Courville At Nashua
Inspection history, citations, penalties and survey trends for this long-term care facility in Nashua, New Hampshire.
- Location
- 22 Hunt Street, Nashua, New Hampshire 03060
- CMS Provider Number
- 305037
- Inspections on file
- 14
- Latest survey
- July 24, 2025
- Citations (last 12 mo.)
- 14
Citation history
Health deficiencies cited at Courville At Nashua during CMS and state inspections, most recent first.
The facility did not implement or annually review its water management program, failing to specify or document control measures for multiple at-risk areas such as water heaters, pipes, faucets, and medical equipment. Key staff could not identify the standards used to develop the program, and the Legionella Policy had not been updated since 2018, potentially affecting all residents.
Surveyors observed a greenish brown film inside the main kitchen ice machine, confirmed by the Food Service Director, indicating a lack of proper cleaning and sanitization as required by the manufacturer's instructions. In a satellite kitchenette, five supplemental shakes were found with handwritten use by dates, and the Food Service Director confirmed these dates corresponded to the 14-day use period from thawing, as specified by product instructions.
A resident with advanced Parkinson's Disease was admitted with a communication board to aid in communication, but the device was not accessible, leading to communication difficulties. The resident's DPOA reported the board missing, and staff interviews revealed a lack of awareness and initial inability to locate the device, which was eventually found in a drawer in the resident's room.
A facility failed to provide appropriate treatment to maintain mobility for a resident with limited range of motion. The care plan required a rolled face cloth in the resident's right hand to prevent pressure injury, but observations showed the resident's hand was clenched without the cloth. A staff member was unaware of this requirement, and the resident's physical therapy goal of tolerating the cloth for at least eight hours was not being met.
A facility failed to coordinate effectively with a hospice company for a resident's care. The hospice care plan required three weekly visits, but documentation showed only one visit per week initially. Interviews confirmed the absence of a visit schedule, leading to inconsistent documentation and visit frequency.
The facility did not follow its contact precautions policy for a resident with CDiff. An LPN entered the resident's room without wearing a gown and gloves while administering medications, contrary to the facility's policy. The Unit Manager/Infection Preventionist confirmed the requirement for PPE use, as outlined in the Infection Prevention and Control Program.
The facility failed to notify two residents' DPOAs about care plan meetings, preventing their participation in care planning. Both DPOAs expressed a desire to attend meetings but were not informed or invited, and no documentation was found in the residents' medical records. Staff confirmed the lack of notification, contrary to the facility's policy encouraging representative involvement.
Failure to Implement and Review Water Management Program for Infection Control
Penalty
Summary
The facility failed to implement and annually review its water management program, which is required for infection prevention and control. A review of the facility's Water Management Program revealed that multiple at-risk areas were identified, including water heaters, expansion tanks, pipes, valves, fittings, faucets, shower heads, air washers, humidifiers, eyewash stations, ice machines, CPAP machines, oxygen bubblers, nebulizers, hydrotherapy equipment, heater-cooler units, and water filters. However, the program did not specify what control measures would be applied or monitored for these at-risk areas. Interviews with the Maintenance Director and Infection Preventionist confirmed that there was no documentation of control measures for the identified areas, and neither staff member could identify the nationally-recognized standard used to develop the water management program. Further review showed that the facility's Legionella Policy had not been reviewed or updated since 2018, and there was no documentation that the Water Management Plan had been discussed at a committee meeting. The Administrator confirmed the absence of documentation regarding the application and monitoring of control measures and acknowledged that the policy had not been reviewed since 2018. The deficiency had the potential to affect all 69 residents residing in the facility.
Unsanitary Kitchen Equipment and Improper Food Handling
Penalty
Summary
The facility failed to ensure that kitchen equipment was clean and sanitary and that food was handled according to professional standards. During an observation of the main kitchen, a greenish brown film was found inside the ice machine below the ice cube metal grid, and this was confirmed by the Food Service Director. Review of the manufacturer's instructions indicated that the ice machine should be cleaned and sanitized every six months. Additionally, in a first floor satellite kitchenette, five supplemental shakes were found in the refrigerator with a handwritten use by date, which was confirmed by the Food Service Director to be the 14th day from the thaw date. The product instructions required that thawed product be used within 14 days and kept refrigerated.
