South Carolina Nursing Home Blog : South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

North Carolina's  Department of Health and Human Services issued a recommendation for $20,000 in penalties against Britthaven of Chapel Hill nursing home where a nurse is accused of murder and patient abuse related to morphine overdoses. Incredibly $20,000 represents the federal maximum the two centers can legally fine the facility for the violations that occurred.

The violations are connected to the activities by Angela Almore. Almore was a registered nurse at the facility charged with second-degree murder and patient-abuse surrounding Rachel Holliday’s death.  Holliday died of pneumonia from asphyxiation; the morphine levels in her body were believed to have contributed to her death.  Injuries involving morphine and six other patients are also involved.  Prosecutors say Almore drugged patients to make them more manageable.  Of note, none of the patients were prescribed the potent pain reliever.

See articles here and here.

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The Las Vegas Sun had an article about a nursing home that was cited and fined $5,100 by the state for repeated health and safety violations and ordered not to accept new residents.  These violations are incredible.  The bureau said an “immediate jeopardy situation” was declared due to missing resident medications, failure to have criminal background checks, an ongoing cockroach infestation, a lack of a functioning auditory alarm system, poor care on a resident with a colostomy, tuberculosis testing and medication administration.

Eight of the deficiencies were repeats from previous inspections. The state Bureau of Health Care Quality and Compliance said there have been repeated violations dating back to February of 2007 at Best Care Facility which was fined $600 last year.  Surveys in 2007, 2008, 2009 and in February this year showed multiple violations. The bureau said the home was inspected Feb. 2 this year and received the grade of D when 30 violations were found.

“It has been determined that residents are not safe at this facility due to chronic, repeated non-compliance and that the facility is engaging in practices detrimental to the health and safety of the residents,” the bureau said.

A person named “Danny” at the nursing home answered the telephone. He said he would return a call later but he declined to give his last name.

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The Des Moines Register ran an article about the settlement of a fine paid by Friendship Manor after it neglected a resident so badly that a leg had to be removed due to gangrene.  The nursing home agreed to pay more than $75,000 to settle allegations of resident neglect.  Officials fined the nursing home $101,250 last fall, after the resident died. It was one of the largest fines ever imposed against an Iowa nursing home.  The case involved Ruth Louden who entered Friendship Manor in 2008 for what was expected to be a short stay. The facility was to provide physical therapy for her after she fractured an ankle in a fall at her home.  Louden's doctors gave Friendship Manor written orders to monitor the circulation in her leg and to check her skin every shift for any signs of swelling or redness.

During the next four weeks, staff ignored Louden's complaints of horrible and excruciating pain. During that time, Friendship Manor staff gave Louden pain medication but never pulled back a stocking to examine her leg.  Workers at Friendship Manor said that during Louden's 25-day stay, they never removed her stocking to look at her leg.  Eventually, a physical therapy aide at Friendship Manor noticed Louden's leg smelled like rotting meat. She also noticed blood seeping through the stocking.

Louden was taken to a Grinnell hospital, where an emergency room physician noted that a wound dressing applied at the hospital a month earlier was untouched, indicating that the staff neglected to change the dressing.  Louden suffered gangrene and the leg was amputated below the knee. She never recovered, and she died three months later.

Federal officials fined Friendship Manor $4,050 for each of the 25 days Louden was there. They also imposed a $150 per-day fine for the 76 days the home needed to correct other problems.

Owner Tim Boyle refused to admit any fault or pay the fine so he appealed the penalty. Finally last month, he agreed to settle the case by paying $75,397 to the U.S. Centers for Medicare and Medicaid Services. Boyle is also the president of the Iowa nursing home industry's main lobbying organization.  Boyle, who has hosted campaign fundraisers for Iowa lawmakers in his South Dakota home, then began lobbying his congresswoman for a less punitive system of regulating nursing homes. The Iowa Healthcare Association, with Boyle as its president, began telling Iowa lawmakers of "rogue" inspectors who were too aggressive in their enforcement of health and safety regulations. In one written presentation for legislators, the association said the fine against Friendship Manor threatened the existence of the facility and its $700,000 payroll. The presentation made no mention of Louden's death or the gangrene that triggered the fine. 

