Above average — CMS composite of the measures below.
A standard survey is most likely before 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 Aristacare At Manchester during CMS and state inspections, most recent first.
The facility did not adequately protect resident-identifiable information or maintain medical records according to professional standards, as observed by surveyors.
Failure to Maintain Resident Dignity During Personal Care: A resident with Parkinson's disease and dementia was observed with drool and later an orange liquid substance dripping from the mouth and beard while staff walked by without assisting. Another resident, who required substantial assistance with toileting hygiene, was observed receiving incontinence care with the bathroom door open, leaving the resident fully exposed and visible to a roommate. The LPN/Unit Manager and DON acknowledged the residents should have been assisted and provided privacy.
Incomplete SNF ABN for Therapy Coverage Notice: A resident with muscle weakness, dysphagia, and colon cancer was found to have an SNF ABN stating Medicare coverage had ended for therapy, but the form was incomplete. The estimated cost was left blank and all three required option boxes were unchecked, while the SW said the business office would handle the cost and the LNH A later acknowledged that an option and estimated cost should have been completed.
A resident with aphasia, dysphagia, FTT, and a feeding tube had an order requiring tube placement checks before each feeding, flush, or medication administration. During observation, an RN attempted to flush the tube without first verifying placement, and both the RN and DON confirmed the required check had been missed.
A resident with dementia and cognitive deficits had a box of eye itch relief drops left on a bedside table in the room. The surveyor observed the medication unsecured, and the LPN/UM acknowledged the resident should not have had the eye drops at the bedside without a self-administration assessment. The DON also stated the eye drops should not have been there due to safety reasons, and facility policy required medications to be stored by nursing staff unless self-administration had been determined safe.
An LPN failed to clean reusable equipment, including a BP cuff, pulse oximeter, and thermometer, between use on two residents during med pass. In a separate observation, soiled linens and clothing were left in an open bag on the shower room floor instead of being secured and sent to the soiled utility area, contrary to staff statements and facility policy.
Failure to ensure the Infection Preventionist carried out the IPC program resulted in a resident not receiving an annual influenza vaccine during the influenza season. The resident had dementia, moderately impaired cognition on BIMS, and had signed consent for the vaccine, but the chart showed only a prior vaccine given before admission and no evidence of administration during the required season. The IP believed the resident was not due until later, while the DON stated the vaccine should have been given during influenza season.
The facility failed to supervise a cognitively impaired resident with exit-seeking behavior, leading to the resident eloping and being found at a local restaurant. Additionally, the facility did not follow the care plan for a fall-risk resident, resulting in the resident falling in the shower and sustaining a skin tear.
The facility failed to maintain an ongoing communication record between the facility and the dialysis center for a resident requiring dialysis services. Observations revealed incomplete and missing documentation in the dialysis communication binder, and interviews confirmed that the facility's policy was not being followed.
The facility failed to ensure accurate ordering and receiving of narcotic medications on DEA 222 forms. Three forms were found incomplete in Part 5, which should have been filled out upon receipt of the medications. The DON acknowledged the oversight.
A facility failed to develop an individualized care plan for a resident with aggressive behaviors, despite multiple incidents of aggression and agitation. The resident was placed on 1:1 observation, but the observation logs did not document the behaviors exhibited. Staff interviews confirmed the lack of a behavioral care plan prior to the incident.
The facility failed to obtain physician orders for an orthotic device and the treatment of a skin tear for a resident with severe cognitive deficits and hemiplegia. The resident fell in the shower when a CNA transferred them without the required two-person assistance, resulting in a skin tear. The resident was not wearing the prescribed AFO at the time of the fall, and there was no physician's order documented for the AFO or the skin tear treatment.
A facility failed to provide a resident with the physician-ordered pudding thick liquid consistency, resulting in the resident receiving improperly thickened coffee. The resident, who had a history of dysphagia and was at high risk for aspiration, was observed coughing after consuming the coffee. The deficiency was identified as Immediate Jeopardy due to the potential for serious harm.
