Adviniacare Newburyport

Inspectors wroteBased on record review and interview the facility failed to ensure treatment and care was provided in accordance with professional standards of practice for one Resident (#87) out of a total sample of 21 residents. Specifically, for Resident #87 the facility failed to ensure timely treatment was provided when the Resident experienced a change in condition following a fall, that resulted in a fractured femur.

Inspectors wroteBased on record review and interview, the facility failed to follow up on a significant weight change for two Residents (#21 and #98) out of a total sample of 21 residents. Specifically, the facility failed to assess two Residents with significant weight changes in a timely manner, as indicated in the facility policy.

Inspectors wroteBased on record review, and interview, the facility failed to provide care and services in accordance with professional standards of practice for one Resident (#109) out of a total sample of 21 residents, who required a vascular access device (device that provides access to the veins for the delivery of medications or fluids). Specifically, the facility failed to provide care and maintenance of Resident #109's midline catheter (a flexible tube inserted through a peripheral vein above the elbow that ends just below the axilla [armpit]) and monitor for catheter related complications.

Inspectors wroteBased on observations and interview the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. Specifically, the facility failed to maintain Contact Precautions while administering medication to a resident.

Inspectors wroteBased on observation, record review, policy review and interview, the facility failed to provide adequate supervision for one Resident (#49) out of a total sample of 27 Residents, and ensure an environment free from accidents and hazards in two resident rooms. Specifically, the facility failed to: 1. Ensure that Resident #49 was not left unattended in the dining room, subsequently the Resident sustained a fall resulting in nasal fracture. 2. Properly store oxygen cylinders in an upright and firmly secured manner on two out of three units. Findings Include: Review of the facility policy titled Accidents and Incidents, revised October 2022, indicated, but was not limited to, the following: [...]

Inspectors wroteBased on interviews and record review, the facility failed to ensure that sufficient staffing levels were maintained to safely and adequately meet each resident's personal care needs.

Inspectors wroteBased on observation and interview the facility failed to store and handle food in accordance with professional standards for food service safety. Specifically, the facility failed to ensure food was labeled in the main kitchen and on the unit kitchenettes and that staff did not contaminate ready to eat food during service.

Inspectors wroteBased on record review and interview, the facility failed to ensure Minimum Data Set (MDS) Assessments were accurately completed to reflect the status of one Resident (#25) out of a total sample of 27 residents. Specifically, the facility failed to document that Resident #25 is receiving antipsychotic medication. Findings Include: Resident #25 was admitted to the facility in September 2022 with diagnoses that include Major Depressive Disorder and Anxiety Disorder. Review of Resident #25's most recent Minimum Data Set (MDS) Assessment, dated 8/16/24, indicated a Brief Interview for Mental Status (BIMS) score of 11 out of 15, indicating that Resident #25 has moderate cognitive impairment. The MDS failed to indicate receiving antipsychotic medication. Review of Resident #25's physician's orders indicated the following order dated 7/18/24: [...]

Inspectors wroteBased on record review and interviews, the facility failed to develop a comprehensive person-centered care plan for two Residents (#36 and #18) out of a sample of 27 residents. Specifically, 1(a) For Resident #36, the facility failed to develop comprehensive person-centered care plans for a history of alcohol abuse and, (b) a history of suicidal ideation. 2. For Resident #18, the facility failed to develop a comprehensive person-centered care plan for a history of alcohol abuse on admission.

Inspectors wroteBased on observations, interview, and record review, the facility failed to meet professional standards of quality for one Resident (#52), out of a total sample of 27 residents. Specifically for Resident #52, the facility failed to assess the diet texture for Resident #52 after swallowing incident.

