Adviniacare at Northbridge

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure that one Resident (#3) out of a total sample of 24 residents, with impaired vision received the proper assistive devices to maintain their vision. Specifically, for Resident #3, the facility failed to ensure that the appropriate corrective lenses were available for the Resident's use when his/her prescription eyeglasses were missing, and he/she was provided with another person's eyeglasses for use.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide foot care and treatment in accordance with professional standards of practice for one Resident (#107) out of a total sample of 24 residents. Specifically, for Resident #107, the facility failed to provide toenail care as required and schedule podiatry services as ordered to assist the Resident in maintaining good foot health and preventing podiatric complications.

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure an environment that was free from accidental hazards for one Resident (#133) out of a total sample of 24 residents. Specifically, for Resident #133, the facility failed to ensure:-that the Resident was provided adequate supervision and assistance during toileting activity to mitigate the risk of a fall.-that a fall sustained by the Resident was investigated, evaluated, and interventions were implemented to reduce fall hazards and risks, and the effectiveness of fall interventions were monitored and modified as required.

Inspectors wroteBased on observation, interview, and record reviews, the facility failed to ensure that complete and accurate medical records were maintained for two Residents (#11 and #2), out of a total sample of 24 residents. Specifically,1. For Resident #11, the facility staff documented for ten months that the Resident's Foley (indwelling urinary) catheter was being changed monthly as ordered when the Foley catheter was not being changed monthly.2. For Resident #2, the facility staff documented two medications as being administered during a medication pass when one medication was not offered or administered to the Resident and the second medication was unavailable for administration to the Resident.

Inspectors wroteBased on observation, interview and policy review, the facility failed to ensure its staff provided a dignified dining experience for one Resident (#103) out of total sample of 21 residents. Specifically, the facility staff remained standing and stood over Resident #103 while assisting the Resident during a breakfast meal.

Inspectors wroteBased on interview, policy and record review, the facility failed to ensure that Skilled Nursing Facility Advanced Beneficiary Notices of Non-coverage (SNF ABN- notice issued to a resident when a facility determines the beneficiary no longer qualifies for Medicare Part A skilled services and the resident has not used all his/her Medicare benefit days) were issued for two Residents (#213 and #215) out of a total applicable sample of three residents, so that the Residents could decide if they wished to continue receiving skilled services that may not be paid for by Medicare, and were aware of the financial responsibility they may have to assume. Specifically, the facility failed to: 1. For Resident #213, issue a SNF ABN when the Resident no longer qualified for Medicare Part A skilled services and chose to remain in the facility. 2. [...]

Inspectors wroteBased on interview, record and policy review, the facility failed to ensure that the Resident and/or Resident Representative was provided the right to participate in the care planning process for one Resident (#8) out of a total sample of 21 residents. Specifically, the facility failed to ensure that: -quarterly care plan meetings (for March 2024 and June 2024) were conducted as required for Resident #8. -the Resident/Resident Representative participated in the care planning process. -the Interdisciplinary Team (IDT) met quarterly in 2024 to review the plan of care as required.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to provide care according to professional standards of practice for one Resident (#76) out of a total sample of 21 residents. Specifically, the facility staff failed to: -adequately assess Resident #76 for bruising (when a part of the body is injured and blood from the damaged capillaries [small blood vessels] leaks out and pools under the skin). -provide interventions to reduce the risk for bruising when the Resident was prescribed antiplatelet (prevents platelets from sticking together and decreasing the body's ability to form blood clots) medication and developed bruises on his/her upper extremities, increasing the Resident's risk for bleeding complications.

Inspectors wroteBased on record and policy review, and interview, the facility staff failed to ensure that one Resident (#112) out of two closed records reviewed, was free from significant medication errors. Specifically, the facility failed to accurately reconcile (the formal process of obtaining a complete and accurate list of a patient's current medications) Resident #112's medication when the Resident was admitted to the facility, resulting in routine daily medication not being administered to the Resident as required and increasing the risk for adverse reactions related to the missed doses of the medications.

