Inspection Reports for
Morrison Nursing Home
6 TERRACE STREET, WHITEFIELD, NH, 03598
Back to Facility ProfileDeficiencies (last 3 years)
Deficiencies (over 3 years)
7.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
78% worse than New Hampshire average
New Hampshire average: 4.1 deficiencies/yearDeficiencies per year
16
12
8
4
0
Inspection Report
Routine
Deficiencies: 3
Date: Jan 8, 2026
Visit Reason
The inspection was conducted to assess compliance with Medicare/Medicaid regulations including beneficiary notification, food storage standards, and smoking policies.
Findings
The facility failed to provide Notice of Medicare Non-Coverage to three residents, had multiple instances of food stored at unsafe refrigerator temperatures, and lacked smoking safety policies for a resident who smokes off campus.
Deficiencies (3)
Failed to provide Notice of Medicare Non-Coverage (NOMNC) form CMS-10123 to 3 of 3 residents reviewed for Beneficiary Notification.
Food stored in refrigerators at temperatures above the acceptable range (33-41°F) in 1 out of 2 kitchen refrigerators and 1 of 3 kitchenette refrigerators.
Lack of smoking policies regarding smoking safety for 1 out of 1 resident reviewed for accidents.
Report Facts
Residents affected: 3
Refrigerator temperatures out of range: 20
Residents affected: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Physical Therapy Director | Confirmed failure to provide Notice of Medicare Non-Coverage to residents #3, #31, and #51 | |
| Dietary Manager (Staff A) | Confirmed refrigerator temperatures were out of acceptable range and was unaware of the issue | |
| Dietary Aide (Staff C) | Confirmed refrigerator temperatures were out of acceptable range | |
| Registered Nurse (Staff E) | Reported resident #29 goes off campus to smoke and obtains lighter from nurse | |
| Administrator (Staff D) | Confirmed resident #29 goes off campus to smoke and no smoking assessment was completed |
Inspection Report
Deficiencies: 5
Date: Dec 10, 2024
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to medication storage, food safety, staffing data submission, infection prevention, and control practices at Morrison Nursing Home.
Findings
The facility was found deficient in multiple areas including improper medication storage with unlabeled medications left unattended, failure to use hair restraints and properly label/store food items, incomplete and inaccurate staffing data submission, and inadequate implementation of infection prevention policies including hand hygiene and use of personal protective equipment.
Deficiencies (5)
Failed to ensure medications were appropriately stored and labeled in medication carts.
Dietary staff failed to use hair restraints and food items were not labeled or stored according to professional standards.
Failed to follow policy for labeling and dating resident food items brought by visitors.
Failed to submit complete and accurate Payroll Based Journal staffing data for multiple dates.
Failed to implement infection prevention policies including hand hygiene and use of appropriate PPE for residents with pressure ulcers and indwelling catheters.
Report Facts
Dates with missing Registered Nurse hours: 22
Dates without Licensed Nursing coverage 24 hours: 62
Medications left unlabeled: 14
Food items unlabeled: 8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff G | Registered Nurse (RN) | Confirmed unlabeled medication cup was his/her personal medication. |
| Staff H | Registered Nurse (RN) | Confirmed unlabeled medication cups belonged to Residents #15 and #42. |
| Staff I | Registered Nurse (RN) | Left medication cart unattended with cups of Miralax mixed with water. |
| Staff C | Dietary Aide | Observed portioning food without hair restraint and confirmed not wearing hair net. |
| Staff B | Dietary Manager | Confirmed unlabeled food items and lack of labeling policy adherence. |
| Staff A | Administrator | Confirmed Payroll Based Journal file was submitted timely but rejected for invalid format. |
| Staff D | Licensed Nursing Assistant | Observed not wearing gown when providing care to Resident #1 on Enhanced Barrier Precautions. |
| Staff E | Licensed Practical Nurse | Observed not performing hand hygiene when changing gloves during dressing change for Resident #1. |
Inspection Report
Complaint Investigation
Deficiencies: 13
Date: Nov 17, 2023
Visit Reason
The inspection was conducted based on multiple allegations and complaints of abuse, neglect, failure to follow physician orders, inadequate care planning, failure to report and investigate abuse, and failure to provide trauma-informed care at Morrison Nursing Home.
Complaint Details
The complaint investigation revealed multiple incidents of resident-to-resident sexual abuse and staff-to-resident abuse that were not reported or investigated timely. Several allegations of staff rough handling and verbal abuse were not investigated. The facility failed to report abuse allegations to the State Survey Agency within required timeframes. Investigations were incomplete or not conducted. Corrective actions to prevent further abuse were not implemented.
