Regalcare at Taunton

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who had severe cognitive impairment, the Facility failed to ensure he/she was free from abuse from a staff member, when on 03/30/25, Resident #1 became combative during care and in response to his/her behaviors, Certified Nurse Aide (CNA) #2, told Resident #1 if he/she hit her again, she would hit him/her back. CNA #2 hit Resident #1 on the top of his/her left hand twice. The incident was witnessed by another staff member who was assisting with Resident #1's care. A cognitively intact person would experience pain and mental anguish after being hit by a caregiver.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who had severe cognitive impairment, the Facility failed to ensure staff implemented and followed their Abuse Identification and Reporting Policy, when on 03/30/25 during the night shift, Certified Nurse Aide (CNA) #1 witnessed CNA #2 slap Resident #1's hand while providing care to him/her. CNA #1 did not immediately report the allegation of physical abuse to the nurse on duty as required and did not do so, until four hours after witnessing the incident.

Inspectors wroteBased on document review and interviews, the facility failed to ensure for one Resident (#40), out of a total sample of 18 residents, to ensure he/she was free from a significant medication error when the Resident's immunosuppressant medication was discontinued in error. As a result, Resident #40 missed 40 doses of tacrolimus (Prograf, an immunosuppressant medication used to prevent transplanted organ rejection) and required emergent hospitalization and medication adjustments during and after hospitalization.

Inspectors wroteBased on a resident group meeting, interviews, and record reviews, the facility failed to ensure concerns from the Resident Council were thoroughly documented to ensure the residents felt their concerns were acted upon timely and included the facility response to the group.

Inspectors wroteBased on interview, observation, and document review, the facility failed to ensure residents had the right to voice and formulate grievances, have those grievances responded to promptly, and be provided a resolution to their grievance. Specifically, the facility failed to: 1. Investigate and address voiced grievances; and 2. Ensure residents had access to grievance/concern forms to submit grievances anonymously, should they choose not to alert a staff member to their concern.

Inspectors wroteBased on records reviewed and interviews, the facility failed to ensure it provided appropriate administrative oversight specific to clinical management when a Resident (#40) did not receive his/her tacrolimus (Prograf, an immunosuppressant medication used to prevent transplanted organ rejection) after readmission from the hospital in February 2025, resulting in abnormally low laboratory results and the Resident required emergent hospitalization and medication adjustments during and after hospitalization. Specifically, the facility administration failed to:1. Ensure effective systems were in place for education, and training for licensed staff to ensure competent, safe, and effective resident care related to medication reconciliation, laboratory result reporting and communication with consulting providers;2. [...]

Inspectors wroteBased on interview and record review, the facility failed to accurately complete a Level I Pre-admission Screening and Resident Review (PASARR) for one Resident (#35), out of a total sample of 18 residents, resulting in Resident #35 being admitted to the facility without the determination of whether he/she screened positive for intellectual disability (ID)/developmental disability (DD) or serious mental illness (SMI) requiring further evaluation.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement the person-centered plan of care for two Residents (#20 and #69), out of 18 sampled residents. Specifically, the facility failed to:1. Implement the care plan for Resident #20 which indicated that the Resident required two staff for all care; and 2. Follow the plan of care for Resident #69 to wear eyeglasses.

Inspectors wroteBased on record review, interview, and observation, the facility failed to ensure a physician and/or the physician assistant (PA) provided supervision and oversight for the care of one Resident (#40) with a known history of an organ transplant, out of a total sample of 18 residents, who required the daily use of tacrolimus (Prograf, an immunosuppressant medication used to prevent transplanted organ rejection). Specifically, the physician and PA failed to: 1. Identify that tacrolimus was discontinued after a recent hospitalization, resulting in a total of 40 missed doses; and 2. Address and intervene on abnormal tacrolimus level laboratory values, leading to the Resident's emergent hospitalization for organ transplant rejection surveillance and medication management.

Inspectors wrote2. Resident #30 was admitted to the facility in November 2020 with diagnoses which included type 2 diabetes mellitus with diabetic neuropathy, dysarthria following cerebral infarct, hemiplegia and hemiparesis, pain, and major depressive disorder. Review of Physician progress notes and assessments indicated Resident #30 had not been seen by a Physician during the timeframe of 6/4/24 through 12/19/24, for a total of 199 days. During an interview on 5/7/25 at 9:00 A.M., the RDO reviewed Resident #30's Physician's notes and said the Physician must see residents every 60 days; visits can alternate between the Physician and NP/PA. The RDO said during the 199-day period from June to December 2024, Resident #30 was not visited by the Physician every 60 days and visits during that time did not alternate between the Physician and the NP/PA. [...]