Failure to Maintain Resident's Communication Ability
Penalty
Summary
The facility failed to maintain a resident's ability to communicate by not ensuring the availability of a communication device. A resident with advanced Parkinson's Disease, who was admitted with a communication board to aid in communication, was unable to use the device as it was not accessible. The resident's Durable Power of Attorney (DPOA) reported that the communication board had not been seen since shortly after admission. Staff interviews revealed that some staff members were unaware of the communication board, while others confirmed its existence but could not locate it initially. Eventually, the communication board was found in a drawer in the resident's room. The resident expressed difficulty in communicating with staff without the board.
Failure to Maintain Mobility Treatment for Resident
Penalty
Summary
The facility failed to ensure that a resident received appropriate treatment to maintain mobility, specifically for a resident with limited range of motion. The care plan for the resident included an intervention to prevent pressure injury by placing a rolled face cloth in the resident's right hand, which was to be changed with care and reapplied if removed. However, observations on multiple occasions revealed that the resident's right hand was clenched without the rolled face cloth in place. An interview with a Licensed Nursing Assistant indicated a lack of awareness regarding the requirement for the resident to have a rolled face cloth in their right hand. The Physical Therapy Discharge Summary had previously set a goal for the resident to tolerate a folded/rolled wash cloth in the right hand for at least eight hours without skin integrity issues or pain, which was not being met.
Lack of Coordination with Hospice Services
Penalty
Summary
The facility failed to ensure effective collaboration and communication with a hospice company for a resident receiving hospice care. The resident was admitted to hospice services, and the care plan specified that a hospice aide should visit three times a week for nine weeks. However, documentation revealed that during the first week, only one visit was recorded, and during the second week, only one visit was documented despite the aide claiming to have visited three times. Interviews with the unit manager and the hospice aide confirmed the lack of a schedule for hospice visits, contributing to the inconsistency in visit documentation and frequency.
Failure to Follow Contact Precautions for CDiff
Penalty
Summary
The facility failed to adhere to its policy on contact precautions, specifically for a resident on transmission-based precautions due to Clostridium Difficile (CDiff) infection. During an observation, a Licensed Practical Nurse (LPN) was seen entering the resident's room without wearing the required personal protective equipment (PPE), such as a gown and gloves, while administering medications. The LPN admitted to not using PPE when not providing direct care, despite the resident being on contact precautions. The Unit Manager/Infection Preventionist confirmed that the facility's policy mandates the use of a gown and gloves before entering rooms with transmission-based precautions for CDiff. A review of the facility's Infection Prevention and Control Program corroborated this requirement.
Failure to Notify Residents' Representatives of Care Plan Meetings
Penalty
Summary
The facility failed to notify residents and/or their representatives about care plan meetings, as evidenced by the cases of two residents. For Resident #16, the activated Durable Power of Attorney (DPOA) reported not being invited to any care plan meetings for over six months, despite expressing a desire to attend and contribute to the resident's care. A review of Resident #16's medical records confirmed the absence of documentation regarding care plan meeting notifications to the DPOA. Staff J, a social worker, corroborated the lack of documentation for the period from December 2023 through May 2024. Similarly, Resident #40's DPOA was unaware of care plan meetings and had not received any invitations, despite being present at the facility almost daily. The DPOA expressed a willingness to participate in the meetings to discuss the resident's care. A review of Resident #40's medical records also showed no documentation of care plan meeting notifications. Staff J confirmed the absence of such documentation. The facility's policy, revised in March 2022, encourages resident and representative participation in care plan development and requires documentation if participation is deemed impracticable, which was not adhered to in these cases.
Latest citations in New Hampshire
Unsanitary conditions were observed in the main kitchen, including debris, wet towels and washcloths on the floor, cloudy liquid under the rinse sink, missing laminate flooring in front of the rinse sink, and buildup of grease and debris under and around the dishwasher, sinks, oven, hood vent, and center island. Bread was stored on shelves with debris underneath, and soda and beer were stored on the floor. The ED confirmed the observations, and the cited FDA Food Code required smooth, easily cleanable, nonabsorbent surfaces.
The facility failed to include personal humidifiers in its Water Management Plan. The Legionella Water Management Program and staff education materials identified humidifiers as a possible source for Legionella exposure, but observations on multiple units found humidifiers in resident rooms and the Water Management Program did not list them or include controls to prevent growth of Legionella and other opportunistic waterborne pathogens. The IP confirmed humidifiers were in use but not included in the plan.
