Westborough Healthcare

Inspectors wroteBased on observations, and interviews, the facility failed to maintain proper sanitation and food handling practices to prevent the outbreak of foodborne illness in the main facility kitchen. Specifically, the facility failed to ensure that the minimum wash temperature necessary was maintained per manufacturer's guidelines for the dish machine utilized for cleaning and sanitizing dishware for resident use in the main facility kitchen, when the low temperature dish machine was operating at registered temperatures below acceptable ranges of 120 degrees Fahrenheit (F) for the wash cycle.

Inspectors wroteBased on observations, record reviews, and interviews, the facility failed to adhere to infection control standards of practice to prevent contamination and the spread of infections for two Residents (#9 and #38) out of a total sample of 21 residents, and also failed to clean and sanitize hands before and after removing resident meal trays on one unit (2nd Floor) out of three units observed. Specifically, 1. For Resident #9 and Resident #38, the facility failed to ensure that appropriate Personal Protective Equipment (PPE: [...]

Inspectors wroteBased on record review, observations, and interviews, the facility failed to provide appropriate access to the call light for one Resident (#16) out of a total sample of 21 residents. Specifically, for Resident #16, the facility staff failed to place the Resident's call light within his/her reach placing the Resident at risk for unmet needs.

Inspectors wroteBased on record review and interview, the facility failed to inform one Resident (#5) out of a total sample size of 21 residents in advance of the risks and benefits of treatments prior to implementation of treatment. Specifically for Resident #5 the facility failed to obtain signed informed consent for the use of two psychotropic medications prior to administration of the medications to the Resident.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide independent activities of choice to meet the mental and psychosocial needs of one Resident (#13), out of a total sample of 21 residents. Specifically, for Resident #13, the facility failed to ensure the Resident was provided with preferred television access in his/her bedroom, after the Resident requested assistance to access television programming, resulting in negative psychosocial outcome of increased anxiety and depressed mood of the Resident.

Inspectors wroteBased on observation, and interviews, the facility failed to ensure that drugs and biologicals were stored in accordance with State and Federal laws in one (2nd Floor) of two medication storage rooms reviewed. Specifically, the facility failed to ensure multi-dose vial medications were dated once opened according to manufacturer's guidelines in the 2nd Floor medication storage room.

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), the Facility failed to ensure they maintained a complete and accurate medical record related to his/her Advanced Directives, when after Resident #1 was found unresponsive, without a pulse, nursing was unable to readily locate and identify his/her code status.

Inspectors wroteBased on record review, and interview, the facility failed to ensure that the required transfer documentation was completed and the required transfer documentation communicated the appropriate information to the receiving health care institution for five Residents (#64, #18, #39, #11 and #29), out of a total sample of 19 residents. Specifically, the facility failed to ensure that Residents #64, #18, #39, #11, and #29, were transferred to the hospital with important information relative to the Residents' medical histories and the reasons for transfer, putting the Residents at risk for complications and adverse events upon transfer to the hospital.

Inspectors wroteBased on record review, and interview, the facility failed to provide a Notice of Bed-Hold Policy at the time of transfer to a hospital or shortly thereafter for five Residents (#64, #18, #39, #11, and #29) and/or their Representatives, out of a total sample of 19 residents. Specifically, the facility staff failed to provide Resident's #64, #18, #39, #11, and #29) and/or their Representatives with written notification relative to Bed-Holds when the Residents were transferred from the facility to the hospital and were expected to return to the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide respiratory care and services consistent with professional standards of practice for three Residents (#18, #10 and #13), out of a total sample of 19 Residents. Specifically, the facility failed to: 1. For Resident #18, obtain Physician's orders for oxygen administration or the maintenance of oxygen and respiratory equipment. 2. For Resident #10, and Resident #13, maintain the Resident's oxygen concentrators (medical device that uses air in the atmosphere, filters it, and delivers concentrated oxygen) and filters in a clean, safe, functioning manner.

Inspectors wroteBased on record review, and interview, the facility failed to post the required nurse staffing information daily. Specifically, the facility failed to: -post the total number and actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift: Registered Nurses (RN), Licensed Practical Nurses (LPN) or Licensed Vocational Nurses (LVN), and Certified Nurses Aides (CNA). -maintain a copy of the staffing records for 18 months as required.

Inspectors wroteBased on observation, and interview, the facility failed to adhere to safe food practices to prevent contamination of food and beverage items intended for resident consumption in the facility's main kitchen. Specifically, the facility failed to implement safe food practices in the main kitchen relative to: -discarding food that was spoiled. -labeling/dating, storage guidelines. -maintaining the facility kitchen in a clean, sanitary, and free of dust and debris manner.

