East Longmeadow Skilled Nursing Center

Inspectors wroteBased on observation, and interview, the facility failed to ensure infection control practices for cleaning medical equipment was maintained to prevent the potential spread of infection within the facility on two Units (100s and 400s), out of four units observed. Specifically, 1. On the 100s Unit, the facility failed to ensure staff cleaned and disinfected the portable vital signs machine (medical device that takes temperature, blood pressure, and blood oxygen readings) in between resident use. 2. On the 400s Unit, the facility failed to ensure that staff disinfected the glucometer machine while performing finger sticks, and portable vital signs machine in between residents, increasing the risk for the potential spread of infection between residents.

Inspectors wroteBased on interview and record review the facility failed to ensure the resident and/or their resident representative was fully informed about treatments being provided to one Resident (#5) out of a total sample of 26 residents. Specifically, for Resident #5, the facility failed to ensure the Resident's activated Health Care Proxy (HCP - representative designated by a resident to make decisions for him/her when he/she is no longer able to do so) was informed of the current dose and frequency of an antipsychotic medication (Seroquel) and an antidepressant medication (Zoloft) that were actively being administered to the Resident.

Inspectors wroteBased on interviews, and record reviews, the facility failed to ensure that as needed (PRN) orders for antipsychotic medications were limited to 14 days for one Resident (#7), of five applicable residents reviewed for unnecessary medications, out of a total sample of 26 residents. Specifically, for Resident #7, the facility failed to ensure that Physician's orders for PRN Seroquel and Haldol medications were limited to 14 days.

Inspectors wroteBased on interview and record review, the facility failed to ensure that a Significant Change in Status Minimum Data Set [MDS] Assessment (SCSA) was completed for one Resident (#22) out of a total sample of 26 residents. Specifically, for Resident #22, the facility failed to ensure that a SCSA was completed when the Resident experienced a decline in the Activity of Daily Living (ADL) function, change in bowel and bladder continence, and experienced a significant weight decline (weight loss of 5% or more in the past 30 days or 10% or more in the last 180 days). Findings Include: Review of the CMS Resident Assessment Instrument (RAI) Version 1.19.1 dated October 2024, indicated the following: [...]

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to provide care and services related to hearing devices for one Resident (#38), out of a total sample of 26 residents. Specifically, for Resident #38, the facility failed to ensure hearing aids were applied per recommendations from the Audiologist and the Resident's plan of care.

Inspectors wroteBased on interviews, and record reviews, the facility failed to ensure that the medication regimen reviews (MRRs) performed by the Consultant Pharmacist were acted upon timely for one Resident (#28) out of a total sample of 26 residents. Specifically, for Resident #28, the Attending Physician failed to document in the Resident's medical record that irregularities identified by the Consultant Pharmacist during the MRRs performed on 6/26/24 and 7/23/24 were reviewed and addressed timely.

Inspectors wroteBased on observations, interviews, and records reviewed, the facility failed to maintain complete and accurate medical records for one Resident (#51), out of a total sample of 26 residents. Specifically, for Resident #51, the facility failed to ensure complete and accurate documentation was maintained for urinary catheter output (documentation indicating the volume of urine collected in a urinary drainage bag connected to a urinary catheter) as required.

Inspectors wroteBased on record review, and interview, the facility failed to ensure the timely completion and transmission of the Minimum Data Set (MDS) Assessments as required for four Residents (#29, #135, #141, #95), out of a total sample of 26 residents. Specifically, the facility failed to ensure that the components of the MDS Assessments were completed and electronically transmitted within the required timeframes when: 1. For Resident #29, the Comprehensive MDS Assessment was transmitted 141 days after the completion of the MDS Assessment. 2. For Resident # 135, the Entry Tracking MDS Assessment was transmitted 140 days after the completion of the MDS Assessment. 3. For Resident # 141, the Discharge Tracking MDS Assessment was completed 19 days after the ARD (Assessment Reference Date). 4. For Resident #95, the Entry Tracking MDS Assessment was completed 27 days after the ARD.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a homelike environment was provided relative to dining for two Residents (#44 and #4) out of a total sample of 27 residents, on two of four units observed (Unit Three and Unit Four). Specifically, the facility failed to ensure: 1. -For Resident #44, that meals were provided timely when he/she was dining with other residents and that blood sugar (glucose) checks were not completed in the dining room. -that residents seated together in a dining area, were served their meals at the same time. 2. For Resident #4, that the Resident's preference for beverages was provided timely with meals.

