Mary Ann Morse Nursing & Rehabilitation

Inspectors wroteBased on records reviewed, interviews and observations for one of three sampled residents (Resident #1), who had been assessed as having moderately impaired cognition, the Facility failed to ensure he/she was provided with an adequate level of staff supervision to prevent an incident of elopement, when on 04/30/26 at 3:00 A.M., Resident #1 was able to exit his/her unit and the Facility, undetected by staff and was found on a loading dock of a neighboring Facility about 150 yards away. Resident #1 was transferred to the Hospital Emergency Department (ED) for evaluation.

Inspectors wroteBased on record and policy review, and interview, the facility failed to ensure that one Resident (#307) out of a total sample of 22 residents, was afforded the ability to review/sign documents pertaining to his/her medical care. Specifically, the facility failed to ensure that Resident #307, who was identified as his/her own person and was able to make his/her own decisions, was able to review and sign documentation relative to Advanced Directives (life sustaining measures), side rail consent, self-administration of medication consent and consent for the use of psychotropic medications.

Inspectors wroteBased on interview, record and policy review, the facility failed to ensure that Advance Directives (legal documents that provide instructions for medical care and only go into effect if you are unable to communicate your own wishes) were accurate for two Residents (#33 and #37) out of a total sample of 22 residents. Specifically, the facility failed to: 1. for Resident #33, ensure that the MOLST (Medical Orders for Life Sustaining Treatment: a form completed by the Resident to indicate their wishes for treatment to sustain their life in emergency situations in case they are not able to make their wishes known) was maintained as part of the Resident's active medical record and was accessible to facility staff in the event the Resident had a change in condition. 2. for Resident #37, ensure that the Physician's orders matched the Resident's current MOLST.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to provide treatment and services, consistent with professional standards of practice to prevent the development of pressure ulcers (localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device)/skin injuries for one Resident (#357) out of a total sample of 22 residents. Specifically, for Resident #357, the facility failed to ensure: 1. that a Licensed Nurse completed an assessment after a Certified Nurses Aide's (CNA) observation of an alteration to the Resident's skin which resulted in the development of pressure ulcers for the Resident. 2. that the Community Physician recommendation for a therapeutic air mattress/alternating pump pad mattress was reviewed with the facility Physician.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide appropriate treatment and interventions for three Residents (#72, #63, and #94) out of a total of 22 sampled residents, who were diagnosed with Dementia (a group of conditions characterized by impairment of at least two brain functions, such as memory and loss of judgment), to attain their highest practicable physical, mental, and psychosocial well-being. Specifically, the facility staff failed to: 1a. provide individualized interventions when Resident #72 and Resident #63 were engaged in verbal interactions and Resident #72 directed undignified statements toward Resident #63. 1b. [...]

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to ensure that residents were free of significant medication errors during the medication pass process for one Resident (#207) out of five residents observed, out of a total sample of 22 residents. Specifically, for Resident #207, the facility staff failed to administer the Sevelamer medication (phosphate binder -used to control high blood levels of phosphorus in people with chronic kidney disease who are on dialysis [the process of cleansing the blood by passing it through a special machine, necessary when the kidneys are unable to filter the blood]) timely and with meals as required.

Inspectors wroteBased on interview, policy and record review, the facility failed to maintain complete and accurate medical records for one Resident (#81), out of a total sample of 22 residents. Specifically, For Resident #81, the facility failed to: -maintain accurate documentation of advanced directives (legal documents that provide instructions for medical care and only go into effect if you are unable to communicate your own wishes) when the MOLST (Massachusetts Medical Orders for Life-Sustaining Treatment) form was not signed by the Resident. [...]

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to adhere to infection control standards to prevent the potential transmission of communicable diseases and infections within the facility on two Units (Birch and Cedar) out of three total Units. Specially, the facility failed to ensure: 1. On the Cedar Unit, that staff utilized the indicated Personal Protective Equipment (PPE-items such as gowns, gloves, etc. worn to protect the wearer for exposure to potential infection or from exposing the care recipient to potential infection) while caring for a Resident (#357) on Enhanced Barrier Precautions (EBP - protective barrier gowns and gloves used as an infection control intervention designed to reduce transmission of multi-drug-resistant organisms [MDROs] during high contact resident care). 2. [...]

