New York Nursing Home Abuse Lawyer Blog

The Hamptons Center for Rehabilitation and Nursing, located on the east end of Long Island, failed to meet minimum standards in a Department of Health deficiency survey dated August 23, 2011. The survey noted issues regarding several areas of care, including proficiency of nurse aides and avoiding significant medication errors.

In large part, the quality of a facility's nursing staff correlates with the quality of care that a resident receives. Nurses and nurse's aides interact with and care for residents constantly. For this reason, section 483.75(f) of the CFR states that nurse aides must demonstrate competency in skills necessary to care for the residents' needs. The DOH found that this level of care was not present in its review of The Hamptons Center. In one instance, a knee separator that had been ordered by a physician was not in place for a resident lying in bed. Separators such as this serve several important functions, among them a higher comfort level for the resident and the prevention of pressure ulcers. Failure to implement the knee separator, contrary to the physician's orders, posed a potential for more than minimal harm according to the DOH.

Elderly nursing home residents rely on their caregivers for the administration of necessary medications. As such, the CFR provides that it is the duty of the facility to ensure that residents remain free of any significant medication errors. The DOH report documents a resident who went three days without receiving a physician-ordered prescription because it had not been received from the pharmacy. For this particular resident, whose diagnoses included atrial fibrillation (irregular heart beat) and hypertension (high blood pressure), this failure to medicate could have had severe consequences. Heart conditions are serious matters for a patient of any age. In an elderly nursing home resident, this failure to medicate exacerbates the risk of harm to the resident.

To read the full report of deficiencies for Hamptons Center for Rehabilitation and Nursing, see the DOH website.

Smithtown Center for Rehabilitation and Nursing Care, located in Suffolk County, received sub-standard ratings from a Department of Health Certification Survey Dated November 2, 2011. Among the several deficiencies noted by the DOH were frequency of meals and providing/obtaining radiology services.

Section 483.35(f) of the CFR dictates that the facility provide three daily meals to residents, with no more than fourteen hours between dinner and breakfast the next day, unless a snack is provided at bedtime, in which case the interval may increase to sixteen hours. One logical reason for this rule is that the facility provides these meals, so the residents eating habits are subject to the staff providing them. Also, as it is the duty of the home to prevent the development of bedsores and infections, a consistent nutritional allowance is a necessity. Hunger can lead to distraction and accidents, which the facility is bound by law to make provisions to avoid. In this instance, residents reported that snacks were not provided on a regular basis by the staff, although these residents claimed feelings of hunger and that they would have readily accepted offered snacks.

For an elderly person, a fracture can have serious, and potentially life threatening, consequences. When a fall with a possible fracture occurs, it is essential to diagnose the results as quickly as possible to ensure that the correct treatment is given and the resident can begin to recover. For this reason, CFR 483.75(k)(1) provides that the facility must obtain radiology and diagnostics for its residents, and that the facility is responsible for the timeliness of obtaining these. In one instance noted in the report, a resident suffered a fall and complained of hip pain. Although an x-ray was ordered immediately, the results of this x-ray were not reported until almost sixteen hours later. As such, the injury, which was an acute right hip fracture, went undiagnosed during this interval. As evidenced by the DOH deficiency report, this lag is unacceptable.

A full list of deficiencies noted by the DOH with reference to Smithtown Center for Rehabilitation and Nursing can be located here.

Petite Fleur, a Sayville, New York based nursing home, was cited by the Department of Health for multiple pressure sore violations in a recently released report. The survey, taken April 9, 2010, detailed a resident whose pressure ulcer (bedsore, decubitis ulcer) went undocumented until it had reached Stage 3. The resident had scored a "15" on the Braden Scale Assessment, indicating a risk for the development of a pressure sore.

Title 42 of the Code of Federal Regulations section 483.25(c) states that "the facility must ensure that (1) A resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable; and (2) A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing."

In this case, the resident was considered "at risk" as determined by on the Braden Assessment. Certainly this does not mean that development of a pressure ulcer is unavoidable. However, due to the risk factors present, the facility should have monitored the resident's skin and put a plan of care in place in order to prevent the development and/or deterioration of pressure ulcers. Failure to chart an ulcer until it has reached Stage 3, at which point there is full thickness tissue loss, is unacceptable. Additionally, the resident had already developed several other pressure sores which should have made the staff more vigilant in the resident's care and treatment.

The complete Department of Health survey can be found here.

