Northwood Rehabilitation & Health Care Center

Inspectors wroteBased on observations and interview, the facility failed to provide each resident with an over the bed table on 1 out of 3 units. Specifically, the C unit had tray tables for only 19 of the 41 beds available on the floor.

Inspectors wroteBased on observations, record review and interviews, the facility failed to provide assistance with Activities of Daily Living (ADLs) for dependent residents for five Residents (#66, #47, #52, #12 and #79) out of a total sample of 27 residents. Specifically:For Resident #66 the facility failed to provide timely incontinence care. For Residents #47, #52 and #12, the facility failed to provide supervision with meals as indicated in the Resident's plan of care. For Resident #79, the facility failed to ensure facial hair was being shaved.

Inspectors wroteBased on record review and interviews, the facility failed to notify the Registered Dietitian and Physician of a significant change in nutritional status for one Resident (#12) out of a total sample of 27 residents.

Inspectors wroteBased on observations, record review, and interviews, the facility failed to ensure one Resident (#66) was free from neglect out of a total sample of 27 residents. Specifically, for Resident #66, the facility neglected to provide the necessary care for incontinence management.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure one Resident (#52) was assessed for and free from restraints, out of a total sample of 27 residents.

Inspectors wroteBased on interview and record review, the facility failed to implement policies and procedures for neglect by a staff member for one Resident (#66), out of 27 residents. Specifically, the facility failed to implement written policies and procedures related to the timely reporting of neglect and removal of the alleged perpetrator from the unit.

Inspectors wroteBased on observation, record review and interviews, the facility failed to develop and implement person centered care plans for two Residents (#52 and #45), out of a total sample of 27 residents. Specifically, the facility failed:1. For Resident #52, a. to develop a care plan for the use of a scoop mattress,b. to implement a personalized care plan for the use of two staff during activities of daily living, andc. to implement a personalized care plan for the use of a pressure relieving device; and2. For Resident #45, to develop and implement an individualized behavioral care plan.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure physician's orders were implemented for two Residents (#40, #10), out of a total of 27 sampled residents. Specifically, the facility failed:1. For Resident #40, to ensure he/she received two tablets of Lactaid as ordered by the physician; and2. For Resident #10, to ensure a wander guard (a bracelet and monitor placed on a resident who is at risk for elopement, that is part of an alarm system to alert staff if a Resident is attempting to exit a unit or facility) was in place per the physician's order. Review of the facility's policy titled Self-Administration of Medications Policy, dated July 2015, indicated: [...]

Inspectors wroteBased on observation, record review and interviews, the facility failed to implement an activity program of choice for one Resident (#12) out of a total sample of 27 residents.

Inspectors wroteBased on observations, record review and interview, the facility failed to ensure that one Resident (#52) received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the Resident's choices out of a total sample of 27 residents. Specifically, the facility did not provide a left-hand splint for Resident #27 to use for contracture management.

Inspectors wroteBased on observations, record reviews and interviews, the facility failed to implement fall interventions to potentially prevent falls for two Residents (#52 and #22) out of a total sample of 27 residents.

Inspectors wroteBased on observations, interviews and record review, the facility failed to maintain professional standards in the management and care for urinary catheter devices for one Resident (#81) out of a total sample of 27 residents. Specifically, the facility failed to ensure the urinary catheter drainage bag was not placed in direct contact with the floor.

Inspectors wroteBased on record review and interviews the facility failed to provide nutritional intervention for one Resident (#12) with a significant weight loss out of a total sample of 27 residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care and maintenance of a Peripherally Inserted Central Catheter (PICC: a flexible tube inserted through a vein in one's arm and passed through to the larger veins near the heart, used to deliver medications intravenously [IV] ), consistent with professional standards of practice for one Resident (#131), out of a total sample of 27 residents. Specifically, for Resident #131, the facility failed to obtain weekly measurements for the external length of Resident #131's PICC line to ensure the PICC line had not migrated (moved from the heart to another area, which could have a significant impact on treatment, or cause serious harm).

