Apple Rehab Rocky Hill

In the surveyor’s words

From the most serious findings on record at Apple Rehab Rocky Hill, in the surveyor’s own words.

• Immediate jeopardy, widespreadF880Apr 15, 2021

  Based on review of facility documentation and facility policies, observations, and interviews, the facility failed to implement an effective water management plan to mitigate the risk of Legionella (originally identified in 2019) and other water borne pathogens and implement immediate control measures for a presumptive Legionella infection identified on 4/5/21 as recommended to protect residents, staff and visitors from potential exposure to Legionella which resulted in Immediate Jeopardy. The findings include: 1. […]

• Immediate jeopardy, isolatedF760Aug 4, 2026

  Based on review of the clinical record, facility documentation/policy, and interviews for one (1) of two (2) residents (Resident #2) reviewed for medication administration, the facility failed to ensure medications were administered to the correct resident when Resident #2, who had no physician orders for Methadone, received 120 milligrams (mg) of Methadone prescribed for Resident #1. Specifically, the licensed nurse failed to use two resident identifiers, failed to verify the resident against the electronic Medication Administration Record (MAR) prior to administration, and the Methadone Chain of Custody Medication Administration Record (CCMAR) contained Resident #2's room number rather than Resident #1's room number. […]

• Actual harm, isolatedF686Apr 27, 2026

  Based on review of the clinical record, facility documentation, facility policy and interviews for 2 of 4 residents (Resident #67 and Resident #64) reviewed for pressure ulcer/injury, the facility failed to ensure offloading interventions were implemented for a resident unable to self-position and identified as being at high risk for the development of pressure ulcers. The lack of interventions to off-load Resident #67's heels/feet resulted in the development of a deep tissue injury (DTI) to the left heel. Subsequent to the development of a left heel DTI, Resident #67 developed a pressure ulcer to the left malleolus (ankle) from the lack of initiating interventions that directed measures to off-load the feet/heels. […]

• Actual harm, isolatedF689Jan 17, 2025

  Based on clinical record review, facility documentation, facility policy and interviews for one sampled resident (Resident #1) who was at risk for falls, the facility failed to ensure a staff member did not leave Resident #1 unattended while ambulating without an assistive device to prevent a fall that resulted with Resident #1 sustaining a fracture of the right humerus and laceration to the right eyebrow. The findings include: Resident #1's diagnoses included dementia, difficulty walking, weakness, osteoporosis and chronic pain. A physician's order dated 9/30/24 directed assist of one (1) with transfers and ambulate with a rolling walker. […]

• Actual harm, isolatedF689Aug 21, 2024

  Based on a review of clinical records, facility documentation, and interviews for one (1) of two (2) residents (Resident #1) reviewed for accidents, the facility failed to ensure that skin protective measures were implemented in accordance with physician orders, and failed to ensure that the residents wheelchair was free from accident hazards, as a result, the resident sustained a laceration that required sixteen (16) sutures. The finding includes: Resident #1 had diagnoses that included speech disorder following a stroke, dementia and thrombocytopenic purpura. An occupational therapist note dated 6/1/23 identified Resident #1 was assessed seated in his/her tilt in space wheelchair that noted continued right lower extremity hip external rotation and knee flexion. […]