Littleton Care and Rehabilitation Center

In the surveyor’s words

From the most serious findings on record at Littleton Care and Rehabilitation Center, in the surveyor’s own words.

• Actual harm, isolatedF600Oct 3, 2024

  Based on record review and interviews, the facility failed to ensure two (#1 and #5) 11 residents out of 12 sample residents were kept free from abuse. Resident #1, who had limited mobility and required staff assistance with bed mobility and transfers due to a recent hip surgery, was admitted to the facility on [DATE]. On the night of 7/21/24, Resident #1 used her call light to request staff assistance with being repositioned in bed. The resident later used her call light to request staff assistance with going to the bathroom. Both times, when staff had not responded to the resident's call light in over one hour, the resident called her legal representative. […]

• No harm, potential for more than minimal, patternF880Feb 19, 2026

  Based on observations and interviews, the facility failed to maintain an infection control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of diseases and infection for one of two units reviewed. Specifically, the facility failed to:-Ensure staff wore the appropriate personal protective equipment (PPE) for Resident #11, who was on enhanced barrier precautions (EBP);-Ensure proper infection control practices were followed during wound care;-Ensure hand hygiene was appropriately performed during wound care; and,-Ensure hand hygiene was appropriately performed during medication administration. Findings include:I. EBP failuresA. […]

• No harm, potential for more than minimal, patternF565Oct 3, 2024

  Based on observations, record review and interviews, the facility failed to ensure prompt action was taken upon the filing of a grievance of a group. Specifically, the facility failed to follow-up with concerns that were brought up by the group of residents during the resident council meetings regarding resident care and life in the facility. Findings include: I. Facility policy The Grievance Policy, dated 10/3/24, was provided by the social services consultant (SSC) on 10/3/24 at 11:47 a.m. It read in pertinent part, To address resident concerns without fear of discrimination or reprisal. […]

• No harm, potential for more than minimal, patternF880Jan 9, 2024

  Based on observations and interviews, the facility failed to maintain an infection control program designed to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of disease and infection. Specifically, the facility failed to: -Ensure resident restrooms were cleaned appropriately; -Ensure surface disinfectant times were followed; and, -Ensure high touch surfaces were cleaned. Findings include: I. Professional reference According to the Environmental Cleaning procedures (reviewed 5/4/23) retrieved on 1/10/24 from: https://www.cdc.gov/hai/prevent/resource-limited/cleaning-procedures.html, documented in part, common high touch surfaces include: sink handles, bedside tables, call bells door knobs, and light switches. […]

• No harm, potential for more than minimal, isolatedF604Jan 9, 2024

  Based on observations, record review and staff interviews, the facility failed to ensure one (#13) resident was free from physical restraints out of 21 sample residents. Specifically, the facility failed to: -Use the least restrictive device for the least time possible, when using a wander guard on Resident #13; -Have a physician's order in place to check for placement and functioning of Resident #13's wander guard; and, -Identify the wander guard as a restraint on Resident #13's minimum data set (MDS) assessment. Findings include: I. Facility policy and procedure The Alarms policy, dated October 2023, was provided by the director of nursing (DON) on 1/8/24 at 2:24 p.m. […]