Inspection Report Summary
The most recent inspection on December 4, 2025, found the facility in compliance with all regulations after correcting one previously identified violation. Earlier inspections showed a pattern of deficiencies related mainly to resident care issues such as timely notification of physicians and families, toileting assistance, medication transcription errors, and staffing levels. Several complaint investigations substantiated violations involving abuse investigations, failure to protect residents, and incomplete or delayed reporting and follow-up on incidents. Enforcement actions such as fines or license suspensions were not listed in the available reports. The facility’s record shows improvement over time, with recent inspections indicating corrected deficiencies and compliance with regulations.
Deficiencies (last 8 years)
Deficiencies (over 8 years)
8.5 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
52% worse than Connecticut average
Connecticut average: 5.6 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
93% occupied
Based on a December 2025 inspection.
Census over time
Inspection Report
Monitoring
Census: 289
Capacity: 310
Deficiencies: 1
Dec 4, 2025
Visit Reason
A desk audit was conducted to monitor compliance with previously cited deficiencies related to 42 CFR Part 483 requirements for Long Term Care Facilities.
Findings
One violation was identified and corrected as of 2025-11-25. No new non-compliance was found, and the facility is in compliance with all regulations.
Deficiencies (1)
| Description |
|---|
| One violation identified and corrected as of 11/25/25 |
Report Facts
Licensed Bed Capacity: 310
Census: 289
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Siobhan O'Neill | Survey Team Leader | Lead surveyor conducting the inspection |
| Maureen Golas-Markure | Supervisor | Supervising nurse consultant/health program supervisor |
| Rosemary Beaudoin | Administrator | Personnel contacted during inspection |
Inspection Report
Monitoring
Census: 285
Capacity: 310
Deficiencies: 2
Sep 26, 2025
Visit Reason
A desk audit was conducted to review the implementation of the Plan of Correction for violations previously identified in the violation letter dated August 22, 2025.
Findings
Violations #1 and #2 were identified as corrected as of September 25, 2025. The facility administrator was notified of the corrections on September 26, 2025.
Deficiencies (2)
| Description |
|---|
| Violation #1 |
| Violation #2 |
Report Facts
Licensed Bed Capacity: 310
Census: 285
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rosemary Beaudoin | Administrator | Notified of correction of violations #1 and #2 |
Inspection Report
Census: 280
Capacity: 365
Deficiencies: 0
Jun 5, 2025
Visit Reason
The inspection was conducted as a Desk Audit on 6/5/25 to review compliance and licensing status of the facility.
Findings
No violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies were identified at the time of this inspection.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Linda Legall Tyndele | DNS | Personnel contacted during the inspection |
| Judith Otwoma | Report submitted by |
Inspection Report
Complaint Investigation
Census: 280
Capacity: 330
Deficiencies: 0
Apr 15, 2025
Visit Reason
The inspection visit was conducted as a complaint investigation related to complaint numbers #43339, #43702, #43784, and #43940.
Findings
Violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies were identified at the time of this inspection.
Complaint Details
Complaint investigation related to complaints #43339, #43702, #43784, and #43940. Violations were identified during the inspection.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rosemary Beaudoin | Administrator | Personnel contacted during the inspection. |
| Linda Legall Tyndale | DNS | Personnel contacted during the inspection. |
Inspection Report
Census: 277
Capacity: 345
Deficiencies: 0
Mar 19, 2025
Visit Reason
The inspection was a Desk Audit conducted on 3/19/25 to review compliance with regulations.
Findings
No violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies were identified at the time of this inspection.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rosemary Beaudoin | Administrator | Named as personnel contacted and notified of violation correction. |
Inspection Report
Complaint Investigation
Census: 270
Capacity: 365
Deficiencies: 0
Mar 10, 2025
Visit Reason
The inspection was conducted as a complaint investigation related to complaint numbers #34349, #37241, and #43229.
Findings
Violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies were identified at the time of this inspection, as referenced in an attached violation letter dated 3/28/25.
Complaint Details
Complaint investigation related to complaints #34349, #37241, and #43229. Violations were substantiated as violations were identified.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rosemary Beaudoin | Administrator | Personnel contacted during the inspection. |
| Connie Vumback | RN | Report submitted by. |
Inspection Report
Complaint Investigation
Deficiencies: 1
Mar 10, 2025
Visit Reason
Unannounced visits were made to Riverside Health & Rehabilitation on March 10 and 11, 2025, by representatives of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting multiple investigations related to complaints #37241 and #43229.
Findings
Violations of Connecticut State Agencies regulations and statutes were identified during the visits, including a medication transcription error involving Resident #2, where the medication administration time was incorrectly transcribed, leading to potential medication errors. The facility was found to have policy gaps in double-checking medication orders prior to transcription.
Complaint Details
The investigation was complaint-driven, related to complaints #37241 and #43229. The report does not explicitly state substantiation status.
Deficiencies (1)
| Description |
|---|
| Medication transcription error for Resident #2 involving incorrect administration time of Quetiapine. |
Report Facts
Medication dosage: 37.5
Dates of visit: 2
BIMS score: 12
Plan of correction submission deadline: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karen Gworek | Supervising Nurse Consultant | Signed the notice letter from the Facility Licensing & Investigations Section. |
| RN #4 | Registered Nurse | Nurse responsible for transcribing Resident #2's medication orders and identified in the medication error finding. |
Inspection Report
Complaint Investigation
Census: 267
Capacity: 345
Deficiencies: 0
Jan 21, 2025
Visit Reason
The inspection visit was conducted as a complaint investigation related to complaint numbers #42720 and #42538.
Findings
Violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies were identified during this inspection, as referenced in an attached violation letter dated 2025-02-14.
Complaint Details
Complaint investigation related to complaint numbers #42720 and #42538. Violations were substantiated as violations were identified during the inspection.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rosemary Beaudoin | Administrator | Personnel contacted during the inspection. |
| Jessica Cusano | ADNS | Personnel contacted during the inspection. |
| Melissa Talamini | Nurse Consultant | Report submitted by and signed nurse consultant. |
Inspection Report
Plan of Correction
Deficiencies: 5
Jan 21, 2025
Visit Reason
Unannounced visits were made to Riverside Health & Rehabilitation on January 21 and 22, 2025, by representatives of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting multiple investigations.
Findings
Violations of the Regulations of Connecticut State Agencies and/or General Statutes were noted during the visits, including issues related to timely notification of physicians and families, neglect in toileting assistance, and failure to ensure timely interventions for residents with low blood sugar. The facility submitted plans of correction addressing these violations with specific corrective actions and monitoring plans.
Complaint Details
Complaints #42538 and #42720 triggered the investigations.
