Alden Courts of Waterford

In the surveyor’s words

From the most serious findings on record at Alden Courts of Waterford, in the surveyor’s own words.

• Immediate jeopardy, patternF689Sep 28, 2021

  Based on observation, interview and record review, the facility failed to identify the root cause of a resident elopement and identify interventions to prevent further resident elopements. The facility failed to provide adequate staffing and supervision for residents at risk for elopement. The facility also failed to assess newly admitted residents ' risk for elopement and provide for accurate and ongoing elopement risk assessments by a trained and qualified individual. The facility also failed to provide staff training on resident elopement and missing resident procedures. These failures resulted in immediate jeopardy and have the potential to affect all residents residing at the facility identified to be at risk for elopement (R1-R8). […]

• Immediate jeopardy, isolatedF689Mar 9, 2026

  Based on interview and record review, the facility failed to prevent a cognitively impaired resident (R1) from eloping through an unalarmed door. The facility also failed to secure an exit door with nonfunctioning alarm in accordance with the facility policy. This failure resulted in R1 exiting the facility unnoticed by staff and discovered outside the facility in cold weather on January 31, 2026, putting R1 at risk for injury due to falls and cold weather, and becoming lost due to cognitive impairment. This applies to 1 of 3 residents (R1) reviewed for risk of elopement in the sample of 13. V1 (Administrator) was notified of the Immediate Jeopardy on March 4, 2026, at 10:55 AM. […]

• No harm, potential for more than minimal, widespreadF745Sep 28, 2021

  The facility Social Services Designee failed to identify residents at risk for elopement, perform accurate and timely elopement risk assessments, and provide care plan interventions for residents who were at risk for elopement to prevent elopement from the facility. This failure has the potential to affect all 43 residents residing in the facility. The findings include: The facility's resident census updated on September 20, 2021 shows the facility census as 43 residents. 1. The EMR (Electronic Medical Record) shows R1 was admitted to the facility on [DATE]. […]

• No harm, potential for more than minimal, patternF880Aug 28, 2025

  Based on observation, interview, and record review, the facility failed to follow standard infection control practices during provisions of care with regards to hand hygiene and changing gloves. The facility also failed to use the required PPE (Personal Protective Equipment) for residents who were placed on EBP (Enhance Barrier Precaution) and Isolation Precaution. This applies to 4 of 16 residents (R3, R24, R29, R36) reviewed for infection control in the sample of 16. The findings include: 1. Face sheet shows that R24 is 81 years-old who has multiple medical diagnoses including neuromuscular dysfunction of the bladder. On August 25, at 10:50 AM, R24 was resting in bed, she had an indwelling urinary catheter. There was an EBP signage posting on her door. […]

• No harm, potential for more than minimal, patternF686Aug 28, 2024

  Based on observation, interview, and record review the facility failed to assess a new pressure injury area, failed to implement pressure injury treatment orders, and failed to ensure pressure reducing interventions were in place for four of six residents (R16, R31, R6, R46) reviewed for pressure injuries in the sample of 15. The findings include: 1. R16's Order Summary Report shows she was admitted to the facility on [DATE] with diagnoses including major depressive disorder, bipolar disorder, dementia with agitation, and pressure injury of sacral region stage II. […]