Articles Posted in Neglect

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Baptist Health Nursing and Rehabilitation Center has received 34 citations for violations of public health code between 2016 and 2020, according to New York State Department of Health records accessed on August 28, 2020. The facility has also received two fines totaling $12,000 in connection to findings that it violated health code provisions, among others, regarding quality of care.. The Scotia nursing home’s citations resulted from a total of four surveys by state inspectors. The deficiencies they describe include the following:

1. The nursing home did not properly implement infection-control measures. Under Section 483.80 of the Federal Code, nursing homes are required to take steps to prevent and control infection via the maintenance of an infection control program that ensures residents a comfortable and sanitary environment. An August 2017 citation found that Baptist Health Nursing and Rehabilitation Center failed to ensure such. The citation states specifically that staff did not properly wear personal protective equipment when necessary, glucometers were not disinfected after use, and employees “did not observe Contact Precautions during Foley catheter care and when providing housekeeping services to 2 residents.” A plan of correction undertaken by the facility included the education of nurses on glucometer cleaning, the education of a certified nursing assistant on proper foley catheter emptying, the education of a housekeeper and CNA on contact precautions, and the education of nursing staff on wound care techniques.

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Penn Yan Manor Nursing Home has received 14 citations for violations of public health code between 2016 and 2020, according to New York State Department of Health records accessed on August 14, 2020. The Penn Yan nursing home’s citations resulted from a total of two surveys by state inspectors. The deficiencies they describe include the following:

1. The nursing home did not adequately supervise residents. Section 483.25 of the Federal Code requires nursing homes to provide residents with “adequate supervision and assistance devices to prevent accidents.” A November 2019 citation found that Penn Yan Manor Nursing Home failed to ensure such for one resident. The citation states specifically that the resident did not receive adequate supervision to prevent her from eloping from the facility undetected and falling outside, after which her care plan “was not revised to include an actual elopement.” The citation goes on to describe the nurse turning off an alarm at the nurse’s station, after which the resident exited the facility undetected, and later being found sitting on the ground by a staffer from a “neighboring facility,” who brought her back. In an interview, the nurse in question said “she thought she was resetting the alarm at the nurses’ station when she turned it off.” A plan of correction undertaken by the facility included the re-education of staff on the nurses’ station alarm system.

2. The nursing home did not adequately prevent medication errors. Section 483.45 of the Federal Code stipulates that nursing homes must ensure their medication errors rates do not meet or exceed five percent. A November 2019 citation found that Penn Yan Manor Nursing Home did not ensure such for two residents. The citation states specifically that one resident’s eye drops “were administered in both eyes instead of one eye,” and the other “had a medication ordered after meals that was given over an hour after meals.” A plan of correction undertaken by the facility included the re-education of nurses on medicine administration and the disciplining of one nurse.

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Troy Center for Nursing and Rehabilitation at Hoosick Falls has received 47 citations for violations of public health code between 2016 and 2020, according to New York State Department of Health records accessed on August 5, 2020. The facility also received a 2016 fine of $4,000 in connection to findings in a 2011 inspection that it violated health code provisions regarding accidents and quality assurance. The Hoosick Falls nursing home’s citations resulted from a total of three surveys by state inspectors. The deficiencies they describe include the following:

1. The nursing home did not employ adequate measures to prevent accidents. Under Section 483.25 of the Federal Code, nursing homes must ensure resident environments remain as free as possible of accident hazards. A February 2020 citation found that Troy Center for Nursing and Rehabilitation at Hoosick Falls failed to ensure such. The citation states specifically that a resident’s skin integrity was not “protected in accordance with manufacturer instructions when a chemical hair relaxant was applied to the resident’s hair.” The citation goes on to describe an instance in which the resident returned from the salon and a pair of nurses noticed her “hairline on her forehead and scalp were red.” The resident’s hair stylist reported that the resident “told her it was burning so she immediately rinsed her hair and applied the neutralizing shampoo that came with the hair straightening chemical kit.”A plan of correction undertaken by the facility included the education of the hairdresser on facility policy.

