Below average — CMS composite of the measures below.
The next survey window likely opens around November 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 Goffstown Nursing And Rehab Center during CMS and state inspections, most recent first.
Failure to document informed consent for psychotropic medication. A resident with bi-polar disorder and psychosis had orders for Depakote, but the record contained no documentation that the resident or the resident representative was informed of the risks, benefits, and alternatives before the psychotropic medication was initiated or increased. The DON confirmed the missing documentation, and the facility policy required this discussion and documentation.
PRN antipsychotic medication was continued for a resident without the required physician evaluation after 14 days. The MAR showed a PRN order for quetiapine for psychosis, and the record lacked documentation that the MD or prescribing practitioner reviewed the order for appropriateness to justify continuation. The DON confirmed the finding, and the facility policy required documentation for extending PRN psychotropic orders beyond the limit.
A resident’s discharge record lacked a discharge summary, med rec, and post-discharge plan of care. The DON and DSD confirmed the missing documentation, and the facility policy listed these items as required discharge documentation.
Improper Disposal of Non-Controlled Medication: An LPN was observed disposing of Aspirin EC 81 mg in a sharps container attached to the med cart instead of the facility’s approved pharmaceutical waste container. The LPN confirmed being unsure of the facility’s medication disposal policy, and the DON stated the facility has a receptacle in the med room for wasting medication.
Failure to Apply Ordered Right Palm-Wrist Splint: A resident with contractures and decreased mobility was repeatedly observed without a right palm-wrist splint, with the right hand resting in a fisted position. Although a bedside sign directed staff to apply the splint in the morning and remove it at bedtime, the chart lacked a current order for the right splint, and the POC task incorrectly listed the left wrist. The DON confirmed no order existed for the right splint, while the Rehab Director stated OT had discharged the resident with an intervention for daily right palm-wrist splint use.
Delayed Provider Review of Pharmacist Medication Recommendation A resident’s monthly pharmacy MRR identified a recommendation to consider gradual dose reduction of olanzapine to reduce fall risk, but the physician response was not documented within the required timeframe. Facility policy required the attending practitioner to review and respond to pharmacist recommendations within 5 business days unless state law required a shorter timeline, and the response was entered much later. The Administrator confirmed the finding.
Medication administration observations found an error rate above 5% after 3 of 27 administrations were in error. An LPN prepared and nearly gave one resident another resident’s meds after placing them on the wrong bedside table, and the same LPN did not prime an insulin pen before giving a scheduled Humalog dose to another resident. The LPN confirmed both observations.
Surveyors found an expired Glucagon on one med cart and observed an opened insulin pen for a resident that was not labeled with a date opened or open expiration date; an LPN confirmed the findings and administered the resident’s scheduled Degludec dose from that pen. Surveyors also found an opened inhaler for another resident on a second med cart without a date opened or open expiration date. Facility policy required opened meds to be dated and expired items removed from active supply.
Failure to Maintain Resident Humidifier: A resident had a bedside humidifier plugged in and in use without documented physician orders or a care plan for its use and maintenance. Staff confirmed the unit had been at the bedside for months, was not cleaned or maintained by the night LPN, and showed standing water with a light tan film in the base; there was also no indication of maintenance inspection.
Residents were unable to access their personal funds during evenings and weekends because staff did not have access to petty cash outside of regular business hours, despite facility policy stating such access should be available.
The facility did not submit complete and accurate direct care staffing information to CMS for Fiscal Quarter 3, 2024. A review of the Payroll Based Journal Staffing Data Report showed the data was missing, which was confirmed by the Business Office Manager.
The facility did not have an RN on duty for 8 consecutive hours on three separate days, as required. This was confirmed by the scheduler and the DON, who was on call but not physically present during these times.
The facility did not follow antibiotic use protocols, failing to monitor, track, and review antibiotic use for 9 out of 12 months. From November 2023 to May 2024 and September 2024 to present, there was no documentation of antibiotic tracking. The Infection Prevention staff confirmed the lack of monitoring, and the facility's policy on Antibiotic Stewardship was not adhered to, resulting in the deficiency.
