North Adams Commons Nursing & Rehabilitation Cente

Inspectors wroteBased on interview, record and policy review, the facility failed to ensure that its staff offered the Pneumococcal (infections caused by bacteria called Streptococcus Pneumoniae, or Pneumococcus that can cause Pneumonia and blood stream infections) Vaccination as recommended to four Residents (#25, #46, #84, and #55), out of five applicable residents, out of a total sample of 19 residents. Specifically, the facility failed to ensure that Pneumococcal Vaccinations were offered to, received by, or declined by Residents #25, #46, #84, and #55, at the time of admission or shortly thereafter, putting the Residents at risk for developing facility acquired Pneumonia.

Inspectors wroteBased on interview, record and policy review, the facility failed to ensure that one Resident (#84), out of five residents reviewed for unnecessary medications, out of a total sample of 19 residents, had a care plan developed for the use of an anticoagulant (anticoagulant or blood thinner medication used to prevent or treat blood clots in blood vessels and the heart) medication. Specifically, the facility failed to develop a care plan for Resident #84 for Eliquis (anticoagulant medication) that addressed the risks, potential side effects, and monitoring associated with the use of the medication.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to ensure that one Resident (#66) had a complete and accurate medical record, out of a total sample of 19 residents. Specifically, the facility failed to accurately monitor and document Resident #66's total fluid intake during a 24-hour period to ensure that he/she was maintaining the 1500 cubic centimeter (cc- unit of measure) Fluid Restriction ordered by the Physician, putting the Resident at increased risk of dehydration, fluid overload and other medical complications.

Inspectors wroteBased on interview and record review, the facility failed to ensure a Level I Preadmission Screening and Resident Review (PASRR- screen to determine if a resident has intellectual or developmental disabilities and/or serious mental illness and is in need of further evaluation) and a Level II PASRR (evaluation done if it was determined by the Level I screen that a resident had an intellectual or developmental disability and/or serious mental illness and if resident was in need of additional support services at the facility) for two Residents (#51 and #5) out of a total sample of 18 residents. Specifically, 1. For resident #51, the facility staff failed to complete a Level I PASRR screen prior to the Resident's admission, and 2. For Resident #5, facility staff failure to request a Level II PASRR evaluation when the Resident exceeded their 30-day convalescent care stay.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to develop and/or implement comprehensive person-centered care plans for two Residents (#1 and #79) out of a total sample of 18 residents. Specifically, the facility staff failed to: 1. For Resident #1, ensure implementation of a fluid restriction as ordered by the Physician, and 2. For Resident # 79, ensure a comprehensive cognitive care plan was developed, as required.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to provide Activities of Daily Living (ADLs-activities related to personal care) assistance for one dependent Resident (#18) out of a total sample of 18 residents. Specifically, facility staff failed to assist with grooming and nail care.

Inspectors wroteBased on interview and record review, the facility failed to provide treatment, consistent with professional standards of practice, to promote the healing of existing pressure ulcer/injuries (also known as pressure sores, pressure injuries, or bed sores: areas of localized damage to the skin and/or underlying tissue that usually occur resulting from prolonged pressure on a given area of the body) for one Resident (#48) out of a total sample of 18 residents. Specifically, the facility failed to implement dietary recommendations for treatment of a pressure ulcer.

Inspectors wroteBased on interview and record review, the facility failed to implement the recommendations of the facility Dietitian intended to improve the impaired nutritional status of one Resident (#64) out of a total sample of 18 residents. Specifically, the facility staff failed to ensure the Resident was ordered for Ensure Plus (a nutrition supplement) as recommended by the Dietitian.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide appropriate respiratory care and services for one Resident (#59) out of a total sample of 18 residents. Specifically, the facility staff failed to ensure that Resident #59's respiratory equipment was adequately maintained and replaced to prevent contamination and infection.

Inspectors wroteBased on observations, interviews, record and policy review, the facility failed to ensure its staff provided care consistent with professional standards of practice related to hemodialysis (dialysis - a treatment to filter waste and water from the blood) for one Resident (#14) out of a total sample of 18 residents. Specifically, the facility failed to ensure: 1. an individualized dialysis Physician's order was in place for hemodialysis treatments, and 2. appropriate equipment was in place to manage a possible hemorrhage from a dialysis access device (a way to reach the blood to perform hemodialysis).

Inspectors wroteBased on observation and interview, the facility failed to ensure medications used for wound care treatment were stored in such a way that only authorized persons had access to them on one unit (Unit Two) out of two units observed. Findings Include: Review of the facility policy titled Storage of Medications, revised 6/10/22, indicated the following: -Medication and biologicals are stored safely, securely, and properly .The medication supply is accessible only to licensed nursing personnel, pharmacy personnel. -Medication rooms, carts, and medication supplies are locked or attended by persons with authorized access. [...]

Inspectors wroteBased on record review and interview, the facility failed to maintain complete and accurate medical records, that were readily accessible for two Residents (#59 and #45) out of a total sample of 18 residents. Specifically, 1. For Resident #59, the facility staff failed to ensure Respiratory Therapist (RT) visit notes were included in the Resident's medical record, and 2. For Resident #45, the facility staff failed to ensure the Nurse Practitioner (NP) and Endocrinologist visit notes were included in the Resident's medical record.

Inspectors wroteBased on record review, policy review and interview, the facility failed to ensure the Pneumococcal Vaccine was offered and/or administered to three Residents (#74, #4, and #40) out of a sample of five residents.

Inspectors wroteBased on interview, record review, and policy review, the facility failed to offer, educate, and document whether COVID-19 booster vaccination was offered to one Resident (#4) out of a sample of five residents.