Below average — CMS composite of the measures below.
The next survey window likely opens around December 2026
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 Andover Manor Rehab And Nursing during CMS and state inspections, most recent first.
Unlocked Chemical Closet on Dementia Unit: A housekeeper repeatedly left a closet containing housekeeping chemicals unlocked on a DSCU where residents with dementia and wandering behaviors were observed ambulating in the hallway. Surveyors were able to access the closet and observe the chemicals inside, and the UM, Infection Preventionist, and Administrator stated the closet should be locked at all times.
A resident with Alzheimer’s disease and vascular dementia, and severe cognitive impairment, had staff personal items stored in the room. Surveyors observed a tote bag and fleece shirts on the night table and later in the closet, and then saw a CNA handling the tote bag in the room while the resident was absent. The ADON stated staff have designated areas for personal belongings and should not keep them in resident rooms.
Failure to Document and Investigate Lost Dentures Grievance: A resident with intact cognition and a hx of heart disease and DM lost upper dentures at the facility after they were left on a meal tray and discarded. The grievance was not entered into the grievance log, no formal investigation was documented, and the resident went without dentures despite difficulty eating; the dentist recommended new upper and lower dentures, and the DON acknowledged missing resident property should be logged and investigated.
A resident with a pacemaker, atrial fibrillation, and CHF did not have a comprehensive care plan that included the pacemaker type, programmed heart rate, or baseline BP. The record also lacked an order for pacemaker care and did not document results of the cardiology pacemaker check, even though the resident was supposed to have annual checks.
Failure to provide scheduled showers for two dependent residents. One resident with hemiplegia and diabetes, and another resident with multiple chronic conditions including pain, osteoarthritis, osteoporosis, and epilepsy, were both cognitively intact and dependent on staff for ADLs. Records showed missed shower appointments with no documented refusals, while interviews revealed one resident had not received a shower in over a year and the other had not had one in months; staff instead provided bed baths or did not complete the showers as scheduled.
Respiratory Equipment Not Maintained per Orders and Facility Policy: The facility failed to follow physician orders and its own policy for oxygen and nebulizer equipment for multiple residents. Surveyors observed oxygen humidification bottles and tubing that were not changed or dated as required, a nebulizer mask and tubing that were not properly dated or documented in the care plan, and an oxygen concentrator filter covered with dust. The DON and UM acknowledged the expected weekly cleaning and changing of the respiratory equipment.
Medication labeling and secure storage were deficient when an A3 med cart contained two Anoro Ellipta inhalers that were not labeled consistently with opening dates, and a resident kept Fluticasone nasal spray on the nightstand without an order or assessment for self-administration. The resident was cognitively intact, had cardiac diagnoses including AFib and CHF, and staff stated that medications should be labeled accurately and not kept in the room without the proper order.
Failure to Provide Recommended Denture Replacement: A resident with heart disease and DM lost upper dentures and a lower partial at the facility and later reported difficulty eating. A dentist recommended new upper and lower dentures and full mouth X-rays after discussing the issue with Social Services and a nurse, but the recommendation was not documented in the medical record or acted on, and staff interviewed were unaware of the dental plan.
Therapeutic Diet Not Followed for Resident With Dysphagia: A resident with dysphagia, GERD, esophagitis, and prior CVA was ordered an NAS dysphagia advanced diet with thin liquids, but was observed receiving dry French toast, toast, a dinner roll, and a cookie instead of the ordered texture. Records showed ongoing swallowing difficulty, and the RD, CNA, UM, DON, and NP all acknowledged the resident needed a dysphagia advanced diet and should not have been served dry breads or toast.
Delayed PT Evaluation After Readmission: A resident with multiple musculoskeletal and functional diagnoses, including impaired ROM and dependence for all functional tasks, was readmitted after a hospital stay but did not receive a PT evaluation after return. The record showed prior PT involvement and orders for PT/OT/ST evaluation and treatment, yet no PT eval was documented after readmission, and progress notes did not show refusal or other barriers. OT and the DOR both stated the resident should have been reevaluated by PT to continue services.
Inaccurate documentation of oxygen equipment changes: two residents receiving O2 via nasal cannula had humidification bottles and tubing observed with old dates, yet the MAR showed an LPN had signed that the tubing and bottle were changed as ordered. One resident was severely cognitively impaired with COPD, lung cancer, and HF; the other was cognitively intact with respiratory failure and sleep apnea. The DON stated nurses should not document completion of a physician order when it was not done.
Failure to follow hand hygiene and glove use practices was observed on the A2 unit. A housekeeper repeatedly removed gloves and entered resident rooms without performing hand hygiene, handled the housekeeping cart, broom, mop, and trash with potentially contaminated hands, touched her face and adjusted her clothing before continuing work, and was also observed drinking from a personal beverage stored on the housekeeping cart. The IP and DON stated that staff should perform hand hygiene between glove changes and should not store personal drinks on the cart.
Bed Failed to Raise to Upright Position: A resident with multiple diagnoses, including asthma, PTSD, depression, anemia, osteoporosis, and epilepsy, was observed eating meals in bed while the HOB remained only in low Fowler’s position. The resident said the bed remote would not raise the HOB higher, reported a recent choking episode and occasional SOB, and a nursing note documented the resident wanting the head up after choking. The DON and Maintenance Director confirmed the bed would not raise higher, while a similar bed of the same make and model could, and the physician order for HOB elevation left the degree blank.
The facility failed to provide a dignified dining experience for residents in the dementia care unit, with significant delays in meal service during breakfast and lunch. Observations showed gaps of six to seventeen minutes between residents at the same table receiving their meals, leading to undignified situations such as a resident attempting to feed a table mate. A nurse described the mealtime tray pass as chaotic, with insufficient staff support.
The facility failed to implement and develop comprehensive care plans for several residents, leading to deficiencies in care. One resident did not receive compression socks as ordered, another's heels were not offloaded despite being at high risk for pressure ulcers, and comprehensive care plans were missing for residents with pacemakers, skin-picking behaviors, and substance abuse histories. Staff interviews revealed a lack of adherence to care plans and awareness of specific resident needs.
The facility failed to meet professional standards for three residents. A resident used an air mattress without a physician's order, another received unnecessary treatment for a non-existent wound, and a third did not receive timely antibiotic administration due to pharmacy delays without notifying the NP/MD.
