Williamstown Commons Nursing & Rehab

Inspectors wroteBased on records reviewed and interviews, for one of three sampled residents (Resident #1), who had severe cognitive impairment and was dependent on staff to meet his/her healthcare needs, the Facility failed to ensure he/she was treated in a respectful and dignified manner, when although Resident #1 said the words no and stop to Certified Nurse Aide (CNA) #1 during the provision of care, CNA #1 did not honor Resident #1's wishes, and continued with care.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure each resident received food that was palatable and served at an appetizing temperature for three units (Unit 1, Unit 2 and Unit 3), out of three units, and for three sampled Residents ( #4, #93 and #136), out of a total of 26 sampled residents. Specifically, the facility failed to ensure the food provided during meals was appetizing in taste, temperature and appearance.

Inspectors wroteBased on observations and interviews the facility failed to ensure its staff prepared, distributed and served food in accordance with professional standards for food service safety. Specifically, facility staff failed to ensure: facial hair was covered by two staff members and, one staff performed hand hygiene when they stepped away from the food tray line, touched other high touch services and, returned to the food tray line, increasing opportunities for cross contamination of exposed food.

Inspectors wroteBased on observations, interviews and records reviewed, the facility failed to maintain a safe and sanitary environment for two Residents with urinary catheters (#102 and #58), of five applicable residents reviewed with urinary catheters, out of a total sample of 26 residents. The facility also failed to ensure hand hygiene was performed during distribution of medications and that shared medical equipment was cleaned and disinfected between resident use on one unit (Unit 3), of three units observed. Specifically,For Resident #102, the facility failed to ensure that the Resident's indwelling urinary catheter drainage bag was not touching the floor on 3/24/26 and 3/25/26, increasing the Resident's risk for infection. [...]

Inspectors wroteBased on observation, interviews, and records reviewed, the facility failed to ensure that the appropriate enteral feeding (nutrients delivered through a feeding tube directly into the stomach, duodenum or jejunum) treatment was provided for one Resident (#2) of one applicable resident, out of a total sample of 26 Residents. Specifically, for Resident #2, the facility failed to administer enteral nutrition according to the Physician's order and administered more than the prescribed volume of enteral nutrition, placing the Resident at an increased risk for complications of enteral feeding including aspiration pneumonia, diarrhea, and vomiting.

Inspectors wroteBased on observations, interviews, and records reviewed, the facility failed to ensure that pain management was provided in accordance with the individual goals for care and preferences for one Resident (#80) out of a total sample of 26 residents. Specifically, for Resident #80, the facility failed to implement the order for Morphine (short-acting opioid medication used to treat moderate to severe pain) medication as indicated by the Physician, resulting in an increased risk for physical pain and psychological upset for the Resident.

Inspectors wroteBased on observations, interviews, and records reviewed, the facility failed to provide pharmaceutical services to meet the needs for one Resident (#80) out of a total sample of 26 residents, and maintain accurate records of controlled substances (drugs or chemicals that the government regulates for its manufacture, possession, and use, that are classified into schedules based on their potential for abuse) for one Unit (Unit Two) out of three units reviewed. Specifically,1. For Unit Two, the facility staff failed to maintain accurate documentation in the Controlled Substance Register (Narcotic Book), relative to the recording of prescription numbers and receipt dates being recorded on the individual pages when a new controlled medication was entered into the Register or the information for a medication was transferred from one page to another. 2. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain a clean and sanitary environment in the facility main kitchen where resident food for consumption was prepared. Specifically, the facility failed to ensure all kitchen equipment was clean and sanitary, including the stove top, oven, and the dishwashing machine.

Inspectors wroteBased on record review and interview, the facility failed to notify the State Mental Health Authority for a resident review (person-centered assessment taking into account all relevant information) after a significant change in mental condition occurred for one Resident (#56) out of a total sample of 26 residents. Specifically, the facility failed to complete and request a Preadmission Screening and Resident Review Level II screen (PASRR- an evaluation done to determine if a resident has an intellectual or developmental disability and/or serious mental illness[SMI] and if a Resident is in need of additional specialized support services at the facility) after Resident #56 received emergency mental health interventions and experienced limitations in major life activities due to mental illness.

