Crescent Manor Care Ctrs

Review of the facility policy, titled Crescent Manor Rehabilitation Grievance Policy and Procedures, no date, found that the procedures state the resident must sign the form.

The form attached to the policy also requires a resident's signature.

Per interview on 1/6/26 at 1:10 PM with three residents, Resident #7, a resident at the facility for several years, stated that if a resident wants to file a grievance, they use the facility-provided form and give it to the Social Worker. S/he does not know of a system within the facility that allows the resident to file the grievance without revealing the writer's identity. Resident #81, who has been a resident for the past several months, was also unable to identify the process for filing an anonymous grievance.

Neither resident can recall a system to keep the process anonymous.

Per interview on 1/6/26 at approximately 2:34 PM with the Social Worker, identified in the policy and procedure as the designated Grievance Official, she indicated the facility uses the envelope located by the grievance forms for anonymous grievances.

She confirmed that the policy and procedure document on display doesn't include a process for filing a grievance anonymously.

The Social Worker confirmed she was unable to locate it in the policy and procedures and stated it was very difficult if someone files an anonymous grievance, and confirmed it is a requirement to have the option of filing a grievance anonymously.

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 TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

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Crescent Manor Care Ctrs 312 Crescent Blvd Bennington, VT 05201

professional principles; and all drugs and biologicals must be stored in locked compartments,

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

medication storage rooms and treatment rooms when expiration dates were reached for 3 out of 3 rooms.

Findings include: Per review of the facility policy titled Storage of Medication dated 1/24, it states that Outdated, contaminated, discontinued or deteriorated medications and those in containers that are cracked, soiled, or without secure closures are immediately removed from stock .Per observation and interview on [DATE] at approximately 9:56 AM in the west wing medication room, the Unit Manager confirmed the following items were expired: three administration sets of priming IV tubing kits with an expiration date of [DATE], eight containers of ten milliliter sterile water for injection with an expiration date of [DATE], Piperacillin and Tazobactam for injection 3.375 grams for IV use with an expiration date of 3/25, Epinephrine 0.3 mg single auto injectors with an expiration date of 3/25, BD Vacutainer safety-lok blood collection set with an expiration date of [DATE], four BD max plus clear needleless connectors with an expiration date of [DATE].

The Unit Manager also confirmed a bottle of glucose tablets that did not have an expiration date and stated that anything without a date should be thrown out.Per observation and interview on [DATE] at 10:13 AM in the north wing medication room, a Licensed Practical Nurse confirmed that a bottle of Vitamin B-Complex did not have an expiration date and that it should be thrown out.Per observation and interview on [DATE] at 10:20 AM, in the medication treatment room near the south/west nursing station, the Nursing Manager confirmed the following items were expired: four Proven (Post insertion foley care wipes) with an expiration date of [DATE], ninety skin protectant ointments with an expiration date of 5/25, and one Intermittent 14 French catheter kit with an expiration date of [DATE].

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Crescent Manor Care Ctrs 312 Crescent Blvd Bennington, VT 05201

the results.

results that fell outside of clinical reference ranges for 1 of 1 residents (Resident #27).

Findings

The purpose of the policy is to ensure the facility promptly informs the resident, consults the resident's physician; and notifies, consistent with his or her authority, the residents representative when there is a change requiring notification.

The policy additionally identifies that when a resident has a significant change in physical condition that the provider should be notified.Per review of the facility's policy titled Laboratory Services and Reporting dated 2020, it states to Promptly notify the ordering physician, physician assistant, nurse practitioner, or clinical nurse specialist of laboratory results that fall outside the clinical reference range.Per record review, a progress note dated 1/5/26 at 7:15 PM, identified that Resident #27 had a critical sodium level of 161.

There is no note indicating that the provider was notified immediately after nursing staff were informed of the critical lab value.

A Nurse Practitioner note dated 1/6/26 at 8:30 AM, identified that Resident #27 had severe hypernatremia with sodium of 161 and that this was a critical condition and that s/he was sent to the emergency department for expedited evaluation and management.Per interview with a Licensed Practical Nurse (LPN) on 1/7/26 at 8:32 AM, she confirmed that the provider and Director of Nursing (DON) were not immediately made aware that Resident #27 had a critical lab value, and that as soon as the Nurse Practitioner was made aware, she sent out the Resident to the Emergency Department.

