Below average — CMS composite of the measures below.
The next survey window likely opens around March 2027
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Hackett Hill Healthcare Center during CMS and state inspections, most recent first.
Water Management Plan Deficiencies: The facility’s WMP did not accurately describe the water system, identify all Legionella-prone areas, or define control limits and monitoring for hot water, dead legs, holding tanks, and PTAC/HVAC units. Staff interviews and observations showed inconsistent documentation of boiler and tank temperatures, undocumented flushing of six dead legs and water holding tanks, and PTAC cleaning logs that did not identify which units were serviced.
Medication administration standards were not followed for two residents. One resident received multiple doses of metoprolol succinate ER and Enestro even when recorded BP values were below the ordered hold parameters, and the DON confirmed the MAR findings. For another resident, an LPN marked Bupropion HCl as given in the EMAR even though the tablet was not placed in the medication cup, then administered the remaining medications without verifying the cup contents.
A resident’s left toenails were observed to be thick and elongated, and the resident was unsure when podiatry care had last occurred. Staff confirmed the resident had last been seen by podiatry months earlier, and the resident was not on the podiatry schedule when the podiatrist last visited the facility. The DON confirmed the findings, and the facility policy required referral to qualified professionals for needed foot care.
A resident admitted with a right groin wound did not receive physician-ordered wound care because no treatment orders were transcribed or implemented at admission. The wound went untreated for seven days, resulting in deterioration and subsequent hospitalization for surgical debridement.
A wound nurse did not consistently perform hand hygiene or use required PPE during a dressing change for a resident on Enhanced Barrier Precautions. The nurse failed to clean hands between glove changes, did not perform hand hygiene after removing gloves and gown, and did not don a gown when returning to complete wound care, contrary to facility policy and CDC guidelines.
Two residents were prescribed psychotropic medications for anxiety without documented consent regarding the risks and benefits of these medications, as required by facility policy. This was confirmed by the Clinical Lead and through review of medical records.
Three residents experienced deficiencies in care when staff failed to follow professional standards: a LPN administered insulin based on an outdated CBG result, a resident received IV antibiotics without a specified infusion rate or proper labeling, and another resident had a dressing applied without a physician's order or date.
Staff failed to disinfect a glucometer between use on two residents during blood glucose testing and did not use required PPE, including a gown and face shield, when accessing a resident's PICC line. These actions were not in accordance with facility infection control policies and Enhanced Barrier Precautions.
A resident's CPAP machine components, including the head strap and tubing, were found to be discolored and in disrepair, with staff confirming that these parts had not been replaced since the resident's admission. This occurred despite orders and manufacturer instructions requiring regular replacement of deteriorated equipment.
Two residents who remained in the facility after Medicare coverage ended were not given written notice detailing the specific items, services, and associated charges for which they could be held financially responsible. Instead, the facility provided only a general 'Medicaid Rate' without itemizing costs, and this practice was confirmed by the Clinical Care Coordinator.
A hospice agency and facility failed to provide coordinated services for a resident, resulting in discrepancies between the care plan and actual services. The lack of communication and coordination led to missed hospice visits and unavailability of nursing assistants and volunteers.
The facility failed to maintain a medication error rate below 5%, with errors involving improper insulin administration for a resident and incorrect administration route for another resident's medication, resulting in a 10.34% error rate.
The facility failed to label open injectable medications according to manufacturer's instructions and did not monitor refrigeration temperatures daily for medication storage. Open Lantus Insulin Pen and Tuberculin Purified Derivative were found without open or expiration dates, and several days of temperature logs were missing.
A resident with Bilateral Hearing Loss did not receive necessary treatment after an audiology visit revealed excessive ear wax, making it difficult to determine the degree of hearing loss. Despite recommendations for a medical consult, no further treatment was provided.
