Leominster Rehabilitation and Nursing Center

Inspectors wroteBased on observations and interviews the facility failed to ensure staff stored drugs and biologicals in accordance with State and Federal requirements. Specifically,1. The facility failed to ensure that medications were dated once opened, according to manufacturer's guidelines in two of two medication carts observed.2. The facility failed to ensure medication and treatment carts were locked while a nurse was not present on all units.

Inspectors wroteBased on observation and interview the facility failed to maintain a clean and comfortable home like environment for one Resident (#40) out of a total sample of 21 residents. Specifically, Resident #40's privacy curtain was soiled with a blood-like substance.

Inspectors wroteBased on observation, record review and interview the facility failed to develop a plan of care for one Resident (#29) and failed to implement a plan of care for two Residents (#4 and #51) out of a total sample of 21 residents. Specifically:1. For Resident #29 the facility failed to develop a plan of care for a pacemaker.2. For Resident #4 the facility failed to implement a physician's order for the use of a low air loss mattress.3. For Resident #51 the facility failed to implement a physician's order for a soft blue boot to the left foot.

Inspectors wroteBased on observation, record review and interview, the facility failed to implement Occupational Therapy (OT) recommendations for one Resident (#47) for the treatment of a contracture to the left hand. Specifically, the facility failed to implement the use of an orthotic device for the maintenance and treatment of a contracture.

Inspectors wroteBased on record review and interview, the facility failed to complete a trauma screen and develop a comprehensive trauma care plan related to Post Traumatic Stress Disorder (PTSD) that identified triggers and interventions for one Resident (#40) out of a total of 21 sampled Residents.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1) who had an indwelling catheter and whose Physician's orders included daily irrigation of the indwelling catheter, the Facility failed to ensure Resident #1 was provided with catheter care including but not limited to catheter irrigation, in accordance with his/her Physician's orders.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1) who had a gastrostomy tube (G-tube, placed through the abdomen into the stomach, for feedings, liquids and medications) in place to meet his/her nutritional and fluid intake needs, and whose physician's orders included specific administration rates and volumes for formula feeds and water flushes, the Facility failed to ensure that Resident #1 was provided with appropriate treatment and services when Resident #1 was administered formula feeds and flushes at an incorrect rate and volume.

Inspectors wroteBased on interview, record review, and review of the Facility Assessment Tool, the facility failed to ensure that Licensed Nurses (#6, #1, #5, and #4) had the specific competencies and skill sets to care for the needs of one Resident (#372) relative to nephrostomy tube (a thin flexible tube that is surgically inserted through the skin, into the kidney and drains urine into a bag outside the body) care. Specifically, facility staff failed to ensure Licensed Nurses were assessed for competency to care for nephrostomy tubes when: -Resident #372 was admitted to the facility with bilateral (right and left side) nephrostomy tubes. [...]

Inspectors wroteBased on record reviewed and interview, the facility failed to ensure that the Director of Nursing (DON) did not serve as the Charge Nurse when the facility had an average daily occupancy of greater than 60 residents. Specifically, the facility failed to ensure the DON did not serve as Charge Nurse, providing direct resident care, when the facility's daily occupancy was greater than 60 residents: -on four dates during the Quarter Three (April 1, 2024 through June 30, 2024) Payroll Based Journal (PBJ) Staffing Data Report period where the facility reported excessively low weekend staffing. -on three dates over the four week time frame prior to the survey start date of 9/6/24.

Inspectors wroteBased on interview, policy and record review, the facility failed to provide one Resident (#59), out of a total sample of 17 residents, the right to participate in their plan of care. Specifically, the facility failed to inform Resident #59 in advance of a medication treatment and the risks and benefits of the medication when the Resident was prescribed a new anti-psychotic (type of medication used to treat symptoms of psychosis including hallucinations [sights, sounds, smells, tastes, or touches that a person believes to be real but are not real] and delusions [false beliefs]) medication.

