Hillcrest Commons Nursing & Rehabilitation Center

Review of the most recent Minimum Data Set (MDS) Assessment, dated 12/4/24, indicated Resident #199: -had clear speech -was usually able to make his/herself understood -usually able to understand others During an interview on 3/18/25 at 4:49 P.M., Resident #199 said he/she had to have his/her room changed multiple times while at the facility. Resident #199 said he/she was very pleased with his/her room previously, but the facility told his/her Guardian that he/she needed to change rooms.

Resident#199 said he/she had moved rooms two times recently and it was very frustrating.

Review of the Clinical/Charting Snapshot dated 3/20/25, indicated Resident #199 had his/her room changed on 3/12/25 and 3/15/25.

Review of the Social Services Progress Note dated 3/4/25, indicated Social Services had let the Resident's Guardian know that Resident #199 was being moved.

Further review of the Resident's medical record failed to indicate written documentation that Resident #199 had been updated about the room changes prior to the room changes on 3/12/25 and 3/15/25.

During an interview on 3/20/25 at 8:26 A.M., SW #1 said Resident #199 was moved to another unit because he/she no longer needed ventilator care. SW #1 said she had spoken with Resident #199's Guardian prior to the Resident's room changes but she had not spoken with Resident #199 prior to the room changes or provided him/her with any written documentation about the room changes. SW #1 further said she was unaware of any written forms or documentation that was to be used and provided to a Resident prior to a room change.

225687 03/25/2025

Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

Review of Resident #532's Nursing Progress Notes dated 8/26/24, indicated: -At 1:42 P.M., that the Resident anticipates discharge home tomorrow. -At 8:19 P.M., that the Resident was due for discharge tomorrow.

Review of the Nursing Progress note dated 8/27/24, indicated: -Resident #532 had signed all discharge paperwork, was provided with discharge paperwork and medications and taken home by Cabulance [sic].

During an interview on 3/20/25 at 1:38 P.M., MDS Nurse #1 said that she was the only person in the facility that could complete NOMNC forms with a resident prior to discharge. MDS Nurse #1 said that Resident's #531 and #532 had received services while at the facility under a Medicare payor source and should have been given a NOMNC but were not. MDS Nurse #1 said that if communication had been better among the departments she may have had more time to complete the NOMNC.

During an interview on 3/25/25 at 1:12 P.M., the Regional Nurse said that the facility did not have a policy related to NOMNC but that the facility followed Federal Regulations for issuing NOMNC.

225687 03/25/2025

Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

Review of the Resident #47's March 2025 Physician orders indicated:

-Prevident 5000 Booster 1/1% Paste (Sodium Fluoride), a pea sized amount, Day shift 7:00 A.M. - 3:00 P.M. for sensitive teeth, effective 1/31/25.

On 3/24/25 at 3:41 P.M., the surveyor and MDS Nurse #1 observed Resident #47's teeth and MDS Nurse #1 said that Resident #47 had tooth fragments and a broken tooth. MDS Nurse #1 said that the Resident's MDS dated [DATE], had not been coded correctly. MDS Nurse #1 said that the MDS should have been coded for broken natural teeth because the Resident presented with broken tooth fragments. MDS Nurse #1 said that accurate coding is important for the MDS so that a Residents' assessments accurately reflected current condition for care planning and delivery of care/services.

Please Refer to F-F688.

225687 03/25/2025

Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

During a follow-up interview with UM #4 on 3/20/25 at 2:32 P.M., UM #4 said Resident #155 was evaluated by the Provider, who ordered an antifungal cream for the Resident's left hand due to a fungal infection.

During an interview on 3/21/25 at 7:58 A.M., UM #4 said that CNAs are responsible to perform fingernail care weekly and as needed, but fingernail care had not occurred for Resident #155. UM #4 said that CNAs inform the Nurses if fingernail care was unable to be performed for any reason.

