Articles Posted in Nursing Home Violations

Silver Lake Specialized Rehabilitation and Care Center received 66 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 seven surveys by state inspectors. The deficiencies they describe include the following:

1. The nursing home did not take adequate steps to prevent infection. Section 483.80 of the Federal Code requires nursing homes to “establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections.” A September 2019 citation found that Silver Lake Specialized Rehabilitation and Care Center failed to ensure such. The citation specifically describes a Registered Nurse who performed wound care for a resident “without performing hand hygiene,” specifically failing to wash her hands between cleansing the resident’s wound and putting on a new set of gloves. The citation goes on to describe instances in which “the nasal cannulas and nebulizer masks” assigned to two residents were not covered properly when the residents weren’t using him, as well as a surveyor’s observation that oxygen tubing was resting on the floor. A plan of correction undertaken by the facility included the counseling of the RN and the replacement of the nasal cannula and tubing.

2. A July 2018 citation also found that Silver Lake Specialized Rehabilitation and Care Center failed to properly comply with Section 483.80. The citation states specifically that for three residents with nasal cannula and one ventilator-dependent resident, partial oxygen tubings were observed resting on the facility’s floor. The citation goes on to state that a ventilator-dependent resident’s foley bag was uncovered and resting on the floor, and that the facility “did not provide documented evidence that it developed an adequate WMP (Water Management Plan) that clearly identifies areas in the facility that are at risk of growth and spread of legionella and other opportunistic pathogens.” The citation states that these deficiencies had the “potential to cause more than minimal harm.”

Verrazano Nursing Home received 14 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 four surveys by state inspectors. The deficiencies they describe include the following:

1. The nursing home did not employ adequate infection-prevention measures. Section 483.80 of the Federal Code requires the establishment and maintenance, by nursing home facilities, of a program designed to prevent and control communicable diseases and infections. A December 2019 citation found that Verrazano Nursing Home failed to ensure such. The citation states specifically that a Licensed Practical Nurse “was observed on five different occasions” providing wound care to a resident without washing her hands or otherwise performing proper hand hygiene. In one instance, for example, she was observed cleansing a resident’s sacral wound that was “soiled with feces,” then removing her gloves and donning new gloves without washing her hand in between, in contravention of policies. The citation goes on to state that residents at the facility “were no provided with hand wipes, or taken to wash hands prior to eating meals,” also in contravention of policy. The citation describes these deficiencies as having the “potential to cause more than minimal harm.” A plan of correction undertaken by the facility included the in-servicing of the LPN and the counseling of two CNAs concerning the need to ensure residents are given hand wipes before and after meals.

2. The nursing home did not guarantee residents’ right to freedom from physical restraints. Section 483.10 of the Federal Code provides nursing home residents with the “right to be treated with respect and dignity,” which includes a right to freedom “from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat… medical symptoms.” A December 2018 citation found that Verrazano Nursing Home failed to ensure such. The citation specifically describes a resident who “was observed with the use of seat belt on several occasions which the resident was unable to intentionally release the belt buckle.” The citation goes on to describe interviews with nursing staff who “did not identify the use of this device as a restraint,” and concludes that there was no medical justification for its use, nor any documented evidence of a physician’s order for its use. A plan of correction undertaken by the facility included the review and revision of the resident’s care plan.

Cortlandt Healthcare suffered 12 fatalities from Covid-19 as of July 18, 2020, per state records. The nursing home also received 18 citations finding it violated public health code between 2016 and 2020, according to health records accessed on July 20, 2020, including one citation over its infection control practices. The Peekskill nursing home’s citations resulted from a total of two surveys by state inspectors. The violations they describe include the following:

1. The nursing home fell short in its infection prevention practices. Section 483.80 of the Federal Code requires nursing home facilities to create and maintain programs designed to prevent and control infection, and to create a safe and sanitary environment for residents. A March 2017 citation found that Cortlandt Healthcare failed to ensure such. The citation states specifically that the nursing home “did not ensure that it implemented a system of surveillance and investigation to identify possible communicable diseases before they can spread to other persons in the facility for seven residents.” It goes on to state that the facility failed to report “cases of skin infection resembling scabies” to state health authorities. It goes on to describe residents with rash and itching symptoms that led the facility to suspect a scabies infestation. In an interview, the facility’s Director of Nursing said that Cortland Home had “no existing policy and procedure for reporting, investigating, and controlling scabies infestation before they can spread to other persons in the facility.” One of the residents suffering from the symptoms “was reported crying hysterically and stated she can’t take the itching anymore.” A plan of correction undertaken by the facility included the placement of affected residents on isolation precautions and the development of new facility policy.