The facility failed to maintain a hoyer lift according to the manufacturer's instructions, as revealed by interviews with staff and a review of the lift's manual. The Maintenance Director admitted to not performing routine inspections or maintenance, and LNAs reported difficulties in maneuvering the lift. The manual specified regular inspections and maintenance, which were not conducted, leading to the deficiency.
A resident fell during a mechanical lift transfer, bumping their head, but the incident was not reported to the SSA as required. The facility's Administrator was unaware of the event until it was highlighted during an interview, and no investigation documentation was available.
A resident fell from a hoyer lift during a transfer, resulting in a slight head bump. The incident was reported to the DON, but the facility failed to investigate or document the event, contrary to its policy requiring thorough investigation and documentation of accidents.
A resident fell and hit their head during a transfer with a hoyer lift, but the facility failed to perform the required neurological assessments. Despite obtaining an order for 72-hour neuro checks, there was no documentation of these assessments being conducted, as confirmed by the facility's administrator. This oversight violated the facility's policy for monitoring residents with head injuries.
A facility failed to identify trauma triggers for a resident with PTSD, potentially leading to re-traumatization. Despite a care plan addressing behaviors like crying and withdrawal, no specific triggers were identified in the resident's records, including the Generations Psychiatry Progress Note and Social Services assessment. Behavior monitoring showed the resident exhibited behaviors such as grouchy, swearing, and shrieking when moved. The facility's administrator confirmed the lack of identified PTSD triggers.
A facility failed to document a Gradual Dose Reduction (GDR) or its clinical contraindication for a resident on Seroquel. Despite a recommendation for GDR by a Pharmacy Consultant, the provider declined without documenting clinical appropriateness. The last GDR attempt was in 2021, and no recent documentation supported the continued dosage. The DON confirmed the lack of documentation.
A facility failed to follow CDC guidance for PPE under Enhanced Barrier Precautions (EBP) for a resident with an indwelling catheter. There was no signage or PPE provided, and an LNA provided care without PPE, unaware of the EBP status. The resident had orders for a urinary catheter, EBP, and Ciprofloxacin for a UTI. Interviews confirmed the resident was not on EBP.
The facility failed to provide two residents with the Skilled Nursing Facility (SNF) Advance Beneficiary Notice (ABN) for services not covered by Medicare. Both residents were discharged from Medicare services but remained in the facility without receiving the required SNF ABN Form CMS-10055 notice. The Director of Social Services confirmed the oversight during an interview.
Failure to Document Informed Consent for Psychotropic Medication
Penalty
Summary
The facility failed to inform a resident or the resident's representative of the risks and benefits of psychotropic medication use for 1 of 6 residents reviewed for unnecessary medications. Resident #18 had physician orders dated 10/28/25 for Depakote Sprinkles 125 mg delayed release capsules, with instructions to give 500 mg by mouth daily for bi-polar with psychosis, hold for sedation, and 750 mg in the evening for bi-polar with psychosis. Review of the medical record on 12/3/25 found no documentation that the resident or the resident representative had been informed of the risks and benefits of this medication. The DON confirmed the findings during interview, and the facility policy stated that prior to initiating or increasing a psychotropic medication, the resident, family, and/or resident representative must be informed of the benefits, risks, and alternatives and that this information must be documented.
PRN Antipsychotic Order Continued Without Required Physician Evaluation
Penalty
Summary
The facility failed to ensure that a PRN order for an antipsychotic medication was limited to 14 days and was not renewed without an evaluation by the attending physician or prescribing practitioner for Resident #2. Review of the resident’s December 2025 MAR showed an order for Quetiapine Fumarate 25 mg by mouth every 12 hours as needed for psychosis, with a start date of 10/23/25. Record review found no documentation from the physician showing an evaluation of the medication’s appropriateness to justify continuation after 14 days. During interview, the DON confirmed these findings. The facility policy titled Use of Psychotropic Medications, dated 2025, stated that PRN orders for psychotropic medications, excluding antipsychotics, are limited to no more than 14 days unless the attending physician or prescribing practitioner believes it is appropriate to extend the order beyond 14 days and documents this in the medical record.