The facility failed to accurately document in the medical records for a resident who sustained a skin tear after being bumped by a meal cart. Although the incident was reported and treated, there was no progress note in the EMR on the day of the incident, only the following day. Staff interviews revealed discrepancies in documentation practices, leading to the deficiency.
The facility failed to follow infection control practices for storing respiratory equipment for two residents. Nebulizer masks and oxygen tubing were left unprotected and exposed, contrary to facility policy, despite multiple observations and staff confirmations of proper procedures.
Failure to Safeguard Resident Information and Maintain Medical Records
Penalty
Summary
The facility failed to safeguard resident-identifiable information and/or did not maintain medical records for each resident in accordance with accepted professional standards. This deficiency was identified through surveyor observation or review, indicating that the required protocols for protecting confidential information and proper record-keeping were not consistently followed. No additional details regarding specific residents, their medical history, or the exact nature of the records involved are provided in the report.
Failure to Maintain Resident Dignity During Personal Care
Penalty
Summary
The facility failed to treat residents with dignity and respect by not providing timely assistance to a resident with drool and an orange liquid substance visibly dripping from the mouth and beard. The resident had diagnoses including Parkinson's disease, dementia, muscle weakness, and lack of coordination, and the admission MDS showed a BIMS score of 8 out of 15 and personal hygiene coded as requiring partial/moderate assistance. On 08/20/2025, the resident was observed seated in a wheelchair in the hallway with a large amount of drool dripping from the mouth while two staff members walked by without offering assistance or cleaning the resident's mouth. On 08/21/2025, the resident was again observed asleep in the dining room with an orange liquid substance dripping from the mouth onto the beard while multiple staff members entered and exited the area without assisting with cleaning. The facility also failed to provide privacy during hygienic care for another resident. That resident had diagnoses including muscle weakness, difficulty walking, and lack of coordination, and the admission MDS showed a BIMS score of 13 out of 15 with toileting hygiene coded as requiring substantial/maximal assistance. During observation, a CNA was providing incontinence care in the bathroom while the bathroom door remained open, leaving the resident's abdomen, breasts, and buttocks fully exposed and visible from the bathroom. The roommate was present in the shared bedroom near the bathroom entrance. Interviews with the LPN/Unit Manager and the DON confirmed that staff should have assisted the first resident with cleaning and that the second resident should have been provided privacy during care.
Incomplete SNF ABN for Therapy Coverage Notice
Penalty
Summary
The facility failed to ensure the SNF ABN was complete and accurate for one resident reviewed for SNF Beneficiary Protection. The resident had diagnoses including muscle weakness, dysphagia, and malignant neoplasm of the colon. The resident's SNF Beneficiary Notification Review indicated that the resident no longer required skilled care effective 5/6/2025, and the ABN stated that beginning on 5/7/2025 the resident may have to pay out of pocket for therapy services because the care did not meet Medicare coverage requirements. The ABN for the resident documented therapy with the reason listed as "Met Max Potential," but the estimated cost was left blank. In addition, all three option boxes in the lower section of the form were left blank even though the instructions stated to check one box. During interview, the Social Worker stated that the estimated cost was not required because the business office would handle it and that the resident or representative do not always check a box. The Licensed Nursing Home Administrator later acknowledged that one of the three options and an estimated cost should have been filled in. The facility did not provide a policy referencing SNF ABN.
Feeding Tube Placement Not Verified Before Flush
Penalty
Summary
Failure to provide appropriate care for a resident with a feeding tube was identified when staff did not verify proper tube placement before administering enteral feeding-related care. Resident #46 was admitted with diagnoses including aphasia, dysphagia, adult failure to thrive, and pneumonitis due to inhalation of food and vomit. The admission MDS showed severe cognitive impairment with a BIMS score of 3 out of 15, and Section K indicated the resident had a feeding tube and received 51% or more of total caloric intake through tube feeding. The physician's order for enteral feeding directed staff to check feeding tube placement prior to each feeding, flush, or medication administration at every shift, and the MAR documented placement checks as completed every shift. However, during observation, a RN attempted to flush the feeding tube without first verifying placement, and the RN acknowledged that the step had been missed. The DON later confirmed that tube placement should have been checked prior to administering flushes and stated that verifying placement was essential to ensure the tube was properly positioned.
