Below average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Apple Rehab Guilford during CMS and state inspections, most recent first.
A resident with a history of sexually inappropriate behaviors and moderately impaired cognition was able to inappropriately touch another resident with dementia and similar cognitive impairment. Despite care plan interventions for monitoring and redirection, staff did not adequately supervise the resident, resulting in an incident of unwanted physical contact. Facility leadership acknowledged that staff vigilance was lacking and that the incident constituted inappropriate behavior under the facility's abuse policy.
Two residents with dementia and impaired cognition were involved in an incident where one was observed touching another inappropriately. An LPN student intervened and notified the charge nurse, but the facility did not report the event to the State Agency as required by policy, despite the incident meeting the definition of sexual abuse.
Several residents did not receive required neurological assessments after falls, with documentation either incomplete or missing, despite facility policy and physician orders. Additionally, a resident at risk for pressure ulcers did not have Braden Scales or weekly body audits completed as ordered, and their low air loss mattress was not set according to manufacturer guidelines or physician order, with staff inconsistencies in following proper procedures.
The facility did not consistently document food temperatures prior to meal service as required by policy, with multiple instances of missing or incomplete temperature records for supper food items. Dietary staff acknowledged that while temperatures were generally taken, they were not always recorded, resulting in noncompliance with established food safety procedures.
A resident with intact cognition and mobility impairments reported that two nurse aides were unpleasant during a hoyer lift transfer, causing pain and discomfort. The aides' behavior, including a sarcastic comment about gratitude, was deemed disrespectful, though no intentional harm was found. The facility's policy on resident rights was not upheld, as residents are expected to be treated with dignity and respect.
A resident with cognitive impairment was admitted with a full code status, but the facility did not obtain a valid, signed advance directive consent form from the resident's representative. Despite policy requiring the form to be signed and documented, the representative's signature was missing, and there was no evidence of follow-up attempts or proper documentation by nursing staff.
The facility failed to promptly notify providers and resident representatives of significant changes in condition for three residents, including a resident expressing suicidal ideation, another experiencing unplanned weight loss with dietary changes, and a third sustaining injuries from an unwitnessed fall. Required notifications and documentation were not completed according to facility policy, resulting in deficiencies related to communication and timely response to resident needs.
A resident with a history of depression and anxiety developed new symptoms of paranoia and delusions, resulting in a diagnosis of psychotic disorder with delusions. Despite this, the facility did not promptly notify the State-designated authority or update the care plan and MDS assessments to reflect the new diagnosis, due to unclear communication and responsibility among staff.
A resident with a stage III pressure ulcer did not receive weekly Braden Scale assessments or body audits as ordered, and their low air loss mattress was not set according to manufacturer weight guidelines. Documentation and staff interviews confirmed missed assessments and improper equipment settings, resulting in a deficiency in pressure ulcer care and prevention.
A resident with right-sided hemiplegia and contracture risk did not receive care in accordance with their care plan and physician orders, resulting in the absence of a required hand splint and rolled washcloth during multiple observations. Staff interviews revealed a lack of awareness and adherence to the care plan, and the physician's order for the splint was discontinued without clear justification, despite the resident's ongoing need for the device.
A resident with a history of heart attack and recent influenza did not have weights obtained and documented as ordered by the physician and required by facility policy. Several weekly and monthly weights were missed, and a significant weight loss was not promptly reweighed or reported. Staff interviews confirmed that nurse aides were self-directed in obtaining weights, and the process lacked consistent oversight, resulting in missed documentation and failure to follow established protocols.
Two residents requiring enhanced barrier precautions (EBP) due to a surgical wound with MRSA history and an indwelling dialysis catheter were not initially placed on EBP. Staff failed to consistently use PPE during direct care, and appropriate signage and PPE were not reliably provided or used, despite facility policy and care plans indicating the need for these infection control measures.
A resident on a mechanical soft diet due to missing teeth was served inappropriate fruit salad, leading to a choking incident. Despite being on a modified diet, the resident received honeydew melon and pineapple, which were not suitable. The LPN and other staff attempted to assist the resident, but emergency services were ultimately required. The dietary manager and Speech Language Pathologist confirmed the dietary error, and the DON acknowledged the failure to follow the prescribed diet.
