Renaissance Manor on Cabot

Inspectors wroteBased on observations, records reviewed, and interviews, the facility failed to provide treatment and care for an indwelling urinary catheter in accordance with the Physician's orders for one Resident (#6), of 2 applicable residents, out of a total sample of 12 residents, which resulted in a delay in care and increased the Resident's risk for indwelling urinary catheter associated complications. Specifically, the facility failed to: -change Resident #6's indwelling urinary catheter in a timely manner, per the Physician's order, when the Resident's indwelling urinary catheter was leaking urine and the Resident was dependent on staff for urinary catheter care, placing the Resident at risk for alteration in skin condition. [...]

Inspectors wroteBased on records reviewed, and interviews, the facility failed to ensure licensed nursing staff (Nurse #2) was assessed for and demonstrated competency and skill sets to provide indwelling urinary catheter care for one Resident (#6) out of a total sample of 12 residents, resulting in the Resident experiencing a delay in care. Specifically, the facility failed to ensure Nurse #2's skills relative to indwelling urinary catheter care had been assessed for competency when: -The facility identified its ability to care for residents with indwelling urinary catheters in the Facility Assessment. -Nurse #2 was assigned to care for Resident #6, who had an indwelling urinary catheter. -Resident #6: >Experienced urinary leakage from his/her indwelling urinary catheter. >Required the urinary catheter to be replaced. [...]

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1) who requested staff assistance with toileting care needs, the Facility failed to ensure he/she was treated in a dignified and respectful manner, when on 10/05/24, Resident #1 used the call light to request assistance to walk to the bathroom, and a Certified Nurse Aide (later identified as CNA #1) refused his/her request and told him/her that he/she could use the bed pan or urinate in his/her bed. Resident #1 said he/she was in a position where he/she had to rely on other people to help him/her, and that CNA #1's response made him/her feel humiliated.

Inspectors wroteBased on record review, and interview, the facility failed to complete a performance review at least once every 12 months for four Certified Nurses Aides [CNA's] (#1, #2, #4 and #5) out of four employee records reviewed. Specifically, the facility failed to complete annual performance evaluations for Certified Nurses Aides (CNA's) #1, #2, #4 and #5 as required placing the facility residents at risk for unevaluated delivery of care.

Inspectors wroteBased on interview, and record review, the facility failed to ensure that an Antibiotic Stewardship Program (ASP-a coordinated effort to improve how antibiotics are prescribed and used in a Heathcare setting) was in place for antibiotic use protocols and monitoring. Specifically, the facility failed to conduct antibiotic monitoring for the facility, placing residents at risk for complications related to antibiotic usage.

Inspectors wroteBased on interview, record and policy review, the facility failed to follow professional standards of practice relative to the transcription of Physician orders for one Resident (#15), of five residents reviewed for unnecessary medications, out of a total sample of 12 residents. Specifically, the facility failed to that ensure laboratory orders and Psychiatric Consult recommendation obtained by the Physician after a Medication Regimen Review (MRR) conducted by the Consultant Pharmacist were completed for Resident #15.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure sufficient nursing staffing levels with the appropriate competencies and experience to provide nursing and related services to the facility residents. Specifically, the facility failed to: 1. provide staffing levels in accordance with the facility assessment for 23 out of 36 days for the period 9/1/24 -10/6/24, placing the facility residents at risk for impeded delivery of care and inability to meet the specific needs and concerns of each resident. 2. provide a sufficient number of nursing staff to provide basic care and respond timely per Resident Council concerns voiced. 3. provide sufficient staffing to assist timely with ADL care for: -Resident's #8, #84, and #5 -Resident Representative (requesting anonymous consideration) advocating for family. -Direct care staff concerns.

Inspectors wroteBased on interview, record and policy review, the facility failed to ensure that one Resident (#8), of five applicable residents reviewed for unnecessary medications, out of a total sample of 12 residents, did not recieve medications outside of the Physician ordered parameters. Specifically, for Resident #8, the facility failed to ensure that Tramadol (an opioid medication used to relieve moderate to moderately severe pain) was administered within the parameters (moderate and severe pain) prescribed by the Physician.

Inspectors wroteBased on interview, and record review, the facility failed to ensure the Notice of Medicare Non-Coverage (NOMNC: notice issued to a resident who is receiving benefits under Medicare Part A when all covered services end) and/or Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNF ABN: notice issued to a resident when a facility determines the beneficiary no longer qualifies for Medicare Part A skilled services and the resident has not used all his/her Medicare benefit days) were issued for three Residents (#81, #82 and #27), out of four residents reviewed. Specifically, the facility failed to issue the: 1. NOMNC notice two calendar days prior to Resident #81's termination of Medicare benefits, as required. 2. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure that a plan of care was developed for monitoring of psychotropic (medication that affects how the brain works and causes changes in mood, awareness, thoughts, feelings or behavior) medications for side effects and response for one Resident (#7), out of five applicable residents reviewed for unnecessary medication review, out of a total sample of 12 residents. Specifically, for Resident #7, the facility failed to develop a plan of care relative to the Resident's use of the antidepressant medications, including monitoring for potential medication side effects and response.

Inspectors wroteBased on observation, interview, record review and policy review, the facility failed to ensure interventions were reviewed/revised pertaining to falls for one Resident (#15), out of a total sample of 12 residents. Specifically, the facility failed to review and revise the fall interventions after Resident #15 experienced an unwitnessed fall to decrease the risk of re-occurrence of falls.