Inspectors wrote4. Resident #42 was admitted to the facility in February 2024, with a diagnosis including Protein Calorie Malnutrition (state of inadequate intake of food including protein, calories and other essential nutrients). Review of the May 2024 Physician's orders included the following: -Keflex (an antibiotic) 500 milligrams (mg) every 8 hours daily (three times daily) for 10 days for infection, initiated 4/23/24 Review of the April 2024 and May 2024 Medication Administration Record (MARs) indicated Keflex 500 mg was administered three times daily to Resident #42 from 4/23/24 through 5/2/24, with the exception of 4/26/24 where an M was documented at 10:00 P.M. Review of the Resident's clinical record did not indicate why the Keflex medication was prescribed. [...]

Inspectors wroteBased on interview and record review, the facility failed to coordinate an assessment with the Preadmission Screening and Resident Review (PASARR- a federal requirement to help ensure that individuals who have a mental disorder or intellectual disabilities are not inappropriately placed in nursing homes for long term care. PASRR requires that: 1) all applicants to a Medicaid-certified nursing facility be evaluated for a serious mental disorder and/or intellectual disability; 2) be offered the most appropriate setting for their needs [in the community, a nursing facility, or acute care setting]; and 3) receive the services they need in those settings) program for one Resident (#76) out of a total sample of 27 residents. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to communicate and implement a Physician's recommendation to start medication for one Resident (#2) out of a total sample of 27 residents. Specifically, for Resident #2, the facility failed to verify the ordered dosage and frequency and appropriately communicate the Physician recommendation of Tylenol medication for pain management for the Resident, resulting in potential delay in treatment.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to ensure that Physician's orders were implemented for one Resident (#10), of seven applicable residents identified with pressure ulcers (injury to underlying tissue resulting from prolonged pressure on the skin), out of a total sample of 27 residents. Specifically, the facility failed to ensure that the Physician orders for the setting of a pressure reducing mattress (air mattress) was implemented for Resident #10, who had an existing pressure ulcer and remained bedbound (confined in bed).

Inspectors wroteBased on observation, interview, and policy review, the facility failed to provide an environment that was free of potential accidents and hazards for one Resident (#384), out of a total sample of 27 residents. Specifically, for Resident #384, the facility staff allowed the Resident to smoke in an undesignated area on the sidewalk in front of the building without any smoking safety equipment available for use in the event of an accidental fire in the vicinity.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to ensure that Enhanced Barrier Precautions (EBP- targeted gown and glove use during high contact resident care activities, designed to reduce transmission of infections) were adhered to for three Residents (#12, #17, #42), of five applicable residents, out of a total sample of 27 residents, to prevent the spread of infections. Specifically, the facility staff failed to: 1. For Resident #12, ensure that the required personal protective equipment (PPE) was worn when providing high contact wound care when the Resident was identified as being on EBP. 2. For Resident #17, ensure the required PPE was worn when assisting the Resident with toileting activities. 3. For Resident #42, ensure the required PPE was worn when assisting the Resident with repositioning when in bed.

Inspectors wroteBased on observation and interview, the facility failed to ensure its staff kept patient specific protected health information in a private location for Resident #89, and provided a dignified environment on three units (200s Unit, 300s Unit, and 400s Unit) out of four units observed. Findings Include: 1. For Resident #89, the facility staff failed to ensure patient specific protected health information was kept in a location not readily visible in a public area to non-clinical staff and visitors on the 400's Unit. Resident #89 was admitted to the facility in May 2022. During an observation on 12/13/22 at 9:44 A.M., the surveyor observed a white board/bulletin board on the wall in the Resident's room visible from the doorway. The white board had instructions regarding toileting and activities of daily living (ADLs) and indicated that the Resident used pull-ups diapers. [...]

Inspectors wrote3. For Resident #92 the facility failed to ensure its staff monitored changes or side effects for the use of Seroquel (an antipsychotic used to treat certain mental/mood conditions and Remeron (an antidepressant). Resident #92 was admitted to the facility in September 2022. Review of the Active Order Report indicated the following: -Seroquel 25 milligram (mg) give 12.5 mg oral twice daily at 2:00 P.M. and 6:00 P.M. for distressing delusions with a start date of 12/2/22. -Remeron 15 mg tablet give one-half tablet oral at bedtime for Major Depressive Disorder with a start date of 10/26/22. During an interview on 12/14/22 at 3:06 P.M., UM #2 said that residents who are on psychotropic medications are monitored for changes and side effects. She said that the information is documented on a flow sheet and there should be an order to do so. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that its staff provided access to the call bell system that alert staff to resident needs, for one Resident (#17), out of a sample of 27 residents.

Inspectors wroteBased on record review and interview, the facility failed to ensure its staff completed the required transfer documentation and communicated the appropriate information to the receiving health care institution for two Residents (#117 and #36), out of a sample of 27 residents, putting the Residents at risk for complications and adverse events upon transfer to the receiving facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure its staff developed and implemented a comprehensive person-centered plan of care for two Residents (#89, and #103), out of a sample of 27 residents. Specifically, the facility failed to: 1. develop and implement a care plan for a Resident (#89) with Dementia, and 2. failed to implement a mood and psychotropic medication care plan for a Resident (#103) with Dementia with behavioral disturbance.

Inspectors wroteBased on observations, record review, and interviews, the facility failed to ensure its staff provided quality of care according to the plan of care, facility protocols, and professional standards of practice for two Residents (#104 and #78), out of a total sample of 27 residents. Specifically, the facility failed to ensure that a medicated cream/lotion for both Residents' #104 and #78 was applied by licensed staff only.

Inspectors wroteBased on observation, interview, and record review, the facility and its staff failed to ensure that routine assessments and devices used to maintain hearing were provided for one Resident (#78), out of 27 sampled residents. Specifically, the facility staff failed to offer and encourage the use of hearing aids when Resident #78 complained of difficulty hearing.

Inspectors wroteBased on observations, policy review, and interviews, the facility and its staff failed to maintain an environment that was free from accident hazards by leaving medications at the Residents bedside, for three Residents (#8, #104 and #78), out of a sample of 27 residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure its staff stored a feeding tube syringe (syringe used to administer a nutrition supplement into a feeding tube) per Physicians' orders and failed to store and/or dispose of unused nutrition supplement per manufacturers guidelines for one Resident (#50), out of 27 sampled residents. Findings Include: Review of the facility policy titled: Enteral Therapy Feeding Administration via Pump, Continuous Pump, Gravity Bag, and via Syringe, revised June 10, 2022, indicated the following: - .ensure feeding administration are administered per Medical Doctor orders . Review of the IsoSource (nutrition supplement used by the Resident) instructions indicated the following: -Once opened, unused portions should be tightly covered, refrigerated, and used within 24 hours. [...]

Inspectors wroteBased on interview and record review, the facility and its staff failed to ensure the attending Physician reviewed recommendations from the Behavioral Health care team to aid in treating increased anxiety and depression for one Resident's (#107), out of 27 sampled residents.

Inspectors wroteBased on interview and record review, the facility failed to ensure its staff had the Physician review and respond to monthly medication regimen reviews (MRRs) for two Residents (#36 and #89), out of 27 sampled residents.

Inspectors wroteBased on interview and record review, the facility failed to ensure that its staff arranged for routine dental care for one Resident (#49), out of 27 sampled residents.

Inspectors wroteBased on interview and record review, the facility failed to ensure its staff maintained complete and accurate medical records for two Residents (#100 and #36) of 27 sampled residents. Specifically, the facility failed to ensure that its staff: 1. provided complete and accurate documentation relative to transfer/discharge/bed hold rights for Resident #100, and 2. that a) meal intakes and b) pharmacy consultation documentation were accurate for Resident #36.

Inspectors wroteBased on observation and interview, the facility failed to ensure that its staff maintained a hygienic environment and performed hand hygiene at recommended intervals during wound care for one Resident (#103), out of 27 sampled residents. Specifically, the facility staff failed to create an aseptic (free from contamination) work area to place wound care supplies and perform hand hygiene between the removal of gloves after removal of old dressings and donning (putting on) new gloves for placement of new dressings during wound care.

Inspectors wroteBased on record review and interview, the facility failed to ensure that its staff transmitted a Minimum Data Set (MDS) assessment within the required 14 days of the MDS Assessment completion for one Resident (#7), out of three sampled residents.