Inspectors wroteBased on observation, interview and records reviewed, the facility failed to provide respiratory care and services based on professional standards of practice for two Residents (#47 and #62), of three applicable residents, out of a total sample of 26 residents. Specifically, the facility failed to: -Change the Oxygen tubing as ordered by the Physician. -Follow infection control measures related to the care, handling, and/or storage of nebulizers (delivery device used to administer medication in the form of an aerosol that is inhaled into the lungs) to prevent contamination and the spread of infections.

Inspectors wroteBased on interview and record review, the facility failed to ensure that an as needed (PRN) psychotropic medication (medication that affect the mind, emotions, and behavior) was limited to 14 days for one Resident (#9), of five applicable residents reviewed, out of a total sample of 26 residents. Specifically, the facility failed to ensure that PRN Ativan (Lorazepam: anti-anxiety medication) was limited to 14 days and if not limited, included a Physician determined duration for continued use of the medication.

Inspectors wroteBased on observations, interviews, and records and policies reviewed, the facility failed to reduce potential transmission of infection by ensuring that: 1. The appropriate personal protective equipment (PPE) was worn by staff for Residents (#181, #124, #182 and #330), who were identified as requiring Transmission-Based Precautions (used in addition to standard precautions for residents who may be infected or colonized with certain infectious agents for which additional precautions are needed to prevent infection transmission), and hand hygiene was conducted by facility staff, as required; and 2. [...]

Inspectors wroteBased on observations, interviews, and policy review, the facility failed to ensure the staff reduced the risk of potential physical contamination of resident food by wearing hair restraints while working in the facility kitchen.

Inspectors wroteBased on interview, record review, and policy review, the facility failed to notify and consult the Physician when a significant change in weight was noted for one Resident (#14), out of a total sample of 25 residents. Specifically, the facility failed to notify and consult with the Physician when Resident #14 experienced continued significant weight loss after a significant weight loss was identified over a period of six months.

Inspectors wroteBased on record review and interview, the facility failed to provide treatment and care in accordance with professional standards of practice for one Resident (#79), out of a total sample of 25 residents. Specifically, the facility failed to recognize that stool softeners and laxatives continued to be administered to a Resident undergoing medical treatment for diarrhea (a condition in which stool is discharged from the bowels frequently and in a liquid form).

Inspectors wroteBased on interview, policy review, and record review, the facility failed to ensure staff addressed the needs of one Resident (#14) to maintain his/her goal body weight, out of a total of 25 residents sampled. Specifically, the facility failed to reassess interventions to prevent significant weight loss for Resident #14 who had a history of weight loss and was identified as being at risk for further significant weight loss resulting in continued weight loss.

Inspectors wroteBased on observation, policy review and interview, the facility failed to ensure infection control guidelines were followed to prevent contamination and transmission of microorganisms, on one of two units observed. Specifically, hand hygiene was not performed as required by an outside vendor (an Ultrasound Technician- a person that use imaging equipment and soundwaves to form images of parts of the body to help diagnose and treat medical conditions), after providing ultrasound services to unit residents.

Inspectors wroteBased on record review and interview, the facility failed to provide education, assess for eligibility, and offer Pneumococcal and Influenza Vaccinations per the Centers for Disease Control and Prevention (CDC) recommendations and facility policy for two Residents (#A1 and #A2) out of a total sample of five residents, putting them at risk for developing facility-acquired Pneumonia and Influenza. Specifically, 1. For Resident #A1, the facility failed to ensure that staff assessed, offered, and provided education on the recommended Pneumococcal Vaccine. 2. For Resident #A2, the facility failed to ensure that staff assessed, offered, and provided education on the recommended Influenza Vaccine.