Blaire House of Worcester

Inspectors wroteBased on observation, interview, and record review, the facility failed to establish an infection prevention and control program (IPCP) to identify and prevent the potential spread of communicable diseases for 14 Residents (#55, #21, #51, #3, #23, #38, #60, #41, #12, #5, #31, #6, #39, #57), out of a total sample of 17 Residents. Specifically, the facility failed to:1. For Resident #55, identify Covid-19 infection when the Resident was exhibiting symptoms of a respiratory infection.2. For Resident #21, to appropriately disinfect a shared hallway bathroom after use when the Resident who used the shared bathroom tested positive for Covid-19.3. ensure staff performed proper hand hygiene and donned PPE (Personal Protective Equipment) upon entering and exiting Resident rooms when posted signage indicated it was required.4. [...]

Inspectors wroteBased on interview and record review, the facility failed to complete a performance review of every Certified Nurse Aide (CNA) at least once every 12 months, for five Certified Nurse Aides (#4, #5, #6, #7, and #8), out of five total records reviewed. Specifically, the facility failed to ensure that annual performance reviews to identify any areas of weakness were completed every 12 months, with regular in-service education provided based on the outcome of those performance reviews.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide specialized rehabilitative services consistent with the comprehensive plan of care for one Resident (#9) out of a total sample of 17 residents. Specifically, for Resident #9, the facility failed to ensure that lateral supports were implemented on the Resident's wheelchair as recommended by the Occupational Therapist (OT) and ordered by the Physician to ensure appropriate positioning, placing the Resident at potential risk for poor positioning, accidents related to falls, skin conditions, and pain.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care and services consistent with professional standards of practice for wound care for one Resident (#5), of two applicable residents with pressure ulcers, out of a total sample of 17 residents. Specifically, for Resident #5, the facility staff failed to:-adhere to the Physician's orders when completing dressing changes for the Resident's Stage 3 Pressure Ulcer, right hip pressure wound, and left elbow skin tear.-implement infection control practices during the Resident's dressing changes to prevent the potential for infection and/or deterioration of the wounds.

Inspectors wroteBased on interview, observation and record review, the facility failed to ensure that the appropriate competencies related to wound care services were completed for one Licensed Nurse (Nurse #5) and one Certified Nursing Assistant (CNA #3), out of 5 staff records reviewed. Specifically, the facility failed to provide documentation that Nurse #5 and CNA #3 had completed the appropriate nursing competencies for wound care and infection control practices.

Inspectors wroteBased on observations, and interview, the facility failed to ensure that all drugs and biologicals were stored in accordance with accepted professional standards of practice on one out of one nurses station. Specifically, the facility to properly secure topical medications that were stored under the desk at the nurses station and was easily accessible to residents or staff.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that complete and accurate medical records were maintained for two Residents (#1 and #9), out of a total sample of 17 residents. Specifically, the facility failed to: 1. For Resident #1, ensure documentation relative to residuals (the amount of fluid that remains in the stomach between feedings when a person is fed through a gastrostomy tube [G-tube: tube inserted directly into the stomach to provide fluid and nutrition when it cannot be taken orally]) checks were accurately recorded in the medical record for the Resident with a history of Aspiration Pneumonia, putting the Resident at risk for complications relative to his/her G-tube.2. [...]

Inspectors wroteBased on interviews and records reviewed, for one of three sampled residents (Resident #1) who was alert, disoriented, unable to make his/her needs known and was dependent on staff for transfers between surfaces, dressing and hygiene, the Facility failed to ensure Resident #1 was free from the use of physical restraint when, on 9/24/24 around 7:20 A.M., the Scheduler and the Activity Director observed Resident #1, who was seated in a wheelchair at a table in the dayroom with a gait belt around him/her that was also wrapped around the back of the wheelchair. The gait belt was clasped closed behind the wheelchair, unable to be removed or unlocked by Resident #1 and therefore restraining his/her ability to get up, if desired.

