South Shore Health & Rehabilitation Center

In the surveyor’s words

From the most serious findings on record at South Shore Health & Rehabilitation Center, in the surveyor’s own words.

• Actual harm, isolatedF684Sep 28, 2023

  Based on record review and interview, the facility failed to ensure a resident who received a left foot/toe injury had thorough and accurate assessments of the area and failed to treat the area as ordered by the Physician, which resulted in the resident being admitted into the hospital with diagnoses of left great toe infection, cellulitis of the left foot, and a MRI of the foot that indicated a result of suspicious for osteomyelitis of the left great toe for 1 of 2 residents reviewed for injuries. (Resident C) Finding includes: Resident C's record was reviewed on 9/27/23 at 10:42 a.m. […]

• No harm, potential for more than minimal, widespreadF812Sep 22, 2025

  Based on observation, record review and interview, the facility failed to maintain a sanitary kitchen related to a low temperature chemical dishwasher not sanitizing properly. This had the potential to affect all 70 residents who received meals prepared in the kitchen. (Main Kitchen)Finding includes:On 9/15/25 at 9:00 a.m. the initial kitchen tour was completed with the Dietary Manager (DM). The DM indicated they used a chemical dishwasher, but it was not working properly at the time, and the company was coming out to service it on Friday. He obtained a test strip and dipped it into the dishwasher water. It did not register any parts per million of sanitizing solution. Dietary Aide 1 indicated she had put bleach in a bucket of water in the sink to sanitize the dishes. […]

• No harm, potential for more than minimal, widespreadF812Jul 24, 2024

  Based on observation and interview, the facility failed to ensure food was served and prepared under sanitary conditions related to touching food with ungloved hands, dirty food preparation equipment and greasy pipes for 1 of 1 residents observed for dining and 1 of 1 kitchens observed. (Resident L and the main kitchen) Findings include: 1. During a dining observation on 7/18/24 at 1:10 p.m., Resident L was observed in bed waiting for lunch. At that time, CNA 2 removed the lid off of the resident's tray. Resident L was served a hot dog on plain white bread. The CNA put ketchup on the hot dog and with her bare hands, broke the hot dog and bread in half and handed Resident L half of the sandwich to eat. […]

• No harm, potential for more than minimal, widespreadF925Sep 15, 2022

  Based on observation, record review, and interview, the facility failed to maintain an environment free of pests related to a dead mouse found in a trap in a resident room and lack of communication for further preventative measures. (Resident B) This had the potential to affect all 83 residents residing in the facility. Finding includes: Interview with Resident C on 9/15/22 at 9:00 a.m., indicated she had seen a mouse run under the wardrobe closet on the floor. At that time, an empty mouse trap was observed on the floor in the corner of the room by the windows. Interview with Housekeeper 1 on 9/15/22 at 9:15 a.m., indicated there had been recent sightings of mice. […]

• No harm, potential for more than minimal, widespreadF880Dec 9, 2021

  Based on observation, record review, and interview, the facility failed to ensure infection control guidelines were in place and implemented, including those to prevent and/or contain COVID-19, related to the lack of protective eyewear worn by staff during random observations. This had the potential to affect all residents residing in the facility. Finding includes: On 12/9/21 at 9:39 a.m., the Nurse Practitioner (NP) was observed entering an isolation room. She had an N95 mask on, but no eye protection. She exited the room at 9:43 a.m. without eyewear on. There was a sign on the door of the room that indicated the resident was on contact and droplet precautions and eyewear was required. Interview with the NP at that time indicated she was not aware she should have eye protection on. […]