time of this inspection, as noted in an attached violation letter dated 11/1/22. Approval for issuance of license was granted.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karen Gworek | RN | Signature of FLIS Staff and report submitter; approved issuance of license |
| Raymond Kasidas | BFSI | Signature of FLIS Staff |
| Daniel Tomascak | BFSI | Signature of FLIS Staff |
| Sheri Stalsburg | Person-in-Charge | Personnel contacted during inspection |
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