Deficiencies (5)
| Description |
|---|
| Delays or inconsistencies in notifying physicians or families about changes in condition or care, with insufficient or unclear documentation of notifications. |
| Failure to ensure Resident #4 was provided timely toileting hygiene and transfer assistance, resulting in neglect. |
| Failure to ensure staff acted on low blood sugar test results timely and to ensure timely endocrinology appointments for Resident #1 with a history of low blood sugars. |
| Failure to ensure proper mechanical lift transfer procedures for Resident #4, including lack of policy and staff training. |
| Failure to ensure accurate and complete documentation of physician orders and nursing actions related to glucose/Glucagon administration for Resident #1. |
Report Facts
Date of visits: Jan 21, 2025
Plan of correction submission deadline: Feb 24, 2025
Number of sampled residents reviewed: 4
Blood sugar readings: 44
Blood sugar readings: 61
Blood sugar readings: 57
Blood sugar readings: 42
Blood sugar readings: 66
Blood sugar readings: 55
Blood sugar readings: 36
Plan of correction target dates: Feb 1, 2025
Plan of correction completion date: Jan 29, 2025
Plan of correction monitoring end date: Mar 3, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karen Gworek | Supervising Nurse Consultant | Signed the notice letter regarding violations and plan of correction instructions |
Inspection Report
Complaint Investigation
Census: 276
Capacity: 345
Deficiencies: 0
Feb 8, 2024
Visit Reason
The inspection visit was conducted as a complaint investigation related to Complaint Investigation #37351.
Findings
Violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies were not identified at the time of this inspection.
Complaint Details
Complaint Investigation #37351 was the reason for the visit. No violations were identified during the inspection.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Deborah Smith | RN, NC | Signature of FLIS Staff and report submitter |
| Rosemary Beaudoin | Administrator | Personnel contacted during inspection |
| Lucia Dike | DNS | Personnel contacted during inspection |
Inspection Report
Renewal
Census: 276
Capacity: 345
Deficiencies: 0
Jan 2, 2024
Visit Reason
The inspection was conducted as a renewal licensing inspection of the Riverside Health & Rehab Center.
Findings
Violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies were identified at the time of this inspection. A full-time Infection Prevention and Control Specialist was noted.
Report Facts
Licensed Bed/Bassinet Capacity: 345
Census: 276
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rosemary Blando | Administrator | Personnel contacted during inspection |
| Lucas Pike | DNS | Personnel contacted during inspection |
Inspection Report
Census: 276
Capacity: 345
Deficiencies: 0
Dec 28, 2023
Visit Reason
The inspection was conducted as a Desk Audit on 12/28/23 to review compliance and certification files.
Findings
The facility was found to be in compliance with the regulations surveyed, with no violations identified at the time of this inspection.
Report Facts
Licensed Bed Capacity: 345
Census: 276
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lucia Duke | Director of Nursing | Personnel contacted during the inspection |
Inspection Report
Complaint Investigation
Census: 295
Capacity: 345
Deficiencies: 2
Nov 14, 2023
Visit Reason
An unannounced visit was made to Riverside Health & Rehabilitation on November 14, 2023, by a representative of the Facility Licensing and Investigations Section for the purpose of conducting a complaint investigation (#36450).
Findings
Violations of Connecticut State regulations were identified during the inspection, including inappropriate language used by a nurse aide towards a resident and failure to maintain staffing levels according to minimum requirements. The facility was required to submit a plan of correction.
Complaint Details
Complaint investigation #36450 was substantiated with findings including inappropriate language used by a nurse aide and staffing deficiencies. The nurse aide involved was terminated for poor customer service.
Deficiencies (2)
| Description |
|---|
| Use of inappropriate language by a nurse aide towards a resident, resulting in removal of the nurse aide pending further investigation. |
| Failure to maintain staffing levels to meet minimum requirements for nurse aide hours on multiple dates in November 2023. |
Report Facts
Census: 295
Total Capacity: 345
Deficiency count: 2
Staffing hours shortfall: 10
Staffing hours shortfall: 64
Staffing hours shortfall: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rosemary Beaudoin | Administrator | Administrator contacted and responsible for monitoring plan of correction |
| Karen Gworek | Supervising Nurse Consultant | Signed the notice letter regarding violations and plan of correction |
Inspection Report
Complaint Investigation
Census: 285
Capacity: 345
Deficiencies: 3
Feb 9, 2023
Visit Reason
An unannounced visit was made to Riverside Health & Rehabilitation on 02/09/2023 for the purpose of conducting a complaint investigation related to alleged abuse.
Findings
Violations of Connecticut State regulations were identified involving failure to protect residents from alleged sexual abuse and failure to notify the State Agency timely of abuse allegations. Deficiencies were found related to supervision, investigation, and reporting of abuse incidents involving multiple residents.
Complaint Details
Complaint Investigation #33851 was conducted. The investigation found deficiencies related to abuse allegations involving Residents #1, #2, #3, and #4. The facility failed to protect residents from abuse, failed to notify the State Agency timely, and failed to investigate allegations thoroughly. The facility was required to submit a plan of correction by March 9, 2023.
Deficiencies (3)
| Description |
|---|
| Facility failed to ensure a resident was protected from alleged sexual abuse when another resident with known wandering and intrusive behaviors was noted exposed and upset in the resident's room. |
| Facility failed to notify the State Agency timely of an allegation of abuse involving two residents. |
| Facility failed to initiate and perform a thorough investigation of an allegation of abuse timely. |
Report Facts
Licensed Bed Capacity: 345
Census: 285
Plan of Correction Submission Deadline: Mar 9, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nicholas Tomczyk | Nurse Consultant | Conducted the complaint investigation and authored the licensing inspection report. |
| Rosemary Beaudoin | Administrator | Named in relation to the inspection and findings. |
| Maureen Golas Markure | Supervising Nurse Consultant | Signed the important notice letter regarding the inspection findings. |
Inspection Report
Complaint Investigation
Deficiencies: 1
Jun 21, 2022
Visit Reason
An unannounced visit was made to Riverside Health & Rehabilitation to conduct an investigation with additional information received through June 22, 2022, related to Complaint 32400.
Findings
The investigation focused on a potential resident-to-resident sexual abuse incident involving Residents #1 and #2. The facility was unable to substantiate abuse as no physical contact was observed, but identified deficiencies in staff response and resident safety monitoring. A plan of correction was submitted addressing safety measures and staff education.
Complaint Details
Complaint 32400 triggered the investigation. The complaint involved an alleged resident-to-resident sexual abuse incident. The facility could not substantiate abuse but identified concerns with staff actions and resident safety. The complaint was investigated with interviews, video review, and policy review.
