Every finding on record at Maine Veterans Home - So Paris

Based on facility policy review, controlled substance (Narcotic Bound) book and interviews, the facility failed to ensure that each nurse signed the controlled substance book after each shift count for 5 out of 5 medication/treatment carts observed.Findings:The facilities Management of Controlled Substances policy and procedure last reviewed 11/12/24 under section 6.5.1 states A count of Scheduled II drugs will be done at the change of shift, or when there is an exchange of keys, by two people who are authorized to administer medications, one of who must be a licensed nurse, utilizing the bound book from which no pages are removed. Accuracy of the count will be acknowledged with the two signatures of the staff members who performed the count and section 6.5.1.1 states, Count of the Schedule 3-5 drugs will be done at the change of each shift, or when there is an exchange of keys, by two people who are authorized to administer medications, utilizing the bound book from which no pages are removed. Accuracy of the count will be acknowledged with the two signatures of the staff members who preformed the count. 1. On 12/15/25 at 8:25 a.m., observation of the Narcotic Bound Book for Unit B nurse treatment cart containing Schedule II drugs with the Registered Nurse #1 (RN#1). The shift count sign off had multiple missing entries for narcotic reconciliation: on 8/2/25 day shift, 8/20/25 night shift, 10/21/25 day shift, 11/9/25 both evening and night shifts, 11/10/25 day shift, 11/12/25 day shift, 11/19/25 day shift, 11/21/25 evening shift and 11/27/25 evening shift. At this time, the RN#1 stated both the nurse coming on and the nurse going off are to count the narcotics and both sign the back of the narcotic book at the change of each shift.2. On 12/15/25 at 9:23 a.m., observation of the Narcotic Bound Book for Unit B Medication cart, containing Schedule 3-5 drugs, with the Certified Medication Technician (CNA-M) #1. The change of shift count had multiple missing entries for the narcotic reconciliation; on 10/11/25 night shift, 10/24/25 evening shift, 11/3/25 day shift, 11/10/25 day shift, 11/11/25 evening and night shift, 11/19/25 day shift, 11/23/25 night shift, 11/24/25 day shift and 12/3/25 day shift. At this time, the above missing entries were discussed with the CNA-M #1.3. On 12/15/25 at 9:52 a.m., observation of the Narcotic Bound Book for Unit C Medication cart, containing Schedule 3-5 drugs, with the Registered Nurse (RN) #2. The change of shift count had multiple missing entries for the narcotic reconciliation; on 11/4/25 day shift, 11/23/25 day shift, 11/24/25 evening shift, 12/1/25 evening and night shift, 12/2/25 day shift and 12/9/25 day shift.4. On 12/15/25 at 10:00 a.m. observation of the Narcotic Bound Book for Unit C nurse treatment cart, containing Schedule II drugs, for rooms C1 through C16 with the Licensed Practical Nurse (LPN) #1. The change of shift count had multiple missing entries for the narcotic reconciliation; on 7/31/25 evening shift, 11/2/25 night shift and 12/9/25 day shift.5. On 12/15/25 at 10:05 a.m. observation of the Narcotic Bound Book for Unit C nurse treatment cart, containing Schedule II drugs, for rooms C17 through C32 with the RN #3. The change of shift count had multiple missing entries for the narcotic reconciliation; on 8/8/25 day shift, 8/27/25 evening shift, 10/26/25 night shift, 11/2/25 night shift, 11/3/25 night shift and 11/4/25 day shift.On 12/15/25 at 12:57 p.m., during an interview, the above missing change of shift signatures for the narcotic reconciliation was discussed with the Director of Nursing.

