Cedar Haven Operations Llc Dba Lake Forrest Health
Inspection Findings
F-Tag F0550
F 0550
dignity relative to his/her right to use electronic monitoring equipment.
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
12/01/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Cedar Haven Operations LLC Dba Lake Forrest Health
180 Log Road Smithfield, RI 02917
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 F0880
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm or potential for actual harm
Based on surveyor observation, record review and staff interview, it has been determined that the facility failed to maintain an infection prevention and control program designed to help prevent the development and transmission of communicable diseases and infections, relative to use of Enhanced Barrier Precautions (EBP, use of gown and gloves for high contact activities) for 1 of 1 resident reviewed, Resident ID #1.
Findings are as follows:Review of a facility policy titled, Guidelines for Management of MDROs [Multi-drug resistant organism] dated 4/15/2024 states in part, Enhanced Barrier Precautions expand the use of PPE [personal protective equipment] beyond which exposure to blood and body fluids is anticipated and refers to gown and glove use during high contact resident care.for those with wounds or indwelling medical devices.examples of resident care activities requiring gown and glove use.dressing, bathing/showering.providing hygiene, changing linens, changing briefs.Record review revealed that Resident ID #1 was admitted to the facility in December of 2024 with diagnoses including, but not limited to, altered mental status, gastrostomy (an artificial opening used to provide nutrition) status, and seizures.During a surveyor observation on 10/15/2025 at 9:37 AM of Resident ID #1's room revealed signage indicating that the resident is on EBP and staff is to wear a gown and gloves while performing care.During a surveyor observation on 10/15/2025 at approximately 8:00 AM, of the video surveillance footage provided by Resident ID #1's family, dated 10/6/2025 at 9:19 AM revealed Nursing Assistant (NA), Staff A, and NA, Staff B, in Resident ID #1's room providing morning care. Additionally, Staff A and Staff B did not have gowns on, as required.During a surveyor observation on 10/15/2025 at approximately 8:00 AM, of the video surveillance footage provided by Resident ID #1's family, dated 10/8/2025 at 8:59 AM revealed Staff A in the resident's room providing care. Additionally, Staff A did not have a gown on, as required.During a surveyor interview on 10/15/2025 at 11:22 AM with the Infection Preventionist he acknowledged that Resident ID #1 has been on EBP due to his/her gastrostomy since his/her admission and all staff providing care should be wearing a gown and gloves.During a surveyor interview on 10/15/2025 at 11:39 AM with Staff A, she acknowledged that she was not wearing a gown while providing care to Resident ID #1 on 10/6 and 10/8/2025.During a surveyor interview on 10/15/2025 at 12:41 PM with Staff B, she acknowledged that she was not wearing a gown while providing care to Resident ID #1 on 10/8/2025.During a surveyor interview on 10/15/2025 at approximately 1:00 PM with the Director of Nursing Services, she was unable to provide evidence that the facility maintained an infection control program to prevent the spread of infection relative to use of EBP for Resident ID #1.
Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Cedar Haven Operations LLC DBA Lake Forrest Health in Smithfield, RI 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 Smithfield, RI, (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 Cedar Haven Operations LLC DBA Lake Forrest Health or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.