Inspectors wroteBased on record review and interview, the facility failed to notify the Physician of a significant change in condition for one Resident (#16), out of a total sample of 17 Residents. Specifically, the facility staff failed to notify the Physician/Nurse Practitioner (NP) so treatment could be altered when Resident #16 was identified with significant weight loss by the Registered Dietician.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to ensure the plan of care was assessed and revised for two Residents (#6, #21) and that a care plan meeting was held for one Resident (#59), out of a total sample of 17 residents. Specifically, the facility staff failed to: 1. For Resident #6, assess and revise the Resident's Care Plan to include measurable goals for falls prevention after the Resident sustained a fall. 2. For Resident #21, obtain a Physician order and revise the Resident's Care Plan to include the use of mattress bolsters and floor mats after the Resident sustained a fall. 3. For Resident #59, provide evidence that an interdisciplinary care plan meeting was held, or that the Resident had participated in the care planning process following an MDS assessment completed on 4/18/24.

Inspectors wroteBased on record review and interview, the facility failed to provide services that met professional standards of quality for one Resident (#25), out of a total sample of 17 residents. Specifically, the facility staff failed to transcribe (to put into written word or print) a verbal order (a Physician order that is received in person via spoken word or over the telephone) for a medication change into the medical record, resulting in the verbal order not being implemented and Resident #25 not receiving an updated medication as ordered by the Physician.

Inspectors wroteBased on observation, interview, policy and record review, the facility failed to provide activities to meet the needs of one Resident (#28), out of a total sample of 17 residents. Specifically, the facility failed to provide activities of interest for Resident #28 based on their plan of care, comprehensive assessment, and preferences.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to provide an environment was free of accidental hazards, relative to swallowing safety during one meal for one Resident (#10) out of a total sample of 17 residents. Specifically, facility staff failed to provide Resident #10 with necessary interventions, in accordance with the Resident's plan of care, to ensure the Resident's safety while eating his/her breakfast meal when the Resident had a diagnosis of Dysphagia (difficulty swallowing), required staff assistance for securing his/her dentures in place, and required verbal cues for safety while eating, which increased the Resident's risk for choking.

Inspectors wroteBased on interview, record and policy review, the facility failed to provide appropriate care and services for a nephrostomy tube (a thin flexible tube that drains urine from the kidney into a bag outside the body) according to professional standards of practice for one Resident (#372), out of a total sample of 17 residents. Specifically, the facility staff failed to flush Resident #372's nephrostomy tubes as ordered by the Physician to prevent blockage and increased risk of infection.

Inspectors wroteBased on interview, policy and record review, the facility failed to provide appropriate treatment and services to attain the highest practicable mental and psychosocial well-being for one Resident (#59), out of a total sample of 19 residents. Specifically, the facility failed: -to develop an individualized care plan to address the emotional and psychosocial needs of Resident #59, -to monitor and provide ongoing assessment as to whether the care approaches were meeting the emotional and psychosocial needs of the Resident after he/she experienced Suicidal Ideation (SI- verbal expressions of thoughts of harming oneself that may or may not lack specific intent), and -to review and revise the Resident's care plan after expression of SI, hospitalization, and re-admission to the facility.

Inspectors wroteBased on policy and record review, and interview, the facility failed to review and address the Pharmacist Medication Review recommendations for two Residents (#6 and #56), out of a total sample of 17 residents. Specifically, the facility failed to: 1. For Resident #6, verify and/or confirm that the Pharmacist recommendations were reviewed or addressed. 2. For Resident #56, verify and/or confirm that the Pharmacist recommendations were reviewed or addressed.

Inspectors wroteBased on interview, policy and record review, the facility failed to ensure that one Resident (#59), out of a total sample of 17 residents, was free from the risks of side effects resulting from the unnecessary use of psychotropic medications. Specifically, the facility failed to ensure that appropriate monitoring for adverse consequences and side effects via an Abnormal Involuntary Movement Scale (AIMS) assessment (a clinical outcome checklist completed by a healthcare Provider to assess the presence and severity of adverse outcomes, such as abnormal movements of the face, limbs, and body) was completed timely in accordance with standards of practice.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain complete and accurate medical records in accordance with accepted professional standards and practices for one Resident (#14), out of a total sample of 17 residents. Specifically, the facility staff failed to document medicated lotion treatments administered to Resident #14's lower extremities as ordered by the Physician.

