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Complaint Investigation

Foremost At Sharon Llc

December 30, 2025 · Sharon, MA · 259 Norwood Street
Citations 4
CMS Rating 2/5
Beds 66
Provider ID 225134
Healthcare Facility
Foremost At Sharon Llc
Sharon, MA  ·  View full profile →
Inspection Summary

FOREMOST AT SHARON LLC in SHARON, MA — inspection on December 30, 2025.

Found 4 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

FF0580
Resident Rights Deficiencies
Potential for More Than Minimal Harm

During a telephone interview on 01/05/26 at 12:32 P.M., Physician #1 said that Resident #1 had a wound to his/her coccyx and that the Facility has a Wound Nurse Practitioner who consults with the Facility and makes recommendations for wound care.

Physician #1 said that she expects that the Facility notify her of the Wound Nurse Practitioners recommendations for wound care and said she could not recall if the Facility notified her of the recommendations for wound care for Resident #1's coccyx wound.

Physician #1 said that she would have implemented the Wound Nurse Practitioner's recommendations for wound care for Resident #1's coccyx wound if she had been notified.

During an interview on 12/30/25 at 3:30 P.M., the Director of Nurses (DON) said that Resident #1 was seen by the Wound Nurse Practitioner and new treatment recommendations were made for Resident #1's coccyx wound.

The DON said that it is her expectation that nurses notify the physician of the Wound Nurse Practitioners recommendations and obtain an order from the physician to implement the wound treatment recommendations.

The DON said she could not explain why the physician was not notified of the Wound Nurse Practitioners' recommendations and why the recommendations were not implemented.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

12/30/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Foremost at Sharon LLC

259 Norwood Street Sharon, MA 02067

SUMMARY STATEMENT OF DEFICIENCIES

and the Director of Nurses to develop a resident care plan and update the care plan as needed.During an interview on 12/30/25 at 3:30 P.M., the Director of Nurses (DON) said that Resident #1 had an open area to his/her coccyx.

The DON said that both the staff nurses and the MDS Nurse were responsible for developing the initial care plans and that the MDS nurse updates the care plans with any new interventions.

The DON said it was her expectation that all care plans are comprehensive and any actual wound care plan identifies the location of the wound and be updated with new interventions.2) Review of a Nurse Progress Note, dated 08/22/25, indicated that an x-ray of Resident #1's left shoulder was obtained, showed a left clavicle fracture and Resident #1 was transferred to the Hospital Emergency Department (ED) for evaluation.Review of a Hospital ED Discharge summary, dated [DATE], indicated that Resident #1 was seen in the ED for evaluation of left shoulder pain after a fall.

The Summary indicated that an x-ray of the left shoulder showed a midshaft fracture of the left clavicle and to manage the fracture, wear a simple sling on the left arm.

The Summary further indicated to check skin around the sling every day, loosen it if your fingers [NAME] or become numb, turn cold and blue and not to put weight on left arm until seen by an orthopedic doctor.Review of Resident #1's Medical Record from 08/23/25 through 09/03/25, indicated there was no documentation to support a Care Plan related to his/her left clavicle fracture, use of a sling to the left arm, non-weight bearing status to his/her left arm and monitoring the left arm for numbness, with interventions, treatment, goals and outcomes, had been developed and implemented by nursing to meet his/her needs.Review of a Nurse Progress Note, dated 09/03/25, indicated that Resident #1 returned from an orthopedic appointment and had new recommendations for weight bearing (to left arm) as tolerated with a walker.

During an interview on 12/30/25 at 3:30 P.M., the DON said that Resident #1 fell and fractured his/her left clavicle and returned from the ED with a sling.

The DON said that it was her expectation that a care plan for a fractured left clavicle, use of a sling, non-weight bearing status and monitoring of the left arm, was developed and implemented by nursing upon Resident #1's return from the ED.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

12/30/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Foremost at Sharon LLC

259 Norwood Street Sharon, MA 02067

SUMMARY STATEMENT OF DEFICIENCIES

cold and blue and not to put weight on left arm until seen by an orthopedic doctor.Review of Resident #1's Medical Record which included but was not limited to his/her Treatment Administration Record (TAR), Medication Administration Record (MAR) and Nursing Progress Notes from 08/23/25 through 09/03/25, indicated there was no documentation to support that nursing monitored Resident #1's left arm, that non-weightbearing status was maintained, and that a sling was provided to him/her and implemented.Review of a Nurse Progress Note, dated 09/03/25, indicated that Resident #1 returned from an orthopedic appointment and had new recommendations for weight bearing as tolerated with a walker.During an in-person interview on 12/30/25 at 2:40 P.M. and a subsequent telephone interview on 01/12/26 at 9:41 A.M, Nurse #1 said that she was familiar with and was assigned to care for Resident #1 many times during his/her stay at the facility.