On 3/21/25 at 8:04 A.M., the surveyor observed Resident #155 lying in bed wearing a hospital gown with a rolled facecloth tucked in both the right and left hands.

225687 03/25/2025

Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

not be done daily after the state left the facility.

225687 03/25/2025

Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

During an interview on 3/21/25 at 8:33 A.M., CNA #4 said that she was not aware of any specified lower extremity PROM program in place for staff to complete with Resident #123. CNA #4 said that she did not provide the Resident with lower extremity PROM.

On 3/25/25 at 10:44 A.M., the surveyor requested to speak to the Rehabilitation Director, but the Rehabilitation Director was unavailable for interview.

During an interview on 3/25/25 at 11:04 A.M., the Director of Nursing (DON) said if a resident could not perform their own ROM, staff would be required to complete PROM with the resident.

The DON said that ROM programs carried out for residents by nursing staff would be based on recommendations from Rehab staff.

The DON said Rehab staff would use an instruction sheet to educate the staff members responsible for the resident's care, and once education was completed, the instruction sheet would be provided to the Unit Manager (UM).

The DON said the UM would then update the resident's [NAME] (document containing information for how to care for each resident) with the specified instructions for the resident to ensure staff caring for the resident had the information needed to effectively carry out the recommendations.

The DON said Resident #123's condition warranted individualized instruction for PROM due to the degree of the Resident's contractures.

Review of Resident #123's active [NAME] failed to indicate any instructions relative to the Resident's lower extremity contractures or ROM.

During a follow-up interview on 3/25/25 at 11:14 A.M., the PT said when he provided PROM to Resident #123, he instructed the Resident on the level of discomfort that may be expected as well as what symptoms would indicate when to stop applying stretch to the Resident's lower extremity contractures.

The PTsaid that it was important to know when to stop applying passive stretch to the contractures to avoid causing muscle damage and an inflammatory response.

The PT said that some CNAs could be expected to perform PROM properly and some CNAs may need more instruction if they do not know how much stretch to apply to a contracted joint.

The PT said that no formal education relative to lower extremity PROM was provided to staff responsible to care for Resident #123.

The PT further said that concerns with PROM not being provided by staff included further progression of contractures and pain.

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Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

probably should.

The Food Service Supervisor said she reviewed what the D: 720 meant on Resident

225687 03/25/2025

Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

During an inteview on 3/24/25 at 4:19 P.M., Nurse #11, who worked Per Diem at the facility, said she obtained the Resident's vitals today upon his/her return from dialysis.

Nurse #11 said she documented the Resident's vitals in the dialysis communication book and they were stable.

Nurse #11 further said the Resident requested medication which was administered for nausea and pain upon return from dialysis.

During an interview on 3/24/25 at 4:27 P.M., Unit Manager (UM) #1 said the expectation was for nursing to assess Resident #40 when he/she returned from dialysis and part of that assessment would include obtaining vitals signs upon return. UM #1 said it was important to check the Resident's dialysis site for bleeding and check his/her vitals to assess tolerance to treatment. UM #1 said she reviewed the Resident's clinical record and the Dialysis Communication Forms and noticed that the required information had not been consistently obtained by the nursing staff.

225687 03/25/2025

Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

Review of the Resident #199's Trauma Care Plan, dated 7/3/24, indicated the following: -Identify triggers for anxiety, psychosocial decline.

Further review of the Trauma Care Plan failed to indicate Resident #199's: -trauma triggers -coping mechanisms During an interview on 3/20/25 at 8:33 A.M., Social Worker (SW) #1 said she was aware Resident #199 had a history of trauma because it was identified on the Trauma Informed Care Assessment completed on 6/20/24 and because the Resident's Guardian had expressed that Resident #199 often became more anxious when he/she heard other people crying out. SW #1 said she had not spoken with Resident #199 about specific triggers or coping strategies he/she used during periods of increased anxiety. SW #1 said a person-centered care plan should be created for any resident with a history of trauma. SW #1 further said the staff should identify what a resident's trauma triggers were and the best interventions/coping mechanisms that the resident could use, or that the staff could use to help the resident through any changes in their psychosocial well-being.

