Adam’s House

MI Elder Abuse Free Legal ConsultationDid someone you love suffer elder abuse or neglect at Adam’s House? Our lawyers can help.

Abuse of the elderly is not acceptable and we fight hard in these types of cases. If you suspect a nursing home or caregiver has caused harm to your loved one in someone elses’ care, contact our law firm today for a free legal consultation.

Talking to us does not obligate you to anything, but we may be able to tell you if you have a claim and the value of your case. If we accept your case, you pay no fee unless we recover for you.

About Adam’s House

Adam’s House is a non-profit, 19-bed Medicare/Medicaid certified skilled nursing facility that provides services to the residents of Somerset, Rehoboth, Swansea, Taunton, Seekonk, Raynham, Norton, and the other towns in and surrounding Bristol County, Massachusetts.

Adam’s House
1168 Highland Avenue
Fall River, MA 02720

Phone: 508-679-0144
Website: https://www.thehomelcc.org/

CMS Star Quality Rating

The Centers for Medicare and Medicaid (CMS) rates all nursing homes that accept medicare or medicaid benefits. CMS created a 5 Star Quality Rating System—1 star is the lowest rating and 5 stars is the highest—that look at three areas.

As of 2017, Adam’s House in Fall River, Massachusetts received a rating of 4 out of 5 stars.

Performance Area Rating
Overall Rating 4 out of 5 (Average)
State Health Inspections 3 out of 5 (Below Average)
Staffing 5 out of 5 (Above Average)
Quality Measures 3 out of 5 (Below Average)

 

Fines and Penalties

Our Elder Abuse Attorneys inspected government records and discovered Adam’s House committed the following offenses:

Failed to immediately tell the resident, the resident's doctor and a family member of the resident of situations (injury/decline/room, etc.) that affect the resident.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on record review, observation and interview, the facility failed to notify the physician of a medication not administer on 6 consecutive occasions, for 1 Resident (#4) out of a total sample of 8 Residents.

Findings include:

Resident #4 was admitted to the facility in 7/2017 with [DIAGNOSES REDACTED]. Review of the medical record indicated that an initial/admission Minimum Data Set (MDS) assessment was not done. The Facility staff had completed multiple admissions assessments which included a Brief Interview of Mental Status (BIMS) on 7/31/17. According to the BIMS assessment the Resident scored a 12 out of 15 for cognition, which indicated the Resident was capable of making his/her own medical decisions. The medical record indicated the Resident had a Health Care Proxy but was not activated.

Review of the admission physician’s orders [REDACTED]. [MEDICATION NAME] is used to prevent [MEDICAL CONDITION] embolism (PE) and/or [MEDICAL CONDITIONS] in residents who are at increased risk of developing these conditions because of decreased mobility. Review of the 7/2017 and 8/2017 Medication Administration Records (MAR) indicated that the Resident had not been administered the medication from 7/31/17 through 8/3/17 (6 doses). The 7/2017 MAR indicated [REDACTED]. The 8/2017 MAR indicated [REDACTED]. A review of the nurse’s notes indicated on 8/2/17, the Resident refused the [MEDICATION NAME] and had informed the nurse that I don’t take that . anymore. On 8/3/17, the nurse’s note indicated the Resident refused the medication and that she educated the Resident on the medication.

Further record review failed to have documentation that the Physician was notified of the [MEDICATION NAME] not being administered for 6 doses. Resident #4 was observed on 8/2/17 from 8:30 A.M. and throughout the day until approximately 2:30 P.M., the Resident was observed not out of the bed and observed lying on his/her back asleep.

On 8/3/17, from 7:00 A.M. through 12:00 P.M., the Resident was observed in bed, lying in a prone position and generally asleep.

During interview on 8/3/17 at 12:40 A.M., Nurse #1 said that she was aware that the [MEDICATION NAME] had not been administered on 6 consecutive occasions. She said that the Resident had told the Facility staff that he/she was no longer on the medication and therefore was refusing the medication. Nurse #1 said that the medication was on the discharge record and the physician had ordered it. She said she thought the real reason was that the first dose was scheduled for 6:30 A.M. and the Resident did not want to be wakened. Nurse #1 said that she had not notified the physician of the 6 medication omissions, or what the Resident had told the staff or requested a time change for the medication. Nurse #1 said that she was not suppose to call the physician unless there was an emergency. She said that day to day information was recorded on a clip board for the physician to address when he was in the facility. Nurse #1 was not sure how many missed doses of [MEDICATION NAME] would require a more urgent notification to the physician. During interview on 8/3/17 at 1:15 P.M., the Director of Nurses said that 2 missed doses of [MEDICATION NAME] should have been immediately brought to the Physician’s attention. She said that the Facility did use a clip board to communicate with the Physician, but also texted the physician on a secured phone. She said the Physician provided the phone and the text messages were sent directly to his address. The Director said that they could send lab information and/or any information that required immediate attention. The Director and the Surveyor reviewed the clip board and found that information about the [MEDICATION NAME] was written on the clip board on 8/2/17 and 8/3/17. The clip board failed to indicate that the physician was notified and/or had seen the information on the clip board. The Director of Nurses reviewed the Facility to Physician text messages and there was no information that the Facility had contacted the Physician about the 6 doses of [MEDICATION NAME] not administered since admission to the facility.