Deficiencies (1)
| Description |
|---|
| Failure to immediately remove Resident #2 from Resident #1's room to ensure safety after potential abuse incident was observed. |
Report Facts
Complaint number: 32400
Plan of correction submission deadline: Jul 7, 2022
Date of incident: Jun 17, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Norma Schuberth | Supervising Nurse Consultant | Signed the notice letter and referenced in relation to complaint investigation |
Inspection Report
Complaint Investigation
Census: 277
Capacity: 345
Deficiencies: 2
Dec 30, 2021
Visit Reason
An unannounced visit was made to Riverside Health & Rehabilitation for the purpose of conducting a complaint investigation related to allegations of mistreatment of a resident.
Findings
The facility failed to report an allegation of mistreatment in a timely manner and failed to initiate and thoroughly investigate the allegation of mistreatment involving Resident #10. Documentation was lacking to reflect statements obtained from the resident's caregivers as part of the investigation.
Complaint Details
Complaint #31314 was investigated. The facility was found noncompliant with regulations related to abuse and mistreatment of Resident #10. The complaint was substantiated based on review of clinical records, interviews, and facility documentation.
Deficiencies (2)
| Description |
|---|
| Failed to report an allegation of mistreatment in a timely manner. |
| Failed to initiate and thoroughly investigate an allegation of mistreatment. |
Report Facts
Licensed Bed Capacity: 345
Census: 277
Complaint Number: 31314
Compliance Date: Feb 10, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rosemarie Beaudoin | Administrator | Named as personnel contacted and responsible for monitoring the plan of correction. |
| Lucia Dikes | DNS (Director of Nursing Services) | Named as personnel contacted and responsible for monitoring the plan of correction. |
| Judith Birtwistle | Supervising Nurse Consultant | Signed the notice letter regarding the complaint investigation. |
| RN #1 | Nurse Supervisor | Involved in investigation and interviews related to Resident #10's mistreatment allegation. |
Inspection Report
Complaint Investigation
Deficiencies: 2
Dec 30, 2021
Visit Reason
A complaint investigation was conducted at Riverside Health and Rehabilitation to determine compliance with 42 CFR Part 483 requirements for Long Term Care Facilities, triggered by an allegation of mistreatment of Resident #10.
Findings
The facility failed to report an allegation of mistreatment in a timely manner and failed to initiate and thoroughly investigate the allegation. Resident #10 alleged being struck on the back of the head and pushed into side rails by a nurse aide. The facility did not obtain a statement from the resident as part of the investigation and was unaware of a police call related to the resident's safety concerns.
Complaint Details
The complaint investigation was substantiated with findings that the facility failed to timely report and properly investigate an allegation of abuse involving Resident #10. The resident reported being struck and pushed by a nurse aide, and the facility failed to obtain a resident statement and was unaware of a police report related to the incident.
Severity Breakdown
SS=D: 1
SS=E: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failed to report an allegation of mistreatment in a timely manner. | SS=D |
| Failed to initiate and thoroughly investigate an allegation of mistreatment, including failure to obtain a statement from the resident. | SS=E |
Report Facts
Date of survey completion: Dec 30, 2021
Plan of correction completion date: Feb 10, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RN #1 | Nurse Supervisor | Named in failure to report and investigate allegation of mistreatment |
| DNS | Director of Nursing Services | Named in failure to be aware of police call and failure to ensure investigation completion |
Inspection Report
Complaint Investigation
Census: 289
Capacity: 345
Deficiencies: 2
Dec 9, 2021
Visit Reason
The inspection was conducted as a complaint investigation following allegations identified in complaint investigations CT31206 and CT31251.
Findings
Violations of Connecticut State regulations were identified related to failure to notify responsible parties about pressure ulcers and failure to implement interventions to prevent pressure ulcer development. The facility was found deficient in documentation and notification practices concerning a resident with a pressure ulcer.
Complaint Details
The visit was complaint-related, investigating complaints CT31206 and CT31251. Violations were substantiated as noted in the attached violation letter dated 12/27/21.
Deficiencies (2)
| Description |
|---|
| Failure to notify the resident's representative and dietitian when a pressure ulcer developed and failure to document wound care properly. |
| Failure to implement interventions to prevent pressure ulcer development, including failure to describe, measure, stage, and maintain weekly documentation of pressure ulcers according to facility policy. |
Report Facts
Licensed Bed/Bassinet Capacity: 345
Census: 289
Dates of onsite inspection: Inspection occurred on 2021-12-07, 2021-12-08, and 2021-12-09.
Compliance date: Plan of correction compliance date is January 19, 2022.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rosemary Beaudoin | Administrator | Named as personnel contacted during the inspection. |
| Lucia Dike | DNS (Director of Nursing Services) | Named as personnel contacted during the inspection and involved in findings. |
| Karen Gworek | Supervising Nurse Consultant | Author of the notice letter regarding violations and plan of correction. |
| Laura Trombley Norton | RN | Signature on the licensing inspection report and report submitter. |
Inspection Report
Renewal
Census: 249
Capacity: 345
Deficiencies: 0
Aug 27, 2021
Visit Reason
The inspection was conducted as a licensing renewal inspection for Riverside Health & Rehabilitation Center.
Findings
The facility was found to be in compliance with visitation requirements and no violations were identified at the time of this renewal inspection.
Report Facts
Licensed Bed/Bassinet Capacity: 345
Census: 249
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karen Chadderton | Administrator | Personnel contacted during the inspection |
Inspection Report
Original Licensing
Deficiencies: 8
Aug 27, 2021
Visit Reason
An unannounced visit was made to Riverside Health & Rehabilitation on August 27, 2021, by a representative of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting a licensure and certification inspection.
Findings
The report details multiple violations of Connecticut state regulations related to resident care, facility cleanliness, grievance processes, smoking policies, respiratory care, medication management, dietary services, and infection control. The facility was found deficient in ensuring resident safety, proper equipment maintenance, grievance handling, medication expiration management, and staff compliance with infection control policies.
Deficiencies (8)
| Description |
|---|
| Facility failed to ensure the resident's call light was within the resident's reach. |
| Facility failed to ensure resident equipment was maintained in a clean and sanitary manner. |
| Facility failed to ensure the grievance process was followed. |
| Facility failed to follow policy regarding use of non-combustible ashtray with self-closing covers for smoking residents. |
| Facility failed to ensure oxygen tubing was changed according to physician order. |
| Facility failed to ensure medications were within expiration and refrigerated narcotics were maintained in locked, permanently affixed compartments. |
| Facility failed to ensure food in the kitchen was dated, labeled, and discarded after expiration and dietary staff followed infection control policy during food preparation. |
| Facility failed to ensure staff performed hand hygiene during meal delivery. |
Report Facts
Compliance date: Oct 8, 2021
Inspection date: Aug 27, 2021
Number of residents reviewed: 8
Number of expired medications observed: 18
Number of trays in refrigerator: 3
Number of cups in refrigerator: 48
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karen Chadderton | Administrator | Named as facility administrator receiving the report |
| Norma Schuberth | Supervising Nurse Consultant | Signed the notice letter and responsible for Facility Licensing and Investigations Section |
| LPN #1 | Identified in multiple observations and interviews related to medication and grievance findings | |
| LPN #2 | Identified in medication and equipment cleaning observations | |
| RN #1 | Interviewed regarding grievance process and medication room findings | |
| Director of Social Services | Responsible for monitoring grievance plan of correction | |
| Director of Environment | Interviewed regarding smoking supervision and ashtray use | |
| Director of Nursing | Responsible for monitoring oxygen therapy and medication plan of correction | |
| Assistant Director of Nursing | Responsible for monitoring call bell placement plan of correction | |
| Infection Preventionist | Responsible for monitoring infection control and hand hygiene plans of correction | |
| Assistant Director of Dietary | Interviewed regarding food labeling and infection control in kitchen | |
| Food Service Director | Responsible for monitoring food service compliance |
Inspection Report
Annual Inspection
Census: 249
Capacity: 345
Deficiencies: 8
Aug 27, 2021
Visit Reason
A recertification survey and licensure inspection were conducted to determine compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities.