Nurse #1 said that she was unaware that Resident #1 sustained a fall at the facility and fractured his/her left clavicle.

Nurse #1 said she was unaware that Resident #1 returned from the Hospital ED with orders for a sling, non-weight bearing of the left arm and to monitor his/her left arm and could not recall him/her wearing a sling.

Nurse #1 said that when a resident has a fractured arm and is in a sling, nursing should monitor the arm for Circulation Sensation Motion (CSM) of the extremity and document it in the medical or treatment administration record.During an interview on 12/30/25 at 3:30 P.M., the DON said that Resident #1 fell and fractured his/her left clavicle and returned from the ED with a sling.

The DON said that it was her expectation that staff implement the orders from the Hospital ED Discharge Summary and that nursing documents in the medical record the use of a sling and monitoring of the left arm following his/her fracture.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

12/30/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Foremost at Sharon LLC

259 Norwood Street Sharon, MA 02067

SUMMARY STATEMENT OF DEFICIENCIES

that the nurses assess the wound and document the description of the wound in the Medical Record after they perform the treatment to the wound.2) Review of a Nurse Progress Note, dated 08/22/25, indicated that an x-ray of Resident #1's left shoulder was obtained, showed a left clavicle fracture and Resident #1 was transferred to the Hospital Emergency Department (ED) for evaluation.Review of a Hospital ED Discharge summary, dated [DATE], indicated that Resident #1 was seen in the ED for evaluation of left shoulder pain after a fall.

The Summary indicated that an x-ray of the left shoulder showed a midshaft fracture of the left clavicle and to manage the fracture, wear a simple sling on the left arm.

The Summary further indicated to check skin around the sling every day, loosen it if your fingers [NAME] or become numb, turn cold and blue and not to put weight on left arm until seen by an orthopedic doctor.Review of Resident #1's Physician Orders, dated August 2025 and September 2025, indicated there was no documentation to support that a Physician's order related to the Hospital ED Discharge Summary orders for Resident #1's left arm to be in a sling, monitoring of his/her left arm and non-weight bearing status, ere obtained.

Review of Resident #1's Treatment Administration Records, dated August 2025 and September 2025, indicated there was no documentation to support that his/her left arm was in a sling, monitored by nursing staff and non-weight bearing status was maintained.Review of Resident #1's Nurse Progress Notes, dated 08/23/25 through 09/02/25, indicated there was no documentation to support that his/her left arm was placed in a sling, monitored by nursing staff and non-weight bearing status was maintained.Review of an Orthopedic Consult, dated 09/03/25, indicated that Resident #1 could bear weight to his/her left arm as tolerated.During an in-person interview on 12/30/25 at 2:40 P.M. and a subsequent telephone interview on 01/12/26 at 9:41 A.M, Nurse #1 said that she was familiar with and was assigned to care for Resident #1 many times during his/her stay at the facility.

Nurse #1 said she was unaware that Resident #1 returned from the Hospital ED with orders for a sling, non-weight bearing of the left arm and to monitor his/her left arm.

Nurse #1 said she could not recall him/her wearing a sling.

Nurse #1 said that when a resident has a fractured arm and is in a sling, nursing should monitor the arm for Circulation Sensation Motion (CSM) of the extremity and document it in the Medical Record.

During an interview on 12/30/25 at 3:30 P.M., the DON said that Resident #1 fell and fractured his/her left clavicle and returned from the ED with a sling.

The DON said that it was her expectation that staff implement the orders from the Hospital ED Discharge Summary and that nursing documents in the medical record the use of a sling and monitoring of the left arm.

Facility ID:

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 SHARON, 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 FOREMOST AT SHARON LLC or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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