Inspectors wroteBased on observations, record review, and interviews, the facility failed to provide supervision with meals for two Residents, (#34 and #52) out of a total sample of 27 residents.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure it was free from a medication error rate of greater than 5% when one out of two nurses observed made two errors out of 25 opportunities, resulting in a medication error rate of 8%. Those errors impacted one Resident (#52), out of two residents observed. Specifically, for Resident #52, Nurse #2 failed to administer the correct doses of his/her medications. Findings Include: Review of facility policy titled Medication Administration, dated as revised 10/2022 indicated the following: -3. Medications must be administered in accordance with the orders, including any required time frame. -6. The medications nurse shall assure that the correct medication is administered by checking the physician's order and the medication label. [...]

Inspectors wroteBased on record reviewed and interviews the facility failed to ensure nursing maintained an accurate medical record for one Resident (#49) out of a sample of 27 residents. Specifically, for Resident #49 nursing documented they obtained blood pressure from his/her left arm when they did not.

Inspectors wroteBased on records reviewed and interviews for one of three sampled residents (Resident #3), who required extensive assistance of two staff members for transfers, the Facility failed to ensure staff implemented and followed his/her plan of care, when on 01/30/24, Certified Nurse Aide (CNA) #2 transferred Resident #3 by herself without another staff member present to assist and Resident #3 ended up on the floor. Findings Include: The Facility Policy titled, Care Plan-Comprehensive, dated as last revised 10/22/22, indicated that a comprehensive person-centered Care Plan that includes measurable objectives, and timetables to meet the resident's physical, psychosocial, and functional needs is developed and implemented for each resident. [...]

Inspectors wroteBased on records reviewed and interviews for one of three sampled residents (Resident #1), who during the provision of personal care on the evening shift on 11/09/23 by a staff member (later identified as Certified Nurse Aide (CNA) #3) experienced a fall out of bed when his/her legs slid off the bed, causing his/her lower torso to slide off the bed and him/her landing on both knees on the floor, the facility failed to ensure he/she was provided with quality of care that met acceptable standards of practice, when CNA #3 picked Resident #1's lower torso/legs up off the floor and placed him/her back into bed, however CNA #3 had not notified his/her nurse or anyone one else in nursing about the fall. [...]

Inspectors wroteBased on records reviewed and interviews for one of three sampled residents (Resident #3), who required extensive assistance of two staff members for transfers, the Facility failed to ensure Resident #1 was provided the necessary level of assistance to maintain his/her safety to prevent an incident or accident, when on 01/30/24 he/she was transferred by Certified Nurse Aide (CNA) #2 without the assistance of another staff member and without the use of a gait belt, per Facility Policy, and he/she sustained a fall. Findings Include: The Facility Policy titled, Fall Prevention and Management, dated as revised 01/2023, indicated that the interdisciplinary team identifies and implements appropriate interventions to reduce the risk of falls or injuries while maximizing dignity and independence. [...]

Inspectors wroteBased on records reviewed and interviews for one of three sampled residents (Resident #1), who was observed with a right swollen leg, complained of pain, and reported to staff that he/she had fallen out of bed, the Facility failed to ensure the Nurse Practitioner's STAT x-ray order was sent to the Radiology Company in a timely manner. Findings Include: The Facility Policy titled Diagnostic Services, dated as revised 01/2023, indicated clinical laboratory and radiology services shall be available twenty-four hours a day, seven days per week, for all residents onsite. The Policy indicated all diagnostic testing procedures shall be performed as ordered by a Physician or licensed independent Practitioner. [...]

Inspectors wrote4. For Resident #63, the facility failed to complete post fall assessments and implement interventions after a fall. Review of the facility policy titled, Fall Prevention, dated 1/23. Indicated the following: * fall risk assessments will be completed for all residents initially on admission, readmission, quarterly, significant change and after an identified fall. Resident #63 was admitted to the facility in January 2023 with diagnoses including history of falling, Alzheimer's disease. Review of Resident #63 most recent Minimum Data Set (MDS) dated [DATE] indicated the Resident has severe cognition and requires limited assist for personal care. Review of Resident #63's medical record indicated the Resident had a fall on the following dates: 6/15/23, 7/14/23, 9/8/23 and 9/27/23. [...]