It is unclear how his role as a lobbyist and his relationship with government officials might have helped in the negotiations to lower the fine.

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San Jose Mercury News had an article about a Stockton nursing home facing California's stiffest penalty after state investigators found the facility did not adequately protect a 92-year-old resident from a fatal fall.   The 120-bed Valley Gardens Health Care and Rehabilitation Center received a "AA" citation and a $90,000 fine for the 2007 death of retired Stockton businessman Robert Doscher.

A California Department of Public Health report found staff at Valley Gardens failed to check on Doscher as often as his chart recommended.  The state said Doscher's death certificate listed his cause of death as accidental from falling down on his head in the bathroom.

 Recordnet.com had additional information in an article.  Valley Gardens failed to ensure that the 92-year-old Doscher was adequately supervised and, as a result, he fell and later died, according to Dr. Mark Horton, director of the California Department of Public Health.  By its own assessment, Valley Gardens knew that Doscher was a serious risk to himself but it failed to act properly in protecting him from falling, according to the state's recently concluded investigation.

Doscher was admitted to Valley Gardens on May 18, 2007, from an acute-care hospital. He required the use of a walker when he was admitted, and it was initially planned that he could be discharged to a board-and-care facility when his condition stabilized. He was assessed by Valley Gardens nursing staff as a "high risk for falls" and his chart indicated that he should be checked every one to two hours. Also, he was to be told not to get up without assistance; a motion-monitor alarm was to be used to alert staff to any unsafe activity; and he should have been placed in front of a nursing station for closer observation.

Three days after he was admitted, he was found on the floor, where he hit his head, apparently after falling while trying to get back into bed by himself, according to the state's report. As of June 4, the report notes that "there was no documented evidence the resident was checked on every two hours" and he still was not located in front of a nursing station, as required by his assessment.

On June 12, two days before he died, he was again discovered on the floor, apparently after a fall. The report notes that "resident A rapidly developed a change in condition manifested by agitation and then a decrease in his level of consciousness." The next day, he was taken to an acute-care hospital in a comatose state, and within 24 hours he was dead.

Doscher's death certificate, according to the state, listed his cause of death as "accidental from falling down on his head in the bathroom," resulting in an acute subdural hematoma from blunt force trauma.

Valley Gardens is a for-profit skilled nursing facility owned by Kindred Healthcare Inc. of Louisville, Ky. Kindred, with revenue of more than $4 billion as of June 30, operates 222 skilled-nursing facilities and more than 650 health care programs in 41 states, according to its Web site.

Its Stockton facility has a two-star "below average" rating - out of five stars - on Medicare's Nursing Home Compare Web site, which looks at health inspections, nurse staffing and quality measures and then assigns ratings based on nationwide standards.

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The L.A. Times had an article discussing the recent fine imposed on a nursing home facility.   Lakewood Manor North Nursing Home has been fined $100,000 after state officials concluded that poor care led to the injury and death of an elderly resident who fell and hurt his head.

The case involved a resident who lost his balance and struck his head on a bed rail when he was being transferred from his bed to a wheelchair. State officials said the facility failed to provide adequate support for the resident as he was transferred to his wheelchair.

At 8:30 a.m., about half an hour after the blow to the head, nurses' notes documented the man had a bluish discoloration on the left side of his head. The attending physician was paged at 8:45 a.m. and 12:30 p.m., but the doctor did not return the call. His condition continued to deteriorate throughout the day; he refused lunch and dinner and complained of not feeling well.  At 8:30 p.m., he was observed as lethargic. Finally, at an unspecified time, an attending physician was reached, and the patient was transferred to a hospital at 9:30 p.m.—more than 13 hours after he had struck his head. The patient had suffered bleeding in the brain and died five days later.

