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 The Haven Of Bridgeport during CMS and state inspections, most recent first.
The facility failed to provide sufficient nursing staff to meet residents’ needs, resulting in delayed call light response and incontinence care for multiple cognitively intact residents with conditions such as morbid obesity, myasthenia gravis, diabetes, heart disease, and chronic incontinence. Care plans required Q2–3H and PRN incontinence checks, barrier cream application, and prompt call light response, yet one resident was found with a saturated brief and moisture-associated skin damage, and several residents and a roommate reported waiting from 30 minutes to a couple of hours for assistance after soiling or for morning and nighttime care. CNAs and other staff reported that there were often only four CNAs on duty, especially on the 2 pm–10 pm shift and on weekends, that many residents required two-person assist, and that this made it difficult to answer call lights and provide incontinence care timely, even as some nursing leadership asserted staffing was adequate and unchanged.
Multiple cognitively intact residents who were incontinent or dependent on staff for toileting reported that their call lights were not answered promptly, with some describing waits of 30 minutes to over an hour after soiling themselves. Staff care plans required that call lights be kept within reach and answered promptly, and the facility’s policy directed staff to answer calls as soon as possible. CNAs and other staff acknowledged that call lights were not always answered timely, especially on the evening shift when only four CNAs were working, many residents required two-person assist, and nurses were occupied with med passes, leading to delays in providing needed care.
The facility failed to reasonably accommodate the needs of two cognitively intact residents who were incontinent of bowel and bladder by not consistently providing correctly sized incontinence briefs. One resident with morbid obesity reported that briefs were too tight and had to be torn at the sides to fit, while another resident dependent on staff for toileting stated that the correct size was never available and that she would wet through the briefs used. A CNA supervisor identified both residents as using extra-large briefs, yet a supply check showed only medium and large packages and just two individual extra-large briefs, with no extra-large or double extra-large packages available. Multiple CNAs reported that correct sizes were not always on hand and that residents sometimes had to use incorrect sizes, while nursing leadership and the administrator stated they had not received any concerns about brief sizing.
Two residents experienced moisture-associated skin damage (MASD) that was not properly identified, assessed, or documented despite existing care plans and physician orders for barrier creams and skin assessments. One resident, occasionally incontinent and ordered Calmoseptine twice daily with weekly skin checks, was later observed with red, irritated buttocks, scrotum, and thighs with open bleeding spots, without corresponding detailed wound documentation or timely recognition by the wound nurse. Another resident, always incontinent and care planned for potential skin impairment, reported soreness in the peri area that appeared red and irritated during incontinence care, but this change was not reported to the wound nurse or documented in progress notes. These failures occurred despite a facility protocol requiring comprehensive skin assessments and documentation of skin condition.
Two residents with bowel and bladder incontinence did not receive incontinence care consistent with facility policy and current standards of practice. For one resident with multiple comorbidities and occasional incontinence, staff removed a saturated brief, used the same side of a washcloth on different perineal areas, did not perform hand hygiene between glove changes, and the resident was found with red, irritated skin and open bleeding spots consistent with moisture-associated skin damage, despite a care plan and orders for regular barrier cream use. For another resident who was always incontinent and dependent for toileting, staff provided perineal care and changed gloves multiple times but failed to use hand sanitizer between glove changes, contrary to the facility’s hand hygiene policy requiring alcohol-based hand rub use before and after PPE, including gloves.
A resident with significant mobility and cognitive deficits, requiring two-person assistance for mechanical lift transfers, was transferred by a CNA alone who failed to secure a lift strap, resulting in the resident being guided to the floor. The resident was assessed and found to have no injuries, but the facility's policy requiring two staff for such transfers was not followed.
Multiple residents who were alert and oriented reported consistently waiting approximately 30 minutes for staff to respond to their call lights. Direct observation confirmed a prolonged wait time, and resident council meeting minutes documented repeated complaints to administration about slow call light response. The DON acknowledged awareness of the issue.
A facility failed to properly restrain residents in a transportation van, leading to significant injuries for one resident during an accident. The resident, with Parkinson's disease, was only secured with a lap belt, contrary to safety protocols. The CNA responsible for the transport admitted to not receiving training on the new van's restraint system. Another resident also reported being transported without a shoulder belt, indicating a pattern of improper restraint use.