Momentum at South Bay, the East Islip based nursing home, was cited in a New York Department of Health deficiency report dated June 20, 2011. The report details numerous citations and violations of policy by the Suffolk County nursing home. The facility was cited for 27 standard health deficiencies. The New York State average number of standard health deficiencies was 17.

Listed first in the report is a violation of 42 CFR 483.20(g)-(j). These sections mandate an accurate assessment of the resident's status, as well as coordination between nurses and health professionals, and certification of the assessments when complete.The report states that according to the facility's Minimum Data Set, "Resident 13" was on a physician-prescribed weight loss program. Documentation of the physician orders contradicted this MDS, however, as there were no physicians orders for weight loss. Ordering a manageable diet in elderly and infirm residents in a nursing home is the responsibility of a physician and/oror dietician. Because these residents must maintain very specific nutritional requirements, a nurse or nurse's aide cannot take it upon him or herself to adjust the diet of a resident. Unfortunately, it appears from the report that this is what occurred at Momentum at South Bay.

A second deficiency noted in the report is a failure to establish an infection control program. This was noted during an unsanitary cleansing of a sacral pressure ulcer. A nurse did not employ adequate sanitation measures while cleansing the ulcer. According to federal regulation, a facility must maintain a program designed to prevent the development and transmission of disease and infection. When dealing with pressure ulcers, this is even more essential than normal. Because they are open wounds, pressure ulcers have a predisposition to infection. Failure to perform any and all necessary sanitation precautions prior to cleansing the wound or changing dressings may lead to an increased risk of infection, or the exacerbation of an infection already present. This in turn may lead to further infection, sepsis, and death.

The above are only two of the deficiencies noted by the DOH in its report. Click here to access its findings in their entirety.

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

A January 31, 2011 survey inspection conducted by the NYS Dept. of Health resulted in numerous deficiencies at Cayuga County Nursing Home, an upstate New York long-term-care facility. More recently, the facility was cited for 40 standard health deficiencies (statewide average is 17) in July 2011. The specifics of the July survey are not yet available online. The most glaring findings in the January 31, 2011 report involved the facility's failure to prevent accidents and falls, the development of bedsores (pressure ulcers, decubitis ulcers) as well as its failure to maintain accurate clinical records.

With respect to the bedsore deficiency, the surveyors found the nursing home failed to prevent the progression of a heel ulcer that resulted in severe pain to an anonymous resident. More specifically, the surveyors found that the facility:
- did not develop and implement a preventive, pressure-relieving comprehensive care plan related to the need for turning and positioning the resident while in bed, or in her wheelchair; the need to float the resident's heels off the bed, and the need for the resident to wear heel protectors;
- did not assess the cause of the resident's pressure ulcers to prevent the recurrence of skin breakdown and promote timely healing; and
- did not ensure pressure relieving foot care measures were consistently implemented to promote healing of the resident's left heel pressure ulcer.

In the event that you or a loved one has developed a bedsore, please contact the New York Bedsore Attorneys at Gallivan & Gallivan for a free initial consultation.

In May 2011, the Supreme Court, Appellate Division, Second Department affirmed a decision by the Trial Court in Rockland County compelling a defendant nursing home to disclose certain information regarding patients that were not parties in the lawsuit. Plaintiff-decedent had suffered pressure sores and a leg fracture, allegedly caused by the negligence of the facility. The plaintiff had requested information of other residents, including names and dates of admission purportedly in order to identify witnesses to the alleged neglect.

Because the plaintiff was not seeking medical information, and because the Court deemed the information necessary to the case, the Court ruled that the information was not protected under CPLR 4504(a). Additionally, the Appellate Court reasoned that due to the numerous services offered by nursing home facilities, information such as names, addresses, and room numbers could not reasonably be used to ascertain a resident's particular affliction--information that would be protected under CPLR 4504(a).

Although plaintiff was initially seeking the information for each and every resident during the plaintiff-decedent's stay at the home, the Court limited the disclosure to a two-month period, and to residents within the plaintiff-decedent's particular unit.

Website Resource: Olkovetsy v Friedwald Ctr. for Rehabilitation & Nursing, LLC (2d Dept. 2011).

A recent study conducted by the University of Iowa revealed that black nursing home residents are more likely than their white counterparts to develop bedsores (pressure ulcers, decubitis ulcers). In a five year study conducted at nursing homes throughout the country, researchers found that black residents were roughly five percent more likely to develop decubitus ulcers than white residents. Although the study does not promulgate definitive conclusions as to the cause of this discrepancy, several factors could be at play. Lack of funding, substandard training, and understaffing at predominantly black homes are potentially all contributing factors. Medical factors, such as diabetes, may also play a role. According to the American Diabetes Association, blacks are more likely than whites to be diagnosed with the disease.

