Civita Care Center At Newington

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

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

she should have reported the critical lab results to the hospital. Interview, and review of the clinical record and facility documentation on 8/28/2025 at 2:36 PM with the DNS identified Resident #4 had blood work ordered STAT on 8/8/2025. The DNS stated the facility physicians and APRNs are aware that STAT blood work is not done after 12 noon, and if APRN #2 wanted it STAT, Resident #4 could have been sent to the hospital. Interview failed to identify the APRN was notified that the blood work was not obtained as ordered.

Further, the DNS stated RN #1 should have called the hospital to report the critical lab results received on 8/10/2025. Interview failed to identify staff notified APRN #2 that the STAT blood work would not be obtained on 8/8/2025, and failed to identify why APRN #2 was not notified. Review of facility Clinical Protocol for Labs and Diagnostic Testing Policy directed in part; a nurse will identify the urgency of communicating with the Attending Physician based on physician request, the seriousness of the any abnormality, and the individual's current condition and identify situations that warrant immediate notification

Review of facility Lab and Diagnostic Test Results Policy: Physician Role and Follow-Up directed in part, clinically significant test results will be reviewed and acted upon appropriately and in a timely manner.

Review of facility Change in Condition Policy directed in part, the facility promptly notifies the resident, his/her attending physician, and resident representative of change in resident's medical condition. The Policy further directed a significant change of condition is a major decline in the resident's status that will not normally resolve itself without intervention.

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

08/28/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Civita Care Center at Newington

240 Church St Newington, CT 06111

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

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

facility documentation on 8/28/2025 at 2:36 PM with the DNS identified RN #1 should have called the hospital to report the critical lab results received on 8/10/2025. Interview failed to identify staff notified APRN #2 that the STAT blood work would not be obtained on 8/8/2025, and failed to identify why APRN #2 was not notified. Review of facility Clinical Protocol for Labs and Diagnostic Testing Policy directed in part;

the staff will process test requisitions and arrange for tests. When lab results are reported to the facility, a nurse will first review the results. A nurse will identify the urgency of communicating with the Attending Physician based on physician request, the seriousness of the any abnormality, and the individual's current condition. Identifying Situations that Warrant Immediate Notification whether physician has requested to be notified as soon as result is received, whether the result should be conveyed to physician regardless of other circumstances. A physician can be notified by phone, fax, voicemail, e-mail, pager or telephone message, facility staff should document information about how, when and to whom the information was provided and the response. Direct voice communication with the physician is the preferred means for presenting any results requiring immediate notification, especially when the resident's clinical status is unstable or current treatment needs review or clarification. Review of facility Lab and Diagnostic Test Results Policy: Physician Role and Follow-Up directed in part the facility shall use a systematic process for obtaining and reviewing lab and diagnostic test results and reporting results to physicians. Clinically significant test results will be reviewed and acted upon appropriately and in a timely manner. Procedure the physician will identify, and order diagnostic and lab testing based on diagnostic and monitoring needs.

The staff will process test requisitions and arrange for tests.

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

08/28/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Civita Care Center at Newington

240 Church St Newington, CT 06111

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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

interview failed to identify how the residents were able to access another resident's room without staff knowing where Resident #2 and Resident #3 were. Review of facility Resident Right To Freedom From Abuse, Neglect, and Exploitation Policy and Procedure directed in part, staff shall monitor for any behaviors that may provoke a reaction by resident or others, which include, but are not limited to: Sexually aggressive behavior such as saying sexual things, inappropriate touching/grabbing. The Policy further directed the facility will take steps to ensure that the resident is protected from abuse.

Event ID:

Facility ID:

If continuation sheet