Greenfield Care Center of Fairfield

In the surveyor’s words

From the most serious findings on record at Greenfield Care Center of Fairfield, in the surveyor’s own words.

• Immediate jeopardy, patternF921Nov 8, 2021

  Based on observation, interview and record review, the facility failed to provide a safe environment to 28 residents, who were identified by facility staff as ambulatory and/or used wheelchairs, enabling them to independently maneuver throughout the facility, when: 1. B-wing exit door was observed left open, with no alarm for unauthorized exit or entry, and with a Wanderguard Alarm which was not functioning; 2. A-wing door alarm was off, and the door was left unlocked and able to be opened from inside and outside; and, 3. […]

• Actual harm, patternF684Mar 13, 2025

  Based on observation, interview, and record review, the facility failed to ensure residents received treatment and care to attain and maintain their highest practical wellbeing consistent with professional standards of practice and facility's policy and procedure (P&P) for nine out of 31 sampled residents (Resident 265, 60, 267, 264, 266, 160, 262, 263, and 48) when: 1. Resident 265's prescribed pain medication, and Resident 60 and Resident 267's prescribed medications were ordered late; 2. Resident 264's order for pain medication was sent to the pharmacy without a valid prescription order and another prescribed medication was ordered late; 3. […]

• Actual harm, patternF760Mar 13, 2025

  Based on observation, interview and record review, the facility failed to ensure four out of 31 sampled residents (Resident 265, 264, 160, and 266) were free from significant medication errors when Resident 265, 264, 160, and 266 did not receive prescribed pain medications in accordance with the physician's order. These failures resulted in Resident 265, 264, 160, and 266 experiencing unnecessary pain and emotional distress which had negatively affected the residents' level of comfort, activity and sleep. Findings: 1a. […]

• Actual harm, patternF686Mar 26, 2024

  Based on observations, interviews and record reviews, the facility failed to accurately assess, monitor, and provide wound care treatment to prevent development of facility acquired pressure ulcer (PU, a damage to an area of the skin caused by constant pressure on the area for a long time) and to prevent the worsening of an existing pressure ulcer for three of 23 sampled residents (Resident 21, Resident 33, and Resident 122), when: 1. a. The facility did not monitor Resident 21's right heel when he was wearing a Pressure Relief Ankle Foot Orthosis (PRAFO, an orthosis with an aluminum heel connecting bar that helps to hold the ankle in a neutral (90 degree) position. b. […]

• Actual harm, patternF689Mar 26, 2024

  Based on observations, interviews and record reviews, the facility failed to develop and implement an effective fall management program for three out of 23 sampled residents(Residents 38, 13 and Resident 26) with Dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities), when: A. 1. The facility did not follow its fall care plan (CP, a form where you can summarize a person's health conditions, specific care needs, and current treatment) when Resident 38 was not observed frequently and was not placed in a supervised area when out of bed such as when she was ambulating. 2. […]