The surveyor and SW #1 reviewed Resident #199's Trauma Care Plan and SW #1 said Resident #199's Care Plan was not individualized. SW #1 said there were no specific triggers for staff to watch out for and no specific coping mechanisms that the Resident utilized to reduce his/her anxiety included in the Care Plan. SW #1 said the Resident's Trauma Care Plan should have been updated to include triggers and person-centered interventions.

225687 03/25/2025

Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

Review of Resident #224's Minimum Data Set (MDS) assessment dated [DATE]. indicated: -based on staff assessment the Resident had some difficulty with daily decision making in new situations only. -the Resident received 25 - 50% of his/her caloric intake from Tube Feeding.

Review of Resident #224's weights indicated the following: -2/21/25: 196.6 pounds (lbs) -3/4/25: 189 lbs. -3/5/25: 186.6 lbs. (a 5% loss in less than 30 days) Review of Resident #224's medical record failed to indicate any evidence the Provider was aware of the Resident's weight loss and was supervising immediate care for nutritional needs.

During an interview on 3/25/25 at 9:52 A.M., the surveyor and Unit Manager (UM) #1 reviewed Resident #224's weights. UM #1 said that the Provider should be made aware of the weight loss and would review the record.

During a follow-up interview on 3/25/25 at 10:24 A.M., UM #1 said that 3/5/25 was a re-weight and that was not accepted. UM #1 further said a second re-weight was completed again on 3/13/25, but waiting eight days to complete a re-weight was not an acceptable timeframe as the weight would have the potential to have changed in that time. UM#1 said that if there is a significant weight loss of 5% or more, the Provider should have been notified to oversee the Resident's care but she could find no evidence in the medical record that the Provider was notified.

225687 03/25/2025

Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

The surveyor observed that the controlled substance register had no

of the controlled substance register indicated Nurse #9 had signed as the Nurse on duty, and had received count of the controlled substances that were in her possession.

During an interview on 3/25/25 at 9:40 A.M., Nurse #9 said there was no need to document the prescription numbers in the controlled substance register.

Nurse #9 also said there was no need to document the date the controlled substances had been received from the pharmacy.

During an interview on 3/25/25 at 11:02 A.M., the Staff Development Coordination (SDC) said Nurse #9 was new to the facility and was hired on 3/2/25.

The SDC said Nurse #9 was in training and did not complete the competency for medication administration and/or competency for the documentation of controlled substances.

During a follow-up interview on 3/25/25 at 1:15 P.M., the SDC said Nurse #9 should not have been in receipt of the controlled substances.

The SDC further said Nurse #9 should not have been on the medication cart by herself until the nursing competency for medication administration and the competency for controlled substances had been completed.

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Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

The surveyor observed that nurse staffing information was posted in the entry of the facility on the following days: -3/18/25 -3/19/25 -3/23/25 -3/24/25 Review of the nurse staffing information posted indicated the name of the facility, the date, and the total amount of nursing staff working on each unit for the day and evening shift.

The posted nurse staffing information was observed to include (2) 3:00 P.M. - 11:00 P.M. (evening) shift staffing and failed to indicate any 11:00 P.M. - 7:00 A.M. (night) shift staffing.

Further review of the nurse staffing information postings failed to indicate the actual hours worked by licensed and unlicensed nursing staff and the daily resident census.

During an interview on 3/24/25 at 7:29 A.M., the facility Scheduler said she was the one who posted the daily staffing information and she was unaware of any additional information that was needed on the posted nursing staff information.

The Scheduler further said at this time she was not tracking the total hours worked each day by nursing staff.

During an interview on 3/24/25 at 3:53 P.M., the Scheduler said the actual working hours were not posted on the daily nurse staffing information and the posting also did not include the daily census.