Inspectors wroteBased on record review, and interviews, the facility failed to provide care and services consistent with professional standards of practice for one Resident (#11) who required renal dialysis (a life sustaining treatment that helps the body remove extra fluids and waste products from the blood when the kidneys are not able to) out of a total sample of 27 residents. Specifically, the facility failed to ensure nursing assessments, including the assessment of the dialysis access site were performed when Resident #11 returned from dialysis treatments.

Inspectors wroteBased on record review and interview, the facility failed to ensure one Resident (#86) was seen by a physician at least once every 30 days for the first 90 days after admission.

Inspectors wroteBased on record review and interview, the facility failed to complete annual Certified Nurse Aide (CNA) performance reviews for five of five sampled CNA's.

Inspectors wroteBased on record review and interview, the facility failed to ensure ongoing behavioral health services were provided for Resident #45. Specifically, the facility failed to ensure the behavioral health provider completed follow up services after the introduction of a new medication and failed to alert the provider when his/her behaviors continued and was sent out on a section-12 hospitalization, (an involuntary psychiatric hospitalization).

Inspectors wroteBased on observation and interviews, the facility failed to ensure staff stored drugs and biologicals in accordance with State and Federal laws. Specifically:1. The facility failed to ensure medications were dated once opened according to manufacturer's guidelines in one of three medication carts observed.2. The facility failed to ensure medications were stored securely in a resident room for one Resident (#40) out of a total of 27 sampled residents.

Inspectors wroteBased on record review and interview, the facility failed to ensure Residents were assisted in making transportation arrangements to Radiology appointments for one Resident (#8) out of a total sample of 27 Residents. Specifically, the facility failed to ensure Resident #8 was provided assistance to obtain transportation for a brain Magnetic Resonance Imaging (MRI) appointment as recommended by a Neurologist.

Inspectors wroteBased on observations, record review and interview, the facility failed to ensure that an accurate medical record was maintained for one Resident (#52) out of a total sample of 27 residents.

Inspectors wroteBased on record review and interview, the facility failed to accurately code Minimum Data Set (MDS) assessments for two Residents (#38 and #110), out of a total of 27 sampled residents.

Inspectors wroteBased on observations, record review and interviews the facility failed to ensure two Residents (#108 and #100) with pressure ulcers receive care consistent with professional standards of practice to promote healing, prevent infection and prevent new ulcers from developing. Specifically, 1. For Resident #108 the facility failed to: 1a. Implement recommendations from the consultant wound physician and, 1b. Ensure air mattress settings were set according to the plan of care. 2. For Resident #100 the facility failed to implement recommendations from the consultant wound physician. Findings Include: Review of facility policy titled Consultant Services, dated as April 2015, indicated the following: -Policy: [The facility] will identify and facilitate consultant services to meet the resident's needs, to ensure optimum care for each resident/ patient through consultant services. - Procedure: [...]

Inspectors wroteBased on observations, record review and interviews, the facility failed to provide behavioral health services by a) ensuring recommendations from the Psychiatric Nurse Practitioner were implemented and b) psychotropic medications were provided as ordered for one Resident (#80) out of a total sample of 30 residents.

Inspectors wroteBased on interviews and record review, the facility failed to ensure that sufficient staffing levels were maintained to safely and adequately meet each resident's personal care needs. Finding Included: Review of the Facility Assessment indicated the following: Staffing Plan: Nursing: Licensed Nurses (LN): RN (Registered Nurse, LPN (Licensed Practical Nurse), LVN (Licensed Vocational Nurse), provided direct care: -Director of Nursing: 1 RN Full time days. -Assistant Director of Nursing: 1 RN full-time days. -2 Unit managers' days: 1 RN, 1 LPN. - Weekend supervisor: 1 RN. -Second Shift Supervisor: Position is open. -12 Nurses for 116 residents first and second shift. -3 Nurses for 116 residents third shift. -8 RN's, 18 LPN's. Direct Care Staff: Certified Nursing Assistants (CNA): -1 CNA per 10 Residents first shift. -1 CNA for 12 Residents second shift. -1 CNA for 20 Residents third shift. [...]

