Country Gardens Health And Rehabilitation

Review of the medical record indicated Resident #44 was admitted to the hospital on [DATE] after sustaining a right hip fracture following a fall.

The hospital Discharge summary, dated [DATE], indicated Resident #44 underwent an open reduction internal fixation (surgery to re-align and stabilize serious fractures) on 8/15/24.

The summary and discharge medications indicated the Resident was to receive enoxaparin (anticoagulant) 40 milligrams/0.4 mL injection every 24 hours starting on 8/19/24 for Deep Vein Thrombosis (DVT) prophylaxis postoperatively.

Review of August 2024 physician's orders indicated, but was not limited to: -Enoxaparin Sodium Injection Solution, Prefilled syringe 40 mg/0.4 mL, inject 40 mg subcutaneously (under the skin) one time a day until 9/20/24 (8/19/24) Review of the August 2024 Medication Administration Record (MAR) indicated the number 9 and initials in the box corresponding to the order for enoxaparin on 8/19/24.

Review of the legend on the MAR identified the code 9 was other/See Nurse Notes.

A medication administration note, dated 8/19/24, indicated a notation of n/a next to the order for enoxaparin 40 mg/0.4 mL with no other documentation.

Further review of the medical record failed to indicate the Physician/Nurse Practitioner was notified that enoxaparin was not administered on 8/19/24 as ordered.

During an interview on 8/20/24 at 3:04 P.M., Nurse #3 said she documented the code 9 on the MAR and n/a in a note for not available because the Resident did not get the enoxaparin as it had not been delivered by the pharmacy yet.

She said it was delivered the next day.

Nurse #3 said she did not notify the Physician or Nurse Practitioner that the enoxaparin was not administered on 8/19/24 as ordered.

During an interview on 8/20/24 at 3:25 P.M., Unit Manager #1 reviewed Resident #44's medical record and said Nurse #3 should have notified the Physician or Nurse Practitioner, but did not.

See F-F760

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

During an interview on 6/27/24 at 8:52 A.M., the surveyor alerted the Director of Nursing (DON) that the SDC's office door was wide open and resident's private health information was not secured and accessible to anyone.

The DON said it should be closed at all times when no one is in the office.

On 7/1/24 at 8:02 A.M., the surveyor observed the SDC's office door wide open with no staff inside the office.

Two large piles of residents' physician's orders were on a table.

The physician's orders contained private health information including but not limited to residents' name, date of birth , allergies, diagnoses, diet orders, treatment orders, and medication orders.

On 7/1/24 at 9:13 A.M., the surveyor observed the SDC's office door wide open with no staff inside the office.

Two large piles of residents' physician's orders were on a table.

The physician's orders contained private health information including but not limited to residents' name, date of birth , allergies, diagnoses, diet orders, treatment orders, and medication orders.

On 7/1/24 at 9:22 A.M., the surveyor observed the SDC's office door wide open with no staff inside the office.

Two large piles of residents' physician's orders were on a table.

The physician's orders contained private health information including but not limited to residents' name, date of birth , allergies, diagnoses, diet orders, treatment orders, and medication orders.

During an interview on 7/1/24 at 10:04 A.M., the CNO said the door to the SDC office should never be left open and unattended because there are resident records in there and accessible to anyone.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

Review of the facility's policy titled MDS 3.0 Completion, dated 3/4/24, indicated but was not limited to the following: -Residents are assessed, using a comprehensive assessment process, in order to identify care needs and to develop an interdisciplinary care plan; -According to federal regulations, the facility conducts initially and periodically a comprehensive, accurate and standardized assessment of each resident's functional capacity, using the RAI (Resident Assessment Instrument) specified by the State; -All disciplines shall follow the guidelines in Chapter 3 of the current RAI Manual for coding each assessment. Resident #10 was admitted to the facility in January 2024 with diagnoses including bipolar disorder.

Review of the Initial Psych Evaluation, dated on 2/7/24, by Nurse Practitioner (NP) #1, indicated Resident #10's prior psychiatric history included bipolar disorder.

Review of Resident #10's Chronic Care Management note, dated 2/2/24, by Physician #1, included a diagnosis of bipolar disorder.

Review of Subsequent Psychopharm Note documentation, written by NP #1, dated 2/21/24, 4/17/24, 5/15/24, and 6/19/24, indicated that Resident #10's psychiatric history included bipolar disorder.

