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 Union House Nursing Home during CMS and state inspections, most recent first.
An LPN diverted controlled substances from four residents, with medication counts not matching the MAR and controlled substance log. The investigation found tampered medication cards in which narcotic tablets were replaced with non-narcotic medications from the cart, and the DON confirmed the diversion occurred.
An LPN administered medications without documented med pass competency before starting the position. Record review showed no competency documentation in the training log, and the DON later confirmed the facility could not find written med pass competency records. The LPN worked for several days before being terminated for medication diversion involving oxycodone, tramadol, and lorazepam.
Expired medications were found in the medication storage room, including Naproxen Sodium, Caltrate Bone Health Advance, Cranberry, Vitamin E, Vitamin D, CoQ10, Biotene Dry Mouth Rinse, Antidiarrheal, Acid Reducer, Bisacodyl, and stool softener. An LPN/Unit Manager confirmed the items were expired.
Missing Required LNA Training and Dementia Education: The facility failed to show that one LNA completed the required annual training hours and that two LNAs completed mandatory dementia training. Review of HR files found no documentation for the annual training requirement for one LNA and no dementia training evidence for two LNAs, and the RN Nursing Supervisor could not provide any additional proof of completion.
A resident who was wheelchair-dependent, had schizophrenia, and lived on the second floor was unable to access the first floor when the elevator was out of service. The resident said staff used a stair-chair to transport him/her down stairs to an ambulance and that this caused fear of being dropped, so the resident stayed in the room and missed visits with social services. The UM stated the facility was not honoring the resident’s rights because no alternate way to reach the first floor was provided other than the stair-chair.
A resident did not receive the required 48-hour Notice of Medicare Non-Coverage before Medicare-covered services ended. Record review showed the notice was dated after services stopped, and the MDS coordinator and SS director confirmed the resident and family were not notified in time, despite the director acknowledging the federal requirement.
Failure to provide proper nail care for a resident who needed ADL assistance. The resident's fingernails were observed to be long, and the resident said they were poking into the skin and not at the desired length. Later, an RN found the resident's toenails to be long and thick, and the resident said the toes hurt while the nurse checked them.
Failure to identify trauma triggers in care plan. A resident with PTSD had a care plan that listed traumatic events and a goal related to feeling safe, but it did not identify specific triggers or interventions to prevent re-traumatization. Family input documented that the resident was startled easily and feared stairs due to past falls. An LNA was unaware of the resident’s triggers, and the DON confirmed the care plan lacked trigger identification and interventions.
A resident with a history of mental health disorders and aggression struck another resident multiple times in the chest after verbally taunting them. The incident was witnessed, reported, and confirmed through investigation, with the aggressor admitting to the physical abuse.
The facility failed to implement a policy for national background checks for LNAs, with only three out of 22 having evidence of such checks. Despite a memo from the Department of Aging and Independent Living requiring these checks, the facility's policy did not reflect this requirement, and the Clinical Lead RN was unaware of the memo.
The facility failed to implement weekly skin checks for three residents at risk for skin integrity issues due to immobility and incontinence. Despite care plans requiring weekly checks, documentation showed significant lapses, with one resident receiving only three checks in 24 weeks, another only one check in 19 weeks, and a third only two checks in 20 weeks. This deficiency was confirmed by an LPN and the DON.
The facility failed to implement adequate fall prevention interventions for two residents at high risk for falls. Despite multiple falls, including incidents resulting in injury, the care plans for these residents were not updated with new interventions as required by facility policy. The Director of Nursing confirmed the lack of adherence to the policy, contributing to the deficiency.
A resident with a hand wound had their soiled gauze dressing improperly handled and reused by an LNA and RN, both of whom were not wearing gloves. The gauze, which had touched the floor, was secured with tape that had been stuck to a chair, violating infection control protocols.
The facility failed to ensure residents' rights to self-determination by keeping all doors locked 24/7, requiring staff intervention for entry and exit. Observations and interviews revealed that residents were dissatisfied with the lack of access to door codes, which restricted their ability to leave and return independently. The DON confirmed that only staff had the code and no policy existed for operating a locked facility.
A resident with Alzheimer's and severe dementia struck another resident with a cane, leading to a physical altercation. Despite interventions in place, the facility failed to prevent the incident, as confirmed by nursing staff. The aggressive behavior of the resident was known, yet the measures were ineffective in ensuring the safety of other residents.
