The Bartlett Skilled Nursing and Assisted Living

In the surveyor’s words

From the most serious findings on record at The Bartlett Skilled Nursing and Assisted Living, in the surveyor’s own words.

• Immediate jeopardy, widespreadF880Oct 4, 2021

  Based on observation, interview and record review, the facility failed to establish and maintain an Infection Prevention and Control Program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for four (June 2021, July 2021, August 2021 and September, 2021) of four months of screening logs reviewed, and failed to insure that all persons entered the facility through the specific single entrance for four (Kitchen Aide C, Kitchen Aide D, Kitchen Aide E and Dietary Manager) of fifteen employees reviewed for compliance with entrance to the facility though a single specified monitored entrance. […]

• Actual harm, isolatedF627Apr 11, 2026

  Based on interviews and record review, the facility failed to follow written policy on permitting residents to return to the facility after they are hospitalized for one of (Resident #1) six residents reviewed for transfer and discharge.The facility failed to readmit Resident #1 to the facility after she was sent to the hospital on [DATE].This failure could place residents at risk of being discharged and not allowed to return to the facility causing a disruption in their care and services and potential for decline.Findings included:Closed record review of the Face Sheet dated 04/10/26 for Resident #1 revealed an original admission date of 5/20/19 and re-admission date 12/08/2023. […]

• Actual harm, isolatedF600Aug 7, 2025

  Based on interview and record review the facility failed to ensure residents were free from abuse, neglect, misappropriation of resident property, and exploitation for 2 of 5 residents reviewed for abuse. The facility failed to ensure Resident #1 was free from abuse when Resident #2 physically struck Resident #1 resulting in a bruise/hematoma to her forehead.This deficient practice placed residents at risk for further abuse.Findings include:1. Record review of Resident #1's face sheet, dated 8/6/25, revealed a [AGE] year-old female who was admitted to the facility on [DATE]. […]

• Actual harm, isolatedF697May 11, 2022

  Based on interview and record review the facility failed to ensure pain management was provided to residents who required such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 1 (Resident #198) of 1 resident reviewed for pain. The facility failed to provide pain relief during wound care for Resident #198. This failure could place residents at risk for unnecessary pain, stress, irritability, aggressive behavior fear of treatment, seeking other means of managing pain, and decreased quality of care. Findings included: Review of Resident #198's undated face sheet revealed she was a [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . […]

• No harm, potential for more than minimal, widespreadF944Jul 11, 2024

  Based on interviews and record review the facility failed to include as part of its QAPI program mandatory training that outlines and informs staff of the elements and goals of the facility's QAPI program for 16 ( the Administrator, the DON, the Infection Disease Preventionist, the Social Worker, the Activity Director, the Housekeeping Supervisor, the Maintenance Supervisor, the Director of Food Services, RN H, LVN I, LVN J, LVN K, CNA L, CNA M, CNA N, and CNA O) of 16 employees reviewed for training regarding QAPI. […]