Forest Hill Manor

In the surveyor’s words

From the most serious findings on record at Forest Hill Manor, in the surveyor’s own words.

• Immediate jeopardy, isolatedF600Oct 16, 2024

  Based on the facility reported incident dated 9/17/24, review of the facility's investigation report dated 9/17/24, facility's investigation follow-up report dated 9/20/24, facility policy, record review, and interviews, the facility failed to protect a resident from being sexually harmed, and potentially being emotionally harmed and causing the resident to sustain emotional fear, sadness, and embarrassment for 1 of 1 resident sampled for abuse (Resident #1 [R1]). A reasonable person could have psychosocial harm. Finding: On 9/17/24, the facility reported to the Maine Department of Health and Human Service, Division of Licensing and Certification a facility reportable incident of staff to resident sexual abuse. […]

• No harm, potential for more than minimal, widespreadF725Feb 20, 2025

  Based on record review and interviews, the facility failed to ensure sufficient direct care staff were scheduled and on duty to meet the needs of residents that reside in the facility. This has the potential to affect all residents needing assistance with Activities of Daily Living (ADL's). Findings: Review of Payroll Based Journal staffing report revealed the facility triggered for low weekend staffing during the fourth quarter of 2024 (July 1 - September 30). On 2/20/25 at 9:58 a.m., during an interview with a surveyor and the Administrator, the staffing schedules were reviewed for the fourth quarter of 2024. The Administrator confirmed the facility did not ensure enough staff were on duty to meet resident needs on the weekends.

• No harm, potential for more than minimal, patternF584Feb 20, 2025

  Based on observations and interviews, the facility failed to adequately provide housekeeping and maintenance services necessary to maintain resident equipment and the building in good repair, homelike, and in a sanitary condition on 2 of 2 units (Skilled Nursing Unit [SNF] and Long Term Care Unit [LTC]). Findings: 1. On 2/19/25 at 10:30 a.m., the Administrator, Housekeeping/laundry Manager (HLM) and a surveyor observed multiple areas of the building that included floors in resident rooms, the Skilled Unit dining room, common areas, and hallways on both units. The flooring was observed to have discolored areas that created a soiled and/or worn appearance and cracked floor coverings, which created uncleanable surfaces. […]

• No harm, potential for more than minimal, patternF657Feb 20, 2025

  Based on observations, record reviews and interviews, the facility failed to update/revise care plans for the use of Enhanced Barrier Precautions (EBP) for 2 of 3 residents reviewed (Resident #26 [R26] and [R27]) Findings: 1. On 2/19/25 at 7:55 a.m., a surveyor observed an EBP sign on the outside of the door of R26's room. Record review showed that R26 has wounds on both heels with daily dressing changes. The care plan was reviewed and lacked evidence of addressing the need for the EBP while providing care to R26. On 2/20/25 at 1:30 p.m., during an interview with a surveyor and the Residential Care Coordinator, the surveyor confirmed that R26's care plan had not been updated to include the required EBP. 33242 2. […]

• No harm, potential for more than minimal, patternF689Feb 20, 2025

  Based on observations and interviews, the facility failed to ensure that hot water temperatures in resident rooms did not exceed 120 degrees Fahrenheit and that blue floor tiles in the Skilled Unit hallway were completely glued to the floor creating a possible trip hazard, on 2 of 3 days of survey (2/18-2/19/25). Findings: 1. On 2/18/25 between 11:25 a.m. - 11:46 a.m., two surveyors observed the following hot water temperatures: room [ROOM NUMBER], the hot water temperature was 124.8; room [ROOM NUMBER], the hot water temperature was 122.1; room [ROOM NUMBER], the hot water temperature was 124.5; room [ROOM NUMBER], the hot water temperature was 124.8; room [ROOM NUMBER], the hot water temperature was 122.5; room [ROOM NUMBER], the hot water temperature was 120.9; and room [ROOM NUMBER],… […]