Below average — CMS composite of the measures below.
The next survey window likely opens around April 2027
Estimate from public CMS data, current as of August 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Mountain Ridge Center, Genesis Healthcare during CMS and state inspections, most recent first.
An LPN used one resident’s insulin pen to give insulin to another resident and then returned the pen to the cart, later using the same pen again after the error was discovered. In separate observations, the LPN did not perform hand hygiene between resident medication administrations, and another LPN did not clean and disinfect a shared glucometer before using it on a different resident. Facility policy and manufacturer guidance required single-patient use of insulin pens, hand hygiene during resident care, and disinfection of blood glucose meters after each use.
Resident Council concerns about call light response times were repeatedly raised over multiple meetings, but residents stated the issue had not been addressed and they were not informed of any actions taken. Meeting minutes documented ongoing complaints that call lights were not consistently responded to timely, and prior grievances reviewed for resolution were marked "No." The Administrator signed the minutes as received and reviewed and later confirmed the facility had not acted on the continued concerns.
Insulin was not administered per manufacturer instructions for a resident receiving Novolog insulin on a sliding scale for DM. During observation, an LPN used the insulin pen and held the plunger for about 4 seconds, and the LPN confirmed the observation. Manufacturer directions stated the needle should remain in the skin for at least 6 seconds and the button should stay fully pressed until the needle is removed to ensure the full dose is given.
An LPN gave one resident another resident’s Novolog after misidentifying the resident in the dining room, and the resident’s ordered insulin was not administered as prescribed. A second resident also received the wrong insulin when staff used another resident’s insulin pen; the record noted the resident was assessed for acute hypoglycemia. The MAR showed missed blood sugar checks and a held dose, and the provider was not notified.
Unlabeled insulin pens were found on a medication cart during observation with the DON. A resident's Novolog pen and another resident's Novolog and Lantus pens were not labeled with the patient or physician's name, which did not match the facility's insulin pen labeling policy.
A resident who requested a vegetarian diet was observed with chicken salad on the lunch tray despite the chart showing a low sodium/vegetarian diet and the meal ticket noting no pork and a vegetarian request. The Dietary Manager said the resident was only given the 2 gm sodium menu because of the diet order, and the RD stated the facility had a vegetarian menu that had not been provided to the resident.
The facility did not provide enough nursing staff to meet resident care needs, often assigning LNAs on light duty as full-duty staff and resulting in inadequate coverage for tasks such as showers, transfers, and timely response to call lights. Staff and residents reported long waits for care, missed showers, and frequent closure of the dining room due to insufficient staffing, with some residents left in bed or grouped together for meals.
Two residents did not receive care and services as ordered, including lack of administration of PRN bowel medications for constipation and failure to schedule or complete specialist referrals and diagnostic procedures for a resident with a non-healing wound. Staff interviews and record reviews confirmed these deficiencies, including missed appointments and lack of documentation of required interventions.
A resident experienced significant weight loss over a one-month period, with records showing consistently low meal intake and no documentation that the dietitian or physician was notified as required by the care plan. The last dietitian assessment was several months prior, and staff confirmed that necessary notifications regarding the resident's nutritional decline were not made.
Surveyors found that multiple opened inhalers on two medication carts were not labeled with open or expiration dates as required by manufacturer instructions and facility policy. LPNs confirmed the lack of labeling for inhalers such as Incruse Ellipta, Breztri, Spiriva, and Trelegy, resulting in a deficiency for improper medication labeling and storage.
A resident's urinalysis was delayed after the initial specimen was forgotten in the refrigerator and not sent to the lab, requiring recollection several days later. Staff interviews confirmed that such oversights occur frequently, resulting in delays in laboratory testing and treatment.
The facility's assessment did not include staffing needs for each resident unit, instead listing only overall RN/LPN and LNA hours for the entire census. The Administrator confirmed that unit-specific requirements were not considered.
