Below average — CMS composite of the measures below.
The next survey window likely opens around January 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 The Elms Center during CMS and state inspections, most recent first.
Admission medication orders were not accurately reconciled for a resident after hospital discharge. The resident received an incorrect Carvedilol dose, Divalproex was given at the wrong interval, and a new Voltaren gel order was not transcribed or administered. The NP confirmed the meds were not reviewed with a provider or reconciled on readmission, and the DON confirmed the findings.
Missed and unavailable medications affected two residents. One resident with CKD4 had repeated missed doses of Cinacalcet because the drug was not available and there was no documented follow-up with the pharmacy or dialysis center. A newly admitted resident had multiple missed doses of ordered meds, including nasal spray, supplements, and antihypertensives; staff confirmed some meds were not available or ordered, one BP med was available in the emergency med system, and the physician was not notified.
The facility failed to review its water management plan annually, with the last review conducted 18 months ago. The plan's committee lacked an Infection Preventionist, and the plan did not specify a frequency for flushing dead legs. The Maintenance Director confirmed flushing dead legs and running water in infrequently used areas monthly, contrary to the plan's weekly requirement. The Infection Preventionist had not reviewed the plan, and the Director of Nursing was unfamiliar with it. The plan referenced CDC protocols, which recommend weekly flushing.
A facility failed to ensure a resident was fully informed of their care and treatment in their primary language, Spanish. Staff used personal translator apps to communicate, and the resident's MDS assessment indicated a preference for an interpreter. The medical record lacked signed consents in the resident's language, and the DON confirmed no interpreter services were available.
A facility failed to ensure a resident's right to formulate advance directives, as a discrepancy was found between a physician's order for DNR status and the resident's care plan, which indicated Full Code status. Interviews revealed that the code status change was made without consulting the resident, their representative, or the NP.
The facility did not hold routine interdisciplinary care plan meetings for two residents. One resident had no meetings for about a year, and another had only one meeting since admission. This was against the facility's policy requiring regular care plan discussions.
The facility failed to label and remove expired medications properly. An Aplisol TB vial in the medication room refrigerator was past its expiration date, and a Timolol Maleate Ophthalmic Solution bottle on a medication cart lacked an open date. Staff confirmed these findings.
The facility failed to label food and maintain a clean kitchen environment. Unlabeled containers of coffee creamer were found in the milk refrigerator, and a dusty fan was observed pointing towards the food preparation area. These issues were confirmed by the Food Service Director and a cook, indicating non-compliance with the facility's policies on food storage and kitchen cleanliness.
The facility failed to ensure the Infection Preventionist attended QAPI meetings at least quarterly, missing two meetings in 2024. This was confirmed by the DON, who acknowledged the absence despite having an Infection Preventionist in October.
The facility did not post daily nurse staffing information as required. An observation on a specific day revealed the absence of this information at all facility entrances. Interviews with the Unit Manager and Nursing Scheduler confirmed that the posting had not been done since the Nursing Scheduler assumed the role in October 2024.
The facility's assessment did not include specific staffing needs for day, evening, and night shifts. This deficiency was confirmed during an interview with the Administrator.
The facility failed to complete comprehensive MDS assessments within 14 days after a significant change in condition for two residents admitted to hospice. One resident did not have a significant change MDS assessment completed, while another resident's assessment was completed five days late. These deficiencies were confirmed by a staff interview.
Admission Medication Orders Were Not Reconciled
Penalty
Summary
The facility failed to ensure physician orders at admission were accurate for one resident reviewed for admission orders. The resident was discharged from the hospital on 5/9/26, but the discharge summary was not reviewed with the physician on call. The hospital discharge summary showed that Carvedilol was changed from 25 mg to 12.5 mg twice daily, Voltaren 1% gel was newly ordered for the lower back twice daily, and Divalproex was changed from three times daily to every 8 hours. Review of the May 2026 MAR showed the resident received Carvedilol 25 mg from 5/9/26 through 5/12/26 for six doses, Divalproex was administered at 8 a.m., 2 p.m., and 8 p.m. from 5/9/26 through 5/12/26 with only 6 hours between doses, and no new order was transcribed or administered for Voltaren gel. The NP confirmed the resident's medications were not reviewed with a provider or reconciled upon readmission, and the DON confirmed the findings.
