Regalcare at Lowell

Inspectors wroteBased on observations, record review and interviews, the facility failed to provide an environment free from accidents and hazards for two Residents (#9 and #39) out of a total sample of 25 residents. Specifically,1. For Resident #9, the facility failed to identify Resident #9's needs to receive 1:1 supervision with meals upon admission, and while eating unsupervised in his/her room, the Resident choked and required the Heimlich maneuver to be administered by facility staff. The Resident was subsequently transferred to the hospital, admitted to the intensive care unit, intubated and required a bronchial scope to remove a piece of chicken from his/her bronchial tube (the main airway leading to the lung), placing the resident at the likelihood of serious harm or death.2. For Resident #38, the facility failed to provide supervision with meals as indicated in his/her care plan.

Inspectors wroteBased on observations and interviews, the facility failed to maintain a homelike environment on 1 of 2 units.

Inspectors wroteBased on record review and interviews, the facility failed to ensure they reviewed and revised the Comprehensive Care Plan following the completion of his/her scheduled Quarterly Minimum Data Set (MDS) assessment for 1 Resident (#6) out of a total sample of 25 residents Specifically, for Resident #6 the facility failed to ensure a dementia care plan was developed following a Psychiatric assessment adding the diagnosis to the resident record. Review of the facility policy titled Comprehensive Assessments and the Care Delivery Process, dated as revised 2/2025, indicated:-Comprehensive assessments will be conducted to assist in developing person-centered care plans.-Comprehensive assessments are conducted and coordinated by a registered nurse with appropriate participation of other health professionals. 7. [...]

Inspectors wroteBased on observations, record review and interviews, the facility failed to provide one Resident (#38) with his/her hearing aids to maintain adequate hearing for communication, out of a total sample of 25 residents.

Inspectors wroteBased on record review and interview, the facility failed to identify a significant weight loss in a timely manner for one Resident (#46) out of a total sample of 25 residents.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure that for 1 Resident (#6), who was diagnosed with dementia, appropriate treatment and services were provided to attain his/her highest practical physical, mental and psychosocial well-being, and that person centered interventions were implemented, out of a total sample of 25 residents.

Inspectors wroteBased on observation, record review and interviews, the facility failed to ensure that one Resident (#39) was free of significant medication errors out of a total sample of 24 residents. Specifically, the nurse substituted and attempted to administer furosemide (a diuretic- used for removing excess fluids from the body) medication without a physician order.

Inspectors wroteBased on observations, record review and interview, the facility failed to provide dental services to one Resident (#9) out of a total sample of 25 residents. Specifically, the facility failed to refer Resident #9 to the dentist to repair or replace his/her broken dentures.

Inspectors wroteBased on interviews and record review, the facility failed to ensure a hospice care plan was present in the medical record and coordinated between facility staff and the hospice agency for one Resident (#48) out of a total sample of 24 residents.

Inspectors wroteBased on record review and interviews, for one of three sampled Personnel Files (Occupational Therapist #1), the Facility failed to ensure they implemented and followed their abuse prohibition procedures as defined in their policy when a Massachusetts Nurse Aide Registry background check was not conducted prior to hire.

Inspectors wroteBased on record review and interview, the facility failed to provide the appropriate treatment and services for one Resident (#7), with a known history of depression and suicidal ideation out of a total sample of 28 residents. Specifically, for Resident #7, the facility failed to implement and update the plan of care, resulting in an attempted suicide after the vocalization of suicidal ideation (SI).

Inspectors wroteBased on observations, interviews and policy review, the facility failed to maintain a homelike environment on 2 out of 2 resident units in the facility. Specifically on 2 of 2 units there were stained ceiling tiles, missing thresholds, broken blinds, holes in walls, gouged walls, peeling baseboards, missing baseboards, peeling wallpaper, dark and brown substance on ceiling tiles, stained floor tiles and missing closet doors.

Inspectors wrote2. Resident #2 was admitted to the facility in January 2023 with diagnoses including hemiplegia and hemiparesis following cerebral infarction effecting right dominant side and weakness. Review of the most recent Minimum Data Set (MDS) assessment, dated 2/27/25, indicated Resident #2 did not have a Brief Interview for Mental Status assessment completed and was assessed by staff to have moderately impaired cognition. The MDS further indicated Resident #2 speaks Cantonese, has clear speech but is rarely/never understood, and is dependent on staff for care. Review of Section F. on the MDS indicated an interview for daily and activity preferences should not be conducted and indicated the Resident is rarely/never understood and family/significant other not available. On 3/25/25 the following was observed:-At 9:30 A.M., Resident #2 was observed sitting in the main dining room in a wheelchair. [...]

