Inspection Report Summary
The most recent inspection on April 25, 2025, identified some violations but did not result in citations or amended letters at that time. Earlier inspections showed a mixed record with several deficiencies related primarily to resident care, medication administration, infection control, and documentation. Complaint investigations were generally unsubstantiated in recent years, though prior substantiated complaints included neglect and mistreatment involving resident transfers and medication errors. Enforcement actions such as fines or license suspensions were not listed in the available reports. The facility’s inspection history shows some improvement since earlier years when multiple deficiencies were cited, but issues related to resident care and infection control have recurred intermittently.
Deficiencies (last 7 years)
Deficiencies (over 7 years)
5.9 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
5% worse than Connecticut average
Connecticut average: 5.6 deficiencies/yearDeficiencies per year
12
9
6
3
0
Census
Latest occupancy rate
86% occupied
Based on a April 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Renewal
Census: 49
Capacity: 57
Deficiencies: 0
Date: Apr 25, 2025
Visit Reason
The inspection was conducted as a licensing renewal inspection and included review of complaint investigations CT40581 and CT41481.
Complaint Details
Complaint investigations CT40581 and CT41481 were reviewed as part of this inspection.
Findings
The report indicates that violations were identified during the inspection, with attached violation letters and certification files referenced. No citations or amended letters were issued at the time of this report.
Report Facts
Licensed Bed Capacity: 57
Census: 49
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Hyacynth Youghn | DNS | Personnel contacted during inspection |
| Kristin Essig | MDS Regional | Personnel contacted during inspection |
Inspection Report
Complaint Investigation
Census: 49
Capacity: 57
Deficiencies: 0
Date: Apr 17, 2025
Visit Reason
The inspection was conducted as a complaint investigation related to Complaint Investigations #43711.
Complaint Details
Complaint Investigations #43711 was the basis for the visit. The complaint was not substantiated as no violations were found.
Findings
No violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies were identified at the time of this inspection.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Yong Crandall | Administrator | Personnel contacted during the inspection. |
| Hyacinth Vaughn | Director of Nursing | Personnel contacted during the inspection. |
Inspection Report
Renewal
Census: 47
Capacity: 57
Deficiencies: 0
Date: Jun 28, 2023
Visit Reason
The inspection visit was conducted as a licensing renewal inspection and included review of complaint investigations.
Complaint Details
Complaint investigations referenced include CT #34118, CT #33796, and CT #31822. No substantiation status is provided.
Findings
The report indicates that complaint investigations were reviewed and the certification file was examined. No violations of the General Statutes or regulations were identified at the time of this inspection.
Report Facts
Licensed Bed/Bassinet Capacity: 57
Census: 47
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jean Medeiros | DNS | Personnel contacted during inspection |
| Jaime Faucher | Admin | Personnel contacted during inspection |
Inspection Report
Renewal
Census: 42
Capacity: 60
Deficiencies: 0
Date: Jul 30, 2021
Visit Reason
The inspection was conducted as a renewal licensing inspection and also referenced a complaint investigation #CT 00030185.
Complaint Details
Complaint investigation referenced as #CT 00030185, but no substantiation status or findings are detailed in this report.
Findings
The facility was found to be in compliance with visitation requirements and did not have violations identified at the time of this inspection. The facility applied for CMP and CRF funds.
Report Facts
Licensed Bed/Bassinet Capacity: 60
Census: 42
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Laurie Cianci | DHS | Personnel contacted during inspection |
| Jaime Faucher | VP of Operations | Personnel contacted during inspection |
Inspection Report
Renewal
Census: 42
Capacity: 60
Deficiencies: 5
Date: Jul 30, 2021
Visit Reason
An unannounced visit was made to Touchpoints At Chestnut by representatives of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting an investigation and renewal inspection, including complaint investigation #CT 00030185.
Complaint Details
Complaint #30185 was investigated related to allegations of neglect involving Resident #23 and Resident #390. The facility failed to report the allegation timely and did not provide a statement from Resident #390 until after the investigation. The complaint was investigated with interviews and record reviews.
Findings
The inspection identified multiple violations related to resident care, medication administration, infection control, and intravenous therapy policies. Specific findings included failure to timely assess injuries, failure to ensure timely receipt of medications, improper use of PPE by staff, and inadequate IV therapy policies. Plans of correction were submitted addressing these issues.
