Brookside Rehabilitation and Healthcare Center

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who had an invoked Health Care Proxy (HCP) that had been affirmed by the Courts, the facility failed to ensure it maintained a complete and accurate medical record when there was no copy of the HCP readily available or accessible in his/her medical record.

Inspectors wroteBased on record review, interviews, and observations, the facility failed to maintain a clean and homelike environment for one Resident (#56) and 12 out of 15 rooms observed on two Units ([NAME] and [NAME]) out of two resident units. Specifically, the facility failed to ensure that room of the day deep-cleaning were completed relative to the room of the day cleaning schedule for:-Resident #56's bedroom.-rooms [ROOM NUMBER] on the [NAME] Unit.-Rooms 201, 202, 204, 206, 207, 208, 209, 221, and 224 on the [NAME] Unit.

Inspectors wroteBased on record reviews, and interviews, the facility failed to ensure that two Residents (#11 and #56) of five applicable residents, out of a total sample of 19 residents were free from unnecessary psychotropic medications. Specifically:For Resident #11, the facility failed to ensure a Physican order for PRN antipsychotic medications was limited to 14 days. For Resident #56, the facility failed to ensure a Gradual Dose Reduction (GDR) was attempted related to antidepressant medication use or provide supporting evidence that a GDR attempt was contraindicated.

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide appropriate treatment and services relative to an indwelling urinary catheter (a thin, flexible tube inserted into the bladder to drain urine outside the body) for one Resident (#56) out of a total sample of 19 residents. Specifically, for Resident #56, the facility staff failed to follow the Physician order's relative to the Foley (type of indwelling urinary catheter) catheter size, increasing the Resident's risk for indwelling urinary catheter complications.

Inspectors wroteBased on record reviews, and interviews, the facility failed to provide adequate nutritional care and services for one Resident (#39), out of a total sample of 19 residents. Specifically, the facility failed to appropriately address a significant weight loss when Resident #39 was identified as having a greater than 5 percent (%) weight loss in one month and no re-weight was completed as required.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide respiratory care and services in accordance with professional standards of practice for one Resident (#29), out of a total sample of 19 residents. Specifically, for Resident #29, the facility failed to ensure that Physician orders for oxygen use were in place when the Resident was being administered oxygen.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to provide care and services consistent with professional standards of practice for one Resident (#54), out of one applicable resident receiving dialysis (process that filters waste and fluids from the blood when the kidneys are unable to work adequately) services, out of a total sample of 19 residents. [...]

Inspectors wroteBased on observations, and interviews, the facility failed to ensure proper sanitation and food storage practices to prevent the potential spread of foodborne illnesses on two kitchenettes ([NAME] Unit and [NAME] Unit) out of two kitchenettes observed. Specifically, the facility failed to ensure that the [NAME] Unit and [NAME] Unit kitchenette refrigerators: -had food items that were dated to ensure proper rotation by expiration dates.-were kept clean and sanitized on a scheduled basis.-had food/drink items that were not expired or past the perish dates.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to maintain clinical records in accordance with professional standards of practice relative to accurate documentation for two Residents (#45 and #56) out of a total sample of 19 residents. Specifically, the facility failed to: 1. For Resident #45, document the PRN (as needed) administration of Tramadol (opioid analgesic - controlled medication used to treat pain, having the potential for abuse and addiction), and its effectiveness, on the Resident's Medication Administration Record (MAR) when a PRN dose of Tramadol was administered to the Resident. 2. For Resident #56, the facility failed to complete accurate documentation relative to changing the Resident's Foley (type of indwelling urinary catheter) catheter size, increasing the Resident's risk for indwelling urinary catheter complications.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to implement an infection control program designed to help prevent the potential transmission of communicable diseases and infections within the facility for one Resident (#6) out of a total sample of 19 residents. Specifically, the facility staff failed to disinfect a multi-use Glucometer (machine used to test a resident's blood for blood sugar levels) after use on a resident, prior to placing the same equipment back into the medication cart.