Failed to make sure services provided by the nursing facility meet professional standards of quality.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on record review and staff interview, the facility failed to ensure the nursing staff provided services in accordance with professional standards of quality for 1 Resident (#3) out of a total sample of 8 residents.

Findings include:

For Resident #3, the facility failed to administer insulin as per the sliding scale/physician’s orders [REDACTED].>Resident #3 was admitted to the facility in 6/2017 with [DIAGNOSES REDACTED]. Clinical record review indicated a physician’s orders [REDACTED].M., 11:30 A.M. and 4:30 P.M. The Resident’s sliding scale Humalog insulin was as follows:

FSBS of 200-250-Administer 2 units of Humalog Insulin
FSBS of 251-300-Administer 4 units of Humalog Insulin
FSBS of 301-350-Administer 6 units of Humalog Insulin
FSBS of 351-400-Administer 8 units of Humalog Insulin
FSBS greater than 400, call the physician.

Further clinical record review, including the Medication Administration Records (MAR), for 6/2017, 7/2017 and 8/2017, and nurse’s notes indicated that on:

-6/15/17 at 11:30 A.M., FSBS was 295, no insulin was administered when according to sliding scale the Resident should have received 4 units of Humalog insulin.

-6/21/17 at 4:30 A.M., the FSBS was documented on the MAR and the Facility’s Ancillary Blood Glucose Testing Record (A.B.G.T.) as 200, however the nurse administered 4 units rather than 2 units of Humalog insulin. Review of the 6/21/17 nurse’s note indicated a blood sugar of 299. There was no indication the nurse clarified the discrepancy of 200 verses 299.

-6/27/17 at 11:30 A.M., there was no indication the FSBS was completed and insulin administered if required.

-7/6/17 at 7:30 A.M., FSBS was 355, no insulin was administered when according to sliding scale the Resident should have received 8 units of Humalog insulin.

-7/12/17 at 11:30 A.M., FSBS was 228, no insulin was administered when according to sliding scale the Resident should have received 2 units of Humalog insulin.

-7/21/17 at 11:30 A.M., FSBS was 203, no insulin was administered when according to sliding scale the Resident should have received 2 units of Humalog insulin.

-7/25/17 at 11:30 A.M., FSBS was documented on the A.B.G.T. record as 219, however the MAR recorded the FSBS as 279 and the Resident was administered 4 units of Humalog insulin, without indication which was the correct FSBS.

-7/26/17 at 11:30 A.M., FSBS was 196, no insulin should have been administered, however according to the [DATE] units of Humalog insulin was administered.

– 8/1/17 at 11:30 A.M., FSBS was 225, no insulin was administered when according to the sliding scale the Resident should have received 2 units of Humalog insulin. During interview on 8/3/17 at 12:40 P.M., Nurse #1 reviewed the MAR and documentation associated with the Resident’s blood sugars and sliding scale insulin. She indicated that she had worked on 8/1/17 and said that she assumed she had given the insulin at 11:30 A.M., but without documentation could not clearly say she had or had not.

Failed to keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on Medication Administration observation, record review and staff interview,the facility failed to have a medication error rate that was not greater than 5%. The facility had two errors out of 28 opportunities resulting in a medication error rate of 7.1%.

Findings include:

During the Medication Administration observation on 8/2/17 from 8:10 A.M. – 9:20 A.M. on the third floor, Staff Nurse #1 failed to administer two scheduled medications. Surveyor #3 had observed a total of 26 medication administered by Staff Nurse #1. On reconciliation of the observed medications for Nonsampled (NS) Resident #1, it was noted that two antihypertensive were missed and not administered. NS Resident #1 has a [DIAGNOSES REDACTED].M. and [MEDICATION NAME] 160 mg. twice daily at 8:00 A.M. and 8:00 P.M.

During interview and review on 8/2/17 at 10:30 A.M., Staff Nurse #1 said, how did I miss that page. She acknowledged she missed that page of the Medication Administration Record [REDACTED]. The total medications that should have been administered at 8:00 A.M. were 28 medications with an error of 7.1 %. The Staff Nurse said she would review this error with the Director of Nurses.

