Regalcare at Sudbury

Inspectors wroteBased on observations, and interviews, the facility failed to ensure that residents were treated with dignity during communal, shared dining experiences on one unit (Concord West, East and Split Units) out of two units observed, and that one Resident (#4) out of a total sample of 16 residents, was provided with a dignified dining experience when the Resident required assistance with eating. Specifically, the facility failed to:1. ensure that residents who resided on the Concord West, Concord East, and Concord Split nursing units were served their meals at the same time as other residents seated at the same table or seated in the dining room for meals.2. For Resident #4, provide assistance and supervision at mealtime as indicated on the Resident's care plan, resulting in an undignified dining experience for the Resident.

Inspectors wroteBased on observation, and interviews, the facility failed to ensure that medication storage was maintained in a clean and sanitary manner for three medication carts (Concord East, Concord West, and Concord Split) out of three medication carts observed. Specifically, the Concord East, Concord West, and Concord Split medication carts were not maintained in a clean and sanitary manner, placing residents receiving medications from the carts at risk for contamination of medications and the spread of infections.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to provide food and drink at safe and appetizing temperatures to residents from three of three breakfast meal carts on one unit (Concord West, East and Split Units) out of two total resident units. Specifically, the facility failed to provide food and drink at safe and appetizing temperatures for the breakfast meal for residents eating breakfast on the Concord East Unit, Concord [NAME] Unit, and in the shared Concord Unit Dining Room, increasing the residents' risks for reduced food/fluid intake and foodborne illness.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to provide an environment that was free from physical restraints imposed for discipline or convenience for one Resident (#5) out of a total sample of 16 residents. Specifically for Resident #5, the facility failed to ensure that the Resident's freedom of movement or activity was not limited, that he/she was capable of unlocking his/her wheelchair, and was evaluated for the least restrictive restraint when staff locked his/her wheelchair brakes to restrict the Resident's movements while he/she was seated in the wheelchair.

Inspectors wroteBased on interviews, and record review, the facility failed to ensure that one Resident (#59) out of a total sample of 16 residents had been provided the right to participate in the care plan process. Specifically, for Resident #59, the facility failed to ensure that the Resident was invited to participate in the initial and quarterly care plan meetings that were conducted as required for him/her or provide rationale why Resident #59 did not participate in the care planning meetings.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide foot care and treatment in accordance with professional standards of practice for one Resident (#9) out of a total sample of 16 residents. Specifically, for Resident #9, the facility failed to provide toenail care as required to assist the Resident in maintaining good foot health and also schedule podiatry services as ordered when two Podiatry visits occurred in the facility after the Resident was admitted , putting him/her at risk of podiatric complications.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to provide respiratory care and services consistent with professional standards of practice for one Resident (#13) out of a total sample of 16 residents. Specifically, for Resident #13, the facility failed to ensure that the Resident's oxygen concentrator (device used to deliver supplemental oxygen) cabinet and filter were cleaned and maintained as required, placing the Resident at risk for infection, impaired oxygen delivery and equipment malfunction.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to provide effective pain management consistent with professional standards of practice, for one Resident (#73) out of a total sample of 16 residents. Specifically, for Resident #73, the facility failed to: -ensure that ordered Oxycodone (opioid pain medication) medication was available for administration to manage the Resident's chronic pain when the pharmacy medication was not confirmed by the Nurse resulting in the oxycodone medication being unavailable for administration to the Resident for approximately 21 hours. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to adhere to infection control standards of practice for one Resident (#10) out of a total sample of 16 residents. Specifically, for Resident #10, the facility failed to ensure that Enhanced Barrier Precautions (EBP's - the use of protective gowns and gloves during high contact care activities that may provide opportunity for transmission of medication resistant organisms through staff hands and/or clothing), were appropriately utilized when providing high contact care for the Resident, to mitigate the risk of organism transmission and the spread of infection to the Resident and other residents within the facility.

Inspectors wroteBased on record review, and interview, the facility failed to provide notice of change in coverage by Medicare for one Resident (#75) out of a total sample of 16 residents. Specifically, the facility failed to issue a Notice of Medicare Non-Coverage to Resident #75 when the Resident had skilled days remaining, was being discharged from Part A services, and was leaving the facility immediately following his/her last covered skilled day.

Inspectors wroteBased on record reviews and interviews, for one of three sampled residents, (Resident #3), who upon admission had been assessed by nursing as being at risk for weight loss, the Facility failed to ensure that he/she maintained acceptable parameters of nutritional status regarding usual body weight and desirable weight range, when he/she experienced an unplanned, undesired significant weight loss and after the weight loss was identified, no additional weight monitoring occurred for two (2) months.