Deficiencies (5)
Failure to report and investigate allegations of neglect related to Resident #23 and Resident #390.
Failure to ensure timely assessment of injuries of unknown origin for Resident #5.
Failure to ensure timely receipt of antipsychotic medication for Resident #138.
Failure to ensure Nurse Aide #1 applied PPE in accordance with facility policy and CDC guidance; failure to screen employees properly for COVID-19.
Failure to ensure IV therapy policy identified responsible staff and availability of supplies.
Report Facts
Licensed Bed/Bassinet Capacity: 60
Census: 42
Inspection Dates: 5
Plan of Correction Submission Deadline: Aug 22, 2021
Audit Period: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maureen Golas Markure | Supervising Nurse Consultant | Author of the inspection report and correspondence. |
| Laurie Cianci | Director of Nursing Services (DNS) | Contacted during inspection and involved in findings. |
| Jaime Faucher | Vice President of Operations | Contacted during inspection. |
Inspection Report
Renewal
Census: 42
Capacity: 60
Deficiencies: 5
Date: Jul 26, 2021
Visit Reason
The inspection was an unannounced renewal visit conducted by the Facility Licensing and Investigations Section of the Department of Public Health to review compliance and investigate complaint #CT 00030185.
Complaint Details
Complaint #CT 00030185 was investigated. Allegations included neglect and abuse related to resident care and medication administration. The complaint was substantiated with findings of neglect in care and medication errors.
Findings
The inspection identified multiple violations related to resident care, medication administration, infection control, and intravenous therapy policies. The facility was required to submit a plan of correction by August 22, 2021. Specific findings included failure to timely assess injuries, medication administration errors, improper PPE use, and incomplete employee screening.
Deficiencies (5)
Failure to ensure timely assessment of injuries of unknown origin for Resident #5.
Failure to ensure timely receipt of antipsychotic medication from pharmacy for Resident #138.
Failure to ensure Nurse Aide applied PPE in accordance with facility policy and CDC guidance.
Failure to ensure employees were screened in accordance with facility policy and COVID-19 screening tool.
Failure to ensure IV therapy policy identified responsible staff and availability of necessary supplies.
Report Facts
Licensed Bed Capacity: 60
Census: 42
Inspection Dates: 2021-07-26 to 2021-07-30
Plan of Correction Submission Deadline: Aug 22, 2021
Number of Employees Not Screened: 8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Laurie Cianci | Director of Nursing Services (DNS) | Named in relation to notification and investigation of resident abuse allegations. |
| Jaime Faucher | Vice President of Operations | Personnel contacted during inspection. |
| Jennifer Daley | Director of Nursing | Contacted during desk audit inspection on 10/28/21. |
| Maureen Golas Markure | Supervising Nurse Consultant | Author of complaint investigation report. |
| Marc Navaroli | RN | Report submitted by during desk audit. |
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Dec 3, 2020
Visit Reason
The Department of Public Health conducted a COVID-19 Focused Survey and a complaint investigation at Touchpoints At Chestnut to determine compliance with Federal requirements related to infection prevention and control and to address an allegation of mistreatment involving improper use of an assistive device during a resident transfer.
Complaint Details
The complaint involved an allegation of mistreatment where Resident #1 sustained a skin tear during a transfer due to improper use of an assistive device. The allegation was substantiated based on clinical record review, staff interviews, and policy review.
Findings
The survey revealed that the facility was not in substantial compliance with infection control requirements. A clinical record review and staff interviews found that the facility failed to ensure proper use of an assistive device during a resident transfer, resulting in a skin tear injury to the resident.
Deficiencies (1)
Failure to ensure an assistive device was utilized during a transfer, resulting in a skin tear to Resident #1.
