Barre Gardens Nursing And Rehab, Llc

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Based on record review and interview it was determined that the facility failed to treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of her/his quality of life, recognizing each resident's individuality for 1 resident in a sample of 9 residents. (Resident #4).Findings include:Per record review, Resident #4 has diagnoses that include Alzheimer's disease, dementia, bipolar disease, schizophrenia, and need for assistance with personal care. Per Resident #4's care plan, revised 11/4/25, EATING: [She/he] requires extensive assist from staff participation to eat. Staff please encourage resident to open hand to engage in self-feeding and holding cup during meals. On 11/4/25 at 12:55 PM, an observation was conducted of Resident #4 during lunch. An LNA (licensed nursing assistant) was observed assisting the resident with eating. She/he was standing next to resident and leaning over to place the food in the resident's mouth. The LNA repeated the process of standing next to the resident and assisting with feeding. On 11/4/25 at 12:57 PM, an interview was conducted with the LNA. She/he was asked if they should be sitting at eye level with

the resident. She/he stated, I choose not to do that. Upon further inquiry about facility practice with regard to sitting next to residents while assisting in eating, She/he responded, ‘I don't do that. Facility policy titled Resident Rights, revised June 2023, states that Federal and state laws guarantee basic rights to all residents of this facility. These rights include the right to a dignified existence and to be treated with respect, kindness and dignity. On 11/4/25 at 2:45 PM, an interview was conducted with the Administrator. They confirmed that facility practice is to sit at eye level with a resident while assisting them with eating, and that

this was communicated to staff when they go through orientation.

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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Barre Gardens Nursing and Rehab, LLC

378 Prospect Street Barre, VT 05641

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 0584

In between room [ROOM NUMBER] and room [ROOM NUMBER] an alcohol wipe package was observed

on the floor with a red piece of plastic and a white piece of plastic lying beside it

Level of Harm - Minimal harm or potential for actual harm

In room [ROOM NUMBER] there were orange crumbs observed by the bottom of the bed

Residents Affected - Many

Outside of room [ROOM NUMBER] there was a rubber band on the floor and a small piece of paper

In room [ROOM NUMBER], the brown bumper guard against the wall was falling off the wall and was observed partially on the empty bed There was a clump of hair observed at the nurse's station by room [ROOM NUMBER]

A dead brown, multilegged insect was observed on the floor and a partial footprint was noted adjacent to

the insect

The entrance to room [ROOM NUMBER] at the base on the doorframe was black and grey with residue on

the floor, visible footprints and black and grey marks that appeared to be from shoes observed in the room and immediately outside of the room Outside room [ROOM NUMBER], immediately to the left, were brown stains extending down from the wall below the handrail. Additionally, there was a cluster of hair against the exterior frame of the door Between room [ROOM NUMBER]-119 two clumps of hair observed on the floor room [ROOM NUMBER] had black residue coming off the floor to the left and right of the doorframe room [ROOM NUMBER] had crumbs below the two dressers with one piece of paper balled up in front of

the trash can near the door room [ROOM NUMBER] had visible brown and black matter on the floor that appears to be dirt

The sunroom (near room [ROOM NUMBER]) had a clump of hair on the floor by the door. Next to the windows facing a small green yard, there was multiple brown clumps and crumbs on the floor. Additionally,

the resident bedside table by the windows had brown matter on it. Opposing the windows facing the green yard, on the other side of the room, there was a rubber band on the floor.

Outside room [ROOM NUMBER], to the left of the exterior door frame, below the handrail, there was a circular blob of a white and grey substance. There was one primary circular blob of this substance with two smaller circles of white and grey matter immediately next to it. Three circular like blobs of an unknown substance in total.

In the shower room there was hair observed on the floor, brown residue smeared onto the wall, and brown residue on the shower chair. Additionally, hair was observed in the shower drain and there was a large amount of a brown smelly substance in the toilet that had not been flushed, on the seat of this toilet, there was also a brown residue. The shower wall had specks of black and grey on the tile and wall and the shower vent was covered in a thick white and grey substance.