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure licensed nursing staff were competent in immunosuppressant drug therapy resulting in: a. failure to identify the adverse discontinuation of a necessary immunosuppressant medication (tacrolimus) for the prevention of organ rejection for one Resident (#40) in a sample of 18 residents; and b. failure to communicate with the practitioner about abnormally low tacrolimus level laboratory results for Resident #40, readmitted to the facility with a known history of heart transplant, resulting in emergent hospitalization in March 2025 for transplanted organ rejection surveillance and medication regimen adjustments.

Inspectors wroteBased on record review and interviews, the facility failed to ensure for one Resident (#40), out of a total sample of 18 residents, an admission Medication Regimen Review (AMRR) was completed by the Consultant Pharmacist upon readmission to the facility and an irregularity was identified. Specifically, the Consultant Pharmacist failed to identify the discontinuation of Resident #40's immunosuppressant medication and, as a result, Resident #40 (a heart transplant recipient) missed 40 doses of tacrolimus (Prograf, an immunosuppressant medication used to prevent transplanted organ rejection) and required emergent hospitalization and medication adjustments during and after hospitalization.

Inspectors wroteBased on document review and interview, the facility failed to ensure that the Quality Assurance Committee developed and implemented an effective Performance Improvement Plan (PIP), including a corrective action plan with effective monitoring for delayed laboratory result reporting, readmission medication reconciliation, and pharmacy admission Medication Regimen Review (AMRR) after admission/readmission.

Inspectors wroteBased on documentation review and interview, the facility failed to provide training and education to all their staff to outline elements and goals of the facility's Quality Assurance Performance Improvement (QAPI) program.

Inspectors wroteBased on Minimum Data Set (MDS) assessment review and staff interview, the facility failed to ensure staff completed the Quarterly MDS assessment within the required timeframe for five Residents (#49, #63, #1, #4, and #27), out of five residents reviewed for overdue assessments.

Inspectors wroteBased on observation and interview, the facility failed to ensure nurse staffing information which included the current date and actual hours worked per shift for licensed and unlicensed staff including Registered Nurses (RN), Licensed Practical Nurses (LPN), and Certified Nurse Aides (CNA) was posted daily as required.

Inspectors wroteBased on records reviewed and interviews for two of three sampled residents' (Resident #1 and #2) who were both assessed as requiring psychiatric interventions and evaluations, the Facility failed to ensure nursing staff provided care and services that met professional standards of quality, when recommendations made by psychiatric services for both residents, were not followed up on timely by nursing.

Inspectors wroteBased on observation, policy review, and interview, the facility failed to follow their policy and professional standards of practice for food safety and sanitation to prevent the potential spread of foodborne illness to residents who are at high risk. Specifically, the facility failed to: 1. Ensure the main kitchen was maintained in a sanitary condition; 2. Ensure food items were properly labeled and dated in the main kitchen refrigerators; 3. Ensure food items were properly stored in the main kitchen walk-in refrigerator; and 4. Ensure staff practiced proper hand hygiene to prevent cross contamination (transfer of pathogens from one surface to another) and to ensure appropriate hand drying provisions in one of two handwashing stations in the main kitchen. In addition, to ensure the use of gloves was limited to a single use task.

Inspectors wroteBased on review of the Resident Council meeting minutes, grievance book review, policy review, and interviews, the facility failed to ensure residents rights to: a. Participate in Resident Council was promoted and residents were not impeded or prevented from participating in Resident Council meetings; and b. Have grievances brought forward through Resident Council acted upon promptly and resolved to the residents' satisfaction within 3-5 working days of the grievance filing date, per the facility's policy.

Inspectors wroteBased on observations, interviews, and records reviewed, for three residents (Resident #216, #23, and #31) of 17 sampled residents, the facility failed to maintain professional standards of practice. Specifically, the facility failed: 1. For Resident #216, to document comprehensive weekly skin assessments; 2. For Resident #23, to ensure medication was administered as ordered by the Physician; and 3. For Resident #31, to ensure a physician's order for Trazodone (antidepressant) was complete and included the strength of the medication ordered.

Inspectors wroteBased on records reviewed and interviews, for four Residents (#15, #17, #18, and #31), of 17 sampled residents, the facility failed to ensure the Resident was seen by the physician at least every 30 days for the first 90 days after admission and at least every 60 days thereafter, with alternate visits by a nurse practitioner as indicated.