2. The nursing home did not properly store and label medications. Section 483.45 of the Federal Code requires nursing homes to label drugs and biologicals “in accordance with currently accepted professional principles, and include… the expiration date when applicable.” An August 2018 citation found that Cortlandt Healthcare did not comply with such. The citation states specifically that the facility did not “ensure that medications were discarded and prevent their potential use beyond the expiration” in connection to one of three medication carts, in which an opened vial of a redacted medication “was found in use after the recommended discard date.” In an interview, the facility’s Licensed Practical Nurse in charge of medication administration “did not give any explanation was to why the expired… vial was not discarded after the 28 days.” A plan of correction undertaken by the facility included the discarding of the expired vial.

Elderwood at Waverly suffered 19 fatalities from Covid-19 as of July 18, 2020, per state records. The nursing home also received 17 citations finding it violated public health code between 2016 and 2020, according to health records accessed on July 20, 2020. It was additionally the recipient of a 2019 fine in connection to findings in a 2018 survey that it violated unspecified health code provisions. The Waverly nursing home’s citations resulted from a total of six surveys by state inspectors. The violations they describe include the following:

1. The nursing home did not properly supervise residents to prevent accidents. Section 483.25 of the Federal Code requires nursing homes to ensure resident environments are kept as free as possible of accident hazards, and that residents received “adequate supervision and assistance devices to prevent accidents.” A January 2019 citation found that Elderwood at Waverly failed to ensure residents received an adequate level of supervision with the use of assistance devices. The citation specifically describes a resident with “moderate cognitive impairment” who required the assistance for transfers and walking. “The resident utilized a wheelchair and walker, was not steady when moving fro a seated to standing position and for surface to surface transfers,” according to the citation, which goes on to describe an instance in which the resident was observed “self-propelling from the dining room to her room using doorways and handrails to assist” and with her feet under her wheelchair’s leg rest foot plates; it also describes another instance in which she stood from her wheelchair to move to the other side of a table in the dining room, and another in which she self-propelled with her feet under her wheelchair’s leg rests. In an interview, the facility’s Director of Therapy stated that “any resident who self-propelled in a wheelchair with their legs and feet should not have leg rests on the chair due to the risk to fall and impeding mobility.” A plan of correction undertaken by the facility included a revision of the resident’s care plan concerning the use of leg rests.

2. The nursing home did not protect residents from abuse. Section 483.12 of the Federal Code requires nursing homes to protect each resident’s right “to be free from abuse, neglect, misappropriation of resident property, and exploitation.” An October 2018 citation found that Elderwood at Waverly failed to ensure such. The citation specifically describes a resident who “was observed on video being hit by facility staff.” According to the citation, a Registered Nurse “bent to kiss the resident on her forehead” after administering medication, at which point the resident struck theRN in the face, and the RN “responded by grabbing and slapping the resident’s left arm.” A plan of correction undertaken by the facility included the termination of the RN.