Underqualified or insufficient staffing is a problem endemic to the nursing home industry. For reasons such as pay scale, stress, or insufficient screening during the hiring process, it seems that many of the problems that arise out of nursing homes are caused by poorly trained or over-worked staff. Regardless of the cause of these issues, however, it is a patient's right to be cared for by a competent, knowledgeable staff. As Title 42 (Public Health) of the Code of Federal Regulations states in Section 483.20(k)(3)(ii), "[T]he services provided or arranged by the facility must be provided by qualified persons in accordance with each resident's plan of care." This right provided by the Code is guaranteed to residents of any race or skin tone. And although, as evidenced in the study, the rate of pressure ulcer cases does seem to be in moderate decline nationwide, the discrepancy between black and white residents is one that should be addressed further to ensure that such cases continue to decline across all races.

Website Resource: Blacks in nursing homes have higher risk of sores

Reuters, Genevra Pittman, July 12, 2011

A jury has awarded $5.4 Million dollars to Robert Messina, a resident of Staten Island. The verdict stems from Messina's development of pressure ulcers during several stays between Staten Island University Hospital and Golden Gate Rehabilitation and Health Care Center between 2006 and 2007. The jury found SIUH 75% responsible, and Golden Gate 25% responsible. Messina has been restricted to using a wheelchair for the past five years, his confinement the result of bedsores that led to a bone infection in his hip. According to his attorney, Mitchel Ashley, Mr. Messina had no skin breakdown at the time of his first admittance to SIUH. Regardless of fault, the debilitating effects of the bedsores have proven to be a significant hinderance to Mr. Messina's quality of life, and certainly that played a part in the jury returning such a substantial verdict.

Additional medical conditions suffered by Mr. Messina (found in the article linked below) put Mr. Messina at risk for the development of bedsores. In our view, the presence of underlying conditions that put Mr. Messina at risk should have made the facilities more vigilant with respect to the assessment, care planning and implementation of appropriate interventions to prevent the development of ulcers. Despite the underlying conditions, the jury found that SIUH did not provide the requisite level of due care guaranteed as a patient right. Whatever the result of the appeal, hopefully Mr. Messina can return to some level of normalcy in his daily life, and avoid future health complications resulting from these incidents.

Website Resource: $5.4M medical malpractice award for Staten Island man

The Long Term Care Community Coalition recently released its report on New York enforcement actions for the period 12/16/10 - 3/15/11. Included in the report were the following instances of nursing home neglect and abuse:

At Terence Cardinal Cooke HCC in Manhattan, LPN Coral Quintyne, gave methadone to the wrong resident, who had to be hospitalized. She did not report her error and falsified documents in an attempt to cover it up. On 2/4/2011, she was sentenced to six months incarceration.

Certified Nurse's Aide, Esmeralda Laureano, at Rockaway Care Center, LLC in Queens stomped on the chest of an 80-year old resident who was lying on the floor after he refused to follow her instructions. On 3/1/2011, she was sentenced to a term of 3 years probation with anger management classes as a condition of probation.

At Diamond Hill Nursing and Rehabilitation Center (formerly Northwoods Rehabilitation and ECF-Troy) Certified Nurse's Aide, Jessica Tremper, falsely documented in the medical record that she turned and repositioned a resident. Turning and repositioning is considerd the most important intervention is the prevention of the development and deterioration of bedsores (pressure ulcers, decubitis ulcers). On 3/4/2011, she was sentenced to a one-year conditional discharge, 40 hours of community service, and surrender of her CNA certificate.

Certified Nurse's Aides, Janine Fedigan and Brandy Peterson, at Finger Lakes Center for Living in Auburn were sentenced to a one-year conditional discharge and surrender of their CNA licenses. In violation of the care plan, CNA Fedigan transferred an 80-year old resident out of bed alone, took resident to the toilet, and tried to apply his leg brace, which caused the resident to tip over in his wheelchair, hit his head and suffer a skin tear. CNA Fedigan and CNA Peterson picked him up and told resident and his wife not to tell anyone what had happened. CNA Fedigan claimed it happened while the resident was in the bathroom.