Two residents in the facility did not receive timely assistance with activities of daily living (ADLs). One resident, with multiple health issues, was found sitting in urine-soaked clothing without help, despite needing substantial assistance for toileting. Another resident, dependent on staff for showers, did not receive any documented assistance with bathing during their stay. The facility's policies for bowel and bladder care and showering were not followed, leading to deficiencies in resident care.
The facility failed to properly label and cover food items and prevent cross-contamination in the kitchen. Observations included unlabeled drink pitchers, dessert bowls, shredded cheese, and salad, as well as an uncovered cake. The bulk sugar container had a cup with no handle and food debris inside, and its lid was sticky with dust and food substances. The cook acknowledged these issues, citing the recent loss of their dietary manager.
The facility failed to refer three residents for Level II PASARR despite their documented diagnoses indicating the need for such a referral. The responsible staff were unaware of the need for Level II screenings until the surveyors' findings were presented.
The facility failed to provide timely toileting assistance to two residents, leading to episodes of incontinence. Both residents, who are cognitively intact and require substantial or dependent assistance, reported waiting up to 30 minutes to one hour for staff to respond to call lights. The facility's policy and resident council meeting minutes highlighted ongoing issues with delayed responses.
A resident with unsteadiness and mobility issues fell and sustained injuries after a CNA let go of him to turn off a call light. The CNA had not worked with the resident before and did not use a gait belt, contrary to facility policy. The resident required supervision and assistance, which was not adequately provided.
A resident with multiple health conditions did not receive the prescribed No Added Salt (NAS) diet on multiple occasions due to recent changes in the dietary department and issues with food ordering. The resident consistently received incorrect meals, and the facility staff acknowledged the discrepancies and attributed them to leadership changes and ordering errors.
Insufficient Staffing Leading to Delayed Call Light Response and Incontinence Care
Penalty
Summary
The deficiency involves the facility’s failure to provide sufficient nursing staff to meet residents’ needs and to ensure timely response to call lights and incontinence care. One resident with morbid obesity, unsteadiness on feet, heart disease, and osteoarthritis was care planned as occasionally incontinent of bowel and bladder, with interventions including check and change every 2–3 hours, PRN, application of barrier cream after each incontinent episode, and prompt call light response. During observation, this resident’s incontinence brief was found saturated with urine, and the buttocks, scrotum, and upper thighs were red, irritated, and had open bleeding spots, which the wound nurse identified as moisture-associated skin damage. The resident reported that staff applied cream at times but was unsure how often, and also stated that it sometimes took a long time for staff to answer the call light, recalling a wait of about an hour and a half on one occasion. Another resident with myasthenia gravis, diabetes, heart disease, unsteadiness on feet, neuropathy, and atrial fibrillation was cognitively intact and dependent on staff for toileting, with a care plan directing check and change every 2–3 hours and PRN and prompt call light response. A family member reported that the facility was short staffed on weekends at times. The resident’s cognitively intact roommate stated that on one occasion it had taken an hour for staff to answer the call light after the resident had soiled himself, and that the CNA explained there were only four CNAs working at the time. A third cognitively intact resident, dependent on staff for toileting and always incontinent of bowel and bladder, was care planned for barrier cream and perineal cleaning with each incontinent episode and prompt call light response. This resident reported that when there was not enough staff, call lights were not answered timely, resulting in long waits to get up in the morning and waits of a couple of hours for incontinence care at night. A fourth cognitively intact resident, always incontinent of bowel and bladder and care planned for prompt call light response, stated that when staffing was low, she had to wait 30 to 45 minutes for care. Multiple CNAs reported that there were not enough staff to meet residents’ needs timely, particularly on the 2 pm–10 pm shift and on weekends, noting that around 4 pm they must get residents ready for supper, answer call lights, and that call lights were not always answered timely. Staff described having four CNAs on weekends, one per hall, and difficulty providing timely assistance to residents requiring two-person assist, which delayed getting such residents to bed after dinner and delayed call light response. Another staff member stated that call lights were answered as timely as possible but acknowledged that with many residents needing two-person assist and nurses occupied with medication pass, call lights could be delayed and residents might sit longer after incontinence episodes before care was provided. While some nursing leadership staff stated they believed staffing was sufficient and that call light response had improved, one RN acknowledged that the 2 pm–6 pm period was very busy and that they could use a couple more CNAs, and the administrator reported that staffing had not changed since the last survey.