Water Management Plan Deficiencies
Penalty
Summary
The facility failed to provide and implement an infection prevention and control program because its water management plan did not accurately describe the facility’s water system, did not identify all specific areas where Legionella and other opportunistic waterborne pathogens may grow, did not outline control measures to prevent such growth, and did not establish monitoring procedures with defined acceptable ranges. Review of the water management plan showed that it stated water flowed through boilers and was heated to 142 plus degrees, but it did not specify Fahrenheit or Celsius and did not identify how many boilers there were or where water flowed from each boiler. The plan also stated that on the domestic side water was delivered to a mixing valve and then to faucets and showers at 105 to 120 degrees, but again did not specify units. The plan identified dead legs and hot water holding tanks as areas subject to Legionella, but it did not describe the locations of the dead legs, the number of hot water holding tanks, or where water flowed from each holding tank. The control measures section stated that hot water temperatures were monitored weekly at point of delivery on the commercial side, washing machine, dish machine, three-bay sinks, and random domestic faucets and showers, but it did not specify acceptable temperature ranges and did not include monitoring of the water holding tanks. There were no control measures listed for dead legs. The control measure for HVAC/PTAC units was to inspect and change filters every three months, and the control measure for hot water holding tanks was to flush the tanks monthly, but it did not indicate temperature monitoring or acceptable ranges. Staff interviews and observations showed that the Infection Preventionist was not involved in reviewing the control measures in the water management plan, while the Maintenance Director was responsible for implementing them. The Maintenance Director stated that the boilers were operating at 180 degrees Fahrenheit and the water holding tanks were at 160 degrees Fahrenheit, initially said there were no dead legs, then later clarified that the facility had six dead legs. He/she reported flushing the water holding tanks weekly and flushing the six dead legs weekly without documenting either activity. Observation identified a boiler in the mechanical room behind the main kitchen at 180 degrees Fahrenheit, a water holding tank in the chemical storage room with no temperature gauge, another water holding tank in the room between the chemical storage room and laundry room with three temperature gauges none above 140 degrees Fahrenheit, and two boilers in the room next to the rehabilitation room reading 180 degrees Fahrenheit when the pump was on. Weekly temperature logs from January through April 2026 contained missing temperatures and locations for boilers and water holding tanks, and flushing logs did not document dead legs being flushed weekly. PTAC cleaning logs also did not identify which units were cleaned or how many, although staff stated there were six PTAC units in the facility.
Medication Administration Errors and Failure to Verify Ordered Doses
Penalty
Summary
The facility failed to follow professional standards for medication administration for Resident #43 and Resident #56. For Resident #43, review of the April 2026 MAR showed physician orders for Metoprolol Succinate ER 50 mg twice daily and Enestro 49-51 mg twice daily, both with instructions to hold the medication for systolic blood pressure less than 110 or heart rate less than 60. The MAR showed multiple morning and evening doses were administered even though the recorded blood pressures were below the ordered hold parameters. The DON confirmed these findings during interview, and the facility policy required staff to review and confirm medication orders before administration. For Resident #56, during medication administration observation, an LPN prepared the resident’s 9:00 a.m. Bupropion HCl 75 mg dose but did not place the tablet into the medication cup, yet still marked the medication as given in the EMAR. The LPN then locked the cart, did not verify that all scheduled medications were in the cup, and proceeded to the resident’s room. The LPN later confirmed the dose was not in the medication cup and stated the medications were being prepared for administration without the Bupropion dose. The LPN also administered the medications without double-checking the contents of the cup before handing them to the resident. The facility policy required medications to be verified three times before administration.
Failure to Ensure Proper Foot Care
Penalty
Summary
The facility failed to ensure proper foot care for Resident #18, whose left toenails were observed to be thick and elongated during surveyor observation. The resident was unsure when they had last been seen by a podiatrist. Staff later confirmed the toenails were still thick and elongated and stated the resident had last been seen by a podiatrist on 9/25/25, with the podiatrist last visiting the facility on 12/29/25. Review of the podiatry note from 9/25/25 stated that non-professional treatment is hazardous to the patient and that recall should occur as medically necessary but no sooner than 60 days. Review of the podiatry schedule for 12/29/25 showed the resident was not listed to be seen. The DON confirmed these findings, and the facility policy stated that residents with complicating disease processes requiring foot care must be referred to qualified professionals and that the center is responsible for assisting with appointments and transportation.
Failure to Obtain and Implement Admission Orders for Wound Care
Penalty
Summary
A deficiency occurred when a resident was admitted with a puncture wound to the right groin, but no physician's orders for wound treatment were obtained at the time of admission. The resident's clinical admission assessment documented the presence of the wound, and the hospital discharge summary included instructions for daily wound care. However, a review of the admission orders and the Treatment Administration Record (TAR) showed that no wound treatment orders were transcribed or carried out for the right groin wound. As a result, the resident went seven days without any wound treatment after admission. During a vascular surgery follow-up appointment, it was noted that the dressing had not been changed, and the wound had deteriorated, showing signs of dehiscence, maceration, slough, and seroma drainage. This led to the resident being hospitalized for surgical debridement. The Director of Nursing confirmed that the wound had not been treated during this period.