Findings
Multiple deficiencies were identified including failure to ensure call bells were within reach, inadequate cleaning of feeding tube equipment, failure to follow grievance procedures, unsafe smoking supervision, improper oxygen tubing changes, expired medications and improper medication storage, undated and unlabeled food items, improper use of PPE in food preparation, and failure to perform hand hygiene during meal delivery.
Severity Breakdown
SS=D: 6
SS=E: 2
Deficiencies (8)
| Description | Severity |
|---|---|
| Failure to ensure call bell was within resident's reach. | SS=D |
| Failure to ensure feeding tube equipment was clean and sanitary. | SS=D |
| Failure to follow grievance process for missing resident property. | SS=D |
| Failure to follow policy regarding use of non-combustible ashtray with self-closing covers during smoking. | SS=D |
| Failure to change oxygen tubing weekly as ordered. | SS=D |
| Medications expired and refrigerated narcotic medications not stored in permanently affixed locked compartments. | SS=E |
| Food in kitchen not dated, labeled, or discarded after expiration; dietary staff failed to follow infection control policy during food preparation. | SS=E |
| Failure to perform hand hygiene during meal delivery. | SS=D |
Report Facts
Total Capacity: 345
Census: 249
Expired Acetaminophen suppositories: 18
Expired Influenza vaccines: 4
Expired Nitroglycerin vials: 3
Expired Heparin lock flush: 1
Expired Nitroglycerin tablets: 3
Expired Nitroglycerin tablets: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| LPN #1 | Identified expired medications and narcotic box storage issues. | |
| RN #1 | Unaware of missing resident phone and grievance process. | |
| RN #2 | Identified expired Heparin lock flush and disposed of it. | |
| Director of Nursing (DNS) | Director of Nursing | Responsible for medication cart review and narcotic box storage. |
| Assistant Director of Dietary | Reported issues with food labeling and dating. | |
| Director of Dietary | Provided expectations on PPE use and food labeling. | |
| Infection Control Nurse (ICN) | Identified hand hygiene deficiencies during meal delivery. | |
| Social Worker #1 | Interviewed about missing resident phone grievance. | |
| Social Worker #2 | Unaware of missing resident phone grievance. | |
| LPN #2 | Identified cleaning issues with feeding tube equipment. | |
| Administrator | Identified smoking supervision issues. | |
| Director of Environment | Identified smoking supervision and ashtray use issues. |
Inspection Report
Renewal
Census: 249
Capacity: 345
Deficiencies: 0
Aug 27, 2021
Visit Reason
The inspection was conducted as a licensing renewal inspection for Riverside Health & Rehab.
Findings
Violations of the General Statutes of Connecticut and/or regulations were identified during the inspection, as referenced in an attached violation letter dated 9/2/21. The facility was found to be in compliance with visitation requirements.
Report Facts
Licensed Bed/Bassinet Capacity: 345
Census: 249
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karen Chadderton | Administrator | Personnel contacted during inspection |
Inspection Report
Renewal
Census: 249
Capacity: 346
Deficiencies: 0
Aug 27, 2021
Visit Reason
The inspection was conducted as a licensing renewal inspection for the facility.
Findings
The facility was found to be in compliance with visitation requirements and no violations of the General Statutes or regulations were identified at the time of this inspection.
Report Facts
Licensed Bed/Bassinet Capacity: 346
Census: 249
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karen Chadderdon | Administrator | Personnel contacted during inspection |
Inspection Report
Complaint Investigation
Deficiencies: 2
Feb 3, 2021
Visit Reason
An unannounced visit was made to Riverside Health & Rehabilitation on February 3, 2021, by a representative of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting an investigation.
Findings
The facility failed to report and document an investigation for one resident who displayed a danger to self, including failure to complete a reportable event form and notify the State agency. Additionally, the clinical record for a resident was incomplete, lacking specific details of the incident and required notifications. The facility's policies on accident and incident reporting were found insufficient in some areas.
Complaint Details
The investigation was complaint-related, focusing on the failure to report and document an incident involving a resident who displayed a danger to self. The complaint was substantiated based on the findings.
Severity Breakdown
Class D: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to report and document an investigation for a resident who displayed a danger to self, including failure to complete a reportable event form and notify the State agency. | Class D |
| Failure to ensure the clinical record was complete for a resident with a change of condition, missing specific details of the incident and required notifications. | — |
Report Facts
Dates: Feb 3, 2021
Dates: Dec 12, 2020
Dates: Jan 31, 2021
Dates: Mar 4, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jacqueline Ruot | Supervising Nurse Consultant | Signed the notice letter and involved in the investigation |
| Karen Chadderton | Administrator | Facility administrator named in correspondence and plan of correction |
| Director of Nurses | Interviewed regarding incident reporting and clinical record documentation |
Inspection Report
Complaint Investigation
Deficiencies: 3
Jan 25, 2021
Visit Reason
The inspection was conducted due to a complaint investigation regarding the facility's failure to notify responsible parties of changes in resident condition, failure to conduct wound assessments, and failure to adhere to infection control practices.
Findings
The facility failed to notify the responsible party when a change in condition was identified and new treatment was initiated for Resident #1. The facility also failed to ensure a wound assessment was conducted when a new skin condition was identified, resulting in an unstageable pressure ulcer and hospital transfer for sepsis. Additionally, the facility failed to adhere to infection control practices by allowing clean linen carts into residents' rooms, risking contamination.
Complaint Details
The investigation was complaint-related, focusing on Resident #1's change in condition, wound care, and infection control practices. The complaint was substantiated by findings including failure to notify responsible parties, incomplete wound assessments, and infection control breaches.
