Fairview Commons Nursing & Rehabilitation Center

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to maintain an environment that was free of accident hazards and risks for three Residents (#7, #63, and #67), out of a total sample of 26 residents. Specifically, For Resident #7, the facility failed to conduct a thorough investigation and provide effective interventions and adequate supervision to prevent falls when the Resident was identified as high falls risk due to cognitive impairment, had multiple previous falls including one fall with sustained fractures, and was left unattended in the Activity Room with other residents and sustained a hip fracture requiring hospitalization and surgical intervention. [...]

Inspectors wroteBased on observations, and interviews, the facility failed to ensure that beverages served during meals were palatable and at appropriate temperatures on three (Unit One, Unit Two and Unit Three) out of three units observed. Specifically, the facility failed to ensure the temperature of coffee served during meals were palatable when numerous residents had expressed concerns to the Food Service Director (FSD).

Inspectors wroteBased on observations, and interviews, the facility failed to adhere to infection control standards of practice while serving meals to residents on one Unit (Unit One), out of three Units observed, and maintain a hygienically clean environment to prevent contamination and the spread of infection in the facility laundry room. Specifically, the facility failed to:1. Ensure that staff passing breakfast meal trays in resident rooms on Unit One removed personal protective equipment (PPE: items such as gowns and gloves worn to prevent the spread of infection) after providing care for one Resident on Enhanced Barrier Precautions (EBP), prior to exiting the resident's room, and did not place a previously delivered resident breakfast meal tray in the unit food truck with undelivered resident meals trays to prevent contamination and the potential spread of infections.2. [...]

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to provide a dignified dining experience for one Resident (#140) out of a total sample of 26 residents. Specifically, for Resident #140, the facility failed to provide a dignified dining experience during breakfast and lunch meal service when the Resident was dependent on staff for assistance with meals and:-was not served his/her meal at the same time as other residents seated at the same table.-had clothing protectors applied instead of napkins before his/her meal was served.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement abuse policies and procedures when two Certified Nurse Aides (CNA #8 and CNA #2) documented a potential allegation of abuse pertaining to one Resident (#7), out of a total sample of 26 residents. Specifically, the facility failed to ensure the allegations of abuse were identified, reported within the required timeframe, and protection was provided to residents pending the outcome of the investigation, when CNA #8 and CNA #2 documented in witness statements that Nurse #4 responded inappropriately to Resident #7 after the Resident sustained a fall.

Inspectors wroteBased on interview, and record review, the facility failed to ensure an effective discharge plan was implemented for post-discharge care for one Resident (#130) out of a total sample of three residents reviewed for closed records. Specifically, for Resident #130, the facility failed to ensure services such as visiting nurse and therapy, were in place when he/she was discharged from the facility when Resident #130 expressed interest in having the services in place for a safe facility discharge and reduce the risk of re-hospitalization.

Inspectors wroteBased on interview, and record review, the facility failed to ensure that Minimum Data Set (MDS) Assessments were accurate for three Residents (#4, #7 and #67), out of a total sample of 26 Residents. Specifically, For Resident #4, the facility failed to ensure the MDS assessment dated [DATE] accurately indicated the daily use of hypoglycemic (medication to lower blood sugar) and antipsychotic (medication to treat mood and behaviors) medications and did not include the use of anticoagulant (medication to thin the blood and prevent blood clotting) medication. For Resident #7, the facility failed to ensure the MDS assessment dated [DATE] accurately indicated three falls that occurred since the last MDS Assessment. For Resident #67, the facility failed to ensure the MDS assessment dated [DATE] accurately indicated falls that occurred since the last MDS Assessment.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure that necessary treatment and services, consistent with professional standards of practice, were provided to promote the healing of pressure ulcers for one Resident (#49) out of a total sample of 26 residents. Specifically, for Resident #49, the facility failed to:-adhere to the Physician ordered wound treatment during wound treatment provided on 7/25/25, putting the Resident at risk for potential worsening of the pressure ulcer.-review the Wound Consultant treatment recommendations made on 7/24/25 to discontinue a medicated cream, with the Resident's Primary Medical Practitioner and update wound treatment orders timely, resulting in a delay in updated wound treatment per the Wound Consultant's recommendations.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care and services consistent with professional standards of practice of fluid management for one Resident (#15), out of one applicable resident receiving dialysis (process that filters waste, salt, and fluid from the blood when the kidneys are unable to work adequately) services, out of a total sample of 26 residents. Specifically, for Resident #15, the facility failed to: -Accurately monitor daily fluid intake as ordered by the Physician, when the Resident was dependent on renal dialysis, placing the Resident at risk for medical complications related to fluid overload. Findings Include: Review of the facility policy titled Dialysis Residents, Coordination of Care Of, dated May 2005, and last revised November 2018, indicated: [...]