Inspectors wroteBased on document review and staff interviews, the facility failed to ensure that they implemented and maintained an effective training program for all new hires, consistent with their expected roles, and failed to determine the amount and type of training necessary based on the facility assessment. Specifically, 22 out of 22 new staff hired in 2023 to date, were not provided training, therefore, failing to ensure competent, safe, and effective resident care.

Inspectors wroteBased on observations, interviews and policy review the facility failed to follow the correct therapeutic menu (mechanical soft) for four Residents (#62, #53, #50 and #4) out of a total sample of 34 residents. Specifically, 1. Resident #62, who has a known history of choking twice at the facility, requiring the Heimlich maneuver and emergent transfer to the hosital, was observed to be served the incorrect diet, placing the Resident at serious risk of a repeated choking incident and/or death, 2. Resident #53 who has a long-standing history of dysphagia (difficulty chewing and swallowing), was served food not on his/her recommended diet, and 3. two Residents (#50 and #4) were provided a meal not in accordance with the physician's order.

Inspectors wroteBased on observations and interviews the facility failed to ensure it was administered in a manner that enabled the facility to use its resources effectively to attain the highest practicable physical, mental, and psychosocial well-being of each resident. Specifically, the facility administration failed to ensure orientation, education and training was provided to all staff to provide competent, safe, and effective resident care as well as ensuring the governance and leadership members sustain a sufficient Quality Assurance Performance Improvement (QAPI) program during transitions in leadership and staffing.

Inspectors wroteBased on interview and record review including the Facility Assessment and facility policies, the facility failed to ensure that the governing body provided oversight and accountability for: 1. ensuring education and competencies were completed per Facility Assessment on hire for 22 out of 22 employees hired since January 2023; 2. ensuring quality of care related to the safety and hazards in the facility was maintained for one Resident (#62) out of a total sample of 34; and 3. ensuring the governance and leadership members sustain a sufficient QAPI program during transitions in leadership and staffing. As a result of the governing body's failure, the facility failed to develop a plan to ensure the facility could safely provide the services to meet the needs of the residents as well as implement an effective QAPI program.

Inspectors wroteBased on observation, record review and interview, the facility failed to 1. assist one Resident (#9) with oral care resulting in candidiasis and a mouth sore, 2. failed to ensure Residents ( #133, #35, and #40) were provided the level of assistance required for meals and 3. failed to ensure Residents (#23, #133 and #31), who are dependent for daily care, were provided morning care in care in accordance to their needs, out of a total sample of 34 residents.

Inspectors wroteBased on record review and interview, the facility failed to protect the resident's right to be free from the deprivation of goods and services by staff for one Resident (#9), specifically failing to provide the plan of care for daily denture cleaning, resulting oral candidiasis and a mouth sore, out of a total of 34 residents:

Inspectors wroteBased on observations, policy review and interview the facility failed to ensure 1) medications with short expirations dates, were dated when opened and 2) Medications were not left in resident's room without an assessment 3) a treatment cart was locked and secured while unattended.

Inspectors wroteBased on observation, record review and interview, the facility staff failed to ensure that the dietary staff had sufficient competencies to ensure resident safety and the appropriate diet textures were followed.

Inspectors wroteBased on interview, document review, and policy review, the facility failed to develop, implement, and maintain a Quality Assurance and Performance Improvement (QAPI) program which addressed the full range of care and services, was comprehensive and data-driven, and focused on indicators of outcomes of quality of life, quality of care, and services to residents in the facility. Specifically, the facility failed to: 1) ensure an ongoing QAPI program is implemented and maintained and addressed identified priorities and; 2) ensure the governance and leadership members sustain a QAPI program during transitions in leadership and staffing.