Inspectors wroteBased on record review, policy review and interview the facility failed to ensure accurate documentation in the medical record for four Residents (#46, #80, #16 and #53) out of a total sample of 30 residents. Specifically: 1. For Resident #46 staff documented in the medical record that blood pressures were being taken in the left arm, when they were being taken in the right arm. 2a. For Resident #80 the facility failed to maintain a valid Massachusetts Order for Life Sustaining Treatment (MOLST) in the medical record. 2b. For Resident #80 the facility failed to accurately code the MDS regarding Advanced Directive status. 2c. For Resident #80's his/her medical record failed to indicate any physician notes were included in the medical chart. 3. For Resident #16 the facility failed to accurately document the wearing of bilateral lower extremity multipodus boots 4. [...]

Inspectors wroteBased on record review and interview the facility failed to obtain informed consent for the administration of psychotropic medication for two Residents (#80 and #98) out of a total sample of 30 residents.

Inspectors wroteBased on observation, record review and interview, the facility failed to notify a physician or provider of a Continuous Positive Airway Pressure (CPAP) machine that was not functioning and was unable to be implemented as per the Resident's plan of care for one Resident (#26) out of a total sample of 30 residents. Findings Include: Review of facility policy titled Condition: Significant Change, dated April 2025, indicated the following: -Staff will communicate with the physician, resident/ patient, and family regarding changes in condition to provide timely communication of resident/ patient status change which is essential to quality care management. -This notification should be documented in the clinical record. [...]

Inspectors wroteBased on observations and interviews, the facility failed to ensure resident protected health information (PHI) was secure and not visible to others on one of three nursing units.

Inspectors wroteBased on observation, record review and interviews the facility failed to maintain a homelike environment at the facility. Specifically, the facility failed to provide the resident's access to the only resident bathroom in the facility located on the level of their main dining room and activity room.

Inspectors wroteBased on record review, interviews, and policy review, the facility failed to ensure a resident-centered personalized care plan was developed and/or implemented for two Residents (#16 and #105) out of a total sample of 30 residents. Specifically: 1. For Resident #16, the facility failed to implement multipodus boots (pressure relieving boots) per his/her physician's order. 2. For Resident #105, the facility failed to develop a care plan for a hearing loss diagnosis. Findings Include: Review of policy titled, Splints/Orthotics/Prosthetics, last revised April 2015, indicated the following: Policy: -Residents will receive splint/orthotic/prosthetic devices as deemed appropriate by the physician and rehabilitation services. [...]

Inspectors wroteBased on observations, record review, policy review and interviews, the facility failed to provide showers for one Resident (#100) out of a total sample of 30 residents.

Inspectors wroteBased on observations, record review and interviews, the facility failed to 1) ensure a diabetic wound dressing was changed daily for one Resident (#8) and 2) failed to follow a physician's order for monitoring of congestive heart failure for one Resident (#100) out of a total sample of 30 residents.

Inspectors wroteBased on observations, record review, policy review and interviews, the facility failed to adequately maintain the nutrition and hydration status of three Residents (#66, #86, and #34) out of a total sample of 30 residents. Specifically, the facility failed to 1) identify and implement interventions for a significant weight loss for Resident #66), 2) identify and implement interventions for a significant weight gain for Resident #86 and 3) failed to obtain monthly weights for one Resident (#34) who was identified to have a significant weight loss when the weight was obtained, out of a total sample of 30 residents.