2. The nursing home did not take adequate steps to prevent infection. Section 483.80 of the Federal Code requires nursing homes to create and maintain an infection control program to help prevent infection and disease. A February 2020 citation found that Troy Center for Nursing and Rehabilitation at Hoosick Falls did not ensure such. The citation states specifically that the facility did not ensure the use of clean scissors during a resident’s pressure ulcer dressing change, that a barrier was not used between the resident’s foot and the floor, that supplies were not “opened properly,” and that gloves were not “changed when contaminated during a dressing change.” A plan of correction undertaken by the facility included the reeducation of nurses with respect to wound care.

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Rosewood Rehabilitation and Nursing Center has received 77 citations for violations of public health code between 2016 and 2020, according to New York State Department of Health records accessed on July 31, 2020. The facility has also received seven fines totaling $48,000 over findings that it violated health code provisions regarding staff mistreatment of residents, medication errors, and more. The Rensselaer nursing home’s citations resulted from a total of seven surveys by state inspectors. The deficiencies they describe include the following:

1. The nursing home did not employ adequate measures to prevent infection. Section 483.80 of the Federal Code stipulates that nursing homes must create and maintain infection control programs designed to provide residents with a safe and sanitary environment. A February 2020 citation found that Rosewood Rehabilitation and Nursing Center failed to ensure such. The citation states specifically that staff did not follow infection control procedures while performing a dressing change procedure on a resident, and that a staff member did not don personal protective equipment and perform hand hygiene before providing care to a resident on contact precautions. As for that staffer, the citation states that a Certified Nursing Assistant was observed standing next to the resident’s bed without PPE “despite presence of signage and supplies outside the room.” In an interview, the CNA stated that they “did not see the contact precaution sign or the cart with the PPE supplies.” A Registered Nurse Unit Manager said in an interview that “there is a very visible sign on the doorway and a cart outside the room notifying everyone.” A plan of correction undertaken by the facility included the re-education of the CNA regarding isolation protocols.

2. The nursing home did not take adequate steps to prevent accidents. Section 483.25 of the Federal Code requires nursing homes to ensure resident environments remain “as free of accident hazards as is possible.” A January 2019 citation found that Rosewood Rehabilitation and Nursing Center did not ensure such for three residents. The citation states specifically that the three residents’ disposable razors were not stored properly, and that the facility did not ensure one of those residents, “who was receiving anticoagulation therapy,” was not using a disposable razor. The citation goes on to state that the facility “did not ensure that chemicals were stored properly” in the facility’s kitchenette.

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New Vanderbilt Rehabilitation and Care Center received 19 citations for violations of public health code between 2016 and 2020, according to New York State Department of Health records accessed on July 22, 2020. The Staten Island nursing home’s citations resulted from a total of two surveys by state inspectors. The deficiencies they describe include the following:

1. The nursing home did not employ adequate accident-prevention measures. Section 483.25 of the Federal Code requires nursing homes to ensure residents an environment free of accident hazards and with adequate supervision to prevent accidents. A November 2018 citation found that New Vanderbilt Rehabilitation and Care Center did not ensure such. The citation states specifically that the facility lacked “clear policies and procedures to prevent residents from storing lighting material on the units.” It goes on to state that residents known to possess lighting materials “on their persons and in their rooms” were given “Out on Pass Privileges,” but they were not provided with adequate  monitoring and supervision when they returned to the facility, nor to ensure that the materials were safely stored. It goes on to state that nursing staff discovered lighting materials in the rooms of several residents but did not report such to their supervisors. A plan of correction undertaken by the facility included the development of clear policies and procedures to prevent residents from storing lighting materials in their units.

