Life Care Center of Acton

Inspectors wroteBased on record review, and interview, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment, and to prevent the development and potential transmission of communicable diseases and infections. Specifically, the facility failed to ensure that water testing for Legionella was completed at least annually placing facility residents at risk for exposure to Legionella Bacterium (bacteria which lives in fresh water and can cause pneumonia-like or flu-like illnesses).

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure proper treatment relative to the Resident's vision was obtained in a timely manner for one Resident (#6) out of a total sample of 24 residents. Specifically, the facility failed to assist Resident #6 in scheduling a follow-up ophthalmology appointment for greater than seven months, after the Resident was evaluated and recommendation made by the Ophthalmologist for cataract surgery to his/her left eye, increasing the Resident's risk for further visual decline.

Inspectors wroteBased on record review, policy review, and interview, the facility failed to provide mental health services for two Residents (#60 and #2) out of a total sample of 25 residents, with a documented history of mental health concerns. Specifically, the facility failed to ensure its staff: 1. followed the facility Suicidal Precaution policy when Resident #60 had expressed suicidal ideation to staff members. 2. provided timely Behavioral Health Services for Resident #2 who was expressing multiple depressive symptoms during the comprehensive assessment.

Inspectors wroteBased on interview, record review, and policies reviewed, the facility failed to offer the Pneumococcal Vaccination as recommended to two Residents (#2 and #50) out of five applicable residents, in a total sample of 25 residents, putting the Residents at risk for developing facility acquired Pneumonia. Specifically, the facility failed to ensure that: 1. Resident #2 was offered an updated Pneumococcal vaccination within the appropriate timeframe as indicated by the CDC (Centers for Disease Control). 2. Resident #50 was offered any Pneumococcal vaccination after admission to the facility.

Inspectors wroteBased on interview and record review, the facility failed to ensure a Level II [comprehensive evaluation that identifies the specialized services required] Preadmission Screening and Resident Review (PASRR- 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) was submitted for one Resident (#48) out of a total sample of 25 residents. Specifically, for Resident #48, the facility staff failed to request a Level II PASRR evaluation when the Resident demonstrated an increase in behavioral, psychiatric, and mood-related symptoms resulting in a change to the Resident's plan of care. Findings Include: Review of the facility policy for Pre-admission Screening and Resident Review; [...]

Inspectors wroteBased on observation, policy review, record review, and interview, the facility failed to ensure its staff provided necessary treatment and services, according to professional standard of practice, to promote healing of a facility acquired (FA) deep tissue pressure injury (DTPI- persistent non-blanchable deep red, maroon or purple discoloration resulting from intense and/or prolonged pressure and shear forces at the bone-muscle interface) for one Resident (#15) out of two applicable sampled residents, out of 22 total sampled residents. Specifically, the facility failed to ensure its staff: [...]

Inspectors wroteBased on observation, policy review, and interview, the facility failed to ensure its staff maintained a clean and sanitary environment in the kitchen where food items were stored and prepared for resident consumption. The facility also failed to ensure its staff adhered to food storage requirements in one of two nourishment kitchens and for one medication room refrigerator. Specifically, the facility failed to ensure its staff: 1) maintained equipment used for meal preparation that was clean and sanitary, 2) discarded outdated food items stored for resident consumption in the central nourishment kitchen freezers, and 3) monitored the temperature in one medication room refrigerator where resident food items were stored.

Inspectors wroteBased on record review and interview, the facility failed to ensure that its staff honored the rights of one Resident (#2) to formulate advanced directives (an individual's wishes regarding medical treatment), out of a total sample of 22 residents. Specifically, the facility staff executed a Medical Order for Life-Sustaining Treatment (MOLST - a medical order form that converts an individual's wishes regarding life-sustaining treatment into medical orders) form with the Resident's Representative, when the Resident continued to be capable of making their own health care decisions.

Inspectors wroteBased on record review, policy review, and interview, the facility failed to ensure its staff notified one Resident's (#15) responsible party of deterioration in the Resident's physical condition, out of 22 sampled residents. Specifically, the facility failed to ensure its staff notified the Resident's appointed guardian of: a) deterioration of the Resident's right heel wound and change in treatment ordered by the Physician when the wound was identified to have deteriorated, and b) a change in skin condition to the Resident's sacrum (bony structure at the base of the spine/ backbone) that required a new treatment intervention to commence.

Inspectors wroteBased on record review and interview, the facility failed to ensure that its staff completed a quarterly Minimum Data Set (MDS) assessment in a timely manner, for two Residents (#4 and #57), out of 22 sampled residents.

Inspectors wroteBased on record review and interview, the facility failed to ensure that its staff accurately coded Minimum Data Set (MDS) assessments for two Residents (#15 and #2). Specifically, the facility failed to ensure its staff coded: 1) Resident #15's deep tissue pressure injury (DTPI - persistent non-blanchable deep red, maroon or purple discoloration resulting from intense and/or prolonged pressure and shear forces at the bone-muscle interface) when the Resident had developed a DTPI during the observation period for the MDS assessment, and 2) Resident #2's fall that was sustained since the prior MDS assessment.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure its staff developed and implemented a comprehensive care plan for one Resident (#304) with a gastrostomy tube (G-tube - a tube that is placed directly into the stomach through an abdominal wall incision for the enteral administration of food, fluids and medication), out of a total sample of 22 residents. Specifically, the facility staff failed to: 1) develop a comprehensive care plan relative to weight monitoring, and 2) implement Physician orders relative to documentation of gastric residual volume (GRV- the volume of stomach contents that can be aspirated through the G-tube using a syringe).

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure its staff provided audiology services for one Resident (#77) out of 22 sampled residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure its staff provided appropriate care and services to one Resident (#304) with a gastrostomy tube (G-tube- a tube that is placed directly into the stomach through an abdominal wall incision for the enteral administration of food, fluids and medication), out of one applicable sampled resident, out of a total sample of 22 residents. Specifically, the facility staff failed to: 1) verify proper placement of a G-tube prior to administering medications, and 2) administer medications via a G-tube according to facility policy and professional standards.

Inspectors wroteBased on observation, record review, policy review, and interview, the facility and its staff failed to ensure the care and treatment of a tracheostomy (a surgical opening that is made through the front of the neck into the windpipe) was provided in accordance with facility policy/protocols and professional standards of practice for one Resident (#13), out of one applicable sampled resident, out of a total sample of 22 residents. Specifically, the facility failed to provide emergency bedside tracheostomy equipment needed in the event of accidental decannulation (the unexpected removal of a tracheostomy tube) or mucus plugging (buildup of thick mucus).

Inspectors wroteBased on observation, policy review, record review, and interview, the facility failed to ensure its staff accurately assessed one Resident (#57) for the risk of entrapment from bed rails, out of 22 sampled residents.