Missing Discharge Documentation
Penalty
Summary
The facility failed to ensure that a documented discharge summary was completed for one of three closed records reviewed, Resident #6. Review of the resident’s medical record on 12/3/25 showed no documentation of a discharge summary, medication reconciliation, or a post-discharge plan of care after the resident was discharged on 12/1/25. Staff C, the DON, confirmed these missing records during interview on 12/3/25, and Staff D, the DSD, also confirmed there was no documentation of a discharge summary, medication reconciliation, or a post-discharge plan of care. The facility policy titled Documentation Requirements at Time of Resident Discharge listed discharge summary, medication reconciliation, follow-up care instructions, communication and notification, and transfer/transport documentation as required elements.
Improper Disposal of Non-Controlled Medication
Penalty
Summary
The facility failed to dispose of a medication in a proper receptacle during observation of medication administration. During observation on 12/3/25 at approximately 7:20 a.m., Staff A, an LPN, disposed of Aspirin EC 81 mg in the sharps container attached to the medication cart. When interviewed at that time, Staff A confirmed the finding and stated he/she was unsure of the facility policy for medication disposal. Later that morning, the DON stated that the facility has a receptacle in the medication room for wasting medication. Review of the facility's undated Medication Wasting Policy stated that non-controlled medications are to be rendered non-retrievable by placing them in the facility's approved pharmaceutical waste container.
Failure to Apply Ordered Right Palm-Wrist Splint
Penalty
Summary
The facility failed to provide services to maintain or prevent a decrease in range of motion and mobility for one resident observed for mobility and positioning. Resident #20 was observed in a wheelchair without a splint on the right hand, and the right hand was resting in a fisted position. A sign near the bed stated to put on the resident’s palm splint in the morning and remove it before bed, but the resident was not wearing the splint during multiple observations in the room, while self-propelling to the dining room, and while seated near the nurse’s station. Record review showed the resident had a care plan for risk for pain, decreased mobility, and skin breakdown related to contractures, with an intervention for splint/braces as per physician order. However, there was no current physician order for application or removal of a right palm-wrist splint. The point of care task for the past 30 days listed a wrist splint task for the left wrist, not the right, and it was documented as applied four times. The DON confirmed there was no order for the right palm-wrist splint, and the Rehab Director stated the resident had been discharged from OT with an intervention to apply a right palm-wrist splint daily for the entire day, confirming the task was entered for the right hand and not the left.
Delayed Provider Review of Pharmacist Medication Recommendation
Penalty
Summary
The facility failed to ensure that the provider reviewed pharmacist-identified irregularities within the required timeframe for 1 of 5 residents reviewed for unnecessary medications, Resident #1. The facility policy stated that pharmacist recommendations and identified irregularities must be reviewed by the attending practitioner and addressed within the required regulatory timeframe, with practitioner response required within 5 business days unless state law requires a shorter timeline. Review of the monthly Omnicare consultation report for Resident #1 showed a pharmacist recommendation on 6/20/25 to consider gradual dose reduction of olanzapine to reduce fall risk, but the physician response was not entered on the consult form until 8/12/25. The Administrator confirmed these findings during interview.
Medication Error Rate Exceeded 5% During Observed Administration
Penalty
Summary
The facility failed to ensure a medication error rate of less than 5% after 3 of 27 observed medication administrations were found to be in error, resulting in an 11.11% error rate. During observation of medication administration to Resident #29, Staff A, an LPN, prepared medications for another resident and carried Metoprolol Succinate ER 50 mg and Vitamin E 200 units into the room. Staff A placed those medications on Resident #29’s bedside table, spoke with Resident #29, obtained an oxygen saturation level, and then stated, “Here is your morning medication.” Staff A was stopped before the medications were given. Staff A later confirmed the observation and stated, “I wish it had A or B next to their names.” During observation of Resident #33’s Humalog insulin pen administration, Staff A did not prime the insulin pen before dialing the ordered 4-unit dose. Staff A confirmed the observation. The resident’s MAR showed an order for Humalog KwikPen 100 units/mL to be given per sliding scale, and the manufacturer’s instructions stated the pen must be primed before each injection because failure to prime may result in too much or too little insulin. The report also states there were 3 medication errors out of 27 medication administration opportunities.
