Grandview Rehabilitation And Healthcare Center

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

verbal exchange with Resident #5, and Resident #5 used foul language. RN #1 then repeated the statement back to Resident #5, and used the same foul language and swearing directed to Resident #5; RN #3 stated I am the ***** supervisor b****, but I need you to lower your voice. The statement further indicated RN #3 received a second call that morning and was informed Resident #5 was yelling in the hallway. Resident #5 had stated the same foul language toward RN #3, and stated ***** b****, I am going to kick you're a** as Resident #5 was approaching her. RN #3 indicated a floor nurse stood in Resident #5's way as Resident #5 was approaching RN #3. RN #3 was holding a pitcher of water in her hand and stated to Resident #5, you will take a bath today if you come closer to me. Facility summary dated 9/22/2025 identified the facility did not substantiate the allegation of abuse because the resident was the aggressor and RN #3 was attempting to de-escalate the situation to protect staff, residents and herself. The summary further identified the facility discussed options with Resident #5 and the COP, and Resident #5 chose to leave the facility Against Medical Advise (AMA). Interview with RN #3 on 10/22/2025 at 12:28 PM identified

she used swear words and foul language directed at Resident #5 and threatened to dump/pour water on Resident #5. RN #3 repeated/echoed the foul language/swearing back to Resident #5 when it was used toward her. RN #3 stated on the second visit to the unit on the morning of 9/17/2025, Resident #5 was yelling and approaching her using slurs and threatening her with physical aggression. RN #3 stated she responded by telling Resident #5 he/she would take an early bath today if he/she came any closer to her.

Interview with the Director of Nurses (DON) #2 on 9/17/2025 at 11:35 AM identified she was not the DON when the incident occurred. DON #2 stated RN #3's response was inappropriate, and a threat to the resident. Interview with facility Manager on 10/23/2025 at 1:09 PM identified when Resident #5 swore at RN #3 and used foul language, RN #3 echoed/repeated the same language back to Resident #5. RN #3 also threatened to throw water on Resident #5. Interview identified the response by RN #3 was not ideal in a perfect world and RN #3 should not have used swearing/foul language directed at Resident #5 and should not have threatened to shower Resident #5 with the pitcher of water. Review of the Abuse, Neglect, and Exploitation policy dated 2/3/2025 directed in part, that abuse was prohibited. The Policy further directed abuse included verbal abuse, mental anguish and mental abuse, which included threats.

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Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

10/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Grandview Rehabilitation and Healthcare Center

55 Grand Street New Britain, CT 06052

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

Level of Harm - Minimal harm or potential for actual harm

Based on review of facility documentation and interviews for 2 of 4 personnel files reviewed, the facility failed to ensure staff working at the facility were properly screened prior to working. The findings include: A request on 10/14/25 at 10:45 AM to review RN#1 personal files revealed that RN #1 is employed through Nursing Scheduling Agency (NSA), therefore, there were no records on file. ADNS indicated that RN #1 received orientation, which covered workplace compliance, customer service, Resident rights, Abuse/ Neglect, fear of retaliation, workplace violence, and smoking on 10/7/25. Review of personnel files from all contracted scheduling agencies affiliated with the facility along with the facilities nursing schedule, revealed that RN #1 and #3 from NSA began working prior to the completion of their background checks. No background check documentation was found on record for either RN #1 or RN #3. Interview with Person #1

on 10/14/25 at 12:05 PM indicated that the facility is responsible for completing the background checks. He reported NSA only does a driver's licenses review to ensure there are no deficiencies. Interview with HR on 10/14/25 at 12:54 PM indicated that the Agency RN#1 is employed through is responsible for completing

the background checks and fingerprinting process (per their contract). HR reported that the Agency started 9/18/25 and though she would normally review each staff background checks prior to them covering a shift;

she reported she has not had the opportunity to review all the staff that was and is scheduled to cover shifts at the facility. Facility is unable to provide any documents that indicated that staff from NSA agency has had a background check completed. Facilities Abuse, Neglect and exportation Policy indicates in part

the facility will make efforts to ensure all residents are protected from physical and psychosocial harm.

Potential employees will be screened for history of abuse, neglect, exploitation or misappropriation of residents' property. Background, reference and credentials check shall be conducted on potential employees, contracted temporary staff. and consultants. Screening may be conducted by the facility itself, third party agency or academic institution. The facility will maintain documentation of proof that the screening occurred.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet