Agawam East Rehab And Nursing

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Resident #1's EHR and said there was no documentation in the EHR to support that a discharge meeting was conducted for him/her.During an interview on 11/25/25 at 4:45 P.M. with the Administrator and the Director of Nursing (DON), the DON said that Resident #1 was admitted to the Facility for short-term rehabilitation with a plan to discharge to his/her home. The DON said discharge care plans should be developed with the IDT, residents and/or their representatives and discharge meetings should be conducted prior to a resident discharging home. The DON said there was no documentation in his/her EHR to support that a discharge care plan was developed for Resident #1 with the input of Family Member #1, or that a discharge meeting was conducted with the IDT and Family Member #1.The Administrator said the DSS did not document any referrals she made to Home Care Agencies or responses from those agencies and said there was no documentation in Resident #1's EHR to support the DSS sent pertinent discharge information to any Home Care Agencies to facilitate Resident #1's discharge home.

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Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Agawam East Rehab and Nursing

464 Main Street Agawam, MA 01001

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on records reviewed and interviews for three of three sampled residents (Resident #1, #2, and #3), the facility failed to ensure that a copy of their transfer discharge notifications were provided to the Office of the State Long Term Care Ombudsman, as required.Findings include:During a telephone interview on 11/21/25 at 11:58 A.M., the Ombudsman said the Facility has not provided copies of discharge and transfer notices to her office in several months. Specifically, the Ombudsman said she has not received any discharge notices since March 2025 and said she has not received any transfer notices since August 2025. Resident #1 was admitted to the Facility in July 2025, diagnoses included Dementia and weakness.Review of Resident #1's Medical Record indicated he/she was discharged home on [DATE REDACTED].Resident #2 was admitted to the Facility

in September 2025, diagnoses included soft tissue disorder and muscle weakness.Review of Resident #2's Medical Record indicated he/she was discharged home on [DATE REDACTED].Resident #3 was admitted to the Facility

in September 2025, diagnoses included Rhabdomyolysis (a medical condition in which damaged skeletal muscle breaks down rapidly), frequent falls and frequent falls.Review of Resident #3's Medical Record indicated he/she was transferred to the Hospital for evaluation and did not return to the Facility after his/her hospitalization.During a telephone interview on 11/25/25 at 1:00 P.M., the Director of Social Services (DSS) said she usually sends transfer notices to the Office of the Long-Term Care Ombudsman, and she said she did not know she was supposed to send copies of discharge notices. The DSS said she did not know if she sent a copy of Resident #3's transfer notice to the Ombudsman. During an interview on 11/25/25 at 4:45 P.M., with the Administrator and the Director of Nursing (DON), the DON said the DSS should be sending copies of discharge and transfer notices to the Long-Term Care Ombudsman office and that the DSS keeps all of the letters on file in a binder in the Social Services office.The DON retrieved and reviewed the binder with the surveyor and said there was a copy of a transfer notice for Resident #3 when he/she was transferred to the hospital but there was no documentation to support that the DSS had sent a copy of the notice to the Ombudsman. The DON said the DSS did not send discharge notices to the Ombudsman for Resident #1, Resident #2, and Resident #3.

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