A facility failed to ensure consistent documentation of Advance Directives for a resident with severe cognitive impairments. The resident's MDS indicated a DNR and DNI status, but a physician order conflicted with this by indicating a FULL CODE status. Interviews with staff revealed acknowledgment of the discrepancy, emphasizing the need for matching documentation to ensure clarity on the resident's code status.
The facility failed to maintain confidentiality of residents' medical records when two nurses left computer screens on medication carts unlocked, exposing sensitive information. Despite being aware of the requirement to lock screens, both nurses left them unattended, leading to a breach of patient confidentiality.
A resident with dementia and a history of wandering approached another resident, leading to an altercation where one resident pinched the other's cheek. The incident occurred during an activity session with insufficient staff supervision, highlighting a failure to prevent resident-to-resident abuse as per facility policy.
A resident with a history of wandering approached another resident, leading to an altercation where the latter pinched the former's cheek, causing redness and pain. Despite facility policy requiring immediate reporting of such incidents, the event was not reported to the state agency. The incident occurred during an activity session with insufficient supervision.
A facility failed to complete a Significant Change in Status Assessment (SCSA) in a timely manner for a resident admitted to hospice services. The resident, with severe cognitive impairment and other medical conditions, was admitted to hospice, but the required SCSA was not completed within the mandated timeframe. Both the MDS coordinator and the DON acknowledged the oversight.
A facility failed to accurately assess a resident's range of motion in the MDS, despite observations and staff interviews indicating limited mobility in the resident's left arm and hand. The resident, diagnosed with Alzheimer's, muscle weakness, and multiple sclerosis, was observed with their left arm contracted, contradicting the MDS assessments. Staff confirmed the resident's dependency on care and impaired mobility, which was not documented in the MDS.
A facility failed to create a baseline care plan for a resident requiring psychotropic medications, leading to a deficiency. The resident, with anxiety disorder, adjustment disorder, and dementia, showed severely impaired cognition and was dependent on self-care. Despite physician orders for Olanzapine and Diazepam, no baseline care plan was documented. The DON confirmed that a care plan should have been established upon admission.
The facility failed to update care plans for two residents regarding hospice services. One resident's care plan was not revised to include hospice services after admission to hospice care, while another resident's care plan was not updated to reflect the discontinuation of hospice services. Interviews with staff confirmed the expectation for care plans to accurately reflect residents' current care status.
A facility failed to ensure interdisciplinary team participation in the discharge planning process for a resident with severe cognitive impairment and multiple health conditions. Despite an active order for discharge, the medical record lacked documentation of the discharge plan, including input from the resident or responsible parties. Interviews revealed a lack of coordination and documentation among staff, leading to the deficiency.
The facility failed to assist two residents with meals as per their care plans. One resident with severe cognitive impairments was left to feed themselves without staff support, despite needing substantial assistance. Another resident, also with cognitive impairments and requiring a mechanically altered diet, was observed with meal trays left within reach but without necessary supervision or assistance. Staff interviews confirmed the residents' needs for meal assistance, which were not consistently met.
A resident at high risk for pressure ulcers was found with an air mattress set incorrectly at the firmest setting, contrary to the physician's order. Despite multiple observations and staff interviews, the mattress remained improperly set, indicating a failure in monitoring and equipment management.
A facility failed to assess the necessity of an indwelling catheter for a resident admitted with dementia, heart failure, and diabetes. The resident had a catheter inserted due to urinary retention during a hospital stay, with a recommendation for a urology consult that was not documented. The care plan indicated catheter use for a healed sacral ulcer and urinary retention, but no approved diagnosis justified its continued use. Staff interviews revealed that a voiding trial should have been conducted, which was not done.
The facility failed to provide sufficient staff during the breakfast meal on the A3 unit, resulting in inadequate assistance for residents who required help with eating. Observations showed that several residents were left without assistance, and their meals were left untouched for extended periods. Interviews with staff confirmed that the staffing levels were insufficient to meet the needs of the residents, with the unit often being staffed with only three CNAs instead of the scheduled four.
A facility failed to provide necessary behavioral health care for a resident with severe cognitive impairments and multiple diagnoses, including dementia and anxiety. Despite a physician's recommendation for a psychiatric consult in December, the resident had not been seen by psychiatric services by January, as confirmed by staff interviews and medical record reviews.
The facility failed to serve meals at an appetizing temperature, as observed during a breakfast service where residents in the Florida room experienced delays in meal delivery. CNAs reported that the last resident was served very late with cold food. A test tray showed pancakes at 90°F and sausage at 80°F, both barely warm. The Food Service Director expected meals to be hot and palatable.
The facility did not adequately offer snacks between meals, as observed during a survey. Some residents reported not being offered snacks after dinner and were unaware of their availability. Although snacks were available in kitchenettes, a CNA stated they were only given upon request, with no routine evening offering. The DON and Administrator acknowledged the expectation for snacks to be offered, but the Administrator was unaware this was not happening.
The facility failed to accurately document blood pressure readings for two residents with orders to avoid using the left arm due to mastectomy. Despite physician orders, records showed blood pressure was documented as taken from the left arm, and care plans did not reflect this restriction. Interviews confirmed the documentation errors.
Unlocked Chemical Closet on Dementia Unit
Penalty
Summary
The facility failed to ensure that a closet containing housekeeping chemicals on one Dementia Special Care Unit was kept locked and inaccessible to residents with dementia and wandering behaviors. On 1/13/26, the surveyor observed a housekeeper open the closet door to obtain supplies and then leave it unlocked. The surveyor was able to access the unlocked closet and observed housekeeping chemicals inside while three residents were wandering and ambulating past the closet in the hallway. The housekeeper later returned to the same closet, which remained unlocked, to get more supplies and again left it unlocked. On 1/15/26, the surveyor again observed a housekeeper open the same closet door, which was unlocked, and obtain supplies while multiple residents were ambulating up and down the hallway. The surveyor was again able to access the unlocked closet and observed multiple housekeeping chemicals stored inside. During interviews, Unit Manager #2 stated the closet should be locked at all times because residents on the unit wander and could potentially open the door and gain access to the chemicals. The Infection Preventionist and the Administrator also stated that the closet containing cleaning chemicals should be locked at all times.