Inspectors wroteBased on interview, and record review, the facility failed to issue 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, the resident has not used all his/her Medicare benefit days, and plans to remain in the facility after coverage has ended) for two Residents (#19 and #141) out of a total sample of 26 residents. Specifically, for Residents #19 and #141, the facility failed to issue a SNF ABN to the Resident and/or Resident Representative for notification that their skilled services may not be paid for by Medicare and what financial responsibility would need to be assumed when the effective date of Medicare Part A coverage for skilled services ended and both Residents remained in the facility.

Inspectors wroteBased on record review, and interview, the facility failed to ensure that a Level II (comprehensive evaluation that identifies the specialized services required) Preadmission Screening and Resident Review (PASARR- evaluation done if it was determined by the Level I (initial pre-screening] screen that a resident had an intellectual or developmental disability and/or serious mental illness [SMI] and if a resident was in need of additional support services at the facility) screen was submitted for one Resident (#60), out of a total sample of 26 residents. Specifically, for Resident #60, the facility failed to request a Level II PASARR evaluation when the Resident screened positive for ID (intellectual Disability)/DD (Developmental Disability) during a Level I PASRR Evaluation.

Inspectors wroteBased on interviews, and record review, the facility failed to ensure that medical records were complete and accurate for one Resident (#76), out of a total sample of 26 residents. Specifically, for Resident #76, the facility failed to:1. ensure the Physician's Orders accurately reflected the Resident's Representative from [DATE] through [DATE], resulting in the potential risk for the Resident's confidential information to be provided to an unauthorized party and the risk for an unauthorized party to make medical decisions for the Resident.2. obtain and document in the Resident's medical record evidence of the Resident's court-appointed Guardian from [DATE] through [DATE].

Inspectors wroteBased on records reviewed and interviews for one of three sampled residents (Resident #1), who required the use of bilateral nephrostomy tubes (a catheter inserted directly into the kidney that drains urine into a collecting bag outside the body), the facility failed to ensure nursing developed and implemented a baseline care plan related to his/her immediate care and treatment needs related to his/her nephrostomy tubes.

Inspectors wroteBased on records reviewed and interviews for one of three sampled residents (Resident #1), who required the use of bilateral nephrostomy tubes (a catheter inserted directly into the kidney that drains urine into a collecting bag outside the body) the facility failed to ensure he/she received adequate nursing care in accordance with professional standards of practice when there were no Physician's orders related to the care and treatment for his/her nephrostomy tubes.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #3), the Facility failed to ensure they maintained complete and accurate medical records when the Certified Nurse Aide (CNA) Assignment Sheets (document that includes the residents' names, room numbers and a brief synopsis of resident care needs that CNAs use daily as a reference tool) and [NAME] (a readily accessible computerized document used by CNAs to quickly reference key information about a patient's care plan, allowing them to efficiently provide appropriate care during their shift), were updated to accurately reflect his/her change in ability to transfer in and out of bed.

Inspectors wroteBased on record and policy review, and review of the facility assessment, the facility failed to ensure that annual performance appraisals were completed every 12 months and regular in-service education was provided based on the outcome of the performance appraisals for four Certified Nurses Aides (CNAs) out of a sample of five CNAs. Specifically, the facility failed to ensure that expectations, individual performance, and training requirements were communicated to CNA #3, CNA #4, CNA #5 and CNA #6 through the annual performance appraisal process as required.