The facility failed to report abuse allegations to the state survey agency. One incident involved two residents with severe cognitive impairment, where an LPN observed one resident exposed while another attempted sexual contact. Another incident involved an LNA witnessing a resident aggressively shake and push another resident’s wheelchair while yelling. Staff confirmed both incidents were not reported to the SSA or law enforcement.
Failure to investigate and report abuse allegations: Staff observed one resident attempting sexual contact with another resident, both with severe cognitive impairment, and another resident aggressively shaking a peer’s wheelchair while yelling. The DON confirmed that neither incident had been investigated, despite staff notification to leadership.
Failure to provide appropriate care to maintain mobility was identified for a resident dependent on an AFO before getting OOB. The resident reported the foot rolled out of the AFO and it caused pain, while the record showed an OT consult order for repair of a broken strap with no evidence the consult was completed or that anyone contacted the AFO provider. The AFO was observed on the bed with the ankle strap missing.
Expired eye drops were found on 2 medication carts, including Timolol for one resident and Latanoprost for another, with staff confirming one should have been discarded. In addition, a medication cart was observed unlocked and unattended, despite facility policy requiring carts to be locked when not in use.
Humidifier equipment was not maintained and cleaned as required for three residents. Staff did not have a reliable tracking system for resident-owned humidifiers, and the DON confirmed the facility was not following manufacturer-specific cleaning instructions. One resident’s humidifier was observed plugged in with an empty tank, another resident did not know how often the unit was cleaned, and staff reported using vinegar for all units instead of the required cleaning methods.
Failure to assess residents for self-administration of medications: two residents had medications left at bedside without the required assessment or provider order. One resident had eye drops on the bedside table and stated he/she self-administered them, while the other had multiple morning meds left at bedside in a medicine cup. Staff confirmed neither resident had documentation authorizing self-administration.
The facility failed to report alleged abuse incidents involving two residents to the SSA within the required timeframe. One resident was documented pushing another resident after grabbing the resident by the chest, and another incident involved physical contact between two residents with one resident sustaining a wrist bruise. The ADON stated these resident-to-resident incidents were not reported to the SSA.
A resident’s fall care plan was not updated after a fall. The fall summary identified a new intervention for staff to offer the resident the choice to keep the curtain open between the sides of the room except during cares, but the care plan was not revised to include it. The UM confirmed the finding, and the facility policy states the IDT fall meeting should develop new fall prevention interventions and update the resident care plan accordingly.
Unsanitary Kitchen Conditions and Improper Food Storage
Penalty
Summary
The facility failed to store and prepare food in accordance with professional standards for food service safety. During an observation of the main kitchen with the Executive Director, multiple unsanitary conditions were identified, including a white substance buildup on the floor beside the dishwasher, a wet hand towel and a wet washcloth on the floor under the dishwasher, debris under the rinse sink, and a pink container filled with cloudy liquid sitting under the drain beneath the rinse sink. The laminate flooring in front of the rinse sink was missing in an area measuring approximately 4.5 inches by 5 inches, and there was also a large amount of debris under the sanitizing sink, dust between the wall and the left side of the oven, debris under the oven, and a buildup of debris and grease on the hood vent. Additional observations showed debris under the center island where bread was being stored, debris on the shelves under the island, and three cases of soda plus a six pack of beer stored on the floor on the corner shelf. The Executive Director confirmed all of these observations during the interview. Review of the FDA Food Code 2017 cited requirements that nonfood-contact surfaces exposed to splash or food debris be constructed of nonabsorbent materials and that floors, walls, wall coverings, and ceilings be smooth and easily cleanable.
Water Management Plan Did Not Include Humidifiers
Penalty
Summary
Provide and implement an infection prevention and control program was deficient because the facility failed to identify personal humidifiers in its Water Management Plan. Review of the facility's Legionella Water Management Program showed that the program was intended to identify areas in the water system where Legionella bacteria can grow and spread and specifically listed humidifiers among the water system components that could encourage the growth and spread of Legionella or other waterborne bacteria. Staff education materials also identified humidifiers as a possible pathway for exposure to Legionella bacteria. However, observations on the Granite, Profile, and Maple Units found humidifiers in use in resident rooms, and review of the Water Management Program showed that it did not identify humidifiers in use in the facility or controls to prevent the growth of Legionella and other opportunistic waterborne pathogens. The Infection Preventionist confirmed that humidifiers were in use in the building but were not included in the Water Management Plan.
