Civita Sheriden Woods

knee he/she felt grinding in the left knee and immediate pain. Resident #1 identified NA #1 also heard the sound and the resident reported his/her left leg was touching the mattress, so NA #1 was able to pull him/her onto the edge of the bed and get him/her into bed without a fall occurring. Resident #1 indicated the transfer was very difficult and NA #1 did not utilize a gait belt.Interview with NA #1 on 1/30/26 at 1:17 PM identified as she was walking by Resident #1's room on 1/16/26, she observed Resident #1 leaning forward in the wheelchair with his/her hands on the side rail and it appeared Resident #1 was trying to stand. NA #1 indicated Resident #1 had been incontinent and although she knew Resident #1 was an assist of two (2) stand pivot with the walker for transfers, she did not call out or use the call bell to request assistance. NA #1 identified she did not place a gait belt around Resident #1 and did not utilize the walker to assist in the transfer. NA #1 explained she assisted Resident #1 in standing while Resident #1 held onto the side rail and as Resident #1 started to pivot, she heard a pop sound and Resident #1 yelled out in pain.

NA #1 identified Resident #1 was close enough to the bed so she was able to get Resident #1 on the edge of the bed and lay Resident #1 into the bed and then left the room immediately to notify the nursing supervisor. NA #1 reported looking back, she should have yelled for assistance, waited so Resident #1 could safely be transferred to the bed, should have put the gait belt on and utilized the walker prior to transferring Resident #1 to bed.Interview with the 3-11PM nursing supervisor, Registered Nurse (RN) #1, on 1/30/26 at 12:18 PM identified on 1/16/26 the 3-11 PM nurse aide, Nurse Aide (NA) #1, came to her around 4:15 PM to report the incident. RN #1 indicated NA #1 reported she went to provide care to Resident #1 because Resident #1 had been incontinent and the incident occurred when she transferred Resident #1 into bed. RN #1 identified she assessed Resident #1 and although Resident #1 complained of pain with movement of the left leg and knee, she did not observe any redness or swelling so she did not report the incident to the provider immediately. RN #1 identified the 3-11PM charge nurse, Licensed Practical Nurse (LPN) #2, came to her just after 10:30 PM and reported Resident #1 had swelling to the left knee and continued to complain of pain with any movement of the left leg. RN #1 explained she assessed Resident #1 and then called the provider to report the initial incident and the subsequent swelling and pain.

RN #1 reported NA #1 should not have transferred Resident #1 without a second staff member present and identified Resident #1 had significant lymphedema to both lower legs.Interview with Physical Therapist #1 and Occupational Therapist #1 on 1/30/26 at 2:02 PM identified Resident #1 had been on therapy services until 12/18/25, when Resident #1 was then discharged as an assist of two (2) for stand pivot transfers from the bed to the wheelchair and from the wheelchair to the bed.

They indicated Resident #1 was not capable of pulling or pushing him/herself up out of the wheelchair unassisted.Interview with the Director of Nursing (DON) on 1/30/26 at 1:29 PM identified at the time of the 1/16/26 incident, Resident #1 was an assist of two (2) stand pivot transfer with the walker per the resident care card and physician's order.

Review of the Use of Care Cards policy dated 3/12/25 directed, in part, that the facility utilizes Care Cards as a supplement tool to communicate essential, resident-specific care information to staff that highlights key care needs to support safe, consistent daily care and that they may include the following minimum necessary information to include mobility/transfer status.

Noncompliance will be addressed through re-education and corrective action as needed.

Review of the Gait Belt policy dated 9/1/22 directed, in part, that gait belts must be used for any residents who requires assistance with transfers or ambulation. A gait belt is required unless the resident is independently mobile or its use is contraindicated.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

01/30/2026

STREET ADDRESS, CITY, STATE, ZIP CODE

Sheriden Woods Health Care Center Inc

321 Stonecrest Drive Bristol, CT 06010

SUMMARY STATEMENT OF DEFICIENCIES

Review of the Pain Assessment and Management policy (undated) directed, in part, that acute pain should be assessed every thirty (30) to sixty (60) minutes after the onset and reassessed as indicated until relief is obtained.

Review the medication administration record to determine how often the individual requests and receives as needed pain medication, and to what extent the administered medications relieve the resident's pain. If pain has not been adequately controlled, the multidisciplinary team, including the physician, shall reconsider approaches and make adjustments as indicated.

Report the following information to the physician or practitioner: significant changes in the level of the resident's pain and prolonged, unrelieved pain despite care plan interventions.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

01/30/2026

STREET ADDRESS, CITY, STATE, ZIP CODE

Sheriden Woods Health Care Center Inc

321 Stonecrest Drive Bristol, CT 06010

SUMMARY STATEMENT OF DEFICIENCIES

Based on review of facility documentation, review of facility policy, and interviews for one (1) of three (3) nurse aides, the facility failed to complete an annual performance evaluation.

The findings include:Review of a 3-11PM nurse aide's, Nurse Aide (NA) #1, personnel file identified a hire date of 11/26/12 and the last performance evaluation was completed on 12/18/22.

The facility failed to identify a yearly performance evaluation was completed in 2023, 2024, and 2025.

Interview with the Administrator on 1/20/2026 at 2:45 PM identified each employee was required to have a performance evaluation completed annually based on their date of hire, yearly anniversary.

The Administrator identified although the facility does not currently have a Human Resources (HR) staff member, HR was expected to make the notification of when the performance evaluation was due, and the annual evaluation was then distributed to the nursing supervisor to complete, HR was then responsible for ensuring the annual performance evaluations were completed and in the employee's record.

The How to Complete the Performance Evaluation policy identified that the facility reviews and summarizes the employee counseling session to identify a trend and pattern.

The facility also reviews the job description performance rating with the employee to ensure the employee understands the performance rating for the function of their position and the performance evaluation is filed in accordance with facility policy.

Facility ID: