Cambridge Rehabilitation & Nursing Center

Inspectors wroteBased on observations, record review, and interviews, the facility failed to ensure staff stored drugs and biologicals in accordance with State and Federal laws. Specifically, the facility failed to ensure that two of two medication room refrigerators were maintained at an appropriate temperature for medication storage.

Inspectors wroteBased on observation and interview, the facility failed to ensure food is stored in accordance with professional standards of food safety and sanitation to prevent the spread of pathogens, which could result in foodborne illness for the residents. Specifically, the facility failed to ensure available food was not expired or showing signs of decompensation, and that food was dated and stored appropriately in the main kitchen refrigerator second-floor kitchenette.

Inspectors wroteBased on observation, record review and interviews, the facility failed to ensure that one Resident (#52) was free from significant medication errors out of a total sample of 18 residents. Specifically, for Resident #52, nursing staff failed to administer scheduled two units of Lispro insulin, and failed to administer 24 units of Insulin Glargine in accordance with the physician's order.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure staff implemented infection control practices to decrease the risk of infection and contamination for three Residents (#59, #6 and #49) out of a total of 18 sampled residents. Specifically:1. The facility failed to ensure staff implemented Enhanced Barrier Precautions (EBP) for Resident #59 and Resident #6.2. For Resident #49 the facility failed to a. change and label oxygen and nebulizer tubing as indicated in the physician's orders and b. properly store a Bi-level positive airway pressure (BiPAP, a noninvasive ventilation device that helps patients breathe by delivering two levels of air pressure: higher during inhalation and lower during exhalation) mask.

Inspectors wroteBased on observation and interview, the facility failed to store food in accordance with professional standards for food service safety. Specifically, the facility failed to ensure that resident food and supplemental drinks were dated in two out of two unit kitchenettes.

Inspectors wroteBased on observation, record review, and interview, the facility failed to accurately document in the medical record for one Resident (#24), out of 33 total sampled residents. Specifically, the facility failed to ensure the nurses accurately documented that Resident #24's insulin lispro (an injectable hormone that lowers the level sugar in the blood) was administered.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure one Resident's (#74) personal care choices were honored, out of a total sample of 33 residents. Specifically, the facility failed to provide showers for Resident #74 per his/her request and preference.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide treatment and care in accordance with professional standards of practice for one Resident (#33), out of a total sample of 33 residents. Specifically, the facility failed to initiate a referral to provide Resident #33 with occupational therapy (OT) services for the treatment of his/her upper extremity contractures as recommended by the Nurse Practitioner (NP).

Inspectors wroteBased on observation and interviews, the facility failed to ensure staff stored drugs and biologicals in accordance with State and Federal laws. Specifically, the facility failed to ensure medications were dated once opened according to manufacturer's guidelines in one of two medication carts observed.

Inspectors wroteBased on observation, policy review and interview, the facility failed to ensure staff stored all drugs and biologicals in accordance with accepted professional standards of practice. Specifically, the facility failed to properly secure medication/treatment carts on two of two units. Findings Include: Review of facility policy titled Storage- Labeling- Maintenance of Medications, dated 11/8/22, indicated the following: -Medications and biologicals are stored safely, securely, and properly, following manufacturer's recommendations or those of the supplier. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel or staff members lawfully authorized to administer medications. -1. All drugs and biologicals are to be stored in the locked designated cabinets for this purpose and shall be stored under proper temperature controls. [...]

Inspectors wroteBased on record review, policy review and interviews, the facility failed to implement their abuse prohibition policy for one Resident (#69) out of a total sample of 19 residents. Specifically, for Resident #69, the facility failed to ensure nursing immediately reported an allegation of potential abuse (bruise of unknown origin) to the Director of Nursing or Administrator, as required.

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure care plans were reviewed with the interdisciplinary team (IDT) as required for one Resident (#16), out of a total sample of 19 residents. Specifically, the facility failed to revise and update Resident #16's Activities of Daily Living (ADL) care plan.

Inspectors wroteBased on observations, record review and interviews, the facility failed to meet professional standards of quality for one Resident (#50) out of a total sample of 19 residents. Specifically, for Resident #50, the facility failed to follow physician's orders to apply offloading booties to bilateral heels while in bed.

Inspectors wroteBased on observation, record review, and interview, the facility failed to maintain professional standards in the managing and care for urinary catheter devices for one Resident (#28) out of a total sample of 19 Residents. Specifically, the facility staff failed to ensure the correct size suprapubic indwelling urinary catheter (a flexible tube that passes through the abdomen and into the bladder to drain urine) was in place for Resident #28 as ordered by the physician.

Inspectors wroteBased on observation, record review, policy review and interview the facility failed to ensure staff provided appropriate care and services for one Resident (#38) with a Gastrostomy tube (G-tube: a tube that is placed directly into the stomach through an abdominal incision for administration of nutrition, fluids, and medication), out of a total of 19 sampled residents. Specifically, the amount of tube feeding infused did not correspond with the rate of infusion and the hours infused as ordered by the physician for Resident #38.

Inspectors wroteBased on observation, policy review, record review and interview the facility failed to provide necessary respiratory care consistent with professional standards of practice for one Resident (#3) out of a total sample of 19 residents. Specifically, the facility failed to implement Resident #3's physician ordered oxygen flow rate.

Inspectors wroteBased on observation, interviews, and policy review, the facility failed to ensure transmission-based precautions were followed to prevent the spread of infections. Specifically, the facility failed to ensure a nurse appropriately donned (put on) a precaution gown while caring for a Resident on enhanced barrier precautions (EBP).

Inspectors wroteBased on record review and interviews for one Resident (#3) out of a total sample of 19 residents, the facility failed to ensure staff adequately identified a significant change in Resident's status and complete a comprehensive Significant Change of Status Assessment Minimum Data Set (MDS) as required. Specifically, the facility failed to identify and complete a Significant Change of Status MDS when Resident #3 experienced significant weight loss and a decline in his/her ability to transfer in and out of bed.