The facility did not consistently include two residents and their DPOAs in care plan meetings, as required by policy. One DPOA had not been invited to a meeting in about two years, and another attended only one meeting since admission, with no documentation of additional meetings. Staff confirmed the lack of invitations and documentation.
A resident was administered PRN Morphine Sulfate multiple times despite documentation of a pain level of 0, contrary to physician orders specifying administration only for pain rated at 5/10 or higher. The Unit Manager confirmed the medication was given without clinical indication, representing a failure to follow professional standards for medication administration.
Surveyors found that expired IV antibiotics and opened, undated multi-dose vials of vaccines were stored in the medication room refrigerator. A nurse confirmed that the vials had been used and the antibiotics were expired, in violation of manufacturer instructions and facility policy requiring removal of outdated medications and proper dating of opened vials.
The facility did not maintain adequate nursing staff coverage for most days reviewed, leading to residents experiencing long waits for assistance with daily care, missed activities, and delays in responding to call bells. Staff, including LNAs, RNs, and the Infection Preventionist, frequently had to cover additional shifts and roles, and residents requiring extensive assistance were particularly affected by the staffing shortages.
The facility did not provide required Medicare beneficiary notices to two residents, including failing to give a NOMNC with 48-hour notice and not issuing SNF ABNs when coverage ended, as confirmed by record review and staff interview.
A facility failed to follow physician-ordered medication parameters for a resident's pain management. The resident's MAR indicated that Oxycodone 5 mg was administered multiple times without documenting the pain level, contrary to the physician's order requiring administration for pain rated 5/10 or greater. This was confirmed by the Unit Manager, highlighting a deviation from professional standards of care.
A facility failed to provide a resident with education and an offer for the Pneumococcal vaccine upon admission. The resident's medical record lacked documentation of immunization history, education, consent, or declination for the vaccine. An interview with the Infection Preventionist confirmed the oversight, which was against the facility's policy requiring vaccination history and administration for eligible adults.
Failure to Follow Infection Control Practices During Insulin Use, Hand Hygiene, and Glucose Monitoring
Penalty
Summary
The facility failed to ensure residents were protected from potential exposure to bloodborne pathogens when an LPN used one resident’s insulin pen to administer insulin to another resident. Resident #62 stated he/she received someone else’s insulin the prior afternoon. The LPN reported that on 5/27/26 he/she used Resident #70’s used Novolog pen to give a lunch dose to Resident #62, then returned the pen to the medication cart. Later that day, after being notified by the DON that the wrong resident had received insulin, the LPN stated the insulin pen was not removed from use and was later used again to administer Resident #70’s dinner dose before being returned to the cart. The EMAR showed an active order for Novolog Penfill Solution Cartridge 100 Unit and documentation of administration on 5/27/26 at 5:09 p.m. The facility also failed to follow infection control practices during medication administration and blood glucose monitoring. During observation, an LPN did not perform hand hygiene after administering medication to one resident before dispensing and administering medication to another resident, and confirmed this omission. In a separate observation, after testing one resident’s blood glucose with an EvenCare G2 meter, an LPN did not clean and disinfect the glucometer before using it on another resident, and confirmed the observation. The facility policies and manufacturer instructions reviewed by surveyors stated that hand hygiene is required before and after resident care and that blood glucose meters must be cleaned and disinfected after each use according to manufacturer instructions.
Resident Council Grievances Not Addressed
Penalty
Summary
The facility failed to act promptly on grievances and recommendations raised during Resident Council meetings regarding resident care. During an interview at the Resident Council Meeting, residents reported that call bell wait times had been a concern for the past 2 months and stated they did not feel the concern had been addressed or that they had been informed of any actions taken. Review of the Resident Council Meeting minutes showed repeated documentation that call lights were not consistently responded to timely, and the minutes for multiple months indicated that previous months' grievances reviewed for resolution was marked "No." The minutes were signed by the Administrator as received and reviewed, and the Administrator later confirmed that the facility had not acted upon the residents' continued concerns.
