German Center for Extended Care

Inspectors wroteBased on records reviewed and interviews for one of three sampled residents (Resident #1) who had been admitted with a Stage II (partial loss of dermis) pressure ulcer, the Facility failed to ensure nursing staff provided care and services that met professional standards of practice related to timely follow up on recommendations regarding nutritional interventions to promote wound healing, and obtaining medication and/or treatment orders in a timely manner.

Inspectors wroteBased on records reviewed and interview for one of three sampled residents (Resident #1), whose Health Care Proxy (HCP) had been invoked, and upon admission his/her Health Care Agent (HCA) signed consent and requested he/she be administered the Influenza (FLU) Vaccine, the facility failed to ensure nursing administered the vaccine as requested, and Resident #1 was not given the vaccine until more than three (3) months later.

Inspectors wroteBased on records reviewed and interview for one of three sampled residents (Resident #1), whose Health Care Proxy (HCP) had been invoked, and upon admission his/her Health Care Agent (HCA) signed consent and requested he/she be administered the Covid-19 Vaccine, the facility failed to ensure nursing administered the vaccine as requested, and Resident #1 was not given the vaccine until more than three (3) months later.

Inspectors wroteBased on interview and policy review the facility failed to ensure that all written grievance decisions included the date the grievance was received, a summary statement of the resident's grievance, the steps taken to investigate the grievance, a summary of the pertinent findings or conclusions regarding the resident's concerns(s), a statement as to whether the grievance was confirmed or not confirmed, any corrective action taken or to be taken by the facility as a result of the grievance, and the date the written decision was issued; the facility failed to maintain evidence demonstrating the results of all grievances for a period of no less than three years from the issuance of the grievance decision.

Inspectors wroteBased on observation, policy review, and interview, the facility failed to store and prepare food in accordance with professional standards for food service safety. Specifically, the facility failed to ensure food was labeled, that food was not stored directly on the floor, and that dented cans were not accepted into storage/circulation.

Inspectors wroteBased on observation, record review and interview, the facility failed to review and revise the plan of care for one Resident (#107) out of a total of 24 sampled residents.

Inspectors wroteBased on observation, policy review, record review, and interviews, for one Resident (#120) of 24 sampled residents, the facility failed to ensure nursing provided services in accordance with the comprehensive care plan that met professional standards of quality. Specifically, for Resident #120 the facility failed to ensure nursing implemented a physician's ordered dressing change to his/her left foot.

Inspectors wroteBased on record review, policy review and interview the facility failed to provide care and treatment in accordance with professional standards of practice for one Resident (#43) out of a total sample of 24 Residents. Specifically, for Resident #43 the facility failed to ensure nursing followed up on coumadin (warfarin - anticoagulant) dosing and nursing failed to obtain repeat laboratory work (a prothrombin time PT/INR test measures how fast a blood sample forms a clot. A high PT/INR means the body takes longer than normal to form blood clots) as recommended by Nurse Practitioner.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), whose diagnoses included Heart Failure, with Physician's Orders for the medication Jardiance (enzyme inhibititor) and weekly weights to be obtained by Nursing, the Facility failed to ensure nursing notified the Physician/Nurse Practioner when 1) Resident #1 consistently refused to take the medication because it made him/her sick, and 2) his/her weights were not obtained, as ordered.

Inspectors wroteBased on record review and interviews the facility failed to meet professional standards of care. Specifically, the facility failed to validate a nurse's education credentials before hire and allowed the nurse to work directly with the residents in the entire facility for a total of 98 days in the last 215 days.

Inspectors wroteBased on employee record review and interview, the facility failed to hire nursing staff with the competencies required to provide safe and effective nursing care to residents in the entire facility. Specifically, the facility failed to verify education credentials for one employee hired as a nurse, who was not qualified to work as a nurse in the Commonwealth of MA.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure three Residents (#19, #70 and #93 ) were provided a dignified existence, out a total sample of 30 residents. Specifically the facility failed to provide facial hair removal.

Inspectors wroteBased on record reviews, policy review and interviews, the facility failed to obtain consent for the use of psychotropic medications for 2 Residents (#56, and #6) out of a total sample of 30 residents.

Inspectors wroteBased on record review, policy review and interviews the facility failed to follow an order to notify the physician when blood sugar levels were less than 100 mg/dl (milligram/deciliter) or greater than 300 mg/dl for two Residents (#48 and #95) out of a total sample of 30 residents.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure a resident with a pressure ulcer received necessary treatment to promote healing for one Resident (#96) out of a total sample of 30 residents. Specifically, for Resident #96, the facility failed to ensure an air mattress was set to the appropriate setting for the treatment of a pressure ulcer.

Inspectors wroteBased on observations, record review, policy review and interviews, the facility failed to administer oxygen and the level ordered by the physician and failed to change the oxygen tubing for one Resident (#55) out of a total sample of 30 residents.

Inspectors wroteBased on observations, record reviews, policy review, and interviews, the facility failed to ensure it was free from a medication error rate of greater than 5 percent. Two out of four nurses observed made three errors in 30 opportunities on two of three units resulting in a medication error rate of 10.0%. These errors impacted three Residents (#369, #57 and #21), out of 4 residents observed.

Inspectors wroteBased on observations, policy review, and interviews the facility failed to: 1. Ensure medication carts were locked when unattended in two out of three resident care units and 2. Ensure medications were not left unattended in resident's rooms.

Inspectors wroteBased on observations, policy review and interviews, the facility failed to follow proper hand hygiene to minimize risk of food borne illness during breakfast service.

Inspectors wroteBased on employee file review and interview, the facility failed to ensure one out of eight nurses (Nurse #6) reviewed had graduated from an accredited nursing program and had the qualifications to perform the duties of a nurse and work in the facility.