Failure to Report Abuse Allegations to State Agency
Penalty
Summary
The facility failed to report allegations of abuse to the state survey agency for two incidents involving residents with severe cognitive impairment. In one event, a nursing note documented that a LPN entered a resident’s room and observed one resident lying back in a recliner with briefs pulled off and pajama pants pulled above the pelvis while another resident was kneeling in front of the recliner attempting to have sex with the resident. The LPN separated the residents, notified the DON and administrator, and placed the resident on 1:1 safety checks. The record showed both residents had BIMS scores indicating severe cognitive impairment, and staff confirmed the incident was not reported to the State Agency. In another event, a nursing note documented that an LNA witnessed one resident coming out of a room and grabbing the back of another resident’s wheelchair and shaking it aggressively. The LNA later confirmed witnessing the resident shake and push the wheelchair while yelling at the other resident. The administrator confirmed this incident was also not reported to the State Survey Agency or other law enforcement. The facility policy required immediate reporting of abuse allegations to the state licensing/certification agency and other officials according to state law.
Failure to Investigate and Report Abuse Allegations
Penalty
Summary
The facility failed to ensure that two allegations of abuse were investigated and reported to the State Agency. One incident involved Resident #82 and Resident #11, both of whom had severe cognitive impairment, with BIMS scores of 02 and 00 respectively. A nursing note documented that a LPN entered Resident #82’s room and observed Resident #11 lying back in a recliner with clothing pulled off and Resident #82 kneeling in front of the recliner attempting to have sex with Resident #11. The LPN separated the residents, notified the DON and Administrator, and placed Resident #82 on 1:1 checks, but the DON later confirmed that no investigation was initiated. A second incident involved Resident #29 and Resident #55. A nursing note stated that an LNA witnessed Resident #29 coming out of a peer’s room and grabbing the back of the peer’s wheelchair and shaking it aggressively. The LNA later confirmed that Resident #29 shook and pushed forward Resident #55’s wheelchair while yelling at them. The DON confirmed that this incident had not been investigated.
Failure to Address Broken AFO for Resident With Limited Mobility
Penalty
Summary
Provide appropriate care for a resident to maintain and/or improve ROM, limited ROM, and/or mobility was not ensured for a resident with limited mobility. Resident #4’s care plan, initiated on 7/9/25, included an intervention stating the resident was dependent on application of an AFO prior to out of bed to the right lower leg. The medical record showed a physician order dated 3/2/26 for an OT consult to have the resident’s right AFO sent for repair because the strap was broken, but there was no indication that an OT consult had been completed or that anyone had been contacted about the AFO needing repair. During interview, the resident stated they had told their provider that their foot rolls out of the AFO and it causes pain when worn, and that no one had come to see them or talk with them about the AFO since they spoke to their provider a few weeks earlier. Observation of the resident’s room showed the AFO lying on the bed with the ankle strap missing.
Medication carts left unsecured and expired eye drops kept in use
Penalty
Summary
Medications and biologicals were not properly labeled and stored on multiple medication carts. On the Maple Unit short hall cart, a bottle of Timolol Maleate solution for Resident #55 was observed with handwritten opening and expiration dates showing it had been opened on 2/27 and expired on 3/27, while the manufacturer’s instructions provided by the facility stated the unit dose container should be used within one month after the foil package is opened. Staff A, a LMA, confirmed the finding during the observation. On the Meadow Unit long hall cart, a bottle of Latanoprost Solution 0.005% for Resident #23 was observed with handwritten dates showing it had been opened on 2/9/26 and expired on 3/23/26, and Staff B, an RN, confirmed the medication had been administered and should have been discarded. In addition, the Profile Unit medication cart was observed unlocked with no nursing staff present, and Staff D, an RN, confirmed the cart was unattended and unsecured. Facility policy stated medication carts are to be locked when not in use and opened multi-dose vials are to be dated and discarded within 28 days unless the manufacturer specifies otherwise.