Inspectors wroteBased on interview, document review, and policy review, the facility failed to develop, implement, and maintain a Quality Assurance and Performance Improvement (QAPI) program which addressed the full range of care and services, was comprehensive and data-driven, and focused on indicators of outcomes of quality of life, quality of care, and services to residents in the facility. Specifically, the facility failed to use a systematic approach to determine underlying causes of problems impacting larger systems, develop corrective actions, and monitor effectiveness of its performance improvement activities to ensure improvements are sustained.

Inspectors wroteBased on observation, interview, record and policy review the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. Specifically, the facility failed to: 1) ensure a system was in place for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement based upon the facility assessment; [...]

Inspectors wroteBased on record review, policy review and interview, the facility failed to implement an Antibiotic Stewardship Program to promote and monitor the appropriate use of antibiotics and failed to complete antibiotic usage audit tools (Line Listings), which are used to guide decisions for evaluating antibiotic prescribing patterns in accordance with the Antibiotic Stewardship Program.

Inspectors wroteBased on interview, policy and Facility Assessment review, the facility failed to provide the designated hours for an Infection Preventionist to carry out the necessary responsibilities of facility's Infection Prevention and Control Program according to the facility's policy.

Inspectors wroteBased on interviews and personnel file review, the facility failed to ensure that 22 of 22 new hires in 2023 were educated on Communication in the facility, as outlined in the Facility Assessment.

Inspectors wroteBased on interviews and personnel file review, the facility failed to ensure that 22 of 22 new hires in 2023 were educated on resident rights, resident bill of rights as well as how to ensure resident safety, as outlined in the Facility Assessment.

Inspectors wroteBased on interviews and personnel file review, the facility failed to ensure that 22 of 22 new staff hires in 2023 were educated on abuse, neglect and exploitation training, as outlined in the Facility Assessment.

Inspectors wroteBased on interviews and personnel file review, the facility failed to ensure that 22 of 22 new staff hires in 2023 were educated on the QAPI (Quality Assurance Performance Improvement) process, as outlined in the Facility Assessment.

Inspectors wroteBased on interviews and personnel file review, the facility failed to ensure that 22 of 22 new staff hires in 2023 were educated on Infection Control, as outlined in the Facility Assessment.

Inspectors wroteBased on interviews and personnel file review, the facility failed to ensure that 22 of 22 new staff hires in 2023 were educated in Ethics and Compliance, as outlined in the Facility Assessment.

Inspectors wroteBased on interviews and personnel file review, the facility failed to ensure that 22 of 22 new staff hires in 2023 were educated on Resident Behaviors, as outlined in the Facility Assessment.

Inspectors wroteBased on observations, record review and interviews, the facility failed to 1) provide a dignified dining experience for the residents on 2 of 3 residents units and 2) failed to maintain a dignified experience by using a privacy bag for a Foley catheter drainage bag for 1 Resident (#24) out of a total sample of 34 residents.

Inspectors wroteBased on record review, interviews and policy review, the facility failed to 1) investigate an allegation of abuse for 1 Resident (#33) and 2) investigate bruises of unknown origin for 2 Residents (#36 and #49) and 3) have evidence an allegation of abuse for 1 Resident (#26) was thoroughly investigated. out of a total sample of 34 residents.

Inspectors wroteBased on observation,record review and interview the facility failed to develop care plans for three Residents (#48, #35, and #75), out of a total sample of 34 residents. Specifically, 1. for Resident #48 the facility failed to develop a care plan for the use of psychotropic medications, 2. for Resident #35 the facility failed to develop care plans with person-centered interventions or measurable goals, and 3. the facility failed to develop a dementia care plan with specific interventions for Resident #75. 1. For Resident #48 the facility failed to ensure a person-centered care plan with measurable goals and interventions for the use of psychotropic medication was developed. Resident #48 was admitted to the facility in January 2023 and has diagnoses that include but are not limited to cognitive communication deficit, dysphagia, unspecified dementia, and Parkinson's disease. [...]