Unsecured Eye Drops Left at Resident Bedside
Penalty
Summary
Medication was left unsecured at a resident’s bedside, and the facility failed to ensure it was stored in a locked compartment accessible only to authorized personnel. During observation, the surveyor found Resident #10 seated in a wheelchair in the bedroom with a bedside table in front of them, and on the table was a box containing a 10-milliliter bottle of eye itch relief drops. The resident stated that their daughter had brought the eye drops because their eyes sometimes feel dry. Record review showed that Resident #10 was admitted with diagnoses including dementia and lack of coordination, had a BIMS score of 12 out of 15 on the admission MDS, and had a care plan noting cognitive deficits. The MAR included physician orders for ophthalmic eye solution to be given as needed for dry eyes. The LPN/UM stated she knew the resident had the eye drops at the bedside and said she would speak with the resident’s family, and she admitted the resident should not have the eye drops at the bedside if she had not been assessed for safe self-medication administration. The DON also stated that Resident #10 should not have had eye drops at the bedside due to safety reasons. Facility policies stated that nursing staff are responsible for medication storage and that residents may self-administer medications only if the attending physician and interdisciplinary care planning team determine they can do so safely.
Failure to disinfect reusable equipment and contain soiled laundry
Penalty
Summary
The facility failed to sanitize reusable medical equipment between resident uses during medication administration. On 8/25/2025, an LPN prepared to administer medications to Resident #155 and later to Resident #81, sanitized hand hygiene, and brought the vital signs machine to each resident’s bedside. In both observations, the nurse applied a BP cuff, used a pulse oximeter on a finger, and touched the resident’s temple with a touch-less sensor thermometer, but did not clean or sanitize the BP cuff, pulse oximeter, or thermometer before or after use. During interview, the DON stated that reusable medical equipment such as the BP cuff, thermometer, and pulse oximeter should be cleansed after each use between residents, and the facility policy stated reusable resident care equipment will be decontaminated and/or sterilized between residents according to manufacturer instructions. The facility also failed to contain soiled laundry securely and transport it to the designated holding area. On 8/26/2025, a surveyor observed a large pile of soiled linens, towels, and clothes in an opened plastic bag on the floor of the nursing unit shower room, with one wet towel partly inside the bag and partly on the floor. The CNA stated the laundry should have been taken to the dirty utility room because there are germs and nothing should be on the floor. The LPN stated dirty laundry should not sit on the floor and should be bagged and put on the chute in the soiled utility room. The IP and DON both stated soiled laundry should be bagged and taken immediately to the soiled utility room or linen chute, and the facility policy stated all soiled linen must be placed directly into a covered laundry hamper that can contain moisture.
Failure to Ensure Annual Influenza Vaccination
Penalty
Summary
The facility failed to ensure the Infection Preventionist actively carried out her designated infection prevention and control responsibilities by not ensuring that Resident #10 received an annual influenza vaccine during the 2024 influenza season. The resident was admitted during influenza season, had signed an influenza immunization consent form on 11/01/2024, and the record showed the last documented influenza vaccine was given on 11/23/2023 before admission, with no evidence that a vaccine was administered during the 2024 season. Resident #10’s record showed diagnoses including dementia and lack of coordination, and the admission MDS dated 07/08/2025 included a BIMS score of 12 out of 15, indicating moderately impaired cognition. The comprehensive care plan dated 05/06/2025 identified cognitive deficits. During interview, the resident stated she could not remember the last time she received an influenza vaccination. The Infection Preventionist stated the resident received an influenza vaccine at a pharmacy on 11/17/2023 and was not due again until 07/2025, while the DON stated the resident should have received influenza vaccination between 10/01/2024 and 03/31/2025, which was considered influenza season.