Inspectors wroteBased on record review and interview, the facility failed to ensure the Arbitration Agreement presented to residents as part of the admission packet was explained to the resident and his/her representative in a form and manner that he/she understands for six of six Arbitration Agreements reviewed.

Inspectors wroteBased on document review and interview, the facility failed to ensure their arbitration agreement specifically provides for the selection of a neutral arbitrator and neutral venue that is convenient to both parties.

Inspectors wroteBased on record review and interviews, the facility failed to notify the physician of a significant change in the resident's physical, mental, or psychosocial status, for one Resident (#14), out of 17 sampled residents. Specifically, for Resident #14, the facility failed to notify his/her physician of significant weight loss.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure residents were provided care and services to meet their care needs and were free from neglect for two Residents (#9 and #35) out of a total sample of 17 residents. Specifically, the facility failed to ensure staff responded to the Residents' call lights in a timely manner to provide assistance with care needs.

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure for one Resident (#18), out of a sample of 17 residents, that respiratory care was provided consistent with professional standards of practice.

Inspectors wroteBased on interview, record review, and policy review, the facility failed to ensure staff implemented dialysis care and services consistent with professional standards of practice and comprehensive care plan for one of one Resident (#11) receiving dialysis, out of a total sample of 17 residents. Specifically, the facility failed to provide ongoing communication between the nursing facility and dialysis facility.

Inspectors wroteBased on record review and interview, the facility failed to ensure the consultant pharmacist identified and reported an incomplete medication order for Trazodone (antidepressant) during the monthly drug regimen review for one Resident (#31), out of a total sample of 17 residents.

Inspectors wroteBased on record review and interview, the facility failed to accurately complete the Minimum Data Set (MDS) assessment for one Resident (#11), out of 17 sampled residents and for one Resident (#65), out of 2 closed records. Specifically, the facility failed: 1. For Resident #11, to ensure dialysis was accurately coded on the MDS; and 2. For Resident #65, to ensure the discharge status was accurately reflected on the MDS.

Inspectors wroteBased on observation and interview, the facility failed to follow professional standards of practice for food safety and sanitation to prevent the potential spread of foodborne illness to residents who are at high risk. Specifically, the facility failed to: 1. Ensure food was stored, labeled, dated and maintained under sanitary conditions in the main kitchen walk-in refrigerator; 2. Maintain a clean and sanitary workstation during meal preparation; 3. Handle ready to eat food (food which does not require cooking or further preparation prior to consumption) utilizing proper hand hygiene to prevent cross contamination; and 4. Ensure the cleanliness of the main kitchen floor was maintained.

Inspectors wroteBased on interview and record review, the facility failed to meet professional standards of practice for three Residents (#41, #12, and #68), out of a total sample of 19 residents. Specifically, the facility failed: 1. For Resident #41, to monitor the Resident's fluid input and output (I&O) to ensure the physician's order of 1,500 milliliters (ml) daily fluid restriction was being followed; 2. For Resident #12, to obtain urine culture sensitivity results from the hospital to ensure the Resident was receiving the appropriate antibiotic; and 3. For Resident #68, to ensure a physician's order was in place to ensure weekly skin assessments were conducted to monitor the Resident's skin integrity.

Inspectors wroteBased on observations, interviews, and test tray results, the facility failed to ensure food was prepared by methods which conserved nutritional value, flavor, appearance, palatability, and appetizing temperatures for two of four meals served.

Inspectors wroteBased on policy review, record review, and interview, the facility failed to ensure staff implemented the facility's abuse policy for two Residents (#31 and #27), out of a total sample of 19 residents. Specifically, the facility failed to: 1. For Resident #31, follow their policy and ensure an allegation of abuse was thoroughly investigated and was reported to the Department of Public Health (DPH) within two hours; and 2. For Resident #27, ensure the allegation of misappropriation was reported to the DPH within two hours.

Inspectors wroteBased on interview and record review, the facility failed to provide one Resident (#41) with an effective bowel management program and dietary options to assist with ongoing constipation concerns, out of a total sample of 19 residents.

Inspectors wroteBased on record review, policy review, and interview, the facility failed to ensure targeted behaviors and signs and symptoms of side effects were adequately monitored to evaluate the effectiveness of psychotropic medication to promote or maintain the resident's highest practicable mental, physical, and psychosocial well-being for one Resident (#28), out of a total sample of 19 residents.

Inspectors wroteBased on Minimum Data Set (MDS) assessment review and staff interview, the facility failed to encode and electronically transmit MDS data to the Centers for Medicare and Medicaid Service (CMS) processing system, for one Resident (#59), out of one resident assessment reviewed.