Inspectors wroteBased on observation, interview, and policy review, the facility failed to provide a dignified dining experience for one Resident (#2), out of a total sample of 19 residents. Specifically, the facility staff stood over and remained standing while assisting Resident #2 during a breakfast meal.

Inspectors wroteBased on interview, and record and policy review, the facility failed to inform three Residents (#5, #4, and #58) and or their Representatives in advance of changes to the plan of care relative to the use of psychotropic (medication that affects how the brain works and causes changes in mood, awareness, thoughts, feelings or behavior) medications, out of a total sample of 19 residents. Specifically, the facility failed to obtain written consent for the use of psychotropic medications before administering: 1. [...]

Inspectors wroteBased on record and policy review, and interview, the facility failed to appropriately review and accurately execute Advance Directives (legal documents that provide instructions for medical care and only go into effect if you are unable to communicate your own wishes) for one Resident (#26) out of a total sample of 19 residents. Specifically, the facility failed to ensure that the correct Resident's name was entered on Resident #26's MOLST (Massachusetts Medical Order for Life-Sustaining Treatment) form, when another individual's name and Resident #26's date of birth were included on the form placing the Resident at risk for not having his/her final wishes upheld.

Inspectors wroteBased on interview, record and policy review, the facility failed to notify the Physician/Non-Physician (NPP) of a significant change in condition for one Resident (#19) out of a total of 19 total residents. Specifically, the facility failed to notify the Physician/NPP of a recommended change in treatment for Candida Glabrata (yeast infection) made by the Consulting Physician/NPP and obtain treatment orders for Resident #19, resulting in unmanaged itching and discomfort of the Resident's genital (external reproductive organ) area.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to provide the necessary activities of daily living (ADLs - personal care activities including but not limited to, eating, grooming, and personal hygiene) care and services for one Resident (#4) out of a total sample of 19 residents. Specifically, for Resident #4, the facility failed to provide continual supervision by staff during mealtimes when the Resident required ADL assistance and supervision while eating.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to provide care and services as required for an indwelling urinary/Foley catheter (a flexible tube that passes through the urethra and into the bladder to drain urine outside the body) for one Resident (#35) out of a total sample of 19 residents. Specifically, for Resident #35, the facility failed to verify and assess that the correct size indwelling urinary/Foley catheter as ordered by the Physician was re-inserted when the Resident required replacement of a urinary catheter after a failed voiding trial (a medical assessment used to determine if a patient can spontaneously urinate after urinary catheter removal).

Inspectors wroteBased on record and policy review, and interview, the facility failed to ensure that Physician's orders were correctly administered relative to dialysis care for one Resident (#5) out of a total sample of 19 residents. Specifically, for Resident #5, the facility failed to assess a complete set of vital signs (medical signs such as temperature, pulse rate, blood pressure, and respiratory rate, that indicate the status of the body's vital functions) prior to dialysis (a treatment in which a machine filters wastes, salts and fluids from your blood when your kidneys are no longer healthy enough to do the work) as ordered by the Physician putting the Resident at risk for dialysis related complications.

Inspectors wroteBased on observation, interview and policy review, the facility failed to follow safe and sanitary food service practices in accordance with professional standards for food service safety to prevent the risk of foodborne illnesses for one Resident (#66), on the [NAME] Nursing Unit during a meal service observation. Specifically, the facility failed to ensure that staff training on food service safety was implemented when Certified Nurses Aide (CNA) #3 replaced a domed lid from a breakfast meal, that had fallen onto the floor in the [NAME] Unit hallway, over a meal plate on a breakfast tray and served the breakfast tray with the contaminated dome lid to Resident #66.

Inspectors wroteBased on observation, interview, policy and record review, the facility failed to adhere to infection control standards of practice for two Residents (#34 and #56) out of a total sample size of 19 residents. Specifically, the facility failed to: 1. For Resident #34, follow Physician orders for Enhanced Barrier Precautions (EBP's - the use of protective gowns and gloves during high contact care activities that may provide opportunity for transmission of medication resistant organisms through staff hands and/or clothing), increasing the risk of organism transmission to the Resident and other Residents within the facility. 2. For Resident #56, perform hand washing procedure as required between glove changes while providing wound care to the Resident and appropriately disinfecting equipment to prevent contamination and the spread of infections.

Inspectors wroteBased on record review, and interview, the facility failed to ensure that the Minimum Data Set (MDS) Assessment was coded accurately for one Resident (#5) out of a total sample of 19 residents. Specifically, the facility failed to ensure that Hemodialysis (a procedure that filters the wastes, salts and fluid from your blood when your kidneys are no longer healthy enough to do the work) was coded correctly on Resident #5's most recent MDS assessment.