Based on observation and interview, the facility failed to ensure the kitchen was maintained in a clean and sanitary manner for a dish machine, a food disposal, fans, mixers, a shake machine and dessert dishes; and failed to ensure a large sugar bin was labeled and dated. Additionally, the facility failed to ensure that kitchen staff members with facial hair wore facial hair protection.Findings: On 12/15/25 from 8:10 a.m. to 8:50 a.m., a surveyor did an initial kitchen tour with the Food Service Director in which the following findings were observed: -The sides and top of the dish machine had a build-up of dried liquid residue and chemical residue. -The food disposal had dried food particles and dried liquid residue on it. -A large standing floor fan was dusty/dirty.-A shelf-top mixer had dried food particles on the unit and base.-A large standing floor mixer had dried food particles and dried liquid residue on the unit and base.-A commercial shake machine had dried food particles and dried liquid residue on the unit and base.-There were approximately one hundred stacked clear plastic dessert cups that had dried liquid residue and chemical residue on them. -A large bin of sugar was not labeled and dated.-Two male kitchen workers, observed to have facial hair, were not wearing facial hair protection. On 12/15/25 at 8:50 a.m., in an interview with a surveyor, the Food Service Director confirmed the findings.

Based on record review and interview, the facility failed to ensure that a Minimum Data Set, Version 3.0 (MDS) was accurately coded for 1 of 1 resident reviewed for hospice (Resident #4). Resident #4's clinical record stated he/she was admitted into hospice for end of life care on 5/17/25. A Significant Change Assessment, with an Assessment Reference Date (ARD) of 5/23/25, and completed on 5/27/25; Section Treatments/Procedures:0: lacked evidence that Resident #4 was admitted to hospice.Review of facility provided Reason for Significant Change dated 5/20/25 states : [Resident #4] opened to Hospice under [Hospice] on 5/17. A significant change MDS has been scheduled. During an interview on 12/16/25 at 1:18 p.m., with 5 surveyors present. the Director of Nursing confirmed Resident #4's Significant Change MDS was initiated, but was not triggered for hospice.

Based on observations, record reviews and interviews, the facility failed to ensure an expired medication was removed from the supply available for use in 1 of 5 medication/treatment carts observed (Unit C nurse treatment cart for rooms C1 through C16).Finding:On [DATE] at 10:00 a.m. during observation of the Unit C nurse treatment cart for rooms C1 through C16 with the Licensed Practical Nurse (LPN) #1, the cart contained an open Lantus insulin pen dated [DATE] with manufactures instruction to Use within 28 days after initial use. At this time LPN#1 confirmed the insulin had expired and retrieved a new insulin pen.

Based on facility policy review, record reviews, and interviews, the facility failed to ensure that the resident and/or resident representative written information, concerning the right to accept or refuse medical or surgical treatment and/or formulate and advanced directive, was completed for 2 of 2 residents reviewed for advanced directives. (Resident #30 and #47) Findings: Review of the facility policy Advance Directives, DNR Orders and Health Care Decision Making Policy: AD14. It is the policy of (Facility) to: Provide to all residents at the time of their admission and subsequently, upon request, written information concerning their rights under Maine law to make decisions concerning their health care, including the right to accept or refuse medical treatment and healthcare services, the right to withhold or withdraw life- sustaining treatment, including attempts to resuscitate in the event of cardiopulmonary arrest, the right to execute advanced directives concerning their health care decisions, and the right to designate a representative to exercise the rights of the resident in accordance with Maine law. Resident #30 was admitted to the facility on [DATE]. Review of Resident #30's clinical record lacked evidence that the facility provided/obtained resident and/or resident representative written information concerning the right to accept or refuse medical or surgical treatment and/or formulate an advance directive. On 10/9/24 at 11:45 a.m. in an interview with a surveyor, the Licensed Social Worker confirmed that Resident #30 states he/she has an advance directive, but not available, and the clinical record lacked evidence that the facility followed up with Resident #30 to obtain the advance directive. Resident #47 was admitted to the facility on [DATE]. Review of Resident #47's clinical record lacked evidence that the facility provided/obtained resident and/or resident representative written information concerning the right to accept or refuse medical or surgical treatment and/or formulate an advance directive. On 10/9/24 at 11:51 a.m., the C - Unit Nurse Manager confirmed Residents #47's clinical record did not include evidence that the residents and/or representatives were asked or offered and refused assistance filling out an advanced directive. 35904

