Regalcare at Greenfield

Inspectors wroteBased on observations, record review, and interviews, the facility failed to maintain an effective pest control program so that the facility was free of pests, placing residents at risk for food, beverage and wound contamination. Specifically, the facility failed to repair/replace grout and tiles in the main kitchen dishwasher area, as initially recommended by the pest company in March 2023 [sic], and reviewed again in October 2025, January 2026, February 2026, and March 2026, resulting in an unresolved flying pests' presence and an optimal, ongoing area for flying pests to eat and breed. 2. implement effective pest control interventions when small flies bred and migrated from Resident #95's room into the Unit Four hallway and into Resident #22's room, placing residents on Unit Four at increased risk for continued small fly infestation.

Inspectors wroteBased on interviews and record review, the facility failed to complete comprehensive assessments in the timeframe specified by the Centers for Medicare and Medicaid Services (CMS) Resident Assessment Instrument (RAI) manual for six Residents (#5, #133, #82, #98, #122 and #9) out of a total sample of 24 residents. Specifically, the facility failed to ensure that:1.annual Minimum Data Set (MDS) assessments were completed for Residents #5, #133, #82 and #98 no later than 14 days after the MDS assessment reference dates (ARDs).2. significant change in status assessments (SCSAs) were completed for Residents #122 and #9 no later than 14 days after determination that significant change in the Residents' status occurred, resulting in both Residents being admitted to hospice services. [...]

Inspectors wroteBased on interview and record review, the facility failed to complete non-comprehensive quarterly Minimum Data Set (MDS) assessments within the timeframe specified by the Centers for Medicare and Medicaid Services (CMS) Resident Assessment Instrument (RAI) manual for six Residents (#34, #115, #3, #124, #138, and #105) out of a total sample of 24 residents. Specifically, the facility failed to complete non-comprehensive quarterly MDS Assessments for Residents #34, #115, #3, #124, #138, and #105 no later than 14 days following the assessment reference date (ARD).

Inspectors wroteBased on observation, interviews, and record review, the facility failed to follow professional standards of practice for food storage and environmental cleaning of the facility's main kitchen, placing the facility residents at risk of contamination and foodborne illnesses. Specifically, the facility failed to ensure that:-food items were properly dated, stored, and/or discarded timely in the main kitchen.-clean and sanitary surfaces were maintained in the food preparation areas.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to maintain an effective QAPI program relative to pest control in the facility, which increased the risk for pest infestation throughout the facility. Specifically, the facility failed to develop and maintain a QAPI project relative to pest control when: -small flies were identified in the facility's main kitchen in October 2025 and repairs and bi-weekly pest control treatment was recommended by the facility's pest control company to treat for small flies. -small flies were still present in the facility's main kitchen and also on Unit Four, in resident areas, migrating from Resident #95's room into the Unit Four hallway and into Resident #22's room, placing residents on Unit Four at increased risk for continued small fly infestation.

Inspectors wrote:Based on observation, interview and review, the facility failed to ensure that a dignified dining experiences was provided for one Resident (#38), out of total sample of 24 residents. Specifically, for Resident #38, the facility failed to ensure that staff were seated while assisting the Resident during a breakfast meal, when Certified Nurse Aide (#1) stood beside Resident #38's wheelchair while assisting him/her with the meal.

Inspectors wroteBased on observation, interview, and record review, the facility failed to coordinate vision care services as required for one Resident (#79) out of a total sample of 24 residents, diagnosed with Type II Diabetes Mellitus (DM II) and Hypertension. Specifically, for Resident #79, the facility failed to schedule routine vision care appointments and ensure that the Resident received appropriate treatment to maintain vision abilities, when the Resident's Healthcare Proxy (HCP- person chosen as the healthcare decision maker when the individual is unable to do so for themself) requested and consented for Resident #79 to receive vision care services, placing the Resident at risk for further vision deterioration.

Inspectors wroteBased on record review and interview, the facility failed to ensure that Behavioral Health Services were provided as required for one Resident (#88) out of a total sample of 24 residents. Specifically, the facility failed to ensure Behavioral Health Services were implemented for Resident #88 when he/she had a change in condition, and the Nurse Practitioner (NP) determined the Resident screened positive for Major Depressive Disorder, referred the Resident for Psychiatry/ Behavioral Health and a Physician order was written for Psychiatry Consult.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that follow-up dental services were implemented timely for one Resident (#2) out of a total sample of 24 residents, when the facility did not initiate dental recommendations until four months later, placing the Resident at risk for unidentified dental disease and deteriorating oral health. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide assistance with activities of daily living (ADLs) care for four Residents (#41, #84, #9, and #19) out of a total sample of 19 residents, who required staff assistance for personal hygiene and grooming. Specifically, 1. For Residents #41 and #84, the facility failed to ensure the Residents were provided with assistance for nail care. 2. For Residents #9 and #19, the facility failed to ensure the Residents were provided assistance with grooming of unwanted facial hair.