Inspectors wroteBased on observation, interview and policy review, the facility failed to ensure that medications were labeled in accordance with professional standards to include an expiration date on two (#2 and #4) out of three observed medication carts, and on two units (Unit 1 and Unit 2) out of three observed units. Specifically, the facility failed to ensure that an ophthalmic (relating to the eye and its diseases) medication was appropriately labeled to indicate the bottle open date and/or discard date according to manufacturer's guidelines and prevent the administration of outdated medications that could result in contamination and infections for facility residents.

Inspectors wroteBased on observation, interview, and policy review the facility failed to maintain a clean and homelike environment for one Resident (#11) on one Unit (#1) out of three units observed. Specifically, for Resident #11 who resided on Unit #1 the facility failed to ensure that the Resident's window covering was maintained in a clean manner.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the accuracy of the Minimum Data Set (MDS) Assessments for two Residents (#60 and #21), out of a total sample of 25 residents. Specifically, the facility failed to ensure the MDS Assessment was accurately coded relative to: 1. For Resident #60, the use of hypoglycemic medications (medications that reduce blood sugar [glucose]), antianxiety medication (used to treat feelings of fear, dread, uneasiness that may occur as a reaction to stress) and that the Resident was on dialysis (procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly). 2. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure that two Residents (#109 and #82) and/or their Representative, out of a total sample of 25 residents, were included in the comprehensive care planning process. Specifically, the facility failed to: 1. For Resident #109, schedule Care Plan meetings as required, and facilitate participation by the Resident and/or Representative in the care planning process. 2. For Resident #82, ensure that a Care Plan conference was held, and the Resident and/or Resident Representative was involved in the care planning process after the completion of two MDS Assessments.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to provide care in accordance with professional standards of practice for one Resident (#18), out of a total sample of 25 residents, with a Peripherally Inserted Central Catheter (PICC: a thin, soft tube that is inserted into a vein in the arm, for long-term antibiotics, nutrition, medications, and blood draws. The PICC is a type of CVAD [Central Vascular Access Device] catheter) placing Resident #18 at risk for undiagnosed infiltration (when fluid or medication given by an intravenous device exits the vein and enters the soft tissues) and/or deep vein thrombosis (DVT: a blood clot in a deep vein). Specifically, the facility staff failed to: -appropriately monitor the PICC device and discontinue use when external catheter length measurements varied from the admission insertion measurements. [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide proper treatment and care for good foot health for one Resident (#226) out of a total sample of 25 residents. Specifically, for Resident #226, the facility staff failed to assess, and assist with completing and submitting the necessary podiatry consent form to facilitate timely podiatry services to address the Resident's long toenails.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that one Resident (#35) out of a total sample of 25 residents, was provided with an environment that was free from accidental hazards. Specifically, for Resident #35, the facility failed to implement the appropriate size bed side rails and maintain the bed in the lowest position after the Resident sustained a fall and injury, as preventative measures for further falls and injuries.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to provide nutritional care and services for two Residents (#63 and #84), out of a total sample of 25 residents. Specifically, the facility staff failed to: 1. For Resident #63, provide a nutritional supplement when the Resident was identified as being at nutritional risk due to a resolving hip fracture. 2. For Resident #84, provide an increase in a nutritional supplement as indicated for added calories, protein and hydration support from once to twice daily.

Inspectors wroteBased on interview and record review, the facility failed to maintain complete and accurate medical records for three Residents (#8, #21 and #60) out of a total sample of 25 residents. Specifically, the facility staff failed to: 1. For Resident #8, ensure accurate documentation relative to the units of Insulin (medication used to manage blood sugar levels) administered per the sliding scale for each of the readings requiring sliding scale coverage. 2. For Resident #21, accurately administer and document the base and sliding scale units of Insulin as ordered by the Physician. 3. For Resident #60, accurately document the bruit and thrill (sounds that can be heard or felt near a dialysis site and indicate that the site is working) assessment of the dialysis access site.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to maintain an infection prevention and control program designed to help prevent the potential transmission of communicable diseases and infections within the facility for one Resident (#112) out of a total sample of 25 residents. Specifically, the facility staff failed to clean and disinfect multi-use equipment after use on a resident prior to using the same equipment on Resident #112 who was at high risk for infection.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who was non-verbal, cognitively intact, understood others and was able to make his/her needs known by typing out messages on his/her cell phone screen, the Facility failed to ensure he/she was free from verbal abuse by a staff member, when on 11/26/23, at approximately 9:00 A.M., Certified Nurse Aide (CNA) #1 sent a text message to Resident #1 using language that included profanity, contained statements that were disparaging, insulting, humiliating, and accusatory toward Resident #1. Findings Include: Review of the Facility's Policy titled Resident Abuse Prevention, Investigation and Reporting, dated as revised 02/17/17 indicated the following: [...]

