Nursing Homes Cited For Injuries And Missing Residents

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Six nursing homes have been fined by the state Department of Public Health (DPH) for various violations in which residents were injured or endangered.

Masonicare Health Center in Wallingford was fined $7,800 after a resident with dementia fell from an X-ray table to the floor.

The resident fell on Aug. 22, 2018, and suffered a head laceration that required five sutures, according to DPH. A registered nurse had asked the X-ray technician whether straps should be used to secure the resident to the table, but the technician said none were available. Following the incident, safety straps were purchased for the X-ray table, the citation said.

Additionally, a January 2019 review of clinical records found the resident’s fall risk assessments should have been completed quarterly but weren’t done since Aug. 17, 2017.

“Masonicare responded immediately with in-service re-education for all staff regarding the safe transfer and positioning of residents, as well as proper reporting protocol,” said Margaret Steeves, vice president of marketing and communications. “The safety and comfort of our residents remains our highest priority and are central to our mandatory educational curriculum.”

St. Camillus Center in Stamford was fined $4,260 for several violations.

A resident with Parkinson’s diseases and dementia had “multiple falls” between Sept. 1 and Oct. 19, 2017. The resident’s care plan outlined interventions, including being placed in front of the nurses’ station when awake, DPH said.

The resident fell on Oct. 20, 2017, and was taken to a hospital, where a small subarachnoid hemorrhage on the temporal lobe was diagnosed. The resident was at the nurses’ station when the fall happened, but staff members were busy and not watching the resident, according to the citation.

On Jan. 7, 2018, the same resident was hospitalized with severe dehydration and documentation failed to show that fluid intake had been monitored as outlined in the resident’s care plan between Dec. 7, 2017, and Jan. 7, 2018.

Separately, a resident with dementia was hospitalized on June 17, 2018, with a broken right hip after falling from bed. Documentation showed the resident had been agitated that day, but failed to show interventions were put in place when the resident exhibited behaviors, including screaming and hallucinations.

St. Camillus Center spokeswoman Lori Mayer said the center is committed to providing high-quality care to patients and residents. “Since [the citation], we provided additional staff education and training, and submitted a plan of correction to the state. At this time, we are in compliance with state and federal regulations.”

Trinity Hill Care Center in Hartford was fined $3,060 after a housekeeper punched a resident in the face.

On Nov. 15, 2018, a housekeeper said he saw a resident with a cigarette and warned the resident that the incident would be reported because smoking is not allowed, the citation said.  The resident later confronted the housekeeper in the dining room and “swung in an attempt to hit him,” the citation said. In surveillance video, it was unclear whether the resident hit the housekeeper but the housekeeper hit the resident with a closed fist.

The resident received two stitches above the left eye, DPH said. The housekeeper was fired once the allegation of abuse was substantiated.

“Trinity Hill Care Center takes the care and safety of our residents very seriously,” said David Skoczulek, spokesman for the iCare Health Network, the facility’s parent company. “The employee related to this complaint was removed from the facility immediately after the incident was reported.”

Water’s Edge Center for Health and Rehabilitation in Middletown was fined $3,060 after a resident was hospitalized following improper monitoring.

According to DPH, the resident was a known risk for dehydration and was supposed to have fluid intake and output levels closely watched, but documentation failed to show that a physician or advanced practice registered nurse were notified about intake and output between April 4 and April 11, 2018. The resident was taken to a hospital for evaluation April 11 after refusing to eat or drink, and subsequently admitted with septic shock, acute kidney injury, right upper lobe pneumonia, small bowel obstruction, ischemic bowel and altered mental status, according to the citation.

Officials at the facility didn’t return a call seeking comment.

RegalCare at New Haven was fined $2,160 after a deaf, nonspeaking resident with dementia left the facility.

The resident, who wore a WanderGuard, couldn’t be located by staff at 8:30 p.m. on Oct. 30, 2018, the citation said. An employee returned the resident to the facility about 45 minutes later. The resident most likely left through the main lobby door and an alarm failed to sound; the resident wasn’t wearing a WanderGuard upon returning and most likely had removed it, according to the citation.

Officials at the facility didn’t return a call seeking comment.

Middlesex Health Care Center in Middletown was fined $1,320 after a resident left the facility for more than 24 hours without permission. The resident had previously been identified as an elopement risk and given a WanderGuard on June 15, 2018, but a re-evaluation in January found no risk and the WanderGuard was removed, according to DPH.

A nurse aide saw the resident walking down a local highway on Jan. 13. According to the citation, the resident exited through a kitchen door and a cook supervisor failed to report the incident. Police returned the resident to the facility more than 24 hours later. Following the incident, a secured keypad was added to the kitchen door and only staff are allowed in the kitchen.

Officials at the facility didn’t return a call seeking comment.