Staff Personal Belongings Stored in Resident Room
Penalty
Summary
The facility failed to provide a dignified environment for one resident by allowing staff personal belongings to be stored in the resident’s room. The resident was admitted in May 2025 with diagnoses including Alzheimer’s disease and vascular dementia, and the MDS dated 12/8/25 showed severe cognitive impairment with a BIMS score of 8 out of 15, indicating the resident was unable to participate in the interview process. During observation, a tote bag with two fleece shirts was seen on the unoccupied bed’s night table, and on later observations the tote bag and shirts were seen on the top shelf of the closet in the resident’s room. The ADON and surveyor later observed a CNA in the room holding the tote bag and removing items from it while the resident was not present. When asked, the CNA stated she was looking for something and planned to place the tote bag at the nurse’s station, and the ADON stated staff have designated areas for personal belongings and should not keep them in resident rooms.
Failure to Document and Investigate Lost Dentures Grievance
Penalty
Summary
The facility failed to follow its grievance process for a resident who lost dentures. The facility policy required staff to document all grievances on the day received or as soon as possible, begin a formal investigation promptly, and advise the resident of the outcome. Review of the grievance logs for 2025 and 2026 showed no entry for the resident’s lost dentures, despite the loss being known to staff and discussed with the resident, family, nursing, social services, and the dentist. Resident #17 was admitted in July 2021 with diagnoses including heart disease and diabetes and had intact cognition on the most recent MDS. The dental care plan identified altered oral/dental health related to a lost upper denture and missing or cavity on bottom teeth, but did not indicate replacement of the lost dentures. The dentist documented that the resident had difficulty eating after losing the dentures a couple of months earlier and recommended fabrication of new upper and lower dentures, with the recommendation reviewed with nursing staff. During interviews, the resident and family stated the dentures were lost at the facility after being left on a meal tray, staff searched for them, and the resident had gone without dentures because replacement was unaffordable. Nursing staff and the DON acknowledged that missing resident property such as dentures should be entered into the grievance log and investigated, and that the facility would pay for replacement dentures if insurance would not cover them.
Incomplete Care Plan and Missing Pacemaker Follow-Up Documentation
Penalty
Summary
The facility failed to develop and implement a comprehensive care plan for Resident #38, who was admitted with diagnoses including presence of a pacemaker, atrial fibrillation, and congestive heart failure. The resident’s MDS dated 10/8/25 indicated the resident was cognitively intact and required supervision to partial assistance with activities of daily living. Facility policy stated that an individualized comprehensive care plan with measurable objectives and timetables should be developed for each resident, and the pacemaker policy stated that testing results should be documented in the medical record. Review of the physician’s orders dated January 2025 failed to show an order for pacemaker care, and the care plan did not identify the type of pacemaker, the programmed heart rate, or the baseline blood pressure. The record also showed that pacemaker checks were to be completed every 12 months at the cardiologist’s office, but the consultation document dated 10/18/24 was blank except for the resident’s name, date, and reason for the visit, with no results documented. The medical record did not show that the resident was sent to the cardiologist every 12 months. During interview, the DON stated she expected documentation in the medical record of the results of any consultation, including a pacemaker check.
Failure to Provide Scheduled Showers for Dependent Residents
Penalty
Summary
The facility failed to provide assistance with ADLs for dependent residents by not providing showers to two residents who were assessed as needing staff help. The facility policy stated that residents unable to perform ADLs independently would receive necessary care and assistance with hygiene, including bathing and grooming, in accordance with the plan of care. Surveyors found that the facility did not follow the residents’ shower schedules and did not document refusals or inability to shower for either resident. Resident #64 was admitted with diagnoses including hemiplegia and diabetes. The resident’s MDS showed a BIMS score of 13, indicating intact cognition, and indicated dependence on staff for showers and baths, with rejection of care one to three days per week. During interview, the resident stated it had been over a year since staff gave a shower, that staff told him/her there was not enough time when a shower was requested, and that the resident believed staff avoided showers because two staff were needed for transfers due to hemiplegia. Review of the shower schedule showed the resident was scheduled for weekly showers, but no shower was provided for three consecutive weeks, and the record did not show refusals or inability to shower. Resident #12 was admitted with multiple diagnoses including asthma, depression, anemia, pain, osteoarthritis, osteoporosis, epilepsy, and disability-related limitations. The resident’s MDS showed a BIMS score of 13 and dependence on staff for all functional tasks. The resident stated he/she had not had a shower in months and wanted one, and said the facility did not have a shower chair that would fit into the shower. The care plan identified extensive assistance with two staff for transfers but did not address shower assistance. Review of shower and bathing records from July 2025 through January 2026 showed no documented showers and no refusals, and staff interviews indicated the resident was receiving bed baths instead of showers because it was too hard to get him/her into the shower chair, although a unit manager stated the chair could fit into another unit’s shower.
Respiratory Equipment Not Maintained per Orders and Facility Policy
Penalty
Summary
The facility failed to provide respiratory care consistent with physician orders and its own policy for multiple residents receiving oxygen therapy. The facility policy stated that humidifier bottles are to be labeled with the date of application and changed weekly, and that nasal cannulas should be changed weekly or when soiled. Surveyors observed that Resident #40, who had diagnoses including COPD, lung cancer, and heart failure and was dependent on staff for ADLs, was receiving oxygen at 2 L/min via nasal cannula with the oxygen humidification bottle and tubing dated 12/29/25. A nurse stated the tubing and bottle should have been changed the prior week. Resident #72, who had diagnoses including respiratory failure and sleep apnea and was cognitively intact, was also observed receiving oxygen at 2 L/min via nasal cannula with the humidification bottle and tubing dated 12/29/25. The resident stated staff had not changed the bottle and tubing for a long time. The DON stated she expected the oxygen tubing and humidification bottle to be changed according to physician orders. The facility policy also directed staff to label tubing connected to the oxygen cylinder with time and date, change the nasal cannula or mask weekly or when soiled, and clean the humidifier bottle and filters according to protocol. For Resident #15, who had diagnoses including COPD and chronic respiratory failure with hypoxia, surveyors observed a nebulizer mask partially inside a plastic bag, with the mask dated 12/29 but the tubing and bag undated. The resident had an active PRN ipratropium-albuterol nebulizer order, and the MAR/TAR showed the medication was administered on 1/12/26, but the record did not show a physician order or care plan for nebulizer machine care, including tubing or mask. Surveyors also observed the oxygen concentrator filter covered with a thick coating of dust, and the record did not show a physician order or care plan for concentrator care. The UM stated the nebulizer equipment should be cleaned and changed weekly and the mask should be stored fully inside the bag and dated, and the DON stated the oxygen concentrator filter must be cleaned weekly and documented in the medical record.
