Inspection Report Summary
The most recent inspection on December 12, 2024, found multiple deficiencies related to PASARR screening accuracy, medication errors causing hospitalization, medication storage, dish sanitation, staffing assessment, and infection control during a gastrointestinal outbreak. Earlier inspections showed a mixed pattern, with prior findings including failure to follow CDC return to work guidelines for COVID-19-positive staff in August 2023 and medication management issues in November 2022. Complaint investigations included substantiated deficiencies in several areas during the latest inspection, while earlier complaints were not noted. Enforcement actions such as fines or license suspensions were not listed in the available reports. The inspection history indicates ongoing challenges in medication management and infection control, with some issues recurring over time.
Deficiencies (last 3 years)
Deficiencies (over 3 years)
3.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
20% better than New Hampshire average
New Hampshire average: 4.1 deficiencies/yearDeficiencies per year
8
6
4
2
0
Inspection Report
Complaint Investigation
Census: 116
Deficiencies: 6
Date: Dec 12, 2024
Visit Reason
The inspection was conducted to investigate complaints related to PASARR screening accuracy, medication errors, medication storage, food sanitation, staffing assessment, infection prevention and control, and outbreak management.
Complaint Details
The complaint investigation revealed multiple deficiencies including inaccurate PASARR screening, medication errors causing hospitalization, improper medication storage, inadequate dish sanitation, incomplete staffing assessment, and ineffective infection control during a gastrointestinal outbreak affecting 22 residents in a census of 116.
Findings
The facility was found deficient in multiple areas including failure to ensure accurate PASARR screening for mental disorders, significant medication errors leading to hospitalization, improper medication storage, inadequate dish sanitation and hand hygiene, incomplete facility-wide staffing assessment, and failure to maintain effective infection surveillance and control during a gastrointestinal outbreak affecting multiple residents.
Deficiencies (6)
Failed to ensure accurate PASARR screening for mental disorders for 1 of 2 residents reviewed.
Failed to ensure residents were free from significant medication errors resulting in hospitalization for 1 of 3 residents reviewed.
Failed to ensure medications were appropriately stored; unlabeled medication cups found for 1 of 4 medication carts observed.
Failed to ensure dishes were handled and sanitized according to professional standards in 1 of 1 main kitchen observed.
Failed to include specific staffing needs for each resident unit and shift in the facility-wide assessment.
Failed to maintain a system of surveillance to identify and manage infections to prevent spread of gastrointestinal infections affecting 22 residents.
Report Facts
Residents affected: 22
Residents affected: 1
Residents affected: 1
Medication carts observed: 4
Medication carts with deficiencies: 1
Facility census: 116
Alzheimer's Unit beds: 24
Hospital stay duration: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Director of Social Services | Confirmed resident diagnosis and failure to refer for PASARR evaluation |
| Staff B | Administrator | Reported medication error incident and corrective actions |
| Staff E | Registered Nurse | Confirmed unlabeled medication cups on medication cart |
| Staff F | Food Service Supervisor | Confirmed expired chlorine test strips and dishwasher sanitization process |
| Staff H | Dietary Aide | Observed not performing hand hygiene between handling dirty and clean dishes |
| Staff I | Infection Preventionist | Confirmed infection control deficiencies and inconsistencies in GI symptom documentation |
| Staff J | Advanced Practical Registered Nurse (APRN) | Participated in infection control meeting and confirmed viral gastroenteritis protocol |
Inspection Report
Annual Inspection
Deficiencies: 0
Date: Jan 5, 2024
Visit Reason
The inspection was conducted as an annual survey to assess compliance with health and safety regulations at Hanover Hill Health Care Center.
Findings
No health deficiencies were found during the inspection, indicating full compliance with applicable standards.
Inspection Report
Routine
Deficiencies: 1
Date: Aug 30, 2023
Visit Reason
The inspection was conducted to assess the facility's compliance with infection prevention and control requirements, specifically regarding adherence to CDC return to work guidelines for healthcare personnel who tested positive for COVID-19.
Findings
The facility failed to follow CDC return to work guidelines for 3 healthcare personnel who tested positive for COVID-19, as they returned to work without completing the required negative viral tests within the specified timeframe. Interviews and record reviews confirmed that staff returned to work early and did not have the second negative test as required.
Deficiencies (1)
Failure to follow CDC return to work guidelines for healthcare personnel positive for COVID-19.
Report Facts
Days before return to work: 5
Days before return to work: 6
Days before return to work: 7
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Licensed Nursing Assistance (LNA) | Tested positive for COVID-19 and returned to work on Day 7 without completing required negative tests. |
| Staff B | Licensed Nursing Assistance (LNA) | Tested positive for COVID-19 and returned to work on Day 5 without completing required negative tests. |
| Staff C | Activities/Social Service | Tested positive for COVID-19 and returned to work on Day 6 without completing required negative tests. |
| Staff E | Administrator | Confirmed the failure to follow CDC guidelines and verified staff return to work dates. |
Inspection Report
Annual Inspection
Deficiencies: 3
Date: Nov 8, 2022
Visit Reason
The inspection was conducted to assess compliance with regulations regarding medication self-administration, adherence to physician orders, and proper medication storage and labeling at Hanover Hill Health Care Center.
Findings
The facility failed to assess residents' ability to self-administer medications for 4 of 4 residents reviewed, failed to follow physician orders for one resident undergoing hemodialysis, and failed to remove expired medications from inventory in medication rooms and carts.
Deficiencies (3)
Failed to assess residents' ability to self-administer medications for 4 of 4 residents reviewed (Residents #3, #27, #50, and #80).
Failed to follow physician orders for Resident #61 regarding administration of sevlamer during hemodialysis.
Failed to ensure expired medications were removed from inventory in 1 medication room and 2 medication carts (Resident #28).
Report Facts
Residents reviewed for self-administration: 4
Final survey sample size: 25
Expired Acetaminophen suppositories: 14
Expired Losartan Potassium tablets: 5
Dates sevlamer not given: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff F | Licensed Practical Nurse | Confirmed leaving medications for Resident #80 to self-administer and confirmed expired medications in medication room and cart |
| Staff A | Director of Nursing | Confirmed no orders for self-administration for Residents #3, #27, #50, and #80 |
| Staff E | Licensed Practical Nurse | Confirmed holding sevlamer dose during dialysis without physician order and confirmed expired Losartan given to Resident #28 |
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