Long Island State Veterans Home suffered 66 fatalities from Covid-19 as of July 18, 2020, per state records. The nursing home also received 10 citations finding it violated public health code between 2016 and 2020, according to health records accessed on July 20, 2020. The Stonybrook nursing home’s citations resulted from a total of two surveys by state inspectors. The violations they describe include the following:

1. The nursing home did not take adequate steps to prevent accidents. Section 483.25 of the Federal Code stipulates that nursing homes must ensure resident environments remain as free from accident hazards as is possible, and that residents receive adequate supervision to prevent accidents. An August 2016 citation found that Long Island State Veterans Home failed to ensure such for one resident. The citation specifically describes a resident who “was observed during a meal being fed by a family member using unsafe techniques.” It goes on to state that the resident was “seated with his head slightly extended,” while the family member was standing over the resident “Forcing his hands down on the table with her left hand while feeding the resident with a spoon.” In an interview, the facility’s Charge Nurse Registered Nurse told a surveyor that the family member “does feed the resident for lunch and dinner three times a week.” In a separate interview, the family member said “she holds his hands down as a distraction so he will eat the food off the spoon.” A plan of correction undertaken by the facility included the education of the family member regarding safe feeding practices.

2. The nursing home did not ensure the reporting of medication irregularities. Section 483.45 of the Federal Code provides for the regular review of resident drug regimens by a licensed pharmacist, and requires the pharmacist to report any irregularities to the resident’s attending physician. A March 2019 citation found that Long Island State Veterans Home did not ensure such. The citation states specifically that a resident received 2.5 milligrams of a redacted medication every eight hours when necessary for 14 days, “without supporting documentation for the use.” The citation additionally states that there was “no documented evidence the Pharmacy Consultant” reported the irregularity to the resident’s physician. The citation states that this deficiency had the “potential to cause more than minimal harm.”

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.

After a string of hidden cameras caught nursing home staff members neglecting and abusing their residents, several states are weighing the legality of allowing surveillance cameras in elder care facilities. The nationwide push for video cameras comes after several deeply disturbing incidents of elder abuse were caught on secret video cameras set up by families concerned about their loved one. The videos have led to widespread moral outrage and now, according to a survey by Care Protect, almost 93 percent of Americans are in favor of using video monitoring to safeguard nursing home patients.

The video footage that has emerged over the last year showed several nursing homes, in different parts of the country, engaging in barbaric and criminal behavior towards the senior citizens they have been charged with protecting. In North Carolina, a video shows nursing home staffers cruelly taunting and blaming an elderly man who had fallen on the floor and could not get up. In Michigan, video footage secretly obtained by an 89-year-old man’s family show the nursing home staff “yelling at and roughly throwing the patient onto his bed and wheelchair,” according to Becker’s Hospital Review. In Atlanta, Georgia, a hidden camera showed an 89-year-old veteran calling for help six times while gasping for air until he finally became unconscious and passed away. The entire time the nursing home staff stood by and laughed at the man.

Given the appalling treatment of these senior citizens, Americans are understandably concerned about how their loved ones are being treated. While nursing homes worry about the privacy implications of recording their facility’s every move on videotape, Americans are prioritizing the safety of their loved ones. In response to the outcry, state officials are moving quickly to legalize the use of surveillance cameras in nursing homes, according to NBC News. In Illinois, New Mexico, Oklahoma, Texas, and Washington, statutes already permit the use of electronic monitoring devices in nursing homes across the state, as long as any roommate gives permission. Maryland took a lighter and likely ineffective approach by requiring any electronic surveillance to receive explicit permission from the nursing home. New Jersey and Wisconsin have adopted a novel approach to the problem, by loaning out video cameras disguised as everyday objects to its citizens concerned about their loved ones.

New York State is proactively training nursing home staff how to be “better whistleblowers” whenever nursing home abuse or neglect is suspected. Describing the training as “the first of its kind” across the country, The Buffalo News said the New York Department of Health trained nursing home workers on submitting reports with important details, which include the “time and location of the alleged infractions” as well as any possible witnesses or other relevant information. The health department, which is responsible for overseeing nursing homes in New York, encouraged filing these “comprehensive complaints” in certain situations such as when the nursing home lacked adequate staffing, when important medical devices are malfunctioning, or anything else that puts the health and safety of nursing home patients in jeopardy.

Currently, anyone can file an anonymous report with the state health department. While staffers are obligated to report some instances of nursing home abuse under the state’s “mandatory reporter” laws, elder care advocates say this law is difficult to enforce. The state also prevents nursing homes from retaliating against any employee who files a report or cooperates with an investigation against the facility.