Delayed Response to Call Lights for Incontinent and Dependent Residents
Penalty
Summary
The deficiency involves the facility’s failure to ensure residents’ call lights were answered promptly, as required by resident care plans and the facility’s “Answering the Call Light” policy. Multiple cognitively intact residents with bowel and bladder incontinence or dependence on staff for toileting reported extended waits after activating call lights. One resident, occasionally incontinent of bowel and bladder, stated that it sometimes took a long time for staff to answer his call light and recalled waiting an hour and a half on one occasion. Another resident, dependent on staff for toileting and frequently incontinent of bowel and occasionally incontinent of bladder, had a roommate who reported that staff took about an hour to respond to the call light after the resident had soiled himself, with the CNA explaining that only four CNAs were working at the time. Additional residents with incontinence and dependence on staff for toileting also reported long waits for call light responses. One resident, always incontinent of bowel and bladder, stated that there were not enough staff and that they had to wait a long time for call lights to be answered. Another resident, always incontinent of bladder and bowel, reported having to wait 30 to 45 minutes for care when staffing was low. CNAs interviewed confirmed that call lights were not always answered timely, particularly on the 2 pm to 10 pm shift when only four CNAs were working and they were simultaneously responsible for getting residents ready for supper and answering call lights. An anonymous staff member stated that call lights were answered as timely as possible but acknowledged delays when many residents required two-person assistance and nurses were occupied with medication passes. The Assistant DON and the Administrator both acknowledged that call lights were not always answered timely, although they believed there had been some improvement.
Failure to Provide Correctly Sized Incontinence Briefs for Residents
Penalty
Summary
Failure to reasonably accommodate residents’ needs and preferences occurred when the facility did not consistently provide appropriately sized incontinence briefs for two cognitively intact residents with bowel and bladder incontinence. One resident with morbid obesity, unsteadiness on feet, heart disease, and osteoarthritis, who was care planned as occasionally incontinent, reported that the facility recently did not have the correct size briefs and that the briefs available were too tight, requiring him to rip the sides so they would fit. Another resident, dependent on staff for toileting and always incontinent of bowel and bladder, reported that the facility never had the right size briefs, that staff used whatever size was available, and that she would wet through them. Staff interviews and supply observations further demonstrated the deficiency. The CNA Supervisor stated that the residents in question used extra-large briefs and asserted that the facility had enough supplies, including in an outside shed, but later acknowledged there were no briefs in the shed at the time of the survey and that she had to go back to rooms to locate more briefs. A supply closet check revealed multiple packages of medium and large briefs but only two individual extra-large briefs and no packages of small, extra-large, or double extra-large briefs, despite residents requiring extra-large sizes. Several CNAs reported that the correct sizes were not always available, that residents sometimes had to use incorrect sizes, and that supplies ran low before new orders arrived. Nursing leadership and the administrator reported they had not received concerns about incorrect brief sizes, despite resident and CNA reports to the contrary.
Failure to Prevent and Assess Moisture-Associated Skin Damage
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate skin care and prevent moisture associated skin damage (MASD) in accordance with physician orders and care plan interventions for two residents. One resident was admitted with morbid obesity, unsteadiness, heart disease, and osteoarthritis, and was documented as cognitively intact and occasionally incontinent of bowel and bladder. The resident’s care plan required barrier cream application after each incontinent episode and routine checks and changes every 2–3 hours and as needed. Despite a standing order for Calmoseptine ointment to be applied to the buttocks every day and night shift for excoriation, and a weekly skin assessment order, the resident was later observed with red, irritated buttocks, scrotum, and upper thighs, with open bleeding spots, and the resident was unsure how often cream was applied. During an observed peri-care episode, the CNA supervisor and CNA exposed the resident’s buttocks and genital area, revealing significant MASD that had not been reported to or recognized by the wound nurse/ADON until that time. The wound nurse documented MASD to bilateral buttocks, upper thighs, and scrotum in a progress note after being called to assess the resident. A prior skin observation tool entry indicated that one or more wounds or injuries were present, but it did not identify the wound type, location, or include an assessment. The treatment administration record showed that Calmoseptine was signed out as administered every day and night shift in the prior month and in the current month except for one missed administration, and weekly skin assessments were signed as completed with no corresponding progress note documenting skin breakdown on the date a “yes” was recorded. The wound nurse later stated that the last time she assessed the resident’s buttocks was several days earlier and that weekly skin assessment orders were not carried over when the facility switched systems, and there were no new skin assessments documenting the MASD. A second resident, with diagnoses including diabetes, malignant neoplasm of the left breast, osteoarthritis, hypertension, and stress incontinence, had a moderate cognitive deficit and was always incontinent of bowel and bladder and dependent on staff for toileting. The resident’s care plan identified a potential for impaired skin integrity related to aging and disease processes, including redness/gaulding to the buttocks, with an intervention to assess and record changes in skin status. During observed incontinence care, the resident reported soreness in the peri area and asked if it was red; the CNA supervisor confirmed it was a little red and stated she would get cream, and the surveyor observed the peri area to be red and irritated. The wound nurse/ADON later stated that this redness, irritation, and soreness had not been reported to her, although she would have expected such a report. There was no documentation in the resident’s progress notes regarding the peri area being red and sore at the time of the observation, despite a prior facility-wide skin sweep note indicating no new skin issues. The facility’s own pressure/skin breakdown clinical protocol required full assessment and documentation of skin condition, including location and characteristics, which was not reflected in the records for these residents.