Medication Labeling and Secure Storage Deficiency
Penalty
Summary
Medications and biologicals were not properly labeled in one medication cart on the A3 unit. On 1/15/26 at 8:25 A.M., the surveyor observed one Anoro Ellipta inhaler open and not labeled with a date, and another Anoro Ellipta inhaler dated as opened on 11/16/25 inside a box dated as opened 10/31/25. The pharmacy label showed one inhaler was dispensed 11/5/25 and the other 10/30/25. The manufacturer’s directions indicated the inhaler should be discarded 6 weeks after opening. During interview, Nurse #3 stated the inhalers should be labeled accurately. Medications were also not stored securely for Resident #38. The resident was admitted in October 2021 with diagnoses including presence of a pacemaker, atrial fibrillation, and congestive heart failure, and the 10/8/25 MDS indicated the resident was cognitively intact with a Brief Interview of Mental Status score of 13 out of 15 and required supervision to partial assistance with ADLs. On 1/13/26 and 1/14/26, the surveyor observed a bottle of Fluticasone nasal spray on the resident’s nightstand. The physician’s orders included Fluticasone Propionate Suspension 50 MCG/ACT, 1 spray in each nostril daily for nasal discomfort, but the record did not include an order for self-administration or an assessment for the ability to self-administer medications and store them safely in the room. Nurse #2 stated that without a doctor’s order, the medication should not be in the resident’s room, and the DON stated that a resident must be assessed and have a physician’s order before self-administering and storing medications in the room.
Failure to Provide Recommended Denture Replacement
Penalty
Summary
The facility failed to provide dental services for one resident when a dentist recommended replacement dentures and the recommendation was not reviewed or implemented. Resident #17, admitted in July 2021 with diagnoses including heart disease and diabetes, had an MDS indicating no broken or loosely fitting dentures and no mouth or facial pain, and a BIMS score of 15 showing intact cognition. The resident’s dental care plan dated 3/31/25 noted altered oral/dental health related to a lost upper denture and missing/cavity on bottom teeth, but it did not include replacement of the lost dentures. A dental note dated 9/5/25 stated the resident had been having difficulty eating since losing the dentures a couple of months earlier. The dentist reported that the resident had a complete upper denture and lower removable partial denture fabricated at an outside dentist in March 2025, that the resident said insurance would cover a one-time replacement, and that the dentist discussed the situation with Social Services and reviewed the recommendation with a staff nurse. The dentist recommended fabrication of complete upper dentures and lower removable partial dentures, along with full mouth X-rays, but the medical record contained no reference to the recommendation and no indication that dentures were ordered. Correspondence dated 1/15/26 showed the dentist’s office was unaware the recommendation had been made. Interviews showed the resident said the dentures were lost at the facility and could not be replaced out-of-pocket, a family member said staff knew the dentures were lost and the resident had gone without them, and nursing, Social Services, and the DON were unaware of the recommendation or the status of replacement dentures.
Therapeutic Diet Not Followed for Resident With Dysphagia
Penalty
Summary
The facility failed to provide one resident with the physician-ordered therapeutic diet. Resident #25 had diagnoses including dysphagia, GERD, esophagitis, muscle weakness, hemiplegia and hemiparesis following cerebral infarction, and cognitive communication deficit. The resident’s record showed a physician order for an NAS diet with Dysphagia Advanced texture and regular/thin liquids dated 10/29/25, after a prior regular-texture diet was discontinued because of increased signs and symptoms of dysphagia. The resident’s MDS also indicated a mechanically altered diet and supervision or touching assistance with eating. During observation on 1/13/26, the resident was seen eating breakfast that included two slices of dry French toast, one slice of toasted wheat bread, and oatmeal. The resident was peeling the crust off the French toast and breaking it into pieces about 2 inches in size, and there was a syrup packet on the table but the French toast was dry and had no syrup on it. The resident stated he/she could not swallow food well and could not eat what was given because it was hard. Later that day, the resident’s lunch tray contained a large round dinner roll and a whole chocolate chip cookie. The dietary slip for that day listed Regular DYS-ADV NAS with extra gravy on the side, and included French toast or pancakes or muffin, hashbrown, oatmeal, and bread. The resident’s records and interviews showed ongoing swallowing difficulty and a need for softer textures. The nutrition assessment noted the resident preferred soft food, broth, and extra gravy, and the dietary progress note documented swallowing difficulty related to esophageal strictures and that the resident did better with soft food cut up. The physiatry note stated the resident reported difficulty with meals, textures that were difficult to tolerate, coughing, hoarseness, and eating bread while leaving the crust, and requested broth with meals. The speech therapy discharge summary identified the diet as Soft + Bite Size/Dys-Adv. The dietitian, CNA, unit manager, DON, and NP all stated that the resident required a dysphagia advanced diet and that dry breads, toast, and similar items should not have been served, yet the resident was observed receiving and attempting to eat those items.
Delayed PT Evaluation After Readmission
Penalty
Summary
The facility failed to ensure that specialized rehabilitative services were provided as required for one resident. Resident #12 was admitted with multiple diagnoses including left hip pain, muscle spasm, arthropathy, osteonecrosis of the left femur, osteoarthritis of both shoulders, major depressive disorder, osteoporosis, anemia, limitation of activities due to disability, and epilepsy. The most recent MDS indicated a BIMS score of 13, no cognitive impairment, dependence on staff for all functional tasks, and functional impairments in range of motion of both upper and lower extremities. During observation and interview, the resident was lying in bed and stated that before hospitalization in October the resident could get up into a wheelchair and stand with staff assistance, but now could not stand or bend the left leg and said the right leg was also worse. The physician orders included PT 5 times per week for 30 days for evaluation and treatment, along with OT, ST screen/eval/treat as indicated, and OT clarification orders for skilled OT. The PT evaluation and plan of treatment dated 9/24/25 stated the resident had limited functional mobility, ROM deficits, severe crepitus to most joints, and needed continued therapy services. However, the record showed a PT discharge summary signed on 10/6/25 noting the resident had been discharged to the hospital at the end of September and readmitted in early October, and the record failed to show a PT evaluation after readmission. Progress notes from 10/7/25 through 1/14/26 did not document refusal or other obstacles to the PT evaluation. OT and the DOR both stated the resident was not evaluated by PT after readmission and should have been reevaluated to continue services.