The health department said the training was necessary because some nursing home residents do not have families advocating on their behalf and the state cannot “monitor each institution around the clock.” Therefore, these vulnerable New Yorkers need nursing home staff to prevent and stop any nursing home abuse or neglect. Speaking to The Buffalo News, a nursing aide named Tanya Goffe said, “We have to recognize that these facilities are people’s homes… We want to make sure that our residents get the care they deserve.” The New York Department of Health apparently agrees and says it plans to conduct more “whistleblowing” seminars for nursing home staffers across the state.

Gov. Andrew Cuomo’s recent budget, passed in the middle of the night to ensure raises for the legislators working on the deal, increased Medicaid funding to nursing home across the state. According to Crain’s New York, the Democrat-controlled government in Albany boosted Medicaid funding by $550 million over the next year. The majority of nursing home funding in the state comes from New York’s Medicaid program, though the increased funding will also help hospitals who serve lower-income populations.

The increase in funding fulfills a promise made by Gov. Andrew Cuomo last year; however, the increase in funding appeared to be on the chopping block in the last few weeks of negotiations between the politicians in Albany. After income from tax revenues came in lower than expected, Cuomo administration officials said it was not the right time to increase Medicaid funding. Hospitals and nursing homes said they would be forced to close if they did not receive increased funding since the federal government is already decreasing its funding to long-term care facilities. According to Long Island Business News, nursing homes are short an average of $68 per Medicaid resident, each day.

Hospitals in New York City will not be so lucky. According to Crain’s New York Business, the City will see a $59 million cut to public health programs. While the rest of the state will receive 36 percent reimbursement for its medical costs at public hospitals, hospitals run by New York City will be capped at 20 percent. One bright spot, however; involves a “study” on nurse staffing levels. The new budget includes a study on whether New York should mandate a certain staffing ratio for nurses. According to the news article, the study will examine “how staffing levels for registered nurses, licensed practical nurses and certified nurse aides affect patient care.” Nurses across the state have been lobbying Albany to mandate that hospitals and nursing homes across the state hire more nurses. According to the nurses, they are overburdened, and patient care is suffering. When the results of the new study are released later this year, New York nurses may get their wish.

State authorities fined a Connecticut nursing home for allegedly allowing their staffers to steal money from the residents. According to The Connecticut Post, the nursing home did not even report the thefts when they became aware of their staffer’s criminal conduct. The thefts are part of a broader elder abuse problem in the nursing home industry. According to a USA Today report, nursing home facilities frequently lack safeguards and appropriate oversight that could prevent their resident’s money from being easily stolen by staffers.

In Connecticut, state authorities are trying to crack down on the problem. At Westport Rehabilitation Complex, the state agency responsible for nursing home oversight fined the facility $8,000 after an investigation revealed that 20 residents had money stolen from their resident trust funds. Commonly, nursing homes manage the finances of their residents through facility-controlled resident trust funds. Legally, the nursing home is responsible for managing and investing the savings of each resident’s trust account. Despite this legal responsibility, financial abuse of the elderly can run rampant in some facilities. At Westport Rehabilitation Complex, withdrawal documents from several of the stolen trust accounts are covered in white-out. A grand total of $3,161 was stolen from residents at the Connecticut nursing home. When reached for comment, Westport Rehabilitation Complex said the felonious staffer was fired.

Unfortunately, stealing from nursing home residents appears to be a nationwide problem. USA Today reports that more than 1,500 cases of theft have been reported in just the last year. The national newspaper says these cases varied wildly – from small, one-time thefts to embezzling hundreds of thousands from vulnerable senior citizens across the country’s nursing homes. A lack of sufficient oversight is generally to blame, according to Ken Moore of South Carolina’s Medicaid Fraud Unit. Moore told USA Today, “I do think there’s an oversight issue… There aren’t a lot of safeguards in the system.” Describing how thousands can be stolen, Moore says, “A lot of these cases involve an office manager or a business or finance manager, and they’re the only ones at the facility who really know how much money is coming in and going out of these accounts.”

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