Failure to Follow Hand Hygiene and PPE Protocols During Wound Care
Penalty
Summary
Staff failed to adhere to infection prevention and control protocols during a dressing change for a resident under Enhanced Barrier Precautions (EBP). The wound nurse performed hand hygiene and donned gloves and a gown before starting the dressing change. However, after removing the initial wound dressing, the nurse changed gloves without performing hand hygiene in between. Following wound cleansing, the nurse removed their gown and gloves, exited the room, and did not perform hand hygiene before retrieving additional supplies from the treatment cart. Upon returning to the resident's room, the nurse performed hand hygiene and donned gloves but did not put on a gown before applying treatment and a new dressing to the wound. These actions were confirmed by the nurse during an interview. Review of facility policies and CDC guidelines indicated that hand hygiene should be performed before donning gloves, immediately after glove removal, and that gowns and gloves are required for high-contact activities such as wound care under EBP.
Failure to Obtain Consent for Psychotropic Medication Use
Penalty
Summary
The facility failed to inform two residents or their representatives about the risks and benefits associated with the use of psychotropic medications. For one resident, a physician's order for Ativan (Lorazepam) was initiated for anxiety, but there was no documentation of consent for the medication's use. Similarly, another resident was prescribed Buspirone HCL for anxiety, and again, no documentation of consent was found in the medical record. These findings were confirmed by the Clinical Lead during an interview. Review of the facility's policy indicated that consent should be obtained when a medication is ordered for behavioral symptoms, but this was not followed in these cases.
Failure to Follow Professional Standards in Medication and Treatment Administration
Penalty
Summary
The facility failed to follow professional standards of care for three residents. For one resident, a LPN administered insulin based on a capillary blood glucose (CBG) result that was obtained by a nurse on the previous shift and recorded on a piece of paper, rather than performing the CBG immediately prior to insulin administration as required by the physician's sliding scale order. The nurse practitioner confirmed that CBGs should be performed closer to the time of administration or meals when using a sliding scale for insulin. For another resident, a review of physician orders for intravenous Ertapenem revealed that the order did not specify an infusion rate. Observation showed an IV bag in the resident's room with only a handwritten label and no pharmacy label or infusion rate indicated. Additionally, a third resident was found to have a dressing applied to the lower left thigh without a corresponding physician's order, and the dressing was undated. The nurse who applied the dressing confirmed that it was done without an order, and the treatment administration record did not show an active order for this intervention.
Failure to Follow Infection Control Policies for Glucometer Disinfection and PPE Use
Penalty
Summary
Staff failed to follow infection prevention and control policies in two separate instances. In the first instance, a Medication Nursing Assistant was observed moving between two residents' rooms to perform capillary blood glucose (CBG) testing without disinfecting the glucometer between uses. The staff member carried the glucometer and supplies in a cup but did not have cleaning or disinfecting wipes, and confirmed during interview that the device was not disinfected between residents, contrary to facility policy and manufacturer instructions which require cleaning with an EPA-approved disinfectant before and after each use. In the second instance, a Registered Nurse accessed a resident's Peripherally Inserted Central Catheter (PICC) line without wearing a face shield or protective gown, as required by the facility's infection control standards and Enhanced Barrier Precautions (EBP) policy. The nurse confirmed not using the required personal protective equipment (PPE), and the facility's Infection Preventionist also confirmed that PPE should have been worn during this procedure. The resident involved had a PICC line, which is considered an indwelling medical device, and the policy specifies the use of gown, gloves, and face protection for such care activities.
Failure to Maintain and Replace CPAP Equipment per Manufacturer Instructions
Penalty
Summary
The facility failed to maintain patient care equipment according to the manufacturer's instructions for a resident receiving respiratory care. The resident reported that parts of their Continuous Positive Airway Pressure (CPAP) machine, specifically the headpiece, needed replacement and that no assistance had been provided. Observation confirmed that the head strap was discolored and in disrepair, and the tubing was yellowed. Staff interviews verified that the face mask, tubing, and headgear had not been changed since the resident's admission in July 2024. Review of the treatment order indicated that CPAP supplies were to be changed or cleaned per manufacturer’s instructions, and the manufacturer’s guidelines specified that visibly deteriorated components should be replaced. Despite this, the equipment had not been replaced as required.
Failure to Provide Written Notice of Charges After Medicare Coverage Ends
Penalty
Summary
The facility failed to provide written notice to residents and/or their representatives regarding the specific items and services offered, the charges for those services, and the amount of those charges when Medicare coverage ended and the residents remained in the facility. For two residents who were discharged from Medicare services but continued to reside in the facility, the required Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN) did not include a detailed list of services and associated costs. Instead, the facility listed only the 'Medicaid Rate' as the per day/item or service charge, without specifying the actual services or their individual costs. Record reviews confirmed that both residents' SNF ABNs lacked the necessary information about potential financial liability for non-covered services. An interview with the Clinical Care Coordinator verified that it was standard practice to write 'Medicaid Rate' rather than providing an estimated cost breakdown for items and services. This omission resulted in residents and their representatives not being properly informed, in writing, about the facility's charges and their potential financial responsibility after Medicare coverage ended.