Inspectors wroteBased on record review, and interview, the facility failed to assess the Pneumococcal Vaccine status, and/or administer Pneumococcal vaccinations as consented to by two Residents (#11 and #9), of five applicable residents, out of a total sample of 19 residents. Specifically, 1. For Resident #11, the facility failed to assess for Pneumococcal consent or declination for the Resident and to provide education relative to Pneumococcal vaccination at the time of admission. 2. For Resident #9, the facility failed to obtain a Physician's order and administer PCV 20 (Pneumococcal Conjugate Vaccine/ Prevnar 20: vaccine used to protect against 20 types of pneumococcal bacteria that commonly cause serious infections) at the time of admission when the Resident consented to PCV20 vaccination.

Inspectors wroteBased on record reviews, and interviews, the facility failed to complete Comprehensive Minimum Data Set (MDS) Assessments that accurately reflected the status of three Residents (#11, #45, and #54) out of a total sample of 19 residents, for care planning and care delivery. Specifically, 1. For Resident #11, the facility failed to accurately code diuretic medications when the Resident was prescribed and received diuretic medication. 2. For Resident #45, the facility failed to accurately code the MDS Assessment relative to the use of anticoagulant medication when anticoagulant medication had not been ordered and administered to the Resident.3. For Resident #11, the facility failed to accurately complete the MDS assessment relative to the use of tobacco products, when the Resident was an identified smoker.4. [...]

Inspectors wroteBased on record review and interview, the facility failed to conduct interdisciplinary care plan meetings after Minimum Data Set (MDS) assessments were completed, and also failed to involve the Resident and/or Resident Representative in the care planning process for four Residents (#2, #67, #3, and #60) out of a total sample of 18 residents. Specifically, the facility failed to: 1. For Resident #2, provide evidence that the Resident and/or their invoked HCP had participated in the care planning process and that Interdisciplinary Team (IDT) care plan meetings were held for the Resident in 2024 following the MDS assessments completed on 1/9/24 and 4/9/24. 2. For Resident #67, provide evidence that the Resident and/or the Resident's Representative participated in the care planning process, or that a care plan meeting was held with the IDT following the MDS assessment completed on 1/24/24. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure that a Resident's choices were honored when requested by his/her Resident Representative for one Resident (#14) out of a total sample of 18 residents. Specifically, the facility failed to evaluate whether the Resident Representatives' request for Resident #14 to receive double meal portions was appropriate for him/her, and implement the request if it was determined to be appropriate for the Resident indicated by family as always being hungry.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that care plans were developed and implemented accordingly for one Resident (#14) out of a total sample of 18 residents. Specifically, -For Resident #14 the facility failed to develop a care plan related to the Resident's behavior of eating nonfood items and topical medications.

Inspectors wroteBased on observation, interview, policy and record review, the facility failed to provide nutrition care and services that meet professional standards of practice in identifying and preventing a significant weight loss for one Resident (#65) recieving artificial nutrition via a Jejunostomy tube (J-Tube: a feeding tube that passes directly into the small intestine), out of a total sample of 18 Residents. Specifically, the facility staff failed to: -appropriately implement, monitor and evaluate weekly weights as ordered for the Resident, and reassess Resident refusal to be weighed. -assess tube feeds recommendations made by the Registered Dietitian (RD), and refer and/or offer alternative options when the Resident was unable to tolerate increased tube feeds and calorie goals. Findings Include: [...]

Inspectors wroteBased on observation, interview, policy and record review, the facility failed to provide respiratory care and services consistent with professional standards of practice for two Residents (#272 and #3), out of 3 applicable residents, out a total sample of 18 residents. Specifically, the facility staff failed to: [...]

Inspectors wroteBased on interview, policy and record review, the facility failed to provide services consistent with professional stands of practice related to hemodialysis (a procedure to remove waste products and fluid from the blood by passing it through a special machine, necessary when the kidneys are unable to filter the blood) were provided for one Resident (#17), out of a total sample of 18 residents. Specifically, the facility failed to monitor Resident #17's AV (Arterio-Venous) Fistula (dialysis access site) for signs and symptoms of patency and infection.

