Above average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Notre Dame Long Term Care Center during CMS and state inspections, most recent first.
A nurse in an LTC facility failed to follow proper infection control practices during wound care for a resident with an unstageable pressure ulcer and MRSA. The nurse did not wash or sanitize hands between glove changes and used non-disinfected scissors, compromising infection control. The facility's Infection Preventionist acknowledged that nursing competency assessments for infection control had not been conducted.
A resident with dementia and muscle weakness was not provided with necessary adaptive eating utensils, despite care plans indicating their need. Observations showed the resident struggling to eat with standard silverware, leading to food spillage. Staff interviews confirmed the oversight, as the required utensils were highlighted on the diet slip but not provided.
The facility failed to adhere to infection control standards for two residents, increasing the risk of contamination and infection spread. One resident with a urinary catheter did not receive care with proper Enhanced Barrier Precautions, as a hospice staff member did not wear a gown. Another resident with a pressure ulcer and MRSA infection experienced improper hand hygiene during wound care, as a nurse repeatedly failed to sanitize hands between glove changes.
A resident with poly-osteoarthritis and dementia, requiring two-person assistance for bed mobility, was repositioned by a single staff member multiple times, contrary to their care plan. This failure was discovered after the resident sustained a fractured tibia, confirmed by an x-ray. Interviews revealed that CNAs were unaware of the two-person requirement for bed mobility, although they knew it was needed for mechanical lift transfers. The DON expected staff to follow care plans.
Inadequate Infection Control During Wound Care
Penalty
Summary
The facility failed to ensure that a Licensed Nurse had the necessary competencies and skills to provide proper wound care for a resident with an unstageable pressure ulcer and a Methicillin Resistant Staphylococcus Aureus (MRSA) infection. During a wound care observation, the nurse did not adhere to infection control practices as outlined in the facility's policies. Specifically, the nurse did not wash or sanitize her hands between glove changes multiple times throughout the procedure, which is a critical step in preventing the transmission of healthcare-associated infections. The nurse also failed to disinfect scissors before using them to cut a piece of Calcium Alginate, which was then placed on the overbed table. Additionally, the nurse handled personal items, such as a pen, without sanitizing her hands, further compromising infection control. The Infection Preventionist/Staff Development Coordinator admitted that nursing competency relative to infection control during wound care had not been performed, which contributed to the deficiency observed.
Failure to Provide Adaptive Eating Equipment
Penalty
Summary
The facility failed to provide adaptive eating equipment for a resident, specifically built-up handled utensils, which were necessary to maintain the resident's current level of function during meals. The resident, who was admitted with diagnoses including unspecified dementia and generalized muscle weakness, had care plans and assessments indicating the need for black handled utensils to aid in eating. Despite these documented needs, observations on two separate occasions revealed that the resident was provided with standard silverware instead of the required adaptive utensils, leading to difficulties in self-feeding. During the observations, the resident struggled to use the standard utensils, resulting in food spillage and the need to use hands to eat. Interviews with staff, including a nurse and a CNA, confirmed that the resident required the black handled utensils for easier grasping, as indicated on the diet slip. The staff acknowledged that the adaptive equipment was highlighted on the diet slip and should have been checked before meal delivery, but this was not done, leading to the deficiency.
Infection Control Lapses in PPE and Hand Hygiene
Penalty
Summary
The facility failed to adhere to infection control standards for two residents, increasing the risk of contamination and the spread of infection. For one resident, the staff did not follow Enhanced Barrier Precautions (EBPs) while providing high-contact care. The resident had an indwelling urinary catheter and was on hospice care. Despite the presence of an EBP sign and PPE supplies, a hospice staff member did not wear a gown while adjusting the resident's urinary catheter and providing morning care. The hospice staff member admitted to not noticing the EBP sign and not understanding the requirements for wearing a gown during care. For another resident, the facility failed to ensure proper hand hygiene practices during wound care. The resident had an unstageable pressure ulcer and a MRSA infection. During a wound care procedure, a nurse did not wash or sanitize her hands between glove changes multiple times. The nurse also used scissors from her pocket without disinfecting them and handled a pen without sanitizing her hands. The nurse acknowledged that she should have cleaned her hands between glove changes but did not. These deficiencies highlight lapses in infection control practices, specifically in the use of PPE and hand hygiene during resident care. The failure to adhere to these standards poses a risk of spreading infections within the facility, particularly among residents with compromised health conditions.
Failure to Implement Care Plan for Resident Requiring Two-Person Assistance
Penalty
Summary
The facility failed to ensure that staff consistently implemented the care plan interventions for a resident who required assistance from two staff members for bed mobility. The resident, who had a history of poly-osteoarthritis and frontotemporal neurocognitive disorder, was non-ambulatory and dependent on staff for bed mobility and transfers. Despite the care plan indicating the need for two staff members for assistance, the resident was repositioned by a single staff member on multiple occasions, as documented in the CNA flow sheets for the evening and night shifts. The deficiency was identified after the resident sustained a fractured left tibia of unknown origin. The fracture was discovered when the resident moaned in pain during morning personal care, and an x-ray confirmed the injury. Interviews with CNAs revealed that they were not aware of the requirement for two-person assistance for bed mobility, although they knew it was necessary for mechanical lift transfers. The Director of Nurses stated that the expectation was for staff to always follow each resident's plan of care.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Worcester
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Regalcare At Worcester | 0.6 mi | ★★★★★ | 0 | 0 |
| Christopher House Of Worcester | 1.3 mi | ★★★★★ | 9 | 0 |
| Holy Trinity Eastern Orthodox N & R Center | 1.9 mi | ★★★★★ | 2 | 0 |
| Odd Fellows Home Of Massachusetts | 2 mi | ★★★★★ | 10 | 0 |
| Knollwood Nursing Center | 2.1 mi | ★★★★★ | 9 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.