Center For Living & Rehabilitation
Center for Living & Rehabilitation in Bennington, VT — inspection on August 28, 2025.
Found 1 citation. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
Based on interview and record review the facility failed to ensure that one of three residents in the applicable sample, (Resident #1) were free from accidents and hazards, causing the Resident to sustain a skin tear.
Per record review on 7/4/2025 Resident #1 was found by staff in bed with a large skin tear on her/his right lower leg. Resident #1 had a care plan focus of ADL (activities of daily living) self-care deficit with a transfer status of 2 staff assist that was implemented on 10/20/2024.
Per review of the facility's internal investigation, it states that Resident #1 was care planned for a 2 person stand pivot transfer to all surfaces and for Dermasaver skin tubes (used to protect skin from injury) to always be on when out of bed.
The Dermasavers are to be removed only when s/he has been safely transferred back into bed.
The investigation further states that Resident #1 had been out of bed in their wheelchair for dinner and was assisted with her/his meal by a nurse.
The next time Resident #1 was observed was back in bed by their primary Licensed Nursing Assistant (LNA) when the skin tear was discovered.
Per review of staff statements obtained by the facility during the internal investigation the LNA who was assigned to Resident #1's care stated that she had transferred the Resident out of bed to chair for dinner by herself but did not transfer the Resident back to bed.
Per interview on 8/27/2025 at 4:10 PM the Director of Nursing confirmed that a staff member had transferred Resident #1 independently and that the Resident had been care planned for 2-assist with transfers. It had been determined through the facility's internal investigation that the skin tear occurred during this transfer.
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.
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