Failure to Follow Incontinence Care and Hand Hygiene Standards
Penalty
Summary
The deficiency involves failure to provide incontinence care and perineal care according to current standards of practice, including hand hygiene and skin protection, for two residents who were incontinent of bowel and bladder. One resident, admitted with morbid obesity, unsteadiness on feet, heart disease, and osteoarthritis, was documented on the MDS as cognitively intact and occasionally incontinent of bowel and bladder, with a care plan directing staff to apply barrier cream after each incontinent episode and to check and change every 2–3 hours and as needed. During observed peri care, the CNA removed a saturated incontinence brief and cleansed the resident’s penis, groin, and scrotum using washcloths with warm water and no-rinse peri solution, wiping up and down and at times using the same side of the cloth on different areas. The CNA changed gloves between cleaning the groin/penis and buttocks and again before drying, but did not perform hand hygiene between glove changes. The resident’s buttocks, scrotum, and upper thighs were red, irritated, and had open bleeding spots; the resident reported that cream was applied at times but was unsure how often. The ADON/wound nurse, when called to assess, identified the condition as moisture associated skin damage (MASD) and stated this was the first time she was aware of it, and the resident’s nurse also reported not being aware of the MASD, despite an existing order for cream twice daily to prevent further skin breakdown. The second resident, admitted with acute pyelonephritis, heart failure, hypertension, respiratory failure, joint stiffness, and scoliosis, was documented as cognitively intact, always incontinent of bowel and bladder, and dependent on staff for toileting. The care plan for this resident included interventions to apply barrier cream after each incontinent episode and to clean the peri area with each incontinent episode. During observed incontinence care, the CNA changed gloves after cleaning the peri area, after cleaning the buttocks, and after drying, but did not perform hand hygiene after removing soiled gloves or before donning clean gloves. Both CNAs later stated they did not hand sanitize between glove changes because they forgot. The facility’s Hand-Washing/Hand Hygiene Policy requires use of alcohol-based hand rub before and after putting on and upon removal of PPE, including gloves, when hands are not visibly soiled, and the ADON stated she would expect staff to hand sanitize between glove changes.
Failure to Provide Adequate Supervision During Mechanical Lift Transfer
Penalty
Summary
A deficiency occurred when a resident with a history of peripheral vascular disease, below-knee amputation, hypertension, anemia, chronic kidney disease, unsteadiness, and a history of falls was not provided adequate supervision and assistance during a mechanical lift transfer. The resident was care planned to require a mechanical (Hoyer) lift with the assistance of two staff members for all transfers due to their high level of dependency and cognitive impairment. Despite this, a CNA attempted to transfer the resident alone using the mechanical lift. During the transfer, the CNA failed to properly connect one of the lift straps, resulting in the resident beginning to fall backward. The CNA intervened by holding and guiding the resident to the floor. Upon assessment, the resident was found lying on their back, denied pain, and exhibited no injuries, though it was noted that the resident's head made contact with the floor. Vital signs and neurological checks were within normal limits, and the resident's power of attorney and physician were notified. The CNA later confirmed that this was the first time they had attempted a mechanical lift transfer without a second staff member present. The facility's policy clearly required two staff for all mechanical lift transfers, and this policy was not followed at the time of the incident. There were no other reported complaints or concerns related to unsafe transfers prior to this event.
