Above average — CMS composite of the measures below.
The next survey window likely opens around January 2027
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 Milford Health And Rehabilitation Center during CMS and state inspections, most recent first.
A resident with severe cognitive and physical impairments was found with a right hip fracture of unknown origin. Although the injury was identified by nursing staff and confirmed by X-ray, the facility did not report the incident to the state agency within the required 2-hour timeframe. The correct report was not submitted until several days after the injury was discovered, despite facility policy and leadership awareness of reporting requirements.
A resident with a history of CVA and cognitive impairment required substantial assistance with personal hygiene. Observations revealed the resident had excessively long, jagged fingernails with debris, indicating a lack of proper care. Despite weekly body audits, the condition was not noted by nursing staff. Interviews revealed a lack of awareness and communication among staff, and a discrepancy in physician's orders for treating a possible fungal infection. The facility failed to adhere to its policy for personal hygiene and grooming.
The facility's Dietary Department failed to properly label and date opened dry food items and canned goods, as observed during a tour with the Food Service Director. Opened items such as flour, rice, sugar, cereals, pasta, and bread lacked labels indicating the date opened or expiration dates. Canned goods had expiration dates in code, which were indecipherable. This was contrary to the facility's policy requiring labeling and rotation of food products to ensure food safety and quality.
A resident experienced a significant weight loss of 9.2 lbs over five days, but the facility failed to notify the provider as required by the physician's order. The resident was at risk for nutritional deficit due to diuretic use, and the care plan included monitoring weights and notifying relevant parties of significant changes. Interviews revealed that the physician was not informed, contrary to facility policy.
A resident with schizoaffective disorder and other conditions had an elevated TSH level that went unaddressed by the APRN, despite being marked as reviewed. The APRN intended to order a redraw but did not follow through, and the facility lacked a policy for handling abnormal lab results.
The facility failed to promptly notify the state mental health authority of new psychiatric diagnoses for two residents, leading to a deficiency in the PASARR process. One resident with delusional disorders and major depressive disorder was not reported for a Level II PASARR, and another resident's major depressive disorder diagnosis was delayed in reporting by ten months. The delay was due to inadequate communication and review processes by the social workers and psychiatric staff.
A facility failed to complete a yearly performance review for a nurse aide hired in early 2023. The review was overdue by four months, and although it was completed, it was not reviewed or signed by the aide due to scheduling issues. The aide worked weekends, and despite having worked shifts on at least two occasions, the DNS had not met with the aide to conduct the review.
A facility failed to store and reconcile a discontinued controlled substance, Lorazepam, for a resident with dementia and anxiety. The medication was found in a locked storage box without a Controlled Substance Disposition Record (CSDR), and only RN Supervisors had access to the keys. The LPN and DNS were unaware of the medication's presence, and the CSDR showed discrepancies in administration records. The facility's policy for controlled substance destruction was not followed.
Failure to Timely Report Injury of Unknown Origin
Penalty
Summary
The facility failed to report an injury of unknown origin to the state agency within the required time frame for one resident with significant cognitive and physical impairments. The resident, who had Alzheimer's disease, muscle weakness, difficulty walking, osteopenia, and expressive aphasia, was dependent on staff for all activities of daily living. On the morning in question, nursing staff observed swelling and redness to the resident's right hip, and an APRN ordered a STAT X-ray. The X-ray revealed an acute fracture of the proximal right femur, and the resident was subsequently sent to the emergency room for further evaluation. Despite the identification of an acute hip fracture of unknown origin, the facility did not report the incident to the state agency within the required 2-hour window. The initial reportable event was not initiated until eight days after the X-ray confirmed the fracture, and the correct event type was not reported until eleven days after the injury was identified. Interviews and documentation confirmed that facility leadership was aware of the reporting requirements but could not explain the delay. The facility's abuse policy required immediate reporting of injuries of unknown origin, which was not followed in this case.
