Advanced Center For Nursing & Rehabilitation

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

not available for Resident #14 on 8/9/2025 and she notified the APRN and transferred Resident #14 to the hospital. Interview with LPN #15 on 8/20/2025 at 2:20 PM identified she was the facility Methadone nurse (obtains the Methadone from the clinic for residents on weekdays) and she was not aware that Resident #14 did not have his/her prescribed Methadone available on 8/7, 8/8 and 8/9/2025. LPN #15 stated if she was aware, she would have obtained the Methadone. LPN #15 stated the facility process for admissions from the hospital with Methadone ordered is for the hospital to send a dose of Methadone with the patient

on a weekday, and if it were a weekend, then the hospital sends a three day supply. LPN #15 stated Resident #14 was transferred to the hospital on 8/9/2025 after missing prescribed doses of Methadone on 8/7 and 8/8/2025. Interview with APRN #1 on 8/20/2025 at 2:00 PM identified he was not notified on 8/7 and 8/8/2025 that Resident #14 did not receive his/her prescribed Methadone. APRN #1 stated he was notified on 8/9/2025, and he expected to be notified when a resident misses a medication. APRN #1 stated

after two (2) missed doses of Methadone, the resident should be transferred to the hospital because withdrawals can begin around day three (3) of missing Methadone. Interview with the DNS on 8/20/2025 at 2:30 PM identified Resident #14 should have received his/her Methadone as ordered, and when it was not available the physician or APRN should have been notified. The DNS was unable to explain why the physician/APRN was not notified on 8/7 or 8/8/2025. 3. Resident #16 was admitted to the facility with diagnoses that included opioid abuse. A physician's order dated 5/23/2025 directed Methadone 75 mg oral once a day at 6:00 AM. The Resident Care Plan (RCP) dated 5/23/2025 identified Resident #16 received Methadone for maintenance for a history of substance use disorder. Interventions directed to maintain required contacts/sessions with outside Methadone agency as needed and provide resident with Methadone as ordered. The admission MDS dated [DATE REDACTED] identified Resident #16 had a Brief Mental

Interview for Mental Status (BIMS) of fifteen (15) indicative of intact cognition and was receiving an opioid.

Review of the MAR for August 2025 identified Resident #16 did not receive Methadone 75 mg oral at 6:00 AM on 8/12/2025; LPN #16 documented the Methadone was unavailable. Record review failed to identify why Resident #16's prescribed Methadone was not available and if the physician/APRN was notified.

Interview and record review on 8/20/2025 at 12:40 PM with RN #3 identified she was the supervisor on 8/12/2025 (11 PM to 7 AM on 8/12/2025) when Resident #16's Methadone was due to be administered at 6 AM. RN #3 stated the charge nurse did not notify her that there was no Methadone available for administration for the 6 AM dose. She stated if she was notified, she would have arranged for Resident #16 to go to the Methadone clinic to obtain the medication. Although attempted, an interview with LPN #16 was not obtained during survey. Interview with the DNS on 8/20/2025 at 2:30 PM identified Resident #16 should have received his/her Methadone as ordered, and when it was not available the physician or APRN should have been notified. The DNS was unable to explain why the physician/APRN was not notified on 8/12/2025.

The facility policy Change of Condition dated 1/30/2025 directed in part, to administer provider ordered treatments and medications as indicated.

Event ID:

Facility ID:

If continuation sheet

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

08/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Advanced Center for Nursing & Rehabilitation

169 Davenport Avenue New Haven, CT 06519

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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Resident's MAR and did not know why the nurses did not sign the MAR to indicate medication was administered to a resident after they signed it out on the CSDR sheet. She stated that if it is not documented it was not done and could not identify where the unaccounted doses were. Further, the DON stated if a controlled medication needs to be destroyed (wasted) for any reason, another nurse needed to witness the destruction of the medication and sign for the destruction on the CSDR, and she did not know why there was not a witness signature for the medication that was destroyed. The DON stated if a resident did not have a current physician order, the narcotic medication should not have been signed out on the CSDR, and should not be administered to the resident. The DON stated she did not know why the narcotic medication was signed out for a resident when there was no current physician/APRN order for the administration. The facility Controlled Substance Handing Policy, dated 1/19/2018, directed in part, that licensed nurses must document (administration) immediately in the MAR. The Policy further directed if destruction is needed it should be destroyed by two (2) nurses. The facility Medication Administration Policy dated 2/16/2018 directed in part, that medication should only be prepared at the intended time of administration. After administering the medication, the person administering the medication should document in the electronic medical record that it was given. The facility policy Resident Abuse, Mistreatment, Neglect, Exploitation, Misappropriation and retaliation dated 1/19/2017 directed in part that is

the policy of the facility to ensure residents are free from misappropriation. The Policy further directed, misappropriation means intentional wrongful misplacement of a resident's belongings.

Event ID:

Facility ID:

If continuation sheet

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

08/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Advanced Center for Nursing & Rehabilitation

169 Davenport Avenue New Haven, CT 06519

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 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

11.5 to 12 inches high). The initial CDSR signed facility receipt of narcotics from the pharmacy were in notebooks (by unit location) behind the stacks of completed CDSRs. There were no audit results or documentation of audits completed observed in the medical records area. Interview failed to identify a process with a tracking system for current audits of controlled medications in the facility. The facility Controlled Substance Handing Policy, dated 1/19/2018, directed in part, directed monthly audits that monitor for discrepancies in counts, unexplained wastage and patterns of high usage. Additionally, the policy directed that a controlled substance accountability records and audit records should be kept on file for period no less than five (5) years and that discontinued controlled drugs are returned to the nursing office after the count was verified.

Event ID:

Facility ID:

If continuation sheet

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

08/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Advanced Center for Nursing & Rehabilitation

169 Davenport Avenue New Haven, CT 06519

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 0684

for administration.

Level of Harm - Minimal harm or potential for actual harm

Interview and record review on 8/20/2025 at 12:40 PM with RN #3 identified she was the supervisor on 8/12/2025 (11 PM to 7 AM on 8/12/2025) when Resident #16’s Methadone was due to be administered at 6 AM. RN #3 stated she was not aware the Methadone was not administered as ordered, and failed to identify why the Methadone was unavailable.

Residents Affected - Few

Although attempted, an interview with LPN #16 was not obtained during survey.

Interview with APRN #1 on 8/20/25 at 2:00 PM identified the Methadone should have been administered as ordered.

Interview with the DNS on 8/20/2025 at 2:30 PM identified Resident #16 should have received his/her Methadone as ordered. The DNS was unable to explain why the Methadone was not available in the facility for administration as ordered.

Review of the Methadone Maintenance policy dated 9/16/2020 directed in part, to provide continued access to Methadone. The Policy further directed, after admission to the facility, a licensed nurse will retrieve the resident’s Methadone bottles for administration until the resident’s next scheduled clinic day.

Review of the Change of Condition policy dated 1/30/2025 directed in part, that the LPN is to administer provider ordered medications as indicated

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

Event ID:

Facility ID:

If continuation sheet