Based on record review and interview, the facility failed to identify resident's past history of Post-Traumatic Stress Disorder (PTSD)/trauma to determine what trigger(s) might cause re-traumatization for 3 of 3 sampled residents reviewed with a diagnosis of PTSD (Resident #9, #23, and #47) Findings: 1. On 10/9/24, review of Resident #9's medical record contained several providers progress notes dated 11/8/23, 12/6/23, 4/26/24 and 9/6/24 under the section Past Medical History indicate he/she has a diagnosis of Anxiety/PTSD. Review of the facilities Trauma Exposure Checklist dated 4/6/23 states Resident #9 has PTSD due to being a Prisoner of War ([NAME]) in Korea This facility form was signed and completed by the Licensed Social Worker (LSW) indicating it was reported to the Unit B Registered Nurse (RN) Manager. Review of the quarterly interdisciplinary team meeting held on 6/25/24 stated Resident #9 has shown increased signs/symptoms of depression/PTSD (a nightmare/flashback from [NAME] experience). A verbal telephone medication order dated 8/23/24 stated the diagnosis for the mediation was for Anxiety/PTSD. In addition, review of Resident #9's care plan lacked evidence of a trauma informed care plan with identified triggers and interventions to prevent re-traumatization. On 10/9/24 at 11:01 a.m., during an interview, the above was discussed with the Director of Nursing who stated Resident #9 does not have a diagnosis of PTSD. 35904 2. Resident Resident #23 was admitted to the facility on [DATE]. The Trauma Exposure checklist indicates that Resident #23 has a diagnosis of PTSD with no listed triggers. Review of Resident #23's care plan, most updated on 7/15/24, states under care area (mood): potential for anxiety anger depression; Resident Choice: I don't want to be re-traumatized; Approach: Social Services --- screen for suicidal thoughts, assist to identify strengths, support daily decision making, provide emotional support, promote sense of control; Will participate in activities, avoid re-traumatization. On 10/9/24 at 1:09 p.m. in an interview with the Unit Manager C Unit, a surveyor confirmed that Resident #23's care plan lacked evidence of what triggers and what interventions are in place to prevent re-traumatization of the PTSD trauma informed care plan section of Resident #23's care plan. 33639 3. Resident #47 was admitted to the facility on [DATE]. The Trauma Exposure checklist indicates that Resident #47 was exposed to combat, war zone and an unexpected death as a stressful event that remains traumatic for the resident. This facility form was signed and completed by the Licensed Social Worker (LSW) on 5/14/24 indicating it was reported to the Unit Manager. The Trauma Exposure checklist instructs staff to notify the Unit Manager and Social Services Manager for follow-up with any affirmative answers. A social service progress note dated. 5/15/24 indicates that Resident #47's Power of Attorney (POA) reported that the resident has significant PTSD and had been attending group sessions. Documentation provided by the facility on 10/9/24 indicates that Resident #47 has a past medical history of PTSD. On 10/9/24 at 11:47 a.m., during an interview with the LSW, she stated that Resident #47 had a diagnosis of vascular dementia and vascular dementia takes over for the PTSD. Resident #47's care plan lacked evidence of a trauma informed care plan with identified triggers and interventions to prevent re-traumatization.

Based on observation and interview the facility failed to promote care for a resident in a manner that maintains dignity and respect when staff failed to respect the residents right to confidentiality for 1 of 1 residents observed (Resident #9). Findings: On 10/7/24 at 9:19 a.m. a surveyor approached the Clinical Resource Nurse (CRN) and asked why Resident #9 was on Enhanced Barrier Precautions. The CRN proceeded to shout down the hall, twice, to the Registered Nurses (RN) Manager, is [Resident #9] on enhanced barrier precautions for [his/her] foley. The CRN then stated, I typically yell louder. On 10/8/24 at 2:32 p.m., during an interview, the above was discussed with the Assistant Director of Nursing who agreed it was a dignity concern.

Based on observation, record review and interview, the facility failed to follow physician orders for treatment related to enteral feeding tube maintenance/care for 1 of 1 resident reviewed with a Percutaneous Gastrostomy tube (G-tube or PEG-tube). (Resident #48) Finding: On 10/8/24 at 7:51 a.m., during observation of Resident #48's G-tube medication administration and maintenance with the Registered Nurse (RN), the RN removed dirty G-tube split gauze dressing from around the stoma. She then obtained a gauze pad and wet it with the faucet water and preceded to clean the G-tube stoma site, then applied new split gauze. At this time, the surveyor asked why she was cleaning the site with water rather than normal saline. The RN stated she uses water to clean around the site. Review of Resident #48's medical record contained a physician order dated 8/14/24 to Cleanse PEG tube Stoma with NS (Normal Saline) and apply split gauze daily. On 10/8/24 at 10:18 a.m., during an interview with Interim Administer, the above was discussed.

Based on observations and interviews, the facility failed to ensure expired medications and medical supplies were removed from the supply available for resident use for 2 of 2 medication rooms observe (Unit B and Unit C) for 1 of 3 days of survey. Findings: 1. On 10/7/24 at 2:34 p.m., during observation of Unit B medication room with the Nurse Manager, two surveyors observed a flat with approx. 3/4 full of vacutainers with an expiration date of 9/30/24 available for use on residents. At this time, the Nurse Manager stated the vacutainers are used to collect residents' blood on the unit for the International Normalized Ratio (INR) labs. 2. On 10/7/24 at 2:52 p.m., during observation of Unit C medication room with the Assistant Director of Nursing (ADON), two surveyors observed a tote with over-the-counter medications on the counter containing the following open bottles available for use: One bottle of Calcium 600 plus D5 milligram (mg) with the expiration date of 6/2024, One bottle of daily multi-vitamin with minerals with the expiration date of 6/2024, and One bottle of Aspirin 325mg with the expiration date of 4/2024. At this time, during an interview, the Director of Nursing (DON) and the ADON stated that the tote is for the overflow of opened medications from the medication cart and are to be used first before obtaining a new unopened bottle from supply, confirming the medications are available to be used on residents.

Based on observations and interviews, the facility failed to serve food in accordance with professional standards for food service safety and failed to follow their own policy and procedure by not delivering food in a sanitary manner for 1 of 2 units observed during dining service and tray pass for 2 of 3 days of survey. (B unit). Findings: Facilities Policy and Procedure for Dining/Meal service, dated 2023 states, All foods should be covered and delivered as soon as possible after plating to maintain food quality and temperature. 1. On 10/7/24 from 12:21 p.m., through 12:49 p.m., 2 surveyors observed the following during the lunch dining service on the B unit in the East dining room: Dietary staff plated the food and handed the uncovered plates to the nursing staff. Nursing staff placed the plates on a tray, added drinks condiments etc. then walked the uncovered food trays through the hallways, to the end of the [NAME] Wing, the [NAME] dining room, the family room and to the end of the East Wing. All trays observed during this dining service were served without being covered to maintain sanitary conditions. 2. On 10/8/24 at 8:44 a.m., 2 surveyors observed the following during the breakfast dining service on the B unit in the East dining room: Nursing staff delivered 2 trays of uncovered food to the end of the [NAME] Wing. In addition, observation of several trays prepped, uncovered and sitting on the dining room island for, approx. 2 mins then delivered to the rooms down the [NAME] Wing hallway, uncovered. 3. On 10/8/24 at 12:14 p.m., 2 surveyors observed the following during the lunch dining service on the B unit in the East dining room: Nursing staff delivered several trays of uncovered food to the end of the [NAME] Wing and the end of the East Wing. In addition, there were no covers available in the dining room for the food to be covered. On 10/8/24 at 12:39 p.m., during an interview with the Interim Administrator and the Director of Nursing (DON) the above was discussed. The DON stated they have never covered the food from the East dining room to the [NAME] dining room, only when they are delivering to rooms. At this time, the Interim Administrator, the DON and a surveyor observed the East dining room with no food covers available. The DON immediately educated staff and plate covers were requested from the kitchen.

Based on observations and interview, the facility failed to adequately maintain housekeeping and maintenance services necessary to maintain in good repair and sanitary condition on 1 of 2 units(B Company unit) for 1 of 1 facility tours. Findings: On 10/20/21 from 8:30 a.m. to 9:05 a.m., a surveyor conducted an environmental tour with the Facilities Manager, in which the following findings were observed: B Company Unit(West side and East side) - The nurse's station, right side cubicle wall corner, was loose and in disrepair. The wall carpet and small step area carpet, to the right of the nurse's desk, was ripped and peeling off floor area. The floor carpet, behind the nurse's station, was heavily soiled and heavily stained. - The B West center island has chipped/gouged and unsealed wooden trim creating an uncleanable surface. - The B West wall corner, near the exit door to the outside patio has a broken peice of drywall exposing the metal corner and creating an uncleanable surface. - A Broda chair on the B West side has ripped material on the back rest and the head rest. - A second Broda chair on the B West side has dried liquid spills on the arms and sides. - The blue desk across from resident room B-4, has a drawer with chipped/gouged wood and is missing finish creating an uncleanable surface. - The B West restroom for the residents beside the whirlpool has a chipped/gouged area at the bottom creating an uncleanable surface. - The B West common area island has ripped/torn wall paper on the wall facing the sitting area. - In the B West hallway area near resident room B-13 dining area, a blue floral chair has worn off finish on the feet areas creating uncleanable surfaces. - A Broda chair, in the B East common area by resident room B-26, is soiled with dried food debris. - The B East counter top table area had ripped/torn and missing wallpaper, exposing sheetrock and creating an uncleanable surface. - Resident Room B-20 shower that soiled with a greenish/brownish residue. - Resident Room B-29 window curtain was in disrepair. - The hallway wall carpets, by resident rooms B-29 and B-30, had dried liquid residue on them. On 10/20/21 at 9:05 a.m., during an interview, the Facilities Manager confirmed the findings.

Based on observation and interviews, the facility failed to serve food in a sanitary manner by handling and preparing food without gloves on 1 of 3 days of survey (10/20/21). Finding: Review of the 2013 FDA Food Code section 3-301.11(B) Preventing Contamination from Hands states the following: FOOD EMPLOYEES may not contact exposed, READY-TO-EAT FOOD with their bare hands and shall use suitable UTENSILS such as deli tissue, spatulas, tongs, single-use gloves, or dispensing EQUIPMENT. Review of the 2013 FDA Food Code section 3-301.11(E) Prior Approval for Food Employees to Touch Ready-to-Eat Food with Bare Hands states the following: Because highly susceptible populations include persons who are immunocompromised, the very young and the elderly, establishments serving these populations may not use alternatives to the no bare hand contact with ready-to-eat food requirement. Review of the facility's Infection Prevention and Control Policy, date approved on 2/25/21, stated on page 51 and 52 the following: Use of Plastic Gloves Policy: Plastic gloves will be worn when handling food directly with hands to ensure that bacteria are not transferred from the food handler's hands to the food product being served. Procedure: Section 3 - Plastic gloves are to be worn whenever handling the food directly with hands when: Handling ready to eat foods, ANYTIME you touch food directly. Serving Guidelines: Avoid bare hand contact with food that is ready to eat. Use clean glove, utensil or disposable napkin to touch/handle food. On 10/20/21 at 11:05 a.m., two surveyors observed Activity staff #1 and Activity staff #2 cutting apples in the activity room without wearing gloves. When asked about using their bare hands, Activity staff #1 stated that it was ok because they had used hand sanitizer first. On 10/20/21 at 11:08 a.m., during an interview, Activity staff #1 confirmed that both Activity staff #1 and Activity staff #2 were preparing and handling food without wearing gloves. On 10/20/21 at 11:30 a.m., during an interview, the Director of Nursing confirmed that it was against facility policy for any staff in the facility to handle and prepare any foods without wearing gloves.

