Inspection Reports for Winthrop House
1946 US Route 202, Winthrop, ME 04364, ME, 4364
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Inspection Report
Renewal
Census: 3
Capacity: 3
Deficiencies: 3
May 8, 2025
Visit Reason
The inspection was conducted as a renewal survey to assess compliance with the Regulations Governing the Licensing and Functioning of Assisted Housing Programs for a Level III Residential Care Facility.
Findings
The facility was found non-compliant due to failure to include signed standard contracts, grievance procedures, resident rights, and admission policies in resident records, improper medication storage mixing external and internal medications, and water temperature exceeding the maximum allowed in resident areas.
Severity Breakdown
Class III: 2
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to include a signed standard contract, grievance procedure, resident rights, and admission policy in the resident record. | — |
| Medications for external use were not kept separate from internal medications. | Class III |
| Water temperature in resident areas exceeded 120°F, reaching over 125°F. | Class III |
Report Facts
Census: 3
Total Capacity: 3
Water temperature: 121
Water temperature: 125
Plan of Correction Completion Date: May 15, 2025
Plan of Correction Completion Date: Jun 30, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jill McKenney | Administrator | Administrator confirmed findings during exit interview |
| Residential Program Manager | Confirmed contract and record findings during survey | |
| House Manager | Confirmed medication storage and water temperature findings during survey and exit interview |
Inspection Report
Biennial Survey
Census: 3
Capacity: 3
Deficiencies: 7
May 2, 2023
Visit Reason
The inspection was a biennial survey to assess compliance with the Regulations Governing the Licensing and Functioning of Assisted Housing Programs for a Level III Residential Care Facility.
Findings
The facility was found non-compliant in multiple areas including failure to append required contract attachments, lack of current written consent to release information for residents, unsafe medication administration and documentation practices, missing duly authorized licensed practitioner orders for medications, lack of diabetes training for employees, failure to destroy expired medications within required timeframes, and incorrect transcription of medication orders in Medication Administration Records.
Severity Breakdown
Class III: 2
Class IV: 1
Classes I/II/III: 1
Deficiencies (7)
| Description | Severity |
|---|---|
| Failure to include grievance procedure, resident rights, and admissions policy appended to contracts for 2 of 2 resident records reviewed. | — |
| 1 of 2 resident records did not contain a current written consent to release information. | Class IV |
| Failure to ensure staff used safe and acceptable procedures for medication administration and documentation for 2 of 2 residents. | Classes I/II/III |
| Lack of duly authorized licensed practitioner orders within 12 months for multiple medications for 2 of 2 residents. | — |
| No evidence of completion of annual diabetes training for 3 of 3 employees. | Class III |
| Failure to destroy expired medications within 60 calendar days. | — |
| Medication incorrectly transcribed to resident's Medication Administration Records. | Class III |
Report Facts
Census: 3
Total Capacity: 3
Number of residents with missing contract attachments: 2
Number of residents missing current written consent to release information: 1
Number of residents with medication label discrepancies: 2
Number of employees missing diabetes training: 3
Number of expired medication items not destroyed within 60 days: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Judy M Seals | Administrator | Named as facility administrator in report header |
| Director of Residential Services | Unable to locate required contract attachments and written consents | |
| Team Leader | Confirmed findings during survey | |
| Director of Behavioral Health | Confirmed lack of diabetes training for employees |
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