Failure to Prevent Resident-to-Resident Sexual Abuse
Penalty
Summary
A deficiency occurred when a resident with a known history of verbally abusive and sexually inappropriate behaviors was able to inappropriately touch another resident. The resident with these behaviors had diagnoses including vascular dementia, adjustment disorder, and anxiety, and was identified as having moderately impaired cognition. The care plan for this resident included interventions such as monitoring behaviors, redirection, removal from public areas when behavior was disruptive or unacceptable, and psychiatric follow-up as needed. Despite these interventions, the resident was observed by a student nurse with their hand under another resident's shirt, touching the upper chest area. The incident was reported and classified as inappropriate behavior. The resident who was touched also had dementia and moderately impaired cognition. The facility's Director of Nursing acknowledged that staff should have been vigilant in monitoring the resident with known behaviors to prevent such incidents. The facility's abuse policy defined sexual abuse as any unwanted touching between residents. The report did not identify whether the resident who was touched had the capacity to consent, nor did it explain why staff failed to monitor the location and behaviors of the resident with a history of inappropriate conduct, leading to the incident.
Failure to Timely Report Alleged Resident-to-Resident Abuse
Penalty
Summary
The facility failed to report an allegation of abuse to the State Agency in a timely manner for two residents with moderately impaired cognition. One resident, with a history of verbally abusive and sexually inappropriate behaviors, was observed by an LPN student with their hand under another resident's shirt, touching the upper chest area. The LPN student intervened by stopping the behavior, moving the affected resident away, and notifying the charge nurse. Facility documentation classified the incident as a Class E and implemented internal interventions, but did not report the event to the State Agency as required. The Director of Nursing (DON) stated that the incident was not reported because it was witnessed, there was no intention of harm, no injuries occurred, no signs of distress were observed, and families did not express concerns. However, the facility's own abuse policy defined sexual abuse to include unwanted touching between residents and required notification of the Department of Public Health and submission of an online report within two hours. Review of the State's event tracking system confirmed that the incident was not reported as mandated.
Failure to Complete Neurological Assessments and Pressure Ulcer Prevention Protocols
Penalty
Summary
The facility failed to provide care in accordance with professional standards of practice for multiple residents, specifically in the areas of post-fall neurological assessments and pressure ulcer prevention. For three residents with a history of falls, the facility did not complete neurological assessments as required by facility policy after unwitnessed falls or head strikes. In several instances, neurological checks were either not initiated, not completed for the required duration, or not documented at all, despite clear policy directives and physician orders. These lapses were confirmed through review of clinical records, facility documentation, and interviews with the Director of Nursing Services (DNS), who acknowledged the assessments were incomplete or missing. In one case, a resident with Parkinson's disease and repeated falls experienced multiple unwitnessed falls, but the neurological assessments were either not started or not completed according to the required schedule. Another resident with dementia and a history of falls sustained a witnessed fall with a head strike, but there was no documentation that neurological assessments were performed as per policy. A third resident with ataxic cerebral palsy and epilepsy had two unwitnessed falls, with incomplete or missing neurological checks and post-accident assessments, even after developing altered mental status and being sent to the hospital. Additionally, the facility failed to follow protocols for pressure ulcer prevention for a resident at risk. The Braden Scale, used to assess risk for pressure ulcers, was not completed weekly as ordered, and weekly body audits were missed on several occasions. Furthermore, the resident's low air loss (LAL) mattress was not set according to manufacturer recommendations or the resident's actual weight, and there was no physician order for the mattress. Interviews revealed confusion among staff regarding mattress settings, with some staff setting mattresses to 'comfort' rather than weight, contrary to manufacturer instructions and hospice guidance.
Failure to Consistently Document Food Temperatures Prior to Service
Penalty
Summary
The facility failed to ensure that food temperatures were routinely monitored and documented prior to food service, as required by facility policy and professional standards. Review of the Cooked Foods Temperature Charts and Meal Serving Temperature Charts over multiple weeks revealed numerous instances where supper food item temperatures were either not documented at all or only partially recorded. There were also periods where temperature charts were not provided for review. The facility's policies require that food temperatures be measured and recorded at specific times to ensure food safety, but these procedures were not consistently followed. Interviews with dietary staff confirmed that while food temperatures were generally taken, documentation was sometimes omitted. The cook acknowledged forgetting to record temperatures on occasion, and the Director of Dietary was aware of the ongoing issue with missing documentation. The facility had multiple cooks, most of whom were Servsafe certified, and the responsibility for obtaining and documenting food temperatures before service was clearly assigned to the cooks. Despite this, the required documentation was incomplete for several dates, indicating a failure to adhere to established procedures for monitoring and recording food temperatures.