Failure to Supervise Cognitively Impaired Resident and Follow Fall Risk Care Plan
Penalty
Summary
The facility failed to adequately supervise a cognitively impaired resident with exit-seeking behavior, resulting in the resident eloping from the facility. The resident, who had diagnoses including senile degeneration of the brain, dementia with behavioral disturbance, and delirium, was found at a local restaurant after being missing for approximately one hour. Despite multiple documented instances of the resident attempting to elope and removing their wander guard, no new interventions were added to the care plan to prevent further exit-seeking behavior. The facility's failure to maintain adequate supervision and update the care plan led to the resident's elopement and an Immediate Jeopardy situation was identified by surveyors. Additionally, the facility failed to maintain the safety of another resident identified as a fall risk by not following the plan of care. This resident, who had severe cognitive deficits and required maximum assistance with activities of daily living, fell in the shower when a CNA attempted to transfer the resident alone, contrary to the care plan that required two-person assistance. The resident sustained a skin tear as a result of the fall. The CNA admitted to not reviewing the assignment sheet and not knowing that the resident required two-person assistance for transfers. The facility's policies and procedures for managing residents at risk for elopement and falls were not adequately followed. The care plans for both residents were not properly implemented, leading to significant safety risks. The staff failed to apply necessary interventions and did not adhere to the established protocols for monitoring and assisting residents, resulting in serious deficiencies in the care provided.
Removal Plan
- Resident 535 was discharged from the facility
- All residents at risk for wandering or elopement had a wandering risk assessment completed and updated Care plans. Assessments reviewed by the Nursing administration, Administrator, Assistant Administrator, Nurse Practitioner (NP), Activities, and Social Work team. The residents indicated were reviewed
- Staff education via facility wide text message portal which consisted of where to find all residents at risk for elopement within the electronic medical record, the requirement to review the at-risk residents, and interventions at each shift. Department heads with departments that don't have access to the electronic medical record, educated their staff that the electronic medical record list will be printed and posted at the time clock and the pictures of the residents at risk will be kept at the reception desk. The lists will be updated with any changes through the intervention meeting or as needed
Failure to Maintain Dialysis Communication Records
Penalty
Summary
The facility failed to complete and maintain an ongoing communication record between the facility and the dialysis center for a resident who required dialysis services. The resident, who had diagnoses including acute kidney failure, psychosis, dementia, and dependence on renal dialysis, had a comprehensive care plan that included attending dialysis three times a week. However, the dialysis communication binder, which was supposed to include pre- and post-dialysis information, was found to be incomplete. Observations revealed that many forms were missing the resident's name, and several forms had incomplete pre- and post-dialysis information. Additionally, multiple dialysis treatment forms were missing for the months of January, February, March, and April 2024. Interviews with the direct care LPN, the DON, and the LPN UM confirmed that it was the nurse's responsibility to document the vitals and ensure the communication book was filled out completely. The DON acknowledged that the facility's policy was not being followed, and the LPN UM admitted that it was her responsibility to check the dialysis communication sheets for completeness. Despite the facility's policy requiring effective communication between the facility and the dialysis center, the surveyor found numerous instances of incomplete documentation, indicating a failure to adhere to the established procedures.
Failure to Complete DEA 222 Forms Accurately
Penalty
Summary
The facility failed to ensure accurate ordering and receiving of narcotic medications on the required Federal narcotic acquisition forms (DEA 222 forms). During a review on 4/17/24, it was found that three out of three provided DEA 222 forms had not been completed in Part 5 upon receipt of the medications from the Provider Pharmacy. The forms in question were order form numbers 231659497, 231659498, and 23165949. The Director of Nursing (DON) acknowledged that Part 5 should have been completed as instructed on the reverse of the DEA 222 form. The instructions for DEA Form 222 specify that the purchaser must fill out the number of packages received and the date received for each line item in Part 5.