Inspectors wroteBased on observation, and interview, the facility failed to provide privacy and confidentiality for one Resident (#26), out of a total sample of 19 residents. Specifically, for Resident #26, the facility staff failed to ensure that personal privacy of the Resident's own body was maintained while providing personal care when he/she was observed to be naked.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure a clean, homelike environment on one unit (Spruce Unit) out of three resident care units. Specifically, the facility failed to maintain the environment in a clean and homelike manner when the source of lingering odors of stale urine and unclean body odors in the Spruce Unit hallway were not adequately addressed and resolved.

Inspectors wroteBased on record review, and interview, the facility failed to coordinate an assessment with the Preadmission Screening and Resident Review (PASARR - a federal requirement to help ensure that individuals who have a mental disorder or intellectual disabilities are not inappropriately placed in nursing homes for long term care) program for one Resident (#44) out of a total sample of 19 residents. Specifically, the facility failed to complete a new Level I PASARR Assessment when Resident #44 had a significat change in status with a new diagnosis of Delusional Disorders (a belief in something that is untrue) following a psychiatric hospitalization and was started on treatment with an antipsychotic medication (medication used to treat symptoms of mental illness, including delusions - false convictions about something that is not real or shared by other people).

Inspectors wroteBased on interview, and record review, the facility failed to ensure that a Preadmission and Resident Review Level (initial PASRR - initial pre-screening completed prior to admission to a Nursing Facility that assess for Serious Mental Illness [SMI] or Developmental Disabilities [DD]) screen was completed prior to admission to the facility for two Residents (#20 and #30) out of a total sample of 19 residents. Specifically, 1. For Resident #20, the facility failed to ensure the PASRR was completed accurately to reflect a psychiatric hospitalization. 2. For Resident #30, the facility failed to ensure that a Level I screen was completed prior to admission to the facility when the Resident had active diagnoses of mental disorders.

Inspectors wroteBased on record review, and interview, the facility failed to meet professional standards of practice pertaining to Polysomnography (sleep study) for one Resident (#10), out of a total sample of 19 Residents. Specifically, for Resident #10, the facility failed to implement a Physician's order to obtain a sleep study to diagnose Obstructive Sleep Apnea (pauses in breathing during sleep, associated with partial or complete collapse of the throat and airway) resulting in delayed interventions and treatments for the Resident based on the sleep study results.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure two Residents (#69 and #82) out of a total sample of 19 residents were provided assistance with personal hygiene care and services. Specifically, the facility failed to ensure that: 1. Resident #69 was offered and/or provided with grooming assistance for nail care when the Resident required partial/moderate (staff does less than half the effort) assistance of staff. 2. Resident #82 was offered and/or provided grooming assistance timely for hair care, facial hair care, and personal care when the Resident required total dependence (full staff performance of an activity with no participation by resident) of staff for hygiene, bathing, and dressing.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an environment that is free of accidents and hazards for one Resident (#18) out of a total sample of 19 residents. Specifically, for Resident #18, the facility failed to: -ensure that potentially hazardous smoking materials were stored in a secure area, and not inappropriately and insecurely stored in Resident #18's bedroom when both a stationary oxygen concentrator and portable oxygen concentrator were also stored and utilized in his/her bedroom putting the Resident and other residents at risk for accidental injury when there was easy access to the smoking materials.

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide care and services according to professional standards of practice pertaining to an indwelling urinary catheter (a flexible tube inserted into the urethra to the bladder to drain urine outside of the body) for one Resident (#64) of two applicable residents, out of a total sample of 19 residents. Specifically, the facility failed to obtain Physician's orders, develop a plan of care, maintain and/or monitor Resident #64's indwelling urinary catheter.

Inspectors wroteBased on observation, and interview, the facility failed to ensure that the appropriate competencies and skills related to medication administration and storage were maintained by one Nurse (#1). Specifically, the facility failed to ensure that Nurse #1 did not pre-pour the residents medications and store the pre-poured medications in the bottom of the medication cart to administer at a later time.

Inspectors wroteBased on observation and interview, the facility failed to accurately and safely provide pharmaceutical services pertaining to administering and storing medications on one of three medication carts observed. Specifically, the facility failed to ensure that medications were not pre-poured in medication cups and the pre-poured medication and medication cups stored in the medication cart prior to being administered to residents.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure it was free of a medication error rate of five percent (5%) or greater when one Nurse (#2) of one Nurse observed during the medication pass procedure, made five errors in 35 opportunities, for a total medication error rate of 15.15%, impacting one Resident (#2) out of five residents observed, out of a total sample of 19 residents. Specifically, for Resident #2, Nurse #2 failed to: 1. Administer the correct dose of Ferrous Sulfate Elixir (Iron) as ordered. 2. Administer the correct form of Ferrous Sulfate Elixir as ordered. 3. Administer the following medications as ordered: Glycolax Powder (stool softener)/ Levetiracetam Solution (antiseizure medication)/Artificial Tears Solution (eye drops)/Ocean Spray Nasal Solution. 4. Administer the correct form of Omeprazole suspension as ordered. 5. [...]