In a certification survey dated December 17, 2009 on the New York State Department of Health (DOH) website, Bishop Charles Waldo Maclean Nursing Home in the Far Rockaway section of Queens received numerous deficiences, ranging from pressure sore treatment to substandard overall safety measures.

The surveyors found that the facility did not ensure that a resident with pressure ulcers received the necessary dietary assessment, treatment and re-evaluation to prevent the development of new pressure ulcers (bedsores, decubitis ulcers) and failed to promote healing of the existing ulcers. The Nursing Readmission Assessment dated 6/19/09 documented ". . .skin dry and intact" and listed the GT site as the only skin problem.

The comprehensive care plan for Pressure Ulcers dated 6/24/09 documented a 13 Braden Score (scale used to predict pressure sore risk). The Braden Risk Assessment documented that a score of 13 placed the resident "at moderate risk" for pressure ulcer development. The pressure ulcer care plan documented interventions to prevent pressure ulcer development and maintain skin integrity.

A pressure ulcer Flow Sheet dated 6/24/09 identified a Sacral Stage II Pressure Ulcer measuring 1 centimeter (cm) x 1 cm . The physician's interim order dated 6/24/09 documented a treatment to cleanse the sacral ulcer with normal saline, apply Dermafix Spray and a dry sterile dressing every shift. There was no documented physician's progress note addressing the Stage II pressure ulcer until one week later when it was identified as a Stage IV on 6/30/09.

The pressure ulcer Flow sheet for the Sacral Pressure Ulcer dated 6/30/09 documented that the ulcer had deteriorated increasing in size to 7 cm x 4 cm. A Physician Progress Note dated 6/30/09 documented that the Sacral Ulcer was a Stage IV measuring 7 cm x 4 cm with 10% bloody drainage. There was no reference to any nutritional recommendations. There was no documented evidence of a Dietary Reassessment addressing the resident's nutritional needs related the the deterioration of the pressure ulcer to a Stage IV on 6/30/09.

The following ulcers developed and deteriorated during the resident's stay at the Queens facility:
Stage II Sacrum 1 cm x 1 cm-onset 6/24/09. 9/1/09-Stage IV 10.0 cm x 12.0 cm x 3.0 cm.
Right Heel closed Blister-onset 7/1/09. 9/1/09-Eschar Stage IV 8 cm x 5 cm.
Left Heel-Blackened discoloration 4 cm x 7 cm-onset 7/9/09. 9/1/09-5 cm x 4 cm.
Stage II Right Hip 0.5 cm x 0.5 cm-onset 7/20/09. 9/1/09-Stage IV 14 cm x 10 cm x 4 cm
Stage II Left Hip 0.3 cm x 0.3 cm-onset 7/28/09. 9/1/09-Stage IV 7 cm x 6 cm x 1.5 cm.

The facility violated at least twenty-six sections of Title 42 (Public Health) of the Code of Federal Regulations. Prior entries in this blog have detailed several of the Code sections violated in this particular instance (bedsores, overrall care, etc.). Below please find a sampling of additional regulations Charles Waldo Maclean failed to comply with according to the survey:

• 483.70(h)(4): The facility must...maintain an effective pest control program so that the facility is free of pests and rodents (both live and dead roaches were observed on several occasions in several different areas of the facility)

• 483.35(d)(3): Food. Each resident receives and the facility provides food prepared in a form designed to meet individual needs

• 483.20(k)(3)(ii): The services provided or arranged by the facility must be provided by qualified persons in accordance with each resident's written plan of care.

Again, these are just several sections of the Code that this facility violated according to the DOH survey. The full list, which is too extensive to replicate here, can be found on the DOH website. The scope of Public Health Law violations that this facility has amassed is disturbing. Changes are certainly in order. Perhaps the DOH survey will serve as the impetus for the facility to reevaluate its standards and increase quality of care for its residents.

The New York State Department of Health (DOH) has cited Elant at Newburgh in Orange County, NY of numerous violations of the state's Public Health Laws. Graphic at times, the report chronicles the deficient care that several residents received throughout their stay at Elant.

As this blog has noted several times in the past, Public Health Laws regarding the prevention and treatment of pressure ulcers articulate very specific standards of care that facilities must maintain with respect to their patients. The extensive document that the DOH recently released to the public details a number of incidents at Elant during which these standards of care were neglected, unknown, or seemingly ignored. In certain cases, the development of pressure ulcers in elderly residents of nursing homes is an unfortunate, yet unavoidable, occurrence. The facility's duty is to ensure that safeguards are in place to prevent avoidable sores. The practices at Elant depicted in the DOH report not only seem to disregard this duty, but also to quicken the development of pressure ulcers in already debilitated patients.