Based on record review and interviews, the facility failed to develop a comprehensive care plan that addressed the use of an anticoagulant drug for 1 of 5 residents reviewed for unnecessary medications (#12). Finding: A review of Resident #12's clinical record indicated that he/she was admitted to the facility on [DATE]. Physician orders [REDACTED]. The resident's current order, dated 09/09/19, indicated the dose as [MEDICATION NAME] 3.5 mg (milligrams) orally 5 times per week on Sunday, Wednesday, Thursday, Friday and Saturday; and 4 mg orally on Monday and Tuesday. The Annual Minimum Data Set (MDS) - Version 3.0, dated 04/15/19, Section N0410, indicated Resident #12's use of an anticoagulant. The medical record lacked evidence of a comprehensive care plan that addressed the goals, and interventions for the use of [MEDICATION NAME], an anticoagulant. On 9/11/19 at 11:45 am, the surveyor confirmed the comprehensive care plan did not include anticoagulant use with the Director of Nursing.

Based on interviews and clinical record review, the facility failed to ensure liability notices, which included appeal rights, were provided to 3 of 3 residents whose Medicare services were discontinued (#3, #205 and #206). Findings: 1. On review of Resident #3's liability notices, issued prior to the end of Medicare Part A services on 6/4/19, the surveyor could not locate evidence that the Notice to Medicare Provider Non-coverage (NOMNC) was provided to the resident informing his/her right to an expedited review of a service termination. 2. On review of Resident #205's liability notices, issued prior to the end of Medicare Part A services on 5/21/19, the surveyor could not locate evidence that the Notice to Medicare Provider Non-coverage (NOMNC) was provided to the resident informing his/her right to an expedited review of a service termination. 3. On review of Resident #206's liability notices, issued prior to the end of Medicare Part A services on 3/18/19, the surveyor could not locate evidence that the Notice to Medicare Provider Non-coverage (NOMNC) was provided to the resident informing his/her right to an expedited review of a service termination. On 09/11/19 at 9:50 a.m., in an interview with the Administrator and the Social Services Manager, the surveyor confirmed that NOMNCs were not issued prior to the end of Medicare Part A services.

Based on record review and interview, the facility failed to ensure a plan of care was updated in the care area of Potential for fluid volume (dehydration/deficit, overhydration fluid) for 1 of 3 Residents reviewed for pressure ulcers. (Resident #11) Finding: Resident #11's clinical record revealed a physician order [REDACTED]. The treatment administration record dated 3/16/18 has the correct order for 1,000 ml fluid restriction daily. Resident 11's plan of care in effect on 8/30/18 and dated 10/4/17 states under Approach, Nurses and Nurse Aide - Monitor intake/output fluid restriction per order 1,500ml/24 hours, and Nurse Aide - Intake/Output every shift, restrict fluids to: 1,500ml/24 hours. The plan of care was reviewed on 6/12/18 during the interdisciplinary team (IDT) meeting that states will update P[NAME] (plan of care) and change goals as necessary. Continue with P[NAME] for 90 days. On 8/30/18 at 10:36 a.m. in an interview, a surveyor confirmed with Nurse Manager, Unit C that the care plan was not updated as above.

Based on observation and interview, the facility failed to ensure an expired medication was removed from the supply available for use in 1 of 2 medication refrigerators in the medication storage room. (C Unit) Findings: On [DATE], at 8:23 a.m., during observation of medication administration, a surveyor observed a Certified Nursing Assistant-Medication (CNA-M), C Unit prepare a liquid medication (Pantoprazole) used to decrease the amount of acid in the stomach, to be administered to Resident #301. The surveyor confirmed with the CNA-M, C Unit that he/she was going to administer the medication. The liquid medication (Pantoprazole) had an expiration date of [DATE] on the label of the bottle and was still available and in use to Resident #301, 2 days past the expiration date. The surveyor confirmed the above finding with the CNA-M and Registered Nurse, Charge Nurse, C Unit at the time of the observation.