Review of Resident #10's MDS assessments, Section I: Active Diagnoses, on the following dates failed to indicate his/her diagnosis of bipolar disorder: -admission assessment, dated 2/6/24, -Quarterly assessment, dated 5/8/24, -Discharge assessment, dated 5/18/24 During an interview on 6/27/24 at 2:18 P.M., MDS Nurse #1 said it was her expectaion that the MDSs were completed accurately.

During an interview on 7/1/24 at 10:04 A.M., the Chief Nursing Officer (CNO) said it was her expectation that the MDSs were completed accurately.

During an interview on 6/27/24 at 2:21 P.M., Nurse #8 reviewed Resident #74's medical record and said there were no baseline or comprehensive care plans for the Resident's admission diagnosis of endocarditis, the use of antibiotic therapy, and a PICC line.

She said a baseline care plan should have been developed for these care needs and were not.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

are assessed as an elopement risk have a comprehensive care plan developed and in place.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

Review of Resident #72's Weekly Skin Assessment tools indicated but was not limited to: - 6/7/24: Yes, has open areas or marks on skin. - 6/8/24: Yes, has open areas or marks on skin. - 6/13/24: right elbow: superficial healing moist area; right ankle: superficial area with moist base; other: left foot open area with sm amt drg [sic].

Further review of Resident #72's Weekly Skin Assessment tools failed to indicate the size and/or a description of the open areas.

During an interview on 6/27/24 at 10:15 A.M., Nurse #4 said that Resident #72 had a wound and that the last time she saw the wound, it was small.

During an interview on 6/27/24 at 9:54 A.M., Unit Manager (UM) #1 said that Resident #72 was admitted with a wound on his/her toe that she had only seen once but was nearly healed when she saw it. UM #1 said that Resident #72 was not followed on wound rounds but should have weekly skin checks documenting the measurements/condition of any wounds.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

During an interview on 06/28/24 at 2:50 P.M., the Administrator said the Physician did not write a recapitulation note.

During an interview on 6/28/24 at 2:55 P.M., the Social Worker reviewed her file and said she could not find a completed discharge summary for Resident #80.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

During an interview on 6/27/24 at 9:35 A.M., the Activity Director said they used to have scheduled activities on the [NAME] Unit, but they don't anymore.

She said staff were pulling the Activity Assistants to work as CNAs, so they stopped sending Activity Assistants to that unit.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

During an interview on 6/25/24 at 11:13 A.M., the Activity Director (AD) said she used to be the First [NAME] at the facility and picked up hours every other week as an Activity Assistant for a while.

She said she was hired as the AD for the facility in July 2023 when the former AD left.

She said a few weeks after she started her position as AD, she had to take a leave of absence, and June 2024 is her first full month back to work.

Review of the AD's personnel file on 6/25/24 failed to indicate she was qualified therapeutic recreation specialist or an activities professional who had two years of experience in a social or recreational program within the last five years, one of which was full-time in a therapeutic activities program, or was a qualified occupational therapist or occupational therapy assistant.

During an interview with the AD and Regional Activity Director on 6/27/24 at 9:35 A.M., the Regional AD said she was aware the AD is not qualified to direct the activity program at the facility.

During an interview on 6/27/24 at 2:15 P.M., the Human Resource Director said the former AD was terminated on 7/19/23, and they have been without a qualified AD since that time.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

Review of a statement from Nurse #1 indicated she was at the medication cart when a CNA told her that the Resident was on the floor.

Review of statements from CNAs #4 and #8 indicated they did not know about the incident.

During an interview on 6/28/24 at 12:20 P.M., CNA #8 said Resident #32 was on her assignment the day he/she fell in the bathroom.

She said she was helping the Resident in the bathroom and left the room to put dirty laundry in a bin in the hallway.

When she returned to the bathroom, she found the Resident on the floor.

She said she picked up the Resident and put him/her onto the toilet, then left the room and got Nurse #1.

When asked if it was routine practice to pick residents up off the floor when they have had a fall, then tell the nurse, CNA #8 said it depends on the fall.

She said if they slide onto the floor, she can pick them up, but if they have a bigger fall (she gave an example of another resident that fell with blood coming from his/her head), then everyone comes to help.

During an interview on 6/28/24 at 12:25 P.M., the DON and Chief Nursing Officer (CNO) said the CNA should not have moved the Resident after finding him/her on the floor after having a fall.