Inaccurate Documentation of Oxygen Equipment Changes
Penalty
Summary
The facility failed to accurately document in the medical record that oxygen tubing and humidification bottles were changed as ordered for two residents. The facility policy on charting and documentation stated that each resident must have an active medical record containing accurately documented information that is systematically organized and readily accessible to authorized persons. One resident was admitted with diagnoses including COPD, lung cancer, and heart failure, was severely cognitively impaired, dependent on staff for ADLs, and receiving oxygen therapy. On observation, the resident was receiving oxygen via nasal cannula at 2 L/min, and the oxygen humidification bottle and tubing were dated 12/29/25. The MAR showed that on 1/4/26 the nurse signed that the oxygen tubing and humidifier bottle were changed as ordered, but the tubing and bottle were still dated 12/29/25. A nurse stated the tubing and bottle should have been changed the prior week. A second resident, admitted with respiratory failure and sleep apnea, was cognitively intact, required assistance with ADLs, and was receiving oxygen therapy. The resident was observed receiving oxygen via nasal cannula at 2 L/min, and the humidification bottle and tubing were also dated 12/29/25. The MAR again showed that on 1/4/26 the nurse signed that the oxygen tubing and humidifier bottle were changed as ordered, and the resident stated staff had not changed the bottle and tubing for a long time. The DON stated nurses should not document that they completed a physician's order when they did not.
Failure to Follow Hand Hygiene and Glove Use Practices
Penalty
Summary
The facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. On the A2 unit, a housekeeper was observed failing to perform hand hygiene after removing gloves and before entering resident rooms, after handling supplies and cleaning equipment, after touching her face and adjusting her clothing, and after emptying trash in a resident bathroom. The housekeeper was also observed moving between resident rooms and other areas of the unit with potentially contaminated hands, applying new gloves without hand hygiene, and using the same gloves while handling the housekeeping cart, broom, mop, and trash. Additional observations on the A2 unit showed the housekeeper drinking from a personal beverage bottle stored on the housekeeping cart and then placing it back on the cart. On another occasion, the housekeeper was observed blowing her nose into a tissue and then entering a resident room without performing hand hygiene or applying gloves, opening the blind, emptying trash in the bathroom with ungloved hands, and then applying gloves to continue cleaning. The Infection Preventionist stated that staff should change gloves between resident rooms and perform hand hygiene before and after glove changes, and that the housekeeper should not store personal drinks on the housekeeping cart. The DON stated that staff should follow the facility policy regarding hand hygiene and glove use.
Bed Failed to Raise to Upright Position
Penalty
Summary
Keep all essential equipment working safely was not met when the facility failed to ensure one resident’s bed was in operating condition. The resident was admitted in July 2025 and had diagnoses including asthma, PTSD, depression, iron deficiency anemia, pain in the left hip, muscle spasm, arthropathy, osteonecrosis of the left femur, primary osteoarthritis of both shoulders, major depressive disorder, osteoporosis, anemia, limitation of activities due to disability, and epilepsy. The most recent MDS showed a BIMS score of 13, indicating no cognitive impairment, and that the resident was dependent on staff for all functional tasks. The resident was observed eating meals in bed on multiple occasions with the head of the bed only in a low Fowler’s position. The resident stated it would be easier to eat if the head of the bed went up higher, but it did not, and showed the surveyor that pressing the remote’s up button did not raise the bed further. The resident also stated he/she was supposed to keep the head of the bed raised and reported a recent choking incident and occasional shortness of breath. A nursing note documented the resident after a choking episode with the head of the bed at 45 degrees and the resident stating a desire to keep the head up. The physician order for head-of-bed elevation for shortness of breath was left blank for the degree of elevation. During observation with the Director of Maintenance, the bed would not raise higher, while a similar bed of the same make and model could be raised higher; the Director of Maintenance said the resident’s bed should be replaced. The DON and Administrator stated they expected the resident to be able to raise the head of the bed and have beds in good working condition.
Undignified Dining Experience in Dementia Care Unit
Penalty
Summary
The facility failed to provide a dignified dining experience for residents in the dementia care unit, as observed during breakfast and lunch meal services. The facility's policy, revised on November 5, 2024, mandates regular audits of the food services department to ensure a safe and pleasant dining experience. However, during breakfast, there were significant delays in serving meals to residents at the same table, with gaps ranging from six to thirteen minutes between the first and last resident receiving their meals. This delay was also observed during lunch, with gaps of ten to seventeen minutes. These delays led to situations where residents were left waiting for their meals, and in one instance, a resident attempted to feed a table mate. During an interview, Nurse #9 described the mealtime tray pass as chaotic, noting that staff did not receive assistance from other floors or departments. The nurse emphasized that meals should be served in order to prevent residents from waiting unnecessarily. The observations and interview indicate a failure to adhere to the facility's policy, resulting in an undignified dining experience for residents in the dementia care unit.
Failure to Implement and Develop Comprehensive Care Plans
Penalty
Summary
The facility failed to develop and implement person-centered care plans for five residents, leading to deficiencies in their care. For one resident with chronic obstructive pulmonary disease and edema, the facility did not implement the use of compression socks as ordered by the physician. Despite the resident's dependence on staff for lower body dressing and the presence of a blister on the heel, there was no documentation explaining the absence of compression socks, and staff interviews revealed a lack of adherence to the care plan. Another resident, who was at high risk for pressure ulcers due to severe cognitive impairment, was observed multiple times with heels flat on the mattress, contrary to the care plan directive to offload heels while in bed. Staff interviews confirmed the expectation to follow the care plan, yet the resident's heels were not offloaded as required, indicating a failure to implement the care plan effectively. Additionally, the facility did not develop comprehensive care plans for residents with specific needs, such as a pacemaker care plan for a resident with severe cognitive impairments, a behavior care plan for a resident with a history of skin picking and hallucinations, and a substance abuse care plan for a resident with a history of alcohol abuse. Interviews with staff, including nurses and social workers, highlighted a lack of awareness and documentation regarding these residents' specific care needs, further contributing to the deficiencies.