The surveyor and the Scheduler reviewed the daily nurse staffing postings from 3/18/25 through 3/24/25 and the Scheduler said none of the daily postings contained the necessary information pertaining to the actual hours worked by nursing staff or the daily resident census.

The Scheduler said she would work with the Director of Nursing (DON) to update the nurse staffing posting to contain all the necessary information.

The surveyor observed that the controlled substance register had no prescription

On 3/25/25 at 9:57 A.M., the surveyor and Nurse #6 reviewed the controlled substance register on

documentation for prescription numbers and dates the controlled substances were received from the pharmacy.

On 3/25/24 at 10:06 A.M., the surveyor and Nurse #10 reviewed the controlled substance register on Unit 1, side one.

Nurse #10 said 175 pages of the controlled substance register did not have the prescription numbers of the controlled substance medications documented and the dates the controlled substances were received from the pharmacy.

During an interview on 3/25/24 at 10:37 A.M., the Director of Nursing (DON) said the prescription numbers for the controlled substance medications and the dates the controlled substances were received should be documented in the controlled substance register, but they were not documented.

The DON further said it was important to accurately document the prescription numbers and dates the medications were received to minimize the opportunity for abuse or diversion of controlled substances.

225687 03/25/2025

Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

During an interview on 3/20/25 at 11:58 A.M., Resident #186 said when the Dentist recommended the

option for him/her. Resident #186 said he/she had not asked facility staff whether they had located a dental facility to accommodate him/her by stretcher. Resident #186 said facility staff told him/her they would work on locating a dental facility that could accommodate a stretcher and get back to him/her, so he/she was waiting. Resident #186 said the Unit One [NAME] Clerk had alerted him/her about 30 minutes earlier that the facility located a dental facility that would accommodate the Resident via stretcher and that his/her extractions would be scheduled for May 2025.

During an interview on 3/20/25 at 1:46 P.M., the Unit One [NAME] Clerk said she had called local dental facilities in September 2024 for Resident #186 when the Resident was recommended to have tooth extractions.

The Unit One [NAME] Clerk said no local dental facilities were able to accommodate a stretcher at that time.

The Unit One [NAME] Clerk said she alerted the Resident in September 2024 that she could not locate a dental facility to accommodate a stretcher, and the Resident said, okay.

The Unit One [NAME] Clerk said she had not contacted any other dental facilities for Resident #186 since September 2024 until the surveyor's inquiry.

The Unit One [NAME] Clerk said she obtained the name of a dental facility that could accommodate residents on stretchers from one of the other [NAME] Clerks in the facility on 3/19/25.

The Unit One [NAME] Clerk further said she contacted that dental facility and that the dental facility would accommodate Resident #186 to have his/her teeth extracted.

During an interview on 3/20/25 at 2:30 P.M., the Director of Nursing (DON) said he knew the facility contacted a local dental facility and the local hospital's emergency department in September 2024 to inquire whether either facility could accommodate Resident #186 via stretcher for dental extractions.

The DON said the local dental office could not accommodate a stretcher and the local hospital's emergency department would not allow a Dental Provider to come in and perform the extractions.

The DON said he was not aware of any other dental facilities that had been contacted until 3/19/25, following the surveyor's inquiry.

225687 03/25/2025

Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

During an interview immediately following the test tray completion, MDS Nurse #2 said that food temperatures in the 80s was too cold and that she would expect food to be served hotter to the Residents.

225687 03/25/2025

Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

During an interview on 3/24/25 at 2:30 P.M., Nurse #7 said that the Nurse who was in the dining room called immediately to notify her that Resident #215 had eaten a small amount of the dessert containing coconut.

Nurse #7 said that Resident #215 arrived on the unit shortly after, at which point Nurse #7 assessed the Resident and offered Benadryl medication, which the Resident declined.

During an interview on 3/24/25 at 2:43 P.M., the Food Service Director (FSD) said that he himself went to the main dining room to check on allergies and reminded staff to pay attention to the allergies listed.

