Bridgeport Medical Lodge

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

knowledgeable about new smoking procedures and fall policy. DON stated there was nothing the facility could have done to prevent this incident from happening. The DON stated the facility had not had issues with the ramp and the past, and residents pushing other residents. During an observation and interview at 10/30/25 at 6:00 pm, surveyor observed Quality Assurance Nurse and Wound Care Nurse taking residents one by one down the 200-hall ramp. Resident #1, Resident #2, Resident #3, and Resident #4 were knowledgeable about not using 200 hall door and residents not pushing each other. During an over-the-phone interview at 10/30/25 at 6:05 pm the V.P. of Operations stated he went over the state requirements and regulations for the ramp with the Administrator . During an interview between 6:10 pm to 6:30 pm, LVN J, LVN K and CNA L revealed staff were knowledgeable about updated smoke protocols, residents not pushing each other, abuse and neglect, reporting accidents and hazards. Record review of a Resident Smoking in-service, dated 10/29/25, with nursing staff reflected: Residents are to enter building and exit building from door across from therapy using concrete ramp [200 hall] 300 hall exit door is an emergency exit only. The in-services additionally covered facility policy and procedures titled, Smoking Policy-Residents, dated 03/2023, reflected, .This facility should establish and maintain safe resident smoking practices. Record review of accident prevention, supervision, and resident transport safety in-service dated 10/29/25 reflected: the class covered facility policy titled, Accidents and Incidents-Investigating and Reporting revised 11/2024, reflected: .All accidents or incidents involving residents, employees, visitors, venders, etc. occurring on [facility] premises shall be investigated and reported to the Administrator . Record review of Immediate reporting of environmental hazards and unsafe resident behaviors class dated 10/29/25 covered facility policy, Hazardous Areas, Devices and Equipment revised 07/2017 reflected: All hazardous area, devices and equipment in the facility will be identified and addressed appropriately to ensure resident safety and mitigate accident hazards to the extent possible.Identification of hazards.A. hazard is defined as anything in the environment that has the potential to cause injury or illness. Examples of environmental hazards include, but are not limited to: E. Irregular floor surfaces Assessments and Analysis of Hazards.2. Any element of the resident environment that has

the potential to cause injury and that is accessible to a vulnerable resident is considered hazardous.Interventions.10. Interventions will be accompanied by communication with staff and leadership, residents, family and visitors.12.Training on safety and interventions to reduce hazard risks will be ongoing.Monitoring to ensure that recommendations are implemented consistently and correctly will be a component of the safety and accident prevention program. Record review of construction quote, dated 10/30/25 reflected, a description of concrete with slope, concrete includes fiber mesh and material reinforcement, slab to be finished with a gradual slope for drainage, price includes materials, equipment, and labor, client responsible for providing clear access to site and adequate water/power supply. Quote accepted and signed on 10/30/25 by contractor and facility The Administrator was informed the Immediate Jeopardy was removed on 10/30/25 at 6:30 pm. The facility remained out of compliance at a severity level of no actual harm with potential for more than minimal harm and a scope of isolation due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place.

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