Royal Nursing Center, LLC

Inspectors wroteBased on observations, interviews, and meal test tray results, the facility failed to serve meals that were palatable and at appetizing temperatures on one (Vineyard Sound) of three units. Using the reasonable person concept, a person would not find the food temperatures palatable and appetizing.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide care and services consistent with professional standards for one Resident (#4), out of a total sample of 20 residents. Specifically, the facility failed to implement physician's orders for air mattress settings.

Inspectors wroteBased on record review and interviews, the facility failed to ensure staff provided residents an environment free from accident hazards for one Resident (#17), out of a total sample of 20 residents. Specifically, the facility failed to implement fall prevention interventions to prevent future falls for Resident #17.

Inspectors wroteBased on observation, interview, and document review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and potential transmission of communicable diseases and infections. Specifically, the facility failed:1. For Resident #4,a. to perform hand hygiene as indicated during a dressing change, andb. to doff (remove) personal protective equipment (PPE) as indicated for a resident on Enhanced Barrier Precautions (EBP); and2. To disinfect shared vital signs equipment after use.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents, (Resident #1), the facility failed to ensure that upon admission, nursing developed and implemented a baseline care plan with interventions, treatments, goals and outcomes that addressed the residents' overall immediate care needs.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents, (Resident #1), who was newly admitted to the facility and whose Physician's orders included PRN (as needed) pain medication to manage chronic pain, the Facility failed to ensure that his/her pain was adequately treated and effectively managed.

Inspectors wroteBased on records reviewed and interviews for one of three sampled residents, (Resident #1), the facility failed to ensure they maintained complete and accurate medical record when nursing documentation in Resident #1's Medication Administration Record (MAR) and documentation in the Controlled Substance Register (record/log book used by the facility for maintaining accurate records of narcotics ordered and administered to each resident) related to the administration of Oxycodone conflicted, and therefore making on of them accurate.

Inspectors wroteBased on records reviewed and interviews for one of three sampled residents (Resident #1), who had severe cognitive impairment and was unable to identify him/herself, the Facility failed to ensure he/she was free from a significant medication error, when on 03/13/25, Resident #1 was administered another resident's medications in error. Resident #1 was transferred to the Hospital Emergency Department (ED) for evaluation, he/she remained in the Hospital overnight for monitoring and treatment to stabilize his/her blood pressure, which included administration of intravenous fluids and medications. Findings Include: Review of the Facility's Policy titled, Administering Medications, dated as revised October 2022, indicated the following: -only persons licensed or permitted by this state to prepare, administer and document the administration of medications may do so; [...]

Inspectors wroteBased on record review, policy 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 (#44), out of a total sample of 22 residents. Specifically, for Resident #44 the facility failed to ensure the MOLST (Massachusetts Medical Order for Life-Sustaining Treatment) form was valid and reflected the signature of Resident #44's invoked (made active by a Physician) 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).

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement a person-centered comprehensive care plan for one Resident (#11), out of a total sample of 18 residents. Specifically, the facility failed to: a. Implement a care plan to ensure Resident #11 was transferred with the assistance of two people; and b. Develop and implement a care plan for pressure injury prevention for Resident #11, who was assessed to be at risk for skin breakdown, resulting in a facility acquired unstageable (actual depth of ulcer is completely obscured by slough and/or eschar in the wound bed) right heel ulcer.

Inspectors wroteBased on observation, interview, and policy review, the facility failed to ensure that infection control and prevention measures were followed during preparation of medication for administration.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to provide one Resident (#21), out of a total sample of 18 residents, an activity program that engaged the Resident and supported their physical, mental, and psychosocial well-being.

Inspectors wroteBased on document review and interview, the facility failed to ensure the activities program was directed by a qualified professional who has completed a state approved training course.

Inspectors wroteBased on observation, record review, policy review, and interview, the facility failed for two Residents (#75 and #185), out of a total sample of 18 residents, to maintain professional standards in the managing and care for urinary catheter devices. Specifically, the facility failed: 1. For Resident #75, to ensure the drainage bag and tubing were positioned to lessen the likelihood of complications; and 2. For Resident #185, to maintain the catheter in a manner to prevent the possibility of infection.

Inspectors wroteBased on record reviews, policy review, and interviews, the facility failed to ensure required physician visits (every 30 days for the first 90 days and at least once every 60 days after) alternated between the Physician and the Nurse Practitioner (NP) for five Residents (#10, #19, #21, #30, and #70), in a total sample of 18 residents.

Inspectors wroteBased on observations, interviews, and review of the meal truck delivery schedule, the facility failed to offer a nourishing evening snack when there was greater than 14 hours between dinner and breakfast service.

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 handle prepared foods during plating utilizing gloves and proper hand hygiene to prevent cross contamination.

Inspectors wroteBased on record review, policy review, and interview, the facility failed to complete a Level I Preadmission Screening and Resident Review (PASRR- screen to determine if a resident had an intellectual or developmental disability and/or serious mental illness and needed further evaluation) for one Resident (#46), out of a total sample of 18 residents.

Inspectors wroteBased on record review, policy review, and interview, the facility failed to ensure staff developed and implemented a baseline care plan within 48 hours of the Resident's admission for one Resident (#46), in a total sample of 18 residents, to ensure that the Resident's immediate care needs were met.

Inspectors wroteBased on record review, policy review, and interview, the facility failed to ensure that individualized, comprehensive care plans were developed for one Resident (#46), out of a total sample of 18 residents. Specifically, the facility failed to ensure that Resident #46 had a care plan developed for the care of a blister formation on top of his/her left foot and left middle toe infection.

Inspectors wroteBased on record reviews, policy review, and interviews, the facility failed to provide a written notice of the discharge/transfer to the resident or responsible party prior to discharging residents from the facility or to the hospital, for two Residents (#10 and #83), in a sample of 18 residents and 2 closed records.