She said she should have notified the Nurse right away so she could assess the Resident.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

During interviews on 6/28/24 at 10:48 A.M. and 7/1/24 at 8:05 A.M., the Staff Development Coordinator (SDC) reviewed Resident #74's medical record and said she could not find any documentation to indicate the external length of the catheter had been measured since the first dressing change upon admission to the facility.

She said the nurse is supposed to measure the external length of the catheter with every dressing change, assess the insertion site and document it in the medical record.

The SDC said when residents are admitted from the hospital, a lot of orders are incomplete and need to be clarified with the Physician.

She said the orders for the PICC line dressing should have identified the type of dressings to be used and allowed for the insertion site to be visible for assessment.

Refer to F-F726

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

During an interview on 7/1/24 at 8:12 A.M., Nurse #9 said Resident #78 should have an order for his/her CPAP but does not.

During an interview on 7/1/24 at 10:04 A.M., the Director of Nursing (DON) and Chief Nursing Officer (CNO) said Resident #78 should have an order for his/her CPAP.

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The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

Review of the Physician's Orders indicated, but was not limited to:

- Change Cap and Extensions set on PICC/ Midline catheter 24 hours after insertion or on admission, then weekly with dressing change, and as needed (prn) (5/29/24) - Change PICC/ Midline dressing on admission, weekly, Thursday and as needed (5/29/24) - Measure external catheter on admission, and with dressing change (5/29/24) - Ampicillin Sodium Injection Solution Reconstituted 2 grams (gm), use 2 gm intravenously every 4 hours for 6 weeks (5/29/24) - Normal Saline Flush Solution, use 10 milliliters (ml) intravenously as needed for IV antibiotics.

Flush each IV catheter lumen with 10 ml normal saline after each intermittent IV administration. AND Use 10 ml intravenously every shift for IV infusion.

Flush each IV catheter lumen with 10 ml normal saline before and after each intermittent IV administration (5/29/24) - Ceftriaxone Sodium Injection Solution Reconstituted 2 gm, use 2 gram intravenously every 12 hours for 6 weeks (5/29/24) Review of a Clinical Nurse's Note, dated 5/29/24, indicated the PICC line dressing was changed upon admission to the facility, the lumen length (external catheter length) was 11 centimeters (cm) and showed no signs or symptoms of infection.

Review of the Medication Administration Records (MAR) and Treatment Administration Records (TAR) for May 2024 and June 2024 indicated that Nurses #1, #3, #5, #8, #10, #12, #13, Unit Manager #1 and the Director of Nursing had all provided care and/or administered medication through Resident #74's IV line.

Review of the June 2024 MARs and TARs indicated Resident #74's PICC line dressing was changed on 6/6/24, 6/12/24, 6/19/24 and 6/26/24.

Review of the medical record, including Nursing Notes and the MARs and TARs, failed to indicate the external catheter length was measured with each dressing change as ordered by the physician.

During interviews on 6/27/24 at 11:00 A.M. and 6/28/24 at 10:48 A.M., the Staff Development Coordinator (SDC) reviewed Resident #74's medical record and said she could not find any documentation to indicate the external length of the catheter had been measured since the first dressing change upon admission to the facility.

She said the nurse is supposed to measure the external length of the catheter with every dressing change and document it in the medical record.

She said when she started in March 2024, she realized there was a need for staff education and competencies to be done.

She provided the surveyor with a sign-in sheet for PICC line and Midline education provided to 16 nurses on 3/18/24, only four of which provided care to Resident #74.

However, she was unable to provide evidence of completed competency checklists for any nursing staff.

She said there was no system in place to determine if all of the Nurses who have provided IV care and services to Resident #74 had the required training and competencies.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

Review of a Clinical Nurse's Note, written by Nurse #12 and dated 5/18/2024, indicated Resident #10 was verbally abusive to staff and physically abusive several times, using his/her cane as a weapon.

Further review of the Clinical Nurse's Note indicated that the Resident was warned multiple times to stop with the aggression and cane use as a weapon or he/she would be sent to the hospital.

The Resident stated he/she wanted to go and 911 was called to transport the Resident to the hospital for further evaluation.

On 6/24/24 at 9:15 A.M., the surveyor observed Resident #10 standing in his/her room, crying and unable to answer questions.

Certified Nursing Assistant (CNA) #1 entered the room to assist the Resident and stated he/she was always like this and assisted the resident back to bed.