Missed and Unavailable Medications
Penalty
Summary
The facility failed to provide routine medications to meet the needs of Resident #3, who had chronic kidney disease stage 4 and an order for Cinacalcet 30 mg daily with dinner. Review of the February 2026 MAR showed multiple missed administrations of the medication across the month. Progress notes from 2/18/26 through 2/20/26 showed the medication was on order, but there was no documentation that the facility followed up with the pharmacy or the dialysis center to obtain it. Staff later confirmed that the medication was not available at the facility and that no follow-up had been made to secure it. The facility also failed to administer multiple ordered medications for Resident #49, a newly admitted resident. The resident arrived at the facility on 2/10/26, and a progress note stated that most medications were not available. Review of the February 2026 MAR showed repeated missed doses of Fluticasone Propionate nasal spray, Glucosamine, and Calcium Plus D Chewable, along with missed doses of Metoprolol Tartrate and Ramipril. Staff confirmed that Fluticasone Propionate, Glucosamine, and Calcium Plus D were not available or ordered, that Metoprolol Tartrate was available in the automated emergency medication dispensing system and should have been administered, and that the physician was not notified of the missed administrations.
Failure to Implement and Review Water Management Plan
Penalty
Summary
The facility failed to implement and review its water management plan annually, affecting the census of 46 residents. The last review of the water management plan was conducted in June 2023, which is 18 months prior to the current review. The water management plan committee, responsible for oversight and implementation, did not include an Infection Preventionist. The plan outlined control measures and monitoring for dead legs and infrequently used areas, but did not specify a frequency for flushing dead legs. Staff J, the Maintenance Director, confirmed flushing dead legs monthly and running water in infrequently used areas monthly, contrary to the plan's weekly requirement. Interviews revealed that the Infection Preventionist, who started in November 2024, had not reviewed the water management plan. Staff J, who developed the plan, could not recall the standards used for its development. The Director of Nursing was unfamiliar with the plan and did not remember reviewing it. The facility's plan referenced CDC protocols for control measures, which recommend flushing low-flow piping and dead legs at least weekly. The lack of adherence to these guidelines and the absence of an annual review contributed to the deficiency.
Failure to Provide Language Interpreter Services
Penalty
Summary
The facility failed to ensure that a resident was fully informed of their care and treatment in a language they understand. Resident #44, whose primary language is Spanish, was not provided with language interpreter services. Interviews revealed that staff members used personal translator applications on their phones to communicate with the resident, and the resident also used a personal translator application to initiate communication. The resident's Admission Minimum Data Set (MDS) assessment indicated a preference for an interpreter, and a review of the medical record showed no signed consents for treatments in the resident's language. The Director of Nursing confirmed the absence of language interpreter services for the resident's primary language.
Failure to Ensure Resident's Right to Formulate Advance Directives
Penalty
Summary
The facility failed to uphold a resident's right to formulate advance directives, as evidenced by a discrepancy in the code status of a resident. A review of the medical record for a resident revealed a physician's order for Do Not Resuscitate (DNR) status, dated January 8, 2025. However, the resident's care plan still indicated Full Code status. An interview with an Advanced Practice Nurse confirmed that no order had been given to change the resident's code status to DNR. Additionally, the Director of Nursing disclosed that the code status was altered without any discussion with the resident, their representative, or the Nurse Practitioner.
Failure to Conduct Routine Care Plan Meetings
Penalty
Summary
The facility failed to conduct routine interdisciplinary care plan meetings for two residents, leading to a deficiency in care planning. For Resident #24, the Durable Power of Attorney reported that no care plan meetings had occurred for about a year, and the last documented meeting was on May 1, 2024. This was confirmed by the Director of Nursing. For Resident #44, who was admitted in May 2024, there were no care plan meetings documented between May and November 2024, with the only meeting occurring on November 27, 2024. The facility's policy requires care plan discussions at regular intervals, initially, and after significant changes, which was not adhered to in these cases.