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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Barre Gardens Nursing and Rehab, LLC

378 Prospect Street Barre, VT 05641

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 0687

Provide appropriate foot care.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, staff interview, and record review the facility failed to ensure that 1 resident in the applicable sample (Resident #6) received proper foot care.Findings include:Per observation on 11/13/25 at 10:21 AM, Resident #6 was sitting barefoot at the edge of the bed with his/her feet on the floor. Resident #6's feet appeared to be dry and had long discolored toenails that were thick.Per interview with Resident #6

on 11/13/25 at 10:21 AM, they reported that their toenails are very long and that it is an issue, they haven't had their nails trimmed in a long time or seen a podiatrist.Per record review of Resident #6's care plan dated 9/19/25, s/he is care planned for skin breakdown due to impaired mobility, DM (Diabetes Mellitus), and peripheral vascular disease. Interventions include Podiatry consult as needed with a date of 3/8/23.

The care plan also identifies that the resident has an ADL (activities of daily living) self-care performance deficient and requires assistance with personal hygiene, dated 3/8/23.Per review of the facilities policy titled Fingernails/Toenails, Care of with a revision date of 2/18, it states that the purpose of this procedure is to clean the nail bed, to keep nails trimmed, and to prevent infections. Nail care includes daily cleaning and regular trimming.Per interview with the Physician on 11/13/25 at 3:30 PM, he reported that he is having to triage work and is prioritizing the most urgent visits as there is only one provider for the residents. He reported that he hasn't time to do anything except for crisis management.Per interview with the Administer and Director of Nursing (DON) on 11/13/25 at 6:17 PM, they reported they don't have a podiatrist here and that the provider trims nails in house.Per interview with a Register Nurse (RN) on 11/13/25 at 6:29 PM, she confirmed that Resident #6's toenails were long and should be trimmed.

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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Barre Gardens Nursing and Rehab, LLC

378 Prospect Street Barre, VT 05641

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 0712 Level of Harm - Minimal harm or potential for actual harm

6/13/25 with a Physicians Assistant (PA) and there was no in-person regulatory visit with a Physician by 9/23/25.

1. 6. Review of Resident #1's medical record shows that Resident #1 was admitted on [DATE REDACTED] and her/his first

regulatory visit was on 10/28/25 which does not meet the regulatory requirement of this regulation.

Residents Affected - Some

2. 7. Review of Resident #11's Physician visits revealed that Resident #11 was admitted on [DATE REDACTED] and had

their initial physician visit on 11/13/25, which does not meet the regulatory requirement of this regulation.

3. 8. Review of Resident #12's Physician visits revealed that Resident #12 was admitted on [DATE REDACTED] and had

their initial physician visit on 11/13/25, which does not meet the regulatory requirement of this regulation.

4. 9. Review of Resident #13's Physician visits revealed that Resident #13 was admitted on [DATE REDACTED] and had

their initial physician visit on 11/10/25, which does not meet the regulatory requirement of this regulation.

5. 10. Review of Resident #15's Physician visits revealed that Resident #15 was admitted on [DATE REDACTED] and had

their initial physician visit on 11/4/25, which does not meet the regulatory requirement of this regulation.

6. 11. Review of Resident #16's Physician visits revealed that Resident #16 was admitted on [DATE REDACTED] and had

their initial physician visit on 9/23/25, which does not meet the regulatory requirement of this regulation.

7. 12. Review of Resident #17's Physician visits revealed that Resident #17 was admitted on [DATE REDACTED] and had

their initial physician visit on 8/25/25, which does not meet the regulatory requirement of this regulation.