Misappropriation of Resident Medications
Penalty
Summary
The facility failed to ensure that four sampled residents were protected from misappropriation of property related to medication. The facility’s policy defined misappropriation of resident property to include drug diversion, and the incident file documented that an LPN who began working at the facility on 11/4/25 diverted controlled substances from Residents #1, #2, #3, and #4 between 11/7/25 and 11/8/25. The diverted medications included Oxycodone, Tramadol, and Lorazepam, and the facility’s initial report to the state agency described discrepancies in controlled substance documentation and medication counts along with medication tampering. The investigation found that medication counts did not match the MARs and controlled substance log, and multiple medication cards had been tampered with by replacing narcotic medications with non-narcotic medications from the medication cart. The incident file stated that Resident #3’s Oxycodone cards had been altered with medications such as Hydroxyzine, Prednisone, Meclizine, and Metoprolol, and that Resident #1’s Oxycodone tablets had been replaced with tablets appearing to be Spironolactone. The DON confirmed that the medications for Residents #1, #2, #3, and #4 had been diverted by the LPN and stated that the incident should not have occurred.
LPN Lacked Documented Medication Administration Competency
Penalty
Summary
The facility failed to ensure that an LPN had the appropriate medication administration competency before administering medications. Record review of the LPN's training log showed no documentation that she received medication administration competency prior to starting her position. She worked for four days without documented medication administration competency before being terminated for medication diversion involving oxycodone, tramadol, and lorazepam. An email from the DON later confirmed that the facility did not have written documentation related to medication administration competency for the LPN and that the med pass competency could not be found.
Expired Medications Found in Medication Storage Room
Penalty
Summary
The facility failed to ensure that drugs and biologicals in the medication storage room were within their expiration date. During an observation of the medication storage room, surveyors found multiple expired items, including Naproxen Sodium 220 mg, Caltrate Bone Health Advance, Cranberry 450 mg, Vitamin E 180 mg/400 IU, Vitamin D 10 mcg/400 IU, CoQ10 100 mg, Biotene Dry Mouth Rinse, Antidiarrheal 2 mg in two package sizes, Acid Reducer 10 mg, Bisacodyl 5 mg, and stool softener 100 mg. The Unit Manager later confirmed that the listed medications were expired.
Missing Required LNA Training and Dementia Education
Penalty
Summary
The facility failed to ensure that 1 of 6 Licensed Nursing Assistants had completed the required 12 hours of annual training and that 2 of 6 Licensed Nursing Assistants had completed dementia training. Review of employee Human Resources files for permanent and contracted staff showed no evidence of the required 12 hours of annual training for LNA #4, who was hired on 9/8/2023. The files also showed no evidence of dementia training for LNA #3, hired on 12/3/1991, and LNA #5, hired on 4/16/2018. During interview on 2/2/26 at approximately 3:30 PM, the RN Nursing Supervisor was unable to provide any evidence that LNA #4 had completed the required annual training or that LNA #3 and LNA #5 had received the mandatory dementia training, and confirmed that the employee files reviewed contained the only documentation the facility had for staff training.
Failure to Provide Safe Access to First Floor
Penalty
Summary
The facility failed to protect a resident’s right to a dignified existence by not providing access to the first floor in a manner that provided safety and comfort for Resident #1. Resident #1 was observed eating lunch in the room on 2/9/26 and 2/11/26. During interview, the resident stated that staff recently used a stair-chair to transport him/her down the stairs to an ambulance and that s/he feared being dropped while being carried in the stair-chair. The resident also stated that s/he enjoyed going by elevator to the first floor to meet with social services, but over the past few weeks was unable to do so because the elevator was out of service, and s/he missed those visits. The care plan identified Resident #1 as having schizophrenia, exhibiting self-isolating behaviors, being wheelchair-dependent for mobility, requiring assistance from one person to transfer into the wheelchair, and residing on the second floor of a two-story structure. The Unit Manager stated that the facility was not honoring the resident’s rights because no alternate way was provided for access to the first floor other than the stair-chair, which caused fear for the resident. The Unit Manager also agreed that the resident benefited from being able to leave the second floor because s/he rarely participated in activities outside the room.
