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F0838
F

Failure to Complete and Update Facility-Wide Assessment and Staffing Documentation

Coventry, Rhode Island Survey Completed on 10-28-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to conduct and document a comprehensive facility-wide assessment to determine the necessary resources for competent resident care during both routine operations and emergencies. Record review revealed that the facility's assessment, dated March 2025-2026, was incomplete, lacking required supporting documentation and a completed Staffing and Personnel Worksheet. Additionally, the assessment listed a previous employee as the Administrator instead of the current one. During an interview, the current Administrator acknowledged that the assessment was not complete and did not accurately reflect the facility's staffing patterns or leadership. A community complaint reported to the Rhode Island Department of Health alleged that a resident sustained two falls and did not receive appropriate care for their injuries. The complaint also raised concerns about insufficient and unqualified staffing. Review of the facility's documentation confirmed these deficiencies, as multiple sections of the assessment were missing records, and there was no evidence of a current, accurate evaluation of staffing sufficiency or qualifications.

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