Inspectors wroteBased on observation, policy review, record review and interview the facility failed to provide respiratory care consistent with professional standards of practice for two residents (#26 and #30) out of a total sample of 30 residents. Specifically, 1. For Resident #26 the facility failed to ensure physician's orders included settings for a Continuous Passive Airway Pressure (CPAP) machine, and that the CPAP machine was functioning and available for use. 2. For Resident #30 the facility failed to obtain a complete physician's order for oxygen administration that included an oxygen flow rate. Findings Include: 1. Review of Facility Policy titled CPAP/ BiPAP Management, dated as revised April 2015, indicated the following: - Licensed nursing will provide CPAP/ BiPAP to treat sleep apnea or sleep disorders as ordered by the physician. [...]

Inspectors wroteBased on observations, record review, policy review and interviews, the facility failed to ensure services consistent with professional standards of practice related to Hemodialysis (the process of cleansing the blood by passing it through a special machine, necessary when the kidneys are unable to filter the blood) were provided for two Residents (#46 and #51) out of a total sample of 30 residents. Specifically, for Residents #46 and #51, the facility failed to ensure that emergency supplies were at the bedside.

Inspectors wroteBased on record review and interview the facility failed to ensure a Trauma Informed Care Plan, with resident specific interventions and triggers, was developed for one Resident (#75), out of a total sample of 30 residents.

Inspectors wroteBased on observations, record review, policy review, and interviews, the facility failed to ensure it was free from a medication error rate of greater than 5% when 1 out of 2 nurses observed made 5 errors out of 26 opportunities, resulting in a medication error rate of 19.23%. Those errors impacted one Resident (#86), out of four residents observed. Specifically, for Resident #86, Nurse #4 failed to administer his/her medications within the one-hour time frame. Findings Include: Review of facility policy titled Medication Administration- Oral, dated June 2015 indicated the following: Procedure: 1. Verify Medication order on Medication Administration Record (MAR). Check against physician order. 9. Verify that the medication is being administered at the proper time, in the prescribed dose, & by the correct route. [...]

Inspectors wroteBased on observations, interviews, and policy review, the facility failed to ensure staff stored all drugs and biologicals in accordance with accepted professional standards of practice. Specifically, 1. The facility failed to ensure medications were labeled and stored according to manufacturer's guidelines in two of four medication carts. 2. The facility failed to ensure that unlicensed personnel were supervised while in the medication room. Findings Include: Review of facility policy titled Medication Storage room/ Medication Cart Policy, dated February 2018, indicated the following: -The facility provides pharmaceutical services that are conducted in accordance with accepted ethical and professional standards of practice and that meet applicable Federal, State and Local Laws, rules, and regulations. [...]

Inspectors wroteBased on observation, interviews, and policy review, the facility failed to ensure transmission-based precautions were followed to prevent the spread of infections, and that appropriate hand hygiene practices were followed. Specifically, 1. The facility failed to ensure a nurse and a certified nursing assistant (CNA) appropriately donned (put on) a precaution gown while caring for a Resident on enhanced barrier precautions (EBP). 2. The facility failed to ensure a nurse performed hand hygiene between glove use. Findings Include: 1. Review of facility policy titled Enhanced Barrier Precautions Policy, undated, indicated the following: -It is the policy of this facility to implement enhanced barrier precautions for preventing transmission of novel or targets multidrug resistant organisms (MDROs). [...]

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #2), whose diagnosis included diabetes, with physician orders to monitor and evaluate skin integrity to his/her feet, the Facility failed to ensure they maintained a complete and accurate medical record, when from 03/06/24 through 04/02/24, diabetic foot care was documented as not applicable (N/A) on a recurring basis.

Inspectors wroteBased on observation, record review , policy review and interview the facility failed to ensure two Residents (#71 and #73) were provided effective interventions and supervision to prevent falls, out of a total sample of 36 residents. Specifically, the facility failed to 1) ensure for Resident #71 that effective interventions were in place to prevent further falls after sustaining multiple falls which then resulted in Resident #71 sustaining a hip fracture, and 2) ensure for Resident #73 was provided effective supervision and interventions to prevent a fall.

