Giving Tree Senior Living

The Residence has chosen to document hourly safety checks of 27 Residents living in the Special Care Residence (SCR) for the month of July 2024 to comply with the regulation to provide timely assistance to a Resident in the event of an emergency needs situation.

Documentation of hourly safety checks for the 27 SCR Residents reviewed by EOEA from July 1, 2024 through July 31, 2024 had multiple instances where staff failed to document the hourly safety checks of the SCR Residents during the hours of 7:00 p.m. and 7:00 a.m.

EOEA reviewed documentation of ten (10) Residents to ensure the Residence has established an effective, ongoing quality improvement and assurance program for Service Planning, Safety Assurances, and Medication Quality to ensure the Residence has developed and implemented systems that support and promote safe SAMM and LMA.

Progress note documentation of two (2) Residents indicated that Residence Care Staff administered cream and powder medications outside of the scope of SAMM.

EOEA reviewed ten (10) Resident progress note records.

Two (2) Resident records indicated multiple incidents meeting the criteria set forth in 651 CMR 12.04(11)(d) and 651 CMR 12.02 were not reported.

One Resident’s progress notes, from [redacted]

One Resident’s progress notes, from [redacted]

EOEA reviewed ten (10) Residents’ records to determine compliance with record requirements.

Inconsistent documentation of significant occurrences in the Progress Notes for ten (10) Residents. On the day of the compliance review, EOEA interviewed several parties who raised the concern that scheduled Resident care is regularly delayed, sometimes by hours, on all shifts. Progress Note documentation of Residents not receiving scheduled medications within the nursing standard practice protocols of one hour before or after the prescribed medication time, late incontinence care visits, and other delayed assistance with Resident Activities of Daily Living in ten (10) Resident Records was missing.

EOEA reviewed the documentation maintained in two 90-day correspondence logs to communicate information necessary to maintain the continuity of care for Residents.

Both the Traditional and SCR logs did not consistently document all significant or pertinent information necessary to maintain the continuity of care for all Residents. On the day of the compliance review, EOEA interviewed several parties who raised the concern that scheduled Resident care is regularly delayed, sometimes by hours, on all shifts. Correspondence Log documentation of Residents not receiving scheduled medications within the nursing standard practice protocols of one hour before or after the prescribed medication time, late incontinence care visits, and other delayed assistance with Resident Activities of Daily Living was missing.

EOEA reviewed the Residence records to determine compliance with Staffing Level requirements to meet the scheduled and reasonably foreseeable unscheduled Resident needs as required by the Residents' assessments and service plans on a 24-hour per day basis.

Documentation to confirm the Residence conducted timely staffing level assessment(s) during the period of June 25, 2024 through the date of the compliance review was missing. During this period, there were twelve (12) new admissions to the Residence including [redacted]

On the day of the compliance review, EOEA interviewed several parties who expressed concern that scheduled Resident care is regularly delayed, sometimes by hours, on all shifts including Residents not receiving scheduled medications within the nursing standard practice protocols of one hour before or after the prescribed medication time, late incontinence care visits, and other delayed assistance with Resident Activities of Daily Living. Care staff attributed delays to the high acuity of regular Resident needs compounded by unforeseen needs such as [redacted]. EOEA’s review of ten (10) Residents’ progress notes indicated that seven (7) Resident records each exhibited multiple instances of the high level of care needs expressed by care staff above since January 1, 2024. Interviewees also indicated that staff scheduled on a Traditional setting frequently are called to temporarily assist with care in the Special Care Residence for scheduled and / or unforeseen needs delaying scheduled care for the Traditional Residents.

On the day of the compliance review, EOEA interviewed multiple members of the Residence’s Management who stated that approximately 10% of regularly scheduled Resident care is provided by agency staff and not care staff employed by the Residence. Residence management and nursing staff stated to EOEA that there is no process in place for agency staff, as relevant personal care workers, to be introduced and made knowledgeable of the specific needs of each Resident’s service plan as required by regulation. This often requires Residence care staff to step in and supplement agency staff. Residence management and care staff also relayed to EOEA that agency staff are specifically restricted from performing SAMM with Residents. This results in additional scheduled SAMM services needing to be performed by Residence care staff. The care staff must shift their assignments.

EOEA reviewed the records of five (5) Residents to determine compliance with the requirements that a nurse review the Resident’s service plan with all relevant personal care workers within the 48 hours after the provision of service or with any change of condition for the Resident:

Five (5) records were without documentation to support that Introductory Visits were consistently conducted with all applicable staff prior to or within 48 hours, at the time of move-in or at the time of change in the Resident’s condition.

On the day of the compliance review, EOEA interviewed multiple members of the Residence’s Management who stated that approximately 10% of regularly scheduled Resident care is provided by agency staff and not Care Staff employed by the Residence. Residence management told EOEA that Introductory Visits “fell under the responsibility of nursing.” Residence management was unaware of a process for agency staff, as the personal care workers, to review the Resident's service plan with a nurse prior to providing care. EOEA also interviewed nursing staff who stated there was no process in place for agency staff to have Introductory Visits.

EOEA reviewed Resident records as required by 651 CMR 12.09.

EOEA was not provided timely access to the requested Residence records. EOEA arrived onsite at 8:00 AM and requested that all documentation be provided no later than 11:00 AM to ensure a thorough audit. Resident business and staff records were made available for review at 11:00AM. Resident charts were presented at 11:55 AM. The remaining records were presented by 12:30PM except for some missing progress notes, Resident introductory visits records, and e-call records which were presented by 1:15PM.

Documentation of a Resident Satisfaction Survey and Quality Assurance and Performance Improvement Review for the 2023 calendar year was missing. Management stated that a Resident Satisfaction Survey had not been completed.

Corrective Actions.