Inspectors wroteBased on observation, and interview, the facility failed to ensure medications were stored according to professional standards of practice for one unit (4th floor) out of three units. Specifically, for the 4th floor unit, the facility failed to: -store medications in pharmacy approved and pharmacy labeled containers. -accurately label medications for precautions and safe administration.

Inspectors wroteBased on observation, interview, and record review, the facility failed to adhere to infection control standards to prevent the transmission of communicable diseases and infections for one Resident (#19) out of a total sample of 19 Residents. Specifically, for Resident #19, the facility failed to ensure that the Resident's indwelling urinary catheter bag and catheter tubing were maintained off the floor to stop the risk of contamination and spread of infections.

Inspectors wroteBased on record review, and interview, the facility failed to ensure that the facility's Arbitration Agreement contained specific language as required pertaining to communication with federal, state, or local officials, for three Resident's (#13, #81, #237) out of a total sample of three residents. Specifically, the facility failed to ensure that the Arbitration Agreements signed by Resident's #13, #81, #237 and/or their Representative's, explicitly stated that the Resident or anyone else (e.g., Resident's Representative) maintained the right to communicate with federal, state, or local officials such as federal and state surveyors, other federal or state health department employees and Representative(s) of the Office of the State Long Term Care Ombudsman.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #3), whose Physician's Orders included the administration of two different narcotic medications for pain, one was scheduled to be administered two times a day, the other medication could be administered every four hours as needed (PRN), the Facility failed to ensure the resident was free from significant medication errors, when on two separate occasions instead of being administered the PRN narcotic medication, Nurse #4 administered him/her the scheduled narcotic medication, placing Resident #1 at increased risk for adverse effects of a narcotic medication.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #3), whose Physician's orders included the administration of two different narcotic pain medications, one that was scheduled, the other was a PRN (as needed only), the Facility failed to ensure nursing maintained an accurate medical record when although Nursing documentation indicated Resident #3 was administered his/her PRN (as needed) pain medication, on two different occasions, he/she was actually administered his/her scheduled narcotic pain medication in error.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure their smoking policy addressed what preventative measures were in place in the event of a fire emergency for one Resident (#8) out of one applicable resident. Specifically, the facility failed to ensure fire prevention equipment was readily available in the smoking area to ensure a safe smoking environment.

Inspectors wroteBased on observation, interview, and policy review, the facility failed to ensure the replacement of an Emergency Kit (E-Kit) medication in one (Unit Three) out of one Medication Storage rooms where the Emergency Kit (E-kit) was stored. Specifically, the facility failed to replace an Insulin (Insulin-a hormone that lowers the level of sugar in the blood, used to treat diabetes) E-Kit for the medication to be available if/when needed urgently.

Inspectors wroteBased on record review and interview, the facility failed to ensure a Notice of Medicare Non-Coverage form (NOMNC - form given by the facility to all Medicare beneficiaries at least two days before the end of a Medicare covered Part A stay) was issued to one Resident (#191) out of three applicable sampled residents.

Inspectors wroteBased on interviews and records review, the facility failed to accurately code the Minimum Data Set (MDS) Assessment for three Residents (#23, #59, and #88) out of a total sample of 18 residents. Specifically, the facility failed to code: 1. For Resident #23, that the Resident utilized a position change alarm (a Velcro seatbelt with an alarm that sounded if the Resident attempted to stand from his/her wheelchair). 2. For Resident #59, that the Resident was receiving Hospice services. 3. For Resident #88, accurately identify the Resident's discharge status.

Inspectors wroteBased on observation, interview, policy and manufacturer's guidelines review, the facility failed to label and date an opened multi-dose vial of Tubersol Purified Protein Derivative (PPD- a skin test where solution is injected under the skin and is used to diagnose Tuberculosis infection) stored in one (Unit Two) out of three Medication Storage rooms.

Inspectors wroteBased on record review and interview, the facility failed to ensure that a complete medical record was maintained for one Resident (#8) out of a total sample of 18 residents. Specifically, for Resident #8, the facility failed to ensure a Massachusetts Medical Orders for Life Sustain Treatment (MOLST-standardized medical order form for use by clinicians that care for patients with serious advancing illnesses that addresses the individual's request for life sustaining treatments) was readily available in the medical record.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who was assessed by nursing as being at high risk for skin breakdown, and who after his/her admission developed a pressure injury to his/her coccyx area, the Facility failed to ensure they developed and implemented a comprehensive person-centered care plan related to his/her individual wound care needs for the promotion of healing and/or the prevention of worsening of his/her wound, which identified interventions, measurable objectives and desired outcomes. Findings Include: Review of the Facility's Policy, Comprehensive Care Plans, dated as revised April 2022 indicated the following: -Assessments of residents are ongoing and care plans are revised as information about the resident or residents condition change. [...]