Cook Willow Health & Rehabilitation Center, Inc.
Inspection Findings
F-Tag F0609
F 0609
completed immediately after the incident has occurred (all abuse, alleged or confirmed), and the facility will follow State Health Department guidelines and other regulatory agencies for reporting requirements.
Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
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
09/12/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Cook Willow Health & Rehabilitation Center, Inc.
81 Hillside Avenue Plymouth, CT 06782
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-Tag F0610
F 0610
Respond appropriately to all alleged violations.
Level of Harm - Minimal harm or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, facility documentation review, facility policy review, and interviews for one of three residents (Resident #56) reviewed for abuse, the facility failed to ensure timely investigation of an allegation of mistreatment. The findings include: Based on clinical record review, facility documentation review, facility policy review, and interviews for one of three residents (Resident #56) reviewed for abuse, the facility failed to ensure timely investigation of an allegation of mistreatment. The findings include: Resident #56's diagnoses included cerebral infarction, dementia, and anxiety disorder. The quarterly Minimum Data Set (MDS) assessment dated [DATE REDACTED] identified Resident #56 had a Brief Interview for Mental Status (BIMS) score of fourteen out of fifteen (14/15), indicating alert and oriented, and required moderate assistance for showers. The Resident Care Plan (RCP) dated 7/9/2025 identified Resident #56 had impaired ADLs (activities of daily living) and mobility related to acute right side cerebral infarction. Interventions directed to provide assistance with ADLs. Interview with Person #1 on 9/4/2025 at 10:15 AM identified on 8/1/2025, Resident #56 reported to Person #1 that during his/her shower, he/she was inappropriately touched by the staff member on the groin. Person #1 stated he/she reported the allegations to the ADON. Although requested, the facility was unable to provide documentation regarding an investigation conducted regarding
the allegation of mistreatment. Interview with ADON on 9/4/2025 at 10:25 AM identified on an unknown date, Person #1 had reported that Resident #56 alleged he/she was inappropriately touched during the shower. The ADON stated that Person #1 did not report any specific type of touching, such as foundling, roughness, or pain. The ADON stated Resident #56 was confused during that timeframe, and although Person #1 reported the allegation, Person #1 verbally indicated he/she did not believe the event had occurred. The ADON stated he did not report or investigate the allegation of abuse, due to Person #1 had requested staff not speak with Resident #56 about the allegation because Resident #56 would think Person #1 had told on him/her and Person #1 did not believe the allegation. Although requested, the facility was unable to provide documentation regarding an investigation was performed for the allegation made on 8/1/2025. Interview with the DON on 9/4/2025 at 2:30 PM identified she was not aware of the allegation of mistreatment. The DON stated all allegations of abuse must be investigated properly, and this allegation should have been reported by the ADON and then investigated in a timely manner. Review of the Abuse Policy dated 11/2021 directed in part, any complaint of, observation of, or suspicion of resident abuse, mistreatment, or neglect is to be thoroughly investigated. The investigation will include an accident report, obtaining statements from potential witnesses, completion of necessary evaluations (i.e., skin/body checks, pain evaluation), and maintaining a timeline of events. Facility investigations will be completed with seventy-two (72) hours.
Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
F-Tag F0628
Federal health inspectors cited COOK WILLOW HEALTH & REHABILITATION CENTER, INC. in PLYMOUTH, CT for a deficiency under regulatory tag F-F0628 during a standard health inspection conducted on 2025-09-12.
Category: Resident Rights Deficiencies
The facility was found deficient in the following area: Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Scope/Severity Level C: pattern, no actual harm with potential for minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of COOK WILLOW HEALTH & REHABILITATION CENTER, INC..
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-22.
F-Tag F0657
Federal health inspectors cited COOK WILLOW HEALTH & REHABILITATION CENTER, INC. in PLYMOUTH, CT for a deficiency under regulatory tag F-F0657 during a standard health inspection conducted on 2025-09-12.
Category: Resident Assessment and Care Planning Deficiencies
The facility was found deficient in the following area: Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of COOK WILLOW HEALTH & REHABILITATION CENTER, INC..
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-22.
F-Tag F0658
Federal health inspectors cited COOK WILLOW HEALTH & REHABILITATION CENTER, INC. in PLYMOUTH, CT for a deficiency under regulatory tag F-F0658 during a standard health inspection conducted on 2025-09-12.
Category: Resident Assessment and Care Planning Deficiencies
The facility was found deficient in the following area: Ensure services provided by the nursing facility meet professional standards of quality.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of COOK WILLOW HEALTH & REHABILITATION CENTER, INC..
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-22.
F-Tag F0689
Federal health inspectors cited COOK WILLOW HEALTH & REHABILITATION CENTER, INC. in PLYMOUTH, CT for a deficiency under regulatory tag F-F0689 during a standard health inspection conducted on 2025-09-12.
Category: Quality of Life and Care Deficiencies
The facility was found deficient in the following area: Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of COOK WILLOW HEALTH & REHABILITATION CENTER, INC..
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-22.
F-Tag F0812
Federal health inspectors cited COOK WILLOW HEALTH & REHABILITATION CENTER, INC. in PLYMOUTH, CT for a deficiency under regulatory tag F-F0812 during a standard health inspection conducted on 2025-09-12.
Category: Nutrition and Dietary Deficiencies
The facility was found deficient in the following area: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of COOK WILLOW HEALTH & REHABILITATION CENTER, INC..
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-22.
F-Tag F0849
Federal health inspectors cited COOK WILLOW HEALTH & REHABILITATION CENTER, INC. in PLYMOUTH, CT for a deficiency under regulatory tag F-F0849 during a standard health inspection conducted on 2025-09-12.
Category: Administration Deficiencies
The facility was found deficient in the following area: Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of COOK WILLOW HEALTH & REHABILITATION CENTER, INC..
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-22.
F-Tag F0880
Federal health inspectors cited COOK WILLOW HEALTH & REHABILITATION CENTER, INC. in PLYMOUTH, CT for a deficiency under regulatory tag F-F0880 during a standard health inspection conducted on 2025-09-12.
Category: Infection Control Deficiencies
The facility was found deficient in the following area: Provide and implement an infection prevention and control program.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of COOK WILLOW HEALTH & REHABILITATION CENTER, INC..
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-22.
COOK WILLOW HEALTH & REHABILITATION CENTER, INC. in PLYMOUTH, CT inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in PLYMOUTH, CT, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from COOK WILLOW HEALTH & REHABILITATION CENTER, INC. or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.