Insulin Pen Administration Did Not Follow Manufacturer Instructions
Penalty
Summary
The facility failed to ensure that insulin was administered per manufacturer instructions for one resident receiving Novolog Insulin (Aspart Insulin) ordered on a sliding scale before meals for diabetes mellitus. During observation of the resident’s insulin administration, an LPN injected the insulin pen and held the plunger for approximately 4 seconds. The LPN confirmed this during interview. Manufacturer instructions reviewed by surveyors stated to keep the needle in the skin for at least 6 seconds and keep the push-button pressed all the way in until the needle has been pulled out from the skin to ensure the full dose is given.
Insulin Given to Wrong Resident and Ordered Dose Missed
Penalty
Summary
The facility failed to ensure residents remained free from significant insulin medication errors for 2 of 2 residents reviewed. Resident #62 reported receiving another resident’s insulin the prior afternoon. The record showed Resident #62 had orders for Novolin 70/30 insulin 29 units subcutaneously at 8:00 a.m. and 25 units at 5:00 p.m., and the medication audit showed the 8:34 a.m. dose was administered as ordered. However, a provider note documented that nursing discovered the resident likely received another resident’s insulin with the same first name, and that the insulin given was rapid-acting rather than the resident’s usual BID 70/30 insulin. The resident was assessed for signs of acute hypoglycemia. For Resident #70, the May MAR showed Novolog sliding-scale insulin ordered before meals, but the 7:30 a.m. blood sugar was documented as NA and the insulin was held, and the 11:30 a.m. blood sugar was documented as 203 with 6 units administered. Review identified that this medication was administered to the wrong person. Staff B stated that while covering a shift for the first time, he/she used Resident #70’s Novolog pen to give 6 units to Resident #62 after asking another staff member who Resident #70 was and approaching Resident #62 in the dining room. Staff B also stated that Resident #70’s 7:30 a.m. and 11:30 a.m. blood sugars were not obtained, insulin was not administered as ordered, and the provider was not notified.
Unlabeled Insulin Pens on Medication Cart
Penalty
Summary
Medications were not labeled according to accepted professional principles on 1 of 3 medication carts observed. Review of the facility policy for insulin pens stated that insulin pens will be clearly labeled with the patient's name, physician name, and date used. During observation of the 200's medication cart with the DON, Resident #59's Novolog insulin pen (Insulin Aspart) was not labeled with the patient or physician's name. Resident #70's Novolog insulin pen (Insulin Aspart) and Resident #70's Lantus insulin pen (Insulin Glargine) were also not labeled with the patient or physician's name. The DON confirmed these findings during interview.
Failure to Honor Resident Vegetarian Diet Preference
Penalty
Summary
The facility failed to ensure that Resident #70’s diet preferences were followed. Resident #70 stated they were supposed to be on a vegetarian diet, and the medical record showed a nutritional assessment dated 3/3/26 documenting a low sodium diet/vegetarian per the resident’s request, along with a care plan intervention to honor food preferences within the meal plan. During observation on 5/28/26 at approximately 12:15 p.m., Resident #70 was seen in the main dining room with chicken salad on their plate for lunch. The resident’s meal ticket indicated 2 gm sodium, no salt packet, no pork, and requests vegetarian diet. The Dietary Manager stated the resident’s preference was for a vegetarian diet, but because of the 2 gm sodium order, the resident was only given the 2 gm sodium menu to choose from. The Regional Dietitian stated the facility did have a vegetarian menu, but it had not been provided to Resident #70.
Failure to Provide Sufficient Nursing Staff for Resident Care Needs
Penalty
Summary
The facility failed to provide sufficient nursing staff to meet the needs of all residents, as evidenced by record reviews, staff interviews, and direct observations. Staffing schedules showed that Licensed Nursing Assistants (LNAs) on light duty with lifting restrictions were counted as full-duty staff and assigned full workloads. On multiple occasions, there were shifts where only one LNA was present on a unit, or where two LNAs on light duty were scheduled together, resulting in inadequate coverage for the number of residents, including those requiring two-person assistance for transfers. Staff interviews consistently reported that the number of LNAs was insufficient to complete required tasks such as showers, transfers, and timely response to call lights, with some staff refusing to work due to unsafe staffing levels. Direct observations and staff accounts indicated that residents were not receiving necessary care, such as showers and assistance with transfers, due to the lack of available staff. Residents dependent on mechanical lifts or two-person assists often had to wait extended periods for care, and some were left in bed or in geriatric chairs for prolonged times. The dining room was frequently closed because of inadequate staffing, and residents were grouped together in rooms for meals instead. Staff also reported an increase in resident falls and that residents were missing outside specialist appointments and meaningful activities because there were not enough staff to assist them. Resident council minutes and interviews with residents confirmed ongoing concerns about insufficient staffing, long waits for care, and missed showers. Residents expressed frustration with the lack of available staff, particularly during evening and night shifts, and reported going extended periods without showers. The facility's failure to adjust staffing assignments to account for light duty restrictions and to ensure adequate coverage for resident care needs directly contributed to these deficiencies.
Failure to Provide Ordered Care and Ensure Specialist Referrals
Penalty
Summary
The facility failed to provide necessary care and treatment according to physician orders and residents' needs for two residents. For one resident, documentation showed prolonged periods without a bowel movement, specifically nine days and six days on separate occasions. Despite physician orders for as-needed administration of Milk of Magnesia and Dulcolax suppositories if no bowel movement occurred in three days, there was no documentation that these interventions were offered or administered during the periods of constipation. The Director of Nursing confirmed that no interventions were documented as provided during these times. For another resident, the facility did not ensure that specialist referrals and diagnostic procedures were scheduled or completed as ordered by the physician. The resident had a persistent, non-healing neck wound with ongoing concern for malignancy, and multiple referrals to dermatology and an MRI were ordered. However, there was no documentation that the dermatology appointment or MRI was scheduled or completed, and the resident missed several specialist appointments, often due to lack of transportation or appointments not being made. The medical record repeatedly noted the need for specialist evaluation and follow-up, but these were not carried out as ordered. Interviews with facility staff, including the Director of Nursing and a Nurse Practitioner, confirmed the lack of documentation and follow-through on physician orders for both residents. The deficiencies were identified through record review and staff interviews, which revealed failures in providing care and ensuring timely access to necessary medical services as ordered.
Failure to Notify Dietitian and Physician of Resident's Significant Weight Loss
Penalty
Summary
A deficiency was identified when a resident experienced significant weight loss, dropping from 154.6 to 144.0 pounds over approximately one month. The resident's last documented assessment by a dietitian occurred several months prior, and there was no evidence that the dietitian or physician was notified of the recent weight loss or the resident's low meal intake, despite care plan interventions requiring such notifications. Meal intake records showed frequent days with only one or two meals documented as eaten, and some days with no meals documented. Staff confirmed that there was no documentation of required notifications to the dietitian or physician regarding the resident's nutritional decline. The care plan for nutritional risk included interventions to monitor intake at all meals, offer alternate choices, and alert the dietitian and physician to any decline in intake, but these interventions were not followed as documented in the resident's records.
Failure to Label Opened Inhalers with Required Dates
Penalty
Summary
Surveyors observed that medications, specifically inhalers, were not labeled with open or expiration dates on two of three medication carts inspected. During the inspection, multiple opened inhalers belonging to several residents were found without the required labeling, including Incruse Ellipta, Breztri, Spiriva, and Trelegy inhalers. Licensed Practical Nurses present at the time confirmed that these inhalers were opened and not labeled as per manufacturer instructions. A review of the manufacturer's instructions for each inhaler indicated that labeling with the date opened and discard date is required to ensure proper use and disposal. The facility's own policy also mandates that medications and biologicals be stored according to manufacturer or pharmacy recommendations to maintain their integrity and support safe administration. The failure to label these medications as required constitutes a deficiency in following professional standards for medication storage and labeling.