Inspectors wroteBased on record review, observation, and interview, the facility failed to assess and provide treatment in accordance with professional standards of practice relative to wound care and assessment for one Resident (#132) out of a total sample of 12 residents placing the Resident at risk for complications of wound healing. Specifically, for Resident #132, the facility failed to: -complete skin and wound assessments upon the Resident's admission to the facility resulting in the delayed management of wound care. -obtain wound care treatment orders as recommended by the discharge facility to provide wound care timely for the Resident.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to ensure professional standards of practice relative to identification and prevention of pressure ulcers (injury to skin and underlying tissue resulting from prolonged pressure on the skin and often develop on the heels, ankles, hips and tailbone) for one Residents (#22), out of a total sample of 12 residents. Specifically, for Resident #22, the facility failed to ensure monitoring and interventions were implemented to prevent a pressure ulcer on his/her upper ears from developing, when the Resident complained of discomfort and pain caused by the use of a nasal cannula (a thin flexible tube that provides supplemental oxygen through the nose via nasal prongs) to those areas.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to ensure that weights were monitored as ordered by the Physician and professional standards of practice for one Resident (#15) who was identified as at risk for malnutrition, had a history of weight loss and was determined to be underweight, out of a total sample of 12 residents. Specifically, for Resident #15, the facility failed to: -identify a significant weight change timely. -obtain a re-weight when the significant weight change was identified by the Registered Dietitian (RD). -obtain a monthly weight as ordered by the Physician.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to provide respiratory care and services in accordance with professional standards of practice relative to the use of supplemental Oxygen (a drug that is a vital and essential medication, usually prescribed to treat cardiac and respiratory conditions) for one Resident (#22), of one applicable resident receiving oxygen therapy, out of a total sample of 12 residents. Specifically, for Resident #22, the facility failed to: -administer supplemental Oxygen in accordance with the Physician's orders. -indicate the flow rate of Oxygen utilized when the oxygen saturations levels (SpO2/ O2 Sat - measure of Oxygen in the blood as a percentage of the maximum Oxygen the blood could carry) were obtained by the nursing staff.

Inspectors wroteBased on observation, interview, record and policy review, the facility failed to obtain consent for the use of bed rails for one Resident (#7), out of a total sample of 12 residents. Specifically, for Resident #7, the facility failed to obtain informed consent that included notification of the risks and benefits for the use of the bed rails from the Resident Representative prior to use.

Inspectors wroteBased on interview, record and policy review, the facility failed to ensure the Medication Regimen Review (MRR) conducted by the Consultant Pharmacist was reviewed and addressed timely by the facility for two Residents (#8 and #15), of five residents reviewed for unnecessary medications, out of a total sample of 12 residents. Specifically, the facility failed to: 1. For Resident #8, ensure the MRR completed by the Consultant Pharmacist on 9/4/24, pertaining to Seroquel (antipsychotic medication) was in the clinical record and was addressed by the Physician. 2. For Resident #15, ensure the MRR completed by the Consultant Pharmacist on 9/11/24 was in the clinical record and indicated a response by the Physician/facility.

Inspectors wroteBased on records reviewed and interviews for one of three sampled residents (Resident #1), who had a Physician's Order for a Dysphagia Advanced Diet, required supervision during meals, and was not to be served bread products (which included rolls) the facility failed to ensure his/her safety was adequately maintained related to meal preparation and meal service, in an effort to prevent an incident of choking. On 11/27/23 the kitchen did not use the correct meal ticket when preparing Resident #1's breakfast tray, after the meal truck was delivered to Resident #1's unit, the nurse checking the trays prior to service, did not notice that a croissant type roll had been put on his/her tray, he/she consumed the roll, started to choke and required the Heimlich maneuver.

Inspectors wroteBased on observation, record review and interview, the facility failed to complete Self-Administration Medication Assessments for two Residents (#7 and #8), out of a total sample of 12 residents. Specifically, the facility failed to complete Self-Administration Medication Assessments for the administration of topical medications for Resident's #7 and #8.

Inspectors wroteBased on observation, record review and interview, the facility failed to follow a plan of care for one Resident (#7), out of a total sample of 12 residents. Specifically, the facility staff failed to ensure the correct setting of a Low Air Loss (LAL- mattress designed to distribute the resident's body over a broad surface area and help prevent skin breakdown) mattress was properly maintained for the Resident. Findins include: Resident #7 was admitted to the facility in November 2022 with a diagnosis of Respiratory Failure (the lungs cannot get enough oxygen into the blood) with Hypoxia (low levels of oxygen in the blood). Review of the most recent Minimum Data Set (MDS) assessment dated [DATE], indicated that Resident #7 was moderately cognitively impaired as evidenced by a score of 11 out of 15 on a Brief Interview for Mental Status (BIMS) assessment. [...]

Inspectors wroteBased on observation, record review and interview, the facility failed to provide the necessary emergency equipment at the bedside for the care and services of a tracheostomy (an opening surgically created through the neck into the trachea (windpipe) to allow direct access to the breathing tube) tube per professional standards, for one Resident (#19) out of one applicable Resident, out of a total sample of 12 residents.

Inspectors wroteBased on policy review, observation and interview, the facility failed to ensure that its staff distributed food in accordance with professional standards for food service safety. Specifically, two dietary staff members failed to wear beard restraints during the food preparation process.