Regalcare at Worcester

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who upon admission had specific physician's orders for treatment of his/her pressure injury, the facility failed to ensure that the treatment orders transcribed and provided by nursing were appropriate and adequate to treat his/her wound.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who required hemodialysis (a life-saving treatment that filters waste products and excess fluid when the kidneys stop working) three times a week for end stage renal disease (ESRD), the facility failed to ensure Resident #1 received the care and services consistent with his/her care plan, when Resident #1 missed a dialysis session because of a transportation issue and miscommunication with the dialysis center, he/she went four days without receiving dialysis and when he/she was transported to the dialysis center for treatment, he/she required Hospital transfer due to a change in status.

Inspectors wroteBased on interview and record review, the facility failed to provide privacy for residents during Resident Council meetings. Specifically, the facility failed to provide a private meeting space for Resident Council meetings where facility staff was not using the meeting space area as a conduit to other building areas during times when Resident Council meetings were in progress.

Inspectors wroteBased on observations, and interviews, the facility failed to maintain a homelike environment on two units (Unit 2 and Unit 4) out of four resident units. Specifically, the facility failed to: -On Unit 2, maintain eight out of 22 resident rooms and the activity room in a safe, clean, comfortable and homelike environment. -On Unit 4, ensure that 19 out of 19 resident rooms were maintained in a safe, clean, comfortable and homelike environment.

Inspectors wroteBased on observations, and interviews, the facility failed to maintain a safe and sanitary smoking environment for residents, staff, and visitors. Specifically, the facility failed to: -Ensure that proper signage was visible to designate resident smoking areas. -Ensure residents were smoking in the designated smoking areas and not on the facility sidewalks and driveways. -Ensure residents were safely disposing of cigarette materials/refuse in the designated receptacles to prevent the risk of starting a fire when cigarettes were thrown near shrubs, mulch and on the ground with other trash.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide necessary care and services relative to enteral feeding (providing nutrition directly into the stomach/intestines through a feeding tube), for one Resident (#114) out of a total sample of 25 residents. Specifically, for Resident #114, the facility failed to record the total amount of administered enteral feeding as ordered by the Physician, and perform weekly weight monitoring with the Resident experiencing a significant weight loss over a one-month period.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure that medications were secure and inaccessible to unauthorized persons, for one Resident (#91), out of a total sample of 25 residents. Specifically, for Resident #91, the facility failed to ensure that medications prepared for the Resident was handled in a safe and secure manner, when Nurse #3 left medications reconstituted in a cup of coffee, with Certified Nurses Aide (CNA) #4, and instructions that CNA #4 ensure the Resident consumed the coffee/ medications, and Nurse #3 did not remain with the Resident to ensure safe medication administration.

Inspectors wroteBased on record review, interview, and observation, the facility failed to provide routine dental services for one Resident (#29) out of a total sample of 25 residents. Specifically, for Resident #29, the facility failed to schedule a follow-up appointment for dental care in a timely manner which resulted in a delay in dental care and increased risk for oral pain and infection.

Inspectors wroteBased on observation, interview, and record review, the facility failed to adhere to infection control standards of practice for one Resident (#48) out of a total sample of 25 residents, increasing the risk of contamination and the spread of infections within the facility. Specifically, for Resident #48, the facility staff failed to appropriately follow 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), while providing high contact care to the Resident during ADLs (Activities of Daily Living: such as bathing, dressing, grooming, personal hygiene) when providing high contact care to the Resident.

Inspectors wroteBased on record reviews, and interviews, the facility failed to accurately code a Minimum Data Set (MDS) Assessment for one Resident (#102), out of a total sample of 25 residents. Specifically, the facility failed to: 1. For Resident #102, accurately code that the Resident used corrective lenses during the MDS observation period putting the Resident at risk for not receiving required vision care and services.

Inspectors wroteBased on interview, record and policy review, the facility failed to ensure the resident's right to make healthcare decisions for one Resident (#8) out of a total sample of 21 residents. Specifically, the facility failed to obtain written informed consent prior to administering a psychotropic (any drug that affects behavior, mood, thoughts, or perception) medication, including providing education on the risks and benefits of proposed care related to the use of the medication. Findings Include: Review of the facility policy titled Psychotropic Medication, revised April 2022, indicated the following: -Purpose is to administer and monitor the effects of psychoactive (also known as psychotropic) medications when prescribed. -Guidelines include: <Obtaining a Physician's order and an appropriate diagnosis is required for all psychoactive medications. [...]

Inspectors wroteBased on interviews, record and policy review, the facility failed to arrange for services or care that accepted standards of quality dictate should have been provided for one Resident (#65) out of a total sample of 21 residents, to aid in treating Tardive Dyskinesia (TD - abnormal movements in the face, tongue, or other body parts that cannot be controlled). Specifically, for Resident #65, the facility staff failed to communicate Behavioral Health recommendations to the Physician so an increased dosage of the medication, Ingrezza (used to treat -TD) could be initiated to manage TD symptoms for the Resident.