Delayed Laboratory Testing Due to Specimen Mismanagement
Penalty
Summary
The facility failed to provide timely laboratory services for a resident who had a physician's order for a urinalysis (UA) with culture and sensitivity due to delusions. The order was written on 5/6/25, and the urine specimen was initially collected on 5/7/25. However, there were no laboratory results for this date, and a subsequent nursing note indicated that the specimen was not tested because it was forgotten in the refrigerator. As a result, the specimen had to be recollected on 5/13/25 and then sent to the laboratory. Staff interviews confirmed that specimens are often forgotten in the refrigerator, leading to delays in treatment.
Facility Assessment Lacked Unit-Specific Staffing Needs
Penalty
Summary
The facility failed to ensure that its facility-wide assessment included specific staffing needs for each resident unit for a census of 68 residents. Record review of the Mountain Ridge Facility Assessment for 2025 showed that staffing requirements were listed only in aggregate for the entire facility, specifying total hours for RN/LPN and LNA staff per shift, but did not break down staffing needs by individual resident units. Further review confirmed that the assessment did not address unit-specific requirements. During an interview, the Administrator acknowledged that the facility assessment did not consider the needs of each resident unit.
Failure to Include Residents and Representatives in Care Plan Meetings
Penalty
Summary
The facility failed to ensure that residents and their representatives were included in the development and implementation of person-centered care plans for two residents. For one resident, the Durable Power of Attorney (DPOA) reported not being notified or invited to a care plan meeting for approximately two years, and there was no documentation of care plan meetings after the resident's admission in 2023. The Director of Social Services confirmed that although the resident was scheduled for care plan meetings, there was no documentation or recollection of the meetings or of the DPOA being invited. For another resident, the DPOA attended only one care plan meeting since the resident's admission, with no documentation of additional meetings before or after that date. The DPOA expressed a desire to be present to understand the goals being set for the resident. Facility policy requires invitations to be sent in advance and documentation of care plan meetings, but records and staff interviews confirmed these steps were not consistently followed.
Failure to Follow Physician-Ordered Pain Parameters for PRN Medication
Penalty
Summary
The facility failed to adhere to professional standards of quality in medication administration for one resident, as evidenced by the administration of Morphine Sulfate without following physician-ordered pain parameters. Specifically, the physician's orders required that Morphine Sulfate 30 mg be given by mouth every four hours as needed for pain rated at 7/10 or greater, and later for pain rated at 5/10 or greater. However, review of the resident's Medication Administration Record (MAR) for March and April revealed multiple instances where the medication was administered despite documentation of a pain level of 0, indicating no pain at the time of administration. Interview with the Unit Manager confirmed that the resident received the medication on these occasions with a documented pain level of 0. This failure to follow the seven rights of medication administration, specifically the right indication, resulted in the administration of a controlled substance without clinical justification as per the physician's orders.
Failure to Remove Expired Medications and Date Opened Vials
Penalty
Summary
Surveyors observed that the facility failed to properly manage medications and biologicals in the medication room. Specifically, an opened bottle of Tuberculin Purified Protein Derivative and an opened bottle of Afluria Influenza Vaccine were found in the vaccine refrigerator without any open date or open expiration date, despite both vials having been used. Additionally, three bags of IV Vancomycin and three bags of IV Zosyn, both antibiotics, were found in the medication room refrigerator with expiration dates that had already passed. These findings were confirmed by a registered nurse present during the observation. Further review of manufacturer instructions indicated that multi-dose vials of Afluria should be discarded within 28 days of being opened, and Tuberculin vials should be discarded after 30 days of use. The facility's own policy requires that outdated, contaminated, discontinued, or deteriorated medications be immediately removed from stock and disposed of according to established procedures. The failure to date opened vials and remove expired medications from stock led to the deficiency cited by surveyors.
