1 Report
Inspection Report — Jul 18, 2024
Routine
Date: Jul 18, 2024
Visit Reason
Biennial state compliance review of the assisted living residence by the Massachusetts Executive Office of Aging & Independence (AGE) on July 18, 2024.
Findings
The state cited 5 findings, including 3 repeat findings, which is below the state median of 6. The action taken was Plan of correction required.
Citations (5)
Emergency call response: In the month of June 2024 there were 114 e-call response times over the ten minutes required by the Residence policy (repeat finding).
Resident screening and assessment: Missing Bedrail assessments.
Quality assurance program: Documentation of audit completion dates and follow-up actions were missing for calendar years 2022 through 2024, and medication storage issues were noted (repeat finding).
Incident reporting: The Residence filed 35 incident reports greater than 24 hours after the occurrence of the incident during the period reviewed (repeat finding).
Resident records: The Residence did not use the Correspondence Log to communicate all significant or pertinent information necessary to maintain the continuity of care for all Residents.
Report Facts
Findings: 5
Repeat findings: 3
State median: 6
Emergency call responses over the ten-minute limit: 114
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