Failure to Adhere to Professional Standards of Practice
Penalty
Summary
The facility failed to meet professional standards of practice for three residents. For Resident #19, the facility did not obtain a physician's order for the use of an air mattress, which was observed in use during a survey. Both Nurse #1 and the Director of Nursing acknowledged that a physician's order should have been in place for the air mattress. For Resident #69, the facility continued a treatment for a right ankle wound that was not present. Despite the absence of any open skin areas, as confirmed by a weekly skin check and direct observation, the treatment order remained active. Nurse #7 and Unit Manager #1 were unaware of any current wounds, and the order's origin was unclear, indicating a lapse in communication and documentation. Resident #106 did not receive timely administration of an antibiotic due to the medication not being delivered by the pharmacy. The progress notes did not indicate that the physician or nurse practitioner was notified of the delay, contrary to the facility's policy. Nurse #6 and the Director of Nursing confirmed that the NP/MD should have been informed about the medication not being administered as ordered.
Inconsistent Documentation of Advance Directives
Penalty
Summary
The facility failed to ensure that Advance Directives were consistently documented in the medical record for a resident with severe cognitive impairments. The resident, admitted in February 2024, had diagnoses including dementia, adult failure to thrive, and anxiety. The resident's Minimum Data Set (MDS) indicated a Do Not Resuscitate (DNR) and Do Not Intubate (DNI) status. However, a physician order dated May 2024 indicated a FULL CODE status, conflicting with the resident's Medical Orders for Life Sustaining Treatment (MOLST) dated August 2024, which confirmed a DNR and DNI status. During interviews, Nurse #3 and the Director of Nurses (DON) acknowledged the discrepancy between the MOLST and the physician order, emphasizing that they should match to ensure clarity on the resident's code status. This inconsistency in documentation could lead to confusion among the nursing staff regarding the resident's end-of-life care preferences, as highlighted by the interviews conducted during the survey.
Failure to Maintain Confidentiality of Medical Records
Penalty
Summary
The facility failed to maintain the privacy and confidentiality of residents' personal and medical records on one of the three resident units. This deficiency was observed when Nurse #10 and Nurse #11 left the computer screens on the medication carts unlocked, exposing residents' medical and private information. On two separate occasions, Nurse #10 walked away from the medication cart without locking the computer screen, leaving it unattended and revealing sensitive information. Similarly, Nurse #11 was observed leaving the computer screen unlocked while walking away to the medication room and a resident's room. Interviews with the involved nurses confirmed that they were aware of the requirement to lock the computer screens to protect resident information. Nurse #11 acknowledged that she should lock the screen when leaving the medication cart, and Nurse #10 confirmed that the computer should always be locked if unattended. The Director of Nurses also stated that she expects nurses to lock the computer screens to ensure the confidentiality of residents' medical records. Despite this expectation, the failure to secure the computer screens resulted in a breach of patient confidentiality.
Resident-to-Resident Altercation Due to Inadequate Supervision
Penalty
Summary
The facility failed to prevent a resident-to-resident altercation involving two residents, one of whom pinched the other's cheek. Resident #56, who has dementia with behavioral disturbance and a history of wandering and encroaching on others' personal space, approached Resident #23, who also has dementia with psychotic features and behavioral disturbance. Resident #23 reacted aggressively by pinching Resident #56's cheek, causing redness and pain. The incident occurred during an activity session where only one staff member, Activity Assistant #3, was present. The assistant was engaged with other residents and did not notice Resident #56 approaching Resident #23 until the altercation occurred. The assistant had to intervene by separating the residents and escorting them to different areas. Both the Activity Assistant and Nurse #12 acknowledged that Resident #56 requires close supervision due to their behavior history. Interviews with staff, including the Unit Manager and Director of Nurses, revealed that the incident was considered physical abuse due to the infliction of pain. However, the Director of Nurses later determined that the incident was not abusive after using a navigation tool to assess the situation. Despite this, the facility's policy requires staff to monitor and prevent such altercations, which was not adequately done in this case.
Failure to Report Resident Altercation
Penalty
Summary
The facility failed to report an allegation of abuse to the state agency within the mandated timeframes following a resident-to-resident altercation. Specifically, the incident involved Resident #23 pinching Resident #56, which was not reported to the state agency as required. The facility's policy mandates that such incidents be reported within two hours, but this was not adhered to in this case. Resident #56, who has a history of wandering and getting close to other residents, approached Resident #23 and moved close to their face, prompting Resident #23 to react aggressively by pinching Resident #56's cheek. This resulted in redness and pain for Resident #56. Both residents have cognitive impairments, with Resident #56 having dementia with behavioral disturbance and Resident #23 having dementia with psychotic features and behavioral disturbance. The incident occurred during an activity session where supervision was insufficient, as noted by Activity Assistant #3, who was the only staff present. Despite the facility's policy and a flyer titled 'Abuse Reporting' indicating the need for immediate reporting of such incidents, the Director of Nurses decided not to report the incident to the state agency, believing it did not meet the criteria for reportable abuse. This decision was made despite the clear expectation from the facility's policy and staff interviews that such incidents should be reported promptly.
Failure to Complete Timely SCSA for Hospice Admission
Penalty
Summary
The facility failed to complete a Significant Change in Status Assessment (SCSA) Minimum Data Set (MDS) in a timely manner for a resident who was admitted to hospice services. According to the MDS 3.0 Resident Assessment Instrument (RAI) Manual, a SCSA is required when a resident enrolls in a hospice program, and it must be completed by the 14th calendar day after the assessment reference date (ARD). In this case, the resident was admitted to hospice services on December 2, 2024, but the SCSA was not completed by the required date of December 30, 2024, and remained incomplete as of January 7, 2025. The resident involved had a history of traumatic subdural hemorrhage, diabetes, and dysphagia requiring tube feedings, and was assessed to have severe cognitive impairment. During interviews, both the MDS coordinator and the Director of Nurses acknowledged that the SCSA should have been completed within the specified timeframe following the resident's admission to hospice services. This oversight represents a failure to adhere to the required assessment protocols for residents experiencing significant changes in their health status.
