Blaire House of Milford

In the surveyor’s words

From the most serious findings on record at Blaire House of Milford, in the surveyor’s own words.

• Actual harm, isolatedF758Mar 14, 2024

  Based on records reviewed and interviews for one of three sampled residents (Resident #1), who was physician's orders included the administration of an antipsychotic medication (clozapine) and an antianxiety medication (clonazepam), the Facility failed to ensure that Resident #1 was free from the use of unnecessary psychotropic medications, when although the dosages of his/her psychotropic medications were successfully titrated down while he/she was in the hospital, upon readmission to the Facility he/she was restarted on his/her previous higher dosages, Resident #1 became lethargic, was transferred to the Hospital Emergency Department for evaluation for mental status changes and required readmission related to drug-induced fever related to the rapid dose increase of clozapine. […]

• Actual harm, isolatedF684Dec 14, 2022

  Based on interview and record review, the facility failed to provide timely medical care resulting in the development of an infection requiring oral and intravenous antibiotics, a seven-day hospitalization , and recommendation for a third toe amputation for one Resident (#20), out of a total sample of 20 residents. Specifically, the facility failed to: a. Notify the physician and/or physician assistant immediately once the Resident reported the right third toe injury to staff, which delayed physician evaluation and treatment for over 48 hours, and b. […]

• Actual harm, isolatedF692Dec 14, 2022

  Based on interviews, record review, and policy review, the facility failed to ensure staff identified, addressed, and monitored gradual unplanned significant weight loss for one Resident (#20), out of a total sample of 20 residents. Specifically, the facility failed to: a. Assess nutritional interventions put in place on 10/7/22 for their effectiveness to prevent continued weight loss through 12/7/22, and b. Identify in a timely manner the Resident's food and flavor preferences to optimize the Resident's caloric intake to prevent continued weight loss. […]

• Actual harm, isolatedF790Dec 14, 2022

  Based on observation, record review, and staff interview, the facility failed to ensure that one Resident (#10), out of a total sample of 20 residents, received dental care/treatment in a timely manner to replace the Resident's damaged dentures, resulting in the Resident having trouble chewing food and experiencing a significant weight loss. Findings include: Resident #10 was admitted in August 2019 with diagnoses which included diabetes mellitus and cerebrovascular accident. Review of the Minimum Data Set (MDS) assessment, dated 9/6/22, indicated the Resident was assessed to be alert and oriented with a Brief Interview for Mental Status (BIMS) score of 15 out of 15 (no cognitive deficits) and had no memory issues. […]

• No harm, potential for more than minimal, widespreadF847May 2, 2024

  Based on document review and interview, the facility failed to fully inform all residents of their right to not sign a binding arbitration agreement upon admission. Findings include: Review of the facility's Resident and Facility Arbitration Agreement, last revised 2/2022, indicated but was not limited to the following: It is understood and agreed by (the Facility) and (Resident, or Resident's Authorized Representative, hereinafter collectively the Resident) that any legal dispute, controversy, demand or claim (herein collectively referred to as claim or claims) that arises out of or relates to the Resident Admission Agreement or any services or health care provided by the Facility to the Resident, shall be resolved exclusively by binding arbitration to be conducted at a pace agreed upon… […]