Findings
The facility failed to ensure confidentiality of medical records, prevent resident-to-resident and staff-to-resident abuse, timely report and investigate abuse allegations, develop appropriate care plans for residents with behavioral issues, follow physician orders for medication administration, provide appropriate pressure ulcer care, maintain range of motion care, and provide trauma-informed care. Several residents exhibited inappropriate sexual behaviors that were not properly addressed or investigated. Staff failed to report abuse allegations timely and conduct thorough investigations. The facility also failed to ensure physician involvement in hospice referrals and failed to provide training to identify trauma history in residents.
Deficiencies (13)
Failed to ensure confidentiality of medical records for 1 of 23 residents.
Failed to protect residents from resident-to-resident sexual abuse and staff-to-resident physical and verbal abuse.
Failed to implement abuse policy and procedures for 5 residents and 2 staff reviewed for abuse.
Failed to timely report suspected abuse and neglect to State Survey Agency and other authorities for 5 residents.
Failed to thoroughly investigate alleged violations of abuse for 5 residents and 2 staff members.
Failed to develop and implement comprehensive care plans addressing inappropriate sexual behaviors for 2 residents.
Failed to follow physician orders for medication administration for 1 resident.
Failed to provide weekly wound assessments with measurements and descriptions for 1 resident with pressure ulcers.
Failed to provide appropriate care to maintain or improve range of motion for 1 resident with limited ROM.
Failed to identify trauma history and provide trauma-informed care for 1 resident.
Failed to obtain physician referral/order for hospice evaluation for 1 resident.
Failed to administer the facility in a manner that ensures effective use of resources to prevent abuse and ensure resident wellbeing.
Failed to employ staff with training or experience necessary to identify residents with trauma history for trauma-informed care.
Report Facts
Residents reviewed for care plans: 53
Residents reviewed for behavioral/emotional: 5
Residents reviewed for hospice: 3
Residents reviewed for pressure ulcers: 1
Residents reviewed for position/mobility: 1
Residents reviewed for unnecessary medications: 5
Sexually inappropriate behavior incidents for Resident #36: 18
Sexually inappropriate behavior incidents for Resident #35: 3
Alleged abuse reporting delay: 26
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff A | Registered Nurse (RN) | Confirmed lack of investigations and care plans for sexual behaviors; confirmed medication administration errors; confirmed abuse reporting failures |
| Staff B | Administrator | Confirmed delays in abuse reporting and lack of investigations |
| Staff C | Administrator in Training | Confirmed no physician referral for hospice; no trauma screening training |
| Staff D | Activities Director | Completed social service assessments without trauma history identification; no trauma screening training |
| Staff F | Registered Nurse | Unaware of physician orders for splint use; confirmed splint in resident's possession |
| Staff G | Minimum Data Set Nurse | Did not initiate care plan or order for splint as recommended |
| Staff I | Licensed Nursing Assistant (LNA) | Alleged to be rough and rude to residents; abuse allegations not investigated or reported timely |
| Staff J | Licensed Practical Nurse (LPN) | Reported abuse allegations; confirmed lack of investigations |
| Staff K | Registered Nurse (RN) | Reported resident sexual behaviors |
| Staff M | Licensed Practical Nurse (LPN) | Alleged abuse; worked during investigation; investigation not completed |
| Staff L | Registered Nurse (RN) | Witnessed sexual abuse incidents; did not report to medical provider |
Inspection Report
Complaint Investigation
Census: 52
Deficiencies: 1
Date: Jul 10, 2023
Visit Reason
The inspection was conducted due to concerns about the facility's failure to follow accepted national standards for return to work guidelines for healthcare personnel who tested positive for COVID-19.
Complaint Details
The visit was complaint-related due to allegations of non-compliance with COVID-19 return to work guidelines. The complaint was substantiated as the facility did not follow CDC guidance and allowed staff to return to work prematurely.
Findings
The facility failed to adhere to CDC return to work criteria for 21 of 21 staff reviewed who tested positive for COVID-19, potentially increasing exposure risk to residents, staff, and visitors. Interviews confirmed staff returned to work earlier than recommended without proper retesting or symptom resolution.
Deficiencies (1)
Failure to provide and implement an infection prevention and control program related to return to work guidelines for COVID-19 positive healthcare personnel.
Report Facts
Staff reviewed: 21
Residents census: 52
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