Agawam East Rehab and Nursing

Inspectors wroteBased on records reviewed and interviews for three of three sampled residents (Resident #1, #2, and #3), the facility failed to ensure that a copy of their transfer discharge notifications were provided to the Office of the State Long Term Care Ombudsman, as required.

Inspectors wroteBased on records reviewed and interviews for one of three sampled residents (Resident #1), who had an invoked Health Care Proxy (HCP), the facility failed to ensure they involved his/her Health Care Agent (HCA) in developing a discharge plan and failed to follow through with a referral to the appropriate home care agency.

Inspectors wroteBased on records reviewed and interviews for one of three sampled residents (Resident #1), the facility failed to ensure they maintained a complete and accurate medical record when Nursing and Certified Nurse Aide (CNA) documentation related to skin integrity was either incomplete and/or inaccurate.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that activities of daily living (ADLs) were performed for one Resident (#4) out of a total sample of 19 residents. Specifically, the facility failed to provide assistance with removing facial hair for Resident #4, when the Resident was dependent on staff for grooming care and needs.

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide three Residents (#1, #56, and #49) with a dignified dining experience, out of a total sample of 19 residents. Specifically, the facility failed to ensure that: 1. Resident #1 was awake and alert prior to bringing him/her into the dining room during meal service, and provided assistance as required per the Resident's care plan. 2. Resident's #56 and #49 were provided with timely assistance as required per the Resident's care plans.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure that the care plan was reviewed and revised by the interdiciplinary team pertaining to Activities of Daily Living (ADL) for one Resident (#1) out of a total sample of 19 residents. Specifically, for Resident #1, the facility failed to: 1. update the ADL care plan after Resident #1 had documented decline in his/her ability to independently feed him/herself and required maximum assistance more frequently. 2. review and revise the care plan with the input of the interdisciplinary team as required.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that necessary respiratory care and services in accordance with professional standards of practice were in place for one Resident (#54) out of a total sample of 19 residents. Specifically, for Resident #54, the facility failed to ensure that: 1. Physician's orders were in place at the time of admission to address liter flow (LPM - flow of oxygen that is received from an oxygen delivery device), monitoring of respiratory status, and for care and services of oxygen equipment. 2. a person-centered respiratory care plan was created within seven days of the admission Minimum Data Set (MDS) Assessment completion.

Inspectors wroteBased on interview, and record review, the facility failed to ensure the Skilled Nursing Facility Advanced Beneficiary Notice 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 with the required information for two Residents (#47 and #22), out of three applicable residents reviewed. Specifically, the facility failed to issue the SNF ABN notices to Residents #47 and #22, so the Resident/Resident Representative 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.

Inspectors wroteBased on observation and interview, the facility failed to ensure its staff provided a meaningful and engaging activity program for residents on one Unit (B Wing), out of three units observed. Specifically, the facility failed to ensure staff implemented facility sponsored group activities for all residents on the B Wing.

Inspectors wroteBased on observation, interview, and policy review, the facility failed to promote care for residents in a manner and in an environment that maintains or enhances each resident's dignity and respect, while dining, on one Unit (B wing), out of three unit dining rooms observed. Specifically, the facility failed to ensure staff engaged with two residents, in a dignified and respectful manner, while they provided assistance with eating.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure one Resident (#54), out of a total sample of 19 residents, received services in the facility with reasonable accommodation. Specifically, Resident #54 did not have access to a call light which he/she was able to effectively use.

Inspectors wroteBased on observation, record review, and interview, the facility failed to implement a facility policy relative to abuse for one Resident (#55), out of a total sample of 19 residents. Specifically, the facility failed to identify, report, and investigate bruises of an unknown origin for Resident #55.

Inspectors wroteBased on record review, policy review, and interview, the facility failed to implement the facility's policy relative to abuse reporting for an incident. Specifically, the facility failed to report a resident-to-resident altercation, involving two Residents (#83 and #90), immediately but not later than two hours after the altercation occurred.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure staff labeled and dated nasal cannula tubing (tubing that delivers Oxygen from an oxygen concentrator to a patient) to identify when it was last changed for one Resident (#24), out of a total sample of 19 residents.

Inspectors wroteBased on observation and interview, the facility failed to ensure there was enough staff available to timely assist dependent residents with meals on one Unit (A Wing), out of three units observed. Specifically, for Resident #46, who was dependent for meals and who resided on A Wing, the facility failed to ensure there was enough staff to assist him/her timely with the breakfast meal.

Inspectors wroteBased on interview and record review, the facility failed to ensure Medication Regimen Reviews (MRR) were acted upon as recommended by the Pharmacist and/or Physician for two Residents (#35 and #9), out of 19 residents sampled. Specifically, the facility failed: 1. For Resident #35, to implement the recommendations from the Pharmacist that the Physician agreed upon implementing; and 2. For Resident #9, to ensure the Physician reviewed and responded to the Pharmacist's recommendations.

Inspectors wroteBased on interview and record review, the facility failed to ensure staff coded Minimum Data Set (MDS) assessments accurately for two Residents (#1 and #2), out of a total sample of 19 residents. Specifically, for Residents #1 and #2, the facility failed to correctly code the use of Clopidogrel Bisulfate (an antiplatelet medication-Brand name Plavix-a medication that reduces the ability of the platelets to stick together to reduce blood clots from forming).