Apple Rehab West Haven

F 0606

Not hire anyone with a finding of abuse, neglect, exploitation, or theft.

Level of Harm - Minimal harm or potential for actual harm

Based on clinical record review and staff interviews for 1 of 3 employee files reviewed for Nurse Aide (NA # 8), the facility failed to conduct a thorough investigation on the history of prospective staff, including required background checks, prior to the hire date. The findings include: On 8/14/2025 at 12:55 PM, an

interview and review of employee files with the Human Resources Director identified NA#8 was hired on 4/12/2024. She was certified as a nursing aide since 3/07/2023. Although NA#8's employee file contained signed employee consents for background checks, the file did not contain documentation of a completed state or federal background check, including fingerprint-based screening through the Applicant Background Check Management System (ABCMS). The Human Resources Director indicated she was unable to retrieve evidence of an ABCMS screening on the online portal. The Human Resource Director indicated background checks, including the ABCMS screening, are done by the facility prior to employing staff and could not identify a reason for NA#8 not having one. Furthermore, the Human Resource Director indicated NA#8 would be removed from the schedule until NA#8 completes an ABCMS screening. On an interview

on 8/14/2025 at 1:35 PM, the Administrator could not explain why NA # 8 did not have a background check or an ABCMS screening prior to being hired. The Administrator indicated that when the Human Resource Director began working at the facility, she had been auditing employee records, and the facility would ensure employee records are audited for background checks. Although requested, the facility was unable to produce a policy for pre-employment screening. However, the facilities abuse policy given during the survey identified a section for pre-hire screening, which indicated the facility would ensure an active license or certification and would review regulatory action reports. The abuse policy did not identify a process for ensuring background checks and ABCMS screenings were completed.

Residents Affected - Some

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

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

Facility ID:

If continuation sheet

Event ID:

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

Apple Rehab West Haven

308 Savin Avenue West Haven, CT 06516

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Note: The nursing home is disputing this citation.

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

the facility's state's reportable events data since the last recertification survey on 12/21/2023 failed to identify an allegation of abuse for Resident #2. On 8/13/2025 at 10:30 AM, an interview with the DNS indicated she was not aware of an incident between Resident #2 and NA#8, but indicated that if a resident refuses care, staff should document it and reapproach later. Additionally, the DNS indicated there were no other incident and accident reports for Resident #2 from 1/1/2025 to 8/6/2025 other than what was already provided. On 8/14/2025 at 9:13 AM, an interview with NA#8 identified NA#8 denied providing care to Resident #2 without his/her consent. NA#8 did indicate that there was an incident a few months prior (NA#8 could not recall the exact day or month) where she was providing incontinence care to Resident #2 after Resident #2 had agreed to be peri care, but Resident #2 complained that NA#8 was taking too long and yelled at her to stop and leave. NA#8 indicated she stopped and reported to LPN#1 the resident did not want her/him (NA #8) taking care of him/her anymore. NA#8 indicated she could not recall which nursing aide switched assignments with her that day. The facility policy for abuse notes any staff suspecting abuse should immediately report it to the supervisor, who would then report it to the DNS and the Administrator.

An Accident and Incident report would be completed, and nursing staff would document a description of the incident in the resident's record. Additionally, the Abuse policy indicated the Administrator, DNS, or designee would initiate an investigation and submit an online report to the Facilities Licensing and Investigation Section.

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

Apple Rehab West Haven

308 Savin Avenue West Haven, CT 06516

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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Note: The nursing home is disputing this citation.

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

providing care to Resident #2 without his/her consent. NA#8 did indicate that there was an incident a few months prior (NA#8 could not recall the exact day or month) where she was providing incontinence care to Resident #2 after Resident #2 had agreed to peri care, but Resident #2 complained that NA#8 was taking too long and yelled at her to stop and leave. NA#8 indicated she stopped and reported to LPN#1 the resident did not want her/him (NA #8) taking care of him/her anymore. NA#8 indicated she could not recall which nursing aide switched assignments with her that day. The facility policy for Abuse notes any staff suspecting abuse should immediately report it to the supervisor, who would then report it to the DNS and

the Administrator. Additionally, the policy directed the Administrator, DNS, or designee would initiate an investigation. The Abuse policy further indicated that an investigation would include interviews of all witnesses, including the accused, interviews with any individual with relevant information, signed and dated statements for all involved parties, and a review of the accused staff member's employment record.

Event ID:

Facility ID:

If continuation sheet