Per interview on 11/13/25 at approximately 11:45 AM, the facility Physician confirmed that regulatory visits had not been completed timely and that s/he was working on getting them caught up. S/he stated that a new PA would be starting next week on Monday and this would help her/him stay caught up on visits.

Per interview on 11/13/25 at approximately 2:00 PM, the Medical Director confirmed that s/he was aware that regulatory visits were behind and that the facility physician was working to get them all caught up. S/he stated they were working on the process and considering getting a tracking tool/system for regulatory visits but at this time had not secured any type of system for doing this. S/he stated, There is no excuse for these visits to not have been completed on time.

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

Event ID:

Facility ID:

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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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Barre Gardens Nursing and Rehab, LLC

378 Prospect Street Barre, VT 05641

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 0744

Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview, and record review, the facility failed to implement interventions to address the residents' dementia care needs for 1 of 1 residents (Resident #10).Findings include:Per an observation on [DATE REDACTED] at 6:43 PM at a nurse's station, Resident #10 was asking to call his/her family member. A Licensed Practical Nurse (LPN) was observed telling Resident #10 that she couldn't call his/her family member because they had died. Upon hearing this, Resident #10 got visibly upset and again asked for the LPN to call Resident #10 ‘s family member and called the LPN a liar. The phone started ringing and Resident #10 was asking for them to pick it up saying it might be their family member, and the nurse was dismissive towards the Resident saying that it couldn't be. At 6:45 PM, the Resident #10 again asked to call the family member to which the LPN again stated that they had passed and that we told you this months ago, but you keep on forgetting. Resident #10 then stated that they were going to try and walk home and hoped they would be killed.Per interview with the LPN on [DATE REDACTED] at 6:48 PM, when asked how she redirects Resident #10 when s/he forgets that their family member has died, the LPN reported that sometimes we say maybe later, sometimes we tell her the truth, and that the Resident #10 calls us liars when we tell him/her that their family member is dead. The LPN also reported Resident #10 has dementia and s/he just gets like this sometimes. The LPN confirmed that each time she reminded Resident #10 that the family member had died, that Resident #10 became visibly upset.Per record review of Resident #10 medical diagnosis on [DATE REDACTED], s/he has a diagnosis of Alzheimer's disease, adjustment disorder with anxiety, and depression. Per

review of a progress note dated [DATE REDACTED], the resident was informed by their family of a family member's death.The Resident's progress notes from [DATE REDACTED] to [DATE REDACTED] document that the Resident was reminded by staff of his/her family member's death on seven different documented occasions since [DATE REDACTED], with resulting behaviors of yelling, crying, wandering, and exist seeking.Per Review of the Resident #10 care plan, it revealed they are care planned for a family member's death on [DATE REDACTED] with interventions of assisting

the resident with their grief to help the resident identify care needs, encourage the resident to express feelings of anger and concern, encourage the resident to recognize grief situation, observe for contributing factors that may delay the grief process, assist the resident to identify, access and use support systems, for consults to be placed to pastoral care, social services, home health, psychiatry as needed, describe to the resident the stages and how to identify grief, and to assist the resident with problem solving. The Resident #10 is also care planned for dementia, for which interventions include allowing the resident time to talk and express feelings. An intervention related to the Resident #10's anxiety and trauma is to engage the resident

in conversations that will help them to remain calm.The observation on [DATE REDACTED] did not demonstrate that care plan interventions were being utilized for this resident regarding assisting with grief, allowing time to talk and express feelings, or engaging the resident in conversation to help them remain calm.

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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Barre Gardens Nursing and Rehab, LLC

378 Prospect Street Barre, VT 05641

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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Based on observation and interview, the facility failed to ensure only authorized personnel had access to

the medication storage rooms. This is a repeat deficiency for this facility, with the violation cited during the previous recertification surveys, dated 6/25/25. Findings include:Per observation on 11/4/25 at 12:45 PM, a pharmacy delivery was accepted by an LPN (Licensed Practical Nurse). The delivery person and LPN went into the medication room together. The LPN emerged without the delivery person who remained alone in

the medication room for approximately 5 minutes before exiting.Per interview on 11/4/25 at 1:00 PM, the LPN confirmed that the delivery person should not go into the medication room alone. The LPN confirmed that he/she was left alone in the medication room. Per interview with the Administrator on 11/4/25 at 2:45 PM, they confirmed the delivery person should not have been in the medication room alone.