Inspectors wroteBased on interviews and records reviewed, for one of three sampled residents (Resident #1), who had a physicians order, dated 5/12/24, for discharge to his/her Assisted Living Facility (ALF) with Hospice services, when family members arrived at the facility on 5/12/24, the day they anticipated him/her to be discharged , facility staff told them them Resident #1 was not scheduled to be discharged until the following day (5/13/24). [...]

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who had a physicians order for discharge home with Hospice Services to the Assisted Living Facility on 5/12/24, the Facility failed to ensure they maintained a complete and accurate medical record when nursing staff and the provider, failed to document his/her discharge in the medical record.

Inspectors wroteBased on observations, interviews, record and policies reviewed, the facility failed to ensure that one Resident (#12) of seven applicable residents who experienced significant weight changes, in a total sample of 18 residents, maintained acceptable parameters of nutritional status. Specifically, the facility failed to ensure that Resident #12: -was provided with nutritional interventions as recommended by the Registered Dietitian (RD) and as ordered by the Physician to prevent further weight decline, -weight was monitored per facility policy when a weight change had occurred and the Resident experienced a significant weight loss.

Inspectors wroteBased on observations, interviews and policies reviewed, the facility failed to ensure that residents were treated with dignity during communal dining on one unit ([NAME]) out of three units observed. Specifically, the facility staff failed to ensure that residents: -were provided their meals off meal trays -were served at the same time when seated with others -were offered timely assistance with meals, if required -were provided with non-disposable cups while dining

Inspectors wroteBased on record review and interview the facility failed to ensure that residents and/or their representatives were informed and given necessary information to make health care decisions including the risks and benefits of psychotropic (any drug that affects behavior, mood, thoughts, or perception) medications prior to their use for one Resident (#57) out of a total sample of 18 residents. Specifically, for Resident #57, the facility failed to: -provide the Resident's invoked (made active) Health Care Proxy (HCP- a legal document that allows you to appoint someone you trust to make medical decisions on your behalf if you are unable to do so) notification of the risks and benefits of the use of antipsychotic and antidepressant medications. -obtain informed consent to administer psychotropic medication as required.

Inspectors wroteBased on record review and interview, the facility failed to accurately execute Advance Directives (written documents that tells your health care providers who should speak for you and what medical decisions should be made, if you become unable to speak for yourself) for one Resident (#60) out of a total sample of 18 residents. Specifically, the facility failed to ensure that the MOLST (Massachusetts Medical Order for Life-Sustaining Treatment) decisions were made by the designated and invoked [made active] Health Care Proxy (HCP-a legal document that allows you to appoint someone you trust to make medical decisions on your behalf if you are unable to do so) for Resident #60, who had been deemed as lacking the capacity for informed decision making by the facility's Physician.

Inspectors wroteBased on record review, policy review and interview, the facility failed to notify the Physician in a timely manner, that an ordered medication was not available for one Resident (#6) out of a total sample of 18 residents. Specifically, the facility failed to notify the Physician that the medication Ingrezza (medication used to treat involuntary movements) was expensive, was not covered by insurance and was not available to be administered to Resident #6.

Inspectors wroteBased on observation, interviews, and record and policy review, the facility failed to ensure that a device utilized for one Resident (#77), was assessed and consent was obtained by the Resident Representative, when used as a physical restraint (defined as any manual method, physical or mechanical device, equipment, or material that meets all of the following criteria: is attached or adjacent to the resident's body, cannot be removed easily by the resident; and restricts the resident's freedom of movement or normal access to his/her body), out of one applicable Resident who had a gastrostomy tube (G-tube: tube inserted through the stomach that delivers nutrition/hydration), in a total sample of 18 residents. [...]

Inspectors wroteBased on interview and records reviewed, the facility failed to refer one Resident (#43) out of a total sample of 18 residents, for a Preadmission Screening and Resident Review (PASARR- a federal requirement to help ensure individuals are not inappropriately placed in long term care ) Level II evaluation (an in-depth evaluation of a person who has a positive Level I screen (a preadmission screening used to determine if a person has a diagnosis or suspected diagnosis of developmental disabilities/related conditions or mental illness) for Mental Illness (MI), intellectual disability, or related condition to determine if they require specialized services). [...]

Inspectors wroteBased on observations, record and policy review, and interview, the facility failed to develop and implement a plan of care for two Residents (#60 and #79) out of a total sample of 18 residents. Specifically: 1) For Resident #60 the facility failed to implement a plan of care for a nutritional supplement three times daily. 2) For Resident #79, the facility failed to develop a comprehensive care plan timely for communication related to severe hearing loss and the Resident's inability to read or write. Findings Include: Review of the facility policy titled Comprehensive Care Plan, revision date unknown, indicated the following: [...]