Inspectors wroteBased on record review and interview, the facility failed to 1. review the effectiveness of a weight loss supplement and address a significant weight loss in a timely manner for 1 Resident (#73), 2. failed to assess a significant weight loss in a timely manner for 3 Residents (#7, #48, and #63), 3. failed to identify and assess a significant weight gain for 1 Resident (#17), and 4. failed to complete an initial nutrition assessment for 1 Resident (#57), out of a total sample of 34 residents.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure staffing was sufficient to meet the activities of daily living needs for residents on 1 of 3 resident care units (Highport Unit). Subsequently, 3 Residents (#23, #133, #31) were not provided positioning, bathing, and incontinence care and the opportunity to get out of bed.

Inspectors wroteBased on interviews and personnel file review, the facility failed to ensure that 7 of 7 newly hired staff into the Nursing Department in 2023 were assessed for competency, as outlined in the Facility Assessment.

Inspectors wroteBased on observations, record reviews, policy review and interviews, the facility failed to ensure it was free from a medication error rate of greater than 5 percent. Two out of three nurses observed made four errors in 47 opportunities on two of three units resulting in a medication error rate of 8.51%. These errors impacted four Residents (#14, #12, #60 and #17), out of 7 residents observed during medication administration pass.

Inspectors wroteBased on record review, policy review and interview the facility failed for 1 Resident (#48), out of a total sample of 34 residents, that informed consent for the administration of an antidepressant medication, including the risk/benefits of the medication and potential side effects, was obtained from the resident representative.

Inspectors wroteBased on observations, record reviews and interviews, the facility failed provide 1 Resident (#33) the right to choose his/her participation in a group activity out of a total sample of 34 residents.

Inspectors wroteBased on observation, interview, and record review the facility failed to notify the physician of a resident's return to the facility following an emergency room visit for 1 Resident (#55), who was diagnosed with urinary tract infection and initiation of antibiotics, out of a total sample of 34 residents, resulting in the delay of antibiotic treatment for two days.

Inspectors wroteBased on review of the grievance book, interviews and policy review, the facility failed to 1) resolve 3 resident grievances and 2) file a grievance for a lost denture for 1 Resident (#75), out of a total sample of 34 residents.

Inspectors wroteBased on record review, interviews and policy review, the facility failed to report an allegation of abuse to the State Agency for one Resident (#33) out of a total sample of 34 residents.

Inspectors wroteBased on record review and staff interviews, the facility failed to allow 1 Resident (#48) out of 34 sampled residents, to return to the facility following a transfer to the hospital for psychiatric evaluation, failed to document any information to support the basis for discharge despite having been cleared by hospital staff to return, and refused to allow the Resident to return citing that he/she was financially unable to pay for his/her bill.

Inspectors wroteBased on observations, interviews and policy review the facility failed to update and revise the plan of care at the time of the comprehensive quarterly review for three Residents (#62, #24 and #7) when their plan of care changed, out of a total sample of 34 residents. Specifically, 1. for Resident (#62) who has a known history of choking twice at the facility, requiring the Heimlich maneuver, the care plan was not updated to reflect the current level of supervision and assist he/she requires with meals and 2. for Resident #24 the facility failed to revise by not discontinuing a care plan related to urinary incontinence and use of a external urinary collection system, and 3. failed to update and revise the fall care plan for Resident #7 after he/she had a fall resulting in a fracture.

Inspectors wroteBased on observation, record review and interviews, the facility failed to meet professional standards of practice during a medication pass. Specifically, 1. during a medication pass a nurse was observed crushing medications without physician orders for one Resident (#60) out of a total 5 residents observed, 2. the facility failed to ensure for two Residents (#50 and #24) that medication were administered timely and 3. the facility failed to adhere to professional standards of care on one of three resident units (Highport Unit), when staff left before the end of their shift and failed to provide report for the oncoming shift.