Based on observation, and interview the facility failed to maintain an Infection Control Program designed to help prevent the development of infection related pressure ulcer treatment for 1 of 3 sampled residents reviewed for pressure ulcers (Resident #27). Findings: On 8/28/18 between 9:32 a.m. to 9:55 a.m., a surveyor observed Resident 27's coccyx pressure ulcer dressing change with the Registered Nurse (RN), Charge Nurse, C Unit. At 9:32 a.m. a plastic bag that contained supplies were placed on the bed. The RN removed items from the bag and placed the bag on another area of the bed. The RN donned gloves and periodically donned and doffed new gloves to ensure they were clean. At 9:42 a.m. the RN donned new gloves, cleaned the wound with normal saline, and patted the wound dry with gauze. The RN's gloved hand was touching the resident's skin and wound area. Without changing gloves the RN placed his/her soiled gloved hand in the plastic bag containing supplies and removed scissors and tape. The RN used the tape, and scissors (wiped the shear with a piece of clean, left over antimicrobial gauze used for packing the wound), and placed them back in the plastic bag of supplies. The handle of the scissors were not cleaned. On 8/28/18 at 10:01 a.m. in an interview, a surveyor confirmed with the RN, Charge Nurse, C Unit that he/she handled scissors and tape with a dirty gloved hand and didn't clean the handle of the scissors or tape prior to placing them in the plastic bag, in addition, the plastic bag that was placed on the resident's bed was put in the treatment cart without cleaning it.

Based on the facility's Reportable Incident Form for Certified, Licensed or Registered Providers, written statements, the facility's Abuse, Neglect, Exploitation and Misappropriation of Property policy, medical record review and interviews, the facility failed to ensure that 1 out of 3 residents sampled reviewed for neglect was free from being left unattended in the bathroom, on the toilet for approximately two hours. Findings: On 11/20/17 at 1:59pm, the Division of Licensing and Certification received a faxed incident from Maine Veteran's South Paris, indicating on 11/17/17 concerns of neglect when Resident #1 was found on the toilet approximately two hours after being placed on the toilet. On 12/20/17 at 8:00am, an unannounced onsite investigation was conducted. Review of the facility's Abuse, Neglect, Exploitation and Misappropriation of Property Policy dated 11/28/16 defines Neglect as The failure of the facility, its employees or service providers to provide the goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish or emotional distress. Review of Resident #1's Annual Minimum Data Set (MDS) dated [DATE] Section G: functional status indicates Resident #1 is extensive assist with 2 plus person's assistance for bed mobility, transfers, dressing and toileting. Review of Resident #1's physician progress notes [REDACTED].#1 being left on the toilet for approximately two and one half hours indicating no harm or injury was sustained as a result of being left on the toilet for approximately two and one half hours, and further review reveals a nurse's note dated 11/18/17 11:37 a.m. confirms Resident #1 was left on the toilet for approximately two and one half hours and the subsequent documentation of skin condition. Review of the written statements from CNAs #1, #2, and #3, during the facility's investigation, reflect Resident #1 was placed on the toilet by CNA #1 and CNA #3 at approximately 7:15 p.m. on 11/17/17. CNA #2 was not informed of Resident #1 being placed on the toilet. CNA #2 found Resident #1 on the toilet at approximately 8:00 p.m. and stated he/she left (Resident #1) on (the toilet) not knowing who put him/her on. At approximately 9:00 p.m. on 11/17/17 CNA#2 asked CNA #3 if he/she had charted on Resident #1 and put him/her back to bed. CNA #3 stated he/she had not. Upon checking Resident #1 at approximately 9:30 p.m. on 11/17/17, the resident was still on the toilet. At approximately 9:45 p.m. Resident #1 was assisted back to be by CNA #2 and CNA#3 and assessed by the charge nurse. On 12/2017 at 3:40 p.m. an interview with the charge nurse confirmed he/she was informed of Resident #1 having been found on the toilet on 11/17/17 at approximately 9:30 p.m., after approximately two and one half hours. The Charge nurse reports Resident #1 was immediately assisted back to bed and complete skin assessment was performed by him/her. Skin was intact, blanchable in on the right thigh and not blanchable on the left thigh. Clearing of all redness documented 11/18/17 at 4:15 a.m. On 12/20/17 at 4:30 p.m., an interview with the Administrator and the Director of Nursing confirms Resident #1 was left in the bathroom on the toilet for approximately two and one half hours without resulting injury. Because of the facility's investigation the following corrective actions were initiated; Licensing and Regulatory Services was notified by fax, on 11/20/17. CNA#1 and CNA#3 were suspended pending investigation. Lack of communication and consequences were reviewed by the DON with all staff. Resident#1 was moved from a private room to a semi private room. The CNA assignments are to be completed for each resident by the same CNA assigned to that resident. When a resident has a refusal or specific request for a particular CNA to care or not care for them performing isolated tasks i.e.: personal care or toileting, then the entire resident assignment gets switched to the preferred caregiver. The preferred CNA will reassign one of his/her residents to the other CNA. The care plan was updated to reflect the resident will be checked on every 15 minute while in the bathroom. The facility instituted a facility wide policy that all residents placed on the toilet will be checked on every 15 minutes regardless of cognitive state or ability to use the call bell.

