New York Nursing Home Abuse Lawyer Blog

The Long-Term-Care Community Coalition's Fall 2011 report on nursing home enforcement actions was recently released. According to the report, the following New York nursing homes were sanctioned by the federal government for failing to comply with quality care requirements. The amount of the civil money penalties, as well as the date of the inspection that lead to the punishment are also listed below. We have discussed some of the specific incidents of nursing home neglect and abuse that resulted in the penalties in previous posts.

Absolute Center For Nursing and Rehab, Endicott, 7/22/09, $2,000

Bishop Henry B Hucles Episcopal Nursing Home Brooklyn 11/30/09 $12,000

Brooklyn United Methodist Church Home Brooklyn 3/8/10 $22,000

Chataugua County Home Dunkirk 1/6/09 $10,000

Elant at Newburgh Inc. Newburgh 9/2/09 $72,000

Franklin County Nursing Home Malone 6/26/09 $8,000

Grandell Rehab and Nursing Center Long Beach 7/29/10 & 1/26/10 $34,000

Guilderland Center Nursing Home Guilderland Center 9/10/09 $10,000

The Hamptons Center for Rehab and Nursing Southampton 7/30/10 $10,000

Jewish Home and Hospital-Bronx Bronx 6/23/09 $6,000

Medford Multicare Center for Living Medford 3/17/10 $10,000

Medford Multicare Center for Living Medford 4/1/09 $12,000

Mount Loretto Nursing Home Inc. Amsterdam 7/6/10 $10,000

Northern Riverview Health Care Center, Inc Haverstraw 4/8/10 $24,000

Petite Fleur Nursing Home Sayville 4/9/10 $10,000

St. Johns Health Care Corporation Rochester 9/27/10 $10,000

Sullivan County Adult Care Center Liberty 4/16/09 $10,000

Summit Park Nursing Care Center Pomana 12/4/09 $10,000

Sutton Park Center for Nursing and Rehab New Rochelle 6/18/09 $4,000

Sutton Park Center for Nursing and Rehab New Rochelle 1/19/10 $10,000

Van Duyn Home and Hospital Syracuse 11/13/08 $2,000

Wayne Health Care Newark 7/9/10 $2,000

Westmount Health Facility Queensbury 2/25/10 $2,000

Wyoming County Community Hospital SNF Warsaw 3/19/09 $10,000

Northern Riverview Health Care Center, Inc. in Rockland County, NY was fined $24,000 as a result of a Department of Health Certification Survey dated April 8, 2010. The survey noted no less than 14 deficiencies that contributed to the substantial fine.

Among the shortcomings noted by the surveyors were failures with respect to comprehensive care plans (a repeat deficiency for Northern Riverview), the failure to keep the facility free of accidents hazards, and failure to take proper measures to treat and prevent/heal pressure sores.

A facility must develop, review, and revise a comprehensive care plan for each resident. With respect to two patients, Northern Riverview failed to do this according to the DOH. In one case, the patient did not have a care plan in place for dehydration treatment, despite the fact that the patient was being monitored for dehdration. In the second instance, a patient had no care plan for limited functionality in her left hand, although it was observed that the resident was unable to unclench that hand.

A facility must also ensure that the resident environment remains as free from accident hazards as possible. On March 22 of last year, a resident eloped from Northern Riverview. The resident had been diagnosed previously with both Alzheimer's Disease and Depressive Disorder. Needless to say, the potential dangers of an elderly resident leaving a facility unattended are amplified when additional diagnoses such as Alzheimer's and depression are added to the situation. Fortunately, in this instance the resident was returned to Northern Riverview unharmed. However, without diligent checks on residents with the potential to wander, occurrences such as this could lead to much more serious consequences in the future.

As this blog has discussed frequently, a facility is required to ensure that a resident who enters a facility without pressure sores does not develop them unless the sores are clinically unavoidable, and a resident with pressure sores receives the necessary treatment to promote healing, prevent infection, and prevent new sores from developing. In the DOH report, it is noted that a resident, although noted to be at moderate risk for the development of pressure sores, still developed several pressure ulcers between Stages II and IV. Although the patient's care plan called for turning and positioning every two hours, it is not noted in the nursing notes that this was performed consistently. Additionally, the survey details departure from protocal while cleaning and dressing the wounds, such as a failures by LPN's to wash hands during the process and placing an undressed wound directly on bed linens. In limited instances, skin breakdown in an elderly person is an unavoidable side effect of underlying disease processes. Failing to take all necessary steps to avoid this breakdown is certainly avoidable, however, as is failing to properly clean and dress wounds.