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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Barre Gardens Nursing and Rehab, LLC

378 Prospect Street Barre, VT 05641

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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Based on observation and interview, the facility failed to ensure that all food was stored safely and to ensure that sanitary conditions for safe food handling were maintained. This has the potential to impact all residents. This is a repeat deficiency for this facility, with violations cited during the previous three recertification surveys, dated 4/26/23, 5/9/24, and 6/25/25. Findings include:A kitchen tour was conducted with a Dietary Staff Member on 11/13/25 at 11:40 AM. Per observation of the dry food storage area, the following items were found improperly stored:Gluten free pasta, (1) expired June 11, 2024, (3) expired July 20, 2024; Baking mix, expired 4/24/24; Pasta, expired May 3, 2025; Hormel Thick & Easy Clear Thickened Cranberry Juice Cocktail, dated 10/24, instructions on back of label discard if not used within 10 days of opening; andHormel Thick & Easy Clear Thickened Orange Juice Cocktail, dated 10/24, instructions on back of label discard if not used within 10 days of opening. Per interview on 11/13/25 at 11:55 AM, the Dietary Staff Member stated the above items should have been discarded and confirmed they were expired.Per observation of the walk-in refrigerator, the following item was found improperly stored: Two packages of deli ham stored on a tray with raw hamburger, sitting in raw meat juices. Per observation of the walk-in freezer, the following item was found improperly stored: A box of hamburger patties left open to air and not sealed. The Dietary Staff Member confirmed the observations in the walk-in refrigerator and freezer and stated that ready-to-eat foods should not be stored with/on/in raw meat and stated that prepared and open food containers and packages should be sealed. She/he confirmed that the above items were improperly stored. Per observation of the kitchen area the following were noted:Preparation trays, cups, and dishes were noted to be wet nesting (stored wet and not air dried). The floor fan facing the food preparation area noted to be covered with dust and debris. The Dietary Staff Member confirmed these observations.

Event ID:

Facility ID:

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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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Barre Gardens Nursing and Rehab, LLC

378 Prospect Street Barre, VT 05641

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 0841 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many

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

Designate a physician to serve as medical director responsible for implementation of resident care policies and coordination of medical care in the facility.

Based on interview and record review, the facility failed to ensure that the Medical Director fulfilled his/her responsibility to coordinate medical care with facility providers and assist the facility with the development and implementation of resident care policies. This deficient practice has the potential to affect all residents residing in the facility.Findings include:Per review of the facility's Medical Director Services policy [policy undated] on 11/13/25, the scope of services for the Medical Director will include:-Ensuring that each resident's responsible physician attends to the resident's medical needs--Periodic review and development of medical care policies and procedures as required to ensure compliance with Federal, State, and local laws, rules, and regulations.An interview was conducted with the facility's Medical Director on 11/13/25 at 2:02 PM. The Medical Director [MD] stated there was no system in place to monitor regulatory visits by physicians, and that they were working on a process regarding required regulatory visits. The MD stated, There is no excuse, they [regulatory visits] have to be done.Further review of the Medical Director Services policy includes: -Participation in policy decision-making and direct supervision regarding quality of care and delivery of medical services to residents-Performance of all necessary general administrative tasks including assigning medical duties and scheduling, and communication of this information to appropriate staff.Per interview on 11/13/25, the Medical Director [MD] stated there is no consistent or scheduled communication between medical providers regarding facility issues or resident status. The MD stated s/he had reviewed the Facility Assessment, dated 6/5/25. Per the facility assessment, Medical/Physician Services list Dr. [A] and Dr. [B] as Attending Physicians. The Medical Director stated s/he was not familiar with those physicians. The MD stated the facility's Acting Physician [APhys] was the eyes and ears of the facility. The MD stated we are working on a process regarding reporting on a weekly basis with [APhys] and other providers, but there was no process currently in place.Review of the Medical Director Services policy also includes: -Supervision of high-level quality of care delivered to residents, with supervision exercised over medical, nursing, and pharmaceutical services.Per interview with the Medical Director [MD] the MD stated the facility's Attending Physician [APhys] notified h/her this morning [11/13/25] of a COVID outbreak