2. The nursing home did not keep residents free from the use of unnecessary drugs. Section 483.45 of the Federal Code requires nursing homes to keep “each resident’s drug regimen… free from unnecessary drugs.” A February 2017 citation found that New Vanderbilt Rehabilitation and Care Center did not ensure such.The citation states specifically that a resident with a redacted diagnosis had no specific documentation i their plan of care noting “which behaviors were being treated by the use of antipsychotic medication, and there was no documented evidence of behaviors to support the ongoing use of antipsychotic medication.” A plan of correction undertaken by the facility included the assessment of the resident by the psychiatrist, who recommended a gradual dose reduction for the medication.

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New York lawmakers plan to strengthen oversight of the state’s nursing home industry with a package of two bills introduced in Albany this month. According to Sen. Robert Ortt, an upstate Republican, the first bill would forbid the New York Department of Health from approving nursing home owners with a record of providing poor care. The second bill would require 40 percent of all inspections conducted by the Department of Health to be conducted outside regular business hours. Sen. Ortt also plans to introduce a third bill later this year which would strengthen the Department of Health’s oversight power and require an independent third party to monitor all failing nursing homes in the state. According to the lawmaker, the third bill still needs an additional sponsor before it can be introduced in Albany.

In an informative interview with Skilled Nursing News, Sen. Ortt expounds on the three bills and the problems facing the New York’s nursing home industry. According to the state senator, New York’s nursing home industry lacks accountability and New York’s vulnerable senior citizens are not receiving the quality of care they deserve. For example, when a nursing home fails a state inspection then the facility’s owners and the Department of Health create a “corrective action plan” outlining corrective actions for each violation. However, the state agency does not monitor whether the facility implements the plan. The Department of Health only finds out if the nursing home corrected their violations at the next inspection.

The new legislation also confronts the increasing number of nursing homes owned by large corporations and operating for profit. Under the second bill introduced in Albany, a nursing home owner with “significant compliance issues” in any of their existing facilities would not be allowed to purchase or assume ownership of any nursing home in New York. According to Sen. Ortt, this bill will prevent the current problem of “prospective [owners] coming here to buy a bunch of nursing homes for the sole sake of making as much money as they can while putting little money into these facilities and providing substandard care.” The bill will also increase fines on nursing homes so nursing homes do not simply ignore regulations when the cost of compliance is higher than the regulatory fine.

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A new edition of the Long Term Care Community Coalition Elder Justice Newsletter asks a simple question: does providing a nursing home resident breakfast in their soiled bed constitute harm? How about failing to provide a stop date for a resident’s psychotropic medication?

“No Harm” deficiencies refer to citations of rule violations at nursing homes in which health inspectors determined that the violations caused “no harm” to residents. As the LTCCC notes, data provided by the Centers for Medicare & Medicaid Service, which mandate minimum standards of care for nursing homes participating in their programs, show that more than 95% of nursing home health citations describe “no harm” deficiencies. The LTCCC argues, however, that these no harm citations reflect systemic failures to recognize the suffering of nursing home residents, which in turn results in systemic failures to hold nursing homes accountable through financial penalties. “In the absence of a financial penalty,” the newsletter states, “nursing homes may have little incentive to correct the underlying causes of resident abuse, neglect, and other forms of harm.”

The newsletter proceeds to provide instances of health violations in which regulators determined that no harm was done to the resident in question. For example:

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New York Senator Kirsten Gillibrand proposed a new federal law aimed at improving staff levels at nursing homes across the country. According to Sen. Gillibrand, the impetus for the new legislation on nursing homes comes from a bipartisan report released this summer, which detailed widespread problems at nursing homes across the state and country. Speaking to reporters, the New York Senator said, “Unfortunately, a report came out on nursing homes and long-term care facilities that have had problems, and 17 are located in New York State.” 

Sen. Gillibrand is referring to the 488 nursing home facilities across the country which the report found a “persistent record of poor care.” Currently, the federal government only applies extra scrutiny on 88 so-called “special focus facilities” across the country. This leaves 400 nursing homes with records of abuse and neglect without sufficient oversight.