Expired and Unlabeled Medications Found on Medication Carts
Penalty
Summary
The facility failed to ensure that drugs and biologicals were labeled in accordance with accepted professional principles when surveyors observed an expired Glucagon on the North Medication Cart and an opened Degludec insulin pen for Resident #16 that was not labeled with a date of opening or an open expiration date. During the medication cart observation, Staff A, an LPN, confirmed the findings and also administered Resident #16’s morning dose of Degludec from the unlabeled insulin pen. Resident #16’s MAR showed the Degludec insulin was ordered as 36 units subcutaneously each morning for DMII. The facility also failed to ensure that medications with a shortened shelf life were labeled with an opening date during observation of the South Medication Cart, where an opened Fluticasone Salmeterol inhaler for Resident #7 was found without a date of opening or an open expiration date. Staff A confirmed the finding during the medication administration observation. The manufacturer instructions reviewed for Glucagon, Degludec insulin, and Fluticasone Salmeterol inhaler described expiration or shortened-use timeframes after opening, and the facility policy required opened multi-use vials to include the date opened and expired items to be immediately removed from active medication supply.
Failure to Maintain Resident Humidifier
Penalty
Summary
The facility failed to maintain a bedside humidifier in accordance with the manufacturer’s instructions for 1 resident. Observation of the resident’s room showed a humidifier plugged into the wall at the bedside. Staff later confirmed that the humidifier had been brought in by the resident’s family and had been present at the bedside since September 2025, and that the night nurse did not clean or maintain it. When the humidifier was re-observed, it contained approximately 1/4 to 1/2 inch of water with a light tan film in the base, and there was no indication that maintenance had inspected it. The Director of Nursing stated that use of a bedside humidifier required a maintenance safety check, a cleaning schedule, and physician orders for use and maintenance. Review of the resident’s medical record showed no care plan and no physician order for the humidifier’s use and maintenance. The facility’s policy required physician/prescriber orders or care plan authorization, daily cleaning and maintenance, and inspection of electrical equipment before use. The manufacturer’s manual also directed that the unit be cleaned, with excess water poured out and the base washed, and noted that descaling may be needed weekly or every other week depending on usage and water type.
Failure to Provide Resident Access to Personal Funds During Off-Hours
Penalty
Summary
The facility failed to ensure that residents had access to their personal funds during off business hours. Review of the facility's Resident Petty Cash Policy indicated that procedures were in place to allow residents access to their funds during evenings and weekends through designated staff such as charge nurses or supervisors. However, interview with the Business Office Manager revealed that, in practice, residents could only request cash during regular business hours, as staff did not have access to the facility's petty cash during evenings or weekends. This resulted in residents being unable to access their personal funds outside of standard business hours, despite the facility managing personal accounts for 25 residents.
Failure to Submit Staffing Data to CMS
Penalty
Summary
The facility failed to submit complete and accurate direct care staffing information to the Centers for Medicare & Medicaid Services (CMS) for Fiscal Quarter 3, covering the period from April 1, 2024, to June 30, 2024. A review conducted on October 20, 2024, of the facility's Payroll Based Journal Staffing Data Report for this quarter revealed that the data was not submitted. This finding was confirmed during an interview on October 22, 2024, with the Business Office Manager, Staff F.