The FSD said he felt confident that Resident #215 would not get the custard dessert and it was his understanding that the Resident did not get the dessert.

During an interview on 3/24/25 at 2:48 P.M., UM #3 said that the Resident had been served the coconut (custard)dessert during lunch, and she was the one who removed the coconut dessert from the table after the Resident asked what was in it due to the texture not feeling right. UM #3 said that she did not see the Resident eat the coconut dessert and could not tell if bites had been taken out of it because the coconut dessert was cut up, but the Resident did have food in his/her mouth. UM #3 said that the meal ticket indicated Resident #215 had a coconut allergy and the allergies were highlighted. UM #3 said that the dessert was not listed on the dietary slip/menu nor was it labeled with what type of custard. UM #3 further said that the coconut dessert never should have been on the tray to begin with but would not have known differently because it was not labeled coconut dessert.

Please Refer to F-F867.

225687 03/25/2025

Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

During an interview at the time, Dietary Staff #3 said the slicer had not been used since the previous

-two fans that were in use (on) and were attached to the walls in the dish room were dust laden.

One fan was located where clean dishware was stored. -the dish machine was in use and the wash temperature was 140 degrees Fahrenheit [F] (after running several racks of dishes through the machine) and the final rinse temperature was ranging from 180- 190 degrees F.

During an interview with the FSD immediately following the observations, the FSD said: -the inside of the flour bin was cleaned out weekly, but the outside of the bin needed to be cleaned -the slicer was not thoroughly cleaned and needed to be cleaned again -the kitchen windows should not be open if there were no screens because it could allow pests (mice/bugs) to enter the kitchen -both of the fans that were in use in the dish room needed to be cleaned because they were covered in dust -the minimum dish machine wash temperature should be 160 degrees F.

The FSD further said he had checked the temperature that morning and it was within range.

The FSD said that the dish machine should not be used and he would contact their vendor for further instructions.

During an interview on 3/25/25 at 10:46 A.M., Dietary Staff #3 said she keeps instructing staff to keep the window in the kitchen closed because there was no screen.

Dietary Staff #3 said she has also been educating the dietary staff about ensuring kitchen equipment, like the can opener and surfaces were cleaned after every use because they could be a cause of potential cross contamination.

During a follow-up interview on 3/25/25 at 11:08 A.M., the FSD said he spoke with the vendor relative to the facility dish machine and was instructed to connect the chemical sanitizer and the dish machine would be safe to use until they were able to provide an on-site visit to remedy the wash temperature issue.

The FSD said the temperatures were taken in the beginning when the dish machine was used and the wash temperature was 167 degrees F.

The FSD said the machine had been running for a while when he and the surveyor observed the wash temperatures of 140 F, and that the staff using the dish machine should be monitoring the temperatures to ensure they are within the acceptable ranges.

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Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

The surveyor asked the FSD and the Food Service Supervisor what the concern would be if only checking ten trays randomly when there was a known problem of allergens being served.

Both the FSD and Food Services Supervisor said they risked missing a tray of a resident who did have allergies, and they should have been monitoring all allergy trays prior to them leaving the kitchen.

The FSD said the PIP was not effective and due to the severity of the concern being addressed in the PIP he would have expected the goal for the project to only have been one month and the fact that it has gone on for many months without resolve was concerning and put residents at risk for having an allergic reaction.

During an interview on 3/25/25 at 11:36 P.M., the Administrator said the current PIP relative to food allergens had not been effective and the team needed to take a deeper look into the problem.

225687 03/25/2025

Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

During an interview on 3/20/25 at 3:27 P.M., Activity Assistant (AA#1) said she was not aware that

During an interview on 3/21/25 at 11:14 A.M., the IP provided a line listing that indicated that four Residents including Resident #209 had nausea and vomiting with symptom onset as of 3/20/25.