Review of employee education documents provided failed to indicate that CNA #1 had in-servicing and/or training on caring for residents with mental and psychosocial disorders.

Review of employee education documents provided failed to indicate that Nurse #12 had in-servicing and/or training on caring for residents with mental and psychosocial disorders.

During an interview on 7/1/24 at 10:00 A.M., the Staff Development Coordinator (SDC) said all education files and records had been provided to the survey team.

The SDC said all education was completed on paper and the facility did not utilize any electronic training programs.

During an interview on 7/1/24 at 12:12 P.M., the Chief Nursing Officer (CNO) said the mandatory training on written standards, policies, and procedures for behavioral health should be completed upon hire and then annually.

Refer to F-F949

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

Review of Resident #10's May and June 2024 MARs indicated he/she was administered insulin and hypoglycemic medications as ordered.

Further review of the May and June 2024 MARs and Treatment Administration Records (TARs) indicated the monitoring of adverse consequences to insulin and hypoglycemic medications was not being documented.

During an interview on 6/28/24 at 12:50 P.M., the CNO said the expectation was for all residents who were administered medications to alter their blood sugar should be monitored for potential adverse reactions and/or side effects.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

Review of Resident #32's April 2024 through June 2024 MAR indicated the Resident received Ativan, Depakote, Seroquel and Trazodone as ordered by the Physician.

Further review of the entire medical record failed to indicate Resident #32 was monitored for potential adverse consequences of antianxiety, antipsychotic and antidepressant medications.

During an interview on 6/25/24 at 11:29 A.M., Unit Manager #1 said residents on psychotropic medications should be monitored for side effects.

She reviewed Resident #32's medical record and said they were not monitoring him/her for adverse consequences of psychotropic medication use.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

Review of the legend on the

A medication administration note, dated 8/19/24, indicated a notation of n/a next to the order for

Further review of the medical record failed to indicate the Physician/Nurse Practitioner was notified that enoxaparin was not administered on 8/19/24 as ordered.

During an interview on 8/20/24 at 3:04 P.M., Nurse #3 said she documented the code 9 on the MAR and n/a in a note for not available because the Resident did not get the enoxaparin as it had not been delivered by the pharmacy yet.

She said it was delivered the next day.

Nurse #3 said she did not notify the Physician or Nurse Practitioner that the enoxaparin was not available and not administered on 8/19/24 as ordered.

Nurse #3 and the surveyor inspected the emergency kits (e-kits) in the medication room. An e-kit labeled #31 was noted to have an inventory list of contents that included enoxaparin 100 milligrams/milliliters.

Nurse #3 said she could have used it for Resident #44, but didn't even think of accessing the e-kit for the medication.

During an interview on 8/20/24 at 3:25 P.M., Unit Manager #1 reviewed Resident #44's medical record and said Nurse #3 should have notified the Physician or Nurse Practitioner and accessed the e-kit to obtain and administer enoxaparin, but did not.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

During an interview on 6/27/24 at 12:30 P.M., Nurse #7 said that that loose pills should have been discarded and not left in the drawer of the medication cart.

Nurse #7 said that inhaler devices should be labeled and stored in boxes marked with the residents' names and prescription information.

Nurse #7 said that the lock on the separately locked compartment in the medication cart, where schedule II-V controlled substances were usually stored, had been broken for a few weeks and that the pharmacy had been contacted for repair.

Nurse #7 did not know when the pharmacy had been contacted or when the lock was scheduled to be repaired.

Nurse #7 said that the Director of Nursing (DON) was aware that the lock was broken.

During an interview on 6/27/24 at 12:30 P.M., the DON said she was aware the lock was broken and that the pharmacy had been contacted.

The DON said that schedule II-V controlled substances should be stored under double-lock and key.

During an interview on 6/27/24 at 12:30 P.M., the CNO said that she was not aware that the drawer lock was broken and that controlled substances should be stored in a double-locked permanently affixed compartment.

During review of the East Unit medication room, on 6/27/24 at 12:38 P.M., with Nurse #7, the surveyor observed a multi-dose vial of Tuberculin, which had been opened/accessed, was not labeled with the opened date and expiration date stored in the medication room refrigerator.

Review of the manufacturer's guide for Tuberculin indicated that once opened/accessed, multiple dose vials should be discarded after 30 days.