Report Facts
Skin tear size: 5
Skin tear width: 2
Skin tear depth: 0.1
Education completion date: Jan 6, 2021
Audit duration: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jacqueline Ruot | Supervising Nurse Consultant | Author of the survey results and plan of correction letter |
| Holly Giuditta-Deming | Administrator | Facility administrator addressed in the survey results letter |
| NA #1 | Nursing assistant involved in the transfer incident causing the skin tear | |
| Director of Nursing | Director of Nursing | Interviewed regarding the incident and facility policy on transfers |
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Dec 3, 2020
Visit Reason
The Department of Public Health conducted a COVID-19 focused survey and complaint investigation at Touchpoints At Chestnut on December 3, 2020, to determine compliance with Federal requirements related to infection prevention and control practices and to investigate an allegation of mistreatment.
Complaint Details
The complaint involved an allegation of mistreatment of Resident #1, who sustained a skin tear during a transfer when a nurse aide pulled the resident's hand instead of using a gait belt as required by facility policy. Interviews and documentation confirmed the incident and policy noncompliance.
Findings
The survey revealed that the facility was not in substantial compliance with infection prevention and control requirements. A clinical record review and interviews found that the facility failed to ensure an assistive device was used during a resident transfer, resulting in a skin tear injury to Resident #1.
Deficiencies (1)
Failure to ensure an assistive device was utilized during a transfer, resulting in a skin tear to Resident #1.
Report Facts
Measurement of skin tear: 5
Measurement of skin tear: 2
Measurement of skin tear: 0.1
Date of Resident Care Plan: Aug 3, 2020
Date of MDS assessment: Oct 13, 2020
Date of nurse's note: Nov 2, 2020
Date of reportable event form: Nov 2, 2020
Date of education completion: Jan 6, 2021
Audit duration: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jacqueline Ruot | Supervising Nurse Consultant | Signed letter and contact person for the survey |
| Holly Giuditta-Deming | Administrator | Facility administrator addressed in the letter |
Inspection Report
Routine
Deficiencies: 1
Date: Oct 15, 2020
Visit Reason
An unannounced visit was conducted at Touchpoints At Chestnut on October 15, 2020, by the Department of Public Health for the purpose of conducting a COVID-19 infection control survey.
Findings
The facility failed to ensure staff utilized personal protective equipment (PPE) according to professional standards, specifically a nursing assistant was observed wearing a surgical mask underneath an N95 mask, which was against infection control protocols.
Deficiencies (1)
Staff failed to utilize personal protective equipment (PPE) according to professional standards; specifically, a nursing assistant wore a surgical mask underneath an N95 mask.
Report Facts
Date of physician's order: Oct 6, 2020
Date of Resident Care Plan: Oct 13, 2020
Date of observation: Oct 15, 2020
Date of education: Oct 15, 2020
Plan of correction submission deadline: Mar 26, 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jacqueline Ruot | Supervising Nurse Consultant | Signed the notice letter from the Facility Licensing and Investigations Section. |
Inspection Report
Complaint Investigation
Census: 43
Capacity: 60
Deficiencies: 1
Date: Oct 15, 2020
Visit Reason
A COVID-19 Focused Survey and complaint investigation was conducted to determine compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities, including proper infection prevention and control practices to prevent the development and transmission of COVID-19.
Complaint Details
The visit was complaint-related and included a substantiation of failure to follow proper PPE protocols, specifically improper use of masks by staff.
Findings
The facility failed to ensure staff utilized personal protective equipment (PPE) according to professional standards, specifically an employee wearing a surgical mask underneath an N95 mask, which is against proper protocol. The facility disagreed with the findings and requested an Informal Dispute Resolution but provided a plan of correction including education and audits.
Deficiencies (1)
Failure to ensure staff utilized personal protective equipment (PPE) according to professional standards, specifically wearing a surgical mask underneath an N95 mask.
Report Facts
Capacity: 60
Census: 43
Completion date for plan of correction: Mar 31, 2021
Audit start date: Mar 17, 2021
Audit duration days: 30
Employees mentioned
| Name | Title | Context |
|---|---|---|
| NA #1 | Nurse Aide | Named in finding for improper PPE use by wearing a surgical mask underneath an N95 mask |
| DON | Director of Nursing | Directed removal of surgical mask under N95 and provided education on proper PPE use |
Inspection Report
Abbreviated Survey
Deficiencies: 1
Date: May 22, 2020
Visit Reason
A COVID-19 Focused Survey was conducted to determine compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities, including proper infection prevention and control practices to prevent the development and transmission of COVID-19.
