Haverhill Rehabilitation and Healthcare Center

Inspectors wroteBased on record review and interview, the facility failed to maintain an effective way to track and measure performance of the Quality Assurance and Performance Improvement (QAPI) program.

Inspectors wroteBased on record review and interview the facility failed to maintain a system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents.

Inspectors wroteBased on record review, policy review and interview the facility failed to implement an Antibiotic Stewardship Program to promote and monitor the appropriate use of antibiotics.

Inspectors wroteBased on record review and interviews, the facility failed to develop and/or implement care plans for two Residents (#68 and #67) out of a sample of 29 Residents. Specifically, 1. For Resident #68, the facility failed to develop a substance use disorder care plan. 2. For Resident #67, the facility failed to implement geri sleeves (skin protectors) to bilateral arms and legs.

Inspectors wroteBased on record review and interviews, the facility failed to respond to concerns voiced by residents in the monthly resident council meetings. Specifically, the facility failed to act promptly upon the grievances of the issues identified during the monthly resident council meetings.

Inspectors wroteBased on interview and record review, the facility failed to provide a prompt resolution or follow up on a grievance for one Resident (#41) out of a total sample of 29 residents. Specifically, the facility failed to follow up on a grievance regarding a lost hearing aid. Findings Include: Review of the facility policy titled Resident and Family Grievances, dated 3/1/25, indicated the following: -It is the policy of this facility to support each resident's and family member rights to voice grievances without discrimination, reprisal or fear of discrimination or reprisal. -Prompt efforts to resolve include the facility acknowledgement of complaint/grievance and actively working toward resolution of that complain/grievance. [...]

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure one Resident (#154) received care in accordance with professional standards of practice, out of a total sample of 29 residents. Specifically, for Resident #154 the facility failed to obtain physician's orders for the placement and care of a Midline (an intravenous (IV) line inserted into the upper arm to deliver medications and fluids over a longer period of time than a standard IV).

Inspectors wroteBased on record review and interview, the facility failed to obtain rehab services to maintain one Resident's (#88) activities of daily living (ADL) out of a total sample of 29 residents.

Inspectors wroteBased on record review and interview, the facility failed to provide services to maintain adequate hearing for one Resident (#41) out of a total sample of 29 residents. Specifically, the facility failed to assist the Resident with replacing his/her lost hearing aid.

Inspectors wroteBased on observation, record review and staff interviews, the facility failed to ensure that one Resident (#67) out of a total sample of 29 residents, received proper foot care (Podiatry services).

Inspectors wroteBased on record review and interview, the facility failed to follow up on significant weight changes for one Resident (#94) out of a total of 29 residents.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure that respiratory care and services, consistent with professional standards of practice, were provided for one Resident (#97) out of sample of 29 residents. Specifically, 1. For Resident # 27, the facility failed to include a physician's order for the use of oxygen in the medical record and have oxygen set at a specified flow rate.

Inspectors wroteBased on record review and interviews, the facility failed to develop a personalized Post Traumatic Stress Disorder (PTSD) care plan for one Resident #68 out of a sample of 29 Residents. Specifically, the facility failed to develop a care plan for the Resident's experiences and preferences in order to eliminate or mitigate triggers that may cause re-traumatization of the Resident.

Inspectors wroteBased on observations, interviews and policy review, the facility failed to ensure staff stored drugs and biological's in accordance with State and Federal requirements. Specifically; the facility failed to ensure medications were not left at the bedside for one Resident (#97) out of a total of 29 sampled residents.

Inspectors wroteBased on record review and interview, the facility failed to follow a physician's order for a fluid restriction for one Resident (#46) out of a total sample of 29 residents.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who on 11/28/24 was re-admitted to the Facility during the day shift and per nursing required assistance of two staff members for bed mobility and during the provision of care because he/she had not been re-evaluated by rehab. The Facility failed to ensure he/she was provided the necessary level of staff assistance during care, when the Certified Nurse Aide (CNA) assigned to meet his/her care needs for the evening shift was not given report by nursing regarding his/her change in care status, the CNA provided care alone, Resident #1 rolled out of bed to the floor, and sustained a head laceration that required two staples to close.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #2) who had an invoked Health Care Proxy (HCP), the Facility failed to ensure they obtained written Informed Consents for his/her psychotropic medications from his/her HCP, prior to administering the medications.

Inspectors wroteBased on observation, record review and interview, the facility failed to identify and address a new onset of limited range of motion for one Resident (#18) out of a total of 23 sampled residents.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure for one Resident (#162) out of two applicable residents out of a total sample 23 residents that professional standards of care were developed and implemented for the care of a hemodialysis access site. Specifically, the care and treatment of an internal jugular (IJ) catheter, (a type of central venous catheter that is inserted in the internal jugular vein for hemodialysis).