Deficiencies (3)
| Description |
|---|
| Failure to notify the responsible party when a change in condition was identified and new treatment was initiated. |
| Failure to ensure that a wound assessment was conducted when a new skin condition was identified. |
| Failure to adhere to infection control practices to ensure residents had clean linen without the possibility of contamination. |
Report Facts
Date of physician order for new treatment: Dec 30, 2020
Date of nurse's note identifying change in skin condition: Dec 30, 2020
Date of hospital transfer: Dec 31, 2020
Wound measurements after debridement: 7.5
Wound measurements after debridement: 3.8
Wound measurements after debridement: 7.7
Resident temperature at hospital admission: 101
Audit frequency: 3
Audit review duration: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karen Chadderton | Administrator | Named as facility administrator in the report. |
| LPN #4 | Licensed Practical Nurse | Involved in failure to notify responsible party and failure to document wound characteristics. |
| Director of Nursing | Director of Nursing | Interviewed regarding notification failures and infection control practices. |
| RN #1 | Registered Nurse | Interviewed about lack of awareness of open wound prior to hospital transfer. |
| RN #2 | Infection Control Preventionist | Interviewed regarding wound assessment and infection control practices. |
| LPN #2 | Licensed Practical Nurse | Interviewed about evaluation of resident's condition and failure to notify supervisor. |
| NA #1 | Nursing Assistant | Observed pushing clean linen cart into residents' rooms against policy. |
| NA #2 | Nursing Assistant | Observed bringing linen cart into residents' rooms and interviewed about infection control. |
| LPN #1 | Licensed Practical Nurse | Interviewed about instructing NA #2 not to bring linen carts into residents' rooms. |
Inspection Report
Abbreviated Survey
Deficiencies: 3
Jan 25, 2021
Visit Reason
A COVID-19 Focused Infection Control Survey and investigation was conducted to determine compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities, including infection prevention and control practices to prevent COVID-19 transmission.
Findings
Deficiencies were identified related to failure to notify responsible parties of changes in resident condition and new treatments, failure to conduct wound assessments for new skin conditions, and failure to adhere to infection control practices regarding clean linen handling.
Severity Breakdown
SS=D: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to notify responsible party when a change in condition was identified and new treatment initiated for Resident #1. | SS=D |
| Failure to ensure wound assessment was conducted when a new skin condition was identified for Resident #1. | SS=D |
| Failure to adhere to infection control practices ensuring clean linen was handled without contamination; clean linen carts were taken into residents' rooms. | SS=D |
Report Facts
Deficiencies cited: 3
Wound measurement: 7.5
Wound measurement: 3.8
Wound measurement: 7.7
Resident temperature: 101
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| LPN #4 | Licensed Practical Nurse | Received order for new treatment on 12/30/20, failed to notify responsible party and nursing supervisor |
| Director of Nursing | Interviewed regarding notification failures and infection control practices | |
| RN #1 | Registered Nurse | Unaware of open wound on Resident #1 prior to hospital transfer |
| RN #2 | Infection Control Preventionist | Informed of open wound after hospital transfer; responsible for monitoring infection control plan |
| NA #1 | Nurse Aide | Observed pushing clean linen cart into residents' rooms contrary to infection control policy |
| NA #2 | Nurse Aide | Observed bringing linen cart into residents' rooms despite awareness of policy |
| LPN #1 | Licensed Practical Nurse | Instructed NA #2 not to bring linen carts into residents' rooms |
Inspection Report
Routine
Census: 256
Capacity: 267
Deficiencies: 1
Nov 4, 2020
Visit Reason
A COVID-19 Focused Survey was conducted to determine compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities, including proper infection prevention and control practices to prevent the development and transmission of COVID-19.
Findings
The facility failed to adhere to its Communal Dining Plan and CDC social distancing guidelines during a pandemic, as residents were observed seated less than six feet apart and sharing food in the dining room. Nursing staff acknowledged social distancing was an oversight during the meal, and the facility's communal dining policy was not followed.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to adhere to facility Communal Dining Plan and CDC social distancing guidelines during a pandemic, including residents seated less than six feet apart and sharing food. | SS=D |
Report Facts
Census: 256
Total Capacity: 267
Residents observed in dining room: 12
Residents per table: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nursing Assistant (NA) #1 | Provided information about dining room observations and seating arrangements | |
| Registered Nurse (RN) #1 | Indicated social distancing was an oversight during the noon meal | |
| Infection Control Nurse (ICN) | Indicated communal dining had been placed on hold and social distancing guidelines | |
| Director of Nursing (DON) | Stated responsibility of nursing staff to ensure social distancing and seating arrangements |
Inspection Report
Abbreviated Survey
Census: 12
Deficiencies: 1
Nov 4, 2020
Visit Reason
An unannounced visit was conducted to Riverside Health & Rehabilitation to perform a Focused Infection Control Survey with additional information received through November 4, 2020.
Findings
The facility failed to adhere to the Communal Dining Plan and CDC social distancing guidelines during a pandemic, with residents seated less than six feet apart in the dining room. Interviews with staff confirmed the lack of designated seating arrangements and oversight of social distancing.
Deficiencies (1)
| Description |
|---|
| Failure to adhere to the facility Communal Dining Plan and CDC social distancing guidelines during a pandemic. |
Report Facts
Residents observed: 12
Residents seated at Table #1: 4
Residents seated at Table #2: 2
Residents seated at Table #3: 2
Residents seated at Table #4: 3
Residents affected by deficient practice: 12
Plan of correction submission deadline: Nov 20, 2020
Audit period: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisa A. DiLorenzo | Supervising Nurse Consultant | Signed the notice letter |
| Karen Chadderton | Administrator | Addressee of the notice and plan of correction |
| RN #1 | Registered Nurse | Interviewed regarding dining room social distancing |
| RN #2 | Registered Nurse | Observed during mealtime and interviewed regarding dining room social distancing |
| NA #1 | Nursing Assistant | Interviewed regarding dining room usage and seating |
| Director of Nursing | Director of Nursing | Interviewed regarding responsibility for social distancing and monitoring plan of correction |
Inspection Report
Abbreviated Survey
Census: 254
Capacity: 345
Deficiencies: 1
Sep 22, 2020
Visit Reason
A COVID-19 Focused Survey was conducted to determine compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities, including proper infection prevention and control practices to prevent the development and transmission of COVID-19.
Findings
The facility failed to adhere to infection control practices and CDC guidelines while handling a contaminated surgical mask, specifically involving improper glove use and mask handling by a nurse aide.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to adhere to infection control practice and CDC guidelines while handling a contaminated surgical mask, including improper glove use and mask handling. | SS=D |
Report Facts
Capacity: 345
Census: 254
Inspection Report
Plan of Correction
Deficiencies: 1
Sep 22, 2020
Visit Reason
An unannounced visit was conducted on September 22, 2020, by the Department of Public Health for the purpose of conducting an Infection Control Focused Survey with additional information received through September 22, 2020.
