Germantown Home

In the surveyor’s words

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

• Immediate jeopardy, isolatedF600Aug 30, 2022

  Based on review of facility policies, review of facility documentation, clinical record review and interviews with staff, it was determined that the facility failed to ensure that a resident was free from physical abuse for one of six residents reviewed (Resident R1). This failure resulted in an Immediate Jeopardy situation for Resident R1 who was rough handled and hit by a nurse aide. Findings include: Review of facility policy, Abuse Prohibition dated last revised March 9, 2021, revealed, Residents will be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion. Residents will not be abused by anyone, including, but not limited to, facility staff. […]

• Immediate jeopardy, isolatedF600Jun 9, 2022

  Based on review of facility policies, review of facility documentation, clinical record review and interviews with staff, it was determined that the facility failed to ensure that a resident was free from physical abuse for one of six residents reviewed (Resident R1). This failure resulted in an immediate jeopardy situation for Resident R1 who was hit on the back of the head by a nursing staff. Findings include: Review of facility policy, Abuse Prohibition dated last revised March 9, 2021, revealed that, Residents will be free from verbal, sexual, physical, and mental abuse, corporal punishment and involuntary seclusion. […]

• Immediate jeopardy, isolatedF600Apr 6, 2022

  Based on the review of clinical records, facility documentation and interviews with staff, it was determined that the facility failed to ensure that residents were free from sexual abuse which resulted in actual harm to Resident 51 who was sexually assaulted by Resident R42 for one of 33 residents reviewed. (Resident R51). Findings include: Review of the facility policy title Freedom from Abuse, Neglect and Exploitation last revised January 2022 revealed that The facility must ensure that all residents are free from abuse, neglect and exploitation. Continued review of the policy indicated that Sexual abuse is nonconsensual sexual contact of any type with a resident. Review of Resident R42's clinical record revealed the diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . […]

• Actual harm, isolatedF689Apr 6, 2022

  Based on the review of clinical records, facility documentation and interviews with staff, it was determined that the facility failed to ensure adequate supervision to Resident R42 which resulted in actual harm to Resident 51 who was sexually assaulted by Resident R42 for one of 33 residents reviewed (Resident R51). Findings include: Review of Resident R42's clinical record revealed the diagnoses of Dementia (a condition characterized by progressive or persistent loss of intellectual functioning especially with impairment of memory and abstract thinking), wandering (a person with dementia roams around and becomes lost and confused), [CONDITION(S)] (cannot sleep at night), and left eye [CONDITION(S)]. […]

• No harm, potential for more than minimal, patternF657Aug 1, 2025

  Based on observations, review of clinical records, review of facility policy, and interview with staff, it was determined that the facility did not develop and implement a comprehensive, resident-centered care plan for seven of 35 residents reviewed related to wounds and Enhanced Barrier Precaution's. (Resident R36, R71, R114, R156, R24, R187, and R41)Findings include:Review of facility policy Resident Centered Care Planning, revised on 06/06, indicates that purpose of policy is to utilize the Resident Assessment Process (RAP) according to Federal Regulations; further indicating that RAP is to be completed by Nursing staff for pressure ulcers.Review of Resident R36's clinical record revealed the resident was assessed with Stage IV (ulcer involving loss of skin layers, exposing muscle)… […]