Failure to Maintain Proper Fingernail Hygiene for a Resident
Penalty
Summary
The facility failed to maintain proper fingernail hygiene and care for a resident with a history of cerebrovascular accident (CVA) resulting in left-sided paralysis, muscle weakness, difficulty in walking, and repeated falls. The resident was cognitively impaired and required substantial staff assistance with personal hygiene, bed mobility, and transfers. Despite these needs, observations on multiple dates identified the resident with excessively long, jagged fingernails with brown debris underneath, indicating a lack of proper care. The facility's records showed that weekly body audits were conducted and signed off by nursing staff, but these audits failed to note the resident's fingernail condition. Interviews with facility staff revealed a lack of awareness and communication regarding the resident's fingernail condition. The Unit Nurse Manager was unaware of the issue until it was pointed out by surveyors, and it was noted that nurse aides were responsible for fingernail care and reporting irregularities to licensed nursing staff. Additionally, there was a discrepancy in the physician's orders, as a previous APRN had recommended treatment for a possible fungal infection on the resident's toenails, but no order was in place for the fingernails. The Assistant Director of Nursing Services acknowledged that fingernail care should have been part of the weekly routine and identified during skin audits, highlighting a failure in the facility's adherence to its policy for Activities of Daily Living, which includes personal hygiene and grooming.
Deficiency in Food Labeling and Dating in Dietary Department
Penalty
Summary
The facility failed to ensure proper labeling and dating of food items in the Dietary Department, as observed during a tour with the Food Service Director. Several opened dry food items, including flour, rice, sugar, oatmeal, various cereals, pasta, and bread, were found without labels indicating the date they were opened or their expiration dates. Additionally, numerous canned goods were identified with expiration dates in code, which could not be deciphered by the Food Service Director. This lack of proper labeling and dating is contrary to the facility's policy, which requires that opened food products be labeled with their contents and used by dates, and that food removed from its original container be labeled with the common name of the food. The Food Service Director acknowledged that dietary staff were responsible for dating food products after opening them but was unsure of the expiration dates on the canned items due to the coded labels. Although the Food Service Director provided USDA guidelines on canned food shelf-life, he was unable to provide documentation of the actual expiration dates for the canned goods. The facility's policy also mandates the rotation of food products to ensure the oldest inventory is used first, known as the first in, first out (FIFO) method, and requires that employees stock shelves with the earliest used by dates in front. However, the lack of proper labeling and dating suggests a failure to adhere to these procedures, potentially compromising food safety and quality.
Failure to Notify Provider of Significant Weight Loss
Penalty
Summary
The facility failed to notify the provider of a significant weight loss for one of the residents, identified as Resident #89, who was at risk for nutritional deficit due to diuretic use. The resident's care plan required monitoring of weights and notifying the dietician, family, and physician of significant weight changes. A physician's order specified that the resident should be weighed daily and the provider notified of a weight change of 3 pounds daily or 5 pounds weekly. However, the clinical record review showed that the resident experienced a weight loss of 9.2 pounds over five days, and there was no documentation indicating that the provider had been notified of this change. Interviews with the Unit Nurse Manager and an Advanced Practice Registered Nurse revealed that the physician was not informed of the resident's weight loss, which was a requirement according to the physician's order. The Unit Nurse Manager could not explain the omission, while the Advanced Practice Registered Nurse indicated that notification would have allowed for potential adjustments to the resident's diuretic medication. The facility's policy mandates that significant weight changes should be verified for accuracy, documented, and communicated to the resident, family, and interdisciplinary team, which was not adhered to in this case.
Failure to Address Abnormal Lab Results
Penalty
Summary
The facility failed to address abnormal laboratory results for a resident diagnosed with schizoaffective disorder, left-sided weakness, and hypertension. The resident, who was moderately cognitively impaired and required supervision for personal hygiene and assistance with eating, had an APRN's order for laboratory work to obtain a thyroid stimulating hormone (TSH) level. The laboratory results indicated an elevated TSH level of 9.487 mU/L, which was outside the normal range of 0.48 - 4.17 mU/L. Despite the APRN signing the results as reviewed, he did not notice the abnormal TSH level and failed to address it. An interview with the APRN revealed that he intended to write an order to redraw the TSH level, but no new orders were found in the clinical record. Additionally, the facility did not provide a policy for addressing abnormal laboratory results when requested.