Inspectors wroteBased on interview and record review, the facility failed to provide care and services for an ileostomy (a surgically made opening that connects the lower end of the small intestine to the abdominal wall. Through the abdominal wall opening, or stoma, the lower intestine is stitched into place. A wafer [a dressing that surrounds the stoma] is applied to the surrounding skin and allows for a bag/pouch to be attached to collect stool) appliance per professional standards, for one Resident (#13) out of a total sample of 21 residents. Specifically, the facility staff did not change the ileostomy bag and appliance (baseplate [or wafer] where the bag/pouch attaches) as required.

Inspectors wroteBased on observation, interview, policy and record review, the facility failed to provide respiratory care services as ordered for one Resident (#29), out of one applicable resident, in a total sample of 21 residents. Specifically, the facility staff failed to change Resident #29's oxygen (O2) tubing weekly, as ordered by the Physician putting the Resident at risk for sinus and airway infections resulting from contaminated equipment.

Inspectors wroteBased on interview and record review, the facility failed to provide coverage by a Registered Nurse (RN) for at least eight consecutive hours a day for seven days a week, as required. Specifically, the facilty was not able to provide evidence that a Registered Nurse (RN) was scheduled and worked for a minimum of eight hours on Saturday, 12/30/2023.

Inspectors wroteBased on observation, interview and policy review, the facility failed to store and serve food in accordance with professional standards for food safety in two out of the three nourishment kitchens. Specifically, the facility failed to properly label and date resident food items, discard perishable foods by the sell by date, and maintain a clean microwave to prevent contamination and the risk of food-borne infections.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to maintain appropriate infection control measures related to a wound dressing change for one Resident (#46) out of a total sample of 21 residents. Specifically, the facility staff failed to perform hand hygiene as required between glove changes during a wound dressing change for Resident #46, putting the resident at risk for contamination and infection of the wound.

Inspectors wroteBased on record review and interview, the facility failed to ensure staff informed residents, their representatives, and their families by 5:00 P.M. the next calendar day following the occurence of a single confirmed COVID-19 infection in the facility as required.

Inspectors wroteBased on record review and interview the facility failed to ensure that staff were tested for COVID-19, based on parameters for outbreak testing, for 2 staff members out of a total of 8 staff members sampled.

Inspectors wroteBased on interview and record review the facility failed to ensure staff provided one Resident (#100) proper foot care, out of 25 sampled residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure staff: (1) provided adequate supervision during smoking for one Resident (#36), (2) failed to evaluate risks associated with smoking for one Resident (#15), and (3) failed to maintain two out of four laundry dryers per manufacturer's guidelines.

Inspectors wroteBased on observation and interview, the facility failed to ensure staff maintained safe sanitation practices to properly dispose garbage by failing to ensure the garbage dumpsters remained covered.

Inspectors wroteBased on record review and interview the facility staff failed to implement the plan of care for two Residents (#52 and #117) out of a total sample of 25 residents, specifically for Resident #52 a medication was not administered as ordered by the physician, and for Resident #52 and #117 weights were not recorded as per the care plan.

Inspectors wroteBased on record review, observation and interview, the facility staff failed to revise the care plan within 7 days after a significant change assessment, for one Resident (#76) out of 25 sampled residents.

Inspectors wroteBased on observation, interview and record review, the facility staff failed to provide one Resident (#100) out of 25 sampled residents with (1.) care and services related to skin breakdown, and (2.) an adequate sized bed.

Inspectors wroteBased on record review and interview the facility failed to ensure that staff provided the necessary behavioral health services and individualized approaches to care directed toward understanding, preventing, relieving, and/or accommodating a resident's distress or loss of abilities related to suicidal ideation and long-term care placement for one Resident (#81) in a total sample of 25 residents.

Inspectors wroteBased on record review and interview the facility failed to ensure that staff acted upon pharmacy recommendations, that were approved by the physician, for a psychiatry (psych) consult to review the appropriateness of psychotropic medications and/or consider a possible decrease in dosages, for three Residents (#59, #81 and #39) in a total sample of 25 residents.

Inspectors wroteBased on interview and record review, the facility failed to ensure staff did not administer an unnecessary psychotropic medication, specifically an anti-anxiety medication, to one Resident (#61) out of 25 sampled residents.

Inspectors wroteBased on interview and record review the facility failed to provide specialized rehabilitative services, specifically speech-language pathology, for one Resident (#61) out of 25 sampled residents, and one Resident (#125) out of 3 sampled closed records.

Inspectors wroteBased on interview and record review, the facility failed to ensure the clinical records for two residents (#27 and #52) were readily accessible relative to monthly weights, and accurate, relative to the documentation of the administration of a medication, in a total sample of 25 residents.

Inspectors wroteBased on record review and interview the facility staff failed to provide a bed-hold notice upon transfer from the facility as required for two residents (#18 and #97) out of a total sample of 25 residents.