Life Care Center of Nashoba Valley

Inspectors wroteBased on observation, record review and interview the facility failed to ensure a comprehensive person-centered care plan with individualized interventions was developed for one Resident (#79), out of three residents reviewed for Activities of Daily Living (ADLS), out of a total sample of 23 residents.

Inspectors wroteBased on record review and interview, the facility failed to ensure for 1 Resident (#3), out of a total sample of 23 residents, that the care plans were revised to reflect a resident's status. Specifically, -For Resident #3 the care plan for anticoagulant medication (a medication used to prevent blood clots from forming in the bloodstream) was not revised to reflect the current anticoagulation treatment.

Inspectors wroteBased on record review and interview, the facility failed to ensure for 2 Residents (#19 and #79), out of 5 applicable residents, out of a total sample of 23 residents, that the consulting pharmacist's monthly medication regimen review recommendations were conveyed to the provider (physician/nurse practitioner) and acted upon timely.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure that medication was stored in accordance with professional standards of practice. Specifically, a medication used to treat hemorrhoids was left on a bureau in Resident #113's room and not secured over three days.

Inspectors wroteBased on observation, record review, and interview the facility failed to ensure that dignity was maintained for residents during dining on one unit, (designated as a Dementia Special Care Unit), out of three resident care units.

Inspectors wroteBased on observation, record review and interview the facility failed to ensure one Resident (#92), out of a total sample of 25 residents, was assessed for the use of a possible physical restraint. Specifically, Resident #92 wore a one- piece outfit adjacent to his/her body and zippered up the back.

Inspectors wroteBased on record review and interview the facility failed for one Resident (#75), out of a sample of 25 residents, to convey to the receiving provider the necessary information to care for the resident. Review of the facility's policy titled 'Transfers and Discharges' dated as revised 6/28/2024 indicates Policy: the facility will follow limited conditions under which CMS (Centers of Medicare and Medicaid) has outlined how the facility may initiate transfer or discharge of a resident, the documentation that must be included in the medical record, and who is responsible for making he documentation. Additionally, the facility will ensure the information that must be conveyed to the receiving provider for residents being transferred or discharged to another health care setting is provided in accordance to federal guidance. [...]

Inspectors wroteBased on observation, record review and interviews, the facility failed to ensure professional standards of practice were followed for one Resident (#19) out of a total sample of 25 residents. Specifically, the facility failed to ensure nurses were not leaving medications with the Resident without proper assessment, and ensuring a physician order was in place for medication administration.

Inspectors wroteBased on observations, record review and interview the facility failed to ensure for one Resident (#55) that care was provided in accordance to the plan of care. Specifically, Resident #55 was not provided supervision by staff during his/her breakfast meals.

Inspectors wroteBased on observation, record review and interview for one Resident (#12), out of a total sample of 25 residents, the facility failed to ensure interventions were implemented in accordance with the medical plan of care. Specifically, the bed alarm for Resident #12, who was assessed by nursing as being a high risk for falls was not in use while Resident #12 was in bed.

Inspectors wroteBased on observation and interview, the facility failed to appropriately use gloves in a sanitary manner during the lunch time meal service.

Inspectors wroteBased on observation, record review and interviews, the facility failed to revise the resident centered care plans for 2 Residents (#11 and #35) out of a total sample of 25 residents. Specifically, 1) for Resident #11 the care plan for risk for falls was not revised and 2) for Resident #35, the facility failed to revise his/her care plan for the use of a bed alarm.

Inspectors wroteBased on observation, record review, and interview the facility failed to implement the physician ordered treatment of a right heel pressure injury for 1 Resident (#97) out of a total sample of 25 residents. Findings Include: Resident #97 was admitted to the facility in June 2022 with a diagnosis of muscle weakness. Review of the Minimum Data Set (MDS), dated [DATE], indicated that Resident #97 scored a 12 out of 15 on the Brief Interview for Mental Status (BIMS), which indicates moderate cognitive impairment. Further review of the MDS indicated Resident #97 requires extensive assist of two persons for bed mobility. Review of Resident #97's physician orders indicated the following order initiated on 2/1/23: *Apply Bilat LE (both lower extremity) prevalon boots (pressure relieving, heel protecting boots) while in bed. [...]

Inspectors wroteBased on record review and interview, the facility failed to 1. ensure recommendations from the Monthly Medication Review, conducted by the pharmacist, were addressed and implemented for 2 Residents (#89 and #11) and 2. ensure the monthly drug regimen review by a licensed pharmacist, reported to the physician, the use of a PRN (as needed) psychotropic medication was limited to 14 days for 1 Resident (#91), out of a total sample of 25 residents.

Inspectors wroteBased on record review and interview the facility failed to ensure for one Resident (#91) out of seven applicable residents in a total sample of 25 residents, that a PRN (as needed) order for clonazepam (an antianxiety medication) was limited to 14 days and was not renewed unless the attending physician or prescribing practitioner evaluated the resident for the appropriateness of the medication.