State Avg
Town/Facility Name	Complaints	Enforcements	Administration	Nursing	Residents Rights	Food Service	Environment	Total
STATEWIDE AVERAGE	Y/N	Y/N	36	27	24	11	18	116
MAXIMUM SCORE POSSIBLE	Y/N	Y/N	39	33	27	12	21	132
CHAPIN CENTER	NO	NO	0	0	0	0	0	0

Facility Details

CHAPIN CENTER

200 KENDALL STREET

SPRINGFIELD , MASSACHUSETTS 01104

TELEPHONE: (413)737-4756

PERFORMANCE SUMMARY FOR EACH CATEGORY

ADMINISTRATION

RESULTS : Standard Survey - 0 of 39 Met Complaint Investigation Deficiencies - 0
Score after Adjustment for Scope and Severity :0

This nursing facility met 0 out of the 39 requirements reviewed in this category in its last 3 standard surveys. The number of deficiencies not met as a result of complaint investigations was: 0 . The facility's score after adjustment for scope and severity is 0. The statewide average facility score was 36.

The following requirement(s) were not met. The regulation(s) survey date and scope and severity rating(s) are listed below.

The services provided or arranged by the facility as outlined by the comprehensive care plan must meet professional standards of quality. (F 658)	11/05/2019 D
The facility must establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection. Identified incidents of infection and corrective measures must be recorded and the infection control program must be reviewed yearly and updated as necessary. (F 880 )	08/23/2022 E	11/05/2019 D

NURSING

RESULTS : Standard Survey - 0 of 33 Met Complaint Investigation Deficiencies - 0
Score after Adjustment for Scope and Severity :0

This nursing facility met 0 out of the 33 requirements reviewed in this category in its last 3 standard surveys. The number of deficiencies not met as a result of complaint investigations was: 0 . The facility's score after adjustment for scope and severity is 0. The statewide average facility score was 27.

The following requirement(s) were not met. The regulation(s) survey date and scope and severity rating(s) are listed below.

A facility must maintain all resident assessments completed within the previous 15 months in the resident?s active record and use the results of the assessments to develop, review and revise the resident?s comprehensive care plan. (F 639 ) and/or; The facility develops and implements comprehensive person-centered care plans for each resident that include measurable objectives and time frames to meet each resident's medical, nursing and mental and psychosocial needs which describe services to be furnished to attain or maintain residents highest practical well-being and assess resident or resident representative goals for desired outcomes. (F 656 )	11/05/2019 D
The facility ensures that each resident receives and the facility provides the necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial well-being. (F 675) and/or; The facility ensures that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents? choices (F 684) and/or; The facility ensures that pain management is provided to residents who require such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents? goals and preferences. (F 697) and/or; The facility ensures that residents who require dialysis receive such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents? goals and preferences. (F 698) and/or; Resident who displays or are diagnosed with dementia, receive the appropriate treatment and services to attain or maintain his or her highest practicable physical, mental, and psychosocial well-being. (F 744)	08/23/2022 G
The facility ensures that residents continent of bladder and bowel on admission receive services and assistance to maintain continence unless his or her clinical condition is or becomes such that continence is not possible to maintain. The facility ensures residents incontinent of bladder receive appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible, specifically not catheterizing residents incontinent of urine who enter the facility without an indwelling catheter and assessing residents who enter with an indwelling catheter for removal of the catheter as soon as possible. (F 690 )	11/05/2019 D

RESIDENT RIGHTS

RESULTS : Standard Survey - 0 of 27 Met Complaint Investigation Deficiencies - 0
Score after Adjustment for Scope and Severity :0

This nursing facility met 0 out of the 27 requirements reviewed in this category in its last 3 standard surveys. The number of deficiencies not met as a result of complaint investigations was: 0 . The facility's score after adjustment for scope and severity is 0. The statewide average facility score was 24.

The following requirement(s) were not met. The regulation(s) survey date and scope and severity rating(s) are listed below.

The facility observes resident rights to personal privacy, including personal and medical records, accommodations, medical treatment, all communications, deliveries, personal care, visits, and meetings of family and resident groups and respects residents? right to refuse the release of personal and medical records when allowed by state and federal law. (F 583) and/or; The facility maintains medical records containing required information on each resident that are complete, accurately documented, readily accessible and Systematically organized; ensures all identifiable resident records remain confidential and does not release identifiable resident information unless permitted to do so; safeguards medical record information against loss, destruction, or unauthorized use; and retains the medical records for the specified amount of time. ( F 842)	11/05/2019 D
The facility observes resident rights to personal privacy, including personal and medical records, accommodations, medical treatment, all communications, deliveries, personal care, visits, and meetings of family and resident groups and respects residents? right to refuse the release of personal and medical records when allowed by state and federal law. (F 583) and/or; The facility maintains medical records containing required information on each resident that are complete, accurately documented, readily accessible and Systematically organized; ensures all identifiable resident records remain confidential and does not release identifiable resident information unless permitted to do so; safeguards medical record information against loss, destruction, or unauthorized use; and retains the medical records for the specified amount of time. ( F 842)	08/23/2022 D
The facility treats each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident?s individuality; provide equal access to quality care regardless of diagnosis, severity of condition, or payment source; and ensures that residents can exercise his or her rights without interference, coercion, discrimination, or reprisal from the facility. (F 550 )	11/05/2019 D
The facility provides each resident with the right to reside and receive services with reasonable accommodation of individual needs and preferences, without endangering the well-being of the individual or other residents. (F 558)	08/23/2022 D
The facility provides, an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community. (F 679 )	08/23/2022 D	11/05/2019 E

	KITCHEN/FOOD SERVICES
	RESULTS : Standard Survey - 0 of 12 Met Complaint Investigation Deficiencies - 0 Score after Adjustment for Scope and Severity :0
	This nursing facility met 0 out of the 12 requirements reviewed in this category in its last 3 standard surveys. The number of deficiencies not met as a result of complaint investigations was: 0 . The facility's score after adjustment for scope and severity is 0. The statewide average facility score was 11.

ENVIRONMENT

RESULTS : Standard Survey - 0 of 21 Met Complaint Investigation Deficiencies - 0
Score after Adjustment for Scope and Severity :0

This nursing facility met 0 out of the 21 requirements reviewed in this category in its last 3 standard surveys. The number of deficiencies not met as a result of complaint investigations was: 0 . The facility's score after adjustment for scope and severity is 0. The statewide average facility score was 18.

The following requirement(s) were not met. The regulation(s) survey date and scope and severity rating(s) are listed below.

The facility ensures that the resident environment remains as free of accident hazards as is possible and each resident receives adequate supervision and assistance devices to prevent accidents. (F 689 )

11/05/2019 D

Nursing Home Performance Tool

Long Term Care Ombudsman