Failure to Provide Coordinated Hospice Services
Penalty
Summary
The hospice agency and the facility failed to provide collaborative services for a resident receiving hospice care. The resident's care plan indicated that hospice nursing was to be provided 2-3 times a week and as needed, along with other services such as social work and volunteer visits. However, the hospice plan of care showed a different frequency of visits, and the medical record only documented sporadic nursing visits with no notes from other hospice services. Interviews with staff revealed a lack of communication and coordination between the hospice agency and the facility, resulting in discrepancies between the care plans and the actual services provided. The facility's policy requires that hospice services meet professional standards and that a coordinated plan of care be established and agreed upon. However, the hospice liaison admitted there was no communication regarding visit schedules, and the hospice agency did not have nursing assistants or volunteers available for the resident. This lack of coordination and communication led to the failure to provide the necessary hospice services as outlined in the resident's care plan and the hospice plan of care.
Medication Administration Errors
Penalty
Summary
The facility failed to ensure the medication error rate was not 5 percent or greater for two residents observed for medication administration. For Resident #24, a Licensed Practical Nurse (LPN) prepared and administered 16 units of Novolin N Insulin without following proper procedures. The LPN did not roll the insulin pen to ensure the correct dosage, did not prime the pen, and did not wait the required 5 seconds before removing the pen from the resident's abdomen. The resident's Medication Administration Record (MAR) confirmed the physician's order for 16 units of Novolin N Insulin and 81 mg of Aspirin for cardiac health. The manufacturer's instructions and the facility's procedure for insulin administration were not followed, as confirmed by the LPN during an interview. For Resident #41, another LPN administered Miralax Oral Powder through the resident's Jejunostomy tube, contrary to the physician's order to give it by mouth. The MAR confirmed the order for Miralax to be given orally for bowel management. The LPN confirmed the error during an interview. These errors contributed to a medication error rate of 10.34%, with 3 errors out of 29 medication administration opportunities.
Failure to Label and Monitor Medications Properly
Penalty
Summary
The facility failed to ensure that open injectable medications were labeled in accordance with the manufacturer's instructions. During an observation of the Webster Street Medication Cart, an open Lantus Insulin Pen was found without an open or open expiration date. This finding was confirmed by a Registered Nurse. The manufacturer's instructions for the Lantus Insulin Pen specify that it should be discarded 28 days after opening. Additionally, an open vial of Tuberculin Purified Derivative was found in the Derryfield Medication Room without an open or open expiration date, which was also confirmed by a Registered Nurse. The manufacturer's instructions for this medication state that vials in use for more than 30 days should be discarded due to possible oxidation and degradation affecting potency. The facility's policy requires that multi-dose vials be dated and discarded within 28 days unless otherwise specified by the manufacturer, which was not adhered to in these instances. Furthermore, the facility failed to monitor refrigeration temperatures daily for medication storage. A review of the medication refrigerator logs for March 2024 revealed missing temperature recordings on several dates. This was confirmed by a Registered Nurse. The facility's policy mandates that the temperature of medication storage areas be monitored at least once a day, which was not consistently followed. These deficiencies indicate lapses in the facility's adherence to its own policies and the manufacturer's instructions for medication storage and labeling.
Failure to Provide Treatment for Hearing Loss
Penalty
Summary
The facility failed to ensure that a resident received treatment for hearing loss. The resident, who was very hard of hearing and had a medical diagnosis of Bilateral Hearing Loss, reported having wax in their ears. An audiology visit revealed that the degree of hearing loss could not be determined due to excessive wax in both ear canals. Although some wax was removed, the resident could not tolerate further cleaning, and a medical consult was needed for wax removal orders. Despite these findings, the resident had not received any treatment after the audiology consult.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 214 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
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Manchester
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Courville At Manchester | 2.4 mi | ★★★★★ | 12 | 1 |
| Mount Carmel Rehabilitation And Nursing Center | 3.2 mi | ★★★★★ | 0 | 0 |
| Maple Leaf Health Care Center | 3.2 mi | ★★★★★ | 2 | 0 |
| Hillsborough County Nursing Home | 3.4 mi | ★★★★★ | 5 | 0 |
| Goffstown Nursing And Rehab Center | 3.5 mi | ★★★★★ | 18 | 0 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Hackett Hill Healthcare Center.
100% money-back within 48 hours.
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.