Inspectors wroteBased on interview, record and policy review, the facility failed to ensure that Pneumococcal (any infection caused by bacteria called Streptococcus Pneumoniae, or Pneumococcus that can range from ear and sinus infections to Pneumonia and blood stream infections) Vaccinations were offered to three Residents (#72, #33, #2) out of five applicable residents, out of a total sample of 22 residents, increasing the residents risk for developing facility acquired Pneumococcal infections. Specifically, the facility failed to: 1. Offer Resident #72 an updated Pneumococcal Vaccine when the Resident was not up to date and was eligible to receive an updated vaccine. 2. Offer Resident #33 an updated Pneumococcal Vaccine when the Resident was not up to date and was eligible to receive an updated vaccine. 3. [...]

Inspectors wroteBased on interview, record and policy review, the facility failed to provide education regarding the benefits and potential risks associated with COVID-19 vaccines for three Residents (#33, #2, and #81), out of five residents reviewed for immunizations, out of a total sample of 22 residents. Specifically, the facility failed: 1. For Resident #33, to provide education regarding the benefits and risks and potential side effects associated with the COVID-19 vaccine prior to administration of the vaccine. 2. For Resident #2, to provide education regarding the benefits and risks and potential side effects associated with the COVID-19 vaccine prior to administration of the vaccine. 3. For Resident #81, to provide education regarding changes in the benefits and risks of additional COVID-19 vaccination doses.

Inspectors wroteBased on record review and interview, the facility failed to ensure that a Minimum Data Set (MDS) Assessment was accurately coded for four Residents (#72, #33, #2, #357) out of a total sample of 22 residents. Specifically, the facility failed to accurately code: 1) For Resident #72, that Pneumonia Vaccination was not up to date. 2) For Resident #33, that Pneumonia Vaccination was not up to date. 3) For Resident #2, that Pneumonia Vaccination was not up to date. 4) For Resident #357, identify the type of urinary catheter in use.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who was moderately cognitively impaired, with hearing, vision and communication deficits, the Facility failed to ensure he/she was free from the use of physical restraints, when on 02/10/24 during the overnight shift, the Nursing Supervisor held Resident #1 by his/her wrists as he/she displayed combative behavior with staff while they tried to meet his/her care needs.

Inspectors wroteBased on policy review, observation, record review and interview, the facility failed to ensure its staff provided treatments in accordance with professional standards of practice for three Residents (#203, #204 and #207) out of a total sample of 21 residents. Specifically, 1. For Resident #203, the facility failed to ensure that its staff removed a post operative dressing in a timely manner, as ordered by the Physician, which resulted in a deterioration of the surgical incision. 2. For Resident #204, the facility failed to ensure that its staff obtained Physician's orders for the application of an ace wrap bandage to the right lower extremity, and the frequency of which to change it. 3. [...]

Inspectors wroteBased on observation, document review and interview, the facility failed to ensure that staff: 1. Maintained appropriate sanitation of dishware as evidenced by the dish machine not having the required final rinse temperatures. 2. Stored food in accordance with professional standards for food service safety.

Inspectors wroteBased on observation, policy review, record review and interview, the facility failed to maintain infection surveillance for three out of three applicable Residents (#14, #22 and #85) for signs and symptoms of COVID-19 during a facility outbreak.

Inspectors wroteBased on interview and record review, the facility failed to provide the required notification to the Office of the State Long-Term Care Ombudsman for two Residents (#33 and #45), when they were transferred to the hospital. Specifically, the facility staff failed to provide evidence that the required Ombudsman notification was completed as required for Resident's #33 and #45.

Inspectors wroteBased on observation, record review and interview, the facility failed to provide Activities of Daily Living (ADL- basic care tasks that an individual does on a day to day basis such as eating, bathing, dressing, grooming and mobility) for one Resident (#91) out of a total sample of 21 residents. Specifically, the facility staff failed to provide grooming services for a resident who was dependent for ADLs.

Inspectors wroteBased on policy review, record review and interview, the facility failed to provide care and services for an ileostomy (a surgically made opening that connects the lower end of the small intestine [ileum] to the abdominal wall. Through the abdominal wall opening, or stoma, the lower intestine is stitched into place. A wafer (dressing that surrounds the stoma) is then applied to the surrounding skin and allows for a bag to be attached to collect stool) appliance, for one Resident (#205), out of two applicable residents, in a total sample of 21 residents.