Inspectors wroteBased on observation, record review and interview the facility failed to ensure licensed nursing staff possessed the appropriate competency and skills to care for one Resident (#162) out of two applicable residents, requiring dialysis, out of a total sample of 23 residents, and 2. the facility failed to ensure nursing staff had been provided with education or demonstrated necessary competencies to care for residents in the facility with specialized needs, inclusive of dialysis care and treatment.

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: 1. The facility failed to properly secure medications and medication carts on two of three units. 2. The facility failed to ensure medication carts were kept clean and orderly on one out of three medication carts reviewed. Findings Include: Review of facility policy titled Medication Storage in the Facility, December 2019, indicated, 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. [...]

Inspectors wroteBased on observations, interviews, the resident group meeting and test tray results, the facility failed to ensure foods provided to residents were prepared by methods that conserve nutritional value, flavor, were palatable and at appetizing temperatures on 3 out of 3 units.

Inspectors wroteBased on observation and interview, the facility failed to store and prepare food under sanitary conditions in the facility's main kitchen.

Inspectors wroteBased on observation, record review, policy review and interview the facility failed to ensure two Residents (#14 and #97) were free from restraints out of a total sample of 23 residents. Specifically, the facility failed to: 1. identify and assess the use of side rails in conjunction with a scoop mattress as a potential restraint for Resident #14. 2. identify and assess the use of pillows wedged up against the side rails extending to the knees, as a potential restraint for Residents #97.

Inspectors wroteBased on record review, policy review and interviews, the facility failed to implement their abuse prohibition policy for one Resident (#97) out of a total sample of 23 residents. Specifically, for Resident #97, 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 record review and interview, the facility failed to report an allegation of potential abuse/neglect to the state agency as required for one Resident (#97) out of a total of 23 sampled residents.

Inspectors wroteBased on record review, policy review and interviews, the facility failed to thoroughly investigate an injury of unknown origin and failed to maintain evidence that a thorough investigation was completed for one Resident (#97) out of a total sample of 23 residents.

Inspectors wroteBased on record review and interview for one Resident (#99), out of a total sample of 23 residents, the facility failed to ensure baseline care plans were developed and implemented within 48 hours of admission.

Inspectors wroteBased on observations, record review, policy review and interviews, the facility failed to develop and implement a comprehensive person-centered care plan with individualized interventions for two Residents (#108 and #64) out of a total sample of 23 residents. Specifically, 1. For Resident #108, the facility failed to develop care plans for activities of daily living, risk for falls and psychoactive medication use. 2. For Resident #64, the facility failed to implement the plan of care for air mattress settings. Findings Include: Review of the facility's policy titled, Interdisciplinary Care Planning, dated as revised 11/2017 indicated the following: Comprehensive Care Plans. 3. The care plan process is not limited to developing a written plan but also addresses the ongoing execution of care, treatment, and services. [...]

Inspectors wroteBased on observation, record review and interview, the facility failed to prevent constipation and implement the bowel management protocol for one Resident (#108) out of a total sample of 23 residents. Specifically, for Resident #108, with a known diagnosis of constipation, while also having physician's orders for narcotics to treat pain, (which contributes to risk for constipation), the facility failed to implement the bowel management protcol and failed to have monitored that Resident #108 had no documented bowel movements from 5/19/24 through 5/27/24.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure the use of an indwelling urinary catheter had a clinical indication for its use for one Resident (#105) out of seven applicable residents in a total sample of 23 sampled residents.

Inspectors wroteBased on observation, record review and interview the facility failed to adhere to professional standards for the administration of enteral feeding (nutrition taken through a tube directly to the stomach or small intestine) for one Resident (#91) out of a total sample of 23 residents. Specifically, the facility failed to implement the enteral feeding in accordance with the physician's order to receive the enteral feeding for 20 hours per day. Findings Include: Resident #91 was admitted to the facility in September 2022 with diagnoses that include dysphagia following cerebral infarction, gastrostomy tube and dementia. Review of Resident #91's Minimum Data Set (MDS) Assessment, dated 3/5/24, indicated he/she was unable to participate in the Brief Interview for Mental Status Exam and was assessed by staff has having severe cognitive impairment. [...]

Inspectors wroteBased on observation, record review, policy review, and interview, the facility failed to provide care and maintenance of a peripherally inserted central catheter (PICC), consistent with professional standards of practice for one Resident (#39), out of a total sample of 23 residents. Specifically, for Resident #39 the facility failed to ensure nursing completed a PICC line dressing change as ordered by the physician. Findings Include: Review of facility policy titled Central Venous Access Device Catheter Dressing Change, dated January 2022, indicated the following: -Policy: 4. dressing changes will occur according to the IV (intravenous) order and when the dressing is compromised (Drainage/ moisture observed, loose, soiled). -Procedure: 16. document site assessment and procedure (dressing change) in resident's medical record. [...]