Findings
The facility failed to adhere to infection control practices and CDC guidelines while handling a contaminated surgical mask, specifically involving improper handling and contamination by a Nursing Assistant. The facility was cited for violations related to infection control and Director of Nurses responsibilities.
Deficiencies (1)
| Description |
|---|
| Failure to adhere to infection control practices and CDC guidelines while handling a contaminated surgical mask, including improper glove use and mask handling. |
Report Facts
Date of visit: Sep 22, 2020
Plan of correction submission deadline: Oct 9, 2020
Plan of correction completion date: Oct 12, 2020
Time of observation: 1045
Time of interview: 1050
Time of interview: 1055
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karen Chadderton | Administrator | Named as recipient of the notice and responsible for facility compliance |
| Lisa A. Dilorenzo | Supervising Nurse Consultant | Author of the plan of correction notice |
Inspection Report
Plan of Correction
Deficiencies: 1
Aug 26, 2020
Visit Reason
Unannounced visits were made to Riverside Health & Rehabilitation for the purpose of conducting an investigation and a COVID-19 Federal Focused Survey with additional information received through August 26, 2020.
Findings
The facility failed to timely report a reportable event involving Resident #1 becoming unresponsive and subsequent death. The event was reported 22 days after occurrence, and the Director of Nursing acknowledged a delay in reporting.
Complaint Details
Complaint CT#28320 was investigated, focusing on the delay in reporting a reportable event. The complaint was substantiated by findings.
Deficiencies (1)
| Description |
|---|
| Failure to timely report a reportable event involving Resident #1 becoming unresponsive and subsequent death. |
Report Facts
Days delay in reporting: 22
Compliance date: Sep 23, 2020
Audit timeframe: 48
Audit review period: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisa A. DiLorenzo | Supervising Nurse Consultant | Signed letter and contact for questions regarding violations. |
| Karen Chadderton | Administrator | Recipient of the notice and responsible for monitoring plan of correction. |
| Director of Nursing | Interviewed regarding delay in reporting the event. |
Inspection Report
Abbreviated Survey
Deficiencies: 0
Aug 26, 2020
Visit Reason
A COVID-19 Focused Survey and investigation were conducted to determine compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities, including proper infection prevention and control practices to prevent the development and transmission of COVID-19.
Findings
Although federal deficiencies were not cited as a result of this survey, a state public health code violation was identified.
Inspection Report
Complaint Investigation
Deficiencies: 1
Jun 30, 2020
Visit Reason
An unannounced visit was made to Riverside Health & Rehabilitation to conduct an investigation and a focused COVID-19 Infection Control survey based on a complaint.
Findings
The facility failed to discharge a resident in a timely manner due to inadequate follow-up on the discharge plan involving the resident's family and outside agencies, resulting in a delay of discharge. Documentation and communication deficiencies were noted regarding the discharge process.
Complaint Details
Complaint #27907 triggered the investigation. The complaint was substantiated based on review of records, interviews, and documentation showing delays and lack of communication in discharge planning.
Deficiencies (1)
| Description |
|---|
| Failure to discharge resident in a timely manner due to lack of follow-up on discharge plan and communication with family and outside agencies. |
Report Facts
Resident reviewed: 1
Dates referenced: 2020
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisa A. DiLorenzo | Supervising Nurse Consultant | Signed the initial notice letter and involved in the investigation. |
| Karen H. Chadderton | Administrator | Facility administrator who submitted the Plan of Correction. |
| Social Worker #1 | Involved in discharge planning and communication with Money Follows The Person program. | |
| Director of Nursing | Director of Nursing | Interviewed regarding awareness of discharge concerns. |
| Director of Social Work | Director of Social Work | Responsible for case management and follow-up on discharge plan compliance. |
Inspection Report
Routine
Census: 239
Capacity: 345
Deficiencies: 0
Jun 18, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted to determine compliance with 42 CFR §483.80 Infection Control regulations for Long Term Care Facilities.
Findings
The facility implemented CMS and CDC recommended practices related to COVID-19. No deficiencies were cited as a result of this survey.
Report Facts
Capacity: 345
Census: 239
Inspection Report
Complaint Investigation
Census: 246
Capacity: 345
Deficiencies: 1
Jun 4, 2020
Visit Reason
A COVID-19 Focused Survey was conducted to determine compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities, including proper infection prevention and control practices. Additionally, the investigation was triggered by allegations of abuse, neglect, exploitation, or mistreatment related to an injury of unknown origin for one resident.
Findings
The facility failed to complete a full investigation according to standards of practice for an injury of unknown origin involving Resident #1. The investigation lacked interviews from key nursing assistants and was not reported to the state agency as potential abuse. The Director of Nursing could not locate investigative interviews, indicating the investigation was not comprehensive. No deficiencies were cited related to infection control.
Complaint Details
The investigation was in response to allegations of abuse, neglect, exploitation, or mistreatment related to an injury of unknown origin for Resident #1. The facility did not thoroughly investigate the alleged violation, failed to interview involved nursing assistants, and did not report the injury as potential abuse to the state agency. The deficiency was substantiated as the investigation was incomplete.
Severity Breakdown
Level D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to complete a full investigation according to standards of practice for injury of unknown origin involving Resident #1. | Level D |
Report Facts
Capacity: 345
Census: 246
Completion date: Jun 23, 2020
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Registered Nurse #1 | Registered Nurse | Assessed Resident #1 after dialysis facility reported injury |
| Director of Nursing | Director of Nursing | Received report from RN #1 and did not report injury as potential abuse; could not locate investigative interviews |
Inspection Report
Complaint Investigation
Deficiencies: 1
Jun 4, 2020
Visit Reason
An unannounced visit was made to Riverside Health & Rehabilitation on June 4, 2020, by a representative of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting a COVID-19 Focused Survey and an investigation based on additional information received through June 4, 2020.
Findings
The facility failed to complete a full investigation for injury of unknown origin for one resident, Resident #1, who had dependent edema and swelling. The investigation lacked interviews with key staff and was deemed not comprehensive. The Director of Nursing did not consider the injury to be of unknown origin and did not report it as potential abuse to the state agency.
Complaint Details
Complaint #27681 triggered the investigation. The complaint involved failure to properly investigate an injury of unknown origin for one resident. The investigation was found not comprehensive and the injury was not reported as potential abuse.
Deficiencies (1)
| Description |
|---|
| Failure to complete a full investigation for injury of unknown origin for Resident #1. |
Report Facts
Resident reviewed: 1
Date of resident admission: Sep 15, 2019
Date of resident care plan: Mar 24, 2020
Date of reportable event form: May 28, 2020
Date of social work note: May 28, 2020
Date of SBAR form: May 28, 2020
Date of RN interview: Jun 4, 2020
Date of DNS interview: Jun 4, 2020
Plan of correction compliance date: Jun 23, 2020
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisa A. DiLorenzo | Supervising Nurse Consultant | Signed letter as Supervising Nurse Consultant for Facility Licensing and Investigations Section |
Inspection Report
Abbreviated Survey
Census: 238
Capacity: 300
Deficiencies: 1
May 25, 2020
Visit Reason
A COVID-19 Focused Infection Control Survey was conducted to determine compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities, including proper infection prevention and control practices to prevent the transmission of COVID-19.