Findings
The facility failed to implement necessary infection prevention measures to prevent the spread of COVID-19 from a resident with potential exposure to a roommate who was considered COVID-19 negative. Specifically, Resident #1, requiring transmission-based precautions, was sharing a room with Resident #2, who was negative and could have been moved to a different room.
Deficiencies (1)
Failure to implement necessary measures to prevent and control the spread of infection to a roommate (Resident #2) from a resident with potential COVID-19 exposure (Resident #1).
Report Facts
Date of survey: May 22, 2020
Number of residents with potential exposure: 6
Transmission-based precautions start date: May 19, 2020
Observation time: 939
Monitoring period: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Interviewed regarding room sharing and infection control measures |
Inspection Report
Follow-Up
Census: 54
Capacity: 60
Deficiencies: 0
Date: Jun 20, 2019
Visit Reason
The visit was a desk audit conducted on 6/20/19 for the purpose of reviewing care related to a violation letter dated 6/15/19, to verify correction of previous deficiencies.
Findings
No violations of the General Statutes of Connecticut or regulations were identified at the time of this inspection. The violations cited in the prior letter dated 6/15/19 were deemed corrected with no remaining violations.
Report Facts
Licensed Bed: 60
Census: 54
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Christina Davis | DNS | Personnel contacted during the inspection |
| Rocky Hanock | RN, MSN, DPH Nurse Consultant | Report submitted by |
Inspection Report
Complaint Investigation
Deficiencies: 8
Date: Apr 18, 2019
Visit Reason
Unannounced visits were made to Touchpoints At Chestnut by representatives of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting an investigation into violations of Connecticut General Statutes and/or Regulations of Connecticut State Agencies.
Complaint Details
The investigation was complaint-driven, focusing on allegations including physical mistreatment of Resident #16 and other care deficiencies.
Findings
The facility was found to have multiple deficiencies including failure to ensure residents were free from physical mistreatment, failure to accurately complete resident assessments, failure to develop comprehensive person-centered care plans, failure to revise care cards to address dental needs, failure to complete assessments after resident deaths, failure to document medication administration and pain management properly, and failure to conduct required tests such as the Abnormal Involuntary Motion Scale (AIMS) test.
Deficiencies (8)
Facility failed to ensure resident was free from physical mistreatment involving Resident #16.
Facility failed to accurately complete the resident assessment for Resident #18 related to dental care.
Facility failed to develop a comprehensive person-centered care plan for Residents #18 and #34.
Facility failed to revise Resident #9's care card to address dental needs.
Facility failed to complete an assessment after the death of Resident #58.
Facility failed to ensure discharge information regarding allergies and medication administration was documented for Resident #59.
Facility failed to conduct an Abnormal Involuntary Motion Scale (AIMS) test for Resident #20 as required.
Facility failed to ensure pain management results were consistently documented in the medical record for Resident #208.
Report Facts
Bruise measurement: 5
Bruise measurement: 7
Dates of resident assessments and events: Multiple dates including 8/3/18, 4/18/19, 7/24/18, 7/31/18, 4/16/19, 4/15/19, 4/8/19, 2/11/19, 1/15/19, 3/4/19, 4/18/19, 2/14/19, 4/9/19, 5/30/19, etc.
Weight increase: 8
Plan of correction deadline: Plan of correction to be submitted by May 25, 2019.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Connie Greene | Supervising Nurse Consultant | Signed the important notice letter regarding the investigation. |
| Holly Giuditta-Deming | Administrator | Facility administrator addressed in the notice letter. |
| Nurse Aide #1 | Identified as the nurse aide involved in the physical mistreatment allegation of Resident #16. | |
| Licensed Practical Nurse #3 | Licensed Practical Nurse (LPN) | Interviewed regarding Resident #16 incident. |
| Licensed Practical Nurse #4 | Licensed Practical Nurse (LPN) | Signed note regarding Resident #9's partial denture. |
| RN #2 | Registered Nurse | Documented Resident #58's death and related nursing notes. |
| Social Worker #1 | Social Worker | Interviewed regarding Resident #20's AIMS test. |
| Corporate Nurse (RN#3) | Registered Nurse | Interviewed regarding Resident #20's AIMS test. |
| Social Worker #2 | Social Worker | Interviewed regarding Resident #20's AIMS test. |
Inspection Report
Renewal
Census: 48
Capacity: 60
Deficiencies: 8
Date: Jun 8, 2018
Visit Reason
The inspection was a desk audit conducted on 6/8/2018 as part of the facility's regulatory oversight and renewal process.