Failure to Provide Sufficient Nursing Staff Resulting in Delayed Resident Care
Penalty
Summary
The facility failed to provide sufficient nursing staff to meet the needs of residents for 24 out of 30 days reviewed, resulting in delays in care and unmet resident needs. Multiple residents reported waiting extended periods for assistance with activities of daily living, such as getting out of bed, dressing, and toileting. One resident, admitted for short-term rehabilitation following a back fracture, experienced incontinence while waiting for staff to respond to a call bell. Another resident reported waiting over an hour to be assisted back to bed, and the resident council expressed concerns about long call bell wait times, particularly on the 3-11 shift and weekends, when only one LNA was often responsible for up to 30 residents per unit. Staff interviews confirmed frequent short staffing, with LNAs and RNs regularly covering additional shifts and roles outside their primary responsibilities, including the Infection Preventionist missing key meetings due to covering direct care shifts. Staff members, including the Scheduling Coordinator, LNAs, RNs, and the Infection Preventionist, consistently reported ongoing short staffing, especially on evening shifts. The Director of Nurses confirmed that a significant number of residents required extensive assistance, including mechanical lifts and two-person assists, yet staffing levels were insufficient to meet these needs. Documentation from resident council meetings and interviews with residents and their representatives further corroborated the persistent issue of inadequate staffing, leading to delays in care and missed activities. The facility's matrix showed 14 new admissions in the past 30 days, further straining available staff resources.
Failure to Provide Timely Medicare Coverage and Liability Notices
Penalty
Summary
The facility failed to provide timely and appropriate beneficiary notices regarding Medicare coverage and potential financial liability for services not covered. For one resident, the Notice of Medicare Non-Coverage (NOMNC) was not given with the required 48-hour notice prior to the last covered day, as the resident was notified only one day in advance. Additionally, the Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN) was not provided to this resident. For another resident, the SNF ABN was also not provided, despite the resident remaining in the facility after Medicare Part A coverage ended. These deficiencies were confirmed through record review and staff interview.
Failure to Document Pain Levels for PRN Medication
Penalty
Summary
The facility failed to adhere to physician-ordered medication parameters for a resident reviewed for pain management. The physician's order specified that Oxycodone 5 mg should be administered at bedtime for pain management and every six hours as needed for pain rated 5/10 or greater. However, the Medication Administration Record (MAR) for June 2024 showed that the resident received the PRN Oxycodone 5 mg tablet on multiple occasions without documentation of the pain level. This discrepancy was confirmed during an interview with the Unit Manager, who acknowledged that the medication was administered without recording the pain level, which is a deviation from the physician's orders and professional standards of quality care.
Failure to Educate and Offer Pneumococcal Vaccine
Penalty
Summary
The facility failed to ensure that residents were offered and provided education on the risks and benefits of Pneumococcal immunization. Specifically, for one resident reviewed for immunizations, there was no record of Pneumococcal immunization history, nor was there documentation of education, consent, or declination for the vaccine. This resident was admitted to the facility in February 2024, and by the time of the review in June 2024, these requirements had not been fulfilled. An interview with the Infection Preventionist confirmed that the resident had not been offered or educated about the pneumonia vaccines, which should have occurred upon admission. The facility's policy mandates obtaining pneumococcal vaccination history upon admission and administering the vaccine to adults aged 65 years or older who have not previously received it or whose vaccination history is unknown.
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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 Franklin
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Merrimack County Nursing Home | 5.6 mi | ★★★★★ | 7 | 0 |
| Saint Francis Rehabilitation And Nursing Center | 9.3 mi | ★★★★★ | 0 | 0 |
| Laconia Rehabilitation Center | 10 mi | ★★★★★ | 0 | 0 |
| Belknap County Nursing Home | 10.3 mi | ★★★★★ | 0 | 0 |
| Golden View Health Care Center | 13.3 mi | ★★★★★ | 3 | 0 |
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