Investigators said the licensed nurses should have called either an alternate physician or the medical director when the attending physician did not respond to pages, or call 911 in an emergency.

“Failure of the facility staff to immediately notify the physician and to provide the necessary care and services to Resident 1 [the patient] ... presented a substantial probability that serious harm would result, and did result to Resident 1 [the patient’s] death,” the report said.
 

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The family of a 69-year-old woman has filed a lawsuit against a Chicago nursing home for failing to protect her from being sexually assaulted by a 21-year-old mentally ill resident.  Maplewood Care's administrator tried to cover up a rape by calling it consensual sex.  It is an example of how mixing frail senior citizens and younger mentally ill residents in nursing homes can lead to violence if facilities do not monitor potentially dangerous residents.

"The only possible reason that you would be in this situation is a profit motive," attorney for the family said. "You want more residents in your facility, but you're unwilling to pay for the necessary elements to protect all the residents."

Christopher Shelton had been diagnosed with bipolar disorder with aggression when he was admitted to the nursing home in November.  Shelton, a convicted felon and a former resident of the Elgin facility, was readmitted to the nursing home without a proper review of his criminal history. Had the facility checked, it would have discovered Shelton had an outstanding arrest warrant on felony battery charges. The state report showed he had told the nursing home staff in December that he was sexually frustrated, but the facility failed to monitor him.

Shelton was missing at bed check, but no search was made or alarm sounded to alert residents and staff that a young, aggressive, sexually frustrated, convicted felon was prowling the halls of the nursing home. Later, a night shift nurse heard an elderly woman moaning and crying.  The nurse found Shelton in her bathroom, where he was calling 911 to report that someone was attacking the woman.  Paramedics and an emergency room doctor later examined the woman and noted signs of sexual trauma.  Doyle who was the Administrator at the facility downplayed the encounter as consensual sex in a report to the state and encouraged employees to lie about it to cover it up.

The state and federal governments only fined the nursing home $44,400 for violations related to the incident.

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The L.A. Times reported another story about a nursing home fined for allowing a resident to choke to death.  This is the third story about choking deaths in nursing homes in the last couple of weeks.  The nursing home was fined $80,000 after a 54-year-old schizophrenic patient choked on a meatball and died.

Raintree Convalescent Hospital had known the patient had problems swallowing.  The spaghetti meatball served to him needed to be chopped or sliced before being given to him.  Both the cook and the nursing assistant who served the meal failed to grind up the meatballs, as required. The cook failed to follow the directions for the patient's meal by not mashing up the meatball. He also said the nursing assistant failed to look at the meal card on the patient's tray -- which would have been a second chance to catch the error -- before serving the lunch. 
 

"I just did not think to chop up his meat that day," the nursing assistant told state investigators.   The facility was probably understaffed which did not allow her time to do her job properly.

The man stumbled out of his room, pale and unable to speak. After a nurse unsuccessfully attempted the Heimlich maneuver, paramedics were able to suction the meatball out of the man's airway, but he was pronounced dead at a hospital emergency room.

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The San Diego Union-Tribune had an article about a nursing home which received the most severe citation and a $90,000 fine after an investigation found that poor treatment and supervision resulted in a resident choking to death last year.   Escondido Care Center, a 180-bed facility, failed to adjust the patient's meal plan to meet his changing dietary needs. The resident suffocated when food became stuck in his windpipe and the right main bronchial stem. He was eating a lunch of beef with barbecue sauce, mashed potatoes, and steamed cabbage and carrots. During lunch, the patient coughed repeatedly until he became unresponsive and slumped over in his wheelchair. The patient died.

The facility was well aware that the resident had swallowing problems and was at risk for choking.  His physician had ordered a strict diet to avoid problems with chewing and swallowing.
On two occasions in November, the facility's dietary supervisor, registered dietitian and a nurse wrote in the patient's file that he was having difficulty chewing and that he was coughing while drinking “thin liquids.”   No records exist to show that any staff member alerted the resident's doctor or tried to alter the man's diet or supervise it more closely.