Failure to Develop Individualized Care Plan for Aggressive Resident
Penalty
Summary
The facility failed to develop an individualized resident-centered care plan for a resident with documented aggressive behaviors toward other residents and staff. The resident, who had diagnoses including schizo-affective disorder, depression, and dementia with behavioral disturbance, exhibited severe cognitive impairment and difficulty communicating. Despite multiple incidents of aggression and agitation, including an episode where the resident lunged at staff and another where the resident assaulted another resident, the facility did not have a behavioral care plan in place prior to 11/30/23. The care plan created on 11/30/23 did not include specific interventions for staff to address the resident's behaviors. The facility's documentation revealed that the resident was placed on 1:1 observation, but the observation logs did not document the behaviors exhibited. Additionally, the facility did not provide documentation to indicate how the resident was able to make contact with another resident while on 1:1 observation. Interviews with staff, including a CNA, LPN, and the DON, confirmed that the resident had increased agitation and aggressive behaviors, but no behavioral care plan was developed to address these issues prior to the incident on 11/29/23. The facility's policy on 1:1 observation required continuous visual supervision within arm's length of the resident and documentation on a designated observation form. However, the 1:1 observation logs did not reflect the resident's behaviors, and the DON stated that the logs were not intended for visual observation. The lack of a comprehensive care plan and proper documentation of the resident's behaviors contributed to the deficiency identified by the surveyors.
Failure to Obtain Physician Orders for Orthotic Device and Skin Tear Treatment
Penalty
Summary
The facility failed to obtain physician orders consistent with professional standards of clinical practice for an orthotic device and for the treatment of a skin tear for Resident #24. The resident, who had severe cognitive deficits, hemiplegia, hemiparesis, hydrocephalus, and dementia, required maximum assistance with activities of daily living and was dependent on staff for transfers. The resident fell in the shower when a CNA transferred them without the required two-person assistance, resulting in a skin tear on the left elbow. The CNA did not review the assignment sheet and was unaware that the resident required two-person assistance for transfers. Additionally, the resident was not wearing the prescribed ankle-foot orthosis (AFO) at the time of the fall, and there was no physician's order for the AFO documented in the Treatment Administration Record (TAR) for March and April 2024. The facility's policies required physician orders for orthotic devices and treatments, but these were not obtained or documented for Resident #24. The Director of Nursing confirmed that a physician's order was required for the treatment of a skin tear and the use of an orthotic device, but this was not followed in the case of Resident #24.
Failure to Provide Physician-Ordered Liquid Consistency
Penalty
Summary
The facility failed to ensure that staff provided a resident with the appropriate physician-ordered liquid consistency. During an observation, a Certified Nurse Aide (CNA) was seen adding only two thickener packets to a resident's coffee instead of the required four packets for pudding thick consistency. The resident, who had a diet order for puree texture and pudding thick liquids, was observed coughing after drinking the improperly thickened coffee. The meal ticket on the resident's tray clearly indicated the need for pudding thick liquids, but the CNA incorrectly stated that the resident was supposed to have nectar thick liquids. Further investigation revealed that the resident had a history of dysphagia, cerebral infarction, and hemiplegia, and was at high risk for aspiration. The resident's electronic medical record and care plan both indicated the need for pudding thick liquids. The Speech Therapist and Registered Dietitian confirmed the importance of the correct liquid consistency to prevent aspiration. The Director of Nursing (DON) acknowledged that the staff should have been trained and competent in preparing thickened liquids, but admitted that competencies might not have been completed. The facility's policy on thickened liquids required staff to use prepared thickened liquid preparation from the dietary department or thickening packets to achieve the appropriate consistency. However, the CNA's failure to follow the physician's order and the facility's policy resulted in the resident receiving an incorrect liquid consistency, posing a serious risk to the resident's health and well-being. The deficiency was identified as Immediate Jeopardy (IJ) due to the potential for serious harm to the resident.