Resident Dignity Compromised During Transfer
Penalty
Summary
The facility failed to ensure that a resident was treated with dignity during a transfer involving a hoyer lift. The resident, who had intact cognition and required assistance with activities of daily living due to impairments, reported that two nurse aides were unpleasant during the transfer. The resident's care plan included interventions for managing accusatory and manipulative behaviors, as well as assistance with transfers. However, during the transfer, the resident's leg was bumped, causing pain, and the resident felt that the aides were not respectful. The incident was reported to the social worker, and an investigation was initiated. Statements from the nurse aides involved revealed that one aide chose to remain silent during the care due to past threats from the resident. After the transfer, the resident thanked one aide, prompting a sarcastic comment from another aide about the lack of gratitude towards all involved. The investigation concluded that there was no intentional harm or injury, and the allegation of abuse was unsubstantiated, but the aides' behavior was deemed disrespectful. Interviews with the resident and staff highlighted the resident's perception of the aides' rudeness and lack of competence during the transfer. The Director of Nursing Services, who was not in the position at the time of the incident, acknowledged that the behavior was disrespectful and emphasized the importance of treating residents with dignity and respect. The facility's policy on resident rights underscores the expectation for residents to be treated with consideration and respect, which was not upheld in this instance.
Failure to Obtain and Document Valid Advance Directive Consent
Penalty
Summary
The facility failed to ensure that a resident's or their representative's wishes regarding advance directives and code status were properly obtained and implemented. A resident with dementia and moderately impaired cognition was admitted with a full code status, and although a care conference was held and a new advance directive consent form was requested, the form was not signed by the resident representative. The clinical record showed that the representative's name was typed on the form, but there was no valid signature, and there was no documentation of further attempts to contact the representative or have them sign the form. The facility's policy required that the advance directive consent form be signed by the resident or representative, the physician, and the nurse who explained the directive, and that it be kept in the resident's medical record. Interviews with nursing staff revealed that it was the admitting nurse's responsibility to complete the advance directive consent form at admission, and if the representative was not present, to call and document attempts to reach them. However, there was no evidence in the record that these steps were completed for this resident. The advance directive was not found in the overflow files, and the required documentation and signatures were missing, resulting in the resident's advance directive wishes not being properly documented or implemented according to facility policy.
Failure to Notify Providers and Representatives of Significant Changes in Resident Condition
Penalty
Summary
The facility failed to notify the physician and/or resident representative of significant changes in condition for three residents, as required by facility policy. For one resident with a history of psychiatric disorders, including major depressive disorder and PTSD, the social worker documented that the resident expressed suicidal ideation during a quarterly assessment. Although this information was relayed to nursing and noted in the psychiatric APRN referral book, there was no immediate notification to the psychiatric APRN or physician. The APRN later confirmed that such comments should be reported right away to allow for timely risk assessment and intervention, but this did not occur. The facility lacked a specific policy on suicidal ideation, and staff interviews revealed uncertainty about the appropriate response and documentation for such disclosures. Another resident with advanced dementia and a history of weight loss experienced a significant unplanned weight loss over a one-month period. The clinical record showed that the resident's weight dropped by more than 7%, and the dietitian increased the resident's nutritional supplements. However, there was no documentation that the resident's representative was notified of either the weight loss or the change in dietary orders. Interviews with the dietitian and APRN confirmed that the charge nurse was responsible for this notification, but the required communication and documentation were not completed as per facility policy. A third resident with a history of falls experienced an unwitnessed fall resulting in injuries, including abrasions and bruising. The nurse on duty attempted to contact the on-call provider but was unsuccessful and did not document further attempts or escalate the notification to the medical director, as required by policy. The clinical record lacked evidence of timely provider notification following the fall, despite the resident's recent history of multiple falls and sustained injuries. The facility's policy directs that the attending physician or covering provider must be notified of any significant change of condition or accident, and if unavailable, the medical director should be contacted, but this protocol was not followed.