Humidifiers Not Maintained or Cleaned per Policy and Manufacturer Instructions
Penalty
Summary
The facility failed to maintain safe and clean humidifier equipment for 3 of 3 residents reviewed for environment, identified as residents #41, #63, and #100. The facility’s admission procedures and Resident Information Guide stated that if a humidifier is brought in, nursing staff must be aware of it so it can be placed on the cleaning schedule. However, interview with staff revealed that the Unit Aide Book did not contain information about which residents had humidifiers or any tracking of cleaning dates, and the Director of Nursing confirmed this. The facility’s Humidifier Maintenance policy stated that nursing staff were to unplug the device daily and rinse/refill it with fresh tap water, while housekeeping was to clean humidifiers monthly with a 1:2 acetic acid and water solution. Resident #41 had a Pelonis humidifier plugged into the room, and the resident’s family stated they purchased it and staff were aware of it; later observation showed the humidifier plugged in with an empty water tank. Resident #63 had a Breezome humidifier in the room, and the resident did not know how often it was cleaned. Resident #100 had a Vick’s humidifier in the room, and the manufacturer’s instructions required weekly cleaning with vinegar for scale removal and a bleach solution for disinfecting. Staff stated that all humidifiers were cleaned with vinegar, and the DON confirmed the facility was not following the specific manufacturer instructions for cleaning individual humidifiers.
Failure to Assess Residents for Self-Administration of Medications
Penalty
Summary
The facility failed to determine that self-administration of medications was clinically appropriate for 2 of 3 residents reviewed for choices in a final sample of 35 residents. For one resident, a box of Ketotifen Fumarate Ophthalmic Solution 0.035% eye drops was observed on the bedside table with an open date of 1/26/26. The resident stated that he/she would self-administer the eye drops, and the MDS showed a BIMS score of 15/15, indicating cognitive intactness. However, the medical record contained no documentation of a self-administration assessment or an order allowing the resident to self-administer the eye drops, and staff confirmed that no such assessment or order existed. For another resident, a medicine cup containing multiple pills/capsules was observed on the bedside table while the resident was in bed with eyes closed and no staff present. Staff stated that the morning medications had been left at the bedside, and further stated that the resident did not have a physician's order or assessment to self-administer medication. The MAR showed multiple morning medications left at bedside, including furosemide, levetiracetam, metformin ER, metoprolol tartrate, multivitamin with minerals, omeprazole magnesium, potassium chloride ER, sertraline HCL, Synthroid, and apixaban. The medical record confirmed there was no physician's order or assessment for self-administration.
Failure to Report Resident-to-Resident Abuse Allegations
Penalty
Summary
The facility failed to ensure that all alleged violations involving abuse were reported immediately, but not later than 2 hours after the allegation, to the State Survey Agency for 2 of 2 residents reviewed for abuse. For Resident #3, nursing progress notes documented that an LNA reported the resident had pushed another resident after grabbing the other resident by the chest while shouting to "get out." The other resident was found on the floor against the wall in a slouched position and was able to get up with assistance from staff. The nursing supervisor was notified, a message was left for the guardian, and 15-minute safety checks were started. Social services notes later referenced the recent resident-to-resident altercation in which one resident pushed another resident who wandered into the room. For Resident #145, nursing progress notes documented a potential altercation between 2 residents after camera footage was reviewed and physical contact was observed between the residents. One resident was observed grabbing at the other resident, and the other resident sustained a bruise to the wrist. The primary nurse was instructed to complete an incident report, and notification was sent to administration. The facility policy titled Abuse And Neglect Policy stated that all allegations of abuse or neglect, including reportable resident-to-resident incidents, would be reported immediately, defined as within 2 hours, yet the Assistant Director of Nursing stated that the resident-to-resident incidents were not reported to the SSA.
Failure to Update Fall Care Plan After Resident Fall
Penalty
Summary
The facility failed to revise a care plan for one resident reviewed for falls. Resident #178 had a fall on 12/24/25, and the fall summary report identified a new intervention to be added to the resident’s care plan: staff were to offer the resident the choice to keep the curtain open between the sides of the room except during cares per resident choice. However, review of the care plan titled "at risk for falls" showed that this intervention was not added after the fall. During interview on 3/25/26 at 8:30 a.m., Staff O, the Unit Manager, confirmed the findings. The facility policy titled, "Fall/Accident Management Program," revised 12/2024, states that the IDT fall meeting will occur weekly after a fall and include discussion of possible causes of the fall and development of new fall prevention interventions, and that the resident care plan will be updated accordingly.
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