Failure to Notify State Authority of New Psychiatric Diagnoses
Penalty
Summary
The facility failed to notify the state mental health authority promptly after a new psychiatric diagnosis for two residents, leading to a deficiency in the Preadmission Screening and Resident Review (PASARR) process. Resident #3, who had diagnoses including delusional disorders and major depressive disorder, was prescribed an antipsychotic medication. Despite these significant changes, the facility did not submit a Level II PASARR in a timely manner. The social worker responsible for the PASARR process did not report the new diagnoses because they were not part of the resident's official diagnosis list, and there was a lack of communication regarding the need to report such conditions. Resident #26, who had a history of chronic atrial fibrillation and muscle weakness, was diagnosed with major depressive disorder, replacing a previous diagnosis of adjustment disorder with mixed anxiety and depressed mood. Despite this change, the facility did not notify the state contracted agency until nearly ten months later, following an annual audit. The delay was attributed to the psychiatric APRN not informing social services of the new diagnosis, and the social workers not reviewing psychiatric progress notes in depth unless there was a specific concern. The facility's PASARR policy, dated April 2023, directed that routine clinical record reviews and communication should help identify residents with new or possible serious mental disorders. However, the social workers did not adhere to this policy, resulting in a failure to make timely referrals to the state designated authority. This oversight in the PASARR process highlights a significant deficiency in the facility's handling of residents with new psychiatric diagnoses.
Failure to Complete Yearly Performance Review for Nurse Aide
Penalty
Summary
The facility failed to complete a yearly performance review for one of its nurse aides, identified as NA #3. NA #3 was hired on January 20, 2023, and as of June 4, 2024, a performance review was overdue by four months. The Director of Nursing Services (DNS) acknowledged that the performance appraisal for NA #3 had been completed but had not been reviewed or signed by NA #3. This was attributed to NA #3's work schedule, as they only worked weekends, and the DNS had not encountered NA #3 to conduct the review. Despite this, records showed that NA #3 had worked weekend shifts on at least two occasions, indicating opportunities for the review to have been conducted.
Failure to Store and Reconcile Discontinued Controlled Substance
Penalty
Summary
The facility failed to appropriately store and reconcile a discontinued controlled substance, Lorazepam, for a resident diagnosed with dementia, depression, psychotic disorder, and anxiety. A physician's order had discontinued the resident's Lorazepam, but during an observation, an open vial of the medication was found in a locked storage box in the locked refrigerator. The Registered Nurse Supervisor (RN) was aware of the vial's presence but indicated that there was no corresponding Controlled Substance Disposition Record (CSDR) to track the medication's usage and remaining quantity. The RN stated that only Registered Nurse Supervisors had keys to the locked medication box, and the unit charge nurses were responsible for counting narcotics every shift, but the Lorazepam had not been counted. The second-floor unit charge nurse, an LPN, was unaware of the Lorazepam's storage and did not have access to the keys or a CSDR for the medication. The Director of Nurses (DNS) also had no knowledge of the Lorazepam's presence and could not explain why it had not been counted or returned for destruction after discontinuation. The CSDR showed the last dose was administered before discontinuation, but another entry indicated administration after discontinuation, with no record of the dose being given. The facility's policy required unused or expired controlled substances to be destroyed per Connecticut regulations, but this was not followed in this case.
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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 Milford
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Civita Care Center At West River | 2.3 mi | ★★★★★ | 0 | 0 |
| Civita Care Center At Milford | 2.5 mi | ★★★★★ | 6 | 0 |
| Orange Health Care Center | 4.2 mi | ★★★★★ | 0 | 0 |
| Apple Rehab West Haven | 4.9 mi | ★★★★★ | 37 | 1 |
| Lord Chamberlain Nursing & Rehabilitation Center | 4.9 mi | ★★★★★ | 0 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.