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Health Inspection

Care One At Millbury

April 25, 2025 · Millbury, MA · 312 Millbury Avenue
Citations 2
CMS Rating 2/5
Beds 154
Provider ID 225720
Healthcare Facility
Care One At Millbury
Millbury, MA  ·  View full profile →
Inspection Summary

CARE ONE AT MILLBURY in MILLBURY, MA — inspection on April 25, 2025.

Found 2 citations. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

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Inspection Findings

FF684
TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 47901 day basis such as eating, bathing, dressing, affected

Review of the facility's policy titled Dignity, effective 2001, indicated:

-Residents may exercise their rights without interference, coercion, discrimination or reprisal from any person or entity.

-Groomed as they wish to be groomed.

Resident #126 was admitted to the facility in December 2024 with diagnoses including generalized anxiety disorder, Depression, and muscle weakness.

Review of a Minimum Data Set (MDS) assessment dated [DATE] indicated Resident #126:

-was cognitively intact as evidenced by a Brief Interview for Mental Status (BIMS) score of 15 out of a total possible score of 15.

-required assistance with personal hygiene.

Review of the Comprehensive Care Plan, last revised 2/13/25, indicated Resident #126:

225720

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 225720 B.

Wing 04/25/2025

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

Care One at Millbury 312 Millbury Avenue Millbury, MA 01527

Review of the 2/26/25 Resident Council Meeting Minutes indicated the following:

-Residents stated that their breakfast items (mostly the eggs) were cold.

Review of the 3/27/25 Resident Council Meeting Minutes indicated the following:

-Residents present at the meeting stated their breakfast meals have been cold.

On 4/17/25, the surveyor observed the following during the breakfast meal service on the [NAME] Unit:

-7:55 A.M.: three meal trucks containing meals for residents arrived to the unit.

-8:54 A.M.: the last meal tray was passed on the unit (just under an hour after the meals had been brought to the unit).

-Residents who needed to be assisted had trays that came up on the first, second, and third meal trucks, but all of the trays that needed to be assisted were served at the end of the meal pass.

On 4/22/25, the surveyor observed the following during the breakfast meal service on the [NAME] Unit:

-Meal truck doors remained open during the entire meal pass.

-7:54 A.M.: the third meal truck was brought to the unit.

225720

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 225720 B.

Wing 04/25/2025

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

Care One at Millbury 312 Millbury Avenue Millbury, MA 01527

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in MILLBURY, MA, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from CARE ONE AT MILLBURY or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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