Residents suffering from incontinence are particularly susceptible to pressure ulcers. Title 10 Section 415.12(d) of the New York Administrative Code states that: "Based on the resident's comprehensive assessment, the facility shall ensure that: (1) a resident who is incontinent of bladder receives the appropriate treatment and services to...restore as much normal bladder function as possible." Yet, at Elant, a tour of the facility revealed that, among other deviations from standard care, 8 of 8 Certified Nursing Assistants (CNA's) interviewed were unaware of the facility's toileting program, and 7 of 8 CNA's demonstrated poor infection control techniques during perineal care. Section 415.12(c) of the Code mandates that the facility ensure that "(2) a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing." Again, the CNA's at Elant failed in this charge, with 5 of 8 interviewed stating that they would not report open skin areas to the charge nurse. On one occasion the Director of Nursing was intervewed following a comment by a Licensed Practical Nurse who posited that a pressure ulcer with a scab was "healed." The Director's response: "No, by no means. I'm so embarassed."

The work of Nursing Home facilities is difficult and intense. This does not excuse a lack of proper care and knowledge by the staffs of such facilities. Based upon the DOH report, it seems that Elant has significant work to do to ensure that it brings its staff members up to date on current acceptable practices for elder care.

Website Resource: New York State DOH

A New York State Department of Health certification survey dated April 8 of last year cited Northern Riverview Health Care Center, located in Haverstraw, NY, for failure to provide proper treatment to prevent/heal pressure sores (bedsores, decubitis ulcers). The findings discuss the development of pressures sores in no fewer than five residents of the facility.

The findings detail a pattern of miscommunication between physicians, nurses, and nurse aides throughout the facility. One resident, referred to in the survey as Resident #18, was admitted to the facility on Christmas Eve, 2008 with risk factors noted for the development of pressure sores, although the resident's skin was intact at the time of admission. Although the resident was confined to a wheelchair, no evidence was readily available to prove that interventions were taken to prevent pressure ulcers to the resident's buttocks. As a result, the resident did, in fact, develop a Stage I pressure ulcer on the left buttock on or around November 15, 2009. Over the next two and a half months, through February 2, 2010, the ulcer deteriorated to a Stage IV pressure ulcer. This is a violation of 10 NYCCR 415.12(c)(2), which states that a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing.

Unfortunately for both Northern Riverview and its residents, Resident #18 was not the only occupant to experience the development and/or exacerbation of pressure sores. Delays in diagnoses, incomplete/unfollowed care plans, and unapplied interventions led to the development of pressure sores in at least four other residents at the facility.

Northern Metropolitan Nursing Home in Monsey, New York was recently cited by the New York State Department of Health for incidents involving residents that developed pressure sores (decubitus ulcers, bedsores) in late 2009. According to the statement of deficiency, inspectors discovered that three out of twenty-one residents surveyed developed pressure sores at the facility. Although the residents were "at risk" for pressure sores, care plans and preventative measures were either not in place, or deficient, in ensuring that the sores did not develop.

One of the residents surveyed was readmitted to Northern Metropolitan on September 2, 2009 with a Stage II pressure ulcer on the sacrum and by December 7, 2009 two more ulcers on the hip and scapula (upper back) had developed. Another resident was readmitted on March 2, 2009 and by August 3, 2009 had developed a Stage IV (the most severe) pressure ulcer on the right Ischium (hip area). In the third case, although a patient was admitted on October 15th, 2009 with noticeably red heels, an individualized care plan was not implemented until November 4th. The resident subsequently developed a Stage II pressure Ulcer. Two of the three patients also experienced significant weight loss.

The actions of Northern Metropolitan are in direct violation of New York Codes, Rule and Regulations, specifically 10 NYCRR 415.12(c). A facility must ensure that all reasonable measures are taken to prevent pressure sores. In the event that a sore is present upon admission or develops despite appropriate measures, a facility must take all reasonable steps to treat existing sores and prevent new ones from developing. Despite the risk factors of these patients, Northern Metropolitan failed to adhere to the standard of care designated by law. This is no doubt a frustrating scenario for both the residents and their families, as with the proper interventions, these sores were, in all likelihood, avoidable.

The facility was also cited for failing to provide services in accordance within accepted parameters of nursing practice.

Website Resource: New York State Department of Health