Inspectors wroteBased on observation, interview, document review, and policy review, the facility failed to ensure an accurate account of a controlled medication was maintained. Specifically, the facility failed to ensure an accurate account of an Opioid; a Fentanyl patch (schedule II -controlled drug with a high potential for abuse, treats pain) was accurately maintained in the controlled substance accountability record book, as required, and failed to implement their policy for the potential discrepancy, loss and/or diversion of a controlled medication.

Inspectors wroteBased on observation, record review, policy review and interviews, the facility failed to provide special eating equipment and utensils for one resident (#101) out of a total sample of 23 residents. Specifically, for Resident #101, the facility failed to provide built-up utensils with foam during meal service. Findings Include: Review of facility policy titled Adaptive Eating Equipment, dated 2/12/24, indicated adaptive eating devices are pieces of equipment used by residents to enable them to achieve or maintain their highest practicable level of eating independence. The policy further indicated the Culinary Department sanitizes the utensils after each use and places the devices on the resident's tray as needed. [...]

Inspectors wroteBased on observation, record review and interview, the facility failed to maintain accurate medical records in accordance with professional standards and practices for one Resident (#39) out of a total sample of 23 residents. Specifically, for Resident #39 the facility inaccurately documented the changing of a peripherally inserted central catheter (PICC) dressing.

Inspectors wroteBased on observations and interviews, the facility failed to ensure that staff transported linens to prevent the spread of infection on one out of three units. Findings Include: On 5/29/24 at 7:15 A.M., the surveyor observed Certified Nursing Assistant (CNA) #5 exit a resident room on the Pentucket Unit with gloved hands carrying dirty, un-bagged linens and bring them into the dirty laundry room. On 5/29/24 at 7:17 A.M., the surveyor observed CNA #1 exit a resident room on the Pentucket Unit carrying dirty, un-bagged linen through the hallway and bring them into the dirty laundry room. On 5/29/24 at 7:37 A.M., the surveyor observed CNA #7 exit a resident room on the Pentucket Unit carrying dirty un-bagged linen through the hallway and bring them into the dirty laundry room. [...]

Inspectors wroteBased on record review, policy review and interview the facility failed to provide pneumococcal vaccination to two Residents (#101 and #93) who consented to receive the vaccine out of a five sampled residents. Specifically: 1. For Resident #93, the facility failed to administer the pneumococcal vaccine after the Resident/ Resident Representative signed the consent for the vaccine on 8/17/23. 2. For Resident #101, the facility failed to administer the pneumococcal vaccine after the Resident/ Resident Representative signed the consent for the vaccine on an undated form. Findings Include: [...]

Inspectors wroteBased on observation and interview, the facility failed to ensure a gap in the bed was filled to prevent possible entrapment for one Resident (#79) out of a total sample of 23 residents.

Inspectors wroteBased on observation and interview, the facility failed to ensure call lights were functional for one Resident (#38) out of a total of 23 sampled residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff assisting residents with meals completed required training. Specifically, on 5/30/24, Unit Secretary #1 assisted Resident #18, who has a diagnosis of dysphagia, with his/her breakfast meal without having training.

Inspectors wroteBased on record review and interview, the facility failed to ensure the Minimum Data Set (MDS) assessments were accurately completed to reflect the status of one Resident (#92) out of a total sample of 23 residents. Specifically, the facility failed to indicate on the MDS assessment that Resident #92 was on hospice services. Findings Include: Resident #92 was admitted to the facility in December 2023 with diagnoses that include chronic kidney disease, neoplastic (malignant) related fatigue and severe protein- calorie malnutrition. Review of Resident #92's most recent MDS indicated a Brief Interview for Mental Status (BIMS) score of 6 out of 15 indicating that the Resident has severe cognitive impairment. The MDS failed to indicate that Resident #92 was on hospice services. Review of Resident #92's physician orders indicated the following: -May be evaluated by Hospice, dated 4/10/24. [...]

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who was cognitively impaired, the Facility failed to implement and follow their Abuse Policy, when on 12/25/23, Certified Nurse Aide (CNA) #2 allegedly heard CNA #1 being verbally abusive towards Resident #1. CNA #2 reported the allegation to Nurse #1, who then reported the incident to Unit Manager #1, however, Unit Manager #1 did not report the incident to the Administrator immediately, per facility policy.