Inspectors wroteBased on observation, interview, policy and record review, the facility failed to maintain an infection prevention and control program to help prevent the development and transmission of communicable diseases and infections for three Residents (#14, #42 and #45) out of a total sample of 17 residents. Specifically, the facility failed to: 1. implement Enhanced Barrier Precautions (EBP - infection prevention practice of wearing gown and gloves to reduce transmission of multi-drug resistant organisms [MDRO's-resistant bacteria that are resistant to three or more types of antimicrobial drugs] during high contact [touching] Resident care for Resident #14 as ordered by the Physician. 2. [...]

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who had severe cognitive impairment, the Facility failed to ensure he/she was treated in a dignified and respectful manner, when on 07/31/24, Certified Nurse Aide (CNA) #1 sat next to Resident #1, with her legs outstretched crossed, raised and extended on top of Resident #1's lap, across both armrests of his/her wheelchair, and enticed him/her to play with her legs and hair to keep him/her calm.

Inspectors wroteBased on observation, records reviewed, and interviews, for one of three sampled residents (Resident #1) who had severe cognitive impairment, the Facility failed to ensure Resident #1 was free from the use of a physical restraint when Facility staff failed to assess whether or not the use of a concave mattress and bed rails on his/her bed, prevented him/her from getting out of his/her bed.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1) who had severe cognitive impairment and had been repeatedly attempting to stand unassisted, the Facility failed to ensure they reported an allegation of abuse by use of a restraint by a staff member, to the Massachusetts Department of Public Health (DPH), when after being notified by the Director of Social Services, the Director of Nurses witnessed Certified Nurse Aide (CNA #1 sitting next to Resident #1 (who was seated in his/her wheelchair) with her legs raised, crossed and extended across his/her lap, with her legs positioned across both of the armrests to Resident #1's wheelchair.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who had severe cognitive impairment and was dependent on staff to meet his/her care needs, the Facility failed to ensure that after being made aware on 07/31/24 of an allegation of a possible restraint, that they obtained and maintained evidence that a thorough investigation was completed.

Inspectors wroteBased on observation, records reviewed, and interviews for one of three sampled residents (Resident #1), who had severe cognitive impairment and was dependent on staff for care, the Facility failed to ensure a Bed Rail Entrapment Assessment was completed prior to putting two quarter rails in the upright position while he/she was in bed.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who had severe cognitive impairment and was dependent on staff for care, the Facility failed to ensure he/she was free from physical abuse and mental anguish, when on 06/11/24 during the evening shift (3:00 P.M. to 11:00 P.M), Resident #1 refused to transfer to bed, he/she became combative with staff and in response, Certified Nurse Aide (CNA) #1 physically restrained Resident #1, to which Resident #1 said stop, you're hurting me! CNA #1 yelled at Resident #1 telling him/her he was the captain, and forced Resident #1 to transfer into bed against his/her will.

Inspectors wroteBased on records reviewed and interviews, for one of one sampled Employee Files, the Facility failed to ensure staff implemented and followed their Abuse Policy when a Criminal Offender Record Inquiry (CORI) was not conducted on Certified Nurse Aide (CNA) #1 prior to his date of employment at the Facility as required, and in accordance with the Facility's Abuse Policy.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who had an indwelling urinary catheter (a flexible tube used to empty the bladder and collect urine into a drainage bag), the Facility failed to ensure nursing developed an individualized comprehensive care plan with interventions, treatment goals and outcomes that addressed his/her risk for complications associated with an indwelling urinary catheter.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who had a pressure injury (injury to skin and underlying tissue resulting from prolonged pressure on the skin) to the coccyx and an indwelling urinary catheter (a flexible tube used to empty the bladder and collect urine into a drainage bag), the Facility failed to ensure they maintained a complete and accurate medical record when nursing failed to transcribe his/her wound care orders and indwelling urinary catheter care orders, in a timely manner, upon readmission to the Facility.

Inspectors wroteBased on record review and interview, the facility failed to inspect all resident beds annually for the 2022 year, including mattresses, frames, and bedrails for possible areas of entrapment as required.

