Regalcare at Harwich

Inspectors wroteBased on records reviewed and interviews for one of three sampled residents (Resident #1), whose Advanced Directives indicated he/she was a full code (attempt resuscitation), the facility failed to ensure nursing provided care and services that met professional standards of nursing practice, when after Nurse #1 found Resident #1 unresponsive, without respirations and without a pulse, the physician was not made aware of Resident #1's change in condition, a Code Blue was not announced, 911 was not activated, therefore other nursing staff in the facility and Emergency Medical Service were not alerted to and could not respond to provide necessary assistance to Nurse #1 with attempts at resuscitation, as a result, the care and treatment provided to Resident #1 by Nurse #1 had not meet acceptable standards of practice.

Inspectors wroteBased on records reviewed and interviews for one of three sampled residents (Resident #1), who was found unresponsive by nursing staff and whose Physician's orders indicated he/she was a full code (in the event of cardiac or respiratory arrest, attempts at resuscitation will be initiated), the Facility failed to ensure nursing staff provided appropriate and necessary basic life saving measures to him/her that were consistent with his/her Advanced Directives and Physician orders.

Inspectors wroteBased on record review and interview, the facility failed to provide care and services consistent with professional standards of practice for one Resident (#11) who required hemodialysis (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 17 residents. Specifically, the facility failed:a. To ensure nursing staff did not obtain blood pressures from the Resident's right arm, where his/her AV fistula (arteriovenous fistula, where an artery and vein connect directly, allowing blood to flow) used for hemodialysis access was located; andb. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents were provided care in accordance with professional standards of practice for two Residents (#95, #5), out of a total sample of 17 residents. Specifically, the facility failed:1. For Resident #95, to ensure administration of antipsychotic and psychotropic medications were properly documented in the Resident's medical record; and2. For Resident #5, to ensure physician's orders were in place for the provision of Hospice services. Review of [NAME], Manual of Nursing Practice 11ed, dated 2019, indicated the following: -The professional nurse's scope of practice is defined and outlined by the State Board of Nursing that governs practice. Review of the Massachusetts Board of Registration in Nursing Advisory Ruling on Nursing Practice, dated as revised April 11, 2018, indicated: [...]

Inspectors wroteBased on observation and interview, the facility failed to ensure that medications were labeled and stored in accordance with accepted professional principles. Specifically, the facility failed:1. For Resident #121, to ensure the Resident's Insulin Lispro (a fast-acting insulin used to manage blood sugar levels) 100 units/milliliter (u/ml) Kwikpen was labeled with the date opened; and2. To ensure an open Lantus Solostar (a long-acting insulin used to manage blood sugar levels) insulin pen was labeled with a resident's name; and3. To ensure two bottles of Acidophilus (a probiotic over-the-counter medication) were stored in the refrigerator after opening as indicated by the manufacturer's label in two of three medication carts inspected.

Inspectors wroteBased on record review and interviews, the facility failed to review and revise the care plan for one Resident (#5), out of a total sample of 17 residents. Specifically, the facility failed to ensure the care plan for disposition was revised to reflect the Resident Representative's decision for the Resident to remain in the facility for long term care.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), the Facility failed to ensure he/she was treated in a dignified and respectful manner by a staff member when 07/27/25, Certified Nurse Aide (CNA) #1 teased Resident #1 and sat on his/her lap.

Inspectors wroteBased on observation and interview, the facility failed to ensure the residents' environment was clean, comfortable, and homelike. Specifically, the facility failed to ensure the residents' rooms and environment were maintained in good repair and homelike on two (Bayview and Cranview) of three resident care units.