in the facility. The MD stated [APhys] reported the first case was identified as 7- 10 days ago. The MD said h/her expectation was to be notified when the first case appeared. Per facility Infection Control records, the first COVID cases were identified 11 days prior on 11/2/25: one resident and one staff member. As of the day of the extended survey [11/13/25], 8 staff members and 16 residents had tested positive for COVID infection.

Event ID:

Facility ID:

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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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Barre Gardens Nursing and Rehab, LLC

378 Prospect Street Barre, VT 05641

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 0880 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many

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

on the windowsill next to the table; a pillow without a pillow case on the steam table; the floors appeared dirty with spills and debris; and cooler cover was dirty. Wing 1 of the nurse's station revealed a thick pile of crumbs/debris in front of the nurse's station that went the length of the nurses' station. There was a used blood glucose test strip on the floor. The overbed table by the door bed was covered on the wheels and the metal support with a thick, dried, white, milky substance. The privacy curtains had a dried, brown substance

on the outer edge and about 2 feet in from it. There was an uncovered pillow on the bed next to the window, with its plastic cover torn in several places, revealing its contents. On 11/13, Floors were dirty; various types of debris were noted; bathroom fans were covered with thick dust; toilets were dirty, not clean inside or out, or the floor around the toilets. In the bathrooms, observations included light-colored caulk between tiles on both floors and walls, with a buildup of black debris that appears to be mold and mildew. A shower chair had a pinkish-orange buildup of debris at the connections. There was debris behind the doors, including spider webs and rust on the doorframes, with holes where the frames met the floors. The bathtub chair foot supports have white residue, and a walker has a used bedsheet. A chair located in the corner had used resident socks. Debris and a brown, dried liquid were noted in the whirlpool.See citation F-F584 for additional information regarding clean, sanitary environment observations.3. Per interview with the (IP) on 11/13/25 at 3:00 PM, she confirmed that the facility's cleanliness is an issue. She explained that short staffing (two members left without notice) in the Housekeeping department has impacted regular scheduled cleaning.

The IP also stated that the Administrator has implemented a plan for the leadership team to assist the Housekeeping department by cleaning five resident rooms per week.4. Per interview with the Administrator

on 11/13/25 at 3:50 PM, she confirmed that the Housekeeping department isn't adequately staffed and that leadership team members (ten members) are assisting the department with resident room cleaning by cleaning five rooms weekly. When asked about education, training, or audits for cleaning, she stated that