During an interview on 6/27/24 at 12:38 P.M., Nurse #7 said that the Tuberculin vial should have been labeled with the opened date and expiration date.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

During an interview with observation on 6/26/24 at 12:30 P.M., the Food Service Director (FSD) said the kitchen staff stocks the Unit kitchenettes, monitors item dating and labeling, monitors for expiration dates, and cleans the refrigerator and freezer.

The FSD also said kitchen staff are responsible for cleaning drawers.

The FSD and the surveyor observed the East Unit kitchenette together.

The FSD said the refrigerator, freezer, drawers, and cabinets needed cleaning.

The FSD said the sink faucets and the hand nozzles should be cleaned of buildup.

The FSD said resident food items stored in the Unit kitchenettes should be labeled and dated and any food or drink that is expired or past the written use by date is discarded.

The FSD said she was unaware of the prune juice's consumption range of seven to ten days after opening, and she was unaware of the expired thickened beverage packets in the [NAME] Unit kitchenette.

The FSD said these items should have been discarded.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

During an interview on 7/1/24 at 10:04 A.M. the DON said skin checks are completed on shower days and should be signed off on the TAR and a UDA completed.

The DON said Residents #6, #231, and #48 all had skin checks signed off on the TAR but all three residents were missing UDAs and should not have been.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

Review of the facility's policy titled Quality Assurance and Performance Improvement (QAPI), dated as revised 3/4/24, indicated but was not limited to: - The QAPI program includes the establishment of a Quality Assessment and Assurance (QAA) Committee and a written QAPI Plan. - The QAA Committee shall be interdisciplinary and shall consist at a minimum of the Director of Nursing Services, the Medical Director or his/her designee, at least three other members of the facility's staff, at least one of which must be the Administrator, Owner, a Board Member or other Individual in a leadership role; and the Infection Preventionist.

Review of the QAPI Attendance Sheets, dated 1/19/24, 2/26/24, 3/15/24, and 4/26/24, failed to indicate the Infection Preventionist was in attendance and the designated signature space was blank.

Further review of the QAPI Attendance Sheets indicated the Quarterly Meetings were held on 1/19/24 and 4/26/24.

During an Interview on 7/1/24 at 12:10 P.M., the Chief Nursing Officer (CNO) reviewed the QAPI Attendance Sheets, dated 1/19/24, 2/26/24, 3/15/24, and 4/26/24 and said the facility IP had not signed in.

The CNO said the expectation was for the facility IP to be present at the QAPI Meetings.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

The surveyor observed the lunch truck arrive at which time staff cleared activities off tables.

The surveyor observed that staff did not clean any tabletops after the activities and prior to serving meals.

The surveyor observed staff also did not perform hand hygiene for the residents prior to the lunch meal.

The surveyor observed two residents eating sandwiches with their bare hands.

During an interview on 6/27/24 at 3:30 P.M., CNA #4 said for the [NAME] unit there was no protocol in place to clean or sanitize tables before serving meals, nor for performing hand hygiene on resident's hands before meals. CNA #4 said staff cleaned tables and residents' hands prior to meals if they were noticeably dirty.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

During an interview on 7/1/24 at 10:00 A.M., the SDC said all education files and records had been provided to the survey team.

The SDC said all education was completed on paper and the facility did not utilize any electronic training programs.

During an interview on 7/1/24 at 10:57 A.M., the SDC said she had only been in the role for three months and has been trying to catch up on the mandatory trainings.

The surveyor and the SDC reviewed the employee records and the SDC said there was no evidence of the mandatory trainings.

The SDC said she would check in her office and review the records again and provide the findings to the survey team, if able.

During an interview on 7/1/24 at 12:12 P.M., the Chief Nursing Officer (CNO) said the mandatory and required trainings should be completed upon hire and then annually per the facility policy.

As of the end of survey, on 7/1/24, the survey team did not receive any additional education/training.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

Review of the facility's policy titled Training Requirements, dated as revised 3/4/24, indicated but was not limited to: -Training requirements should be met prior to staff and volunteers independently providing services to residents, annually, and as necessary based on the facility assessment. -Training content includes, at a minimum: a.

Effective communication for direct care staff -The Staff Development Coordinator (SDC) maintains a training schedule and documentation system for completed training by all staff, contracted staff, and volunteers.

The facility was unable to provide the surveyor with an education folder/packet for Nurses #1 and #9.

Review of the staff education records for CNAs #4, #11, and #10 failed to include mandatory training on effective communications.