Failed to have a program that investigates, controls and keeps infection from spreading.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on staff interview and documentation review, the facility failed to establish an infection control program that investigates, controls and prevents infections. The facility failed to develop a policy and procedure for infection control that would prevent, recognize and control the spread of potential infections. The facility could not provide documentation that they followed the Center for Disease Control (CDC) guidelines for infection prevention and control practices.

Findings include:

During interview on 8/3/17 at 1:30 P.M., the Director of Nurses (DON) said the facility had a new nurse hired 2-3 weeks ago who was responsible for the infection control program, but was not available for interview during survey. The DON explained she was hired as the Staff Development Coordinator (SDC) and in charge of the infection control program.

The Director of Nurses explained that the nurse on the unit is responsible to complete the surveillance data record along with the SDC nurse and then the information is given to the Quality Assurance committee and reviewed quarterly with the committee. The DON said the data is not submitted to any outside laboratory consultant for review and analysis. A review of the monthly surveillance records from January to 2017 listed the following:

– January and February 2017 was combined on one record and listed 6 residents with respiratory infections with the antibiotics given but had no information of symptoms of information, no chest x-rays, no resolution of the infections and if the infections were Healthcare acquired or community acquired.

– March 2017 listed one urinary tract infection with the antibiotic but had no information of symptoms, no information of a culture obtained to identify the type of infection, no resolution of the infection and no information of the infection being Healthcare or Community acquired.

– April 2017 listed one resident with a urinary tract infection that did list the pathogen and antibiotic but no information of Healthcare or Community acquired. Another resident was listed as having pneumonia from the hospital and listed the antibiotic but no information of symptoms, or of the pneumonia clearing.

– May 2017 listed 2 residents with urinary tract infections, with no infection on culture results, type of organisms, resolution and if the resident’s infections were Healthcare or Community acquired. One resident was identified as having[DIAGNOSES REDACTED] (Clostridium Difficile is the inflammation of the colon and can be transmitted person to person by spores. It spreads by contaminated surfaces and can live on contaminated surfaces for up to 5 months). This entry listed no information of symptoms, treatment for [REDACTED].

– June 2017 listed one resident with[DIAGNOSES REDACTED] infection also listed in May and no information for the treatment, symptoms, resolution and if this was Healthcare or Community acquired. The record listed two urinary tract infections and the antibiotic used to treat the residents, but no information of symptoms, resolution and if the infections were Healthcare or Community acquired.

After reviewing the data records for the 6 months, the Director of Nurses was not aware of the lack of information and the surveyor said to the DON that at the bottom of each monthly surveillance record, the surveillance log was submitted to the DON at the end of each month. The Director said she has been in her position since March 2017 and had not reviewed the monthly surveillance data.

The Surveyor asked to review the facility’s policy and procedure on the Infection control program and the DON said she would look for it. Later that afternoon the Director of Nurses said she only found information on outbreaks and no information for the infection control program. The Director then said this had been on her to do list and was aware of the lack of infection control program.

Adam’s House, Nursing Home Neglect and Elder Abuse Lawyers

If someone you love has suffered neglect or elder abuse by a senior caregiver, nursing home, or other care facility, our lawyers may be able to help. Regardless of whether or not criminal charges are filed against an alleged abuser, you may still be able to pursue compensation in a civil claim. Compensation in elder abuse cases may be awarded if someone in the care of another suffers harm due to intentional or negligent actions (including failure to take action).

Abuse of the elderly is not acceptable and we fight hard in these types of cases. If you suspect a nursing home or caregiver has caused harm to your loved one in someone elses’ care, contact our law firm today for a free legal consultation. Talking to us does not obligate you to anything, but we may be able to tell you if you have a claim and the value of your case. If we accept your case, you pay no fee unless we recover for you.

Oftentimes, victims of abuse either cannot or will not speak up for themselves out of fear. If you notice any warning signs or symptoms of neglect of abuse an an elderly person, it is important you contact an elder abuse lawyer immediately. Not only are there statute of limitations on filing a claim, but the sooner we start helping you, the easier it will be to collect evidence and talk to any witnesses before important details are lost, hidden, or forgotten.

Boston Personal Injury Lawyers for Elder Abuse Cases

We offer a free, no-obligation legal consultation to help you understand your rights and the value of your case. Our personal injury law firm takes cases involving elder abuse and neglect. We offer legal service to clients in Massachusetts, Rhode Island and New Hampshire.


Sources:

Medicare Nursing Home Profile for Adam’s House

Nursing Home Safety, Health and Inspection Report for Adam’s House 08/03/2017

Page Last Updated: February 15, 2017

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