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 The Syracuse Post Standard had an article recently discussing the (small) fine that a nursing home received for neglecting a resident who died as a result of choking.  How could they levy such a small fine for a preventable death? 

The government fined a Minoa nursing home $13,300 for failing to provide prompt emergency care to a choking resident who died.  The Centers for Medicare & Medicaid Services said The Crossings put residents in immediate jeopardy and provided substandard quality of care, the most serious deficiencies.

The Crossings was one of four nursing homes in the region fined for poor care between June 1 and Sept. 19, according to the Long Term Care Community Coalition.   The fine against The Crossings stems from an Oct. 15, 2007, incident involving a resident:  The report said:

The woman was served a dinner of blueberry pancakes and sausage that a nurse aide cut into bite-sized pieces. A short time later, the aide noticed the women's mouth was open, she was not breathing and her lips were blue.  The aide failed to call a "code blue," an announcement that alerts all staff to an emergency situation and summons them to provide assistance. It also activates the 911 system. The aide also failed to start the Heimlich maneuver.  A licensed practical nurse who came to help did not take these steps, either.  The registered nurse supervisor who arrived on the scene did not immediately call a "code blue" or 911.

I wonder what "a short time later" means?  I am surprised the nursing home did not claim that the resident had a DNR so they did not need to intervene!!

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The Almanac News had an article about a nursing home appealing a fine after a resident's death caused by their inattentiveness and lack of supervision.

During her 10-month stay at Atherton Healthcare nursing home in Menlo Park last year, 51-year-old resident Debra Nickel fell 14 times, including a fall where she suffered a traumatic brain injury. She died several days later.  State investigators have determined that the nursing home staff is at fault for Ms. Nickel's death.  The facility was fined $100,000 for the neglect which is the most severe citation possible.

The Department of Public Health concluded that Atherton Healthcare staff was inattentive in caring for Ms. Nickel, who was known to be at risk for falls. The facility was hit with an "AA" citation the most severe citation under state standards.  "The facility failed to identify and continuously assess, evaluate and update the resident's needs and plan of care to prevent further falls and injuries," according to the report.

Nana Cocachvili, executive director of Atherton Healthcare, located at 1275 Crane St., said the nursing home is appealing the decision, and that Ms. Nickel's falls were "unavoidable."

Ms. Nickel died Dec. 1, a week after staff member noticed a "deep lacerated wound" on the patient's head most probably from an "unwitnessed fall," according to the report. The staff member informed a nursing home physician, who stated that Ms. Nickel "does not need to be sent out for stitches because scalp wounds heal easily," the report says.  The staff member notified a second physician, who recommended Ms. Nickel be taken to the emergency room, where she was admitted three hours later with high blood pressure and a heart rate of 128 beats per minute, the report says.

The San Mateo County Coroner's Office confirmed Ms. Nickel died Dec. 1 of swelling of the brain and brain hemorrhages caused by blunt trauma.

The citation linked to Ms. Nickel's death isn't the only Department of Public Health claim Atherton Healthcare is currently fighting.   In April, the state fined the nursing home $20,000 following an investigation into the Oct. 28 death of a 79-year-old man who fell backwards off a wheelchair lift.

The patient, Menlo Park resident Charles Ladeau, suffered major head trauma when he fell while being lifted into a van, and died shortly after the fall.  The incident exposed the fact that Atherton Healthcare was outsourcing the driving of patients to off-site appointments through a private company without a formal contract, and without "written standards how transportation services should be provided," according to the reports.

Ms. Cocachvili said Atherton Healthcare has appealed that decision too, and she argued the blame should lie on the transportation provider whose employee was supervising the patient when he fell, not the nursing home.   however, the nursing home cannot delegate care to a third party.  The nursing home is the health care provider who is ultimately responsible for the care provided to their residents.

In 2005, the facility changed ownership and was known as Canaan Healthcare. The current owners took over in early 2007 and the name switched to Atherton Healthcare.

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