Inaccurate MDS Assessment of Resident's Range of Motion
Penalty
Summary
The facility failed to ensure an accurate assessment of a resident's condition, specifically regarding the Minimum Data Set (MDS) for a resident with Alzheimer's disease, muscle weakness, and multiple sclerosis. The MDS inaccurately reported that the resident had no functional limitation in the range of motion (ROM) in their extremities, despite observations and staff interviews indicating otherwise. The resident was observed with their left arm pulled across their chest and fingers contracted into a fist, suggesting a limitation in ROM that was not documented in the MDS assessments dated September and December 2024. Interviews with staff and a family member confirmed that the resident had impaired mobility in their left arm and hand, which had been present for some time. Certified Nursing Assistants and nurses reported the resident's dependency on care and inability to use their left arm and hand due to contraction. The MDS nurse acknowledged that the impaired ROM was present at the time the December 2024 MDS was completed and should have been accurately reflected in the assessment. This discrepancy between the MDS documentation and the resident's actual condition constitutes a deficiency in the facility's assessment process.
Failure to Develop Baseline Care Plan for Psychotropic Medications
Penalty
Summary
The facility failed to develop a baseline care plan for a resident who requires psychotropic medications, resulting in a deficiency. The resident, admitted in January 2024, has diagnoses including anxiety disorder, adjustment disorder, and dementia, and scored a 3 out of 15 on the Brief Interview for Mental Status exam, indicating severely impaired cognition. The resident is dependent on self-care activities and exhibits behaviors that impact care delivery. Physician orders for the resident included Olanzapine and Diazepam for psychotic disorder and anxiety, respectively. However, a review of the medical record revealed that a baseline care plan for these psychotropic medications was not created. During an interview, the Director of Nursing acknowledged that such a care plan should have been developed upon admission.
Failure to Update Care Plans for Hospice Services
Penalty
Summary
The facility failed to ensure that the comprehensive care plans for two residents were reviewed and revised by the interdisciplinary team following significant changes in their care status. For one resident, the facility did not update the care plan to include hospice services after the resident was admitted to hospice care. The resident, who was admitted in March 2024 with conditions such as traumatic subdural hemorrhage, diabetes, and dysphagia, was receiving hospice services as of December 2, 2024. However, the hospice care plan was not included in the resident's active plan of care until January 7, 2025, after the surveyor inquired about it. Interviews with the MDS nurse and the Director of Nursing confirmed that they expected a hospice care plan to be in place for residents receiving such services. For another resident, the facility failed to update the care plan after the discontinuation of hospice services. This resident, admitted in October 2021 with diagnoses including epilepsy, chronic obstructive pulmonary disease, and Alzheimer's disease, was discharged from hospice care on April 27, 2024. Despite this, the hospice care plan remained active for over eight months, even after two quarterly MDS assessments. Interviews with a nurse and the Unit Manager revealed that the resident had been off hospice services for some time, and the care plan should not have indicated ongoing hospice care. The Unit Manager acknowledged that the care plan should have been updated to reflect the resident's current status.
Failure in Discharge Planning Process
Penalty
Summary
The facility failed to ensure that the interdisciplinary team participated in the discharge planning process for a resident with severe cognitive impairment and multiple health conditions, including memory deficit following cerebral infarction, type 2 diabetes mellitus with diabetic neuropathy, and bipolar disorder. The facility's policy requires a post-discharge plan to be developed by the care plan team with the assistance of the resident or their family, but this was not adhered to in the case of the resident. The resident's care plans indicated no plans for discharge, yet there was an active physician's order for discharge home with services and medications. The medical record lacked documentation of the discharge planning process, including the resident or responsible parties' input, and failed to specify the agency or contact information for services post-discharge. Interviews with facility staff revealed a lack of coordination and documentation regarding the discharge process. The Administrator believed the discharge was planned with the PACE program, but there was no documentation to support this in the resident's medical record. The Director of Nursing expected the facility's social worker to document the discharge planning, but this was not done. Additionally, Nurse #15 confirmed that there was no nursing discharge assessment or progress note indicating the resident's discharge. This lack of documentation and coordination among the care team members led to the deficiency in the discharge planning process for the resident.
Failure to Assist Residents with Meals
Penalty
Summary
The facility failed to provide necessary assistance with Activities of Daily Living (ADLs) for two residents, specifically in the area of meal assistance. Resident #94, who was admitted with diagnoses including dementia and adult failure to thrive, was observed on multiple occasions without the required assistance during meal times. Despite having severe cognitive impairments and a care plan indicating the need for substantial assistance with eating, Resident #94 was left to attempt feeding themselves without staff support. Interviews with nursing staff confirmed that the resident required assistance during meals, yet this was not consistently provided. Similarly, Resident #26, who has severe cognitive impairments and requires a mechanically altered diet, was observed multiple times with meal trays left within reach but without the necessary supervision or assistance. The resident's care plan indicated a need for partial assistance with eating, yet staff were not present to provide this support. Interviews with staff, including a Speech Language Pathologist and a CNA, acknowledged the resident's need for meal setup and occasional assistance, but these needs were not met as per the care plan.
Failure to Ensure Proper Functioning of Pressure-Relieving Mattress
Penalty
Summary
The facility failed to adhere to professional standards of care for the prevention of pressure ulcers for a resident who was assessed as being at high risk for developing pressure ulcers. The resident, who has a history of pressure wounds and severe cognitive impairment, was dependent on staff for all aspects of care. Despite the physician's order for a pressure-redistribution mattress to be set at a specific setting, the air mattress was consistently observed to be set at the highest, firm setting, contrary to the medical plan of care. Multiple observations over several days showed that the air mattress was not functioning as intended, as it was blinking at the highest setting instead of being set to the prescribed level. Interviews with nursing staff and the unit manager confirmed that the mattress should have been set to a lower setting as per the physician's order. The unit manager attempted to adjust the mattress but was unable to set it correctly, indicating a failure in monitoring and ensuring the proper functioning of the equipment, which is crucial for the resident's care.
