Not rated by CMS — ratings are suppressed for new or low-volume facilities.
The next survey window likely opens around November 2026
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Avantara Groton during CMS and state inspections, most recent first.
A resident's right to refuse a COVID-19 vaccination was not honored when an LPN misread a declination form and administered the vaccine despite the resident's verbal refusal. The resident expressed frustration over the lack of autonomy in decision-making. The incident was reported, and the resident's power of attorney was informed and accepted the situation. No further concerns were identified among other residents and staff.
The facility failed to update care plans for three residents requiring Enhanced Barrier Precautions (EBP). A resident with a pressure ulcer and two others with EBP signs on their doors did not have their care plans revised to reflect this need. The DON and RN unit manager confirmed the oversight.
A medication error rate of 9.68% was observed when an RN failed to prime insulin pen needles before administering Aspart, Degludec, and Lispro insulin to two residents. The manufacturer's instructions require priming to ensure accurate dosing, but the facility's policy lacked specific guidance for insulin pen use.
The facility failed to ensure proper infection control practices during resident care. An RN did not change gloves or perform hand hygiene appropriately during a dressing change, and a resident with a wound vacuum was not placed on enhanced barrier precautions. Additionally, a CNA did not follow proper hand hygiene and glove use during foley catheter care, using improper technique that could introduce bacteria.
Resident's Right to Refuse Vaccination Not Honored
Penalty
Summary
The provider failed to honor a resident's right to refuse a COVID-19 vaccination, resulting in the resident receiving the vaccine against her wishes. During a vaccination clinic, an LPN misread the resident's vaccine declination form, mistakenly believing that the resident's power of attorney had consented to the vaccination. Despite the resident's verbal refusal and expression of frustration, the LPN insisted that the resident's family wanted her to receive the vaccine, leading to the administration of the vaccine. The resident expressed feelings of frustration and a lack of autonomy in decision-making following the incident. The LPN acknowledged the error, confirming that the resident had clearly stated her refusal. The incident was reported to the social services designee, who informed the director of nursing. The resident's power of attorney was contacted and informed about the situation, and they accepted that the resident had received the vaccine. Interviews with other residents and staff revealed no additional concerns regarding resident rights or similar errors.
Failure to Update Care Plans for Enhanced Barrier Precautions
Penalty
Summary
The provider failed to ensure that the care plans for three residents were updated to reflect the need for Enhanced Barrier Precautions (EBP). Resident 11, who had a pressure ulcer on her left calf, was readmitted with a wound vacuum, yet her care plan was not revised to include EBP. The Director of Nursing (DON) acknowledged that the care plan should have been updated during care conferences or when changes occurred, but it was not. Similarly, residents 15 and 32 had EBP signs on their doors and personal protective equipment available, indicating the need for EBP. However, their care plans did not reflect this requirement. Resident 32 had an indwelling Foley catheter, and resident 15 had an open wound on his coccyx region. Both the RN unit manager and the DON confirmed that the care plans for these residents should have included EBP but were not updated accordingly.
Medication Error Due to Improper Insulin Administration
Penalty
Summary
The provider failed to ensure proper administration of insulin for two residents, resulting in a medication error rate of 9.68%. During observations, a registered nurse (RN) did not prime the insulin pen needles before administering Aspart and Degludec insulin to one resident and Lispro insulin to another. The manufacturer's instructions for the Lispro Injection KwikPen clearly state that priming is necessary before each injection to ensure the correct dose is delivered. The facility's medication administration policy did not include specific instructions for the use of insulin pen devices, contributing to the oversight in proper insulin administration.
Infection Control Deficiencies in Resident Care
Penalty
Summary
The provider failed to ensure proper infection prevention and control practices during a dressing change performed by an RN unit manager for a resident. The RN did not change gloves or perform hand hygiene at appropriate times, such as after handling soiled items and before touching clean supplies. The RN also used a marker from her pocket, which was not a clean area, and did not sanitize the resident's dressing container before returning it to the medication cart. These actions were contrary to the facility's hand hygiene policy. Another deficiency was observed with a resident who had returned from the hospital with a wound vacuum device. The resident was not placed on enhanced barrier precautions (EBP) as required by the facility's policy for residents with wounds or indwelling devices. Staff did not wear gowns or gloves when providing care, and there was no signage indicating EBP until later. The director of rehabilitation confirmed that EBP measures were not in place during her care of the resident. Additionally, a CNA failed to perform appropriate hand hygiene and glove changes during foley catheter care for a resident on EBP. The CNA did not wash her hands before donning PPE or after performing tasks that required it, such as emptying the catheter. She also used improper technique by cleaning the groin area first and using the same towel for multiple areas, which could introduce bacteria. These actions were inconsistent with the facility's hand hygiene policy.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Groton
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Bethesda Home Of Aberdeen | 17.7 mi | — | 7 | 0 |
| Sun Dial Manor | 18.6 mi | — | 1 | 0 |
| Avera Mother Joseph Manor Retirement Community | 18.7 mi | — | 9 | 0 |
| Prairie Heights Healthcare | 19.1 mi | — | 0 | 0 |
| Aberdeen Health And Rehab | 20 mi | — | 1 | 1 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.