these areas had not been addressed and said, all had to do it before. The Administrator also confirmed high-touch surfaces (i.e., bedrails, doorknobs, light switches, call buttons, bedside tables, remote controls, or surfaces in bathrooms) are not regularly disinfected.5. Per the Centers for Disease Control and Prevention (CDC) Nursing Home Infection Preventionist Training Course - WB4973, Module 11-B, titled Environmental Cleaning and Disinfection 2025, slide 24 states, Common areas in the facility should also be cleaned and disinfected. High-touch surfaces in the facility's common areas, such as the family room or lounge, should be cleaned and disinfected when soiled and on a regular basis, such as daily.6. Per the CDC's Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings (2024), core practice for Environmental Cleaning and Disinfection states Clean and disinfect surfaces in close proximity to the patient and frequently touched surfaces in the patient care environment on a more frequent schedule compared to other surfaces. Reference:Centers for Disease Control and Prevention. (2025, September 15). Environmental Cleaning and Disinfection 2025. https://www.train.org/cdctrain/course/1131818/details Centers for Disease Control and Prevention. (2024, April 12). CDC's Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings. https://www.cdc.gov/infection-control/hcp/core-practices/index.html#:~:text=Require%20routine%20and%20targeted%20cle for Disease Control and Prevention. 2024, June 24). Infection Control Guidance: SARS-CoV-2. https://www.cdc.gov/covid/hcp/infection-control/#:~:text=test%20or%20NAAT-,Environmental%20Infection%20Control,-Ded

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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Barre Gardens Nursing and Rehab, LLC

378 Prospect Street Barre, VT 05641

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 0887 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.

Based on interview and record review, the facility failed to develop and implement policies and procedures to ensure when COVID-19 vaccine is available to the facility, each resident and staff member is offered the COVID-19 vaccine unless the immunization is medically contraindicated or the resident or staff member has already been immunized.Findings include:A review of the facility's Coronavirus Disease- Infection Prevention and Control Measures Policy Statement [Version 2.0 Revised 2023] includes: This facility follows infection prevention and control (IPC) practices recommended by the Centers for Disease Control and Prevention to prevent the transmission of COVID-19 within the facility. Policy Interpretation and Implementation:1.The infection prevention and control measures that are implemented to address the SARS-CoV-2 pandemic are incorporated into the facility infection prevention and control plan. These measures include: a. encouraging staff, residents and visitors to remain up-to-date with all COVID-19 vaccine doses.A review of the facility's documented COVID-19 outbreak line listing revealed that 16 residents tested positive for COVID-19 between 11/2/25 and 11/13/25. An interview was conducted with the facility's Medical Director on 11/13/25 at 2:02 PM. The Medical Director [MD] stated the facility's Acting Physician [APhys] notified him this morning [11/13/25] of a COVID outbreak in the facility. The MD stated [APhys] reported the first case was identified as 7- 10 days ago. The MD said his expectation was to be notified when the first case appeared. Per facility Infection Control records, the first COVID cases were identified 11 days prior, on 11/2/25: one resident, one staff member. As of the day of the extended survey [11/13/25], 8 staff members and 16 residents had tested positive for COVID infection.Per record review, 10 of 16 residents who tested positive for COVID as of 11/13/25 were sampled regarding having signed consent forms in October to receive the COVID vaccine and then having received the vaccine. Per record review, 2 of the 10 residents sampled refused consent to be vaccinated. Further review revealed the remaining 8 sampled residents [Resident #4, #11, #12, #13, #14, #15, #16, & #17] had all consented to be administered the COVID vaccine, but none had received it prior to being infected by the virus.Per interview with the Director of Nursing on 11/13/25, the facility had only begun vaccinating residents for COVID on 11/12/25, 10 days after the initial infection was identified, and 55 days after the Quality Assurance Performance Improvement meeting noting the facility would be receiving the COVID vaccine.

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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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Barre Gardens Nursing and Rehab, LLC

378 Prospect Street Barre, VT 05641

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 0947 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.

Based on review of employee training records and interview, the facility failed to provide evidence of the minimum 12 hours of nurse aide training per year required to ensure the continuing competence of the LNAs (Licensed Nursing Assistants) for 1 (LNA #1) of 3 LNAs sampled. Findings include:Per review of the training records, three LNAs sampled were noted to have start dates before the 2025 calendar year. LNA #1's education file lacked documentation of evidence of the 12 hours of training per year required to meet identified staff or resident needs.Per interview on 11/13/25 at 5:18 PM, the Director of Nursing (DON) was unable to provide evidence that the LNA #1 had completed their required 12-hour annual training.

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