During an interview on 7/1/24 at 10:00 A.M., the SDC said all education files and records had been provided to the survey team.

The SDC said all education was completed on paper and the facility did not utilize any electronic training programs.

During an interview on 7/1/24 at 10:57 A.M., the SDC said she had only been in the role for three months and has been trying to catch up on the mandatory trainings.

The surveyor and the SDC reviewed the employee records and the SDC said there was no evidence of effective communication training.

The SDC said she would check in her office and review the records again and provide the findings to the survey team, if able.

During an interview on 7/1/24 at 12:12 P.M., the Chief Nursing Officer (CNO) said the mandatory training for effective communication should be completed upon hire and then annually.

As of the end of survey, on 7/1/24, the survey team did not receive any additional education/training.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

Review of the facility policy titled, Training Requirements, dated as revised 3/4/24, indicated but was not limited to: -Training requirements should be met prior to staff and volunteers independently providing services to residents, annually, and as necessary based on the facility assessment. -Training content includes, at a minimum: b.

Resident rights and facility responsibilities for caring for residents -The Staff Development Coordinator (SDC) maintains a training schedule and documentation system for completed training by all staff, contracted staff, and volunteers.

The facility was unable to provide the surveyor with an education folder/packet for Nurses #1 and #9.

Review of the staff education records for CNAs #4, #11, and #10 failed to include mandatory training on resident rights.

During an interview on 7/1/24 at 10:00 A.M., the SDC said all education files and records had been provided to the survey team.

The SDC said all education was completed on paper and the facility did not utilize any electronic training programs.

During an interview on 7/1/24 at 10:57 A.M., the SDC said she had only been in the role for three months and has been trying to catch up on the mandatory trainings.

The surveyor and the SDC reviewed the employee records and the SDC said there was no evidence of the training on resident rights.

The SDC said she would check in her office and review the records again and provide the findings to the survey team, if able.

During an interview on 7/1/24 at 12:12 P.M., the Chief Nursing Officer (CNO) said the mandatory training for resident rights should be completed upon hire and then annually.

As of the end of survey, on 7/1/24, the survey team did not receive any additional education/training.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

Review of the facility's policy titled Training Requirements, dated as revised 3/4/24, indicated but was not limited to: -Training requirements should be met prior to staff and volunteers independently providing services to residents, annually, and as necessary based on the facility assessment. -Training content includes, at a minimum: h.

Abuse, neglect, and exploitation prevention -The Staff Development Coordinator (SDC) maintains a training schedule and documentation system for completed training by all staff, contracted staff, and volunteers.

The facility was unable to provide the surveyor with an education folder/packet for Nurses #1 and #9.

During an interview on 7/1/24 at 10:00 A.M., the SDC said all education files and records had been provided to the survey team.

The SDC said all education was completed on paper and the facility did not utilize any electronic training programs.

During an interview on 7/1/24 at 10:57 A.M., the SDC said she had only been in the role for three months and has been trying to catch up on the mandatory trainings.

The surveyor and the SDC reviewed the employee records and the SDC said there was no evidence of the training on abuse, neglect, and exploitation prevention.

The SDC said she would check in her office and review the records again and provide the findings to the survey team, if able.

During an interview on 7/1/24 at 12:12 P.M., the Chief Nursing Officer (CNO) said the mandatory training for abuse, neglect, and exploitation prevention should be completed upon hire and then annually.

As of the end of survey, on 7/1/24, the survey team did not receive any additional education/training.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

Review of the facility's policy titled Training Requirements, dated as revised 3/4/24, indicated but was not limited to: -Training requirements should be met prior to staff and volunteers independently providing services to residents, annually, and as necessary based on the facility assessment. -Training content includes, at a minimum: c.

Elements and goals of the facility's QAPI program -The Staff Development Coordinator (SDC) maintains a training schedule and documentation system for completed training by all staff, contracted staff, and volunteers.

The facility was unable to provide the surveyor with an education folder/packet for Nurses #1 and #9.

Review of the staff education records for CNAs #4, #11, and #10 failed to include mandatory training on elements and goals of the facility's QAPI program.

During an interview on 7/1/24 at 10:00 A.M., the SDC said all education files and records had been provided to the survey team.

The SDC said all education was completed on paper and the facility did not utilize any electronic training programs.

During an interview on 7/1/24 at 10:57 A.M., the SDC said she had only been in the role for three months and has been trying to catch up on the mandatory trainings.