Inspectors wroteBased on interview, policy and record review, the facility failed to develop a discharge plan for one Resident (#79) out of a total sample of 18 residents.

Inspectors wroteBased on record review and interview, the facility failed to provide treatment and care in accordance with professional standards of practice for one Resident (#38), out of a total sample of 18 residents. Specifically, the facility staff failed to recognize that stool softeners (medications that increase the amount of water absorbed by stool in the intestines, to make it softer and easier to pass) and laxatives (work by softening hard stools or stimulating the bowels to get stool moving) continued to be administered to a Resident undergoing medical treatment for diarrhea (a condition in which stool is discharged from the bowels frequently and in a liquid form).

Inspectors wroteBased on observations, interviews, record and policy review, the facility failed to ensure that one Resident (#38) out of one applicable resident with wounds, in a total sample of 18 residents, received the care/services as recommended by the Wound Care Practitioner, for treatment of a Stage 3 Pressure Ulcer (Full-thickness loss of skin, in which subcutaneous fat may be visible in the ulcer and granulation tissue [pink healthy tissue] and epibole [rolled wound edges] are often present. Slough [yellow/white material in a wound bed] and/or eschar [dead tissue] may be visible but does not obscure the depth of tissue loss) which had been assessed to have increased drainage. [...]

Inspectors wroteBased on observations, interviews, record and policy review, the facility failed to provide adequate supervision/assistance and implemented interventions in order to reduce/prevent falls for one sampled Resident (#65), out of a total sample of 18 residents. Specifically, the facility failed to provide assistance when the Resident was observed ambulating unassisted, failed to implement interventions to prevent falls as addressed in his/her plan of care, failed to investigate fall incidents, determine the root cause, and provide effective interventions to prevent further falls.

Inspectors wroteBased on observations, interviews, record and policy review, the facility failed to ensure one Resident (#77) out of a total sample of 18 residents who received enteral (delivery of nutrients via a feeding tube) nutrition via a gastrostomy tube (G-tube: opening into the stomach made surgically for enteral nutrition/tube feeding), received appropriate care and services to reduce the risk of dehydration. Specifically the facility failed to provide the bolus fluids (rapid infusion of fluids over a short period of time) as ordered by the Physician for Resident #77 who had a history of abnormal labs and Acute Kidney Failure (a condition in which the kidneys suddenly cannot filter waste from the blood).

Inspectors wroteBased on record review and interview the facility failed to ensure recommendations made by the Consultant Pharmacist during a monthly Medication Regime Review (MRR) were reviewed by the Physician and responded to as required, for one Resident (#57) out of a total sample of 18 residents. Specifically, for Resident #57, the facility failed to respond to the Pharmacist Consultant's request to limit the use of an as needed (PRN) antipsychotic medication to 14 days or less.

Inspectors wroteBased on record review and interview, the facility failed to include a duration for an as needed (PRN) psychotropic medication (a medication that affects brain activities associated with mental processes and behavior) for one Resident (#57) out of a total sample of 18 residents. Specifically, the facility staff failed to add a stop date of 14 days or less as required for a PRN Olanzapine (an antipsychotic medication) order for Resident #57.

Inspectors wroteBased on observations, interviews and records reviewed, the facility failed to maintain a medication pass error rate of less than five percent (%) for two Residents (#6 and #54), out of five applicable residents, out of 36 opportunities of medication administration observation. Specifically, the medication error rate was observed to be 11.11%: 1. For Resident #6, relative to the administration of eye drops and two (Ingrezza and Metoprolol) oral medications that were not given as ordered. 2. For Resident #54, relative to Trelegy Ellipta Aerosol Powder Breath inhaler (an inhaled medication used to relieve bronchial congestion) which was not administered as ordered.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure a significant medication error did not occur for one Resident (#6), out of five applicable residents, out of 36 opportunities. Specifically, the facility failed to ensure Ingrezza (a medication used to treat symptoms of involuntary movements) was available for administration before discontinuing Benztropine (a medication used to treat movement disorders) as ordered by the Prescriber.

Inspectors wroteBased on record review and interview the facility failed to issue notices of transfer paperwork to the Resident, Resident Representative, and the Office of the Long-Term Care Ombudsman for two Residents (#19, and #77) out of a total sample of 18 residents, as required.

Inspectors wroteBased on record review and interview the facility failed to provide notice of Bed Hold Policy prior to transfer to the Resident and/or their Representative for two Residents (#19 and #77) out of a total sample of 18 residents, as required.

Inspectors wroteBased on record review and interview, the facility failed to accurately code a Minimum Data Set (MDS) assessment for one Resident (#9) out of a total sample of 18 residents. Specifically, for Resident #9, the facility staff failed to correctly code a fall with injury on the MDS assessment.