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), the Facility failed to ensure that staff implemented and followed their Abuse Policy related to the need to immediately report allegations of abuse to the Supervisor, Administrator or Director of Nurses (DON), when on 11/26/23, after Certified Nurse Aide (CNA) #3 received a copy of a text message that CNA #1 had sent to Resident #1, that contained profanity, disparaging comments, insults, and ridiculed him/her (Resident #1), CNA #3 did not immediately report it to Facility administration as required, and waited until 11/30/23 (four days later) to report, therefore placing Resident #1 and other residents at risk for abuse.

Inspectors wroteDuring observation, interview, and record review, the facility failed to ensure its staff provided repositioning as required to prevent the development of a facility acquired pressure injury for one Resident (#50), out of a sample of 24 residents.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure there was sufficient nursing staff (including Certified Nurses Aides-CNAs) to provide services and nursing care that met the needs of residents on three Units (Unit One, Unit Two, and Unit Three), out of three units observed.

Inspectors wroteBased on interview and record review, the facility failed to ensure that its staff conducted twice weekly COVID-19 testing for staff who are not fully up to date with COVID-19 vaccinations, for three staff members (Nurse #1, Laundry Staff #1 and Activities Assistant #1), out of a sample of three staff members. Findings Include: Review of the facility policy titled COVID-19 Testing, revised on 11/10/22, indicated the following: -In compliance with local, state, and federal regulation, has a testing plan for symptomatic, surveillance, and outbreak testing . -Staff who are not up to date with COVID-19 vaccines must conduct twice-weekly testings . [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure its staff followed their COVID-19 monitoring plan to prevent the spread of infection. Specifically, the facility's staff failed to screen for signs and symptoms of COVID-19 every shift (Q shift) on units experiencing a COVID-19 outbreak for two Residents (#65 and #158), out of a sample of three residents. Findings Include: Review of the facility policy titled COVID-19 Prevention and Outbreak Management, revised 5/12/22, indicated the following: - .It is the practice .of this facility to follow the guidance of government resources including Centers for Disease Control and Prevention (CDC), Centers for Medicare and Medicaid (CMS), Massachusetts Department of Public Health (DPH) . -If a resident is symptomatic for COVID-19 or positive for COVID-19 or exposed to COVID-19, symptom monitoring is enhanced to every shift. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure its staff provided the required discharge/transfer notices for two Residents (#56 and #97), and/or their Representatives and the Long-Term Care Ombudsman office, out of a sample of 24 residents.

Inspectors wroteBased on interview and record review, the facility failed to ensure that services were provided by a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week.

Inspectors wroteBased on interview and record review, the facility failed to ensure that its staff monitored the use of psychotropic medications (medications that affect brain activities associated with mental processes and behavior) to promote and maintain the highest practicable mental, physical, and psychosocial well-being of two Residents (#10 and #162), out of a sample of 24 residents.

Inspectors wroteBased on interviews and record review, the facility failed to ensure that its staff coordinated and provided Hospice Care services in accordance with the plan of care for one Resident (#208), out of a sample of 24 residents. Specifically, facility staff failed to: 1) communicate with the contracted Hospice to assist with symptom management resulting in prescribed medications of the same drug class being used for the Resident, and 2) ensured that the contracted Hospice provided the facility with documentation of the care and services provided to the Resident by Hospice and ensure the documentation was readily available in the Resident's record.