Late Notice of Medicare Non-Coverage
Penalty
Summary
The facility failed to provide the Notice of Medicare Non-Coverage at least 48 hours before the end of a Medicare-covered Part A stay or when Part B therapies were ending for one resident reviewed, Resident #32. Review of the resident’s BNP notice showed that services ended on 10/19/25, but the notice was dated 10/20/25, which did not provide the required 48-hour notification. During interview, the MDS coordinator confirmed that Resident #32 was not notified until after services ended. The Social Services Director stated the resident had been informed in September 2025 that benefits would end on 10/19/25 based on a letter received from the insurance company, but also confirmed that neither the resident nor the family were informed at least 48 hours before services ended and acknowledged this was a federal requirement.
Failure to Provide Proper Nail Care
Penalty
Summary
The facility failed to ensure that a resident who was unable to perform ADLs without assistance received proper nail care. The facility policy for fingernail and toenail care stated that nails should be cleaned daily and regularly trimmed, with gloves used as needed. During observation and interview, the resident's fingernails were noted to be long on both hands, and the resident stated that the nails were poking into the skin when closing a fist, that the nails were not at the desired length, and that one long fingernail had been peeled off. During later interview, an RN stated the resident's fingernails had been cut, but when the resident's feet were observed, the toenails were long and thick. The resident stated that the toes hurt while the nurse checked the toenails, and the RN confirmed that the toenails needed to be trimmed and were thick.
Failure to Identify Trauma Triggers in Care Plan
Penalty
Summary
The facility failed to provide culturally competent and trauma-informed care for Resident #8 by not ensuring the care plan identified trauma triggers and interventions to address them. Resident #8 had a diagnosis of post-traumatic stress disorder, and the care plan, with a review date of 01/08/26, listed several traumatic events and included a goal that the resident would feel safe in the living environment and not exhibit negative psychosocial impact related to trauma triggers. A Primary Care PTSD Screen dated 4/17/25 documented that the family provided information about past traumas, including that the resident was startled easily and was afraid of stairs due to past falls. However, the care plan did not identify triggers that may retraumatize the resident or interventions to mitigate them. An LNA stated she was not aware of the resident's triggers, and the DON confirmed that the care plan did not include identification of triggers or interventions to prevent re-traumatization.
Resident-to-Resident Physical Abuse Due to Unmanaged Aggression
Penalty
Summary
A resident with a history of schizophrenia, major depressive disorder, anxiety disorder, and prior aggression towards others was involved in a physical altercation with another resident. The care plan for this resident identified a potential for behavioral issues and aggression. On the date of the incident, the resident was observed sitting in the dining area when another resident walked by. The aggressive resident began calling the other resident names and then struck them in the chest multiple times. The incident was witnessed and subsequently reported to the state agency as a facility reported incident (FRI). During the facility's investigation, the resident admitted to striking the other resident, citing personal dislike as the reason. The investigation confirmed that physical abuse occurred.
Failure to Implement National Background Checks for LNAs
Penalty
Summary
The facility failed to develop and implement a policy related to national background checks for their employees, specifically Licensed Nursing Assistants (LNAs). A review of the human resource files revealed that only three out of 22 LNAs employed at the facility had evidence of national background checks. This deficiency was confirmed through interviews and record reviews, where the Clinical Lead Registered Nurse (RN) admitted that the facility did not complete national background checks for their employed LNAs. A memo from the Department of Aging and Independent Living, dated October 5, 2022, outlined the requirement for facilities to conduct national criminal background checks prior to employment and annually thereafter. The facility's existing policy, titled Abuse Prevention Program, last revised in December 2016, did not specify the requirement for national background checks. The Clinical Lead RN was unaware of the memo and confirmed that the abuse policy had not been updated to reflect the requirement for national background checks, leading to the deficiency.
Failure to Implement Weekly Skin Checks for Residents
Penalty
Summary
The facility failed to implement care plan interventions for three residents, leading to a deficiency in care. Resident #27 had a care plan initiated to address the risk of skin integrity alteration due to immobility and urinary incontinence, with a goal to remain free from skin alterations. The care plan required weekly skin checks by a licensed nurse, but documentation showed that skin checks were conducted only three times over a 24-week period. Similarly, Resident #39's care plan, initiated to prevent skin integrity issues related to incontinence and immobility, was not followed as required. The resident's records indicated only one skin check in 19 weeks. Resident #294 also had a care plan for skin integrity risks, with only two skin checks documented in 20 weeks. During an interview, both a Licensed Practical Nurse and the Director of Nursing confirmed that the weekly skin checks were not implemented as per the care plans for these residents.