Inspectors wroteBased on observation, interview, policy and record review the facility failed to ensure that Transmission-Based Precautions (TBP: infection control measures used in addition to standard precautions [infection prevention practices that apply to all residents, regardless of suspected or confirmed diagnosis or presumed infection status] for patients who may be infected with certain infectious agents) were implemented for one Resident (#36) out of a total sample of 21 residents. Specifically, the facility staff failed to follow Contact Precautions (refers to measures that are intended to prevent transmission of infectious agents which are spread by direct or indirect contact with the resident or the resident's environment) for Resident #36 whose urine was infected with extended-spectrum beta-lactamase (ESBL: [...]

Inspectors wroteBased on interview, policy and record review, the facility failed to provide a Pneumococcal (bacteria often found in the nose and throat, is transmissible to others, and can cause infection) Vaccine to one Resident (#9) out of five applicable residents, out of a total sample of 21 residents. Specifically, the facility staff failed to provide a Pneumococcal Vaccine to Resident #9 when the Resident had previously received Pneumococcal Vaccine doses, was not up-to-date with his/her Pneumococcal Vaccine status, and consented to receive the Pneumococcal Vaccine when it was offered to him/her by the facility.

Inspectors wroteBased on record review and interview, the facility failed to accurately code two Minimum Data Set (MDS) Assessments for one Resident (#82) out of a total sample of 21 residents. Specifically, the facility staff coded Section N (Medications) to indicate Resident #82 had received Insulin (medication used to regulate blood sugar levels) injections (given by use of a needle) one time during the observations periods (period of look-back used for data collection) for each of the two (February 2024 and May 2024) MDS Assessments completed when the Resident did not receive Insulin injections.

Inspectors wroteBased on interviews and records reviewed, for one of three sampled residents (Resident #1) who had a court appointed a legal Guardian, the Facility failed to ensure they notified Resident #1's Guardian that Resident #1 refused his/her daily antipsychotic medication and meals for several days, and that Resident #1 was transferred to the Hospital.

Inspectors wroteBased on interviews and records reviewed, for one of three sampled residents (Resident #1), the Facility failed to permit Resident #1 to remain in the Facility or to ensure that, prior to discharge, Resident #1's Physician documented the danger posed by the Facility's failure to discharge Resident #1 and the Resident's needs which could not be met in the Facility, as required.

Inspectors wroteBased on interviews and records reviewed, for one of three sampled resident (Resident #1) the Facility failed to provide a properly completed written Notice of Transfer or Discharge to the resident/resident's representative at the time the Facility initiated discharge for Resident #1, in accordance with the Federal regulations and per Facility Policy.

Inspectors wroteBased on interviews and records reviewed, for one of three sampled residents (Resident #1), who had a court appointed legal Guardian who specified to Facility staff that if needed that Resident #1 be transferred to the closest hospital (which was only 10 miles away,) the Facility failed to ensure Resident #1's transfer was safe and orderly when, on 3/12/24 a physician order was obtained by nursing for Resident #1 to be transferred to the Hospital Emergency Department (ED) for evaluation however, the Facility instead discharged Resident #1 to an ED approximately 60 miles away, alone via a wheelchair van with all of his/her personal belongings.

Inspectors wroteBased on interviews and records reviewed for one of three sampled residents (Resident #1), who had a court appointed legal Guardian, the Facility failed to ensure the Guardian was provided with a written notice which specified the duration of the Facility Bed-hold Policy at the time of Resident #1's transfer to the hospital on 3/12/24, as required.

Inspectors wroteBased on interviews and records reviewed, for one of three sampled residents (Resident #1), the Facility failed to permit Resident #1 to return following an evaluation in the emergency department (ED) when on 03/12/24, the Facility considered Resident #1 discharged at the time of the transfer.

Inspectors wroteBased on interviews and records reviewed, for one of three sampled residents (Resident #1), who had a court appointed legal Guardian and complex mental health needs, the Facility failed to ensure they developed an effective discharge plan that addressed his/her needs and availability of services, prior to discharge, as required.

Inspectors wroteBased on interviews and records reviewed, for one of three sampled residents (Resident #1) for whom the Facility initiated a discharge, the Facility failed to ensure completion of a discharge summary that included a recapitulation of the Resident #1's stay, course of illness/treatment or therapy, final summary of his/her status and a post-discharge plan of care developed with the participation of Resident #1 and the Guardian, as required.