Medication Labeling and Expiration Deficiency
Penalty
Summary
The facility failed to ensure proper labeling and removal of expired medications, as observed during a survey. In the medication room refrigerator, a vial of Aplisol TB was found with an open date of 11/22/24, which should have been discarded by 12/22/24 according to the manufacturer's instructions. This was confirmed by Staff G, the Unit Manager. Additionally, a medication cart inspection revealed a bottle of Timolol Maleate Ophthalmic Solution 0.5% without an open date, despite manufacturer guidelines stating that opened bottles should be discarded after 28 days. Staff I, a Registered Nurse, confirmed that the Timolol Maleate was actively in use.
Failure to Label Food and Maintain Clean Kitchen Environment
Penalty
Summary
The facility failed to ensure proper labeling and cleanliness in the main kitchen, as observed during a survey. Individual plastic containers containing white liquid, identified as coffee creamer, were found in the milk refrigerator without any labeled identifiers or dates. This was confirmed by the Food Service Director, Staff F, who acknowledged the oversight. Additionally, a fan with accumulated dust on its blades and cage was observed pointing directly towards the food preparation area, which was confirmed by Staff K, a cook, who stated that the fan was used during meal preparation. The facility's policies on food storage and kitchen environment, which require labeling of all foods and maintaining a clean and sanitary kitchen, were not adhered to, as evidenced by these observations.
Infection Preventionist Absence in QAPI Meetings
Penalty
Summary
The facility failed to ensure that the required committee members attended the Quality Assurance Performance Improvement (QAPI) meetings at least quarterly, as mandated. Specifically, the Infection Preventionist, a required member of the QAPI committee, was absent from two of the four quarterly meetings reviewed for the year 2024. The absence was noted in the second quarter meeting held in July 2024 and the third quarter meeting held in October 2024. This deficiency was confirmed through an interview with the Director of Nursing, who acknowledged that although there was an Infection Preventionist in October, they did not attend the QAPI meeting.
Failure to Post Daily Nurse Staffing Information
Penalty
Summary
The facility failed to post daily nurse staffing information as required. On January 9, 2025, at approximately 9:45 a.m., an observation of all facility entrances revealed that there was no nurse staffing information posted. This was confirmed by an interview with Staff G, the Unit Manager, at the same time. Further investigation through an interview with Staff H, the Nursing Scheduler, at approximately 2:00 p.m. on the same day, revealed that the daily posting of nurse staffing information had not been done since Staff H took over the position in October 2024.
Facility Assessment Lacks Shift-Specific Staffing Details
Penalty
Summary
The facility failed to ensure that its assessment included specific staffing needs for each shift, such as day, evening, and night. This deficiency was identified during a review of the facility assessment, which was dated but not specified in the report. The assessment lacked detailed information on the staffing levels required for different shifts. This finding was confirmed during an interview with the facility's Administrator, Staff E, on January 9, 2025, at approximately 8:15 a.m.
Failure to Timely Complete MDS Assessments After Significant Change
Penalty
Summary
The facility failed to conduct a comprehensive Minimum Data Set (MDS) assessment within the required 14 days after a significant change in condition was identified for two residents. Resident #47 was admitted to hospice on November 1, 2024, but a significant change MDS assessment was not completed. Similarly, Resident #24 was admitted to hospice on April 18, 2024, and although a significant change MDS assessment was initiated, it was completed five days late, on May 7, 2024. These findings were confirmed through interviews with Staff D, who acknowledged that the assessments were not completed in a timely manner as required by the MDS Resident Assessment Instrument Manual.
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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 Milford
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Crestwood Center | 0.3 mi | ★★★★★ | 3 | 0 |
| Courville At Nashua | 11.3 mi | ★★★★★ | 0 | 0 |
| Nashua Post Acute Care | 11.7 mi | ★★★★★ | 13 | 0 |
| Bedford Nursing & Rehabilitation Center | 12.2 mi | ★★★★★ | 7 | 1 |
| Ridgewood Center, Genesis Healthcare | 12.4 mi | ★★★★★ | 5 | 0 |
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