The IP said Resident #209 should not have attended the bingo activity without a mask and proper hand hygiene.

The surveyor and the IP reviewed the line listing, and the IP said she was not aware that the GI symptom onset was 3/19/25 and had not reviewed Resident #209's progress notes.

The surveyor, IP, and CIP, reviewed Resident #209's progress note dated 3/19/25 at 8:18 P.M., indicating the Resident was experiencing nausea and vomiting.

The IP said Resident #209 should have been placed on Contact Precaution as soon as his/her symptoms were identified on 3/19/25 to avoid the spread of the virus but he/she was not placed on precautions.

The IP further said Resident #209 should not have attended the bingo activity with other residents.

During an interview on 3/25/25 at 10:18 A.M., the IP and CIP provided a line listing that indicated fifteen other residents had developed nausea and vomiting and one resident was hospitalized .

The IP further said six out of the total 16 residents on the line listing for the outbreak were on Unit 2, the same unit as Resident #209, seven of the residents resided on Unit 4, one resident resided on Unit 3, and one resident resided on Unit 1.

225687 03/25/2025

Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

During an interview on 3/25/25 at 8:37 A.M., the DON said the facility followed the CDC guidelines for Pneumococcal immunization.

The DON said that Resident #25 was due for PCV 20 immunization at the time of admission to the facility in June 2024.

The DON said that Resident #25 should have been administered the PCV20 in June 2024 when the Resident had signed the consent form but was not administered the vaccine.

The DON said that Pneumococcal immunization was important to prevent complications from Pneumococcal disease.

225687 03/25/2025

Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

Review of the facility policy titled Care of Foot and Nails, dated 2/27/17, indicated but was not limited to the following:

-Resident's need special care to prevent infection, odors, and injury to soft tissue.

> .To provide nail care to promote optimum health, safety and comfort of the Resident, reduce health risk secondary to existing medical condition, and prevent infection.

>Licensed Nurse can delegate to Nursing Assistants the trimming of nails of non-diabetic residents or residents without circulatory impairments.

Licensed Nurse can trim the nails of residents with diabetes and circulatory impairments only.

Review of the facility policy titled Skin Integrity Management, revised 5/21/21, indicated:

225687

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 225687 B.

Wing 03/25/2025

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

Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201

During an interview with the FSD immediately following the observations, the FSD said:

-the inside of the flour bin was cleaned out weekly, but the outside of the bin needed to be cleaned

-the slicer was not thoroughly cleaned and needed to be cleaned again

-the kitchen windows should not be open if there were no screens because it could allow pests (mice/bugs) to enter the kitchen

-both of the fans that were in use in the dish room needed to be cleaned because they were covered in dust

-the minimum dish machine wash temperature should be 160 degrees F.

The FSD further said he had checked the temperature that morning and it was within range.

The FSD said that the dish machine should not be used and he would contact their vendor for further instructions.

During an interview on 3/25/25 at 10:46 A.M., Dietary Staff #3 said she keeps instructing staff to keep the window in the kitchen closed because there was no screen.

Dietary Staff #3 said she has also been educating the dietary staff about ensuring kitchen equipment, like the can opener and surfaces were cleaned after every use because they could be a cause of potential cross contamination.

During a follow-up interview on 3/25/25 at 11:08 A.M., the FSD said he spoke with the vendor relative to the facility dish machine and was instructed to connect the chemical sanitizer and the dish machine would be safe to use until they were able to provide an on-site visit to remedy the wash temperature issue.

The FSD said the temperatures were taken in the beginning when the dish machine was used and the wash temperature was 167 degrees F.

The FSD said the machine had been running for a while when he and the surveyor observed the wash temperatures of 140 F, and that the staff using the dish machine should be monitoring the temperatures to ensure they are within the acceptable ranges.

225687

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 225687 B.

Wing 03/25/2025

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

Hillcrest Commons Nursing & Rehabilitation Center 169 Valentine Road Pittsfield, MA 01201