Failure to Implement Fall Prevention Interventions
Penalty
Summary
The facility failed to ensure adequate supervision and implementation of interventions to prevent falls for two residents. Resident #39, diagnosed with Alzheimer's disease, anxiety disorder, and muscle weakness, was identified as high risk for falls due to disorientation, poor vision, and unsafe attempts to get out of bed and chairs. Despite sustaining five falls in two months, including two consecutive falls and a subsequent fall on December 5, 2024, no new interventions were added to the resident's care plan after the last fall. The facility's policy requires reviewing and updating the care plan after each fall, but this was not adhered to, as confirmed by the Director of Nursing. Similarly, Resident #11, with diagnoses including dementia, schizophrenia, anxiety, depression, and psychosis, was also at risk for falls due to poor safety awareness and unsteadiness. This resident experienced four falls in four months, with the last fall occurring on December 5, 2024, resulting in bruising. Despite the facility's policy to update care plans after falls, no new interventions were added to Resident #11's care plan following the last incident. The Director of Nursing confirmed the lack of adherence to the policy, which contributed to the deficiency in preventing falls.
Inadequate Infection Control During Wound Care
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, as evidenced by an incident involving a resident with a wound on their hand. During an observation, the resident was seen unwrapping a soiled gauze dressing that was visibly contaminated with blood. The gauze was allowed to dangle and come into contact with the floor of the dining area/TV room. A Licensed Nursing Assistant (LNA), who was not wearing gloves, attempted to redress the wound using the same contaminated gauze. Subsequently, a Registered Nurse (RN) also assisted without wearing gloves and secured the gauze with the original tape that had been stuck to the arm of the resident's chair. The Director of Nursing (DON) later confirmed that the soiled dressings should not have been reused.
Facility Fails to Ensure Residents' Right to Self-Determination
Penalty
Summary
The facility failed to honor residents' rights to self-determination and access to the outside world by keeping all doors locked 24/7, requiring staff intervention for entry and exit. This practice was observed during a survey when the front door was locked, and access was only possible by ringing a doorbell to alert staff. A staff member explained that exiting the facility required entering a code on a keypad, which only employees knew. The Director of Nursing (DON) confirmed that residents were not allowed to have the code, and there was no policy or procedure for operating a locked facility or assessing residents' ability to exit independently. Interviews with residents revealed dissatisfaction with the locked doors. One resident, who had been at the facility since 2014, expressed frustration at no longer having the code to exit independently, as they frequently used the porch and left for outside interests. Another resident, who had been at the facility for two years, stated they enjoyed sitting outside but required staff assistance to exit and re-enter the building. The DON confirmed that only staff had the code and could not locate any policy addressing the locked facility.
Failure to Protect Residents from Physical Abuse
Penalty
Summary
The facility failed to ensure a resident's right to be free from physical abuse, as evidenced by an incident involving two residents. Resident #1, who has Alzheimer's, severe vascular dementia, and an agitation-induced psychotic disorder, struck Resident #2, who has end-stage Lewy body dementia and parkinsonism, with a cane. This incident occurred in the early morning hours when Resident #2 was standing in the doorway of their room. Despite attempts by witnesses to intervene and redirect, both residents fell to the ground during the altercation. Resident #2 recalled the incident, stating that Resident #1 had hit them multiple times and often caused trouble with others. The facility's records indicate that Resident #1 had a history of aggressive behavior, including hitting staff and other residents with a cane. Interventions in Resident #1's care plan included monitoring while walking the halls and encouraging appropriate use of the cane. However, these measures were ineffective in preventing the incident. Interviews with the Assistant Director of Nursing and the Director of Nursing confirmed that Resident #1 had struck Resident #2 and staff members during attempts to manage the behavior, indicating a failure to protect residents from physical abuse.
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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 Glover
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Greensboro Nursing Home | 6.8 mi | ★★★★★ | 10 | 0 |
| Maple Lane Nursing Home | 8.5 mi | ★★★★★ | 3 | 0 |
| Pines Rehab & Health Center | 15 mi | ★★★★★ | 2 | 0 |
| St. Johnsbury Health & Rehab | 18.2 mi | ★★★★★ | 11 | 0 |
| Bel Aire Center | 19.2 mi | ★★★★★ | 6 | 0 |
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