Delayed Call Light Response Times
Penalty
Summary
The facility failed to answer call lights in a timely manner for three residents who were alert and oriented, as evidenced by direct observation, resident interviews, and review of resident council meeting minutes. One resident activated her call light and waited 28 minutes before the DON responded, and reported routinely waiting 25-30 minutes for assistance regardless of time of day or staff on duty. Two other residents also reported consistently waiting about 30 minutes for their call lights to be answered. Resident council meeting minutes from two separate months documented repeated complaints to administration regarding delayed call light response times. These findings indicate that the facility did not honor residents' rights to prompt communication and response to their needs.
Improper Restraint in Facility Van Leads to Resident Injuries
Penalty
Summary
The facility failed to ensure that residents were properly restrained while being transported in the facility van, resulting in significant injuries to one resident. The incident involved a resident with Parkinson's disease and difficulty walking, who was being transported in a wheelchair in the facility van. During the transport, the van hydroplaned and was involved in an accident, causing the resident to be thrown from her wheelchair. The resident sustained a laceration to her head requiring 14 staples and 8 sutures, a fracture to the second digit of the right foot, a left nasal bone fracture with deviation of the septum, and bruising to the lower abdomen and upper thighs. The investigation revealed that the resident was only restrained by a lap belt and not a shoulder belt, contrary to the facility's safety protocols and the manufacturer's instructions for securing passengers. The Certified Nursing Assistant (CNA) responsible for the transport initially stated that the resident was only secured with a lap belt, but later changed her statement to say that the resident was wearing a shoulder belt. However, the Chief of Police and the Registered Nurse who assessed the resident after the accident both noted the absence of shoulder belt bruising, supporting the initial claim that the resident was not properly restrained. Additionally, another resident reported being transported in the same van without a shoulder belt, indicating a pattern of improper restraint use. The CNA admitted to not receiving training on how to properly secure residents in the new transportation van, which had been in use since the end of October 2024. This lack of training and failure to follow proper restraint procedures directly contributed to the accident and the resulting injuries.
Failure to Provide Timely Assistance with ADLs
Penalty
Summary
The facility failed to provide timely assistance with toileting and showers for two residents, R1 and R4, as observed during the survey. R4, who was admitted with multiple diagnoses including sepsis, heart disease, and polyosteoarthritis, was found sitting in a recliner covered with a blanket and emitting an odor of urine. R4 reported sitting in wet clothes since the morning without assistance, despite requiring substantial assistance for toilet transfer. The CNA responsible for R4's care admitted to not assisting R4 with toileting since the start of her shift and had turned off the call light without providing help. Upon inspection, R4's gown and chair were saturated with urine, indicating a lack of timely care. R1, another resident with diagnoses including diabetes, cirrhosis of the liver, and heart failure, was documented as being dependent on staff for showers. However, there was no record of R1 receiving assistance with a shower or bath during her stay from September 19 to September 25, despite the facility's policy to offer showers twice a week. The Director of Nurses confirmed the lack of documentation for R1's showers, which was contrary to the facility's hygiene policy. The facility's policies for bowel and bladder assessment and showering were not adhered to, as evidenced by the lack of timely assistance and documentation for R4 and R1. The Director of Nurses stated that residents should be checked every two hours, but this was not followed in R4's case. Similarly, the facility's shower policy was not implemented for R1, leading to a deficiency in maintaining proper hygiene and dignity for the residents.
Improper Food Labeling and Storage
Penalty
Summary
The facility failed to properly label and cover food items and prevent cross-contamination in the kitchen. During an initial tour of the kitchen, surveyors observed several items in the refrigerators that were not labeled or covered, including drink pitchers, dessert bowls, shredded cheese, and salad. Additionally, a cake was found uncovered on a tray. The bulk sugar container had a cup with no handle inside, and other food debris was seen in the container. The lid of the sugar container was sticky and had dust and food substances stuck to it. The cook acknowledged these issues and mentioned that they were working through them due to the recent loss of their dietary manager. The facility's food storage policy requires all food items to be labeled with the name of the food and the date by which it should be sold, consumed, or discarded.
Failure to Refer Residents for Level II PASARR
Penalty
Summary
The facility failed to refer three residents for a Level II Preadmission Screening and Resident Review (PASARR) despite their documented diagnoses indicating the need for such a referral. Resident 40 had diagnoses of Bipolar Disorder, Major Depressive Disorder, and Unspecified Dementia, but only had a Level I PASARR completed. Resident 43 had diagnoses of Major Depressive Disorder and Psychotic Disorder with delusions, but the Level I PASARR did not include the psychotic disorder and incorrectly stated that no Level II was required. The facility's administrator and staff responsible for PASARR screenings were unaware of the need for Level II screenings for these residents until the surveyors' findings were presented to them. Resident 15 had diagnoses of visual hallucinations and bipolar disorder, but the PASARR Level I was outdated and did not reflect these mental health conditions. The bookkeeper, responsible for submitting PASARR screenings, was unaware of the new diagnoses and had not submitted a Level II PASARR. The facility's policy on PASARR, which aims to ensure appropriate care for individuals with mental illness and intellectual disabilities, was not followed, leading to these deficiencies in the residents' assessments and care planning.