Failure to Ensure RN Coverage
Penalty
Summary
The facility failed to ensure that a Registered Nurse (RN) was on duty for 8 consecutive hours a day, 7 days a week, as required. This deficiency was identified for 3 out of 30 days reviewed between September 15, 2024, and October 20, 2024. Specifically, on September 15, September 28, and October 13, 2024, there were no RN hours documented as worked. This was confirmed through interviews with the facility's scheduler and the Director of Nursing (DON). The DON stated that he/she was on call every other weekend when there was no RN working but was not physically present in the building for the required 8 consecutive hours.
Failure to Monitor and Track Antibiotic Use
Penalty
Summary
The facility failed to adhere to antibiotic use protocols by not implementing a system to monitor, track, and review antibiotic use for 9 out of 12 months reviewed. Specifically, from November 2023 through May 2024 and again from September 2024 to the present, there was no documentation of antibiotic tracking. An interview with the Infection Prevention staff confirmed the absence of monitoring and tracking, including documentation that antibiotics met criteria for use. The facility's policy on Infection Control - Antibiotic Stewardship, revised in February 2022, outlines the need for an Antibiotic Stewardship Program (ASP) team to be accountable for reviewing infections, monitoring antibiotic usage patterns, and reporting on antibiotic prescriptions and residents treated each month. However, these procedures were not followed, leading to the deficiency.
Failure to Maintain Hoyer Lift as per Manufacturer's Instructions
Penalty
Summary
The facility failed to maintain resident care equipment according to the manufacturer's instructions for the hoyer lift. During an interview, the Maintenance Director, Staff J, admitted that the legs on the hoyer lift were difficult to open and that no routine inspections or maintenance had been performed on the lift since their employment began four months ago. Staff J also confirmed the absence of any documentation indicating that the hoyer lift had been maintained, inspected, or repaired at any time, despite the lift being over a year old and requiring routine inspection and maintenance. Further interviews with two Licensed Nursing Assistants (LNAs), Staff K and Staff L, revealed that the hoyer lift was difficult to maneuver and wobbly when in use with a resident. A review of the hoyer lift manual indicated that after the first year of use, specific components of the lift should be inspected every three to six months for wear and tightness, with replacements made if necessary. Additionally, the manual specified that for institutional use, the lift and all components should be inspected or adjusted monthly. The facility's failure to adhere to these maintenance guidelines led to the deficiency.
Failure to Report Resident Fall Incident
Penalty
Summary
The facility failed to report an alleged violation of neglect to the State Survey Agency (SSA) concerning a resident who experienced a fall during a mechanical lift transfer. The incident occurred when the resident was being transferred from a wheelchair to a bed using a hoyer lift, resulting in the resident being lowered to the floor after bumping their head against a window sill. Despite the incident being documented in the resident's medical record, the facility's Administrator was unaware of the event until it was brought to their attention during an interview. The facility's policy requires the Administrator and/or Director of Nursing to ensure state reporting occurs within required time frames, but no documentation of an investigation or report to the SSA was provided.
Failure to Investigate Resident Fall from Hoyer Lift
Penalty
Summary
The facility failed to thoroughly investigate an alleged incident of neglect involving a resident who fell from a hoyer lift. The incident occurred approximately six weeks prior to the surveyor's interview with the resident, who reported falling during a mechanical lift transfer. The resident's medical record included a provider note indicating that the resident had an accidental fall during a transfer, resulting in a slight bump to the head. However, the facility's administrator was unaware of the incident and could not provide documentation of an investigation. Further interviews revealed that a Licensed Nursing Assistant and another staff member were involved in the transfer when the resident began flailing, causing the lift to tip. The staff reported the incident to the Director of Nursing, who was present at the time, but no written statement was requested from the staff involved. The facility's policy requires that all accidents and incidents be reviewed and investigated by the Administrator, DON, or designee, including conducting witness interviews and documenting the root cause. The lack of documentation and investigation indicates a failure to adhere to these policies.