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure they provided laboratory services to meet the needs of its residents. Specifically, the facility failed to maintain a current Clinical Laboratory Improvement Amendment (CLIA) certificate appropriate for the level of testing performed within the facility.

Inspectors wroteBased on observations, diet manual review, and interviews, the facility failed to ensure that the [NAME] consistently prepared meals according to the therapeutic diet manual as ordered by the physician. Specifically, the facility failed to ensure the [NAME] consistently served the IDDSI 6 (soft and bite sized) therapeutic diet in accordance with 13 applicable resident's physician's order.

Inspectors wroteBased on observation, interviews, and reviewed records, the facility failed to ensure staff treated residents in a dignified manner to effectively communicate in a language they understand for one Resident (#2) out of a total sample of 28 Residents.

Inspectors wroteBased on observations, record review, and interviews, the facility failed to ensure a call light was within reach for one Resident (#2) out of a total sample of 28 residents.

Inspectors wroteBased on observation, interviews, and reviewed records, the facility failed to implement a communication care plan for one Resident (#2) out of a total sample of 28 Residents.

Inspectors wroteBased on observation, record review and interview, the facility failed to provide treatment and care in accordance with professional standards of practice for one Resident (#51), out of a total sample of 28 residents. Specifically, the facility failed to identify a skin wound to the right elbow and document it on a skin assessment.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure professional standards of practice for the care of a suprapubic urinary catheter (a tube placed through the suprapubic region into the bladder to drain urine) for one Resident (#47) out of a total sample of 28 residents. Specifically, the facility failed to ensure nursing changed Resident #47's urinary catheter in accordance with physician's orders.

Inspectors wroteBased on record review and interview, the facility failed to maintain the highest practicable physical, mental, and psychosocial well-being for one Resident (#7) with a history of suicidal ideation (SI) and depression, out of a total sample of 28 residents. Specifically, Resident #7 was not provided with appropriate behavioral health services following verbalization of SI and attempted to kill him/herself at the facility by ingesting nail polish remover.

Inspectors wroteBased on record review and interview, the facility failed to provide medically related social services to one Resident (#7) out of a total sample of 28 residents, after their verbalization of suicidal ideation (SI).

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide foods that accommodates resident preferences to one Resident (#6) out of a total sample of 28 residents. Specifically, the facility failed to consistently honor Resident #6's food preferences.

Inspectors wroteBased on interview and record review, the facility failed to develop, implement and maintain a Quality Assurance and Performance Improvement (QAPI) program, which focuses on indicators of outcomes of quality of life, quality of care, and services to residents in the facility. Specifically, the facility failed to ensure a QAPI plan was implemented and addressed concerns regarding the behavioral health services and medically related social services provided when a Resident (#7) with a known history of suicidal ideations (SI) attempted suicide at the facility.

Inspectors wroteBased on observation, interview and policy review the facility failed to provide a safe environment on one of two nursing units. Specifically, in an resident room on the unit, that was not secured and was accessible to residents and staff, a radiator cover was removed and the electric radiator parts/motors were spread out on the floor, exposing electric wires within the radiator.

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide water flushes via an enteral feeding tube in accordance with physician's orders for one of two applicable Residents (#37), out of a total of 16 sampled Residents.

Inspectors wroteBased on observation, record review and interview for two Residents (#37 and #47), out of a total sample of 16 residents, the facility failed to provide activities of daily living (ADLs) in accordance with the plan of care. Specifically, 1. The facility failed to provide Resident #37, mouth care and 2. The facility failed to provide supervision during meals that included soft bread for Resident #47.

Inspectors wroteBased on observation, interview, and record review for one Resident (#48), the facility failed to implement the use of one available hearing aid, out of a total sample of 16 residents.

Inspectors wroteBased on observations, interviews and record review, the facility failed to provide food in form to meet the needs of one Resident (#47) out of a sample of 16 Residents. Specifically, the facility failed to provide an International Dysphagia Diet Standardization Initiative (IDDSI) level 5 diet as indicated in the physician's orders.