Inspectors wroteBased on records reviewed and interviews for one of three sampled residents (Resident #2), who had a legal guardianship in place, which was updated on [DATE] to include the right to make decisions regarding Advanced Directive with an elected code status of Do Not Resuscitate (DNR, medical order which instructs healthcare providers not to do cardiopulmonary resuscitation, in the event of cardiac or respiratory arrest) the Facility failed to ensure that new physician's orders were obtained, so in the event of cardiac or respiratory arrest, staff did not attempt to resuscitate him/her.

Inspectors wroteBased on records reviewed and interviews for three of seven sampled Employee Personnel Records (Certified Nurse Aide (CNA) #1, CNA #2, and Nurse #2, who were all contracted to work at the facility through a staffing agency), the Facility failed to ensure that Massachusetts Nurse Aide Registry (NAR) checks were conducted prior to their date of employment at the facility, in accordance with their Abuse Policy.

Inspectors wroteBased on record review and interview, the facility failed to implement advance directives and follow policies pertaining to advance directives for two Residents (#48 and #91) out of a total sample of 24 residents. Specifically, the facility staff failed to: 1. For Resident #48, follow the advance directive for a Do Not Resuscitate (DNR - a medical order issued by a physician or other authorized non-physician practitioner that directs healthcare providers not to administer CPR [cardiopulmonary resuscitation] in the event of cardiac or respiratory arrest), and provided CPR, with resulting hospitalization, rib fractures, and uncontrolled pain. 2. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide an environment that was free of accidental hazards, for five Residents (#88, #45, #42, #70 #104 and #54) out of a total sample of 24 residents. Specifically, the facility failed to: 1. For Resident #88, assess for the ability to safely self-perform g-tube (gastrostomy tube- a tube placed through an opening into the stomach from the abdominal wall, made surgically for the introduction of food) care when the Resident cut off his/her g-tube with scissors while performing an unsupervised dressing change. 2. For Resident's #45, #42, #70, and #104, provide proper receptacles for the disposal of cigarette butts and proper storage of smoking materials. 3. [...]

Inspectors wroteBased on observation, record review and interview, the facility failed to consult the Physician regarding the need to alter treatments for one Resident (#70) out of a total sample of 24 total residents. Specifically, the facility failed to consult with the Physician regarding Hospice recommendations to: -Change the size of the Resident's indwelling urinary catheter/ Foley catheter (catheter that is inserted into the bladder through the urethra to drain urine) when the catheter was leaking urine. -Change the treatment provided to care for the Resident's left buttock Stage 3 (full-thickness loss of skin, in which subcutaneous fat may be visible in the ulcer and granulation tissue and epibole [rolled wound edges] are often present. [...]

Inspectors wroteBased on observations, record reviews and interviews, the facility failed to provide assistance with Activities of Daily Living (ADLs) for one Resident (#92) out of a total sample of 24 residents. Specifically, the facility staff failed to provide ADL assistance to Resident #92, a dependent resident who was incontinent of bowels and stool.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure one Resident (#88) was provided with treatment and care, in accordance with professional standards of practice, relative to treatment of an upper abdominal surgical site. Specifically, the facility failed to identify and provide needed education and supplies to Resident #88, for treatment of his/her upper abdominal surgical Gastrostomy tube (G-tube) site and allowed the Resident to self-perform a treatment to the site that was not ordered by the Physician.

Inspectors wroteBased on observation, record review and interview, the facility failed to provide indwelling Foley catheter (a drainage tube that is inserted into the urinary bladder through the urethra, is left in place, and is connected to a closed collection system to drain urine) care, per professional standards of practice for three Residents (#9, #17 and #70) out of a total sample of 24 residents. Specifically, For Resident's #9, #17 and #70, the facility staff failed to ensure that the Residents received the right size of Foley catheter based on the Physician's orders and care plan.

Inspectors wroteBased on record review and interview, the facility failed to maintain complete and accurate medical records for two Residents (#32 and #62) out of a total sample of 24 residents. Specifically, the facility failed to maintain accurate medical record of Resident #32 and Resident #62's advanced directives.