Inspectors wroteBased on observation, record review, and staff interview, the facility failed to ensure food was stored, in accordance with professional standards. Specifically, the facility failed to ensure 2 out of 3 kitchenettes were maintained in a sanitary manner to store food.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an infection prevention and control program to help prevent the development and potential transmission of communicable diseases and infections for five Residents (#24, #19, #82, #16, and #57). Specifically, the facility failed: 1. For Resident #24, to ensure staff wore personal protective equipment (PPE) as required for Isolation/Droplet Precautions (infection control precautions used for residents who are infected with certain infectious agents including COVID-19 for which additional precautions are needed to prevent infection transmission) while entering the room for medication administration; 2. For Residents #19 and #82, to ensure staff wore PPE as required for Isolation/Droplet Precautions while entering the room and providing morning coffee/snack and daily activity Chronicle; 3. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure a [NAME] Treatment Plan (court approved treatment plan for the administration of antipsychotic medications) was obtained prior to the administration of an antipsychotic medication for one Resident (#24), in a total sample of 20 residents.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure one Resident's comprehensive and individualized plan of care was implemented, for one Resident (#60), out of a total sample of 20 residents. Specifically, for Resident #60, the facility failed to place a padded floor mat to the left side of his/her bed.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure that for one Resident (#2), of a total sample of 20 residents, the pharmacy's monthly medication regimen review with recommendations for the Resident was reported to the attending physician and director of nursing and acted upon timely.

Inspectors wroteBased on record review and staff interview, the facility failed to maintain medical records that are complete, accurate, and systemically organized within accepted professional standards and practice for one Resident (#91), out of a total sample of three closed records. Specifically, the facility failed to ensure the physician's order for destination of discharge was accurate.

Inspectors wroteBased on interview and record review, the facility failed to ensure the Minimum Data Set (MDS) assessment was accurately completed for one Resident (#3), in a sample of 20 residents, and one Resident (#91), in a sample of three closed record reviews. Specifically, the facility failed: 1. To ensure the accurate admission date was reflected on three MDSs and limited range of motion was reflected on two MDSs for Resident #3; and 2. To ensure the accurate discharge location was reflected on the MDS for Resident #91.

Inspectors wroteBased on observation, interview, and Centers for Disease Control and Prevention (CDC) guidance, the facility failed to ensure facemasks were used by staff in the long term care setting as a method of source control during the Department of Health and Human services Federal public health emergency for COVID-19.

Inspectors wroteBased on interview, policy review, and document review, the facility failed to implement a policy to grant COVID-19 vaccination exemptions for staff that included all the required components that were current and based on national standards for 2 of 2 reviewed exempt employees. Specifically, the facility failed to: 1. Ensure documentation was complete for Activity Assistant #2 with a length of time the exemption was granted, and which authorized or licensed COVID-19 vaccine was clinically contraindicated for the staff member; and 2. Maintain completed documentation for Certified Nurse Assistant (CNA) #3 indicating which authorized or licensed COVID-19 vaccine was clinically contraindicated for the staff member.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure an individualized plan of care was followed for two Residents (#53 and #45), in a total sample of 22 residents. Specifically, the facility failed: 1. For Resident #53, to follow the care plan of not providing paper products to the Resident who had a history of eating non-edible items; and 2. For Resident #45, to develop an individualized comprehensive plan of care following a new left clavicle fracture.

Inspectors wroteBased on record review, observation, interview, and policy review, the facility failed to ensure quality care and services were provided for one Resident (#46), out of a total sample of 22 residents. Specifically, the facility failed to ensure diabetic care was provided as ordered and documented correctly in the medical record.

Inspectors wroteBased on observation, interview, record review, and policy review, the facility failed to ensure one Resident (#65), out of a total sample of 22 residents, received care and services consistent with professional standards of practice to prevent and/or promote healing of pressure injuries. Specifically, the facility failed to conduct a comprehensive skin assessment including the size of a newly identified right outer ankle wound and initiate a (pressure or non-pressure) form per facility policy.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure an indwelling catheter was assessed for removal following a urology consult for Resident #56, out of four residents with catheters and a total sample of 22 residents.

Inspectors wroteBased on observation, interview, and policy review, the facility failed for one Resident (#86), out of a total sample of 22 residents, to safely maintain and store respiratory equipment when not in use by the Resident. Specifically, the facility failed to ensure filters on the oxygen concentrator were clean and nebulizer respiratory treatment equipment was stored in a manner to prevent germs and environmental debris from contaminating it, potentially resulting in respiratory infection.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure the physician reviewed the total program of care for Residents #56, out of a total sample of 22 residents. Specifically, the physician failed to review the total programs of care for the re-admission status of Resident #56 with a new Foley catheter.

Inspectors wroteBased on observation and interview, the facility failed to maintain a clean and sanitary environment for one Resident (#17), out of a total sample of 22 residents. Specifically, the facility failed to maintain the cleanliness of the Resident's room to avoid a strong smell of urine for three consecutive days.