Failure to Perform Neurological Assessments After Resident Fall
Penalty
Summary
The facility failed to perform neurological assessments after a resident fell and hit their head. This deficiency was identified for one out of three residents reviewed for falls in a sample of 15 residents. The incident involved a resident who fell while being transferred with a hoyer lift, resulting in a head injury. Although the provider was notified and an order was obtained to conduct neurological checks for 72 hours, there was no electronic documentation indicating that these assessments were performed. An interview with the facility's administrator confirmed the absence of documentation for the required neurological assessments following the fall. The facility's policy mandates that residents with head injuries be observed for neurological abnormalities, but this was not adhered to in this case.
Failure to Identify PTSD Triggers for a Resident
Penalty
Summary
The facility failed to identify trauma triggers for a resident diagnosed with Post Traumatic Stress Disorder (PTSD), which could potentially lead to re-traumatization. The resident's diagnosis of PTSD was confirmed through a record review, and the Minimum Data Set Assessment indicated PTSD as a current diagnosis. Despite having a care plan for behaviors such as crying, withdrawal, and lack of appetite associated with PTSD, no specific triggers were identified. Additionally, the Generations Psychiatry Progress Note and Social Services assessment did not list any PTSD triggers. Behavior monitoring records showed the resident exhibited behaviors like grouchy, swearing, and shrieking when moved. An interview with the facility's administrator confirmed the absence of identified PTSD triggers for the resident.
Failure to Document Gradual Dose Reduction for Psychotropic Medication
Penalty
Summary
The facility failed to ensure that a resident taking psychotropic medication received a Gradual Dose Reduction (GDR) or documented if the GDR was clinically contraindicated. The resident was prescribed Seroquel 50 mg, to be taken three times a day. A Pharmacy Consultant Report recommended a GDR for the Seroquel, but the provider declined the recommendation without providing documentation of continued clinical appropriateness. The Generations Geriatric Psychiatry Progress Note indicated that the last GDR attempt was in May 2021, and suggested considering a medication decrease in the future, but did not document the clinical appropriateness of continuing the current dosage. The Director of Nursing confirmed the absence of documentation for a GDR attempt or its clinical contraindication.
Failure to Implement Enhanced Barrier Precautions
Penalty
Summary
The facility failed to adhere to CDC guidance for wearing Personal Protective Equipment (PPE) under Enhanced Barrier Precautions (EBP) for a resident with an indwelling catheter. During an observation, it was noted that there was no signage indicating the resident was on EBP, nor was PPE provided for care. A Licensed Nursing Assistant (LNA) was observed performing care without PPE. The LNA later confirmed they were unaware of the EBP status. A review of the resident's active orders showed an order for a urinary catheter and EBP, as well as an order for Ciprofloxacin for a Urinary Tract Infection (UTI). Interviews with the Director of Nursing and Infection Prevention staff confirmed the resident was not on EBP.
Failure to Provide SNF ABN Notices to Residents
Penalty
Summary
The facility failed to inform two residents and/or their representatives about the Skilled Nursing Facility (SNF) Advance Beneficiary Notice (ABN) for services not covered by Medicare. Resident #135 was discharged from Medicare services on June 28, 2024, but remained in the facility without receiving the SNF ABN Form CMS-10055 notice prior to the discharge from Medicare Part A services. Similarly, Resident #136 was discharged from Medicare services on May 3, 2024, and also remained in the facility without receiving the required notice. An interview with the Director of Social Services confirmed that the SNF ABN Form CMS-10055 was not completed for these residents. This oversight was identified during a review conducted on October 20, 2024, which highlighted the facility's failure to ensure proper notification regarding potential liability for services not covered by Medicare.
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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 Goffstown
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Hillsborough County Nursing Home | 1.2 mi | ★★★★★ | 5 | 0 |
| Hackett Hill Healthcare Center | 3.5 mi | ★★★★★ | 5 | 0 |
| Courville At Manchester | 4.5 mi | ★★★★★ | 12 | 1 |
| Bedford Nursing & Rehabilitation Center | 4.5 mi | ★★★★★ | 7 | 1 |
| Maple Leaf Health Care Center | 5.2 mi | ★★★★★ | 2 | 0 |
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