Altercare Cambridge Inc.

#50 began receiving her pain medication every four hours as previous until discontinuation of the order.

Record review revealed no documentation of non pharmacological pain interventions attempted or implemented to address Resident #50 pain between the hours of 7:13 P.M. on 06/22/25 and 5:21 A.M. on 06/23/25.

Interview on 08/25/25 at 9:25 A.M. with certified nursing assistant (CNA) #888 revealed staff was telling Resident #50 her pain medication was due every eight hours however Resident #50 pain medication was due every four hours at that time. CNA #888 stated on 06/22/25 on night shift into 06/23/25 Resident #50 was upset because she had asked for pain medication several hours prior and still had not received any.Interview on 08/26/25 at 8:41 A.M. with ADON revealed Resident #50 wanted pain medication on 06/22/25, stated Resident #50 is very consistent with timing of her pain medication and knows when they are due.Interview on 08/26/25 at 12:36 P.M. with Resident #50 revealed on 06/22/25 on night shift she had requested pain medication, she had fell and broke something and had surgery on a couple weeks prior so she had been in a lot of pain. Resident #50 stated she requested the pain medication on night shift on 06/22/25, she waited several hours and no one brought her pain medication.

Their pain continued to get worse as she waited and it got pretty bad due to how long they had been waiting. Resident #50 stated it was not until early morning sometime on 06/23/25 that she received her pain medication.Interview on 08/26/25 at 12:40 P.M. with ADON revealed on 06/22/25 at 8:00 P.M. she authored a note which stated Resident #50 pain medication was just then due. ADON confirmed on 06/22/25 Resident #50 pain medication was actually due at 5:13 P.M. approximately three hours prior to the resident being told it was due. ADON stated she did not get to the building until about 7:00 P.M. on 06/22/25. ADON confirmed after Resident #50 received pain medication from her on 06/22/25 at 7:47 P.M. Resident #50 did not receive pain medication again until 06/23/25 at 5:21 A.M., ADON stated she was not on the floor the entire night shift of 06/22/25. ADON stated Resident #50 was very on top of her pain medication, she always knew when it was due, and she took it right when it was due.Interview on 08/26/25 at 12:55 P.M. with PTA #999 revealed PTA #999 was assisting Resident #50 with therapy on 06/24/25 when Resident #50 had stated on the night of 06/22/25 into 06/23/25 she requested pain medication and had been waiting a long time, at least six hours.

PTA #999 stated she immediately went to administration and filed a statement reporting what she had been told by resident #50.Review of Facility policy named Pain Medication Administration revised 05/21/25 revealed It is the facilities policy to administer pain medications in accordance with professional standards of practice.

Review the residence care plan to assess for any special needs of the resident.

The residents ' experience of pain is highly individual and subjective.

Pain is whatever the resident says it is.

Intense pain can result from even minor procedures or surgery.

Not attempt nonpharmacological interventions as per the residence plan of care prior to administering pharmacological interventions if possible.

Administer as needed pain medication as ordered.This deficiency represents non-compliance investigated under Complaint Numbers 2568688, 1274323, 1274309, and 1274308.

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