The surveyor and the SDC reviewed the employee records and the SDC said there was no evidence of the training on elements and goals of the facility's QAPI program.

The SDC said she would check in her office and review the records again and provide the findings to the survey team, if able.

During an interview on 7/1/24 at 12:12 P.M., the Chief Nursing Officer (CNO) said the mandatory training for elements and goals of the facility's QAPI program should be completed upon hire and then annually.

As of the end of survey, on 7/1/24, the survey team did not receive any additional education/training.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

Review of the facility's policy titled Training Requirements, dated as revised 3/4/24, indicated but was not limited to: -Training requirements should be met prior to staff and volunteers independently providing services to residents, annually, and as necessary based on the facility assessment. -Training content includes, at a minimum: d.

Written standards, policies and procedures for the facility's infection prevention and control program -The Staff Development Coordinator (SDC) maintains a training schedule and documentation system for completed training by all staff, contracted staff, and volunteers The facility was unable to provide the surveyor with an education folder/packet for Nurses #1 and #9.

Review of the staff education records for CNAs #7 and #10 failed to include mandatory training on written standards, policies and procedures for the facility's infection prevention and control program.

During an interview on 7/1/24 at 10:00 A.M., the SDC said all education files and records had been provided to the survey team.

The SDC said all education was completed on paper and the facility did not utilize any electronic training programs.

During an interview on 7/1/24 at 10:57 A.M., the SDC said she had only been in the role for three months and has been trying to catch up on the mandatory trainings.

The surveyor and the SDC reviewed the employee records and the SDC said there was no evidence of the training on written standards, policies and procedures for the facility's infection prevention and control program.

The SDC said she would check in her office and review the records again and provide the findings to the survey team, if able.

During an interview on 7/1/24 at 12:12 P.M., the Chief Nursing Officer (CNO) said the mandatory training on written standards, policies and procedures for the facility's infection prevention and control program should be completed upon hire and then annually.

As of the end of survey, on 7/1/24, the survey team did not receive any additional education/training.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

Review of the facility's policy titled Training Requirements, dated as revised 3/4/24, indicated but was not limited to: -Training requirements should be met prior to staff and volunteers independently providing services to residents, annually, and as necessary based on the facility assessment. -Training content includes, at a minimum: e.

Written standards, policies, and procedures for the facility's compliance and ethics program -The Staff Development Coordinator (SDC) maintains a training schedule and documentation system for completed training by all staff, contracted staff, and volunteers During survey the facility was unable to provide an education folder/packet for Nurses #1 and #9.

Review of the staff education records for Nurse #8, CNA #1, CNA #7, CNA #4, CNA # 11, and CNA #10 failed to include mandatory training on written standards, policies, and procedures for the facility's compliance and ethics program.

During an interview on 7/1/24 at 10:00 A.M., the SDC said all education files and records had been provided to the survey team.

The SDC said all education was completed on paper and the facility did not utilize any electronic training programs.

During an interview on 7/1/24 at 10:57 A.M., the SDC said she had only been in the role for three months and has been trying to catch up on the mandatory trainings.

The surveyor and the SDC reviewed the employee records and the SDC said there was no evidence of the training on written standards, policies, and procedures for the facility's compliance and ethics program.

The SDC said she would check in her office and review the records again and provide the findings to the survey team, if able.

During an interview on 7/1/24 at 12:12 P.M., the Chief Nursing Officer (CNO) said the mandatory training on written standards, policies, and procedures for the facility's compliance and ethics program should be completed upon hire and then annually.

As of the end of survey, on 7/1/24, the survey team did not receive any additional education/training.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

Review of the facility's policy titled Training Requirements, dated as revised 3/4/24, indicated but was not limited to: -Training requirements should be met prior to staff and volunteers independently providing services to residents, annually, and as necessary based on the facility assessment. -Training content includes, at a minimum: f.

Behavioral health -The Staff Development Coordinator (SDC) maintains a training schedule and documentation system for completed training by all staff, contracted staff, and volunteers.

The facility was unable to provide the surveyor with an education folder/packet for Nurses #1 and #9.

Review of the staff education records for Nurse #8, CNA #1, CNA #7, CNA #4, CNA # 11, and CNA #10 failed to include mandatory training on behavioral health.

During an interview on 7/1/24 at 10:00 A.M., the SDC said all education files and records had been provided to the survey team.