Findings
The facility failed to ensure proper personal protective equipment (PPE) was utilized according to CDC guidelines by staff on COVID-19 positive units, including improper use and lack of fit testing for N95 masks. The facility had adequate PPE supplies and initiated re-education and audits to address the deficiencies.
Deficiencies (1)
| Description |
|---|
| Failure to ensure proper personal protective equipment (PPE) was utilized according to CDC guidelines on COVID-19 positive units. |
Report Facts
Total Capacity: 300
Census: 238
N95 masks in supply: 5300
KN95 masks in supply: 6500
Completion date for plan of correction: Jun 8, 2020
Date of facility audit: May 29, 2020
Scheduled date for additional fit testing: Jun 9, 2020
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RN #1 | Registered Nurse | Observed not wearing N95 mask on COVID-19 positive unit and interviewed regarding PPE use |
| LPN #1 | Licensed Practical Nurse | Observed wearing surgical mask instead of N95 on COVID-19 positive unit and interviewed regarding PPE use |
| NA #1 | Nursing Assistant | Observed wearing N95 mask improperly and instructed on proper use |
| NA #2 | Nursing Assistant | Observed wearing double surgical masks instead of N95 and interviewed regarding PPE use |
| Director of Nursing | Director of Nursing | Interviewed regarding PPE guidance and facility education plans |
Inspection Report
Routine
Deficiencies: 1
May 25, 2020
Visit Reason
An unannounced visit was made to Riverside Health & Rehabilitation on May 25, 2020, by a representative of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting a COVID-19 Infection Control survey.
Findings
The facility failed to ensure proper personal protective equipment (PPE) was utilized according to CDC guidelines, with multiple staff members observed wearing masks incorrectly or not wearing N95 masks when required. The facility had adequate PPE supplies and planned re-education and fit testing for staff to correct deficiencies.
Deficiencies (1)
| Description |
|---|
| Failure to ensure proper personal protective equipment (PPE) was utilized according to CDC guidelines during care of COVID-19 positive residents. |
Report Facts
Staff interviewed: 4
PPE stock: 5300
PPE stock: 6500
Plan of correction submission deadline: Jun 7, 2020
Fit testing scheduled date: Jun 9, 2020
Plan of correction monitoring deadline: Jun 8, 2020
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lisa A. DiLorenzo | Supervising Nurse Consultant | Author of the notice and contact for questions regarding violations |
| Karen H. Chadderton | Administrator | Facility administrator who submitted the plan of correction |
| RN #1 | Registered Nurse | Observed not wearing N95 mask on COVID-19 positive unit and involved in medication administration |
| LPN #1 | Licensed Practical Nurse | Observed not wearing N95 mask on COVID-19 positive unit |
| NA #1 | Nursing Assistant | Observed wearing blue surgical mask under N95 mask incorrectly |
| NA #2 | Nursing Assistant | Observed wearing double blue surgical masks and not wearing N95 mask |
| Director of Nursing | Provided information on mask guidance and responsible for monitoring plan of correction |
Inspection Report
Routine
Census: 241
Capacity: 345
Deficiencies: 0
May 14, 2020
Visit Reason
The visit was conducted for the purpose of conducting a COVID-19 infection control survey.
Findings
No violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies were identified at the time of this inspection.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karen Chadderton | Administrator | Personnel contacted during the inspection. |
Inspection Report
Abbreviated Survey
Census: 241
Capacity: 345
Deficiencies: 0
May 14, 2020
Visit Reason
A COVID-19 Focused Survey was conducted to determine compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities, including proper infection prevention and control practices to prevent the development and transmission of COVID-19.
Findings
No deficiencies were cited as a result of this COVID-19 focused survey.
Report Facts
Capacity: 345
Census: 241
Inspection Report
Abbreviated Survey
Deficiencies: 0
May 5, 2020
Visit Reason
A COVID-19 Focused Survey was conducted to determine compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities, including proper infection prevention and control practices to prevent the development and transmission of COVID-19.
Findings
No deficiencies were cited as a result of this COVID-19 focused survey.
Inspection Report
Abbreviated Survey
Deficiencies: 0
Apr 30, 2020
Visit Reason
A COVID-19 Focused Survey was conducted to determine compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities, including proper infection prevention and control practices to prevent the development and transmission of COVID-19.
Findings
The COVID-19 Focused Survey found no deficiencies as a result of this inspection.
Inspection Report
Routine
Census: 226
Capacity: 345
Deficiencies: 0
Apr 15, 2020
Visit Reason
A COVID-19 Focused Survey was conducted to determine compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities, including proper infection prevention and control practices to prevent the development and transmission of COVID-19.
Findings
The survey found the facility in compliance with no deficiencies cited related to infection prevention and control practices for COVID-19.
Inspection Report
Plan of Correction
Deficiencies: 1
Sep 3, 2019
Visit Reason
Unannounced visits were made to Riverside Health & Rehabilitation to conduct an investigation for noncompliance with Connecticut General Statutes and Regulations of Connecticut State Agencies.
Findings
The facility failed to notify the state agency of a newly identified fracture in a resident, which was initially misclassified as a Class E event but later reclassified as a Class D event and reported. The facility submitted a plan of correction addressing the reporting requirements and monitoring procedures.
Severity Breakdown
Class D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to notify the state agency of a newly identified fracture in Resident #1. | Class D |
Report Facts
Date of visit conclusion: Sep 3, 2019
Plan of correction submission deadline: Oct 15, 2019
Audit frequency: 2
Audit review period: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Heidi Caron | Supervising Nurse Consultant | Named as the contact for questions regarding deficiencies and instructions |
| Karen Chadderton | Administrator | Named in relation to the plan of correction and monitoring responsibilities |
Inspection Report
Complaint Investigation
Census: 324
Capacity: 345
Deficiencies: 4
Aug 28, 2019
Visit Reason
The inspection was conducted as a complaint investigation related to alleged violations of Connecticut General Statutes and regulations at Riverside Health & Rehabilitation Center.
Findings
Violations were identified during the complaint investigation, including failure to notify the state agency of a newly identified fracture, misclassification of incident reports, and deficiencies in resident care and facility policies. The facility submitted plans of correction for the identified violations.
Complaint Details
The complaint investigation was substantiated with violations identified, including failure to notify the state agency of a newly identified fracture and misclassification of incident reports as Class E instead of Class D.
