Congregational Home, Inc.

In the surveyor’s words

From the most serious findings on record at Congregational Home, Inc., in the surveyor’s own words.

• Actual harm, isolatedF686May 1, 2024

  Based on observation, record review, and interview, the facility did not ensure residents at risk for pressure injuries, and with pressure injuries, were comprehensively assessed for the development of an individualized plan of care with interventions to promote healing, prevent infection and prevent new pressure injuries from forming. This was observed with 1 (R34) of 3 residents reviewed with pressure injuries and at risk for the development of pressure injuries. *R34 was assessed at high risk for the development of pressure injuries. Despite this, the facility did not initiate a turning or repositioning schedule for R34. On 11/7/23, R34 was noted to have developed a suspected deep tissue injury to the right heel. […]

• No harm, potential for more than minimal, widespreadF812Jul 31, 2025

  Number of residents sampled: 61Number of residents cited:Based on observation, interview and record review, the facility did not ensure food was prepared, and served, in a sanitary manner. This was observed with the dish machine and the facility's 3 compartment sink which has the potential to affect all 61 Residents that reside at the facility.* The facility did not ensure the facility kitchen dish machine was functioning to sanitize dishware.*The facility did not ensure proper procedure for sanitization of dishes involving the 3-compartment sink.Findings include:The facility's Dish Machine policy and procedure dated 1/24/25 documents: . […]

• No harm, potential for more than minimal, widespreadF812May 1, 2024

  Based on observation, record review, and interview, the facility did not ensure that food was prepared, distributed, and served in accordance with professional standards for food service safety for 1 of 1 serving kitchens. *Cook-J was observed preparing food for residents while not wearing a beard hair restraint. *Server- L was observed walking around the kitchen in areas where food is prepared for residents while not wearing a beard hair restraint. *Server-K was observed grabbing ready to eat food with gloved hands, after touching non-sanitized food surfaces, and placing the ready to eat food on plates for residents to eat. This deficient practice has the potential to affect 61 of 61 residents who eat and receive their meals from the main serving kitchen. Findings include: 1. […]

• No harm, potential for more than minimal, widespreadF880Mar 29, 2023

  Based on observation, record review and staff interview, the facility did not ensure infection control prevention was implemented with hand hygiene. This was based on 1 (R17) of 1 handwashing observations. The facility did not establish an infection control water plan to prevent Legionella in the facility. This has the potential to effect all 53 residents in the facility. * The facility's Water Management Plan (WMP) was not based on current standards of practice and did not: - Include water management team members who were knowledgeable about Legionella and the facility's water system. […]

• No harm, potential for more than minimal, widespreadF812Jan 26, 2022

  Based on observation, interview and record review the facility did not ensure that food was prepared, stored and served under sanitary conditions in the facility kitchen with the potential to affect 59 of 59 residents whom receive food from the main serving kitchen in the facility. Findings include: Surveyor reviewed facility's Food Storage Policy with a date of 2017. Documented was: Policy: Sufficient storage facilities will be provided to keep food safe, wholesome, and appetizing. Food will be stored in an area that is clean, dry and free from contaminants. Food will be stored at appropriate temperatures and by methods designed to prevent contamination or cross contamination. Procedure . 4. […]