The SDC said all education was completed on paper and the facility did not utilize any electronic training programs.

During an interview on 7/1/24 at 10:57 A.M., the SDC said she had only been in the role for three months and has been trying to catch up on the mandatory trainings.

The surveyor and the SDC reviewed the employee records and the SDC said there was no evidence of the training on behavioral health.

The SDC said she would check in her office and review the records again and provide the findings to the survey team, if able.

During an interview on 7/1/24 at 12:12 P.M., the Chief Nursing Officer (CNO) said the mandatory training on written standards, policies, and procedures for behavioral health should be completed upon hire and then annually.

As of the end of survey, on 7/1/24, the survey team did not receive any additional education/training.

225185 07/01/2024

The Gardens at Country 2045 Grand Army Highway Swansea, MA 02777

Review of Resident #78's Brief Interview for Mental Status (BIMS) assessment, dated 4/4/24, indicated Resident #78 was cognitively intact as evidenced by a score of 15 out of 15.

During an interview with observation on 6/24/24 at 9:10 A.M., Resident #78 said he/she brought the CPAP from home and that he/she manages the CPAP themselves.

The surveyor observed a CPAP machine on Resident #78's nightstand with the CPAP mask in the top drawer, a one-gallon distilled water jug was noted next to his/her nightstand.

Review of Resident #78's medical record failed to indicate Resident #78 had an order for their CPAP.

During an interview on 6/25/24 at 8:50 A.M., Resident #78 said he/she would wear their CPAP sometimes. Resident #78 said the nurses would fill the water reservoir with distilled water and turn the machine on for him/her.

225185

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 225185 B.

Wing 07/01/2024

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

Country Gardens Health and Rehabilitation Center 2045 Grand Army Highway Swansea, MA 02777

During an interview on 6/26/24 at 4:27 P.M., the Administrator said the doctors and nurse practitioners would fax their notes to the fax machine and the two boxes of medical records were waiting to be filed.

The Administrator said the door to the copy room should be locked to protect resident information because it is accessible to anyone walking by.

On 6/26/24 at 4:51 P.M., the surveyor observed the door to the copy room of the main hallway with the door open and unattended with two boxes labeled medical records visible from the hallway and physician notes which included medical diagnoses and resident face sheets on the fax machine.

Upon further investigation, the boxes labeled medical records contained but were not limited to hospital discharge summaries and resident diagnoses.

During an interview on 6/26/24 at 4:55 P.M., the Chief Nursing Officer (CNO) said the door to copy room should have been closed and locked because the room contains residents' personal medical information but it was not.

34145

225185

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 225185 B.

Wing 07/01/2024

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

Country Gardens Health and Rehabilitation Center 2045 Grand Army Highway Swansea, MA 02777

Review of the facility's policy titled High Risk, dated 3/4/24, indicated but was not limited to the following:

- Policy: This facility recognizes that some medications, including anticoagulants, are associated with greater risks of adverse consequences than other medications.

This policy addresses the facility's collaborative, systemic approach to managing anticoagulant therapy for efficacy and safety.

Policy Explanation and Compliance Guidelines:

- The resident's plan of care shall alert staff to monitor for adverse consequences.

Risks associated with anticoagulants include:

a.

Bleeding and hemorrhage (bleeding gums, nosebleed, unusual bruising, blood in urine and stool)

b.

Fall in hematocrit or blood pressure

c.

Thromboembolism (a dangerous condition that occurs when a blood clot breaks free)

A. Resident #231 was admitted to the facility in June 2024 with diagnoses including hypertension and alcohol abuse.

Review of Resident #231's Minimum Data Set (MDS) assessment, dated 6/8/24, indicated Resident #231 had a moderate cognitive impairment as evidenced by a Brief Interview for Mental Status (BIMS) score of 12 out of 15.

Further review of the MDS indicated that Resident #231 received anticoagulant medication.

Review of Resident #231's current Physician's Orders indicated but was not limited to:

- Enoxaparin Sodium (anticoagulant) 40 milligrams (mg)/0.4 milliliter (ml) Inject subcutaneously (under the skin) one time a day (6/5/24)

Review of Resident #231's June 2024 Medication Administration Record (MAR) indicated he/she received Enoxaparin Sodium as ordered.

225185

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 225185 B.

Wing 07/01/2024

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

Country Gardens Health and Rehabilitation Center 2045 Grand Army Highway Swansea, MA 02777