Inspectors wroteBased on interviews and records reviewed, for one of three sampled residents (Resident #1) whose diagnoses included severe Obsessive Compulsive Disorder (OCD, OCD is a mental disorder that affects a person's brain and behavior which causes excessive thoughts that lead to repetitive behaviors and often centers on themes such as a fear of germs and commonly causes food aversion) the Facility failed to ensure Resident #1 received and was provided appropriate Behavioral Health services that addressed and met his/her mental health needs.

Inspectors wroteBased on interviews and records reviewed, for one of three sampled residents (Resident #1), the Facility failed to ensure they maintained compliance with regulation 258 CMR 20.00 relating to Professional Standards for social workers when, between 3/06/24 and 3/12/24, the Licensed Social Work Associate (LSWA) documented four Progress Notes in Resident #1's electronic health record (EHR) using the name (and therefore credentials) of the Licensed Independent Certified Social Worker (LICSW)

Inspectors wroteBased on interviews and records reviewed, for one of three sampled Residents (Resident #1), the Facility failed to ensure they maintained accurate and complete medical records related to social services, when documentation for services provided by a staff member for social services in Resident #1's electronic health record (EHR) was signed under another contracted staff member's name and professional credentials.

Inspectors wroteBased on record review and interview, the facility failed to accurately execute Advanced Directives (written statement of a person's wishes regarding medical treatment) for one Resident (#24) out of a total sample of 21 residents. Specifically, the facility staff failed to include the invoked (activated) designated Health Care Proxy (HCP- an appointed individual who could legally make medical decisions on a person's behalf when he/she became unable to do so) regarding the decision making process for Resident #24, when completing a Medical Order for Life Sustaining Treatment (MOLST - a standardized medical order form for use by Clinician's caring for patients) form.

Inspectors wroteBased on record review and interview, the facility failed to ensure that two Residents (#47 and #28) out of a total sample of 21 residents, and/or Resident Representatives were included in the care planning process. Specifically, the facility failed to provide evidence that Resident's #47 and #28, and/or Resident Representatives had been invited to, and participated in their care plan meetings.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to provide an adequate level of assistance to prevent an accident for one Resident (#74), out of a total sample of 21 residents. Specifically, the facility staff failed to ensure that Resident #74's coffee was re-heated in a safe manner and temperature checked before providing to Resident #74 per facility policy.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure professional standards of care regarding respiratory equipment for one Resident (#11) out of a total sample of 21 residents. Specifically, the facility failed to: -obtain a Physician's order for oxygen use, -properly store respiratory equipment and change oxygen tubing timely to prevent contamination and infection.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure its staff provided a Physician ordered medication for one Resident (#20) out of a total sample of 21 residents. Specifically, the facility failed to provide Potassium Chloride (a medication used to help regulate fluid balance, muscle contraction and nerve signals) 20 milliequivalent (mEq) over five consecutively ordered dates in April 2023.

Inspectors wroteBased on record review and interview, the facility failed to ensure limited use of a PRN (as needed) antipsychotic (used to treat psychosis [mental disorder characterized by a disconnection from reality]) medication to 14 days for one Resident (#23) out of a total sample of 21 residents. Specifically, the facility failed to ensure its staff limited the use of Haloperidol (antipsychotic medication) to 14 days when it was ordered by the Physician on a PRN basis and the Resident received the medication.

Inspectors wroteBased on observation, interview and policy review, the facility failed to ensure its staff adhered to sanitary standards of practice during food distribution in the main kitchen. Specifically, the facility failed to ensure dietary staff wore hair restraints that fully covered their hair during meal service.

Inspectors wroteBased on policy review, record review and interview, the facility failed to ensure that its staff administered the influenza vaccine after obtaining consent for one Resident (#1) out of five applicable sampled residents.

Inspectors wroteBased on observation and interview, the facility failed to ensue a safe environment was provided for residents, visitors and staff. Specifically, the facility staff failed to properly secure Liquid Propane Gas (LPG) cylinders in the courtyard near the main dining room of the facility. During an observation and interview on 4/24/23 at 12:55 P.M., the surveyor observed three unsecured LPG cylinders on the ground near a barbecue grill, and in close proximity to patio chairs available for smokers outside in the courtyard near the entrance to the main dining room. The Assistant Director of Nurses (ADON) said that the courtyard area was designated as the resident smoking area of the facility and that the residents who smoked were supervised by staff in the courtyard during scheduled smoking times. [...]