According to Sen. Gillibrand, insufficient and incompetent staffing is one of the root causes of the poor performance and conditions at these nursing homes. The bill she proposed in the Senate last month aims to fix that problem. The bill, which has bipartisan backing and is sponsored by Colorado Republican Cory Gardner, would expand access to Medicare and Medicaid data to “nursing homes, home health agencies, and hospice programs,” reports The Buffalo News. The bill, called Promote Responsible Oversight and Targeted Employee Background Check Transparency for Seniors (PROTECTS) Act, would improve the standard of living at nursing homes by “bringing more transparency to workforce quality,” says Sen. Gillibrand. 

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In 2018, one-third of all nursing homes in the country received a citation for violating federal standards on safely storing, preparing, and serving food to their residents. This makes food safety the third most common violation at nursing homes in the United States. The safety violations are not minor infractions, either. The Centers for Disease Control and Prevention (CDC) reported 230 foodborne illness outbreaks at nursing homes between 1998 and 2017. These outbreaks resulted in 532 hospitalizations and 52 deaths, reports NBC News. Further, the news agency says this number is almost certainly undercounted since the federal agency relies on voluntary reporting by nursing homes – facilities who do not have a track record of following even mandatory reporting requirements for heinous crimes such as sexual abuse or theft.

Similar to stories of nursing home abuse, horror stories about foodborne illnesses abound. In California, one woman described moving her 98-year-old mother out of a nursing home after finding cockroaches in the kitchen. In Arkansas, one facility was cited six times over the course of two years – including one health inspection detailing “grimy kitchen appliances” and “staff with unwashed hands,” according to NBC News. Such occurrences are not uncommon, according to the news report many nursing homes with the worst problems are usually repeating offenders. 

According to NBC News, food safety is especially imperiled for nursing homes owned by for-profit chains. For example, nursing homes owned by Genesis Healthcare, one of the largest nursing home corporations in the country, were 11 percent more likely to receive a citation for food safety violations in the last year. Speaking to NBC News, a representative for the nursing home chain said, “We are aware of some regulatory compliance issues and are working diligently to resolve any problems as quickly as possible.”

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Riverdale Nursing Home received 37 citations for violations of public health laws between 2015 and 2019, according to New York State Department of Health records accessed on November 21, 2019. Those citations number five more than the statewide average of 32. The Bronx nursing home’s citations resulted from a total of four inspections by state authorities. The violations they describe include the following:

1. The nursing home did not ensure it provided an accident-free environment. Section 483.25 of the Federal Code stipulates that nursing homes must provide residents an environment as free as possible from accident hazards, and with adequate supervision and assistive devices to prevent accidents. According to a December 2015 inspection, the facility failed to provide adequate supervision when a resident exited the premises “unnoticed by staff.” The male resident left Riverdale Nursing Home “around 4:36 AM,” according to the citation, and “was not identified as missing until 2:23 PM, nearly 10 hours later.” A surveillance video showed the resident exiting through a door to a patio area, wheeling a barbecue grill to a 6-foot fence, putting a chair next to the grill, and trying three times to climb from the chair to the grill and over the fence; he fell on the first two attempts, then made it over the fence on the third. A report found that the security guard on duty had “failed to lock the patio door” and to monitor security footage.

2. The nursing home did not maintain an effective pest control program. Section 483.70 of the Federal Code requires that nursing homes “maintain an effective pest control program so that the facility is free of pests.” A September 2016 citation describes an inspector’s observation that “numerous live roaches were… crawling on walls and floor” of a second floor closet. The citation notes that the closet is across from several resident rooms and adjacent to a common area. The closet itself was used for the storage of “cleaning supplies such as broom and detergents.” An inspector noted live roaches crawling in the closet, as well as dead roaches on the floor. The citation states that this deficiency had the “potential to cause more than minimal harm.”

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