Inspectors wroteBased on interview and record review, the facility failed to ensure documentation was available to show that Nurse Aide registry checks were completed for three Staff Members (#1, #2, and #3), out of five staff members personnel files reviewed. Specifically the facility failed to provide documentation that showed Nurse Aide registry checks were completed for screening of Staff Members #1, #2, and #3, prior to the staff members working with residents in the facility.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to ensure that infection surveillance was implemented for skin infections requiring medical intervention for eight Residents (#9, #8, #52 #2, #45, #59, #20, and #61) out of a total sample of 20 residents. Specifically, the facility failed to track and trend skin disorders in order to assess/evaluate rashes that developed for Resident's (#9, #8, #52 #2, #45, #59, #20, and #61), and to implement strategies to minimize the potential risk of transmission of infections.

Inspectors wroteBased on interview, record and policy review, the facility failed to offer Pneumococcal Vaccinations as recommended for three Residents (#42, #56, and #14) out of five applicable Residents, out of a total sample of 20 residents, putting the Residents at risk for developing facility acquired Pneumonia. Specifically, the facility failed to ensure that Pneumococcal Vaccinations were offered, received, or declined to Resident's #42, #56 and #14 per Physician's orders and after obtaining consent from the Residents and/or their Representatives.

Inspectors wroteBased on records reviewed and interviews for one of three sampled residents (Resident #1) who required the use of a Hoyer lift (mechanical lift system used to transfer a medically dependent person from point A to point B) with the assistance of two staff members for transfers from bed to chair, the Facility failed to ensure he/she was provided with the necessary assistance during a Hoyer lift transfer. On 12/22/23, prior to attempting to transfer Resident #1 by the Hoyer lift, the two certified nurse aides (CNA's) had not checked to see if the lower straps of the Hoyer lift sling/pad were properly connected to the Hoyer, and as they started to raise Resident #1 up, he/she slid out of the sling/pad, fell to the floor and hit his/her head. [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure that its staff implemented a plan of care for one Resident (#12), out of a total sample of 15 residents. Specifically, the facility failed to implement a Physician's order and care plan intervention for the use of an AFO (Ankle-Foot Orthoses - an orthopedic appliance, brace or splint devised to control, limit, or assist foot and ankle motion and provide leg support).

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure that its staff provided an environment that remained as free of accident hazards as possible and utilized assistive devices to prevent accidents for one Resident (#34), out of a total sample of 15 residents. Specifically, the facility staff failed to utilize a mechanical lift for transferring Resident #34 as ordered by the Physician and according to the plan of care.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure its staff provided adequate nutritional and hydration services, according to their plan of care, for one Resident (#51), out of a total sample of 15 residents. Specifically, for Resident #51, who was identified as a nutritional risk and had an unplanned weight loss of greater than 5%, the facility staff failed to: 1) offer a breakfast and lunch meal on 3/7/23 2) implement weekly weight monitoring 3) adequately implement an order for fluid intake to maintain proper hydration and health and notify the Physician when that order had not been implemented, and 4) Notify the responsible party or family of the Resident's significant unplanned weight loss

Inspectors wroteBased on record review and interview, the facility failed to ensure its staff provided a Pneumococcal (serious infection caused by bacteria called Streptococcus pneumoniae, or pneumococcus) Vaccination, according to Centers for Disease Control and Prevention (CDC) recommendations, for one Resident (#12) out of five applicable sampled residents. Specifically, the facility failed to ensure its staff provided the Resident with one dose of Pneumococcal Vaccine, when informed written consent had been obtained for the vaccine and the Resident was due for the dose to be up to date with his/her pneumococcal vaccine status, based on CDC recommendations.

Inspectors wroteBased on record review and interview, the facility failed to ensure its staff completed Minimum Data Set (MDS) assessment timely for one Resident (#46), out of a total sample of 15 residents. Specifically, the facility failed to ensure its staff completed the Entry Tracking Record within seven days of the Resident's re-entry to the facility, as required.