Based on observations and interviews, the facility failed to adequately maintain housekeeping and maintenance services necessary to maintain in good repair and sanitary condition residents' rooms cove base, bathroom doors, room doors, nurse's station wall carpet and room/bathroom baseboard heaters for 40 of 50 resident rooms (B Company Unit and C Company Unit) and 1 of 2 nursing station areas (B Company Unit) for 3 of 3 days of survey. Findings: On 07/17/17 from 8:30 a.m. to 9:30 a.m., during an environmental tour with the Facilities Manager, the following findings were observed: B Company Unit: The cove base was ripped and/or missing, by bathrooms, in rooms: #2, #3, #4, #5, #11, #12, #16, #18, #19,#20, #26, and #29. The bathroom doors were marred and scratched and/or chipped in rooms: #1, #2, #3, #4, #5, #7, #11, #12, #13, #14, #15, #16, #17, #18, #19, #20, # 22, #23, #24, #25, #26, #27, #28, #29 and #30. The resident room doors were marred and scratched and/or chipped in rooms: #15, #16, #19, #20, and #25 as well as B Company Unit entrance door. The wall carpet across from the nurse's station was soiled and stained. The baseboard heaters were marred and scratched in rooms: #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #11,#12, #13, #14, #15, #16, #17, #18, #19, #20, #21, #22, #23, #24, #25, #26, #27, #28, #29 and #30 and in bathrooms #15, #16, #19, #20 and #25. C Company Unit: The cove base was ripped and/or missing, by bathrooms, in rooms: #11/12, #25/26 and #27/28. The bathroom doors were marred and scratched and/or chipped in rooms: #7/8, #11/12 and #13/14. The baseboard heaters were marred and scratched in rooms: #2, #9/10, #11/12, #13/14, #15/16, #17/18, #19/20, # 23/24, #25/26 and #27/28. On 7/19/17 at 9:30 a.m., a surveyor confirmed the findings in an interview with the Facilities Manager.

Based on closed record reviews and interview, the facility failed to ensure liability notices, which included appeal rights, were provided at least two days prior to a planned discharge for 2 of 3 residents, whose Medicare services were discontinued (#14 and #17). Finding: 1. Resident #14's closed medical record indicated that the resident was discharged on [DATE]. A liability notice provided to the resident indicated that Medicare services would be no longer be needed and was signed by the resident on 4/4/16, one day before his planned discharge. On 7/13/16 at 2:30 p.m., a surveyor discussed this finding with the Licensed Social Worker (LSW). 2. Resident #17's closed medical record indicated that the resident was discharged on [DATE]. A liability notice provided to the resident indicated that Medicare services would be no longer be needed and was signed by the resident on 6/7/16, one day before his planned discharge. On 7/13/16 at 2:30 p.m., a surveyor discussed this finding with the Licensed Social Worker (LSW).