Inspectors wroteBased on interview and record review, the facility failed to ensure that medications were stored safely and remained inaccessible to one Resident (#14) out of a total of 18 sampled residents. Specifically, the facility failed to: -ensure that [NAME] Lotion (an anti-itch topical [applied to the skin] medication) was safely stored, and locked up out of reach for Resident #14, resulting in him/her ingesting the medication and requiring hospitalization. -ensure that house barrier cream (a skin protectant cream) was safely stored and not easily accessible to Resident #14, resulting in him/her ingesting the medication and requiring monitoring for possible gastrointestinal upset.

Inspectors wroteBased on interview and record review, the facility failed to maintain complete and accurate medical records for one Resident (#14) out of 18 residents sampled. Specifically, for Resident #14, the facility staff failed to accurately update the Resident's Physician's orders to accurately match the Massachusetts Medical Order for Life-Sustaining Treatment (MOLST- form that indicates a person's medical wishes regarding life sustaining treatments).

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to adhere to infection control standards for one Resident (#272) out of a total sample of 18 residents, putting the Resident at risk for contamination and the spread of infection. Specifically, the facility staff failed to: -identify the need for Enhanced Barrier Precautions (EBP) for Resident #272, when the Resident was indicated with indwelling medical devices of tracheostomy (an opening surgically created through the neck into the trachea [windpipe] to allow direct access to the breathing tube) and gastrostomy tube (G -Tube: a tube that is placed directly into the stomach through an abdominal wall incision for the enteral [passing through the gastrointestinal tract] administration of food, fluids, and medication). [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that the Minimum Data Set (MDS) Assessments were accurately coded for two Residents (#22 and #29), out of a total sample of 18 residents. Specifically, the facility failed to: 1. For Resident #22, accurately code the MDS to reflect pressure ulcers as present on re-admission to the facility and not facility acquired. 2. For Resident #29, accurately code the MDS to reflect the use of IV (intravenous- within a vein) hydration.

Inspectors wroteBased on observations, record review, document review and interview, the facility failed to ensure its staff provided adequate assistance devices to prevent accidents for one Resident (#42), out of three discharged sampled Residents and failure to ensure the environment remained as free of accidents as possible. Specifically, 1) the facility failed to ensure that Resident #42's wheelchair foot pedals were functioning properly to help prevent major injuries from one of two falls the resident sustained, and 2) the staff failed to monitor the temperatures of foods that had been reheated in the microwave and provided to residents.

Inspectors wroteBased on document review, and interview, the facility failed to ensure its staff reviewed and updated the Facility Assessment yearly (missing two years), to determine what resources are necessary to competently care for its residents during both day-to-day operations and emergencies.

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure that its staff provided Podiatry care for one Resident (#20) out of 15 sampled residents. Specifically, lack of appropriate foot care leading to poor foot health and the development of a pressure ulcer on the Resident's left index toe.

Inspectors wroteBased on interview, the facility failed to ensure that all Certified Nurses Aides (CNA) were offered the 12 hours of in-service education training as required annually.

Inspectors wroteBased on record review, and interview, the facility failed to ensure its staff provided care and services related to Substance Use Disorder (SUD- a mental disorder that affects a person's brain and behavior, leading to a person's inability to control their use of substances such as legal or illegal drugs, alcohol, or medications. Symptoms can range from moderate to severe, with addiction being the most severe form of SUDs) for one Resident (#18) out of 15 sampled residents.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure its staff maintained a medication error rate less than 5%. Specifically, two out of three nurses observed failed to administer medications as ordered, for one Resident (#7). The medication error rate was calculated at 8% with 25 opportunities for error.

Inspectors wroteBased on document review and interview, the facility failed to ensure that its staff notified Residents, families, or Resident Representatives of COVID-19 positive staff cases in the facility by 5:00 P.M. the next calendar day during the month of October 2022, as required.

Inspectors wroteBased on record review, policy review and interview the facility failed to ensure that its staff maintained education regarding the potential benefits and risks of the COVID-19 vaccination for two Residents (#50 and #51) out of five sampled residents. Specifically, the facility failed to ensure that its staff provided evidence of offering the COVID-19 vaccination and that the Residents refused.