Inspection Reports for Pendleton Rehabilitation and Nursing Center

44 Maritime Dr, Mystic, CT 06355, United States, CT, 06355

Back to Facility Profile

Deficiencies per Year

4 3 2 1 0
2022
2023
2024
2025
2026
Severe High Moderate Low Unclassified

Census Over Time

91 98 105 112 119 126 Apr '23 Jun '24 Jan '25 Sep '25 Jan '26 Jan '26
Census Capacity
Inspection Report Monitoring Census: 110 Capacity: 120 Deficiencies: 1 Jan 9, 2026
Visit Reason
A desk audit was completed to determine compliance with 42 CFR Part 483 requirements for Long Term Care Facilities following a previous deficiency cited on 2025-11-18.
Findings
One previously cited violation was identified as corrected as of 2025-12-23. No new non-compliance was found and the facility is in compliance with all regulations.
Deficiencies (1)
Description
Previous deficiency cited on 2025-11-18 corrected as of 2025-12-23
Report Facts
Licensed Bed Capacity: 120 Census: 110
Inspection Report Monitoring Census: 110 Capacity: 120 Deficiencies: 1 Jan 9, 2026
Visit Reason
A desk audit was completed to determine compliance with 42 CFR Part 483 requirements for Long Term Care Facilities following a previous deficiency cited on 2025-11-18.
Findings
One previously cited violation was identified as corrected as of 2025-12-23. No new non-compliance was found and the facility is in compliance with all regulations.
Deficiencies (1)
Description
Previous deficiency cited on 2025-11-18 related to 42 CFR Part 483 requirements for Long Term Care Facilities
Report Facts
Licensed Bed Capacity: 120 Census: 110
Employees Mentioned
NameTitleContext
Siobhan O'NeillSurvey Team LeaderNamed as survey team leader conducting the inspection
Karen GworekSupervisorNamed as supervising nurse consultant/health program supervisor
Susan PeglowAdministratorPersonnel contacted during inspection
Inspection Report Monitoring Census: 115 Capacity: 120 Deficiencies: 1 Sep 15, 2025
Visit Reason
A desk audit was conducted to monitor compliance with a previously cited deficiency related to 42 CFR Part 483 requirements for Long Term Care Facilities.
Findings
The audit found that one previously cited violation was corrected as of 2025-09-08, with no new non-compliance identified. The facility is in compliance with all regulations.
Deficiencies (1)
Description
Previously cited deficiency related to 42 CFR Part 483 requirements
Report Facts
Licensed Bed Capacity: 120 Census: 115 Deficiencies corrected: 1
Employees Mentioned
NameTitleContext
Siobhan O'NeillSurvey Team LeaderLead surveyor conducting the inspection
Maureen Golas MarkureSupervisor, SNCSupervising nurse consultant overseeing the inspection
Inspection Report Renewal Census: 118 Capacity: 120 Deficiencies: 0 Jan 23, 2025
Visit Reason
The inspection visit was conducted as a licensing inspection including renewal and complaint investigation purposes.
Findings
The report indicates that violations of the General Statutes of Connecticut and/or regulations were identified during the inspection, with attached violation letters referenced. No narrative report or additional information is attached in this document.
Complaint Details
Complaint investigation referenced with complaint numbers 415167 and CT#35614; substantiation status not stated.
Report Facts
Licensed Bed Capacity: 120 Census: 118
Employees Mentioned
NameTitleContext
Susan PeglowPersonnel contacted during inspection
Lindsay ShawPersonnel contacted during inspection
Inspection Report Monitoring Census: 116 Capacity: 120 Deficiencies: 1 Jun 24, 2024
Visit Reason
A desk audit was conducted on 6/24/24 to review the implementation of the Plan of Correction for a prior violation letter dated 05/20/24.
Findings
Violations #1 were identified and corrected as of 6/17/24. The Administrator, Susan Peglow, confirmed via telephone on 6/24/24 that all violations were corrected.
Deficiencies (1)
Description
Violation #1 identified and corrected
Report Facts
Licensed Bed Capacity: 120 Census: 116
Employees Mentioned
NameTitleContext
Susan PeglowAdministratorNotified via telephone that all violations were corrected
Inspection Report Follow-Up Census: 102 Capacity: 120 Deficiencies: 3 Apr 4, 2023
Visit Reason
A desk audit was conducted to review the plan of correction for a prior violation letter dated 2/28/23.
Findings
All three violations identified in the prior inspection were corrected as of 3/3/23, and the administrator was notified on 4/4/23 that all violations were corrected.
Deficiencies (3)
Description
Violation #1
Violation #2
Violation #3
Report Facts
Licensed Bed Capacity: 120 Census: 102 Violations corrected: 3
Employees Mentioned
NameTitleContext
Judy BirtwistleSNCReport submitted by and signature on inspection report
Inspection Report Original Licensing Deficiencies: 0 Sep 11, 2022
Visit Reason
This document is a Pre-Licensure Consent Order for Pendleton SNF Operations LLC seeking an initial license to operate a Chronic and Convalescent Nursing Home in Connecticut.
Findings
The document outlines the terms and conditions for the issuance of the nursing home license, including requirements for an Independent Nurse Consultant (INC), infection preventionist, staffing ratios, quality assurance, emergency preparedness, and other regulatory compliance measures.
Report Facts
Duration of Order: 1 INC consulting hours: 8 Infection preventionist hours: 32 Nurse staffing ratios: 30 Nurse aide staffing ratios: 12 Nurse aide staffing ratios: 20 Retention period for records: 5 Quality Assurance Committee meeting frequency: 30 Water management program report timeframe: 14 Plan of correction implementation timeframe: 14 Payment terms for vendors: 90 Fine amount: 1000
Employees Mentioned
NameTitleContext
Kim HriceniakPublic Health Services ManagerActing on behalf of the Department in executing the Pre-Licensure Consent Order
Moshe GottliebMemberMember of Pendleton SNF Operations LLC, signing the Consent Order

Loading inspection reports...