Delayed Response to Call Lights for Toileting Assistance
Penalty
Summary
The facility failed to ensure that dependent residents received timely assistance for toileting needs, as evidenced by the experiences of two residents. One resident, admitted with diagnoses including Parkinson's Disease and blindness, reported that it took staff an average of 30 minutes to one hour to respond to call lights, leading to episodes of incontinence. This resident, who is cognitively intact and requires substantial assistance for toileting, found the delays frustrating and embarrassing. The resident's care plan documented the need for substantial assistance with toileting, but the facility did not meet this requirement in a timely manner. Another resident, admitted with diagnoses including morbid obesity and chronic kidney disease, also reported experiencing incontinence while waiting for staff to respond to call lights. This resident, who is also cognitively intact and dependent on staff for toileting, noted that it could take up to 30 minutes for staff to respond. The resident's care plan indicated a need for dependent assistance with toileting, including the use of a sit-to-stand lift with two people. Despite the facility's policy that call lights should be answered promptly, the resident council meeting minutes from several months documented ongoing concerns about delayed responses to call lights.
Failure to Implement Fall Prevention Interventions
Penalty
Summary
The facility failed to implement interventions to prevent falls with injuries for a resident (R169) who was admitted with diagnoses including unsteadiness on feet, abnormalities of gait and mobility, and lack of coordination. The resident's admission MDS indicated that he was cognitively intact and required supervision or touching assistance for activities. Despite this, the resident experienced a fall on the night of his admission while being assisted to the restroom by a CNA (V11). The CNA let go of the resident to turn off the call light, resulting in the resident falling backward, hitting his head, and sustaining a laceration and a skin tear. The resident was sent to the emergency room for evaluation and returned to the facility with no new orders or injuries other than the initial wounds. The CNA admitted to not having worked with the resident before and not using a gait belt during the transfer, which was against the facility's policy for manual transfers and gait belt use. The Director of Nursing (V2) confirmed that the CNA let go of the resident to turn off the call light and mentioned that the resident might have been groggy from a line placement earlier that day. The Therapy Director (V15) stated that a resident requiring supervision or touching assistance should not be left unattended and that a gait belt should be used due to the resident's unsteadiness. The facility's Fall Prevention Program and Transfers-Manual Gait Belt and Mechanical Lift policies were not followed, as the resident was left unattended and a gait belt was not used during the transfer, leading to the fall and subsequent injuries.
Failure to Provide Prescribed Therapeutic Diets
Penalty
Summary
The facility failed to ensure therapeutic diets were provided as ordered for a resident with multiple health conditions, including atrial fibrillation, atherosclerotic heart disease, heart failure, and essential hypertension. The resident's physician had ordered a No Added Salt (NAS) diet, but the resident reported consistently receiving incorrect meals. Observations confirmed that the resident received meals that did not match the dietary orders on multiple occasions. For example, on one day, the resident received ravioli instead of meatballs with spiral noodles, and on another day, the resident received bratwurst instead of hot pork on a bun. The discrepancies were attributed to recent changes in the dietary department's leadership and issues with food ordering. The Director of Nursing acknowledged that residents should receive the diet printed on their cards and that any menu changes should be communicated to them. The cook confirmed that the menu was altered due to the previous dietary manager's failure to order the correct food items, leading to substitutions with available alternatives. These actions and inactions resulted in the resident not receiving the prescribed therapeutic diet, highlighting a failure in the facility's dietary management and communication processes.
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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 Bridgeport
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Gentle Care Strategies | 12.7 mi | ★★★★★ | 0 | 0 |
| Lodge Of The Wabash | 13.2 mi | ★★★★★ | 18 | 0 |
| Bridgepointe Health Campus | 13.6 mi | ★★★★★ | 5 | 0 |
| Richland Nursing & Rehab | 17.1 mi | ★★★★★ | 9 | 1 |
| Helia Healthcare Of Olney | 17.5 mi | ★★★★★ | 4 | 0 |
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