Inspectors wroteBased on record review, policy review, and interview, the facility failed to complete a thorough background screening for one staff member (Nurse #1), out of three sampled staff members, prior to Nurse #1's employment start at the facility. Specifically, the facility failed to complete a criminal background check or Professional Nurse License Check for Nurse #1 before the Nurse began working at the facility on a resident unit.

Inspectors wrote1b. The facility failed to ensure its staff comprehensively assessed Resident #170's cognitive patterns and mood on one MDS Assessment, when the Resident was identified as having adequate hearing, usually understood others, and was sometimes understood. Review of Resident #170's MDS Assessment, dated 5/17/23, Section B, indicated the Resident had adequate hearing, usually understood others, and was sometimes understood. Further review of Sections C (Cognitive Patterns) and D (Mood) indicated : Not Assessed. During an interview on 6/22/23 at 11:34 A.M., the MDS Coordinator said staff were required to assess cognitive patterns and mood on the MDS assessment for residents who usually understood others and were usually understood. [...]

Inspectors wroteBased on record review and interview, the facility failed to notify the Physician and the Resident's Responsible Party/ family member in a timely manner, of the unavailability and multiple missed doses of the anxiolytic (anti-anxiety) medication for one Resident (#271), out of a total sample of 18 residents. Specifically, the facility staff failed to: -Notify the Physician and the Responsible Party/ family member when multiple missed doses of prescribed anti-anxiety medication, Klonopin was not administered to Resident #271.

Inspectors wroteBased on record review, policy review, and interview, the facility failed to implement the facility's policies relative to abuse reporting. Specifically, the facility staff failed to immediately report two incidents of resident to resident altercations, involving three Residents (#170, #30, and #19), but not later than two hours after the altercations occurred.

Inspectors wroteBased on record review and interview, the facility failed to develop a Baseline Care Plan within 48 hours of admission for one Resident (#18), out of a total sample of 18 residents.

Inspectors wroteBased on observations, interview and record review, the facility failed to provide Activities of Daily Living (ADLs-bathing, dressing, grooming) care for one Resident (#42), out of a total sample of 18 residents. Specifically, the facility staff failed to ensure Resident #42 was provided grooming per his/her preference/comfort.

Inspectors wroteBased on record review and interview, the facility failed to provide an environment free of accidental hazards for one Resident (#170), out of a total sample of 18 residents. Specifically, for Resident #170, the facility staff failed to: -provide adequate supervision and assistance when the Resident was identified at risk for elopement, and had eloped from the facility. -investigate the elopement incident, and review and implement interventions to reduce further episodes of wandering/attempts to elope.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure dialysis (a process by which waste substances are removed from a patient's body) care and services were provided for one Resident (#121), out of one applicable resident who receive dialysis, out of a total sample of 18 residents. Specifically, the facility failed to ensure that its staff: A. Coordinated timing of medication administration around the Resident's dialysis schedule. B. Maintained an ongoing communication record with the Dialysis clinic.

Inspectors wroteBased on observation, interview and record review, the facility failed to assess and provide individualized interventions for two Residents (#30 and #121), out of four applicable residents, out of a total sample of 18 residents. Specifically, the facility failed to assess and provide interventions for Resident's #30 and #121 who were identified as having Post Traumatic Stress Disorder (PTSD- a mental health condition that is triggered by an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual's functioning and mental, physical, social, emotional, or spiritual well-being), in order to mitigate and eliminate potential triggers that may cause re-traumatization.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the staff provided appropriate treatment/services for one Resident (#30), out of a total sample of 18 residents, who was identified as having Post Traumatic Stress Disorder (PTSD) and was exhibiting signs/symptoms related to his/her possible trauma.

Inspectors wroteBased on record review and interview, the facility failed to ensure that one Resident (#271), out of a total sample of 18 residents, was free of significant medication errors per facility policy and professional standards. Specifically, the facility failed to administer 15 doses of an anxiolytic (anti-anxiety) medication as ordered by a Physician for a total of eight days.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure the required staff attended the scheduled quarterly Quality Assurance and Performance Improvement (QAPI) Program Meetings, as required.