Failure to Notify State of New Psychiatric Diagnosis
Penalty
Summary
The facility failed to notify the State-designated authority when a resident received a new psychiatric diagnosis. The resident was originally admitted with diagnoses including Parkinson's disease, depression, and anxiety, and the initial PASARR did not identify any major mental disorder or psychotic/delusional disorder. Over time, clinical documentation, including psychiatric notes and physician orders, indicated the development of new symptoms such as paranoia, delusions, and psychosis, leading to a diagnosis of psychotic disorder with delusions. Despite these changes, the care plan and MDS assessments did not consistently reflect the new diagnosis, and the required notification to the State-designated authority was not made in a timely manner. Interviews with facility staff revealed a lack of clear communication and responsibility regarding the process for updating the State when a new psychiatric diagnosis is made. The social worker indicated it was the psychiatric provider's responsibility to inform her of new diagnoses, while the psychiatric APRN identified the date when the new diagnosis was first documented. The failure to coordinate and communicate the new diagnosis resulted in a delay in submitting the necessary PASARR Level 1 screening to determine if a Level 2 evaluation was needed.
Failure to Follow Pressure Ulcer Prevention Protocols and Equipment Settings
Penalty
Summary
The facility failed to provide appropriate pressure ulcer care and prevention for a resident at risk, as evidenced by multiple lapses in following physician orders and manufacturer recommendations. The resident, who had a history of fibromyalgia, delirium, stroke, and a stage III pressure ulcer to the sacrum, was admitted and readmitted with orders for Braden Scale assessments on admission and weekly for four weeks, as well as weekly body audits. However, documentation revealed that the Braden Scale was not completed weekly as ordered following both the initial admission and subsequent readmission. Additionally, weekly body audits were inconsistently performed, with several weeks missing documentation despite physician orders specifying the schedule and responsible staff. Further deficiencies were observed in the use of a low air loss (LAL) mattress for the resident. Physician orders and manufacturer guidelines required the LAL mattress to be set according to the resident's weight, with regular checks for function and placement. Observations showed that the mattress was set significantly above the resident's actual weight on multiple occasions. Interviews with facility staff revealed confusion regarding whether the mattress should be set to weight or comfort, and the responsible nurse was unable to provide a current list of residents using LAL mattresses or the manufacturer guidelines. Facility protocols required risk assessments and skin audits to be completed as specified, but these were not consistently followed. The lack of adherence to physician orders, incomplete documentation, and improper equipment settings directly contributed to the deficiency in pressure ulcer care and prevention for the resident.
Failure to Provide and Document Use of Adaptive Device for Resident with Contracture Risk
Penalty
Summary
A deficiency occurred when a resident with right-sided hemiplegia and contracture risk did not receive appropriate care and use of adaptive devices as outlined in their care plan and physician orders. The resident's care plan required the application of a resting hand splint after morning care, removal after evening care, and use of a rolled washcloth after the splint was removed. However, the physician's order conflicted with the care plan, directing the splint to be applied during the evening shift and removed after morning care. The order was later discontinued without clear justification, despite the resident's ongoing need for the splint due to contracture. Multiple observations revealed that the resident was found in bed with a contracted right hand, without the splint or rolled washcloth in place, at times when the care plan indicated these should have been applied. Interviews with nursing staff and nurse aides confirmed that morning care had been completed and that the resident had not refused care. One nurse aide, who was not regularly assigned to the resident, was unaware of the splint requirement and had not reviewed the care card prior to providing care. The Director of Rehabilitation, responsible for recommending the splint, had discontinued the physician's order but could not explain the rationale, and acknowledged the resident still needed the device. Further interviews with clinical staff, including an APRN, confirmed that the splint should not have been discontinued and that the lack of its use could negatively impact the resident. Review of facility policy indicated that splints are to be provided per physician order and care plan, with documentation and skin checks required. Documentation review showed no evidence that the resident refused the splint during the relevant period, and staff interviews indicated a lack of awareness and adherence to the care plan and physician orders regarding the use of the splint and adaptive devices.
