Giving Tree Senior Living

Emergency Response

• AGE reviewed the Personalized Emergency Response procedures developed to provide timely assistance to a Resident in the event of an emergency.
• There were 12 e-call response times over the seven-minute limit in accordance with the Residences policy in May 2026.

Documentation of the Residence testing the system to ensure functionality

• was missing for the 2024 and 2025 calendar years reviewed and through the date of the compliance review.
• The Residence is not demonstrating an effective means of monitoring to ensure reasonable staff response times to Resident requests for assistance.
• The Residence has chosen to manually document hourly safety checks of Residents living in the Special Care Residence (SCR) to comply with the regulations to provide timely assistance to a Resident in the event of an emergency needs situation.
• The Residence is not demonstrating an effective means of monitoring hourly safety checks to ensure staff is available to provide "timely assistance to Residents and prompt response to urgent or emergency needs" during those times when they are not visible in the common areas of the community.

B. General Requirements for an Assisted Living Residence (ALR)

• AGE reviewed the documentation of seven Resident records to determine compliance with the requirements for Screenings, Assessments, and Service Plan Development and Requirements.

Service Plan Development and Requirements

• Documentation of individualized enrichment activities provided to the residents was missing in two SCR (service plan) records
• Two records were missing documentation of six-month Service Plan reviews.
• Three records were missing documentation of a service plan review required within 30 days after the commencement of residency.

C. Quality Assurance and Performance Improvement

• AGE reviewed documentation to ensure the Residence has established an effective, ongoing quality improvement and assurance program for Service Planning, Safety Assurances, and Medication Quality.

Service Planning

• Documentation that the Residence completed the annual Service Planning review was missing for Calendar year 2024.
• Documentation that the Residence Identified dates the annual Service Planning conducted was missing for calendar years 2024 and 2025.
• Documentation that the Residence identified a target date for follow-up action, staff responsible for follow-up were missing for calendar years 2025 and 2026.

Resident Safety Assurances

• Documentation that the Residence completed the annual Safety Assurances review was missing for Calendar year 2024.
• Date the audit was completed was missing for Calendar years 2025 and 2026.

Medication Quality Plan

• AGE reviewed Residence's quarterly medication documentation audits to ensure compliance with Residence's SAMM and LMA policies.
• Documentation that the Residence identified a target date for follow-up action, staff responsible for follow-up were missing for calendar years 2025 and 2026.

Medication administration observation

• AGE observed two Personal Care (PC) staff and one Nurse providing medication assistance to eight Residents to ensure the Residence has developed and implemented systems that support and promote safe SAMM and LMA.

SAMM

• One Resident had expired pharmacy filled bubble medication packs in the SAMM medication box.
• One Resident had pharmacy filled bubble medication packs unopened and not received on and in SAMM medication box.
• One Resident had loose pills noted on the bottom of the SAMM medication box.

LMA

• AGE observed Wellness Nurse pre-signing LMA MAR sheets prior to administering mediation to residents.
• One Resident had a PRN pharmacy filled medication missing an expiration date.

D. Special Care

• AGE reviewed the Special Care Residence (SCR) operations review for the period reviewed to verify that the SCR is operating with all the required safeguards.
• Documentation to support the required SCR operations review including all required operational components was incomplete for calendar 2024 and first quarter of Calendar year 2026.

AGE observed the Special Care Residence

• One Dryer Vent noted with a cracked vent hose.
• Resident Food Allergy Board was not updated.
• Unsecured Chemicals noted on SCR unit.

Supervision

• AGE reviewed the records of three Personal Care (PC) staff to determine compliance with SAMM skills and Personal Care evaluation requirements.
• Documentation confirming the completion of one additional hour of SAMM training by a Nurse was missing from three records for the 2025 calendar year reviewed.

Training Needs Assessment

• AGE reviewed the Residence records to determine compliance with the annual training needs assessment requirements.
• Documentation of an annual training needs assessment was missing for the 2025 calendar year reviewed.

Identify the designation of the individual(s) who will be responsible for monitoring the correction; and,

• The date by which each correction will be achieved.
• B. Specific Corrective Actions.

Submit to AGE the following:

• 1.Documentation of re-training on SAMM AND LMA to all applicable staff.
• 2.Documentation confirming current biannual personal care skills evaluations have been completed by a nurse for all Personal Care staff.
• 3. Documentation of an SCR operational safeguards review related to secure entry and exit doors and procedures to reduce the risk of potential hazards in the physical environment.

V. NEXT STEPS:

• In accordance with 651 CMR 12.09(4)(g), you are required to respond in writing to AGE within ten (10) days after receiving this notice indicating your agreement or disagreement with the findings. If you agree with the findings, please submit in writing to AGE all required information/corrections by August 21, 2026
• If you disagree with the findings, you may request an informal review pursuant to 651 CMR 12.10(1) by submitting your request using certified mail, return receipt requested, together with a detailed written rebuttal of the findings within ten (10) days of your receipt of this letter.
• If you have any questions regarding this matter, please email ALRHelp@mass.gov.