Inspection Reports for
Pinnacle Health & Rehab at South Portland

The facility failed to promote resident dignity during meals, ensure call bells were within reach, provide advance directives information, maintain a safe environment, hold timely interdisciplinary team meetings, prevent accidents, maintain respiratory care, monitor medication storage and administration, ensure food safety, and maintain resident records.

The facility failed to conduct required emergency preparedness exercises twice per year, maintain unobstructed means of egress, ensure proper locking arrangements on exit doors, maintain emergency lighting and exit signage, have policies for fire alarm and sprinkler system outages, maintain corridor doors to resist smoke passage, conduct quarterly fire drills on all shifts, adopt smoking regulations, perform annual fire door inspections, and maintain documentation of essential electrical system testing.

Pinnacle Health and Rehabilitation of South Portland was determined to be in compliance with 42 CFR Part 483, Subpart B, Requirements for Long Term Care Facilities.

This plan of correction addresses deficiencies cited on 9/25/2024 related to the facility's Quality Assurance Committee's failure to ensure the effectiveness of the Plan of Correction from the complaint survey dated 7/30/2024, specifically regarding infection prevention and control practices.

The facility failed to maintain and implement an effective infection prevention and control program related to Enhanced Barrier Precautions for residents with indwelling medical devices, resulting in repeated citation of infection control deficiencies.

The facility failed to follow its Infection Prevention and Control Policy on 7/30/24, resulting in inadequate use of PPE by staff and potential exposure to COVID-19.

The facility failed to report complete COVID-19 information to the CDC's National Healthcare Safety Network during a required seven-day period, potentially causing more than minimal harm to residents.

This document is the facility's plan of correction for the survey dated prior to November 1, 2025, addressing deficiencies related to resident rights, accommodations, advanced directives, environment maintenance, care planning, accident hazards, respiratory care, trauma informed care, medication management, drug labeling, food sanitation, and resident records.