Findings
Violations of the General Statutes of Connecticut and/or regulations were identified during the inspection, with an amended violation letter dated April 23, 2018. The report includes detailed findings of deficiencies related to resident care, medication administration, documentation, and staff performance evaluations.
Deficiencies (8)
Facility failed to ensure Resident #206 was treated in a dignified manner, including inappropriate staff comments and lack of privacy.
Facility failed to ensure medications were administered according to physician orders for Resident #44 and others, including failure to obtain Dilantin levels and administer Lovenox as ordered.
Facility failed to ensure proper assessment and care after resident falls, including failure to report incidents and complete RN assessments.
Facility failed to appropriately apply orthotic cervical collar for Resident #5, including improper placement and lack of care plan interventions.
Facility failed to ensure timely oral hygiene, repositioning, and incontinent care for Resident #44, resulting in skin integrity issues.
Facility failed to ensure physician orders and supplies were in place for respiratory/tracheostomy care for Resident #44.
Facility failed to ensure clinical records were accurate and complete for Resident #54, including missing physician signatures and documentation of death.
Facility failed to complete performance evaluations for RN #5 and ensure staff education on pronouncement policy.
Report Facts
Licensed beds: 60
Census: 48
Inspection dates: Apr 2, 2018
Inspection dates: Jun 8, 2018
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Mueller | RN | Report submitted by |
| Carla Sandstrom | ADNS (Acting DNS) | Personnel contacted during inspection |
| Dennis Billings | Administrator | Personnel contacted during inspection |
| Kelly Madden | Report submitted by | |
| Donna Billings | Administrator | Facility administrator named in correspondence |
| Connie Greene | Supervising Nurse Consultant | Signed letter regarding violations |
| Norma Schuberth | Supervising Nurse Consultant | Signed letter regarding violations |
Inspection Report
Complaint Investigation
Census: 52
Capacity: 60
Deficiencies: 10
Date: Apr 12, 2017
Visit Reason
Unannounced visits were made on April 12 and 13, 2017, by the Department of Public Health for the purpose of conducting multiple investigations related to complaints and regulatory compliance.
Complaint Details
Complaint investigations #21521, 21407, CT209633, CT2045 were conducted. Violations were substantiated as noted in attached violation letters dated 4/26/17 and 2/14/17.
Findings
Violations of Connecticut State Agencies regulations were identified during the inspection, including failures in comprehensive assessment of residents, timely physician visits, verbal abuse, inadequate care planning, medication administration, and environmental safety. Plans of correction were submitted with target compliance dates.
Deficiencies (10)
Failure to conduct a comprehensive assessment of an extremity to set an initial baseline for decline.
Failure to ensure a new admission resident was seen by a physician within 48 hours of admission.
Verbal abuse by a nursing assistant towards a resident.
Failure to provide resident with 8 ounces of milk at each meal as ordered.
East wing laundry room door leading to stairwell was unlocked without alarm system.
Failure to facilitate inclusion of resident/family in care plan process.
Failure to provide appropriate services as recommended for PASRR resident.
Failure to ensure eye drops were administered and pacemaker checks conducted per physician orders.
Failure to ensure resident environment remained free from potential hazards.
Failure to consistently monitor orthostatic blood pressures according to physician orders.
Report Facts
Licensed Bed Capacity: 60
Census: 52
Target Date of Compliance: 2017
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Donna Grant | DNS | Personnel contacted during inspection |
| Blair Quasnitschka | Acting Administrator | Personnel contacted during inspection and signed plan of correction |
| John Kolenda | Administrator | Named in correspondence and plan of correction |
| Karen Gworek | Supervising Nurse Consultant | Signed complaint letter dated April 26, 2017 |
| Maria M. LaRocco | Supervising Nurse Consultant | Signed narrative report |
| Norma Schuberth | Supervising Nurse Consultant | Signed letter dated February 23, 2017 |
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