Inspectors wroteBased on observation, record review and interview, the facility failed to provide care and services in accordance with physician's orders and wound physician's recommendations for one Resident (#286) out of a total sample of 34 residents. Specifically, the facility failed to perform wound care dressing to the left lower extremity hematoma (front of lower leg) as ordered.

Inspectors wroteBased on observation, record review, policy review and interviews, the facility failed to provide the necessary treatment and services to prevent the development and promote healing of pressure ulcers for three Residents (#286, #17 and #31) out of a total sample of 34 residents.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure 1 Resident (#24) out of a total sample of 34 residents was provided the correct Foley catheter (a Foley catheter is a tube that drains urine from the bladder) in accordance with the medical plan of care. Resident #24 was admitted to the facility in March 2023 and has diagnoses that include but are not limited to neuromuscular dysfunction of the bladder. Review of the Minimum Data Set (MDS) assessments dated 3/20/23, 6/13/23 and 8/24/23 indicated Resident #24 has an indwelling urinary catheter. Further, the MDS dated [DATE] indicated Resident #24 was cognitively intact with a score of 15 out of 15 on the Brief Interview for Mental Status exam and was dependent on staff for all care. [...]

Inspectors wroteBased on observations, record review and interview the facility failed to provide respiratory care services in accordance with professional standards of practice. Specifically the facility failed to 1. follow physician orders for oxygen setting for one Resident (#292), and 2. failed to administer oxygen in accordance with the physician's orders and failed to develop a plan of care for oxygen use for one Resident (#23) out of a total sample of 34 residents.

Inspectors wroteBased on record review and interviews, the facility failed to ensure that one Resident (#37) was seen by a physician every 90 days out of a total sample of 34 residents.

Inspectors wroteBased on record review, policy review and interviews, the facility failed to provide behavioral psychiatric services for one Resident (#48) out of a total sample of 34 residents.

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure staff had appropriate competencies and skill sets to provide nursing and related services to attain the highest practicable psychosocial well-being for one Resident (#48) out of a total sample of 34 residents.

Inspectors wroteBased on record reviews and interviews, the facility failed to provide sufficient and appropriate social services to meet one Resident's (#48) needs out of a total sample of 34 residents.

Inspectors wroteBased on record review and interview, the facility failed to ensure that pharmacy recommendations were reviewed and addressed by the attending physician for one sampled Resident (#297) out of a total of 34 sampled residents.

Inspectors wroteBased on observations, record review, policy review and interviews, the facility 1) failed to ensure a diagnosis was in place for the use of antipsychotic medications for one Resident (#48) and 2) failed to complete an Abnormal Involuntary Movement (AIMS) assessment (a test used monitor for adverse consequences of antipsychotic medication) for one Resident (#75) out of a total sample of 34 residents.

Inspectors wroteBased on record review and interview, the facility failed to ensure that as needed (PRN) orders for psychotropic medications were limited to 14 days and the orders were not renewed unless the attending physician or prescribing practitioner evaluated the Resident for the appropriateness of that medication for two Residents (#297 and #73) and failed to ensure a psychotropic medication was not continued to be administered after a three day trial for one resident (#48), out of a total sample of 34 residents. Findings Include: Review of facility policy titled 'Psychotropic Medication' date revised 10/2022 indicated the following but not limited to: [...]

Inspectors wroteBased on observations, record review, policy review and interviews, the facility failed to provide dental services to replace a missing partial denture for one Resident (#75) out of a total sample of 34 residents.

Inspectors wroteBased on observation, record review and interviews the facility failed to keep an accurate medical record for one Resident (#17) out of a total sample of 34 residents. Specifically, for Resident #17 the facility documented in the Treatment Administration Record (TAR) that ordered treatments were provided that were not.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure Nursing Staffing data was posted daily in a prominent area and readily accessible to residents and visitors as required.