The LPN confirmed that a provider should be notified right away of critical lab values.Per interview with the DON on 1/7/26 at 8:37 AM, she confirmed that the provider should have been notified of the critical lab value at the time the nurse was notified of the lab value.

During initial tour of the kitchen's dry storage area on 1/5/26 at approximately 11:00 AM with the Food Service Manger (FSM), revealed boxes of condiments containing individual servings of saltines, salad dressings, and catsups that did not have expiration dates on the boxes.

Also observed in the dry storage room were (5) 5# bags of Devil's Food cake, (4) 5# bags of brownie mix, (12) 5# bags of white cake mix, (2) 5# bags of basic muffin mix, all with no expiration dates on the packages.

The FSM stated that they did not know what the expiration dates of these food items were because the original boxes had been thrown away.

There were 4 racks of bread in the hall of the dry storage area that had no expiration dates.

Per interview with the FSM on 1/5/26 during the tour of the dry storage area, confirmed that the condiments did not have expiration dates on the boxes and they could not provide them.

The FSM confirmed the mixes did not have expiration dates and the boxes that the mixes came in had been thrown away.

The FSM confirmed that the (4) racks of bread did not have expiration dates. 2.

Observation of the kitchen area on 1/5/26 at approximately 11:15 AM it was noted that a commercial can opener and meat slicer were not clean.

The can opener blade was covered in a thick, sticky, wet, black substance, and dried red substance near blade and on the bracket of the can opener.

The meat slicer appeared to have been wiped down, however upon further inspection the meat tray was noted to be dry but with gritty residue and specks of a dried light pink substance.

The back of the blade was noted to have a dried light pink colored substance dried/stuck on that was easily scraped off.

Per interview on 1/5/26 at approximately 11:17 PM, the FSM confirmed the can opener was not clean and should have been put through the dishwasher and stated the staff probably used the meat slicer this morning and that it was not clean. 3.

Observation of the freezer on 1/5/26 at approximately 11:40 AM revealed (4) packages of 12 count hot dog rolls with no expiration dates, and 1 box of [NAME] fish sticks with no expiration date.

Interview on 1/5/26 at approximately 11:41 AM, the FSM and dietician confirmed the hot dog rolls and box of [NAME] fish sticks had no expiration dates. 4.

Observation on 1/5/26 at approximately 2:45 PM, the South Unit kitchenette refrigerator freezer contained a pink substance in a clear plastic cup with a dome lid containing a straw that was covered with a piece of paper towel that was not labeled with a resident's name or an expiration date.

Interview on 1/5/26 at approximately 2:50 PM with the Activities Director, they confirmed the pink substance in the cup should not be in the resident's refrigerator freezer and should be thrown out as it did not belong to a resident and could have been brought in by family or may have belonged to staff. 5.

Observation on 1/6/26 at approximately 8:15 AM observation of the [NAME] Unit kitchenette revealed (2) containers with lids containing foods that were not dated with preparation date or expiration date.

Also identified was a loaf of white bread that was not dated with either an expiration date or an opened date.

Various individual sized condiments and snacks (Oreo's, Fig Newtons, oatmeal bars, saltines, graham crackers, catsup, maple syrup, mayonnaise, honey, and peanut butter) were noted in bins with no expiration dates.

Interview on 1/6/26 at approximately 8:20 AM with an LPN working on the [NAME] Unit confirmed the above findings.

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Crescent Manor Care Ctrs 312 Crescent Blvd Bennington, VT 05201

According to the Mayo Clinic: The virus that causes COVID-19 spreads mainly through the air when a person coughs, sneezes, sings, talks or breathes.face masks or respirators are products that cover the nose, mouth and chin.

Most research finds that these products can slow the spread of the virus that causes COVID-19 when they are worn consistently, fit properly and are worn correctly. (https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-mask/art-20485449)

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Crescent Manor Care Ctrs 312 Crescent Blvd Bennington, VT 05201

assistance.

The SDC confirmed that call light cords should not be pinned up out of reach or

475033 01/07/2026

Crescent Manor Care Ctrs 312 Crescent Blvd Bennington, VT 05201