Failure to Assess Indwelling Catheter Necessity
Penalty
Summary
The facility failed to ensure that a resident admitted with an indwelling catheter was assessed for its removal as soon as possible, unless the resident's clinical condition demonstrated a continued need for catheter use. The resident, who was admitted in August 2023 with diagnoses including dementia, heart failure, and diabetes, had an indwelling catheter inserted due to urinary retention during a hospital stay from August 2 to August 14, 2023. The hospital paperwork recommended a urology consult, which was not documented in the resident's medical record. The resident's care plan, updated in January 2025, indicated the presence of an indwelling Foley catheter for a history of unstageable sacrum region pressure and urinary retention. However, the resident's medical history and diagnosis lists did not indicate a diagnosis justifying the continued use of the catheter. Interviews with facility staff revealed that a resident with an indwelling catheter without an approved diagnosis should undergo a voiding trial, which was not conducted for this resident. Additionally, the sacral ulcer had healed in June 2024, further questioning the necessity of the catheter.
Inadequate Staffing During Breakfast Meal
Penalty
Summary
The facility failed to ensure sufficient staffing during the breakfast meal on the A3 unit, which resulted in inadequate assistance for residents who required help with eating. Observations on January 6, 2024, revealed that there were only two staff members present in the dining room initially, with one staff member being a nurse who remained with a single resident throughout the meal. Several residents were left without assistance, and their meals were left untouched for extended periods. At one point, a resident who required one-on-one assistance attempted to eat a napkin, highlighting the lack of adequate supervision and assistance. Interviews with staff members, including CNAs and nurses, confirmed that the staffing levels were insufficient to meet the needs of the residents in the Florida room, where all residents required some form of assistance with eating. The working schedule review indicated that on multiple occasions, the unit was staffed with only three CNAs instead of the scheduled four, contributing to the inability to provide timely assistance to all residents. The deficiency was acknowledged by the facility's administrator during a Quality Assurance and Performance Improvement review.
Failure to Provide Timely Psychiatric Consultation
Penalty
Summary
The facility failed to provide necessary behavioral health care and services for a resident, identified as Resident #70, who was admitted with diagnoses including dementia with behaviors, restlessness, agitation, delirium, and insomnia. The resident's Minimum Data Set (MDS) indicated severe cognitive impairments, and the resident was receiving antidepressant and antianxiety medications. A physician's order from September 2024 included Counseling and Psychology Services as needed, and a progress note from December 2024 suggested the resident might benefit from an SSRI and a referral to psychiatry. However, the facility did not ensure that a psychiatric consult was completed. Interviews with facility staff revealed that the nursing staff was responsible for notifying the psychiatric provider when a resident needed to be seen, and psychiatric services were available weekly. Despite this, the resident had not been seen by psychiatric services by January 2025, as confirmed by the absence of a note in the medical record. The Director of Nurses acknowledged that the resident should have been seen by psychiatric services following the physician's recommendation in December 2024.
Deficiency in Meal Temperature and Palatability
Penalty
Summary
The facility failed to provide meals that were palatable and served at an appetizing temperature, as observed during a breakfast meal service on the A3 unit. Twelve residents were present in the Florida room, all requiring assistance or being dependent on staff to eat. The first resident received their meal at 9:10 A.M., while the last resident was served at 9:43 A.M., resulting in a 43-minute delay. Certified Nursing Assistants (CNAs) reported that the last resident was served very late and the food was not warmed up. During a Resident Council Meeting, all ten residents reported that their meals were cold upon delivery. Further observations on a subsequent day revealed that the second food truck arrived at the A3 unit at 8:57 A.M., and a test tray was received at 9:15 A.M. The pancakes on the test tray registered at 90 degrees Fahrenheit and were barely warm, while the sausage patty registered at 80 degrees Fahrenheit and was also barely warm with a small hard piece. The Food Service Director acknowledged that she would expect food to be hot and palatable for residents and delivered in a timely manner.
Failure to Offer Snacks Between Meals
Penalty
Summary
The facility failed to provide or offer adequate snacks between meals, as observed during a survey. During a resident group meeting, half of the residents who could not independently obtain snacks reported not being offered snacks after dinner and were unaware of their availability. Observations confirmed that kitchenettes on all units had a variety of snacks available. However, a CNA stated that snacks were only given upon request, and there was no routine offering of snacks in the evening. The Director of Nursing and Administrator acknowledged that residents should be offered snacks between meals and that there should be a snack pass in the evening, but the Administrator was unaware that this was not occurring.
Inaccurate Blood Pressure Documentation for Residents with Mastectomy
Penalty
Summary
The facility failed to ensure accurate documentation of blood pressure readings for two residents, both of whom had medical orders specifying that blood pressure should not be taken on their left arms due to a history of mastectomy. Resident #2, who was admitted with chronic heart failure, chronic respiratory failure, diabetes, and hypertension, had a physician order dated 9/9/21 indicating no blood pressure should be taken on the left arm. However, multiple entries in the resident's medical record inaccurately documented blood pressure readings as being taken from the left arm. The resident's care plan also failed to include the restriction on taking blood pressure from the left arm. Similarly, Resident #19, admitted with traumatic subdural hemorrhage, diabetes, and hypertension, had a physician order dated 3/25/24 specifying that blood pressure should only be taken from the right arm due to a left mastectomy. Despite this, the resident's medical records showed several instances where blood pressure was documented as being taken from the left arm. The care plan for Resident #19 also did not reflect the restriction on using the left arm for blood pressure measurements. Interviews with nursing staff and the Director of Nurses confirmed that the documentation was incorrect and did not adhere to the physician's orders.
What surveyors are citing around you — mapped
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Illustrative
What surveyors actually found near you
We read the 1,115 citations issued within 25 miles in the last 12 months — including the 2 immediate-jeopardy cases — and tell you exactly what happened, in plain English, matched to your record.
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.
Illustrative
A prioritized, do-first checklist
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Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Andover
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Vantage At Andover Llc | 1.9 mi | ★★★★★ | 38 | 0 |
| Andover Forest Post Acute Care Center | 3 mi | ★★★★★ | 0 | 0 |
| Meadows, The | 3.4 mi | ★★★★★ | 12 | 0 |
| Prescott House | 3.5 mi | ★★★★★ | 22 | 0 |
| Royal Wood Mill Center | 4 mi | ★★★★★ | 4 | 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.