Severity Breakdown
Class D: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Failure to notify the state agency of a newly identified fracture and misclassification of incident reports. | Class D |
| Failure to ensure care and services were provided in a timely manner to prevent pressure ulcers and complete timely RN assessments. | — |
| Failure to ensure sanitizing solution levels were monitored for a dishwasher machine and proper storage of juices. | — |
| Failure to provide adequate supervision to ensure resident safety related to smoking policy violations and elopement risk. | — |
Report Facts
Licensed Bed Capacity: 345
Census: 324
Plan of Correction Submission Deadline: 2019
Plan of Correction Submission Deadline: 2019
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lucia Dike | Director of Nursing Services | Contacted personnel during inspection |
| Nicholas Tomczyk | Nurse Consultant | Report submitted by and involved in notification of plan of correction approval |
| Michael Bernardi | Assistant Administrator | Contacted personnel during complaint investigation |
| Karen Chadderton | Administrator | Named in multiple letters and plan of correction correspondence |
| Heidi Caron | Supervising Nurse Consultant | Signed important notice letters regarding plan of correction |
| Peggy Ortola | Nurse Consultant | Submitted desk audit report |
| Norma Schuberth | Supervising Nurse Consultant | Signed letter regarding plan of correction |
Inspection Report
Annual Inspection
Deficiencies: 1
May 2, 2019
Visit Reason
The inspection was conducted to assess the accuracy of resident assessments, specifically reviewing the Minimum Data Set (MDS) for compliance with regulatory requirements.
Findings
The facility failed to ensure the accuracy and consistency of the MDS assessments for Resident #316, particularly regarding hospice care status and prognosis documentation. The coding errors were acknowledged by staff, and the facility did not meet the requirement for accurate resident assessment documentation.
Deficiencies (1)
| Description |
|---|
| Failure to ensure the Minimum Data Set (MDS) assessment accurately reflected Resident #316's hospice care status and prognosis. |
Report Facts
Deficiency cited: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Registered Nurse #6 | MDS Director | Supervises MDS assessments and responsible for ensuring MDS accuracy |
| Licensed Practical Nurse #6 | LPN | Acknowledged miscoding of hospice services and prognosis in MDS assessment |
Inspection Report
Annual Inspection
Deficiencies: 3
May 2, 2019
Visit Reason
Unannounced visits were made to the facility on April 29 and 30 and May 1 and 2, 2019 by representatives of the Facility Licensing & Investigations Section for the purpose of conducting a licensure inspection, certification survey, and multiple investigations.
Findings
The facility was found deficient in quality of care related to timely RN assessments and pressure ulcer care for two residents, failure to provide adequate supervision to a resident with a history of elopement and smoking policy violations, and food safety issues including inadequate monitoring of dishwasher sanitizing solution and improper storage of juices prior to serving.
Severity Breakdown
SS=D: 1
SS=E: 2
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to ensure care and/or services were provided in a timely manner to promote the healing of a pressure ulcer and to complete RN assessment for a change in condition in a timely manner for two residents. | SS=D |
| Failure to provide appropriate supervision to a resident with a known history of non-compliance with the facility smoking policy and/or failure to implement measures to prevent elopement and smoking violations. | SS=E |
| Failure to ensure sanitizing solution levels were monitored for a dishwasher machine that did not meet temperature levels required for heat sanitation and failure to ensure juices were stored properly prior to serving. | SS=E |
Report Facts
Deficiencies cited: 3
Wound measurement: 7.8
Dishwasher minimum wash temperature: 160
Dishwasher minimum rinse temperature: 180
Sanitizer solution level: 100
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| LPN #5 | Licensed Practical Nurse | Named in deficiency related to failure to replace pressure ulcer dressing timely and inaccurate documentation |
| RN #5 | Registered Nurse | Named in deficiency related to wound care and RN assessment |
| LPN #4 | Licensed Practical Nurse, Nursing Supervisor | Named in deficiency related to failure to timely assess Resident #621 after change in condition |
| RN #8 | Registered Nurse | Involved in supervision and documentation related to Resident #158 smoking and elopement incidents |
Inspection Report
Plan of Correction
Deficiencies: 4
May 2, 2019
Visit Reason
Unannounced visits were made to Riverside Health & Rehabilitation on May 2, 2019, by representatives of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting multiple investigations and a licensure renewal inspection.
Findings
The report identifies multiple violations of Connecticut General Statutes and Regulations related to clinical record accuracy, timely nursing assessments, resident supervision, smoking policy compliance, and food service sanitation. The facility failed to ensure accurate Minimum Data Set assessments, timely care for pressure ulcers, adequate supervision of residents with a history of non-compliance, and proper sanitizing solution levels for dishwashers.
Deficiencies (4)
| Description |
|---|
| Failure to ensure the Minimum Data Set (MDS) assessment was accurate for Resident #316, including coding errors related to hospice care and prognosis. |
| Failure to ensure timely care and Registered Nurse assessments for pressure ulcers for Residents #111 and #621. |
| Failure to provide appropriate supervision to Resident #158 with a history of non-compliance with the facility smoking policy, including failure to prevent elopement and implement safety measures. |
| Failure to ensure sanitizing solution levels were monitored and maintained for the facility dishwasher, and failure to ensure juices were stored properly prior to serving. |
Report Facts
Compliance date for plan of correction: 2019
Compliance date for plan of correction: 2019
Compliance date for plan of correction: 2019
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Norma Schuberth | Supervising Nurse Consultant | Signed letter directing submission of plan of correction |
| Karen Chadderton | Administrator | Named as facility administrator receiving the notice |
| Director of Nursing | Responsible for monitoring plan of correction for violations #1 and #2 | |
| Director of Social Services | Responsible for monitoring plan of correction for violation #3 | |
| Director of Food Management | Interviewed regarding dishwasher sanitizing violation |
Inspection Report
Renewal
Census: 316
Capacity: 345
Deficiencies: 0
May 2, 2019
Visit Reason
The inspection was conducted as a licensing renewal inspection and included complaint investigations for CT#24996, CT#25296, and CT#25345.
Findings
The report indicates that violations of the General Statutes of Connecticut and/or regulations were identified during the inspection, as referenced by attached violation letters and complaint investigations.
Complaint Details
Complaint investigations were conducted for CT#24996, CT#25296, and CT#25345; substantiation status is not stated.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karen Chadderton | Administrator | Personnel contacted during the inspection |
| Lucia Dike | DNS | Personnel contacted during the inspection |
Inspection Report
Complaint Investigation
Census: 324
Capacity: 345
Deficiencies: 0
Mar 15, 2018
Visit Reason
The inspection was conducted as a complaint investigation related to complaint numbers 22495, 22331, 21734, and 22797, and also included a renewal licensure inspection.
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 6/24/18.
Complaint Details
Complaint investigation numbers 22495, 22331, 21734, and 22797 were reviewed; violations were substantiated as indicated by the attached violation letter.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lucie Dike | Personnel contacted during the inspection |
Report
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