Removal Plan
- Resident #24 was examined by the Nurse Practitioner.
- The physician was made aware.
- The Nurse Aide was in-serviced which included return demonstration.
- All other staff who may serve Resident #24 as well as any other staff who may serve other residents with thickened liquids have been in-serviced with return demonstration.
Failure to Accurately Document Medical Records
Penalty
Summary
The facility failed to accurately document in the medical records for one resident, identified as Resident #183. The resident was admitted with diagnoses including lack of coordination, type 2 diabetes mellitus, and abnormalities of gait and mobility. An incident occurred where a CNA accidentally bumped into the resident with a meal cart, resulting in a skin tear on the resident's right third toe. Although the incident was reported, assessed, and treated, there was no progress note documented in the electronic medical record (EMR) on the day of the incident. The progress note was only entered the following day, which indicated redness and a physician-ordered X-ray and bacitracin treatment for the resident's toe injury. Interviews with various staff members, including LPNs, CNAs, the Unit Manager, and the Director of Nursing (DON), revealed that the facility's protocol required documenting a progress note in the EMR for any incident. The staff emphasized the importance of documenting progress notes as a communication tool for shift-to-shift awareness and continuity of care. However, the DON mentioned that if an incident report was completed, a progress note in the EMR was not always necessary, as the incident report could be printed out. This discrepancy in documentation practices led to the failure to record the incident in the EMR promptly. The facility's Charting and Documentation policy mandates that all incidents, accidents, or changes in a resident's condition be recorded as soon as possible. The policy also requires documentation of procedures and treatments, including assessment data and notification of family and physicians. The Assistant Licensed Nursing Home Administrator (LNHA) acknowledged in the presence of the survey team that the progress note was missing and should have been included in the EMR, confirming the deficiency in documentation practices.
Improper Storage of Respiratory Equipment
Penalty
Summary
The facility failed to adhere to accepted standards of infection control practices for the proper storage of respiratory tubing and masks for two residents. For Resident #241, the surveyor observed a nebulizer mask placed directly on the nightstand, touching the nebulizer machine and in close proximity to the resident's phone and toiletries. This mask was not stored in a plastic bag as required to prevent infection. Despite multiple observations over several days, the mask remained unprotected and exposed to the environment. The resident's medical record indicated diagnoses of acute respiratory failure with hypoxia and pneumonia, and the resident had orders for nebulizer treatments. Both the Infection Control Nurse Preventionist and the LPN confirmed that the mask should have been stored in a plastic bag when not in use. For Resident #40, the surveyor observed oxygen tubing and a nasal cannula left unprotected on the bed and nightstand. The nasal cannula was not labeled or dated. The physical therapy staff used the unprotected nasal cannula left on the bed when assisting the resident. The resident's medical record indicated diagnoses of acute respiratory failure with hypoxia, pneumonia, emphysema, and adult failure to thrive, with orders for continuous oxygen therapy. The facility's policy required that respiratory equipment be disinfected and stored in a plastic bag when not in use, but this policy was not followed. The LPN confirmed that all respiratory equipment should be disinfected and stored properly to prevent infection.
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 372 citations issued within 25 miles in the last 12 months — including the 20 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) |
|---|---|---|---|---|
| Complete Care At Arbors | 2.1 mi | ★★★★★ | 0 | 0 |
| Shore Gardens Rehabilitation And Nursing Center | 3.3 mi | ★★★★★ | 2 | 0 |
| Hampton Ridge Healthcare And Rehabilitation | 4.2 mi | ★★★★★ | 9 | 0 |
| Childrens Specialized Hospital Toms River | 4.2 mi | ★★★★★ | 0 | 0 |
| Complete Care At Green Acres | 4.2 mi | ★★★★★ | 0 | 0 |
Every risk area ranked, a do-first checklist, and your local survey patterns
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.