Documentation of Northern Riverview's fine can be found here. The full DOH survey results are linked below.

Website Resource: Northern Riverview Health Care Center, Inc.

We have discussed the Orange County, NY nursing home Elant at Newburg several times on this blog. The Fall 2011 Long Term Community Care Coalition Newsletter documents a $72,000 fine levied against the facility resulting from a September 2, 2009 Department of Health survey.

Many of the deficiencies chronicled in the report will not be unfamiliar to readers of this blog: 483.75(f)--Proficiency of Nurse Aides; 483.25(c)--Proper Treatment to Prevent/Heal Pressure Sores; 483.13(c)--Facility Prohibits Abuse, Neglect; and so on. The deficiency discussed below, however, illustrates problems that exist as high up as the management level.

Title 42 Section 483.75(i) of the Code of Federal Regulations states that "(1) The facility must designate a physician to serve as medical director. (2) The medical director is responsible for (a) [I]mplementation of resident care policies; and (b) [T]he coordination of medical care in the facility." The report, linked below, states that the Medical Director at Elant is the sole treating physician in the entire facility, thus the MD by default. The report also illustrates a lack of fundamental knowledge on the part of the MD with respect to diagnosis and treatment of pressure sores, as well as state and federal regulations regarding the same. There are 178 residents of Elant at Newburg; the MD is responsible for the medical treatment of each one.

Expecting a single physician to care for and treat close to two hundred residents is a lofty goal. Asking that physician to be knowledgeable about one of the most widespread health issues facing her residents is not, however. Perhaps the repeated individual deficiences documented by the DOH at Elant at Newburg are represenatative of deficiences at the top of the organizational structure. Regardless of the cause, it is evident that a shift in culture is necessary at Elant to stem what seems to be an incessant tide of deficiencies and failures.

Website Resource: Elant at Newburgh, Inc

Grandell Rehabilitation and Nursing in Long Beach, New York was fined for several deficiencies after surveys taken in January and July of last year. Among the numerous violations found during the survey were:

• CFR 483.7(h)(3) Corridors have firmly secured handrails. The study found that not only did the facility lack the requisite number of handrails, but also not all handrails were securely fastened in place. Due to a propensity for falls by residents of nursing homes, and for increased damage to an elderly resident who suffers a fall, securely fastened handrails are an absolute necessity in elder care facilities. A fall can lead to injuries such as bruising and bone fractures. Additionally, the long term reduced mobility resulting from a fall can lead to advanced medical issues, such as bedsores (pressure sores / decubitis ulcers) for an elderly resident. The effects, both direct and indirect, of a fall can be deadly for an elderly nursing home resident. All precautions must be taken to ensure that avoidable falls are, in fact, avoided.

• CFR 483.65 Facility Establishes Infection Control Program. An infection in an elderly patient can have dire consequences. As such, all necessary precautions must be taken by resident facilities to avoid preventable infections. Instances such as failure to wash hands before administering medicine, failure to replace a visibly soiled cervical collar, and failure to employ sanitary methods of taking blood (all noted in the deficiency report) can each lead to an infection. Simple precautions like these, which an individual would almost certainly take if administering medicine or taking blood from him or herself, were not taken on several occassions during the period of time monitored by the survey.

As mentioned above, there were numerous additional violations found in the DOH survey. These can be found in the link to the site below. According to the Long-Term-Care Community Coalition, Grandell was fined $34,000 as a result of the deficiencies noted in the surveys.

Website Resource: New York State Department of Health

Late last week, the New York State Department of Health discontinued Soundview's participation in the state's Medicaid program. Citing lack of a Medicaid Compliance Plan on the part of Soundview, the DOH has removed the home from Medicaid participation effective September 12th of this year. The Department acted upon recommendation by the Office of the Medical Inspector General, which noted lack of compliance with state Medicaid regulations and shortcomings within the home's operations.

Soundview residents receiving Medicaid benefits will not be denied access to medical care. The DOH ruling does not immediately impact those residents receiving aid from Medicare or private insurance.

Title 18 Section 521.3(a) of the New York Administrative Code states that all providers "shall adopt and implement an effective compliance program." Such compliance programs are applicable to billing, payments, and mandatory reporting, among other operational aspects of healthcare providers. Based on the findings of the OMIG, the Department of Health found this compliance lacking in the case of Soundview, and thus stripped it of its Medicaid eligibility.

Website Resource: New York State Department of Health