Care One At Weymouth

F 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Resident #4 of the error that had been discovered.During an interview on 11/26/25 at 3.32 P.M., the Director of Nurses (DON) said that she was unaware (until date of survey 11/26/25) that the Facility had some of Resident #4's private health information in Resident #1 paperwork upon discharge.The DON said that she should have been made aware of the issues when she had returned from vacation and the event should have been investigated when the complaint was given.The DON said that it is the Facility's expectation that Providers double-check that medical record entries are for the intended Resident being documented on prior to entering the information into a Resident's record and that the party involved with

the privacy breach needs to be informed of the error in a timely manner.

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If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Care One at Weymouth

64 Performance Drive Weymouth, MA 02189

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on records reviewed and interviews for two of three sampled residents (Resident #1 and #2), the Facility failed to ensure that upon admission, nursing developed and implemented baseline care plans with interventions, treatments, goals, and outcomes that addressed the residents' overall immediate care needs.Findings include:Review of the Facility Policy titled Baseline Care Plans, dated as last revised 3/2022, indicated that

a baseline plan of care to meet the resident's immediate health and safety needs is developed for each resident within 48 hours of admission.The Policy further indicated the baseline care plan includes instructions needed to provide effective, person-centered care of the residents that meet professional standards of quality care and must include the minimum healthcare information necessary to properly care for the residents.1) Resident #1 was admitted to the Facility in 9/2025, diagnoses include respiratory failure, pneumonia, chronic obstructive pulmonary disease and is oxygen dependent.Review of Resident #1 Hospital Discharge summary, dated [DATE REDACTED], indicated his/her immediate care needs were identified as followed;-Acute on chronic respiratory failure, dependent on four (4) liters (l) of oxygen;-Average Volume-Assured Pressure Support (AVAPS) use at night;-Pneumonia with antibiotic use;-Acute heart failure; and-Subcutaneous anticoagulation.Review of Resident #1's admission Resident Evaluation, dated 09/09/25, indicated he/she had an open area to his/her coccyx requiring a treatment.Review of Resident #1's Medical Record indicated that there was no documentation to support that Baseline Care Plans were developed and implemented to address these areas of concern within 48 hours of his/her admission.2) Resident #2 was admitted to the Facility in 11/2025, diagnoses include acute respiratory failure with hypoxia, dependent on supplemental oxygen related to chronic obstructive pulmonary disease, and congestive heart failure.Review of Resident #2 Hospital Discharge summary, dated [DATE REDACTED], indicated his/her immediate care needs were identified as followed;- Chronic respiratory failure, dependent on two (2) l of oxygen;-Frequent falls; and-Constipation.Review of Resident #2's Medical Record indicated that there was no documentation to support that Baseline Care Plans were developed and implemented, or that the Comprehensive Care Plans addressed these areas of concern were in place within 48 hours of admission.During an interview on 11/26/25 at 1:42 P.M., the Unit Manager said that she was not aware that Resident #1 did not have a completed baseline care plan and said that it was her responsibility to complete

the baseline care plans.The Unit Manager said that as a team the management staff is to review a new admission chart the next day at morning meeting to ensure that the baseline care plans are completed.During an interview on 11/26/25 at 2:18 P.M., the Assistant Director of Nurses (ADON) said that

she was unaware that Resident #1 and Resident #2's baseline care plans had not been completed.The ADON said that each disciple should be initiating their individual baseline care plan and that the Unit Manager and Night Shift Supervisor should be checking for completion.During an interview on 12/26/25 at 3:32 P.M., the Director of Nurses (DON) said that she was not aware of Residents #1 and #2 were missing their baseline care plans upon admission.The DON said that it is the Facility's expectation that the admitting nurse is to initiate the resident's baseline care plan and said, along with the other disciplines complete the Baseline care plan within 48 hours of admission.

Event ID:

Facility ID:

If continuation sheet