Failure to Obtain and Document Resident Weights per Policy
Penalty
Summary
The facility failed to obtain and document resident weights according to physician orders and facility policy for one resident reviewed for nutrition. Specifically, a resident with a history of heart attack and recent influenza had physician orders for weekly weights, but three of nine required weekly weights were not obtained during the specified period. Additionally, a monthly weight was not recorded for January, despite ongoing monitoring for nutritional decline and a care plan that included regular weight checks. The weight log later showed a significant weight loss of 8 lbs. (6.6%) between late November and late February. Interviews with the dietitian and LPN revealed that nurse aides were responsible for obtaining and documenting weights and reweights, but the process was self-directed and lacked clear time frames for reweighing after significant discrepancies. The dietitian and DNS acknowledged that weights were missed and not always documented as required, and that significant weight changes should have triggered reweights and notifications per policy. Review of the facility's weight monitoring policy confirmed that weights should be recorded regularly, and significant discrepancies should prompt immediate reweighing and reporting, which did not consistently occur.
Failure to Implement Enhanced Barrier Precautions for Residents with Wounds and Indwelling Devices
Penalty
Summary
The facility failed to develop and implement effective infection prevention and control policies for two residents with conditions requiring enhanced barrier precautions (EBP). One resident with a surgical wound and a history of colonized MRSA was not initially placed on EBP, despite the care plan identifying the need for advanced barrier precautions. Observations revealed the absence of appropriate signage and accessible PPE near the resident's room, and staff interviews indicated a lack of understanding regarding the necessity of EBP for residents with wounds or a history of MDROs. The Infection Preventionist incorrectly stated that only residents with specific novel or targeted MDROs required EBP, and the resident was not placed on precautions until after the deficiency was identified. Further observations showed that, even after EBP signage and PPE were provided, staff failed to consistently don PPE before providing direct care to the resident. Nursing assistants entered the room and performed care activities such as providing a bedpan without wearing the required PPE, later admitting that they forgot to do so. The facility's policy required adherence to CDC and CMS guidelines, including visible signage and readily accessible PPE, but these measures were not reliably implemented or followed by staff. A second resident with an indwelling medical device for dialysis was also not placed on EBP as required. The care plan and physician's orders identified the presence of a central venous catheter and the need for infection monitoring, but interventions did not include EBP. Observations and staff interviews confirmed the absence of EBP signage and PPE, and direct care staff were unaware of the need for precautions. The Infection Control Nurse and DNS both acknowledged that the resident should have been on EBP due to the indwelling device, but this was not done until after the issue was raised during the survey.
Failure to Provide Correct Diet Consistency Leads to Choking Incident
Penalty
Summary
The facility failed to provide the correct diet consistency for a resident who was on a modified diet due to missing teeth, which increased the difficulty of chewing. The resident, diagnosed with schizoaffective disorder, was discharged from the hospital on a regular diet but was later evaluated by speech therapy and recommended a mechanical soft diet with thin liquids. Despite this, the resident was served fruit salad, which was not suitable for their dietary needs, leading to a choking incident. The resident approached the nurse's station with difficulty breathing after consuming the fruit salad, which included pieces of honeydew melon and pineapple, items not allowed on a mechanical soft diet. The incident was further detailed through interviews with facility staff. The LPN on duty described the resident's distress and the unsuccessful attempts to clear the airway, including the Heimlich maneuver, until emergency services arrived. The dietary manager confirmed that the fruit served was inappropriate for the resident's prescribed diet. The Speech Language Pathologist also confirmed that the fruit served was not suitable for a mechanical soft diet. The Director of Nursing acknowledged that the staff did not adhere to the prescribed diet consistency for the resident.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Guilford
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Autumn Lake Healthcare At Madison | 0.5 mi | ★★★★★ | 26 | 0 |
| Guilford House, The | 4.4 mi | ★★★★★ | 2 | 0 |
| Evergreen Woods | 5.8 mi | ★★★★★ | 5 | 0 |
| Ark Healthcare & Rehabilitation At Branford Hills | 10.4 mi | ★★★★★ | 24 | 0 |
| Whispering Pines Rehabilitation And Nursing Center | 11.3 mi | ★★★★★ | 7 | 1 |
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