Inspectors wroteBased on observations, policy review, record reviews and interviews, the facility failed to implement the plan of care for 2 Residents (#1 and #59) out of a total sample of 36 residents.

Inspectors wroteBased on observation, record review and interview the facility failed to 1. monitor and notify the medical provider to evaluate the effectiveness of a psychotropic medication, prescribed and administered for the targeted behavior of refusing showers for one Resident (#86) and 2. failed to ensure psychotropic medications administered as needed (PRN) were re-evaluated, included a duration of use for 2 Residents (29 and #38) and 3. failed to review the duplicative use of two different anti-anxiety medications for one Resident (#38) out of a total sample of 36 residents. Specifically, 1. Resident #86 was administered a dose of Trazadone once a week for 8 consecutive weeks and a shower was not provided. 2. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide dental services for 4 Residents (#46, #74, #88 and #23) out of a total sample of 36 residents.

Inspectors wroteBased on record review and interview, the facility failed to report an unexpected death to the state survey agency for 1 Resident (#101) out of a total sample of 36 residents.

Inspectors wroteBased on record review and interview, the facility failed to 1. investigate a bruise of unknown origin for 1 Resident (#62) and 2. investigate an unexpected death for 1 Resident (#101) out of a total sample of 36 residents.

Inspectors wroteBased on observations, interview and record review, the facility failed to provide the necessary activities of daily living care for a dependent resident for one Resident (#37) out of a total sample of 36 residents. Specifically, the facility failed to 1a) provide supervision with meals and 1b) remove unwanted facial hair for Resident #37. Review of the facility policy titled Activities of Daily Living dated April 2015 indicated the following: *A program of activities of daily living (ADL) is provided to residents to maintain or restore maximum functional independence. A program of assistance and instruction in ADL skills is developed and implemented based on individual evaluation to encourage the highest level of functioning.

Inspectors wroteBased on observations, record reviews and interviews, the facility failed to provide activities for 1 Resident (#23) out of a total sample of 36 Residents.

Inspectors wroteBased on observation, policy review, record review, and interview the facility failed to ensure staff provided care consistent with professional standards, related to replacing and dating oxygen tubing for two Residents (#32 and #40) out of a total sample of 36 residents. Review of the facility policy titled Oxygen Administration Nasal Cannula, dated and revised November 2020 indicated the following: *Replace and date cannula and tubing weekly or when visibly soiled or damaged

Inspectors wroteBased on record review and interview the facility failed to develop a comprehensive trauma informed care plan for 2 Residents (#38 and #45) out of a total sample of 36 residents.

Inspectors wroteBased on record review and interviews, the facility failed to ensure that 1 Resident (#86) was seen by a physician every 90 days out of a total sample of 36 residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure it was free from a medication error rate of greater than 5 percent. Two out of 4 nurses observed made 2 errors in 27 opportunities on one of four units resulting in a medication error rate of 7.41%. These errors impacted 2 Residents (#56 and #96) out of 6 residents observed.

Inspectors wroteBased on observations, interviews and record review, the facility failed to provide a prescribed therapeutic diet for one Resident (#34) out of a total sample of 36 residents. Specifically, the facility failed to provide lactose free milk during meals for Resident #34.

Inspectors wroteBased on record review and interview, the facility failed to maintain accurate medical records. Specifically, staff signed off on the Treatment Administration Record (TAR) that oxygen tubing was changed, when it had not been changed, for 2 Residents (#32 and #40) out of a total sample of 36 residents. Review of the facility policy titled Oxygen Administration Nasal Cannula, dated and revised November 2020 indicated the following: *Replace and date cannula and tubing weekly or when visibly soiled or damaged Review of the facility policy titled Treatments dated April 2015 indicated the following: *All treatments must be charted as ordered on the treatment sheet by indicating initial inappropriate slot. If the treatment is omitted, circle your initials and indicate on the back of the treatment sheet the date, time, and reason for omission.