Agawam North Rehab And Nursing

Review of a Hospital Consultation Note, dated 12/8/24, indicated the following for Resident #9:

-was seen for a safety consult as he/she alluded to passive SI, expressed frustration with being in the hospital and his/her overall health.

-was withdrawn, reporting he/she did not want to continue medication or procedures.

-said he/she wished he/she would go to sleep and not wake up.

-had a history of Depression with outpatient psychiatry and psychotherapy support.

-reported feeling depressed at the time of the assessment.

Review of the Provider Encounter Note, dated 3/3/25, indicated Resident #9:

-endorsed passive SI with plans to stop taking his/her insulin and medication.

-was visibly distressed and appeared depressed.

Review of Resident #9's Alteration in Mood Care Plan, initiated on 2/27/25 (greater than two months after the Resident's admission to the facility) failed to indicate any documented evidence relative to the Resident's history of SI.

During an interview on 4/8/25 at 10:54 A.M., with Minimum Data Set (MDS) Nurse #1 and MDS Nurse #2, the following was discussed relative to Resident #9:

-MDS Nurse #1 said she added the SI diagnosis on 4/7/25, when she learned about the diagnosis while completing the Resident's quarterly review, which was in progress now.

-MDS Nurse #2 said this was new information to them and did not know that Resident #9 had been seen by Psychiatry while at the hospital for SI.

225766

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 225766 B.

Wing 04/09/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Agawam North Rehab and Nursing 55 Cooper Street Agawam, MA 01001

The facility failed to ensure that staffing levels on the A-Wing, C-Wing, D-Wing and F-Wing were provided to meet the residents needs of each unit safely.

2.

For Resident #51, the facility failed to ensure toileting assistance was provided promptly when the Resident was indisposed and had the call light on for over 20 minutes.

3.

For Resident #45, the facility failed to provide assistance of two staff with transfers as required resulting in a fall when the Resident was transferred with one staff memebr.

4.

For Resident #13, the facility failed to provide timely notification to the Physician when the Resident experienced a change in condition and the Nurse responsible for providing care had worked 27 hours that weekend in addition to her regularly worked 40-hour schedule.

Findings include:

1.

Review of the Facility Assessment (self-completed assessment that indicate what types of care the facility provided as well as what their staffing and educational plans are to meet the residents residing in the facility's needs), dated 1/28/25, failed to indicate evidence that the facility had assessed for how many Certified Nurses Aides (CNAs) were required per resident, unit or shift to ensure appropriate care was provided to the residents residing in the facility.

During an interview on 4/8/25 at 11:37 A.M., the Director of Nursing (DON) said the facility staffing plan was to have:

-three CNAs on each unit for the Day (7:00 A.M. to 3:00 P.M.) shift

-three CNAs on each unit for the Evening (3:00 P.M. to 11:00 P.M.) shift

-two CNAs on each unit for the Night (11:00 P.M. to 7:00 A.M.) shift.

The DON said in an ideal world they would additionally have one CNA split between the A-Wing and C-Wing, and one split CNA between the D-Wing and F-Wing during day and evening shifts, but that the facility could run adequately with three CNAs on each unit.

225766

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 225766 B.

Wing 04/09/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Agawam North Rehab and Nursing 55 Cooper Street Agawam, MA 01001

Review of the Resident's At Risk for Skin Alteration Care Plan, initiated 4/4/24 indicated Resident #45 was at risk for skin concerns related to possible shearing due to sliding down in bed, impaired mobility and incontinence, and included the following interventions initiated 4/4/25:

- weekly nurse skin review,

- lotion to dry skin, and

- skin checks weekly

Review of the MDS Assessment, dated 3/25/25 indicated the following for Resident #45:

- he/she understands and was understood

- was cognitively intact as evidenced by a BIMS score of 14 out of a possible 15 points.

- required assistance of staff with dressing, toileting and personal hygiene

- was at risk for pressure ulcers and had none at the time of the assessment.

Review of the clinical record indicated no documented evidence that weekly skin checks were performed on after 1/14/25 until 3/4/25.

On 4/6/25 at 10:16 A.M., the surveyor observed Resident #45 dressed and seated in a wheelchair. A bruise was observed on the top of the Resident's left hand and the Resident's bilateral lower extremities were observed to be swollen and had very dry, flaky skin.

During an interview at this time, Resident #45 said the bruise on his/her left top hand was from an intravenous (IV) line from a recent hospitalization . Resident #45 said the edema in his/her lower legs had improved and that staff were supposed to apply lotion to his/her lower extremities daily but this rarely happened because the staff are too busy and running around.

225766

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 225766 B.

Wing 04/09/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Agawam North Rehab and Nursing 55 Cooper Street Agawam, MA 01001