German Center for Extended Care

In the surveyor’s words

From the most serious findings on record at German Center for Extended Care, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF658Aug 17, 2023

  Based on record review and interviews the facility failed to meet professional standards of care. Specifically, the facility failed to validate a nurse's education credentials before hire and allowed the nurse to work directly with the residents in the entire facility for a total of 98 days in the last 215 days. Findings include: Review of the state of Massachusetts guidance titled, Nursing Practice by Graduates and Students in Their Last Semester of Nursing Education Programs - Authorization Extended, dated May 11, 2023, indicated the following: *The employing licensed health care facility or licensed health care provider has verified that the individual is: - a graduate of a BORN (Massachusetts Board of Registration in Nursing) approved registered nursing or practical nursing program; or… […]

• No harm, potential for more than minimal, widespreadF726Aug 17, 2023

  Based on employee record review and interview, the facility failed to hire nursing staff with the competencies required to provide safe and effective nursing care to residents in the entire facility. Specifically, the facility failed to verify education credentials for one employee hired as a nurse, who was not qualified to work as a nurse in the Commonwealth of MA. Findings include: Review of the facility document titled Pre-employment Protocol, undated, indicated the following: *License or Certification Verification - Facility will conduct license verification for applicable personnel to verify validity of licensure. […]

• No harm, potential for more than minimal, patternF585Aug 30, 2024

  Based on interview and policy review the facility failed to ensure that all written grievance decisions included the date the grievance was received, a summary statement of the resident's grievance, the steps taken to investigate the grievance, a summary of the pertinent findings or conclusions regarding the resident's concerns(s), a statement as to whether the grievance was confirmed or not confirmed, any corrective action taken or to be taken by the facility as a result of the grievance, and the date the written decision was issued; the facility failed to maintain evidence demonstrating the results of all grievances for a period of no less than three years from the issuance of the grievance decision. […]

• No harm, potential for more than minimal, patternF812Aug 30, 2024

  Based on observation, policy review, and interview, the facility failed to store and prepare food in accordance with professional standards for food service safety. Specifically, the facility failed to ensure food was labeled, that food was not stored directly on the floor, and that dented cans were not accepted into storage/circulation. Findings include: Review of the current FDA (Food and Drug Administration) food code indicated the following: - food shall be protected from contamination by storing the food: 1) In a clean, dry location; 2) Where it is not exposed to splash, dust, or other contamination; and 3) At least 15 cm (6 inches) above the floor. […]

• No harm, potential for more than minimal, isolatedF658Feb 27, 2025

  Based on records reviewed and interviews for one of three sampled residents (Resident #1) who had been admitted with a Stage II (partial loss of dermis) pressure ulcer, the Facility failed to ensure nursing staff provided care and services that met professional standards of practice related to timely follow up on recommendations regarding nutritional interventions to promote wound healing, and obtaining medication and/or treatment orders in a timely manner. Findings include: Resident #1 was admitted to the Facility in November 2024, diagnoses include fall with a left humeral (upper arm) fracture, anemia, Stage II pressure ulcer, and dementia. […]