State Findings:
The Department of Health & Human Services conducted an inspection of the facility. The following highlighted decencies listed below were found in a 148 page public survey.
Immediately tell the resident, the resident’s doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
On 09/25/2021, Resident #87 sustained a laceration to his/her forehead, which staff determined was an injury of unknown origin. The resident’s forehead wound was open and the LPN, who assessed him/her, determined the resident needed to go to the hospital emergency room (ER). The LPN notified the Nurse Practitioner and the facility transferred Resident #87 to the ER for evaluation of the head wound. Resident #87 was readmitted to the facility from the ER with seven (7) sutures to his/her head, and a splinted right wrist. The resident was diagnosed with a fracture of his/her fifth (5th) digit. Facility staff documented Resident #87’s RR was notified; however, interview with the RR revealed the facility had not notified her of the resident’s injuries.
Honor the resident’s right to a dignified existence, self-determination, communication, and to exercise his or her rights
Based on observation, interview, record review, and review of the facility’s policy it was determined the facility failed to ensure dignity during dining for residents on two (2) of six (6) floors (2nd and 5th floors). The facility provided disposable cutlery and dishware for residents dining on the second and fifth floors.
Honor the resident’s right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Based on observation, interview, record review, and review of the facility’s policy, it was determined the facility failed to ensure resident rights were promoted and protected for two (2) of one-hundred and thirteen (113) sampled residents (Residents #26 and #147). Residents #26 and #147 provided the facility with their food preferences. However, the facility did not promote the recognition of individuality of residents with preferred foods, food items requested, or menu preferences.
Honor the resident’s right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Based on observation, interview, record review, and review of the facility’s policy it was determined the facility failed to ensure a safe, clean, comfortable, and homelike environment for seven (7) of twelve (12) shower rooms; four (4) of six (6) ice machines; broken outlet, soiled privacy curtains, and peeling/missing wallpaper. In addition, Resident #102’s wall and bathroom door were heavily soiled with a black, brown, and red substance; and, there was debris scattered on the floor.
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
1. On 03/19/2021, after the dinner meal, around 7:30 PM, Certified Nurse Aide (CNA) #36 left the unit to go on break. The CNA left Resident #161 in the dining room/dayroom unsupervised. CNA #35 was at the nurse’s station and watched the camera monitor. However, the CNA left the nurse’s station to assist another resident, and was gone from the monitor for about five (5) minutes. Upon CNA #35’s return to the nurse’s station, she observed on the camera monitor, Resident #47 next to Resident #161 in the dayroom. The lights in the dayroom had been turned off. CNA #35 observed Resident #161 with his/her hand on Resident #47’s exposed genitalia, in the fourth floor dining room/dayroom. The facility did not assess Resident #161 and Resident #47 for capacity to consent to sexual contact with others to protect the resident(s) from further abuse.
2. Resident #74’s bathroom overflowed, with water and feces all over the floor. Upon discovery of the bathroom, Licensed Practical Nurse (LPN) #11 cursed. Resident #74 and Resident #343 indicated they heard the nurse’s comments.
3. On 05/05/2020, Resident #345 hit Resident #344 with a reacher multiple times and caused a skin tear to Resident #344’s upper chest.
4. On 05/21/2021, Resident #136 was talking with a nurse when Resident #90 came over and also started talking to the nurse. Resident #136 began to disagree about staff, Resident #136 became upset and made a comment to Resident #90 about his/her mother. Resident #90 became upset and hit Resident #136 in the face with his/her fist.
Your Experience Matters
...and we want to hear it.
NHAA is here to assist families, residents, and the community by sounding the alarm on issues like those found above. This nursing home and many others across the country are cited for abuse and neglect.
If you have or had a loved one living in this nursing home or any other nursing home where you suspect any form of abuse or neglect, contact us immediately.
We have helped many already and we can help you and your loved one as well by filing a state complaint, hiring a specialized nursing home attorney or helping you find a more suitable location for your loved one.
You can make a difference, even if your loved one has already passed away.
Please give us a call at 1-800-645-5262 or fill out our form detailing your experience.
Personal Note from NHA-Advocates
NHAA shares with all the families of loved ones who are confined to nursing homes the pain and anguish of putting them in the care of someone else. We expect our loved ones to be treated with dignity and honor in the homes we place them. We cannot emphasize enough to family members of nursing home residents; frequent visits are essential to our loved ones’ well-being and safety.
If you are struggling and upset, click here to understand your options, or contact us through our contact form or call our toll free hot line number: 1-800-645-5262.
